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Sample records for manage withdrawal related

  1. Inpatient management of acute alcohol withdrawal syndrome.

    Science.gov (United States)

    Perry, Elizabeth C

    2014-05-01

    Alcohol withdrawal is a common condition encountered in the hospital setting after abrupt discontinuation of alcohol in an alcohol-dependent individual. Patients may present with mild symptoms of tremulousness and agitation or more severe symptoms including withdrawal seizures and delirium tremens. Management revolves around early identification of at-risk individuals and symptom assessment using a validated tool such as the revised Clinical Institute Withdrawal Assessment for Alcohol score. Benzodiazepines remain the mainstay of treatment and can be administered using a front-loading, fixed-dose, or symptom-triggered approach. Long-acting benzodiazepines such as chlordiazepoxide or diazepam are commonly used and may provide a smoother withdrawal than shorter-acting benzodiazepines, but there are no data to support superiority of one benzodiazepine over another. Elderly patients or those with significant liver disease may have increased accumulation and decreased clearance of the long-acting benzodiazepines, and lorazepam or oxazepam may be preferred in these patients. Patients with symptoms refractory to high doses of benzodiazepines may require addition of a rescue medication such as phenobarbital, propofol or dexmedetomidine. Anticonvulsants (carbamazepine, valproate, gabapentin) may have a role in the management of mild to moderate withdrawal. Other medications such as β-antagonists or neuroleptics may offer additional benefit in select patients but should not be used a monotherapy.

  2. Clinical management of alcohol withdrawal: A systematic review

    Directory of Open Access Journals (Sweden)

    Shivanand Kattimani

    2013-01-01

    Full Text Available Alcohol withdrawal is commonly encountered in general hospital settings. It forms a major part of referrals received by a consultation-liaison psychiatrist. This article aims to review the evidence base for appropriate clinical management of the alcohol withdrawal syndrome. We searched Pubmed for articles published in English on pharmacological management of alcohol withdrawal in humans with no limit on the date of publication. Articles not relevant to clinical management were excluded based on the titles and abstract available. Full-text articles were obtained from this list and the cross-references. There were four meta-analyses, 9 systematic reviews, 26 review articles and other type of publications like textbooks. Alcohol withdrawal syndrome is a clinical diagnosis. It may vary in severity. Complicated alcohol withdrawal presents with hallucinations, seizures or delirium tremens. Benzodiazepines have the best evidence base in the treatment of alcohol withdrawal, followed by anticonvulsants. Clinical institutes withdrawal assessment-alcohol revised is useful with pitfalls in patients with medical comorbidities. Evidence favors an approach of symptom-monitored loading for severe withdrawals where an initial dose is guided by risk factors for complicated withdrawals and further dosing may be guided by withdrawal severity. Supportive care and use of vitamins is also discussed.

  3. Inpatient management of alcohol withdrawal: a practical approach

    OpenAIRE

    2008-01-01

    Alcohol intake contributes directly or indirectly to 15 to 20% of medical problems in primary care or an inpatient setting. It is estimated that approximately 500,000 episodes of withdrawal will be severe enough to require pharmacologic intervention. The total cost to the United States economy from alcohol abuse was estimated to be $185 billion for 1998. This review attempts to put forth a practical and evidence based approach towards the inpatient management of alcohol withdrawal. Various ag...

  4. Identification and management of alcohol withdrawal syndrome.

    Science.gov (United States)

    Mirijello, Antonio; D'Angelo, Cristina; Ferrulli, Anna; Vassallo, Gabriele; Antonelli, Mariangela; Caputo, Fabio; Leggio, Lorenzo; Gasbarrini, Antonio; Addolorato, Giovanni

    2015-03-01

    Symptoms of alcohol withdrawal syndrome (AWS) may develop within 6-24 h after the abrupt discontinuation or decrease of alcohol consumption. Symptoms can vary from autonomic hyperactivity and agitation to delirium tremens. The gold-standard treatment for AWS is with benzodiazepines (BZDs). Among the BZDs, different agents (i.e., long-acting or short-acting) and different regimens (front-loading, fixed-dose or symptom-triggered) may be chosen on the basis of patient characteristics. Severe withdrawal could require ICU admission and the use of barbiturates or propofol. Other drugs, such as α2-agonists (clonidine and dexmetedomidine) and β-blockers can be used as adjunctive treatments to control neuroautonomic hyperactivity. Furthermore, neuroleptic agents can help control hallucinations. Finally, other medications for the treatment for AWS have been investigated with promising results. These include carbamazepine, valproate, sodium oxybate, baclofen, gabapentin and topiramate. The usefulness of these agents are discussed.

  5. Outpatient management of alcohol withdrawal syndrome.

    Science.gov (United States)

    Muncie, Herbert L; Yasinian, Yasmin; Oge', Linda

    2013-11-01

    Approximately 2% to 9% of patients seen in a family physician's office have alcohol dependence. These patients are at risk of developing alcohol withdrawal syndrome if they abruptly abstain from alcohol use. Alcohol withdrawal syndrome begins six to 24 hours after the last intake of alcohol, and the signs and symptoms include tremors, agitation, nausea, sweating, vomiting, hallucinations, insomnia, tachycardia, hypertension, delirium, and seizures. Treatment aims to minimize symptoms, prevent complications, and facilitate continued abstinence from alcohol. Patients with mild or moderate alcohol withdrawal syndrome can be treated as outpatients, which minimizes expense and allows for less interruption of work and family life. Patients with severe symptoms or who are at high risk of complications should receive inpatient treatment. In addition to supportive therapy, benzodiazepines, either in a fixed-dose or symptom-triggered schedule, are recommended. Medication should be given at the onset of symptoms and continued until symptoms subside. Other medications, including carbamazepine, oxcarbazepine, valproic acid, and gabapentin, have less abuse potential but do not prevent seizures. Typically, physicians should see these patients daily until symptoms subside. Although effective treatment is an initial step in recovery, long-term success depends on facilitating the patient's entry into ongoing treatment.

  6. A 'symptom-triggered' approach to alcohol withdrawal management.

    Science.gov (United States)

    Murdoch, Jay; Marsden, Janet

    In acute hospital settings, alcohol withdrawal often causes significant management problems and complicates a wide variety of concurrent conditions, placing a huge burden on the NHS. A significant number of critical incidents around patients who were undergoing detoxification in a general hospital setting led to the need for a project to implement and evaluate an evidence-based approach to the management of alcohol detoxification-a project that included a pre-intervention case note audit, the implementation of an evidence-based symptom-triggered detoxification protocol, and a post-intervention case note audit. This change in practice resulted in an average reduction of almost 60% in length of hospital stay and a 66% reduction in the amount of chlordiazepoxide used in detoxification, as well as highlighting that 10% of the sample group did not display any signs of withdrawal and did not require any medication. Even with these reductions, no patient post-intervention developed any severe signs of withdrawal phenomena, such as seizures or delirium tremens. The savings to the trust (The Pennine Acute Hospital Trust) are obvious,but the development of a consistent, quality service will lead to fewer long-term negative effects for patients that can be caused by detoxification. This work is a project evaluation of a locally implemented strategy, which, it was hypothesised,would improve care by providing an individualised treatment plan for the management of alcohol withdrawal symptoms.

  7. Management of surface water and groundwater withdrawals to maintain environmental stream flows in Michigan

    Science.gov (United States)

    Reeves, Howard W.; Seelbach, Paul W.; Nicholas, James R.; Hamilton, David A.; Potter, Kenneth W.; Frevert, Donald K.

    2010-01-01

    In 2008, the State of Michigan enacted legislation requiring that new or increased high-capacity withdrawals (greater than 100,000 gallons per day) from either surface water or groundwater be reviewed to prevent Adverse Resource Impacts (ARI). Science- based guidance was sought in defining how groundwater or surface-water withdrawals affect streamflow and in quantifying the relation between reduced streamflow and changes in stream ecology. The implementation of the legislation led to a risk-based system based on a gradient of risk, ecological response curves, and estimation of groundwater-surface water interaction. All Michigan streams are included in the legislation, and, accordingly, all Michigan streams were classified into management types defined by size of watershed, stream-water temperature, and predicted fish assemblages. Different streamflow removal percentages define risk-based thresholds allowed for each type. These removal percentages were informed by ecological response curves of characteristic fish populations and finalized through a legislative workgroup process. The assessment process includes an on-line screening tool that may be used to evaluate new or increased withdrawals against the risk-based zones and allows withdrawals that are not likely to cause an ARI to proceed to water-use registration. The system is designed to consider cumulative impacts of high-capacity withdrawals and to promote user involvement in water resource management by the establishment of water-user committees as cumulative withdrawals indicate greater potential for ARI in the watershed.

  8. Experience of the use of Ketamine to manage opioid withdrawal in an addicted woman: a case report.

    Science.gov (United States)

    Lalanne, Laurence; Nicot, Chloe; Lang, Jean-Philippe; Bertschy, Gilles; Salvat, Eric

    2016-11-10

    Opioids are good painkillers, but many patients treated with opioids as painkillers developed a secondary addiction. These patients need to stop misusing opioids, but the mild-to-severe clinical symptoms associated with opioid withdrawal risk increasing their existing pain. In such cases, ketamine, which is used by anaesthetists and pain physicians to reduce opioid medication, may be an effective agent for managing opioid withdrawal. We describe the case of a woman who developed a severe secondary addiction to opioids in the context of lombo-sciatic pain. She presented a severe opioid addiction, and her physicians refused to prescribe such high doses of opioid treatment (oxycontin® extended-release 120 mg daily, oxycodone 60 mg daily, and acetaminophen/codeine 300 mg/25 mg 6 times per day). To assist her with her opioid withdrawal which risked increasing her existing pain, she received 1 mg/kg ketamine oral solution, and two days after ketamine initiation her opioid treatment was gradually reduced. The patient dramatically reduced the dosage of opioid painkillers and ketamine was withdrawn without any withdrawal symptoms. Ketamine displays many interesting qualities for dealing with all symptoms relating to opioid withdrawal. Accordingly, it could be used instead of many psychotropic treatments, which interact with each other, to help with opioid withdrawal. However, the literature describes addiction to ketamine. All in all, although potentially addictive, ketamine could be a good candidate for the pharmacological management of opioid withdrawal.

  9. Determining Regional Sensitivity to Energy-Related Water Withdrawals in Minnesota

    Science.gov (United States)

    McCulloch, A.; Brauman, K. A.

    2015-12-01

    Minnesota has abundant freshwater resources, yet concerns about water-impacts of energy and mining development are increasing. Statewide, total annual water withdrawals have increased, and, in some watersheds, withdrawals make up a large fraction of available water. The energy and mining sectors play a critical role in determining water availability, as water is used to irrigate biofuel feedstock crops, cool thermoelectric plants, and process and transport fuels and iron ore. We evaluated the Minnesota Department of Natural Resources (DNR) Water and Reporting System (MPARS) dataset (1988-2014) to identify regions where energy and mining-related water withdrawals are high or where they are increasing. The energy and mining sectors account for over 65 percent of total water extractions in Minnesota, but this percentage is greater in some regions. In certain southern and northeastern Minnesota watersheds, these extractions account for 90 percent of total water demand. Sensitivity to these demands is not dependent on total water demand alone, and is also not uniform among watersheds. We identified and evaluated factors influencing sensitivity, including population, extraction type (surface water or groundwater), percentage of increased demand, and whether withdrawals are consumptive or not. We determined that southern Minnesota is particularly sensitive to increased water demands, because of growing biofuel and sand extraction industries (the products of which are used in hydraulic fracturing). In the last ten years, ethanol production in Minnesota has increased by 440 percent, and over fifteen refineries (each with a capacity over 1.1 billion gallons), have been built. These users primarily extract from surface water bodies within a few watersheds, compromising local supplies. As these energy-related industries continue to grow, so will the demand for freshwater resources. Determining regional sensitivity to increased demands will allow policy-makers to manage the

  10. Neuroticism and Conscientiousness as Moderators of the Relation Between Social Withdrawal and Internalizing Problems in Adolescence.

    Science.gov (United States)

    Smith, Kelly A; Barstead, Matthew G; Rubin, Kenneth H

    2017-04-01

    Social withdrawal, or refraining from social interaction in the presence of peers, places adolescents at risk of developing emotional problems like anxiety and depression. The personality traits of neuroticism and conscientiousness also relate to emotional difficulties. For example, high conscientiousness predicts lower incidence of anxiety disorders and depression, while high neuroticism relates to greater likelihood of these problems. Based on these associations, socially withdrawn adolescents high in conscientiousness or low in neuroticism were expected to have lower levels of anxiety and depressive symptoms. Participants included 103 adolescents (59 % female) who reported on their personality traits in 8th grade and their anxiety and depressive symptoms in 9th grade. Peer ratings of social withdrawal were collected within schools in 8th grade. A structural equation model revealed that 8th grade withdrawal positively predicted 9th grade anxiety and depressive symptoms controlling for 8th grade anxiety and depressive symptoms, but neuroticism did not. Conscientiousness moderated the relation of withdrawal with depressive symptoms but not anxiety, such that high levels of conscientiousness attenuated the association between withdrawal and depressive symptoms. This buffering effect may stem from the conceptual relation between conscientiousness and self-regulation. Conscientiousness did not, however, moderate the association between withdrawal and anxiety, which may be partly due to the role anxiety plays in driving withdrawal. Thus, a conscientious, well-regulated personality partially protects withdrawn adolescents from the increased risk of emotional difficulties.

  11. Alcohol withdrawal.

    Science.gov (United States)

    Manasco, Anton; Chang, Shannon; Larriviere, Joseph; Hamm, L Lee; Glass, Marcia

    2012-11-01

    Alcohol withdrawal is a common clinical condition that has a variety of complications and morbidities. The manifestations can range from mild agitation to withdrawal seizures and delirium tremens. The treatments for alcohol withdrawal include benzodiazepines, anticonvulsants, beta-blockers and antihypertensives. Although benzodiazepines are presently a first-line therapy, there is controversy regarding the efficacies of these medications compared with others. Treatment protocols often involve one of two contrasting approaches: symptom-triggered versus fixed-schedule dosing of benzodiazepines. We describe these protocols in our review and examine the data supporting symptom-triggered dosing as the preferred method for most patients in withdrawal.The Clinical Institute Withdrawal Assessment for Alcohol scoring system for alcohol withdrawal streamlines care, optimizes patient management, and is the best scale available for withdrawal assessment. Quality improvement implications for inpatient management of alcohol withdrawal include increasing training for signs of withdrawal and symptom recognition, adding new hospital protocols to employee curricula, and ensuring manageable patient-to-physician and patient-to-nurse ratios.

  12. Management and treatment of gamma butyrolactone withdrawal syndrome: a case report and review.

    Science.gov (United States)

    Ghio, Lucio; Cervetti, Alice; Respino, Matteo; Belvederi Murri, Martino; Amore, Mario

    2014-07-01

    Gamma butyrolactone (GBL) is an increasingly popular drug of abuse that is readily available in most countries, and it is often purchased over the Internet. In addition to the acute hazards of intoxication and overdose, users who are dependent on GBL can also experience severe withdrawal reactions, including hallucinations, agitation, confusion, delusions, delirium, rhabdomyolysis, and seizures. Most of the existing literature suggests the use of a high-dose benzodiazepine as a first-line treatment for GBL withdrawal. However, several cases of resistance to benzodiazepines have been observed, which likely reflect some pharmacological differences between benzodiazepines and GBL. Specifically, the effects of benzodiazepines are primarily mediated by gamma-aminobutyric acid (GABA)-A receptors, while GBL and its analogues act mainly at GABA-B receptors, with possible additional effects via the ionotropic GABA-A receptors. In this regard, recent studies have found that GBL and its analogues possess a high affinity for a specific form of extrasynaptic GABA-A receptors that are strongly activated by barbiturates, such as phenobarbital, but that are insensitive to benzodiazepines. Taken together, these findings suggest that barbiturates could be evaluated as first-choice agents for the treatment of GBL/gamma hydroxybutyrate (GHB) withdrawal instead of benzodiazepines. In support of this view, we describe a clinical case of difficult to manage GBL withdrawal symptoms in a 42-year-old male. We also review the literature on treatment options for GBL/GHB withdrawal, including benzodiazepine-resistant withdrawal.

  13. Withdrawal-related adverse events from clinical trials of clobazam in Lennox-Gastaut syndrome.

    Science.gov (United States)

    Tolbert, Dwain; Harris, Stuart I; Bekersky, Ihor; Lee, Deborah; Isojarvi, Jouko

    2014-08-01

    To assess withdrawal-related adverse event (AE) rates following abrupt clobazam discontinuation in Phase I trials and gradual clobazam tapering (2-3 weeks) following discontinuation from III trials met the criteria for potential/III trials, we evaluated AE data from four multiple-dosage Phase I trials (duration: 8-34 days). Therapeutic (20 and 40 mg/day) and supratherapeutic clobazam dosages (120 and 160 mg/day) were administered. Adverse events (AEs) were also assessed for patients with Lennox-Gastaut syndrome enrolled in Phase II (OV-1002) and Phase III (OV-1012) studies (duration ≤15 weeks) and in the open-label extension (OLE) trial OV-1004 (≤5 years). Potential withdrawal-related AEs were identified by preferred terms, provided that the AEs occurred ≥1 day following and ≤30 days after the last clobazam doses, or were deemed withdrawal symptoms by investigators. Clinical Institute Withdrawal Assessment for Benzodiazepines (CIWA-B) scale was used to evaluate withdrawal intensity in three of the four Phase I trials. A total of 207 participants in Phase I trials received steady-state clobazam dosages of 20-160 mg/day, 182 received clobazam dosages of ≥40 mg/day, and 94 received clobazam dosages of ≥120 mg/day. Abrupt clobazam discontinuation led to 193 withdrawal-related AEs for 68 Phase I participants. Nearly 50% of AEs occurred after discontinuation of clobazam dosages of ≥120 mg/day. Adverse events were mild or moderate and included headache (14% of Phase I participants), insomnia (12.6%), tremor (10.1%), and anxiety (8.7%). The CIWA-B scores varied (range: 0-59). Most scores were clobazam dosages of ≤40 mg/day, and those in the OLE trial received clobazam dosages of ≤80 mg/day. Eighty-seven patients discontinued clobazam and were gradually tapered. No withdrawal-related AEs or incidences of status epilepticus were reported. Withdrawal-related AEs observed in Phase I studies following abrupt clobazam discontinuation at therapeutic and

  14. Delirium and High Creatine Kinase and Myoglobin Levels Related to Synthetic Cannabinoid Withdrawal

    Directory of Open Access Journals (Sweden)

    Ahmet Bulent Yazici

    2017-01-01

    Full Text Available Synthetic cannabinoids (SCs are included in a group of drugs called new psychoactive substances. Effects of SCs on the central nervous system are similar to other cannabinoids, but 2–100 times more potent than marijuana. Thus, addiction and withdrawal symptoms are more severe than natural cannabinoids. Withdrawal symptoms of SCs were reported in the literature previously. But there is no report about SC withdrawal delirium and its treatment. Several studies reported that agonists of CB1 receptors play a role in GABA and glutamatergic neurotransmission, which is similar to the effects of alcohol on GABA and glutamatergic receptors. Previous studies on alcohol delirium cases suggested that elevated creatine kinase (CK can be a marker of progress. This study reports delirium and high serum CK levels related to SC withdrawal and offers a treatment with benzodiazepine for them. We described two cases treated in our inpatient clinic about SC withdrawal with increase of serum CK level and other laboratory parameters. One of them demonstrated delirium symptoms and the other did not with early rapid treatment.

  15. An Investigation of Personality Traits in Relation to Intention to Withdraw from College

    Science.gov (United States)

    Lounsbury, John W.; Saudargas, Richard A.; Gibson, Lucy W.

    2004-01-01

    We examined the Big Five (De Raad, 2000) personality traits of Agreeableness, Conscientiousness, Emotional Stability, Extraversion, and Openness, plus the narrow personality traits of Aggression, Career-Decidedness, Optimism, Self-Directed Learning, Sense of Identity, Tough-Mindedness, and Work Drive in relation to intention to withdraw from…

  16. Blood component recalls and market withdrawals: frequency, reasons, and management in the United States.

    Science.gov (United States)

    Ramsey, Glenn

    2013-04-01

    In a previous article, we reviewed the management of blood component recalls and withdrawals (G. Ramsey. Transfusion Med Rev 2004;18:36-45). Since then, US rates of recall and biological product deviation for blood components have improved significantly, particularly with regard to reduced recalls for donor infectious disease risks or testing. However, analysis of the current data from the US Food and Drug Administration suggests that 1 (0.4%) in 250 blood components is involved in market withdrawals and quarantines, with 1 in 5800 components formally recalled. Most of these units, unfortunately, had already have been transfused. The U.S. Food and Drug Administration has issued several recent guidances that address transfusion service actions for dealing with specific infectious disease problems. This present article updates our 2004 recommendations as to when to notify physicians about transfused nonconforming blood components. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. BLM National Surface Management Agency: Area Polygons, Withdrawal Area Polygons, and Special Public Purpose Withdrawal Area Polygons

    Data.gov (United States)

    Federal Geographic Data Committee — The SMA implementation is comprised of one feature dataset, with several polygon feature classes, rather than a single feature class. SurfaceManagementAgency: The...

  18. Mixed-grade rejection and its association with overt aggression, relational aggression, anxious-withdrawal, and psychological maladjustment.

    Science.gov (United States)

    Bowker, Julie C; Etkin, Rebecca G

    2014-01-01

    The authors examined the associations between mixed-grade rejection (rejection by peers in a different school grade), anxious-withdrawal, aggression, and psychological adjustment in a middle school setting. Participants were 181 seventh-grade and 180 eighth-grade students (M age = 13.20 years, SD = 0.68 years) who completed peer nomination and self-report measures in their classes. Analyses indicated that in general, same- and mixed-grade rejection were related to overt and relational aggression, but neither type was related to anxious-withdrawal. Mixed-grade rejection was associated uniquely and negatively with self-esteem for seventh-grade boys, while increasing the loneliness associated with anxious-withdrawal. The results suggest that school-wide models of peer relations may be promising for understanding the ways in which different peer contexts contribute to adjustment in middle school settings.

  19. Managing or Relating?

    DEFF Research Database (Denmark)

    Sproedt, Henrik; Buur, Jacob

    2010-01-01

    This paper describes a case of user-driven innovation. We draw on social capital theory and the concept of complex responsive processes to examine the role of relations for the exchange and generation of knowledge across different knowledge traditions. We argue that innovation as a social phenome...... phenomenon with a high degree of uncertainty and complexity requires more relating and less managing to use conflict as a resource by turning the friction between different knowledge traditions into creative friction....

  20. Beijing Managing Government Relations

    Institute of Scientific and Technical Information of China (English)

    MICHAELO'NEILL

    2005-01-01

    Aroster of top-level speakers and over 100 delegates gathered at the 2nd China Government Relations Management Summit held in Beiiing at the end of March and organized by the Research Center on Transnational Corporation (CAITEC) of the Ministry of Commerce (MOFCOM). With presentations from a number of multinational corporations including Coca-Cola, Kodak,

  1. Prospective Relations among Fearful Temperament, Protective Parenting, and Social Withdrawal: The Role of Maternal Accuracy in a Moderated Mediation Framework

    Science.gov (United States)

    Kiel, Elizabeth J.; Buss, Kristin A.

    2011-01-01

    Early social withdrawal and protective parenting predict a host of negative outcomes, warranting examination of their development. Mothers' accurate anticipation of their toddlers' fearfulness may facilitate transactional relations between toddler fearful temperament and protective parenting, leading to these outcomes. Currently, we followed 93…

  2. Antidepressant Withdrawal

    Science.gov (United States)

    Diseases and Conditions Depression (major depressive disorder) If you stop taking antidepressants, could you experience antidepressant withdrawal? Do withdrawal symptoms mean you were addicted to the drug? Answers from Daniel K. Hall-Flavin, M.D. Antidepressant withdrawal is possible if you ...

  3. Amphetamine and morphine may produce acute-withdrawal related hypoactivity by initially activating a common dopamine pathway.

    Science.gov (United States)

    White, Wesley; White, Ilsun M

    2016-10-15

    uses dopamine as a neurotransmitter. Different signs of acute withdrawal (hypoactivity and hypophagia) may involve the short-term activation of the same common pathway. Low withdrawal rats may have a different vulnerability to amphetamine and may show differences in drug assessment outcomes relative to animals that manifest distinct signs of acute withdrawal. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Differential Changes in Expression of Stress- and Metabolic-Related Neuropeptides in the Rat Hypothalamus during Morphine Dependence and Withdrawal.

    Directory of Open Access Journals (Sweden)

    Bernadett Pintér-Kübler

    Full Text Available Chronic morphine treatment and naloxone precipitated morphine withdrawal activates stress-related brain circuit and results in significant changes in food intake, body weight gain and energy metabolism. The present study aimed to reveal hypothalamic mechanisms underlying these effects. Adult male rats were made dependent on morphine by subcutaneous implantation of constant release drug pellets. Pair feeding revealed significantly smaller weight loss of morphine treated rats compared to placebo implanted animals whose food consumption was limited to that eaten by morphine implanted pairs. These results suggest reduced energy expenditure of morphine-treated animals. Chronic morphine exposure or pair feeding did not significantly affect hypothalamic expression of selected stress- and metabolic related neuropeptides - corticotropin-releasing hormone (CRH, urocortin 2 (UCN2 and proopiomelanocortin (POMC compared to placebo implanted and pair fed animals. Naloxone precipitated morphine withdrawal resulted in a dramatic weight loss starting as early as 15-30 min after naloxone injection and increased adrenocorticotrophic hormone, prolactin and corticosterone plasma levels in morphine dependent rats. Using real-time quantitative PCR to monitor the time course of relative expression of neuropeptide mRNAs in the hypothalamus we found elevated CRH and UCN2 mRNA and dramatically reduced POMC expression. Neuropeptide Y (NPY and arginine vasopressin (AVP mRNA levels were transiently increased during opiate withdrawal. These data highlight that morphine withdrawal differentially affects expression of stress- and metabolic-related neuropeptides in the rat hypothalamus, while relative mRNA levels of these neuropeptides remain unchanged either in rats chronically treated with morphine or in their pair-fed controls.

  5. Opioid and benzodiazepine withdrawal symptoms in paediatric intensive care patients.

    Science.gov (United States)

    Franck, Linda S; Naughton, Ita; Winter, Ira

    2004-12-01

    The purposes of this prospective repeated measures study were to: (a) describe the occurrence of withdrawal symptoms with the use of a standardised protocol to slowly taper opioids and benzodiazepines; and (b) to test the predictive validity of an opioid and benzodiazepine withdrawal assessment scoring tool in critically ill infants and young children after prolonged opioid and benzodiazepine therapy. Fifteen children (6 weeks-28 months of age) with complex congenital heart disease and/or respiratory failure who received opioids and benzodiazepines for 4 days or greater were evaluated for withdrawal symptoms using a standardized assessment tool. Thirteen children showed moderate to severe withdrawal symptoms a median 3 days after commencement of tapering. Symptom intensity was not related to prior opioid or benzodiazepine exposure, extracorporeal membrane oxygenation (ECMO) therapy or length of tapering. Children who received fentanyl in addition to morphine more often exhibited signs of withdrawal. This study demonstrated that significant withdrawal symptoms occur in critically ill children even with the use of a standardised assessment tool and tapering management protocol. The predictive validity and utility of the Opioid and Benzodiazepine Withdrawal Score (OBWS) was adequate for clinical use, but areas for further improvement of the tool were identified. Problems with the clinical withdrawal prevention and management guidelines were also identified. More research is needed to establish the optimal methods for prevention and management of iatrogenic opioid and benzodiazepine withdrawal in paediatric critical care.

  6. Expression of apoptosis-related factors in chronic cyclosporine nephrotoxicity after cyclosporine withdrawal

    Institute of Scientific and Technical Information of China (English)

    Can LI; Byung-kee BANG; Chul-woo YANG; Sun-woo LIM; Bo-kyung SUN; Bum-soon CHOI; Sylvia GLOWACKA; Alison J COX; Darren J KELLY; Yong-soo KIM; Jin KIM

    2004-01-01

    AIM: To examine whether the reversibility of chronic cyclosporine A (CsA) nephrotoxicity is associated with apoptotic cell death and its regulatory factors. METHODS: Chronic CsA nephrotoxicity was induced in SpragueDawley rats by administering CsA (15 mg/kg, sc) for 5 weeks, and then withdrawing it for 5 or 10 weeks. The effect of CsA withdrawal on apoptotic cell death was evaluated by an in situ TdT-mediated deoxyuridine triphosphate-biotin nick end-labeling (TUNEL) assay and the expression of pro-apoptotic [(transforming growth factorbetal (TGF-31) and Fas] and anti-apoptotic [epidermal growth factors (EGF) and Bcl-2] factors. RESULTS:Discontinuation of CsA induced significant decreases in TUNEL-positive cells in a time-dependent manner and the reduction in TUNEL-positive cells was correlated with the tubulointerstitial fibrosis score (r=0.919, P<0.01).Upregulation of TGF-βI and Fas expression in CsA-treated rat kidneys was decreased significantly after withdrawal of CsA. In contrast, downregulated EGF and Bcl-2 expression returned to normal or supernormal levels.CONCLUSION: CsA withdrawal is associated with a decrease in apoptotic cell death and with changes in the expression of pro-apoptotic and anti-apoptotic molecules involved in renal wound repair. This may constitute one of the mechanisms underlying the reversibility of chronic CsA nephrotoxicity.

  7. Relations between Chinese Mothers' Parenting Practices and Social Withdrawal in Early Childhood

    Science.gov (United States)

    Nelson, Larry J.; Hart, Craig H.; Wu, Bo; Yang, Chongming; Roper, Susanne Olsen; Jin, Shenghua

    2006-01-01

    Researchers have identified specific parenting practices used by parents of preschoolers in mainland China (e.g., physical coercion, overprotection, shaming, directiveness, encouragement of modesty). Some of the intrusive practices have been linked to social withdrawal in western societies (e.g., United States, Canada). It seemed important to…

  8. Wnt16 Is Associated with Age-Related Bone Loss and Estrogen Withdrawal in Murine Bone.

    Directory of Open Access Journals (Sweden)

    Henry Todd

    Full Text Available Genome Wide Association Studies suggest that Wnt16 is an important contributor to the mechanisms controlling bone mineral density, cortical thickness, bone strength and ultimately fracture risk. Wnt16 acts on osteoblasts and osteoclasts and, in cortical bone, is predominantly derived from osteoblasts. This led us to hypothesize that low bone mass would be associated with low levels of Wnt16 expression and that Wnt16 expression would be increased by anabolic factors, including mechanical loading. We therefore investigated Wnt16 expression in the context of ageing, mechanical loading and unloading, estrogen deficiency and replacement, and estrogen receptor α (ERα depletion. Quantitative real time PCR showed that Wnt16 mRNA expression was lower in cortical bone and marrow of aged compared to young female mice. Neither increased nor decreased (by disuse mechanical loading altered Wnt16 expression in young female mice, although Wnt16 expression was decreased following ovariectomy. Both 17β-estradiol and the Selective Estrogen Receptor Modulator Tamoxifen increased Wnt16 expression relative to ovariectomy. Wnt16 and ERβ expression were increased in female ERα-/- mice when compared to Wild Type. We also addressed potential effects of gender on Wnt16 expression and while the expression was lower in the cortical bone of aged males as in females, it was higher in male bone marrow of aged mice compared to young. In the kidney, which we used as a non-bone reference tissue, Wnt16 expression was unaffected by age in either males or females. In summary, age, and its associated bone loss, is associated with low levels of Wnt16 expression whereas bone loss associated with disuse has no effect on Wnt16 expression. In the artificially loaded mouse tibia we observed no loading-related up-regulation of Wnt16 expression but provide evidence that its expression is influenced by estrogen receptor signaling. These findings suggest that while Wnt16 is not an

  9. Wnt16 Is Associated with Age-Related Bone Loss and Estrogen Withdrawal in Murine Bone

    Science.gov (United States)

    Todd, Henry; Galea, Gabriel L.; Meakin, Lee B.; Delisser, Peter J.; Lanyon, Lance E.

    2015-01-01

    Genome Wide Association Studies suggest that Wnt16 is an important contributor to the mechanisms controlling bone mineral density, cortical thickness, bone strength and ultimately fracture risk. Wnt16 acts on osteoblasts and osteoclasts and, in cortical bone, is predominantly derived from osteoblasts. This led us to hypothesize that low bone mass would be associated with low levels of Wnt16 expression and that Wnt16 expression would be increased by anabolic factors, including mechanical loading. We therefore investigated Wnt16 expression in the context of ageing, mechanical loading and unloading, estrogen deficiency and replacement, and estrogen receptor α (ERα) depletion. Quantitative real time PCR showed that Wnt16 mRNA expression was lower in cortical bone and marrow of aged compared to young female mice. Neither increased nor decreased (by disuse) mechanical loading altered Wnt16 expression in young female mice, although Wnt16 expression was decreased following ovariectomy. Both 17β-estradiol and the Selective Estrogen Receptor Modulator Tamoxifen increased Wnt16 expression relative to ovariectomy. Wnt16 and ERβ expression were increased in female ERα-/- mice when compared to Wild Type. We also addressed potential effects of gender on Wnt16 expression and while the expression was lower in the cortical bone of aged males as in females, it was higher in male bone marrow of aged mice compared to young. In the kidney, which we used as a non-bone reference tissue, Wnt16 expression was unaffected by age in either males or females. In summary, age, and its associated bone loss, is associated with low levels of Wnt16 expression whereas bone loss associated with disuse has no effect on Wnt16 expression. In the artificially loaded mouse tibia we observed no loading-related up-regulation of Wnt16 expression but provide evidence that its expression is influenced by estrogen receptor signaling. These findings suggest that while Wnt16 is not an obligatory contributor to

  10. The alcohol withdrawal syndrome.

    LENUS (Irish Health Repository)

    McKeon, A

    2008-08-01

    The alcohol withdrawal syndrome (AWS) is a common management problem in hospital practice for neurologists, psychiatrists and general physicians alike. Although some patients have mild symptoms and may even be managed in the outpatient setting, others have more severe symptoms or a history of adverse outcomes that requires close inpatient supervision and benzodiazepine therapy. Many patients with AWS have multiple management issues (withdrawal symptoms, delirium tremens, the Wernicke-Korsakoff syndrome, seizures, depression, polysubstance abuse, electrolyte disturbances and liver disease), which requires a coordinated, multidisciplinary approach. Although AWS may be complex, careful evaluation and available treatments should ensure safe detoxification for most patients.

  11. Enhanced Human Decidual Cell-Expressed FKBP51 May Promote Labor-Related Functional Progesterone Withdrawal.

    Science.gov (United States)

    Schatz, Frederick; Guzeloglu-Kayisli, Ozlem; Basar, Murat; Buchwalder, Lynn F; Ocak, Nehir; Guzel, Elif; Guller, Seth; Semerci, Nihan; Kayisli, Umit A; Lockwood, Charles J

    2015-09-01

    Sustained plasma progesterone (P4) levels suggest initiation of human term labor by functional P4 withdrawal, reflecting reduced progesterone receptor (PR) and/or glucocorticoid receptor (GR) expression or activity. The steroid-induced immunophilin cochaperone FKBP51 inhibits PR- and GR-mediated transcription, suggesting a labor-initiating role. Gestational age-matched decidual sections were immunostained for FKBP51 and decidual cell (DC) and interstitial trophoblast (IT) markers, vimentin and cytokeratin, respectively. Term DC cultures were incubated with vehicle (control), estradiol (E2) with or without medroxyprogesterone acetate, dexamethasone (Dex), or Organon 2058. FKBP51 histologic scoring was significantly higher in DC nuclei during labor versus prelabor decidua, whereas FKBP51 immunostaining was undetected in interstitial trophoblasts (P Organon 2058 inhibited PR expression (P < 0.05), and E2 + Dex inhibited GR expression (P < 0.05). Unlike term DCs, FKBP51 was undetected in control or Dex-treated cultured third-trimester trophoblasts. Electrophoretic mobility shift assays revealed that FKPB51 overexpression or silencing in cultured DCs altered PR-DNA binding. Increased FKBP51 levels in term DCs during labor complement our prior in situ observations of significantly lower PR in labor versus prelabor DCs. In a milieu of sustained plasma P4 levels, these reciprocal changes will amplify functional P4 withdrawal in DCs via FKBP51-mediated PR resistance coupled with declining PR levels, whereas the lack of FKBP51 expression in interstitial trophoblasts suggests unopposed constitutive GR action.

  12. Comment on: withdrawal of growth-promoting antibiotics in Europe and its effects in relation to human health

    DEFF Research Database (Denmark)

    Hammerum, Anette Marie; Heuer, Ole Eske; Lester, Camilla H.

    2007-01-01

    In response to a review titled 'Withdrawal of growth-promoting antibiotics in Europe and its effects in relation to human health', published in this Journal by Ian Phillips, we hereby comment on the review. Phillips makes use of data from the Danish Integrated Antimicrobial Resistance Monitoring...... and Research Programme (DANMAP) reports and studies on Campylobacter and enterococci. Unfortunately, we find these data frequently misinterpreted by Phillips, leading to false conclusions such as inferences that the ban of antibiotic growth promoters should cause an increased prevalence of resistant...

  13. Psychosis following Tramadol Withdrawal

    OpenAIRE

    Rajabizadeh, Ghodratolah; Kheradmand, Ali; Nasirian, Mansoureh

    2009-01-01

    Background: Tramadol is a centrally acting opioid analgesic used to treat moderate to sever pain. It has more advantage and less opioid adverse effects than conventional opioid analgesia. Case Report: This article reports a patient with tramadol dependency that had psychosis after tramadol withdrawal. Conclusion: By the increase of tramadol usage for relief of chronic pain, tramadol abuse and dependency is increased. Some of tramadol withdrawal symptoms are not related to opioid, for example ...

  14. Lorazepam withdrawal catatonia: a case report.

    Science.gov (United States)

    Sivakumar, Thanapal; Yadav, Anil; Sood, Mamta; Khandelwal, Sudhir K

    2013-12-01

    Catatonia is a rare manifestation of benzodiazepine withdrawal in elderly patients who have used it for a long time. We present a case of lorazepam withdrawal catatonia and highlight issues in diagnosis and management.

  15. Response to anticoagulant drug withdrawal.

    Science.gov (United States)

    Mulligan, R

    1987-09-01

    This study evaluated 44 separate medication withdrawal periods in 17 subjects who were attending a hospital anticoagulation clinic for management of anticoagulation medication. The data suggest that when anticoagulant withdrawal is needed for particular dental procedures, a 2-day hold is an effective period of medication withdrawal. No thromboembolic events were observed after any of the withdrawal periods. Further, no posttreatment hemorrhagic episodes were observed when the anticoagulant medication was reinstituted after dental treatment. Prothrombin time blood levels should be determined in the immediate pretreatment period, however, because the prothrombin time can fluctuate even in the best maintained patients.

  16. 76 FR 54384 - California State Implementation Plan, South Coast Air Quality Management District; Withdrawal of...

    Science.gov (United States)

    2011-09-01

    ... AGENCY 40 CFR Part 52 California State Implementation Plan, South Coast Air Quality Management District... to the California State Implementation Plan (SIP). This revision concerned South Coast Air Quality Management District (SCAQMD) Rule 1143, Consumer Paint Thinner & Multi-Purpose Solvents and Rule 1144,...

  17. Complete Remission of Methotrexate-Related Epstein-Barr-Virus-Associated Hodgkin-Like Lymphoma following Withdrawal of MTX Coupled with Clarithromycin Administration

    Directory of Open Access Journals (Sweden)

    Nobuo Takemori

    2012-01-01

    Full Text Available Patients with rheumatoid arthritis (RA are known to develop lymphoproliferative disorders (LPDs during the course of illness, particularly in cases treated with methotrexate (MTX for long periods. We describe a case of MTX-related Epstein-Barr-virus-(EBV- associated LPD resembling Hodgkin’s lymphoma (HL, in which a dramatic complete remission was achieved after withdrawal of MTX coupled with clarithromycin (CAM administration. Withdrawal of MTX coupled with CAM administration seemed to be effective for treating MTX-related EBV-associated LPDs. In particular, an immunomodulative effect of CAM might have been involved in achieving complete remission.

  18. Relations between precipitation, groundwater withdrawals, and changes in hydrologic conditions at selected monitoring sites in Volusia County, Florida, 1995--2010

    Science.gov (United States)

    Murray, Louis C.

    2012-01-01

    A study to examine the influences of climatic and anthropogenic stressors on groundwater levels, lake stages, and surface-water discharge at selected sites in northern Volusia County, Florida, was conducted in 2009 by the U.S. Geological Survey. Water-level data collected at 20 monitoring sites (17 groundwater and 3 lake sites) in the vicinity of a wetland area were analyzed with multiple linear regression to examine the relative influences of precipitation and groundwater withdrawals on changes in groundwater levels and lake stage. Analyses were conducted across varying periods of record between 1995 and 2010 and included the effects of groundwater withdrawals aggregated from municipal water-supply wells located within 12 miles of the project sites. Surface-water discharge data at the U.S. Geological Survey Tiger Bay canal site were analyzed for changes in flow between 1978 and 2001. As expected, water-level changes in monitoring wells located closer to areas of concentrated groundwater withdrawals were more highly correlated with withdrawals than were water-level changes measured in wells further removed from municipal well fields. Similarly, water-level changes in wells tapping the Upper Floridan aquifer, the source of municipal supply, were more highly correlated with groundwater withdrawals than were water-level changes in wells tapping the shallower surficial aquifer system. Water-level changes predicted by the regression models over precipitation-averaged periods of record were underestimated for observations having large positive monthly changes (generally greater than 1.0 foot). Such observations are associated with high precipitation and were identified as points in the regression analyses that produced large standardized residuals and/or observations of high influence. Thus, regression models produced by multiple linear regression analyses may have better predictive capability in wetland environments when applied to periods of average or below average

  19. Is antiepileptic drug withdrawal status related to quality of life in seizure-free adult patients with epilepsy?

    Science.gov (United States)

    Zou, Xuemei; Hong, Zhen; Chen, Jiani; Zhou, Dong

    2014-02-01

    This study aimed to determine factors that influence the quality of life (QOL) of seizure-free adult patients with epilepsy in western China and address whether these determinants vary by antiepileptic drug (AED) withdrawal. A cross-sectional study was conducted in the epilepsy outpatient clinic of West China Hospital, Sichuan University. Patients with epilepsy who were aged at least 18years and seizure-free for at least 12months were interviewed using the Quality of Life in Epilepsy Inventory-31 (QOLIE-31); the National Hospital Seizure Severity Scale (NHS3); the Liverpool Adverse Events Profile (LAEP); the Social Support Rating Scale (SSRS); the Family Adaptation, Partnership, Growth, Affection, and Resolve (APGAR) Questionnaire; and the Scale of Knowledge and Attitudes Toward Epilepsy. Eligible patients were divided into two groups: the nonwithdrawal group and the withdrawal group. The independent-samples t-test was used to compare the QOL between the groups, and linear regression analysis was used to explain the variance of their QOL. One hundred and eighty-seven (135 nonwithdrawal and 52 withdrawal) patients were included in the analysis. The QOLIE-31 overall score of the nonwithdrawal group was lower than that of the withdrawal group (pfree adult patients with epilepsy, those with AED withdrawal experienced better QOL than those continuing AED treatment. Furthermore, the determinants of QOL varied by AED withdrawal. Individual strategies to optimize QOL should be developed based on these differences. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. The Effect of Cognitive-Behavioral Stress Management with Methadone to Reduce Stress and Voracity in Drug use among Addicts referring to Withdrawal Camps

    Directory of Open Access Journals (Sweden)

    Yaghoub Norouzpour Ahmadi

    2016-03-01

    Full Text Available The present study was conducted with the aim of examining the effect of cognitive-behavioral stress management with methadone to reduce stress and voracity in drug use among addicts referring to withdrawal camps. The design of the present study is quasi-empirical (quasi-experimental and pretest -posttest have been together with control group. Statistical population was all the addicts referring to one of the withdrawal camps in Bandar Abbas that among them 30 persons were selected to participate in group therapy. Scale of 21-question Das- form (DASS-21 from the subscale of the stress and the questionnaire for measuring voracity in drug use in a moment to collect data were used. Training workshop on cognitive - behavioral stress management in 10 sessions was conducted an hour and a half on the experimental group. Covariance analysis was utilized for data analysis. The results showed that cognitive-behavioral stress management with methadone therapy has been effective in reducing stress in addicts referring to withdrawal camps (P≤ 0.05. Also, the results showed that cognitive-behavioral stress management with methadone therapy has been effective in reducing willingness and intention to use drugs, reducing the propensity to consume and negative reinforcement and drug velocity in addicts referring to withdrawal camps (P≤ 0.05. In general, these findings show that this curriculum in addition to reduce the symptoms in three levels of physiological, cognitive and behavioral leads to the change in person's lifestyle that this factor plays an important role in reducing drug use and preventing the recurrence and fault.

  1. 78 FR 25353 - Proposed Guidance on Deposit Advance Products; Withdrawal of Proposed Guidance on Deposit-Related...

    Science.gov (United States)

    2013-04-30

    ... Bulletin, 2001-47, ``Third-Party Relationships: Risk Management Principles for Third-Party Relationships... protection statutes, management's oversight, and relationships with third parties will also be assessed... Proposed Guidance on Deposit-Related Consumer Credit Products AGENCIES: Office of the Comptroller of...

  2. Dovish Candidate Withdraws

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Former Japanese Chief Cabinet Secretary Yasuo Fukuda formally announced on July 21 his withdrawal from the upcoming Liberal Democratic Party's (LDP) presidential election in September, citing his opposition to officials' visits to the war-related Yasukuni Shrine and his advanced age.

  3. DIFFERENTIAL EFFECTS OF SINGLE VERSUS REPEATED ALCOHOL WITHDRAWAL ON THE EXPRESSION OF ENDOCANNABINOID SYSTEM-RELATED GENES IN THE RAT AMYGDALA

    Science.gov (United States)

    Serrano, Antonia; Rivera, Patricia; Pavon, Francisco J.; Decara, Juan; Suárez, Juan; de Fonseca, Fernando Rodriguez; Parsons, Loren H.

    2011-01-01

    Background Endogenous cannabinoids such as anandamide and 2-arachidonoylglycerol (2-AG) exert important regulatory influences on neuronal signaling, participate in short- and long-term forms of neuroplasticity, and modulate stress responses and affective behavior in part through the modulation of neurotransmission in the amygdala. Alcohol consumption alters brain endocannabinoid levels, and alcohol dependence is associated with dysregulated amygdalar function, stress responsivity and affective control. Methods The consequence of long-term alcohol consumption on the expression of genes related to endocannabinoid signaling was investigated using quantitative RT-PCR analyses of amygdala tissue. Two groups of ethanol-exposed rats were generated by maintenance on an ethanol liquid diet (10%): one group received continuous access to ethanol for 15 days, while the second group was given intermittent access to the ethanol diet (5 days/week for 3 weeks). Control subjects were maintained on an isocaloric ethanol-free liquid diet. To provide an initial profile of acute withdrawal amygdala tissue was harvested following either 6 or 24 hours of ethanol withdrawal. Results Acute ethanol withdrawal was associated with significant changes in mRNA expression for various components of the endogenous cannabinoid system in the amygdala. Specifically, reductions in mRNA expression for the primary clearance routes for anandamide and 2-AG (FAAH and MAGL, respectively) were evident, as were reductions in mRNA expression for CB1, CB2 and GPR55 receptors. Although similar alterations in FAAH mRNA were evident following either continuous or intermittent ethanol exposure, alterations in MAGL and cannabinoid receptor-related mRNA (e.g. CB1, CB2, GPR55) were more pronounced following intermittent exposure. In general, greater withdrawal-associated deficits in mRNA expression were evident following 24 versus 6 hours of withdrawal. No significant changes in mRNA expression for enzymes involved in

  4. A Case Report of Kratom Addiction and Withdrawal.

    Science.gov (United States)

    Galbis-Reig, David

    2016-02-01

    Kratom, a relatively unknown herb among physicians in the western world, is advertised on the Internet as an alternative to opioid analgesics, as a potential treatment for oploid withdrawal and as a "legal high" with minimal addiction potential. This report describes a case of kratom addiction in a 37-year-old woman with a severe oploid-like withdrawal syndrome that was managed successfully with symptom-triggered clonidine therapy and scheduled hydroxyzine. A review of other case reports of kratom toxicity, the herb's addiction potential, and the kratom withdrawal syndrome is discussed. Physicians in the United States should be aware of the growing availability and abuse of kratom and the herb's potential adverse health effects, with particular attention to kratom's toxicity, addictive potential, and associated withdrawal syndrome.

  5. Anticonvulsants for alcohol withdrawal.

    Science.gov (United States)

    Minozzi, Silvia; Amato, Laura; Vecchi, Simona; Davoli, Marina

    2010-03-17

    Alcohol abuse and dependence represents a most serious health problem worldwide with major social, interpersonal and legal interpolations. Besides benzodiazepines, anticonvulsants are often used for the treatment of alcohol withdrawal symptoms. Anticonvulsants drugs are indicated for the treatment of alcohol withdrawal syndrome, alone or in combination with benzodiazepine treatments. In spite of the wide use, the exact role of the anticonvulsants for the treatment of alcohol withdrawal has not yet bee adequately assessed. To evaluate the effectiveness and safety of anticonvulsants in the treatment of alcohol withdrawal. We searched Cochrane Drugs and Alcohol Group' Register of Trials (December 2009), PubMed, EMBASE, CINAHL (1966 to December 2009), EconLIT (1969 to December 2009). Parallel searches on web sites of health technology assessment and related agencies, and their databases. Randomized controlled trials (RCTs) examining the effectiveness, safety and overall risk-benefit of anticonvulsants in comparison with a placebo or other pharmacological treatment. All patients were included regardless of age, gender, nationality, and outpatient or inpatient therapy. Two authors independently screened and extracted data from studies. Fifty-six studies, with a total of 4076 participants, met the inclusion criteria. Comparing anticonvulsants with placebo, no statistically significant differences for the six outcomes considered.Comparing anticonvulsant versus other drug, 19 outcomes considered, results favour anticonvulsants only in the comparison carbamazepine versus benzodiazepine (oxazepam and lorazepam) for alcohol withdrawal symptoms (CIWA-Ar score): 3 studies, 262 participants, MD -1.04 (-1.89 to -0.20), none of the other comparisons reached statistical significance.Comparing different anticonvulsants no statistically significant differences in the two outcomes considered.Comparing anticonvulsants plus other drugs versus other drugs (3 outcomes considered), results

  6. Marketing management enhances customer relations.

    Science.gov (United States)

    Lazarus, I R; Petras, G J; Bradford, C

    1992-10-01

    The implementation of automated marketing management systems in hospitals across the United States can change dramatically the way in which a hospital builds business by managing relationships with prospective customers.

  7. Crisis - Strategic Management in Public Relation

    OpenAIRE

    Saari Ahmad

    2012-01-01

    This is a concept paper to explore the strategic management approaches in public relations during crisis. The main objective of this article is to identify the most effective action plan for Public relation. The review of the strategic management in public relations literature reveals that the relationship between strategic management and public relations is still vague. Four stages were identified in the process of establishing the action plan for public relations and eleven strategic action...

  8. Inpatient Opioid Withdrawal Management of Street Children and Adolescents Admitted to Child and Adolescent Psychiatric Ward: A Preliminary Case Series

    Directory of Open Access Journals (Sweden)

    Mahboubeh Firouzkouhi Moghadam

    2016-07-01

    Full Text Available Background About 10 million children worldwide live or work on the street. International reports estimate the prevalence of substance use among street children to be between 25% - 90%, which is who were referredntal disorders and high-risk behaviors. Objectives The objective of this study was to report the outcomes of assisted withdrawal of opioid-dependent vulnerable children and adolescents who were referred to child and adolescent psychiatric ward of Ali Ebne Abitaleb hospital, an academic hospital in Zahedan city. Methods Clinical chart abstractions were performed on a convenience sample of 40 serial opioid-dependent street children and adolescents (mean age: 11.14 ± 3.6 years who were referred to child and adolescent psychiatric ward of Ali Ebne Abitaleb treatment and research center from November 2014 to May 2015. The demographic data, drug use history, comorbid physical and psychiatric conditions, symptomatology of opioid withdrawal syndrome, pharmacotherapies and psychosocial services, length of hospital stay, and any adverse events were extracted from the patients’ files using a checklist developed by the authors. Results Twenty-four (60% patients were male, and 16 (40% were female. The main drug used by all patients was opioids. Heroin Kerack (which has a street name of crystal in southeast Iran was the most common (75% drug of use, followed by opium (10% and opium residue (7.5%. None of the participants self-reported using injected drugs. The high rate of a lack of eligibility for guardianship was documented among parents (87.5% mainly due to their use of illegal drugs. Musculoskeletal pain and diarrhea were the most common withdrawal symptoms of the patients upon admission. The mean length of stay was 10.8 (± 7.30 days, and no significant adverse events were reported during the symptomatic treatment of opioid withdrawal syndrome. Conclusions To our knowledge, this is the first study to report on the safety and feasibility of

  9. Zolpidem withdrawal delirium

    Directory of Open Access Journals (Sweden)

    Surendra K Mattoo

    2011-01-01

    Full Text Available The Z-category hypnotics are promoted for their relative safety. However, this view is challenged by the emerging clinical evidence in the form of zolpidem related intoxication delirium and seizures, and dependence and complicated withdrawal. We report the case of a zolpidem-naive alcohol-dependent inpatient that, while undergoing alcohol de-addiction, was prescribed zolpidem for insomnia and developed delirium during taper-off. He was successfully detoxified for alcohol, treated for delirium and put on disulfiram prophylaxis. The case highlights the need for being cautious while using zolpidem for insomnia in alcohol dependent subjects.

  10. Are organisational factors affecting the emotional withdrawal of community nurses?

    Science.gov (United States)

    Karimi, Leila; Leggat, Sandra G; Cheng, Cindy; Donohue, Lisa; Bartram, Timothy; Oakman, Jodi

    2016-12-05

    Objective The aim of the present study was to investigate the effects of work organisation on the emotional labour withdrawal behaviour of Australian community nurses.Methods Using a paper-based survey, a sample of 312 Australian community nurses reported on their emotional dissonance, withdrawal behaviours (i.e. job neglect, job dissatisfaction, stress-related presenteeism) and work organisation. A model to determine the partial mediation effect of work organisation was developed based on a literature review. The fit of the proposed model was assessed via structural equation modelling using Analysis of Moment Structures (AMOS; IMB).Results Community nurses with higher levels of emotional dissonance were less likely to be satisfied with their job and work organisation and had a higher tendency to exhibit withdrawal behaviours. Work organisational factors mediated this relationship.Conclusion Emotional dissonance can be a potential stressor for community nurses that can trigger withdrawal behaviours. Improving work organisational factors may help reduce emotional conflict and its effect on withdrawal behaviours.What is known about the topic? Although emotional labour has been broadly investigated in the literature, very few studies have addressed the effect of the quality of work organisation on nurses' withdrawal behaviours in a nursing setting.What does this paper add? This paper provides evidence that work organisation affects levels of emotional dissonance and has an effect on job neglect through stress-related presenteeism.What are the implications for practitioners? In order to minimise stress-related presenteeism and job neglect, healthcare organisations need to establish a positive working environment, designed to improve the quality of relationships with management, provide appropriate rewards, recognition and effective workload management and support high-quality relationships with colleagues.

  11. Stigma Management in International Relations

    DEFF Research Database (Denmark)

    Adler-Nissen, Rebecca

    2014-01-01

    with their stigma and may, in some cases, challenge and even transform a dominant moral discourse. A typology of stigma management strategies is presented: stigma recognition (illustrated by Germany); stigma rejection (illustrated by Austria); and finally counter-stigmatization (illustrated by Cuba). Because...

  12. Effects of groundwater withdrawal on borehole flow and salinity measured in deep monitor wells in Hawai'i-implications for groundwater management

    Science.gov (United States)

    Rotzoll, Kolja

    2010-01-01

    Water-resource managers in Hawai`i rely heavily on salinity profiles from deep monitor wells to estimate the thickness of freshwater and the depth to the midpoint of the transition zone between freshwater and saltwater in freshwater-lens systems. The deep monitor wells are typically open boreholes below the water table and extend hundreds of feet below sea level. Because of possible borehole-flow effects, there is concern that salinity profiles measured in these wells may not accurately reflect the salinity distribution in the aquifer and consequently lead to misinterpretations that adversely affect water-resource management. Steplike changes in salinity or temperature with depth in measured profiles from nonpumped deep monitor wells may be indicative of water moving within the well, and such changes are evident to some extent in all available profiles. The maximum vertical step length, or displacement, in measured profiles ranges from 7 to 644 feet. Vertical steps longer than 70 feet exceed the typical thickness of massive lava flows; they therefore cannot be attributed entirely to geologic structure and may be indicative of borehole flow. The longest vertical steps occur in monitor wells located in southern O'ahu, coinciding with the most heavily developed part of the aquifer. Although regional groundwater withdrawals have caused a thinning of the freshwater lens over the past several decades, the measured midpoint of the transition zone in most deep monitor wells has shown only inconsequential depth displacement in direct response to short-term variations in withdrawals from nearby production wells. For profiles from some deep monitor wells, however, the depth of the measured top of the transition zone, indicated by a specific-conductance value of 1,000 microsiemens per centimeter, has risen several hundred feet in response to withdrawals from nearby production wells. For these deep monitor wells, monitoring the apparent top of the transition zone may not

  13. 2017-2022 Proposed Program - Withdrawal Areas

    Data.gov (United States)

    Bureau of Ocean Energy Management, Department of the Interior — This file represents the areas of the Outer Continental Shelf that have been withdrawn from disposition by leasing. The withdrawal of these areas prevents...

  14. Stigma Management in International Relations

    DEFF Research Database (Denmark)

    Adler-Nissen, Rebecca

    2014-01-01

    This article develops a theoretical approach to stigma in international relations and resituates conventional approaches to the study of norms and international order. Correcting the general understanding that common values and norms are the building blocks of social order, this article claims...... that international society is in part constructed through the stigmatization of “transgressive” and norm-violating states and their ways of coping with stigma. Drawing on Erving Goffman, this article shows that states are not passive objects of socialization, but active agents. Stigmatized states cope strategically...... avenues for research on norms, identities, and international order....

  15. Alcohol Withdrawal Mimicking Organophosphate Poisoning

    Directory of Open Access Journals (Sweden)

    Nezihat Rana Disel

    2014-02-01

    Full Text Available Organophosphates, which can cause occupational poisoning due to inappropriate personal protective measures, are widely used insecticides in agricultural regions of southern Turkey. Therefore, the classical clinical findings of this cholinergic poisoning are myosis, excessive secretions, bradicardia and fasciculations are easy to be recognized by local medical stuff. Diseases and conditions related to alcoholism such as mental and social impairments, coma, toxicity, withdrawal, and delirium are frequent causes of emergency visits of chronic alcoholic patients. Here we present a case diagnosed and treated as organophosphate poisoning although it was an alcohol withdrawal in the beginning and became delirium tremens, due to similar symptoms.

  16. Structuring medication related activities for information management.

    Science.gov (United States)

    Luukkonen, Irmeli; Mykkänen, Juha; Kivekäs, Eija; Saranto, Kaija

    2014-01-01

    Medication treatment and the related information management are central parts of a patient's health care. As a cross-organizational and cooperative process, medication information management is a complex domain for development activities. We studied medication activities and related information management in a regional project in order to produce a shared broad picture of its processes and to understand the main issues and the needs for improvement. In this paper we provide a summary of the findings in a structured form, based on a six-dimensioned framework for design and analysis of activities and processes.

  17. Managing military training-related environmental disturbance.

    Science.gov (United States)

    Zentelis, Rick; Banks, Sam; Roberts, J Dale; Dovers, Stephen; Lindenmayer, David

    2017-09-17

    Military Training Areas (MTAs) cover at least 2 percent of the Earth's terrestrial surface and occur in all major biomes. These areas are potentially important for biodiversity conservation. The greatest challenge in managing MTAs is balancing the disturbance associated with military training and environmental values. These challenges are unique as no other land use is managed for these types of anthropogenic disturbances in a natural setting. We investigated how military training-related disturbance is best managed on MTAs. Specifically, we explored management options to maximise the amount of military training that can be undertaken on a MTA while minimising the amount of environmental disturbance. MTAs comprise of a number of ranges designed to facilitate different types of military training. We simulated military training-related environmental disturbance at different range usage rates under a typical range rotation use strategy, and compared the results to estimated ecosystem recovery rates from training activities. We found that even at relatively low simulated usage rates, random allocation and random spatial use of training ranges within an MTA resulted in environmental degradation under realistic ecological recovery rates. To avoid large scale environmental degradation, we developed a decision-making tool that details the best method for managing training-related disturbance by determining how training activities can be allocated to training ranges. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Baclofen for alcohol withdrawal.

    Science.gov (United States)

    Liu, Jia; Wang, Lu-Ning

    2017-08-20

    Baclofen shows potential for rapidly reducing symptoms of severe alcohol withdrawal syndrome (AWS) in people with alcoholism. Treatment with baclofen is easy to manage and rarely produces euphoria or other pleasant effects, or craving for the drug. This is an updated version of the original Cochrane Review published in 2015, Issue 4. To assess the efficacy and safety of baclofen for people with AWS. We updated our searches of the following databases to March 2017: the Cochrane Drugs and Alcohol Group Specialised Register, CENTRAL, PubMed, Embase, and CINAHL. We also searched registers of ongoing trials. We handsearched the references quoted in the identified trials, and sought information from researchers, pharmaceutical companies, and relevant trial authors about unpublished or uncompleted trials. We placed no restrictions on language. We included all randomised controlled clinical trials (RCTs) evaluating baclofen versus placebo or any other treatment for people with AWS. We excluded uncontrolled, non-randomised, or quasi-randomised trials. We included both parallel group and cross-over studies. We used standard methodological procedures expected by Cochrane. We included three RCTs with 141 randomised participants. We did not perform meta-analyses due to the different control interventions. For the comparison of baclofen and placebo (1 study, 31 participants), there was no significant difference in Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) scores (very low quality evidence). For the comparison of baclofen and diazepam (1 study, 37 participants), there was no significant difference in CIWA-Ar scores (very low quality evidence), adverse events (risk difference (RD) 0.00, 95% confidence interval (CI) -0.10 to 0.10; very low quality evidence), dropouts (RD 0.00, 95% CI -0.10 to 0.10; very low quality evidence), and dropouts due to adverse events (RD 0.00, 95% CI -0.10 to 0.10; very low quality evidence). For the comparison of

  19. Public Relations Ethics in Information Management

    Directory of Open Access Journals (Sweden)

    Hrvoje Jakopović

    2013-06-01

    Full Text Available Public relations is involved in all communication between an organization and the public. In the contemporary world, PR practitioners have become the facilitators of information. Information and communication technology (ICT have imposed new rules in the field of public relations. Communication strategy and information management have become crucial parts of modern public relations. People change their habits with regard to the consumption of traditional and new media. The challenges imposed by the development of information and communication technology are also related to understanding the new information society. For that reason information ethics deals with the ethical implications of dissemination, use, development and safety of information. Public relations follow new information and communication trends, and they need to build firm ethical principles for the age of information. The author examines the ethical implications of the framing concept in public relations.

  20. Proton-pump inhibitor therapy induces acid-related symptoms in healthy volunteers after withdrawal of therapy

    DEFF Research Database (Denmark)

    Reimer, Christina; Søndergaard, Bo; Hilsted, Linda

    2009-01-01

    BACKGROUND & AIMS: Rebound acid hypersecretion (RAHS) has been demonstrated after 8 weeks of treatment with a proton-pump inhibitor (PPI). If RAHS induces acid-related symptoms, this might lead to PPI dependency and thus have important implications. METHODS: A randomized, double-blind, placebo...... dyspepsia, heartburn, or acid regurgitation in the PPI group was 13 of 59 (22%) at week 10, 13 of 59 (22%) at week 11, and 12 of 58 (21%) at week 12. Corresponding figures in the placebo group were 7% at week 10 (P = .034), 5% at week 11 (P = .013), and 2% at week 12 (P = .001). CONCLUSIONS: PPI therapy...

  1. Pregnancy related acute kidney injury: nondialytic management

    Directory of Open Access Journals (Sweden)

    Kaliki Hymavathi Reddy

    2015-04-01

    Full Text Available Acute Kidney Injury (AKI is associated with increased mortality and morbidity unless timely diagnosed and promptly managed. An understanding of the renal physiologic changes that occur during pregnancy is essential for Proper evaluation, diagnosis, and management of Pregnancy Related AKI (PRAKI. In the general population, AKI can occur from prerenal, intrinsic/renal, and post-renal causes. Major causes of pre-renal azotemia include hyperemesis gravidarum and uterine hemorrhage in the setting of placental abruption. Intrinsic etiologies include infections from acute pyelonephritis and septic abortion, bilateral cortical necrosis, and acute tubular necrosis. Particular attention should be paid to specific conditions that lead to AKI during the second and third trimesters, such as preeclampsia, HELLP syndrome, acute fatty liver of pregnancy, and TTP-HUS. An understanding of the various etiologies of AKI in the pregnant patient is key to the appropriate clinical management and prevention of adverse maternal/fetal outcomes. Sometimes PRAKI may require intensive management and even dialysis adding additional economical burden to the patient. We here, with report an interesting case of PRAKI diagnosed and managed in time by simple medical measures thus delivering an effective treatment at a much lesser cost. [Int J Reprod Contracept Obstet Gynecol 2015; 4(2.000: 486-489

  2. Managing Port-Related Supply Chain Disruptions: A Conceptual Paper

    Directory of Open Access Journals (Sweden)

    Hui Shan Loh

    2014-04-01

    This paper synthesizes the current literature into a management model that seeks to target operational deficiencies at ports. The management model is operationalized in three tiers, from the top management level to the front-line employees, with characteristics from risk management, business continuity management and quality management theories. The proposed model serves as a universal guide in assisting port management in managing port-related disruptions and seeks to reduce the occurrences of port-related supply chain disruption threats.

  3. Nicotine addiction and withdrawal

    Science.gov (United States)

    ... Hg Possibly cause sweating, nausea, and diarrhea Stimulate memory and alertness; people who use tobacco often depend on it to help them accomplish certain tasks and perform well Symptoms of nicotine withdrawal appear within 2 to 3 hours after ...

  4. Managing Objects in a Relational Framework

    Science.gov (United States)

    1989-01-01

    the object-oriented approach can also serve as a unifying scheme for de- veloping EDSs . This paper presents a novel architecture, called PENGUIN, for... EDSs . We introduce an object-based interface on top of a relational database, which can improve database transactions and serve as an efficient scheme...the system with regard to our two scenarios for EDSs , before concluding in Section 7. The ES/DBMS Connection Database management systems evolved in

  5. Quantifying the Clinical Significance of Cannabis Withdrawal

    Science.gov (United States)

    Allsop, David J.; Copeland, Jan; Norberg, Melissa M.; Fu, Shanlin; Molnar, Anna; Lewis, John; Budney, Alan J.

    2012-01-01

    Background and Aims Questions over the clinical significance of cannabis withdrawal have hindered its inclusion as a discrete cannabis induced psychiatric condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). This study aims to quantify functional impairment to normal daily activities from cannabis withdrawal, and looks at the factors predicting functional impairment. In addition the study tests the influence of functional impairment from cannabis withdrawal on cannabis use during and after an abstinence attempt. Methods and Results A volunteer sample of 49 non-treatment seeking cannabis users who met DSM-IV criteria for dependence provided daily withdrawal-related functional impairment scores during a one-week baseline phase and two weeks of monitored abstinence from cannabis with a one month follow up. Functional impairment from withdrawal symptoms was strongly associated with symptom severity (p = 0.0001). Participants with more severe cannabis dependence before the abstinence attempt reported greater functional impairment from cannabis withdrawal (p = 0.03). Relapse to cannabis use during the abstinence period was associated with greater functional impairment from a subset of withdrawal symptoms in high dependence users. Higher levels of functional impairment during the abstinence attempt predicted higher levels of cannabis use at one month follow up (p = 0.001). Conclusions Cannabis withdrawal is clinically significant because it is associated with functional impairment to normal daily activities, as well as relapse to cannabis use. Sample size in the relapse group was small and the use of a non-treatment seeking population requires findings to be replicated in clinical samples. Tailoring treatments to target withdrawal symptoms contributing to functional impairment during a quit attempt may improve treatment outcomes. PMID:23049760

  6. Practical Management of Lenalidomide-Related Rash.

    Science.gov (United States)

    Tinsley, Sara M; Kurtin, Sandra E; Ridgeway, Jean A

    2015-06-01

    Lenalidomide (LEN) is an immunomodulatory drug with US Food and Drug Administration approval for use in myelodysplastic syndromes (MDS), multiple myeloma (MM), and mantle cell lymphoma (MCL). The toxicity profile for LEN is similar across indications, with the most common adverse events reported in registration trials being hematologic in nature, and Grade ≥ 3 hematologic toxicities the most common reasons for treatment interruption or permanent LEN discontinuation. However, an analysis of the Celgene Global Drug Safety database showed that nonserious rash was the leading cause of permanent early discontinuation of LEN in patients with MDS treated in the postmarketing setting (similar data not available for patients with MM or MCL). In registration trials, rash was reported in up to a third of patients, but Grade ≥ 3 rash was uncommon and rash rarely led to LEN treatment interruption or permanent discontinuation. This suggests differences in management of LEN-related rash in clinical trials versus real-world use. Most LEN-related rash is mild to moderate in severity and might present as patchy, raised, macular skin lesions, sometimes with localized urticaria, which might be associated with pruritus. Mild to moderate rash might be treated with topical corticosteroids and/or oral antihistamines. Any grade LEN-related rash should be appropriately managed through awareness of symptoms, appropriate and prompt intervention, and maximizing patient self-reporting of early signs of rash using upfront educational initiatives. This guide to management of LEN-related rash reviews key clinical data from registration trials, and the incidence and physiology of LEN-related rash, grading of rash, and guidelines for patients and caregivers.

  7. Withdrawing Benzodiazepines in Patients With Anxiety Disorders.

    Science.gov (United States)

    Lader, Malcolm; Kyriacou, Andri

    2016-01-01

    The large class of CNS-depressant medications-the benzodiazepines-have been extensively used for over 50 years, anxiety disorders being one of the main indications. A substantial proportion (perhaps up to 20-30 %) of long-term users becomes physically dependent on them. Problems with their use became manifest, and dependence, withdrawal difficulties and abuse were documented by the 1980s. Many such users experience physical and psychological withdrawal symptoms on attempted cessation and may develop clinically troublesome syndromes even during slow tapering. Few studies have been conducted to establish the optimal withdrawal schedules. The usual management comprises slow withdrawal over weeks or months together with psychotherapy of various modalities. Pharmacological aids include antidepressants such as the SSRIs especially if depressive symptoms supervene. Other pharmacological agents such as the benzodiazepine antagonist, flumazenil, and the hormonal agent, melatonin, remain largely experimental. The purpose of this review is to analyse the evidence for the efficacy of the usual withdrawal regimes and the newer agents. It is concluded that little evidence exists outside the usual principles of drug withdrawal but there are some promising leads.

  8. Fluctuations in groundwater levels related to regional and local withdrawals in the fractured-bedrock groundwater system in northern Wake County, North Carolina, March 2008-February 2009

    Science.gov (United States)

    Chapman, Melinda J.; Almanaseer, Naser; McClenney, Bryce; Hinton, Natalie

    2011-01-01

    A study of dewatering of the fractured-bedrock aquifer in a localized area of east-central North Carolina was conducted from March 2008 through February 2009 to gain an understanding of why some privately owned wells and monitoring wells were intermittently dry. Although the study itself was localized in nature, the resulting water-resources data and information produced from the study will help enable resource managers to make sound water-supply and water-use decisions in similar crystalline-rock aquifer setting in parts of the Piedmont and Blue Ridge Physiographic Provinces. In June 2005, homeowners in a subdivision of approximately 11 homes on lots approximately 1 to 2 acres in size in an unincorporated area of Wake County, North Carolina, reported extremely low water pressure and temporarily dry wells during a brief period. This area of the State, which is in the Piedmont Physiographic Province, is undergoing rapid growth and development. Similar well conditions were reported again in July 2007. In an effort to evaluate aquifer conditions in the area of intermittent water loss, a study was begun in March 2008 to measure and monitor water levels and groundwater use. During the study period from March 2008 through February 2009, regular dewatering of the fractured-bedrock aquifer was documented with water levels in many wells ranging between 100 and 200 feet below land surface. Prior to this period, water levels from the 1980s through the late 1990s were reported to range from 15 to 50 feet below land surface. The study area includes three community wells and more than 30 private wells within a 2,000-foot radius of the dewatered private wells. Although groundwater levels were low, recovery was observed during periods of heavy rainfall, most likely a result of decreased withdrawals owing to less demand for irrigation purposes. Similar areal patterns of low groundwater levels were delineated during nine water-level measurement periods from March 2008 through

  9. Cerebrolysin Attenuates Heat Shock Protein (HSP 72 KD) Expression in the Rat Spinal Cord Following Morphine Dependence and Withdrawal: Possible New Therapy for Pain Management.

    Science.gov (United States)

    Sharma, Hari S; Ali, Syed F; Patnaik, Ranjana; Zimmermann-Meinzingen, Sibilla; Sharma, Aruna; Muresanu, Dafin F

    2011-03-01

    The possibility that pain perception and processing in the CNS results in cellular stress and may influence heat shock protein (HSP) expression was examined in a rat model of morphine dependence and withdrawal. Since activation of pain pathways result in exhaustion of growth factors, we examined the influence of cerebrolysin, a mixture of potent growth factors (BDNF, GDNF, NGF, CNTF etc,) on morphine induced HSP expression. Rats were administered morphine (10 mg/kg, s.c. /day) for 12 days and the spontaneous withdrawal symptoms were developed by cessation of the drug administration on day 13(th) that were prominent on day 14(th) and continued up to day 15(th) (24 to 72 h periods). In a separate group of rats, cerebrolysin was infused intravenously (5 ml/kg) once daily from day one until day 15(th). In these animals, morphine dependence and withdrawal along with HSP immunoreactivity was examined using standard protocol. In untreated group mild HSP immunoreaction was observed during morphine tolerance, whereas massive upregulation of HSP was seen in CNS during withdrawal phase that correlated well with the withdrawal symptoms and neuronal damage. Pretreatment with cerebrolysin did not affect morphine tolerance but reduced the HSP expression during this phase. Furthermore, cerebrolysin reduced the withdrawal symptoms on day 14(th) to 15(th). Taken together these observations suggest that cellular stress plays an important role in morphine induced pain pathology and exogenous supplement of growth factors, i.e. cerebrolysin attenuates HSP expression in the CNS and induce neuroprotection. This indicates a new therapeutic role of cerebrolysin in the pathophysiology of drugs of abuse, not reported earlier.

  10. Sodium Valproate Withdrawal Correlates with Reduced Aggression

    Science.gov (United States)

    Pritchard, Duncan; Hoerger, Marguerite; Dyer, Tim; Graham, Nicola; Penney, Heather; Mace, F. Charles

    2014-01-01

    People with learning disabilities are sometimes prescribed psychotropic medication to help manage their challenging behaviour. This case study describes how a multicomponent behavioural intervention in conjunction with the systematic withdrawal of sodium valproate was strongly correlated with reduced aggression. No symptoms of bipolar disorder or…

  11. Catatonia in mixed alcohol and benzodiazepine withdrawal

    Directory of Open Access Journals (Sweden)

    Aniruddha Basu

    2014-01-01

    Full Text Available Catatonia is mostly caused by different neuropsychiatric conditions. We report a case of a 30 year old man suffering from both alcohol and benzodiazepine dependence who exhibited catatonic features soon after stopping the intake of substances. This case will help clinicians to recognize catatonic features within the varied symptomatology of substance withdrawal and thereby helping in its early diagnosis and management.

  12. Neuroleptic malignant syndrome-like reaction precipitated by antipsychotics in a patient with gamma-butyrolactone withdrawal.

    Science.gov (United States)

    Eiden, Céline; Capdevielle, Delphine; Deddouche, Charlotte; Boulenger, Jean-Philippe; Blayac, Jean-Pierre; Peyrière, Hélène

    2011-12-01

    We report the case of a patient with chronic abuse of gamma-butyrolactone (GBL, 3 bottles per week for 4 months), who in the course of the management of acute agitation and hallucinations developed symptoms compatible with both neuroleptic malignant syndrome and GBL withdrawal symptoms.Some GHB withdrawal symptoms are similar to those of neuroleptic malignant syndrome, and the administration of antipsychotics might worsen the neurological condition of patients. So, it seems important to rapidly detect drugs taken by patients with mental agitation, to optimize management and minimize complications related to drugs.

  13. Study on the Social Withdrawal Behaviors and Related Factors of Ecological Immigrant Children%生态移民儿童社会退缩行为及其相关因素的初步研究

    Institute of Scientific and Technical Information of China (English)

    王媛; 方建群; 陈诗祺

    2016-01-01

    目的:考察宁夏生态移民儿童中退缩行为的发生特点,进一步研究与其相关因素之间的关系。方法:选取宁夏生态移民聚集区2653名6~16岁的生态移民儿童为研究对象,采用量表法和家长评定法评价其退缩行为的发生特点,同时分析家庭环境和班级环境与其退缩行为之间的相互关系。结果:不同年龄的移民儿童的社会退缩行为比较差异有统计学意义(P<0.05);不同性别移民儿童的社会退缩行为比较,男性高于女性,差异有统计学意义(P<0.05);家庭环境中的组织性、娱乐性对社会退缩行为有负向预测作用,班级环境中的竞争对社会退缩行为有正向预测作用。结论:不同年龄和性别的生态移民儿童间退缩行为比较差异明显,且家庭环境和班级环境共同影响退缩行为的发生。%Objective:To investigate the characteristic of the social withdrawal behaviors in ecological immigrant children and further study the relationship between the related factors.Method:Two thousand six hundred and fifty-three ecological immigrant children during 6-16 years old were selected as the objects,the characteristics of their withdrawal behaviors were evaluated by the scaling method and the parents evaluation method,at the same time,the relationship among the family environment,the class environment and their withdrawal behaviors were analyzed.Result:The differences were statistic significant on the social withdrawal behaviors among immigrant children of different ages(P<0.05).The social withdrawal of boys were more than which of girls,the differences were statistically significant between different genders(P<0.05).The sense of organization and entertaining in family environment had negative prediction function to the social withdrawal behaviors,while the competition in the classroom environment had a positive prediction function on the social withdrawal behaviors

  14. Impacts of impervious cover, water withdrawals, and climate change on river flows in the conterminous US

    Directory of Open Access Journals (Sweden)

    P. V. Caldwell

    2012-08-01

    Full Text Available Rivers are essential to aquatic ecosystem and societal sustainability, but are increasingly impacted by water withdrawals, land-use change, and climate change. The relative and cumulative effects of these stressors on continental river flows are relatively unknown. In this study, we used an integrated water balance and flow routing model to evaluate the impacts of impervious cover and water withdrawal on river flow across the conterminous US at the 8-digit Hydrologic Unit Code (HUC watershed scale. We then estimated the impacts of projected change in withdrawals, impervious cover, and climate under the B1 "Low" and A2 "High" emission scenarios on river flows by 2060. Our results suggest that compared to no impervious cover, 2010 levels of impervious cover increased river flows by 9.9% on average with larger impacts in and downstream of major metropolitan areas. In contrast, compared to no water withdrawals, 2005 withdrawals decreased river flows by 1.4% on average with larger impacts in heavily irrigated arid regions of Western US. By 2060, impacts of climate change were predicted to overwhelm the potential gain in river flow due to future changes in impervious cover and add to the potential reduction in river flows from withdrawals, decreasing mean annual river flows from 2010 levels by 16% on average. However, increases in impervious cover by 2060 may offset the impact of climate change during the growing season in some watersheds. Large water withdrawals will aggravate the predicted impact of climate change on river flows, particularly in the Western US. Predicted ecohydrological impacts of land cover, water withdrawal, and climate change will likely include alteration of the terrestrial water balance, stream channel habitat, riparian and aquatic community structure in snow-dominated basins, and fish and mussel extirpations in heavily impacted watersheds. These changes may also require new infrastructure to support increasing anthropogenic

  15. Conducting a Withdrawal Survey.

    Science.gov (United States)

    Aldridge, Sue; Rowley, Jennifer

    2001-01-01

    A survey at Edge Hill College of Higher Education in Canada, designed to be part of the mechanism for monitoring and evaluating the quality of the student experience, revealed that key factors influencing withdrawal were: course not as expected, traveling difficulties, institution not as expected, domestic difficulties, and financial difficulties.…

  16. Hypertension after clonidine withdrawal.

    Science.gov (United States)

    Husserl, F E; deCarvalho, J G; Batson, H M; Frohlich, E D

    1978-05-01

    Rebound hypertension occurred in two patients upon clonidine withdrawal. Treatment of the hypertensive crisis consists of both alpha- and beta-adrenergic receptor blockade, reserpine, or the reintroduction of clonidine. With effective control of pressure during the crisis, long-term antihypertensive therapy must be resumed.

  17. Sex differences in affective response to opioid withdrawal during adolescence

    OpenAIRE

    Hodgson, Stephen R; Hofford, Rebecca S.; Roberts, Kris W.; Eitan, Dvora; Wellman, Paul J.; Eitan, Shoshana

    2009-01-01

    Drug withdrawal is suggested to play a role in precipitating mood disorders in individuals with familial predisposition. Age-related differences in affective responses to withdrawal might explain the increased risk of mental illnesses when drug use begins during adolescence. Recently we observed that, in contrast to adult male mice, adolescent males exhibited a decrease in immobility in the forced swim test on the third day of withdrawal, as compared with controls. Thus, the present study exa...

  18. Management of sport-related maxillofacial injuries.

    Science.gov (United States)

    Roccia, Fabio; Diaspro, Alberto; Nasi, Andrea; Berrone, Sid

    2008-03-01

    By analyzing sports-related maxillofacial fractures, we sought to describe preventive measures and recovery times until sporting activities could be resumed. Between January 2001 and December 2006, 1241 patients were hospitalized as a result of maxillofacial fractures. The patients with sports-related maxillofacial fractures were analyzed based on age, sex, type of sport, injury mechanism, trauma site, presence of associated fractures, hospitalization, treatment method, and recovery time until the resumption of sporting activities. One hundred thirty-eight patients (11.4%) sustained sports-related maxillofacial fractures: 121 males and 17 females (ratio 8:1), aged between 11 and 72 years. The sport producing the greatest number of injuries was soccer (62.3%), followed by skiing (14.5%), and horseback riding (6.5%). The injuries involved mainly the middle third of the face (71.6%), and the mandible was the most affected site (27.2%), followed by the maxillary-zygomatic-orbital complex (25.9%). Treatment was surgery in 93.5% of the patients, with an average hospitalization period of 3.5 days. The protocol created to manage the follow-up of maxillofacial injury patients advised resuming sports activities at least 40 days after the trauma, except in the case of combat sports, when a period of 3 months was required. Although the results of this study indicate a reduction in the total incidence of sports-related maxillofacial injuries, they also show an alarming secondary increase in trauma resulting from the most popular sport in Italy-soccer. Therefore, stricter regulations are needed to discourage violent play, rather than relying on the use of protective equipment. Moreover, patients should be advised when they can resume sports activities, particularly in the case of professionals and semiprofessionals.

  19. Groundwater withdrawal rates from the Ozark Plateaus aquifer system, 1900 to 2010

    Science.gov (United States)

    Knierim, Katherine J.; Nottmeier, Anna M.; Worland, Scott C.; Westerman, Drew A.; Clark, Brian R.

    2016-01-01

    Groundwater is an often overlooked freshwater resource compared to surface water, but groundwater is used widely across the United States, especially during periods of drought. If groundwater models can successfully simulate past conditions, they may be used to evaluate potential future pumping scenarios or climate conditions, thus providing a valuable planning tool for water-resource managers. Quantifying the groundwater-use component for a groundwater model is a vital but often challenging endeavor. This dataset includes groundwater withdrawal rates modeled for the Ozark Plateaus aquifer system (Ozark system) from 1900 to 2010 by groundwater model cell (2.6 square kilometers) for five water-use divisions—agriculture (including irrigation and aquaculture), livestock, public supply (including municipal and rural water districts), and non-agriculture (including thermoelectric power generation, mining, commercial, and industrial)—and by country for domestic (self-supplied) use. Two child items are included with the dataset: “Domestic groundwater withdrawal rates from the Ozark Plateaus aquifer system, 1900 to 2010” and “Public supply, non-agriculture, livestock, and agriculture groundwater withdrawal rates from the Ozark Plateaus aquifer system, 1900 to 2010”. The Ozark system is located in the central United States and is composed of interbedded Cambrian to Pennsylvanian clastic and carbonate lithologies. In stratigraphic order, the Ozark system includes the Basement confining unit, St. Francois aquifer, St. Francois confining unit, Ozark aquifer, Ozark confining unit, Springfield Plateau aquifer, and Western Interior Plains confining system. Generally, the lower portion of the Ozark aquifer is the primary source of groundwater across much of Missouri and the Springfield Plateau aquifer is used across northern Arkansas. A full description of the methods used to model groundwater withdrawal rates from the Ozark system are available in Knierim et al., IN

  20. 2017-2022 Draft Proposed Program - Withdrawal Areas

    Data.gov (United States)

    Bureau of Ocean Energy Management, Department of the Interior — This file represents the areas of the Outer Continental Shelf that have been withdrawn from disposition by leasing. The withdrawal of these areas prevents...

  1. OCS Oil and Gas Leasing Withdraw & Moratoria Areas - Alaska Region

    Data.gov (United States)

    Bureau of Ocean Energy Management, Department of the Interior — Areas currently under congressional moratoria or executive (presidential) withdraw from leasing for oil, gas, or minerals within the US Outer Continental Shelf. The...

  2. OCS Oil and Gas Leasing Withdraw & Moratoria Areas - Pacific Region

    Data.gov (United States)

    Bureau of Ocean Energy Management, Department of the Interior — Areas within the BOEM Pacific Region currently under congressional moratoria or executive (presidential) withdraw from leasing for oil, gas, or minerals within the...

  3. OCS Oil and Gas Leasing Withdraw & Moratoria Areas - Atlantic Region

    Data.gov (United States)

    Bureau of Ocean Energy Management, Department of the Interior — Areas within the BOEM Atllantic Region currently under congressional moratoria or executive (presidential) withdraw from leasing for oil, gas, or minerals within the...

  4. OCS Oil and Gas Leasing Withdrawal and Moratoria Areas

    Data.gov (United States)

    Bureau of Ocean Energy Management, Department of the Interior — Areas currently under congressional moratoria or executive (presidential) withdrawal from leasing for oil, gas, or minerals within the US Outer Continental Shelf....

  5. Adaptive management of watersheds and related resources

    Science.gov (United States)

    Williams, Byron K.

    2009-01-01

    The concept of learning about natural resources through the practice of management has been around for several decades and by now is associated with the term adaptive management. The objectives of this paper are to offer a framework for adaptive management that includes an operational definition, a description of conditions in which it can be usefully applied, and a systematic approach to its application. Adaptive decisionmaking is described as iterative, learning-based management in two phases, each with its own mechanisms for feedback and adaptation. The linkages between traditional experimental science and adaptive management are discussed.

  6. Management of Dysgeusia related to Cancer

    Directory of Open Access Journals (Sweden)

    DURGESHWORI MUNANKARMI

    2017-05-01

    Full Text Available Introduction: Taste change due to cancer is a notorious side effect, adversely affecting appetite and weight. Even though taste change or dysgeusia is one of the major causes of poor nutritional status in cancer survivors, it is not addressed as a significant problem and is often left untreated. The main purpose of this review is to explore current knowledge of pharmacological and behavioral interventions for the treatment of cancer related taste change. Methods: This systematic review was conducted in accordance with PRISMA guidelines to identify original articles on taste change. Multiple databases including; Scopus, Medline, EMBASE, CINAHL, and all databases via Pro quest were searched for original articles or studies related to taste change caused by cancer or its treatment. Relevant articles were subjected to a full text evaluation and assessed by Critical appraisal skills program (CASP guidelines and the Effective public health practice project (EPHPP instrument. Results: The search revealed 12 eligible studies, six of which were randomized controlled trials. Most of the studies used a standardized validated tool to measure taste change. Dysgeusia is common in cancer, 14 to 100% cancer patient report it. Pharmacological management with zinc remains inconclusive as one study reports it as beneficial and two other studies reported null effect. Few studies suggested dietary modifications such as use of sugary, salty foods that are helpful to reduce the effect of dysgeusia. Conclusion: Dietary counseling and informing the patient well about self-care strategies before treatment has consistently shown positive results on taste change, with strong statistical power. Other potential treatments for dysgeusia such as zinc, amifostine, and megestrol acetate gave inconsistent results.

  7. Considerations in change management related to technology.

    Science.gov (United States)

    Luo, John S; Hilty, Donald M; Worley, Linda L; Yager, Joel

    2006-01-01

    The authors describe the complexity of social processes for implementing technological change. Once a new technology is available, information about its availability and benefits must be made available to the community of users, with opportunities to try the innovations and find them worthwhile, despite organizational resistances. The authors reviewed the literature from psychiatry, psychology, sociology, business, and technology to distill common denominators for success and failure related to implementing technology. Beneficial technological innovations that are simple to use and obviously save everyone time and effort are easy to inaugurate. However, innovations that primarily serve management rather than subordinates or front-line utilizers may fail, despite considerable institutional effort. This article reviews and outlines several of the more prominent theoretical models governing successful institutional change. Successful implementation of difficult technological changes requires visionary leadership that has carefully considered the benefits, consulted with influence leaders at all organizational levels to spot unintended consequences and sources of resistance, and developed a detailed plan and continuous quality assurance process to foster implementation over time.

  8. The Antiandrogen Withdrawal Syndrome

    Institute of Scientific and Technical Information of China (English)

    华立新; 吴宏飞; 眭元庚; 程双管; 徐正铨; 张炜; 钱立新

    2002-01-01

    Objective To evaluate the response to antiandrogen withdrawal in patients with advanced prostate cancer treated with combined androgen blockade. Methods Twenty-four cases of advanced prostate cancer (10 in stage C and 14 in stage D) were retrospectively studied. All the patients were treated with combined androgen blockade (bilateral orchiectomy and flutamide ). After initial response to hormone therapy for 7 to 36 months, flutamide was discontinued because of deterioration of the disease. Serum prostate specific antigen ( PSA ) levels were checked every 2 to 4 weeks and symptoms observed. Results The results following withdrawal of flutamide were as follows: 8 patients showed a decline in PSA (mean 7 4. 8 o% ), of whom 6 cases had the PSA decline greater than 5 0 %. Clinical symptoms improved in 4 cases. The nodules of the prostate were smaller than before in cases. The mean duration of response was 4. 3 months. Conclusion In patients with hormone refractory advanced prostate cancer after initial combined androgen blockade therapy, a trial of "antiendrogen withdrawal" is a reasonable choice of therapeutic maneuver.

  9. CONSUMER'S RIGHT TO WITHDRAW

    Directory of Open Access Journals (Sweden)

    ANCA NICOLETA GHEORGHE

    2013-05-01

    Full Text Available The right of withdrawal (of a contract belongs to the consumer, and is an essential means for the improvement of regulations that protect the consumer.. Right of withdrawal is not a recent creation and is not even specific to the consumer field. He was previously recognized in civil and commercial law (without special regulation. The right to withdraw may even have as ground the parties will. Thus, based on the contractual freedom, the parties may agree that one of them has the right to terminate the contract unilaterally The possibility of unilateral denunciation of the contract, gives the consumer, added protection by being able to reflect the decision and to check how the trader fulfil its obligations. In this context, through its effects, the right of denunciation, forces the professional parties to conduct themselves as fair as possible to the consumer and to execute the contract properly. In the study of the consumer protection, the time of conclusion is essential because in this stage is manifested, the inequality between the consumer and professional. Thus, the lack of information, the major of products and activities, commercial practices, influence the formation of consumer will, preventing the expression of a freely and knowingly consent.

  10. 20 CFR 702.225 - Withdrawal of a claim.

    Science.gov (United States)

    2010-04-01

    ... HARBOR WORKERS' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Claims Procedures... request for withdrawal is approved, such withdrawal shall be without prejudice to the filing of another claim, subject to the time limitation provisions of section 13 of the Act and of the regulations in...

  11. Tissue concentrations of sulfamethazine and tetracycline hydrochloride of swine (Sus scrofa domestica) as it relates to withdrawal methods for international export.

    Science.gov (United States)

    Mason, Sharon E; Wu, Huali; Yeatts, Jim E; Baynes, Ronald E

    2015-04-01

    The use of water medications is a common practice in the US swine industry to treat and prevent infections in swine herds with minimal labor and without risk of needle breakage. There are concerns that FDA-approved withdrawal times (WDT) may be inadequate for several water medications when exporting pork products to countries where MRLs (maximum residue limits) are lower than US tolerance levels. In this study, withdrawal intervals (WDI) were estimated for pigs when dosed with tetracycline and sulfamethazine in water. The WDI were calculated using the FDA tolerance method (TLM) and a population-based pharmacokinetic method (PopPK). The estimated WDIs (14-16 days using TLM) were similar to the approved WDT of 15 days for sulfamethazine. However, the PopPK method extended WDIs for both sulfamethazine (19-20 days) and tetracycline (12 days) compared to the currently approved WDTs in the U.S. This study also identified potential differences in WDI between weanling and finisher pigs. In conclusion, the TLM may not always provide adequate WDT for foreign export markets especially when MRLs differ from tolerance levels approved for US markets. However, PopPK methods can provide conservative WDIs in situations with considerable variability in medication exposure such as with administration in water. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Does melissa officinalis cause withdrawal or dependence?

    Science.gov (United States)

    Demirci, Kadir; Akgönül, Mehmet; Demirdaş, Arif; Akpınar, Abdullah

    2015-02-01

    Melissa officinalis is a medical and aromatic plant that is used for its hypnotic, sedative, and spasmolytic effects. This report presents a case study of30-year-old patient who was admitted to an emergency department with restlessness, tremor, distractibility, and sweating following a discontinuation of Melissa officinalis consumption. In this case, withdrawal symptoms may be related to the dependence effect caused by long-term use of Melissa officinalis. Although Melissa officinalis, a plant, is preferred by many patients as an alternative to pharmaceutical drugs, patients should be made aware that it may have a risk of dependency and can lead to withdrawal symptoms.

  13. Time-course of the DSM-5 cannabis withdrawal symptoms in poly-substance abusers

    DEFF Research Database (Denmark)

    Hesse, Morten; Thylstrup, Birgitte

    2013-01-01

    the DSM-5 Withdrawal Symptom Check List with withdrawal symptoms from all classes of substances, with no indication that the described symptoms should be attributed to withdrawal. Self-reported time since last use of cannabis was used as a predictor of cannabis withdrawal severity. Results...... With the exception of loss of appetite, time since last use of cannabis was associated with all types of withdrawal symptoms listed in the DSM-5. Only four of 19 symptoms intended to measure withdrawal from other substances were related to time since last use of cannabis, including vivid, unpleasant dreams...

  14. Effect of Potassium Channel Modulators on Morphine Withdrawal in Mice

    Directory of Open Access Journals (Sweden)

    Vikas Seth

    2010-01-01

    Full Text Available The present study was conducted to investigate the effect of potassium channel openers and blockers on morphine withdrawal syndrome. Mice were rendered dependent on morphine by subcutaneous injection of morphine; four hours later, withdrawal was induced by using an opioid antagonist, naloxone. Mice were observed for 30 minutes for the withdrawal signs ie, the characteristic jumping, hyperactivity, urination and diarrhea. ATP-dependent potassium (K + ATP channel modulators were injected intraperitoneally (i.p. 30 minutes before the naloxone. It was found that a K + ATP channel opener, minoxidil (12.5–50 mg/kg i.p., suppressed the morphine withdrawal significantly. On the other hand, the K + ATP channel blocker glibenclamide (12.5–50 mg/kg i.p. caused a significant facilitation of the withdrawal. Glibenclamide was also found to abolish the minoxidil's inhibitory effect on morphine withdrawal. The study concludes that K + ATP channels play an important role in the genesis of morphine withdrawal and K + ATP channel openers could be useful in the management of opioid withdrawal. As morphine opens K + ATP channels in neurons, the channel openers possibly act by mimicking the effects of morphine on neuronal K + currents.

  15. Data withdrawal in randomized controlled trials: Defining the problem and proposing solutions: a commentary.

    Science.gov (United States)

    Ye, Chenglin; Giangregorio, Lora; Holbrook, Anne; Pullenayegum, Eleanor; Goldsmith, Charlie H; Thabane, Lehana

    2011-05-01

    It is not uncommon for a participant to withdraw from a randomized controlled trial (RCT). The withdrawal of a participant results in missing data and the potential for withdrawal bias. Data withdrawal, or a request from a participant to withdraw all of their previously collected data from a study, is particularly problematic because it leaves little opportunity to characterize or statistically address those that have withdrawn to minimize withdrawal bias. The aim of this commentary is to (1) provide a synthesis of available information on the ethical and methodological issues related to data withdrawal in RCTs and (2) provide some suggestions on how to minimize the impact of data withdrawal during the execution or analysis phases of an RCT. We searched PubMed, EMBASE and JSTOR for published articles on data withdrawal. In addition, we used internet sources as an additional tool to identify content on data withdrawal from research ethics guidelines, legislation, research ethics boards, funding agencies, professional organizations and researchers. We did not find any definitive guidelines for dealing with data withdrawal. We propose recommendations for minimizing the occurrence of data withdrawal, including explicit and clear descriptions in consent forms of how data will be handled after participant withdrawal. We also suggest using imputation techniques to deal with the missing data during analysis. The current commentary can be used to minimize the impact of data withdrawal in RCTs. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. 31 CFR 103.84 - Withdrawing requests.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Withdrawing requests. 103.84 Section 103.84 Money and Finance: Treasury Regulations Relating to Money and Finance FINANCIAL RECORDKEEPING AND REPORTING OF CURRENCY AND FOREIGN TRANSACTIONS Administrative Rulings § 103.84...

  17. Collective management of copyright and related rights

    CERN Document Server

    2010-01-01

    In the course of the last decade, collective management organizations (CMOs) have become the nerve centres of copyright licensing in virtually every country. Their expertise and knowledge of copyright law and management have proven essential to make copyright work in the digital age. This book, an extensively revised and updated edition of the only major work on the legal status of CMOs, offers an indepth analysis of the various operating CMO models, their rights and obligations vis-a-vis both users and members, acquisition of legal authority to license, and (most important) the rights to license digital uses of protected material and build (or improve current) information systems to deal with ever more complex rights management and licensing tasks. All the chapters have been updated since the 2005 edition, and a new chapter on multiterritorial licensing has been added. Factors considered include the following: * role of 'families' such as the International Confederation of Societies of Authors and Composers ...

  18. Modeling IRA Accumulation and Withdrawals

    OpenAIRE

    Sabelhaus, John

    2000-01-01

    Empirical analysis of IRA accumulation and withdrawal patterns is limited because information about IRA balances and flows is not available for a sample of taxpayers. This paper combines survey data on IRA balances with individual tax return data on IRA flows to study IRA accumulation and withdrawal patterns across cohorts. The analysis shows that IRA rules such as penalties for early withdrawals and minimum distribution requirements have predictable effects on IRA flows. The estimated propen...

  19. Relational Information Management Data-Base System

    Science.gov (United States)

    Storaasli, O. O.; Erickson, W. J.; Gray, F. P.; Comfort, D. L.; Wahlstrom, S. O.; Von Limbach, G.

    1985-01-01

    DBMS with several features particularly useful to scientists and engineers. RIM5 interfaced with any application program written in language capable of Calling FORTRAN routines. Applications include data management for Space Shuttle Columbia tiles, aircraft flight tests, high-pressure piping, atmospheric chemistry, census, university registration, CAD/CAM Geometry, and civil-engineering dam construction.

  20. Computer Viruses and Related Threats: A Management Guide.

    Science.gov (United States)

    Wack, John P.; Carnahan, Lisa J.

    This document contains guidance for managing the threats of computer viruses, Trojan horses, network worms, etc. and related software along with unauthorized use. It is geared towards managers of end-user groups, managers dealing with multi-user systems, personal computers, and networks. The guidance is general and addresses the vulnerabilities…

  1. Prolonged cannabis withdrawal in young adults with lifetime psychiatric illness.

    Science.gov (United States)

    Schuster, Randi Melissa; Fontaine, Madeleine; Nip, Emily; Zhang, Haiyue; Hanly, Ailish; Eden Evins, A

    2017-02-27

    Young adults with psychiatric illnesses are more likely to use cannabis and experience problems from use. It is not known whether those with a lifetime psychiatric illness experience a prolonged cannabis withdrawal syndrome with abstinence. Participants were fifty young adults, aged 18-25, recruited from the Boston-area in 2015-2016, who used cannabis at least weekly, completed the Structured Clinical Interview for DSM-IV to identify Axis I psychiatric diagnoses (PD+ vs PD-), and attained cannabis abstinence with a four-week contingency management protocol. Withdrawal symptom severity was assessed at baseline and at four weekly abstinent visits using the Cannabis Withdrawal Scale. Cannabis dependence, age of initiation, and rate of abstinence were similar in PD+ and PD- groups. There was a diagnostic group by abstinent week interaction, suggesting a difference in time course for resolution of withdrawal symptoms by group, F(4,46)=3.8, p=0.009, controlling for sex, baseline depressive and anxiety symptoms, and frequency of cannabis use in the prior 90days. In post hoc analyses, there was a difference in time-course of cannabis withdrawal. PD- had significantly reduced withdrawal symptom severity in abstinent week one [t(46)=-2.2, p=0.03], while PD+ did not report improved withdrawal symptoms until the second abstinent week [t(46)=-4.1, p=0.0002]. Cannabis withdrawal symptoms improved over four weeks in young people with and without a lifetime psychiatric diagnosis. However, those with a psychiatric illness reported one week delayed improvement in withdrawal symptom severity. Longer duration of cannabis withdrawal may be a risk factor for cannabis dependence and difficulty quitting. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Method for Estimating Water Withdrawals for Livestock in the United States, 2005

    Science.gov (United States)

    Lovelace, John K.

    2009-01-01

    Livestock water use includes ground water and surface water associated with livestock watering, feedlots, dairy operations, and other on-farm needs. The water may be used for drinking, cooling, sanitation, waste disposal, and other needs related to the animals. Estimates of water withdrawals for livestock are needed for water planning and management. This report documents a method used to estimate withdrawals of fresh ground water and surface water for livestock in 2005 for each county and county equivalent in the United States, Puerto Rico, and the U.S. Virgin Islands. Categories of livestock included dairy cattle, beef and other cattle, hogs and pigs, laying hens, broilers and other chickens, turkeys, sheep and lambs, all goats, and horses (including ponies, mules, burros, and donkeys). Use of the method described in this report could result in more consistent water-withdrawal estimates for livestock that can be used by water managers and planners to determine water needs and trends across the United States. Water withdrawals for livestock in 2005 were estimated by using water-use coefficients, in gallons per head per day for each animal type, and livestock-population data. Coefficients for various livestock for most States were obtained from U.S. Geological Survey water-use program personnel or U.S. Geological Survey water-use publications. When no coefficient was available for an animal type in a State, the median value of reported coefficients for that animal was used. Livestock-population data were provided by the National Agricultural Statistics Service. County estimates were further divided into ground-water and surface-water withdrawals for each county and county equivalent. County totals from 2005 were compared to county totals from 1995 and 2000. Large deviations from 1995 or 2000 livestock withdrawal estimates were investigated and generally were due to comparison with reported withdrawals, differences in estimation techniques, differences in livestock

  3. Management of gallstones and its related complications.

    Science.gov (United States)

    Portincasa, P; Di Ciaula, A; de Bari, O; Garruti, G; Palmieri, V O; Wang, D Q-H

    2016-01-01

    The majority of gallstone patients remain asymptomatic; however, interest toward the gallstone disease is continuing because of the high worldwide prevalence and management costs and the development of gallstone symptoms and complications. For cholesterol gallstone disease, moreover, a strong link exists between this disease and highly prevalent metabolic disorders such as obesity, dyslipidemia, type 2 diabetes, hyperinsulinemia, hypertriglyceridemia and the metabolic syndrome. Information on the natural history as well as the diagnostic, surgical (mainly laparoscopic cholecystectomy) and medical tools available to facilitate adequate management of cholelithiasis and its complications are, therefore, crucial to prevent the negative outcomes of gallstone disease. Moreover, some risk factors for gallstone disease are modifiable and some preventive strategies have become necessary to reduce the onset and the severity of complications.

  4. Managing IT-related operational risks

    Directory of Open Access Journals (Sweden)

    Savić Ana

    2008-01-01

    Full Text Available Not so long ago, information technology (IT risk occupied a small corner of operational risk - the opportunity loss from a missed IT development deadline. Today, the success of an entire financial institution may lay on managing a broad landscape of IT risks. IT risk is a potential damage to an organization's value, resulting from inadequate managing of processes and technologies. IT risk includes the failure to respond to security and privacy requirements, as well as many other issues such as: human error, internal fraud through software manipulation, external fraud by intruders, obsolesce in applications and machines, reliability issues or mismanagement. The World Economic Forum provides best information about this problem. They rank a breakdown of critical information infrastructure among the most likely core global risks, with 10-20 % likelihood over the next 10 years and potential worldwide impact of $250 billion. Sustained investment in IT - almost $1.2 trillion or 29% of 2006 private-sector capital investment in the U.S. alone fuels growing exposure to IT risk. Greg Hughes, chief strategy officer in Symantec Corp. recently claimed "IT risk management is more than using technology to solve security problems. With proper planning and broad support, it can give an organization the confidence to innovate, using IT to outdistance competitors".

  5. School Management Related Knowledge Levels of Primary School Teachers

    Science.gov (United States)

    Ugurlu, Celal Teyyar

    2013-01-01

    The knowledge levels of the teachers affect the qualifications of operations and transactions in schools. School management related knowledge of the teachers is an essential tool to reach the targets of the school. The objective of this study was to determine the school management related knowledge levels of the teachers. Qualitative and…

  6. Mitragynine attenuates withdrawal syndrome in morphine-withdrawn zebrafish.

    Directory of Open Access Journals (Sweden)

    Beng-Siang Khor

    Full Text Available A major obstacle in treating drug addiction is the severity of opiate withdrawal syndrome, which can lead to unwanted relapse. Mitragynine is the major alkaloid compound found in leaves of Mitragyna speciosa, a plant widely used by opiate addicts to mitigate the harshness of drug withdrawal. A series of experiments was conducted to investigate the effect of mitragynine on anxiety behavior, cortisol level and expression of stress pathway related genes in zebrafish undergoing morphine withdrawal phase. Adult zebrafish were subjected to two weeks chronic morphine exposure at 1.5 mg/L, followed by withdrawal for 24 hours prior to tests. Using the novel tank diving tests, we first showed that morphine-withdrawn zebrafish display anxiety-related swimming behaviors such as decreased exploratory behavior and increased erratic movement. Morphine withdrawal also elevated whole-body cortisol levels, which confirms the phenotypic stress-like behaviors. Exposing morphine-withdrawn fish to mitragynine however attenuates majority of the stress-related swimming behaviors and concomitantly lower whole-body cortisol level. Using real-time PCR gene expression analysis, we also showed that mitragynine reduces the mRNA expression of corticotropin releasing factor receptors and prodynorphin in zebrafish brain during morphine withdrawal phase, revealing for the first time a possible link between mitragynine's ability to attenuate anxiety during opiate withdrawal with the stress-related corticotropin pathway.

  7. Healthcare managers' construction of the manager role in relation to the medical profession.

    Science.gov (United States)

    von Knorring, Mia; Alexanderson, Kristina; Eliasson, Miriam A

    2016-05-16

    Purpose - The purpose of this paper is to explore how healthcare managers construct the manager role in relation to the medical profession in their organisations. Design/methodology/approach - In total, 18 of Sweden's 20 healthcare chief executive officers (CEOs) and 20 clinical department managers (CDMs) were interviewed about their views on management of physicians. Interviews were performed in the context of one aspect of healthcare management; i.e., management of physicians' sickness certification practice. A discourse analysis approach was used for data analysis. Findings - Few managers used a management-based discourse to construct the manager role. Instead, a profession-based discourse dominated and managers frequently used the attributes "physician" or "non-physician" to categorise themselves or other managers in their managerial roles. Some managers, both CEOs and CDMs, shifted between the management- and profession-based discourses, resulting in a kind of "yes, but […]" approach to management in the organisations. The dominating profession-based discourse served to reproduce the power and status of physicians within the organisation, thereby rendering the manager role weaker than the medical profession for both physician and non-physician managers. Research limitations/implications - Further studies are needed to explore the impact of gender, managerial level, and basic profession on how managers construct the manager role in relation to physicians. Practical implications - The results suggest that there is a need to address the organisational conditions for managers' role taking in healthcare organisations. Originality/value - Despite the general strengthening of the manager position in healthcare through political reforms during the last decades, this study shows that a profession-based discourse clearly dominated in how the managers constructed the manager role in relation to the medical profession on the workplace level in their organisations.

  8. Afghanistan after NATO Withdrawal

    Directory of Open Access Journals (Sweden)

    Bojor Laviniu

    2015-06-01

    Full Text Available The conclusion of a conflict, called by some American analysts as “America’s Longest War”, after the withdrawal of the majority of NATO military forces, requires a careful analysis of the conditions and security environment that ISAF mission, International Security Afghan Forces, leaves as legacy to the Afghan military forces. The transfer of authority towards a strong government, recognized by most Afghan provinces, and benefiting from the support of national military forces able to cope with terrorist and insurgent threats on its own, are the minimum and necessary conditions leading the country towards a stable and secure environment and towards a sustainable development. Given these realities, any approach on the consequences of the transition towards self-sustainable governance becomes interesting and timely for any military political study. These are the prospects that we propose in our paper.

  9. Recalls, Market Withdrawals and Safety Alerts

    Science.gov (United States)

    ... Home Safety Recalls, Market Withdrawals, & Safety Alerts Recalls, Market Withdrawals, & Safety Alerts Share Tweet Linkedin Pin it ... Safety Alerts Archive. Sign up to receive Recalls, Market Withdrawals and Safety Alerts . Filter by Keyword(s): Filter ...

  10. Analysis of Evolution of Water Withdrawal Governance and Its Relation with Water Rights Institution%格尔木市取水管理制度发展演变及其与水权制度关系分析

    Institute of Scientific and Technical Information of China (English)

    李建平; 贾绍凤; 吕爱锋; 刘志明

    2012-01-01

    There was no water withdrawal governance at the beginning when Golmud City was firstly constructed as Aerdunquke Kazakh Autonomous District in 1954. Before 1977, the main task of wa- ter management was to construct water supply and hydropower engineering projects for supplying water and electricity for the city. From 1978 - 1990, there was still no water permission regulation under the administration of city construction department of the government. In 1990, Golmud city took the lead to enforced water withdrawal permission regulation in Qinghai province. Now almost all water us- ers, except military units and small irrigation districts, applied and got water withdrawal permission. Although the initial water right distribution approved by the city Government in 2010 inherited water permission licensed before, and clear water use right can give support to future water permission trea- ting, there are radical difference between water permission and water right. Water permission is a kind of administration tool of the government, while water right is a kind of asset of users. Water permission regulation should be substituted by water right institution for the long term.%取水许可是目前中国水资源管理的主要落实手段。取水许可制度的实际运行情况是未来水权制度建设的基础。以格尔木市为典型,分析了取水管理的发展演变历程:工程管理阶段、城市部门主管阶段、水利部门主管阶段和取水许可初步完善阶段。目前面临的主要问题是已有的取水许可制度与正在建设的水权制度的冲突:取水许可属于行政管理行为,而水权属于产权。取水许可可以根据政府政策进行调整,而水权必须作为财产,根据民法来切实保护,不能由政府随意变动或剥夺。水权初始分配可以继承过去的取水许可作为初始水权,但取水许可制度代替不了水权制度,而必须为水权制度让路。

  11. 77 FR 60458 - Public Land Order No. 7803; Withdrawal of Public Lands for the Limestone Hills Training Area; MT

    Science.gov (United States)

    2012-10-03

    ... Bureau of Land Management Public Land Order No. 7803; Withdrawal of Public Lands for the Limestone Hills... laws, for a period of 5 years. This withdrawal will protect the Limestone Hills Training Area in... hours. SUPPLEMENTARY INFORMATION: The Limestone Hills Training Area withdrawal will maintain the...

  12. Management-Employee Relations, Firm Size and Job Satisfaction

    OpenAIRE

    Tansel, Aysit; Gazioglu, Saziye

    2012-01-01

    This paper investigates the job satisfaction in relation to managerial attitudes towards employees and firm size using the linked employer-employee survey results in Britain.We first investigate the management-employee relationships and the firm size using maximum likelihood probit estimation . Next various measues of job satisfaction are related to the management-employee relations via maximum likelihood ordered probit estimates. Four measures of job satisfaction that have not been used oft...

  13. Sodium valproate in the treatment of the alcohol withdrawal syndrome.

    Science.gov (United States)

    Lambie, D G; Johnson, R H; Vijayasenan, M E; Whiteside, E A

    1980-09-01

    The value of sodium valproate in the management of patients during withdrawal from alcohol dependence has been assessed. Alcoholic inpatients were randomly allocated to two groups - one treated with sodium valproate and the other acting as a control. All patients received multivitamins and fluid and electrolyte replacement, and some received chlormethiazole or other tranquillisers. Treatment with sodium valproate (1200 mg daily) was continued for one week. The occurrence of seizures and other withdrawal symptoms (tremulousness, nausea, sweating, disorientation) were noted daily. Forty-nine episodes of withdrawal have been included in the trial - 22 in the sodium valproate group and 27 in the control group. Five patients, all in the control group, had seizures. Other withdrawal symptoms disappeared more quickly in the sodium valproate group even though fewer patients were receiving chlormethiazole.

  14. Alcohol consumption increases locomotion in an open field and induces Fos-immunoreactivity in reward and approach/withdrawal-related neurocircuitries.

    Science.gov (United States)

    Wscieklica, Tatiana; de Barros Viana, Milena; Le Sueur Maluf, Luciana; Pouza, Kathlein Cristiny Peres; Spadari, Regina Célia; Céspedes, Isabel Cristina

    2016-02-01

    Drug addiction is a chronically relapsing disorder characterized by compulsion to seek and take the drug, loss of control in limiting intake and, eventually, the emergence of a negative emotional state when access to the drug is prevented. Both dopamine and corticotropin-releasing factor (CRF)-mediated systems seem to play important roles in the modulation of alcohol abuse and dependence. The present study investigated the effects of alcohol consumption on anxiety and locomotor parameters and on the activation of dopamine and CRF-innervated brain regions. Male Wistar rats were given a choice of two bottles for 31 days, one containing water and the other a solution of saccharin + alcohol. Control animals only received water and a solution of 0.2% saccharin. On the 31st day, animals were tested in the elevated plus-maze and open field, and euthanized immediately after the behavioral tests. An independent group of animals was treated with ethanol and used to measure blood ethanol concentration. Results showed that alcohol intake did not alter behavioral measurements in the plus-maze, but increased the number of crossings in the open field, an index of locomotor activity. Additionally, alcohol intake increased Fos-immunoreactivity (Fos-ir) in the prefrontal cortex, in the shell region of the nucleus accumbens, in the medial and central amygdala, in the bed nucleus of the stria terminalis, in the septal region, and in the paraventricular and dorsomedial hypothalamus, structures that have been linked to reward and to approach/withdrawal behavior. These observations might be relevant to a better understanding of the behavioral and physiological alterations that follow alcohol consumption.

  15. Managing work-related stress in the district nursing workplace.

    Science.gov (United States)

    Burke, Michelle

    2013-11-01

    This article aims to highlight the issue of work-related stress within the district nursing workplace. It will acknowledge how the management of work-related stress has previously been discussed within nursing literature and will consider the emerging relationship between staff working conditions, staff wellbeing and quality of patient care. It will reintroduce the Health and Safety Executive's (HSE's) Management Standards approach to tackling work-related stress, which provides management support to reduce environmental work stressors and encourage enabling work environments and a positive workplace culture.

  16. Time-course of the DSM-5 cannabis withdrawal symptoms in poly-substance abusers

    Science.gov (United States)

    2013-01-01

    Background Evidence is accumulating that a cannabis withdrawal syndrome is common, of clinical significance, and has a clear time course. Up till now, very limited data exist on the cannabis withdrawal symptoms in patients with co-morbid substance use disorders, other than cannabis use and tobacco use. Methods Symptoms of withdrawal were assessed through patient self-reports during detoxification in Danish residential rehabilitation centers. Patients (n = 90) completed booklets three times during their first month at the treatment centre. Self-reported withdrawal symptoms was rated using the DSM-5 Withdrawal Symptom Check List with withdrawal symptoms from all classes of substances, with no indication that the described symptoms should be attributed to withdrawal. Self-reported time since last use of cannabis was used as a predictor of cannabis withdrawal severity. Results With the exception of loss of appetite, time since last use of cannabis was associated with all types of withdrawal symptoms listed in the DSM-5. Only four of 19 symptoms intended to measure withdrawal from other substances were related to time since last use of cannabis, including vivid, unpleasant dreams. Conclusions The findings yield strong support to the notion of a cannabis withdrawal syndrome, and gives further evidence for the inclusion of the criterion of vivid, unpleasant dreams. Further, the findings speak against the significance of demand characteristics in determining the course of the symptoms of cannabis withdrawal. PMID:24118963

  17. 77 FR 56842 - Labor-Management Relations Information Collection Requests

    Science.gov (United States)

    2012-09-14

    ... CONCILIATION SERVICE Labor-Management Relations Information Collection Requests AGENCY: Federal Mediation and... and Conciliation Service (FMCS) hereby announces the submission of the following public information collection request (ICR) to the Office of Management and Budget (OMB) for review and approval in...

  18. Crisis Communication and Management: Surviving a Public Relations Crisis

    Science.gov (United States)

    Eramo, Eric M.

    2009-01-01

    Crisis management, or crisis communication, is never a good thing for a business to experience. It is, however, a public relations' professional moment to shine and put their honed skills to good use. A good crisis management plan is not only action during the crisis but preparation and reflection. Hiring a PR firm that deals with crisis…

  19. Management of Travel-Related Illness Acquired in Haiti.

    Science.gov (United States)

    Walters, Michele

    2015-12-01

    Management of travel-related diseases acquired in Haiti begins with the identification of tropical diseases that are prevalent in the region. Knowledge of various tropical disease incubation periods and presenting symptoms is crucial to ensure rapid triage and management of care.

  20. Oil sands water withdrawal challenges and the Athabasca River

    Energy Technology Data Exchange (ETDEWEB)

    Smith, J.; Baker, M. [Shell Canada Ltd., Calgary, AB (Canada). Calgary Research Centre

    2003-07-01

    Drought conditions in Alberta have raised concerns regarding water withdrawal from the Athabasca River for oil sands development projects in the Regional Municipality of Wood Buffalo in Northeastern Alberta. In particular, concerns have been raised about the potential increased rates of water withdrawal during seasonal low flow periods. A committee has been established under the Cumulative Environmental Management Association (CEMA) to develop a management system for the Athabasca River. The committee includes stakeholders from federal and provincial governments, First Nations, non-government groups and industry. This paper describes the challenges facing oil sands developers in the region with particular emphasis on the role that the newly developed management system called 'Instream Flow Needs', will have on the cumulative water withdrawal from the Athabasca River. tabs., figs.

  1. Public Relations Manager Involvement in Strategic Issue Diagnosis.

    Science.gov (United States)

    Lauzen, Martha M.

    1995-01-01

    Reports on an exploratory study that seeks to build theoretical understanding of how public relations practitioner involvement in one type of strategic organizational decision making--strategic issue diagnosis--is related to shared values with top management, diagnosis accuracy, strategy pursued, and the power of the public relations function. (TB)

  2. Notice of Withdrawal.

    Science.gov (United States)

    2015-03-27

    Notice of Withdrawal: 'Odanacatib restores trabecular bone of skeletally mature female rabbits with osteopenia but induces brittleness of cortical bone: a comparative study of the investigational drug with PTH, Estrogen and Alendronate' by Mohd. Parvez Khan, Atul Kumar Singh, Abhishek Kumar Singh, Pragya Shrivastava, Mahesh Chandra Tiwari, Geet Kumar Nagar, Himangshu Kousik Bora, Venkitanarayanan Parameswaran, Sabyasachi Sanyal, Jayesh R. Bellare and Naibedya Chattopadhyay The above article from the Journal of Bone and Mineral Research, published online on 27 March 2015 in Wiley Online Library (wileyonlinelibrary.com), has been withdrawn by agreement between the journal's editor-in-chief, Juliet E. Compston, the American Society for Bone and Mineral Research, and Wiley Periodicals, Inc. This action has been agreed due to an error at the publishers which caused a duplicate of the article to be published on 22 September 2015. The correct version of the article is to be found at: 'Odanacatib restores trabecular bone of skeletally mature female rabbits with osteopenia but induces brittleness of cortical bone: a comparative study of the investigational drug with PTH, Estrogen and Alendronate' by Mohd. Parvez Khan, Atul Kumar Singh, Abhishek Kumar Singh, Pragya Shrivastava, Mahesh Chandra Tiwari, Geet Kumar Nagar, Himangshu Kousik Bora, Venkitanarayanan Parameswaran, Sabyasachi Sanyal, Jayesh R. Bellare and Naibedya Chattopadhyay (doi: 10.1002/jbmr.2719).

  3. 76 FR 28034 - Labor-Management Relations Information Collection Requests

    Science.gov (United States)

    2011-05-13

    ... CONCILIATION SERVICE Labor-Management Relations Information Collection Requests AGENCY: Federal Mediation and... information collection requests. The information collection requests are FMCS forms: Arbitrator's Report and... Request for Arbitration Services (Agency Form R-43). These information collection requests were...

  4. Community-related factors militating against effective management ...

    African Journals Online (AJOL)

    Community-related factors militating against effective management of ... high rates of out-of-hospital delivery,many affected babies often reach the health facility ... such as female education, mass media campaigns, development of national ...

  5. Intramammary antibiotics in dairy goats : withdrawal periods of three intramammary antibiotics compared to recommended withdrawal periods for cows

    Directory of Open Access Journals (Sweden)

    J. Karzis

    2007-09-01

    Full Text Available Intramammary antibiotics are registered and tested for use in dairy cattle. This study investigated withdrawal periods of three intramammary antibiotics (Curaclox LC [Norbrook Pharmacia AH], Spectrazol Milking Cow (Schering-Plough Animal Health and Rilexine 200 LC (Logos Agvet [Virbac] in dairy goats and compared them to withdrawal periods recommended for use in cattle. Three trials were carried out in two different herds. The withdrawal periods for Curaclox LC in eight relatively low producing Saanen goats were 74.3 h (+ 19.21 measured by Thermo-Resistant Inhibitory Substances (TRIS, 90.0 h (+ 16.97 measured by colour dye, 99.4 h (+ 9.07 for cloxacillin measured by Parallux Beta Lactam Assay test (IDEXX distributors, and 92.6 h (+ 11.41 for ampicillin measured by Parallux. The withdrawal period for Curaclox LC recommended for use in cattle (72 h was significantly shorter than the withdrawal periods as measured by colour dye (P < 0.001, Parallux testing for cloxacillin (P < 0.001 and ampicillin (P = 0.003. There was a significant difference in withdrawal periods as measured by TRIS (P = 0.009 and colour dye (P = 0.036. The mean withdrawal periods measured on 12 relatively high producing Saanen and Saanen-Toggenburg crossbreed dairy goats measured by TRIS, colour dye and Parallux for ampicillin and cloxacillin were, however, shorter at 42.0 h (+ 7.077, 64.5 h (+ 60.26, 77.3 h (+ 13.56 and 70.7 h (+ 12.65, respectively. These withdrawal periods for Curaclox LC were significantly longer than the withdrawal periods recommended for cattle as measured by TRIS (P < 0.001 and colour dye (P < 0.001. The combined withdrawal periods for Curaclox LC in the two trials as measured by TRIS, colour dye, Parallux testing for Cloxacillin and Ampicillin were 58.64h (+ 24.31, 75.8 h (+ 17.70, 87.0 h (+ 16.10 and 80.3 h (+ 16.23, respectively. The withdrawal period, when data of the two trials were combined, measured by TRIS (P < 0.001 was significantly longer than

  6. A Content Analysis on Management and Terms related with Management in the Quran

    Directory of Open Access Journals (Sweden)

    Kürşat ÖZDAŞLI

    2014-05-01

    Full Text Available Guidelines and principles feeding the system of belief have the power of diverting behaviors of an individual included in that system as well as being able to affect the management style of managers. Therefore, use of the term of management by basic sources of Islamic belief and which other sources it refers to along with the term of management will be helpful in understanding the holistic message given in terms of management in Islamic style, and approaching from a different aspect to the management literature. This study aims to reveal characteristics of management and related terms in basic Islamic sources, and with which words and in what aspects they are associated and used, and to see the perception of the religion of Islam on management. The content analysis conducted in this context included examination of the verses containing the terms of management, administration, leader, directing and steering

  7. Sex differences in affective response to opioid withdrawal during adolescence.

    Science.gov (United States)

    Hodgson, Stephen R; Hofford, Rebecca S; Roberts, Kris W; Eitan, Dvora; Wellman, Paul J; Eitan, Shoshana

    2010-09-01

    Drug withdrawal is suggested to play a role in precipitating mood disorders in individuals with familial predisposition. Age-related differences in affective responses to withdrawal might explain the increased risk of mental illnesses when drug use begins during adolescence. Recently we observed that, in contrast to adult male mice, adolescent males exhibited a decrease in immobility in the forced swim test on the third day of withdrawal, as compared with controls. Thus, the present study examined forced swim test behaviors of adolescent female mice during opioid withdrawal. Similar to the male study, adolescent female mice were injected with two morphine regimens which differed in dosage. Three and nine days following discontinuation of morphine administration, forced swim test immobility time and locomotion were evaluated. In contrast to males, which exhibited a decrease in immobility, no significant differences in immobility were observed in female adolescents undergoing withdrawal as compared with saline-injected controls. This sex difference in forced swim test behaviors was not due to changes in overall motor activity, since differences in locomotion were not observed in either male or female adolescent mice. Thus, this study demonstrates sex differences in forced swim test behavior during opioid withdrawal. Forced swim test behaviors are classically used to evaluate mood in rodents, thus this study suggests that opioid withdrawal might affect mood differentially across sexes.

  8. PUBLIC RELATIONS PROFESSIONALS’ PERCEPTION OF CONFLICT MANAGEMENT AS A MANAGEMENT FUNCTION

    Directory of Open Access Journals (Sweden)

    Tugce Ertem Eray

    2016-12-01

    Full Text Available Conflicts are a part of daily life that people encounter at home, work, and in organizations. It is evident that organizational conflicts are becoming more complex. In this respect, it is important for senior executives not to disregard these conflicts and involve public relations professionals in the conflict management processes. Hence, it is expected that public relations professionals become participants in the strategic planning process and that senior management relies on their experience and talents during the strategic planning process of organizations and resolution of issues. Another definition of public relations has emerged over the past years, even though the recent definitions of public relations focus on developing mutually beneficial relationships between organizations and their publics. Glen T. Cameron from University of Missouri defines public relations as management of conflict and competition strategically for the benefit of one’s own organization and, if possible, mutual benefit of organizations and individuals. It is impossible to disregard the influence of public relations professionals on managing the conflicts between an organization and its peers, and hence it is important to conduct further research on their approach to conflict management. With this motive, research questions have been generated based on the data presented by Professor Kenneth Plowman as a result of his analysis of strategic management of public relations in conflict management. Using the semi-structured interview technique, public relations professionals in Turkey were asked to describe their approach to conflict management.

  9. [Ambulant treatment of alcohol withdrawal].

    Science.gov (United States)

    Nüstedt, Volker

    2016-07-01

    Most of the patients addicted to alcohol are socially well integrated. The offer of a low threshold ambulant withdrawal therapy opens an opportunity to build a sustainable therapeutic relationship. The so started empathic addiction therapy will be well accepted and will lead to a satisfying outcome. Using Clomethiazole or Oxazepam in a daily reduced dose and with daily personal contacts, the ambulant withdrawal in patients without seizures or delir in medical history is a secure and successful therapeutic option.

  10. Management of work-related stress by Finnish occupational physicians.

    Science.gov (United States)

    Kinnunen-Amoroso, M; Liira, J

    2013-07-01

    Occupational stress is a serious threat to the well-being of employees and organizations and may cause ill-health and loss of productivity. Determining the methods that occupational health (OH) services and employers use to manage work-related stress can help to detect both barriers and facilitating factors for effective stress management. To examine stress management methods used by OH physicians in Finland. Anonymous, self-administered e-mail questionnaire to Finnish OH physicians. A total of 222 OH physicians responded. Neither OH services nor their client organizations used standardized tools to assess or manage work-related stress. Work-related stress was assessed using patient interviews. Physicians reported that the main method used to manage occupational stress was supporting the individual employee. Half of the physicians attempted to involve workplaces in stress management by asking their patients to contact their supervisors regarding stress issues. In order to tackle work-related stress consistently and effectively employers and OH services should have agreed standardized protocols for managing stress in the workplace.

  11. Cost-effectiveness analysis of baclofen and chlordiazepoxide in uncomplicated alcohol-withdrawal syndrome

    Directory of Open Access Journals (Sweden)

    Vikram K Reddy

    2014-01-01

    Full Text Available Objectives: Benzodiazepines (BZDs are the first-line drugs in alcohol-withdrawal syndrome (AWS. Baclofen, a gamma-aminobutyric acid B (GABA B agonist, controls withdrawal symptoms without causing significant adverse effects. The objective of this study was to compare the cost-effectiveness of baclofen and chlordiazepoxide in the management of uncomplicated AWS. Materials and Methods : This was a randomized, open label, standard controlled, parallel group study of cost-effectiveness analysis (CEA of baclofen and chlordiazepoxide in 60 participants with uncomplicated AWS. Clinical efficacy was measured by the Clinical Institute Withdrawal Assessment for alcohol (CIWA-Ar scores. Lorazepam was used as supplement medication if withdrawal symptoms could not be controlled effectively by the study drugs alone. Both direct and indirect medical costs were considered and the CEA was analyzed in both patient′s perspective and third-party perspective. Results : The average cost-effectiveness ratio (ACER in patient′s perspective of baclofen and chlordiazepoxide was Rs. 5,308.61 and Rs. 2,951.95 per symptom-free day, respectively. The ACER in third-party perspective of baclofen and chlordiazepoxide was Rs. 895.01 and Rs. 476.29 per symptom-free day, respectively. Participants on chlordiazepoxide had more number of symptom-free days when compared with the baclofen group on analysis by Mann-Whitney test (U = 253.50, P = 0.03. Conclusion : Both study drugs provided relief of withdrawal symptoms. Chlordiazepoxide was more cost-effective than baclofen. Baclofen was relatively less effective and more expensive than chlordiazepoxide.

  12. Acute toxicity and withdrawal syndromes related to γ-hydroxybutyrate (GHB) and its analogues γ-butyrolactone (GBL) and 1,4-butanediol (1,4-BD).

    Science.gov (United States)

    Wood, David M; Brailsford, Alan D; Dargan, Paul I

    2011-01-01

    Gamma-hydroxybutyrate (GHB) has been used as a recreational drug since the 1990s and over the last few years there has been increasing use of its analogues gamma-butyrolactone (GBL) and to a lesser extent 1,4-butanediol (1,4BD). This review will summarize the literature on the pharmacology of these compounds; the patterns and management of acute toxicity associated with their use; and the clinical patterns of presentation and management of chronic dependency associated with GHB and its analogues.

  13. Selecting a Relational Database Management System for Library Automation Systems.

    Science.gov (United States)

    Shekhel, Alex; O'Brien, Mike

    1989-01-01

    Describes the evaluation of four relational database management systems (RDBMSs) (Informix Turbo, Oracle 6.0 TPS, Unify 2000 and Relational Technology's Ingres 5.0) to determine which is best suited for library automation. The evaluation criteria used to develop a benchmark specifically designed to test RDBMSs for libraries are discussed. (CLB)

  14. The Network Configuration of an Object Relational Database Management System

    Science.gov (United States)

    Diaz, Philip; Harris, W. C.

    2000-01-01

    The networking and implementation of the Oracle Database Management System (ODBMS) requires developers to have knowledge of the UNIX operating system as well as all the features of the Oracle Server. The server is an object relational database management system (DBMS). By using distributed processing, processes are split up between the database server and client application programs. The DBMS handles all the responsibilities of the server. The workstations running the database application concentrate on the interpretation and display of data.

  15. 儿童社交退缩、同伴关系和社会信息加工特点的关系%The Relation Among Social Withdrawal, Peer Relationship and Social-information-processing in Middle Childhood

    Institute of Scientific and Technical Information of China (English)

    刘爱书; 于增艳; 杨飞龙; 裴亮

    2011-01-01

    As the psychological and social risks associated with social withdrawal have become clear, social withdrawal has become a very important issue in developmental psychology and cross-cultural psychology since 1980s. It has been found that socially withdrawn school-age children were reported to have more negative self-perceptions, greater feelings of social anxiety and loneliness, higher rates of depression, and are more likely to be rejected by peers than their non-withdrawn classmates. Several factors have been protxxsed that may underlie the development and display of social withdrawal in childhood, including biological and physiological factors, as well as parental beliefs and practices. Another process that might underlie the development of social withdrawal is children' s social information processing abilities. However, there has been surprisingly little research exploring the social information processing of socially withdrawn children. Although certain characteristics of SIP may place withdrawn children at risk for maladjustment, it is also important to assess those factors that can protect children from maladaptive social interpretations and coping strategies. One such protective factor for socially withdrawn children may be friendship. As such, the pmlxx~ of this study was to explore the peer relationships and social information processing of the different types of social withdrawal in middle childhood, and to find the relations between peer relationships and social information processing of withdrawn children. The Class Play Scale was used to screen 121 socially withdrawn children from 929 third- to fifth-graders and a control group was established. The Peer Nomination, Friend Nomination and Friendship Quality Questionnaire were administered to all the children and a structural interview of social information processing was admimistered to a part of them. The results indicated as follows: 1. The peer relationships of the passive withdrawn children

  16. 30 CFR 229.106 - Withdrawal of Indian lands from delegated authority.

    Science.gov (United States)

    2010-07-01

    ....106 Withdrawal of Indian lands from delegated authority. If at any time an Indian tribe or an... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Withdrawal of Indian lands from delegated authority. 229.106 Section 229.106 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR...

  17. 5 CFR 4.3 - Prohibition against securing withdrawal from competition.

    Science.gov (United States)

    2010-01-01

    ... from competition. 4.3 Section 4.3 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE RULES PROHIBITED PRACTICES (RULE IV) § 4.3 Prohibition against securing withdrawal from competition. No person shall influence another person to withdraw from competition for any position in the...

  18. The mechanism of pollination drop withdrawal in Ginkgo biloba L.

    Directory of Open Access Journals (Sweden)

    Jin Biao

    2012-05-01

    Full Text Available Abstract Background The pollination drop (PD is a characteristic feature of many wind-pollinated gymnosperms. Although accumulating evidence shows that the PD plays a critical role in the pollination process, the mechanism of PD withdrawal is still unclear. Here, we carefully observed the PD withdrawal process and investigated the underlying mechanism of PD withdrawal, which will aid the understanding of wind-pollination efficiency in gymnosperms. Results In Ginkgo biloba, PDs were secreted on the micropyle during the pollination period and persisted for about 240 h when not pollinated under laboratory conditions. The withdrawal of an isolated PD required only 1 h for evaporation, much less than a PD on the living ovule, which required 100 h. When pollinated with viable pollen, PDs withdrew rapidly within 4 h. In contrast, nonviable pollen and acetone-treated pollen did not cause PD withdrawal. Although 100% relative humidity significantly inhibited PD withdrawal, pollinated PDs still could withdraw completely within 48 h. Pollen grains of Cycas revoluta, which are similar to those of G. biloba, could induce PD withdrawal more rapidly than those of two distantly related gymnosperms (Pinus thunbergii and Abies firma or two angiosperms (Paeonia suffruticosa and Orychophragmus violaceus. Furthermore, pollen of G. biloba and C. revoluta submerged immediately when encountering the PD, then sank to the bottom and entered the micropyle. The saccate pollen of P. thunbergii and A. firma submerged into the PD, but remained floating at the top and finally accumulated on the micropyle after PD withdrawal. In contrast, pollen of the angiosperms P. suffruticosa, Salix babylonica, and O. violaceus did not submerge, instead remaining clustered at the edge without entering the PD. Conclusions We conclude that PD withdrawal is primarily determined by the dynamic balance between evaporation and ovule secretion, of which pollen is a critical stimulator

  19. Managing Relational Legacies: Lessons from British Columbia, Canada

    Directory of Open Access Journals (Sweden)

    Sofiane Baba

    2014-01-01

    Full Text Available Issues related to company-community relations and the social license to operate have emerged as strategic business issues. This paper aims to contribute to the growing body of research on long-term company-community relations. An analysis of the relationship between Alcan (Aluminum of Canada, Montréal, Canada part of Rio Tinto since 2007 with the Cheslatta Carrier First Nation in the Kemano-Kitimat area of northern British Columbia, Canada, provides three contributions. The first is related to the notion of relational legacy, which refers to the sedimentation of unresolved issues that have the potential to impede the realization of corporate activities and the reproduction of low levels of social license to operate. The second concerns stakeholder management. While the literature suggests that stakeholders should be managed by companies according to the degree of salience, this analysis suggests that researchers and managers should consider the evolution of the environmental context in their analyses. Third, the analysis suggests that small or marginalized groups, depicted by the stakeholder management literature as dormant stakeholders, should not be underestimated.

  20. Diagnosis-Related Groups (DRG and Hospital Business Performance Management

    Directory of Open Access Journals (Sweden)

    Szynkiewicz Piotr

    2014-12-01

    Full Text Available The goal of this article is to present the possibility of using Diagnosis- Related Groups (DRG in the hospital management process and to analyse the need for business performance management on the part of hospital management staff. The following research methods were used: literature analysis, case studies, and poll analysis. It is not possible to increase the effectiveness of operation of healthcare entities without increasing the importance of IT systems and using DRG more effectively in the management process. Training users in IT and the use of DRGs is important to achieving hospital effectiveness. The increased importance of analyses and planning in a hospital should be reflected in the organisational structure of service providers. Hospital controllers should have a similar role to those present in most companies in other industries.

  1. Niche applications of metal hydrides and related thermal management issues

    Energy Technology Data Exchange (ETDEWEB)

    Lototskyy, M., E-mail: mlototskyy@uwc.ac.za [HySA Systems Competence Centre, South African Institute for Advanced Materials Chemistry, Faculty of Natural Sciences, University of the Western Cape, Private Bag X17, Bellville 7535 (South Africa); Satya Sekhar, B. [HySA Systems Competence Centre, South African Institute for Advanced Materials Chemistry, Faculty of Natural Sciences, University of the Western Cape, Private Bag X17, Bellville 7535 (South Africa); Muthukumar, P. [Mechanical Department, Indian Institute of Technology Guwahati, Guwahati 781039 (India); Linkov, V.; Pollet, B.G. [HySA Systems Competence Centre, South African Institute for Advanced Materials Chemistry, Faculty of Natural Sciences, University of the Western Cape, Private Bag X17, Bellville 7535 (South Africa)

    2015-10-05

    Highlights: • MH H{sub 2} storage, compression & heat management: developments/thermal management. • Thermodynamic criteria for proper selection of MH for different gas phase applications. • Factors influencing on H{sub 2} charge/discharge dynamic performance and energy efficiency. • The improvement of MH heat transfer characteristics is crucial. • Ways of improvement of heat transfer in the MH systems. - Abstract: This short review highlights and discusses the recent developments and thermal management issues related to metal hydride (MH) systems for hydrogen storage, hydrogen compression and heat management (refrigeration, pump and upgrade, etc.). Special attention is paid to aligning the system features with the requirements of the specific application. The considered system features include the MH material, the MH bed on the basis of its corresponding MH container, as well as the layout of the integrated system.

  2. 31 CFR 281.6 - Withdrawals from Treasury accounts.

    Science.gov (United States)

    2010-07-01

    ... the Secretary, indicating the amount of exchange required, in units of foreign currency, and the name...) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE FOREIGN EXCHANGE OPERATIONS § 281.6 Withdrawals from Treasury accounts. Foreign exchange shall be withdrawn from accounts of...

  3. Preschool Teachers' Beliefs, Knowledge, and Practices Related to Classroom Management

    Science.gov (United States)

    Drang, Debra Michal

    2011-01-01

    This study examined preschool teachers' beliefs, knowledge, and practices related to classroom management. The rationale for researching this topic is based on the role of teachers in the special education referral process, the poor success rate for inclusion for children with disabilities who demonstrate problematic classroom behaviors, and the…

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

    Science.gov (United States)

    Fleisher, Craig S.; Mahaffy, Darren

    1997-01-01

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

  5. Managing treatment-related peripheral neuropathy in patients with multiple myeloma

    Directory of Open Access Journals (Sweden)

    Grammatico S

    2016-06-01

    Full Text Available Sara Grammatico, Laura Cesini, Maria Teresa Petrucci Division of Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy Abstract: Peripheral neuropathy is one of the most important complications of multiple myeloma treatment. Neurological damage can be observed at the onset of the disease, due to the effect of monoclonal protein or radicular compression, but more often is treatment related. Vinca alkaloids in the past era, and more recently, thalidomide and bortezomib are mainly responsible. Degeneration of dorsal root ganglion is common, prevalently related to angiogenesis inhibition and cytokine modulation in the case of thalidomide and inhibition of the ubiquitin proteasome system in the case of bortezomib. Sensory neuropathy and neuropathic pain are more common; motor neuropathy and autonomic damage are less frequently observed. Neurotoxicity often affects patient's quality of life and requires dose modification or withdrawal of therapy, with a possible effect on the overall response. A prompt recognition of predisposing factors (such as diabetes mellitus, alcohol abuse, vitamin deficiencies, or viral infections and appearance of signs and symptoms, through a periodic neurological assessment with appropriate scales, is extremely important. Effective management of treatment at the emergence of peripheral neuropathy can minimize the incidence and severity of this complication and preserve therapeutic efficacy. Dose adjustment could be necessary during treatment; moreover, gabapentin or pregabalin, tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, carbamazepine, and opioid-type analgesics are suggested according to the pain severity. Some authors reported that patients who develop peripheral neuropathy during their multiple myeloma treatments presented a particular gene expression profile; therefore, future studies could be helpful for a better understanding of possible

  6. Water withdrawals in Florida, 2012

    Science.gov (United States)

    Marella, Richard L.

    2015-09-01

    In 2012, the total amount of water withdrawn in Florida was estimated to be 14,237 million gallons per day (Mgal/d). Saline water accounted for 7,855 Mgal/d (55 percent), and freshwater accounted for 6,383 Mgal/d (45 percent). Groundwater accounted for 4,167 Mgal/d (65 percent) of freshwater withdrawals, and surface water accounted for the remaining 2,216 Mgal/d (35 percent). Surface water accounted for nearly all (99.9 percent) saline-water withdrawals. Freshwater withdrawals were greatest in Palm Beach County (682 Mgal/d), and saline-water withdrawals were greatest in Pasco County (1,822 Mgal/d). Fresh groundwater provided drinking water (through either public supply or private domestic wells) for 17.699 million residents (93 percent of Florida’s population), and fresh surface water provided drinking water for 1.375 million residents (7 percent). The statewide public-supply gross per capita water use for 2012 was estimated at 136 gallons per day.

  7. HSE management standards and stress-related work outcomes.

    Science.gov (United States)

    Kerr, Robert; McHugh, Marie; McCrory, Mark

    2009-12-01

    The UK Health and Safety Executive's (HSE) Management Standards (MS) approach has been developed to help organizations manage potential sources of work-related stress. Although there is general support for the assessment model adopted by this approach, to date, there has been no empirical investigation of the relationship between the actual MS (as measured by the final revised version of the HSE Indicator Tool) and stress-related work outcomes. To investigate the relationship between the HSE MS and the following stress-related work outcomes: 'job satisfaction', job-related anxiety and depression and errors/near misses. An anonymous cross-sectional questionnaire was distributed by either e-mail or post to all employees within a community-based Health and Social Services Trust. Respondents completed the HSE Indicator Tool, a job-related anxiety and depression scale, a job satisfaction scale and an aggregated measure of the number of errors/near misses witnessed. Associations between the HSE Indicator Tool responses and stress-related work outcomes were analysed with regression statistics. A total of 707 employees completed the questionnaire, representing a low response rate of 29%. Controlling for age, gender and contract type, the HSE MS (as measured by the HSE Indicator Tool) were positively associated with job satisfaction and negatively associated with 'job-related anxiety', 'job-related depression' and 'witnessed errors/near misses'. This study provides empirical evidence to support the use of the MS approach in tackling workplace stress.

  8. Antecedents of Sustainable Management Support for IT-Related Initiatives

    Directory of Open Access Journals (Sweden)

    Acklesh Prasad

    2012-04-01

    Full Text Available Having IT-related capabilities is not enough to secure value from the IT resources and survive in today’s competitive environment. IT resources evolve dynamically and organisations must sustain their existing capabilities to continue to leverage value from their IT resources. Organisations’ IT-related management capabilities are an important source of their competitive advantage. Organisations can sustain these capabilities through appropriate considerations of resources at the technology-use level. This study suggests that an appropriate organisational design relating to decision rights and work environment, and a congruent reward system can create a dynamic end-user environment. This environment will be a vital source of knowledge that could help organisations to sustain their IT-related management capabilities. Analysis of data collected from a field survey demonstrates that a dynamic end-user environment, a result of a coordinated change in complementary factors, helps organisations to sustain their IT-related management capabilities. This study adds an important dimension to understanding why some organisations continue to perform better with their IT resources than others. For practice, this study suggests that organisations need to consider a comprehensive approach to what constitutes their valuable organisational resources.

  9. Evidence-Based Management of Common Gallstone-Related Emergencies.

    Science.gov (United States)

    Demehri, Farokh R; Alam, Hasan B

    2016-01-01

    Gallstone-related disease is among the most common clinical problems encountered worldwide. The manifestations of cholelithiasis vary greatly, ranging from mild biliary colic to life-threatening gallstone pancreatitis and cholangitis. The vast majority of gallstone-related diseases encountered in an acute setting can be categorized as biliary colic, cholecystitis, choledocholithiasis, and pancreatitis, although these diagnoses can overlap. The management of these diseases is uniquely multidisciplinary, involving many specialties and treatment options. Thus, care may be compromised due to redundant tests, treatment delays, or inconsistent management. This review outlines the evidence for initial evaluation, diagnostic workup, and treatment for the most common gallstone-related emergencies. Key principles include initial risk stratification of patients to aid in triage and timing of interventions, early initiation of appropriate antibiotics for patients with evidence of cholecystitis or cholangitis, patient selection for endoscopic biliary decompression, and growing evidence in favor of early laparoscopic cholecystectomy for clinically stable patients. © The Author(s) 2014.

  10. Statistics and Corporate Environmental Management: Relations and Problems

    DEFF Research Database (Denmark)

    Madsen, Henning; Ulhøi, John Parm

    1997-01-01

    Statistical methods have long been used to analyse the macroeconomic consequences of environmentally damaging activities, political actions to control, prevent, or reduce these damages, and environmental problems in the natural environment. Up to now, however, they have had a limited and not very...... specific use in corporate environmental management systems. This paper will address some of the special problems related to the use of statistical techniques in corporate environmental management systems. One important aspect of this is the interaction of internal decisions and activities with conditions...

  11. 21 CFR 314.620 - Withdrawal procedures.

    Science.gov (United States)

    2010-04-01

    ... Efficacy Studies Are Not Ethical or Feasible § 314.620 Withdrawal procedures. (a) Reasons to withdraw... diligence; (3) Use after marketing demonstrates that postmarketing restrictions are inadequate to...

  12. Water withdrawals, use, discharge, and trends in Florida, 2000

    Science.gov (United States)

    Marella, Richard L.

    2004-01-01

    In 2000, the estimated amount of water withdrawn in Florida was 20,148 million gallons per day (Mgal/d), of which 59 percent was saline and 41 percent was fresh. Ground water accounted for 62 percent of freshwater withdrawals and surface water accounted for the remaining 38 percent. Ninety-two percent of the 15.98 million people in Florida relied on ground water for their drinking water needs in 2000. Almost all of the saline water withdrawals (99.9 percent) were from surface water. Public supply accounted for 43 percent of ground water withdrawn in 2000, followed by agricultural self-supplied (39 percent), commercial-industrial self-supplied (including mining) (8.5 percent), recreational irrigation (4.5 percent), domestic self-supplied (4 percent), and power generation (1 percent). Agricultural self-supplied accounted for 62 percent of fresh surface water withdrawn in 2000, followed by power generation (20 percent), public supply (8 percent), recreational irrigation (6 percent), and commercial-industrial self-supplied (4 percent). Almost all of saline water withdrawn was used for power generation. The largest amount of freshwater was withdrawn in Palm Beach County and the largest amount of saline water was withdrawn in Hillsborough County. Significant withdrawals (more than 200 Mgal/d) of fresh ground water occurred in Miami-Dade, Polk, Orange, Palm Beach, Broward, and Collier Counties. Significant withdrawals (more than 200 Mgal/d) of fresh surface water occurred in Palm Beach, Hendry, and Escambia Counties. The South Florida Water Management District accounted for the largest amount of freshwater withdrawn (49 percent). About 62 percent of the total ground water withdrawn was from the Floridan aquifer system; 17 percent was from the Biscayne aquifer. Most of the surface water used in Florida was from managed and maintained canal systems or large water bodies. Major sources of fresh surface water include the Caloosahatchee River, Deer Point Lake, Hillsborough

  13. Prediction of withdrawal symptoms during opioid detoxification

    NARCIS (Netherlands)

    Dijkstra, Boukje A G; Krabbe, Paul F M; De Jong, Cor A J; van der Staak, Cees P F

    2008-01-01

    OBJECTIVE: The severity of self-reported withdrawal symptoms varies during detoxification of opioid-dependent patients. The aim of this study is to identify subgroups of withdrawal symptoms within the detoxification trajectory and to predict the severity of withdrawal symptoms on the basis of

  14. A Detection Model of College Withdrawal

    Science.gov (United States)

    Pleskac, Timothy J.; Keeney, Jessica; Merritt, Stephanie M.; Schmitt, Neal; Oswald, Frederick L.

    2011-01-01

    Many students during their college careers consider withdrawing from their respective college or university. Understanding why some students decide to withdraw yet others persist has implications for both the well being of students as well as for institutes of higher education. The present study develops a model of the decision to withdraw drawing…

  15. OCS Oil and Gas Leasing Withdraw & Moratoria Areas - Gulf of Mexico Region

    Data.gov (United States)

    Bureau of Ocean Energy Management, Department of the Interior — Areas currently under congressional moratoria or executive (presidential) withdraw from leasing for oil, gas, or minerals within the US Outer Continental Shelf. The...

  16. Optimizing withdrawal from drinking water reservoirs to reduce downstream temperature pollution and reservoir hypoxia.

    Science.gov (United States)

    Weber, M; Rinke, K; Hipsey, M R; Boehrer, B

    2017-03-20

    Sustainable management of drinking water reservoirs requires balancing the demands of water supply whilst minimizing environmental impact. This study numerically simulates the effect of an improved withdrawal scheme designed to alleviate the temperature pollution downstream of a reservoir. The aim was to identify an optimal withdrawal strategy such that water of a desirable discharge temperature can be supplied downstream without leading to unacceptably low oxygen concentrations within the reservoir. First, we calibrated a one-dimensional numerical model for hydrodynamics and oxygen dynamics (GLM-AED2), verifying that the model reproduced water temperatures and hypolimnetic dissolved oxygen concentrations accurately over a 5 year period. Second, the model was extended to include an adaptive withdrawal functionality, allowing for a prescribed withdrawal temperature to be found, with the potential constraint of hypolimnetic oxygen concentration. Scenario simulations on epi-/metalimnetic withdrawal demonstrate that the model is able to autonomously determine the best withdrawal height depending on the thermal structure and the hypolimnetic oxygen concentration thereby optimizing the ability to supply a desirable discharge temperature to the downstream river during summer. This new withdrawal strategy also increased the hypolimnetic raw water volume to be used for drinking water supply, but reduced the dissolved oxygen concentrations in the deep and cold water layers (hypolimnion). Implications of the results for reservoir management are discussed and the numerical model is provided for operators as a simple and efficient tool for optimizing the withdrawal strategy within different reservoir contexts.

  17. Acute pregabalin withdrawal: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Barrett JA

    2015-05-01

    Full Text Available Objective: Pregabalin is a commonly prescribed GABA analog most commonly used for the treatment of neuralgia. Recently, case reports on pregabalin have been published describing episodes that may be associated with withdrawal-like symptoms after extended or aggressive therapy. This report describes a case in which long term exposure of high dose pregabalin may have resulted in acute withdrawal, and outlines the subsequent medical management of these symptoms. Case Summary: A 61-year-old male presenting with severe agitation presumed to be withdrawal from long term and high dose exposure to pregabalin. Medical management included the use of haloperidol, diphenhydramine, lorazepam and the addition of clonidine over the course of several days for the pharmacological management of withdrawal symptoms. Discussion: Although case reports are available to guide clinicians in the recognition of acute pregabalin withdrawal, definitive evidence on how best to treat these patients remains severely limited. With an increase in the prescribing practices of pregabalin, insight into the acute management by fellow clinicians is further needed. Conclusion: Caution must be practiced when prescribing and educating patients on the use of pregabalin to prevent associated withdrawal-like symptoms. In addition, documentation by the medical community on methods utilized to treat pregabalin withdrawal syndromes remains crucial for the advancement of patient care. Benzodiazepines and clonidine are the current therapies that have been documented as potentially effective treatment modalities at this time.

  18. In-office management of sport-related concussion.

    Science.gov (United States)

    Reynolds, Erin; Collins, Michael W

    2014-01-01

    The field of sport-related concussion has grown exponentially over the past decade, with more concussion-specific clinics being identified in major hospital systems as well as independent practitioner's offices. To date, there is no standardized in-office protocol for managing ongoing symptoms. The University of Pittsburgh Medical Center (UPMC) Sports Concussion Program, established in 2000, is one of the largest programs in the USA, pioneering the way in clinical management, research, and education of sport-related concussion. This report will outline the essential components of a successful concussion clinic, using the UPMC Sports Concussion Program as a case example of best practice. We will share several case studies illustrating the individualized and complex nature of this injury, as well as review important rehabilitation components.

  19. Managing anxiety related to anaphylaxis in childhood: a systematic review.

    Science.gov (United States)

    Manassis, Katharina

    2012-01-01

    Objectives. This paper reviews the relationship between anxiety and anaphylaxis in children and youth, and principles for managing anxiety in the anaphylactic child and his or her parents. Methods. A review of the medical literature (Medline) was done using the keywords "anxiety," "anaphylaxis," and "allergy," limited to children and adolescents. Findings were organized into categories used in the treatment of childhood anxiety disorders, then applied to managing anxiety in the anaphylactic child. Results. Twenty-four relevant papers were identified. These varied widely in methodology. Findings emphasized included the need to distinguish anxiety-related and organic symptoms, ameliorate the anxiety-related impact of anaphylaxis on quality of life, and address parental anxiety about the child. Conclusion. Children with anaphylaxis can function well despite anxiety, but the physical, cognitive, and behavioral aspects of anxiety associated with anaphylactic risk must be addressed, and parents must be involved in care in constructive ways.

  20. Water withdrawals, use, and trends in Florida, 2010

    Science.gov (United States)

    Marella, Richard L.

    2014-01-01

    -landscape irrigation and domestic self-supplied (5 percent each), and power generation (less than 1 percent). Agricultural self-supplied accounted for 51 percent of fresh surface-water withdrawals, followed by power generation (25 percent), public supply (11 percent), recreational-landscape irrigation (9 percent), and commercial-industrial-mining self-supplied (4 percent). Power generation accounted for nearly all (99.8 percent) saline-water withdrawals. Of the 18.80 million people who resided in Florida during 2010, 41 percent (7.68 million people) resided in the South Florida Water Management District (SFWMD), 25 percent each resided in the Southwest Florida Water Management District (SWFWMD) and the St. Johns River Water Management District (SJRWMD) (4.73 and 4.70 million people, respectively), 7 percent (1.36 million people) resided in the Northwest Florida Water Management District (NWFWMD), and 2 percent (0.33 million people) resided in the Suwannee River Water Management District (SRWMD). The largest percentage of freshwater withdrawals was from the SFWMD (47 percent), followed by the SJRWMD (21 percent), SWFWMD (18 percent), NWFWMD (9 percent), and SRWMD (5 percent). Between 1950 and 2010, the population of Florida increased by 16.03 million (580 percent), and the total water withdrawals (fresh and saline) increased by 12,334 Mgal/d (465 percent). More recently, total freshwater withdrawals decreased by more than 1,792 Mgal/d (22 percent) between 2000 and 2010, while the population increased by 2.82 million (18 percent), and total freshwater withdrawals decreased by more than 474 Mgal/d (7 percent) between 2005 and 2010, while the population increased by 0.88 million (8 percent). The recent trend of decreases in freshwater withdrawals is a result of increased rainfall during this period, the development and use of alternative water sources, water conservation efforts, more conservative regulations and mandates, changes in economic conditions, and losses of irrigated lands

  1. Discussion series on PURPA related topics: load management

    Energy Technology Data Exchange (ETDEWEB)

    Sturgeon, J I

    1980-08-01

    The Discussion Series on PURPA Related Topics is composed of five volumes: Metering, Billing, Information to Customers, Load Management Techniques and Master Metering. These reports are based on twenty-five Demonstration and Implementation projects sponsored and directed during the past five years by the US Department of Energy, Office of Utility Systems. Each of the topics bears directly on one or more of the federal standards contained in the Public Utilities Regulatory Policies Act of 1978 (PURPA). This volume, Load Management Techniques, relates primarily to the Time-of-Day rates standard, PURPA IB(d)3. The experiences related in this report deal, in part, with the procedures and equipment which are affected when time-of-day rates are implemented. One goal of this report is to describe how people in a variety of settings have dealt with the many practical issues in load management. Another is to highlight the lessons and summarize the experiences of the Project participants. This report does not stand as a manual nor provide prescriptive guidelines on how to deal with the topic. Rather it offers an account for those charged with the responsibility of implementing PURPA requirements to learn from the insights and problems which occurred during the Rate Demonstration projects.

  2. Changes in plasma noradrenaline and serotonin levels and craving during alcohol withdrawal.

    Science.gov (United States)

    Patkar, Ashwin A; Gopalakrishnan, Raman; Naik, Prakash C; Murray, Heather W; Vergare, Michael J; Marsden, Charles A

    2003-01-01

    Despite substantial preclinical evidence that supports the involvement of noradrenergic (NA) and serotonergic (5-HT) mechanisms in alcohol withdrawal, human data remain inconsistent. We examined whether plasma levels of NA and 5-HT were altered during alcohol withdrawal and whether these measures were related to craving. We also explored whether alterations in NA and 5-HT activity differ between type I and type II alcohol-dependent patients during withdrawal. Plasma measurements of NA and 5-HT and assessments of craving were performed longitudinally in 26 Caucasian alcohol-dependent men who were hospitalized for detoxification, at baseline (day 0), and on the 1st, 7th and 14th days of withdrawal. These measures were compared with NA and 5-HT levels obtained in 28 controls. During withdrawal, NA levels declined significantly from day 1 through day 14, whereas 5-HT levels and craving declined significantly from day 0 through day 14. The NA levels on days 0 and 1 of withdrawal were significantly higher than those in controls; however, by day 7 the NA levels were similar to the control values. In contrast, the 5-HT levels on day 0 of withdrawal resembled control values; however, the 5-HT concentrations on days 1, 7 and 14 were significantly lower than those in controls. There were no significant correlations between NA and 5-HT levels or between craving and the biological measures during withdrawal. Type I and type II patients did not differ in NA or 5-HT levels during withdrawal. These findings indicate that both plasma NA and 5-HT levels change during withdrawal; however, the pattern of change is different for the two measures. Also, while alterations in NA activity appear to normalize by late withdrawal, 5-HT changes seem to be more persistent. Neither craving nor subtypes of alcoholism seem to be related to alterations in NA or 5-HT during withdrawal.

  3. Water Withdrawals, Use, and Trends in Florida, 2005

    Science.gov (United States)

    Marella, Richard L.

    2009-01-01

    generation (20.5 percent), public supply (13 percent), recreational irrigation (6 percent), and commercial-industrial self-supplied (4.5 percent). Power generation accounted for nearly all (99.9 percent) saline-water withdrawals. Of the 17.92 million people who resided in Florida during 2005, 41 percent (7.36 million people) resided in the South Florida Water Management District (SFWMD), followed by the St. Johns River Water Management District (SJRWMD) and the Southwest Florida Water Management District (SWFWMD) with 25 percent each (4.46 and 4.44 million people, respectively), the Northwest Florida Water Management District (NWFWMD) with 7.5 percent (1.34 million people), and the Suwannee River Water Management District (SRWMD) with 1.5 percent (0.32 million people). The largest amount of freshwater withdrawals was from the SFWMD, which was one-half (50 percent) of the State's total freshwater withdrawals, followed by the SJRWMD (19 percent), SWFWMD (16 percent), NWFWMD (10 percent), and SRWMD (5 percent). Between 1950 and 2005, the population of Florida increased by 15.15 million (550 percent), and the total water withdrawals (fresh and saline) increased 15,700 Mgal/d (600 percent). More recently, total withdrawals decreased 1,790 Mgal/d (9 percent) between 2000 and 2005, but the total population increased by 1.94 million (12 percent). Between 1990 and 2005, saline-water withdrawals increased 1,120 Mgal/d (11 percent), whereas between 2000 and 2005, saline-water withdrawals decreased 470 Mgal/d (4 percent). Between 1990 and 2005, freshwater withdrawals decreased 710 Mgal/d (9 percent), whereas between 2000 and 2005, freshwater withdrawals decreased 1,320 Mgal/d (16 percent). The use of highly mineralized groundwater as a source of supply, primarily for public supply, also has increased in Florida. This water, referred as nonpotable water, increased from just less than 2 Mgal/d in 1970, to 142 Mgal/d in 2005. Nonpotable water is treated to meet drin

  4. Management of secondary lymphedema related to breast cancer

    Science.gov (United States)

    Cheifetz, Oren; Haley, Louise

    2010-01-01

    Abstract OBJECTIVE To review recent literature on the management of secondary lymphedema following breast cancer. QUALITY OF EVIDENCE MEDLINE, EMBASE, AMED, PubMed, and the Internet were searched for articles published between 2005 and 2009. Articles were evaluated using Sackett’s levels of evidence. The literature search focused on primary research and systematic reviews. MAIN MESSAGE Secondary lymphedema related to breast cancer is an ongoing challenge. Evidence suggests that there are several safe and beneficial treatments, including complex decongestive therapy, physiotherapy, and exercise. Furthermore, resistive exercises, previously contraindicated on the affected side, have been found to be both beneficial and safe with careful progression and monitoring. Exercise guidelines and patient education topics are presented with a comprehensive reference list for further reading. CONCLUSION Advances in cancer treatment, cancer and exercise research, and lymphedema management require that physicians have a basic understanding of the current evidence to provide appropriate patient education and referral. PMID:21375063

  5. Object-Relational Management of Multiply Represented Geographic Entities

    DEFF Research Database (Denmark)

    Friis-Christensen, Anders; Jensen, Christian Søndergaard

    2003-01-01

    Multiple representation occurs when information about the same geographic entity is represented electronically more than once. This occurs frequently in practice, and it invariably results in the occurrence of inconsistencies among the different representations. We propose to resolve this situation...... by introducing a multiple representation management system (MRMS), the schema of which includes rules that specify how to identify representations of the same entity, rules that specify consistency requirements, and rules used to restore consistency when necessary. In this paper, we demonstrate by means...... of a prototype and a realworld case study that it is possible to implement a multiple representation schema language on top of an object-relational database management system. Specifically, it is demonstrated how it is possible to map the constructs of the language used for specifying the multiple representation...

  6. Diagnosis and Management of AIDS-related Diarrhea

    Directory of Open Access Journals (Sweden)

    John F Johanson

    1996-01-01

    Full Text Available The spectrum of illness associated with the acquired immunodeficiency syndrome (AIDS has been increasing since the initial description in 1981. While virtually all organ systems may be affected, the gastrointestinal tract appears to be a major target. Diarrhea is the most common symptom, affecting up to half of all AIDS patients during the course of their disease. Although diarrhea occurs frequently, its optimal management remains controversial. An extensive evaluation including stool studies and endoscopic biopsies of both the colon and small intestine has been widely recommended to identify all potential pathogenic organisms. An alternative approach is a more limited evaluation consisting of stool and blood cultures followed by symptomatic treatment with antidiarrheal agents if no specific organisms are identified. The clinical presentation of the most common opportunistic pathogens are reviewed, including several recently discovered organisms. Recommendations for treatment are followed by a brief discussion of management strategies used to care for patients with AIDS-related diarrhea.

  7. 78 FR 28654 - National Council on Federal Labor-Management Relations Meeting

    Science.gov (United States)

    2013-05-15

    ... MANAGEMENT National Council on Federal Labor-Management Relations Meeting AGENCY: Office of Personnel... Curry, Deputy Associate Director for Partnership and Labor Relations, Office of Personnel Management... Director of the Office of Personnel Management and the Deputy Director for Management of the Office of...

  8. Rapidly progressive post-transplant lymphoproliferative disease following withdrawal of sirolimus.

    Science.gov (United States)

    Mendelson, Marc; Barday, Zunaid; Eastman, Roland; Le Feuvre, David; Candy, Sally; Wu, Hue-Tsi; Swanepoel, Charles

    2012-08-24

    Sirolimus, a potent inhibitor of B- and T-cell activation. is a commonly used immunosuppressant after renal transplantation. Withdrawal of sirolimus from the immunosuppression regimen may reduce B-cell surveillance. We present a case of rapidly progressive central nervous system (CNS) polymorphic Epstein-Barr virus (EBV)-related post-transplant lymphoproliferative disorder following the withdrawal of sirolimus.

  9. 15 CFR 30.55 - Confidential information, import entries, and withdrawals.

    Science.gov (United States)

    2010-01-01

    ... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Confidential information, import entries, and withdrawals. 30.55 Section 30.55 Commerce and Foreign Trade Regulations Relating to Commerce... Requirements § 30.55 Confidential information, import entries, and withdrawals. The contents of the statistical...

  10. Takotsubo Cardiomyopathy and Catatonia in the Setting of Benzodiazepine Withdrawal

    Directory of Open Access Journals (Sweden)

    Teng J. Peng

    2016-01-01

    Full Text Available We report two serious and unusual complications of benzodiazepine withdrawal in a single patient: takotsubo cardiomyopathy and catatonia. This 61-year-old female patient was brought to the emergency department with lethargy and within hours had declined into a state of catatonia. Although there was never a complaint of chest pain, ECG showed deep anterior T-wave inversions and cardiac enzymes were elevated. An echocardiogram was consistent with takotsubo cardiomyopathy. She later received 1 mg of midazolam and within minutes had resolution of catatonic symptoms. Careful history revealed that she had omitted her daily dose of lorazepam for 3 days prior to admission. To our knowledge, the case presented herein is the first report of simultaneous catatonia and takotsubo cardiomyopathy in the setting of benzodiazepine withdrawal. The pathogenesis of both conditions is poorly understood but may be indirectly related to the sudden decrease in γ-aminobutyric acid (GABA signaling during benzodiazepine withdrawal.

  11. Takotsubo Cardiomyopathy and Catatonia in the Setting of Benzodiazepine Withdrawal.

    Science.gov (United States)

    Peng, Teng J; Patchett, Nicholas D; Bernard, Sheilah A

    2016-01-01

    We report two serious and unusual complications of benzodiazepine withdrawal in a single patient: takotsubo cardiomyopathy and catatonia. This 61-year-old female patient was brought to the emergency department with lethargy and within hours had declined into a state of catatonia. Although there was never a complaint of chest pain, ECG showed deep anterior T-wave inversions and cardiac enzymes were elevated. An echocardiogram was consistent with takotsubo cardiomyopathy. She later received 1 mg of midazolam and within minutes had resolution of catatonic symptoms. Careful history revealed that she had omitted her daily dose of lorazepam for 3 days prior to admission. To our knowledge, the case presented herein is the first report of simultaneous catatonia and takotsubo cardiomyopathy in the setting of benzodiazepine withdrawal. The pathogenesis of both conditions is poorly understood but may be indirectly related to the sudden decrease in γ-aminobutyric acid (GABA) signaling during benzodiazepine withdrawal.

  12. Takotsubo Cardiomyopathy and Catatonia in the Setting of Benzodiazepine Withdrawal

    Science.gov (United States)

    Peng, Teng J.

    2016-01-01

    We report two serious and unusual complications of benzodiazepine withdrawal in a single patient: takotsubo cardiomyopathy and catatonia. This 61-year-old female patient was brought to the emergency department with lethargy and within hours had declined into a state of catatonia. Although there was never a complaint of chest pain, ECG showed deep anterior T-wave inversions and cardiac enzymes were elevated. An echocardiogram was consistent with takotsubo cardiomyopathy. She later received 1 mg of midazolam and within minutes had resolution of catatonic symptoms. Careful history revealed that she had omitted her daily dose of lorazepam for 3 days prior to admission. To our knowledge, the case presented herein is the first report of simultaneous catatonia and takotsubo cardiomyopathy in the setting of benzodiazepine withdrawal. The pathogenesis of both conditions is poorly understood but may be indirectly related to the sudden decrease in γ-aminobutyric acid (GABA) signaling during benzodiazepine withdrawal. PMID:27547472

  13. 22 CFR 1421.1 - Foreign Service Labor-Management Relations Statute.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Foreign Service Labor-Management Relations... RELATIONS AUTHORITY MEANING OF TERMS AS USED IN THIS SUBCHAPTER § 1421.1 Foreign Service Labor-Management Relations Statute. The term Foreign Service Labor-Management Relations Statute means chapter 10 of title 1...

  14. Codes of practice and related issues in biomedical waste management

    Energy Technology Data Exchange (ETDEWEB)

    Moy, D.; Watt, C. [Griffith Univ. (Australia)

    1996-12-31

    This paper outlines the development of a National Code of Practice for biomedical waste management in Australia. The 10 key areas addressed by the code are industry mission statement; uniform terms and definitions; community relations - public perceptions and right to know; generation, source separation, and handling; storage requirements; transportation; treatment and disposal; disposal of solid and liquid residues and air emissions; occupational health and safety; staff awareness and education. A comparison with other industry codes in Australia is made. A list of outstanding issues is also provided; these include the development of standard containers, treatment effectiveness, and reusable sharps containers.

  15. Risk of Misinforming and Message Customization in Customer Related Management

    Directory of Open Access Journals (Sweden)

    Dimitar Grozdanov Christozov

    2015-08-01

    Full Text Available This paper discusses applications of the measures of the risk of misinforming and the role of the warranty of misinforming in the context of the informing component of Customer Related Management (CRM issues. This study consists of two parts. Firstly, we propose an approach for customers’ grouping based on their attitude toward assessing product's properties and their expertise on the terminology/domain of the seller’s message describing the product. Also we discuss what the most appropriate personal/group warranty is for each of these group/clusters.

  16. Water withdrawals, use, discharge, and trends in Florida, 1995

    Science.gov (United States)

    Marella, R.L.

    1999-01-01

    In 1995, the total amount of water withdrawn in Florida was nearly 18,200 million gallons per day (Mgal/d), of which 60 percent was saline and 40 percent was freshwater. Ground water accounted for 60 percent of freshwater withdrawals and surface water accounted for the remaining 40 percent. Ninety-three percent of the 14.15 million people in Florida relied on ground water for their drinking water needs in 1995. Almost all (99.9 percent) saline water withdrawals were from surface water. Public supply accounted for 43 percent of ground water withdrawn in 1995, followed by agricultural self-supplied (35 percent), commercial-industrial self-supplied (including mining) (10 percent), domestic self-supplied (7 percent), recreational irrigation (4.5 percent), and power generation (0.5 percent). Agricultural self-supplied accounted for 60 percent of fresh surface water withdrawn in 1995, followed by power generation (21 percent), commercial-industrial self-supplied (9 percent), public supply (7 percent), and recreational irrigation (3 percent). Almost all of saline water withdrawn was used for power generation. The largest amount of freshwater was withdrawn in Palm Beach County and the largest amount of saline water was withdrawn in Hillsborough County. Significant withdrawals (more than 200 Mgal/d) of fresh ground water occurred in Dade, Broward, Polk, Orange, and Palm Beach Counties. Significant withdrawals (more than 200 Mgal/d) of fresh surface water occurred in Palm Beach, Hendry, and St. Lucie Counties. The South Florida Water Management District accounted for the largest amount of freshwater withdrawn (nearly 50 percent). About 57 percent of the total ground water withdrawn was from the Floridan aquifer system; 20 percent was from the Biscayne aquifer. Most of the surface water used in Florida was from managed and maintained canal systems or large water bodies. Major sources of fresh surface water include the Caloosahatchee River, Deer Point Lake, Hillsborough River

  17. Ecohydrology and Its Relation to Integrated Groundwater Management

    Science.gov (United States)

    Hunt, Randall J.; Hayashi, Masaki; Batelaan, Okke

    2016-01-01

    In the twentieth century, groundwater characterization focused primarily on easily measured hydraulic metrics of water storage and flows. Twenty-first century concepts of groundwater availability, however, encompass other factors having societal value, such as ecological well-being. Effective ecohydrological science is a nexus of fundamental understanding derived from two scientific disciplines: (1) ecology, where scale, thresholds, feedbacks and tipping points for societal questions form the basis for the ecologic characterization, and (2) hydrology, where the characteristics, magnitude, and timing of water flows are characterized for a defined system of interest. In addition to ecohydrology itself, integrated groundwater management requires input from resource managers to understand which areas of the vast world of ecohydrology are important for decision making. Expectations of acceptable uncertainty, or even what ecohydrological outputs have utility, are often not well articulated within societal decision making frameworks, or within the science community itself. Similarly, “acceptable levels of impact” are difficult to define. Three examples are given to demonstrate the use of ecohydrological considerations for long-term sustainability of groundwater resources and their related ecosystem function. Such examples illustrate the importance of accommodating ecohydrogeological aspects into integrated groundwater management of the twenty-first century, regardless of society, climate, or setting.

  18. 31 CFR 539.704 - Penalty imposition or withdrawal.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Penalty imposition or withdrawal. 539.704 Section 539.704 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY WEAPONS OF MASS DESTRUCTION TRADE...

  19. Pediatric heat-related illness: recommendations for prevention and management

    Science.gov (United States)

    Dunn, Roberta J.; Kim, Tommy Y.

    2017-08-01

    Infants, children, and adolescents are at increased risk for heat-related illness due to their inability to remove themselves from dangerous environments. Evidence shows that morbidity and mortality from heat illness is related to the length of time core temperature is elevated, so rapid reduction and accurate serial measurements are crucial to prevention of organ system damage and death. The primary methods of patient cooling are conduction (ice-water immersion, cold packs) and convection (moisture and moving air). The choice of method used may depend on availability of equipment, but there is evidence that can guide optimal use of resources. This issue presents evidence-based recommendations and best practices in heat-illness resuscitation, including managing children who are obese, have special needs or take medications, and advocacy for prevention strategies. Copyright © 2017 EB Medicine

  20. Management of acid-related disorders in patients with dysphagia.

    Science.gov (United States)

    Howden, Colin W

    2004-09-06

    Dysphagia affects a large and growing number of individuals in the United States, particularly the elderly and those who are neurologically impaired. Swallowing difficulties may be due to age-related changes in oropharyngeal and esophageal functioning as well as central nervous system diseases such as stroke, Parkinson disease, and dementia. Among institutionalized individuals, dysphagia is associated with increased morbidity and mortality. An appreciation of the physiology of swallowing and the pathophysiology of dysphagia is necessary for proper patient management. Careful history, physical examination, and evaluation of radiologic and endoscopic studies should differentiate oropharyngeal and esophageal etiologies of dysphagia and distinguish mechanical (anatomic) disorders from functional (motor) disorders. A significant percentage of patients with dysphagia have concomitant acid-related disorders that are managed best with proton pump inhibitor (PPI) therapy. Three of the currently available PPIs are manufactured as capsules containing enteric-coated granules that may be mixed with soft foods or fruit juices before oral administration to those with swallowing difficulties. In addition, omeprazole and lansoprazole may be administered via gastrostomy or nasogastric feeding tubes as suspensions in sodium bicarbonate. Novel dosage formulations of lansoprazole that may be appropriate for patients with dysphagia include the commercially manufactured lansoprazole strawberry-flavored enteric-coated granules for suspension and lansoprazole orally disintegrating tablets.

  1. Supply chain management and relational competitive advantage in footwear industry

    Directory of Open Access Journals (Sweden)

    Fernando Luiz Emerenciano Viana

    2014-11-01

    Full Text Available This work investigated the supply chain management contribution to competitive advantage for companies in the footwear industry, with a primary focus on the inter-organizational relationship analysis. It was used an analysis model developed by Viana (2010, whose main theoretical support is given by relational view (DYER; SINGH, 1998. It is an interpretive multiple case study, including two companies that operate in Ceará State. The data analysis procedure used the constant comparison method, with the Atlas/ti software assistance. In general, it is realized that in the buyers-suppliers relationships prevails the partnership and the main assumptions of supply chain management are applied, which contributes for the relational competitive advantage. In the relationships between enterprises and the government and development institutions, tax incentives are the main resource accessed, which contribute for temporary competitive advantage over competitors that do not have production facilities in the Northeast region as well as lead to a competitive parity situation to competitors that have production facilities in the Northeast region and to the external market competitors.

  2. Managing Anxiety Related to Anaphylaxis in Childhood: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Katharina Manassis

    2012-01-01

    Full Text Available Objectives. This paper reviews the relationship between anxiety and anaphylaxis in children and youth, and principles for managing anxiety in the anaphylactic child and his or her parents. Methods. A review of the medical literature (Medline was done using the keywords “anxiety,” “anaphylaxis,” and “allergy,” limited to children and adolescents. Findings were organized into categories used in the treatment of childhood anxiety disorders, then applied to managing anxiety in the anaphylactic child. Results. Twenty-four relevant papers were identified. These varied widely in methodology. Findings emphasized included the need to distinguish anxiety-related and organic symptoms, ameliorate the anxiety-related impact of anaphylaxis on quality of life, and address parental anxiety about the child. Conclusion. Children with anaphylaxis can function well despite anxiety, but the physical, cognitive, and behavioral aspects of anxiety associated with anaphylactic risk must be addressed, and parents must be involved in care in constructive ways.

  3. Treatment of alcohol withdrawal with gabapentin.

    Science.gov (United States)

    Bozikas, Vasilis; Petrikis, Petros; Gamvrula, Katerina; Savvidou, Ioanna; Karavatos, Athanasios

    2002-01-01

    Gabapentin is an anticonvulsant agent, also effective in the treatment of mood disorders and anxiety disorders. Three cases of alcohol withdrawal treated with gabapentin are presented. All patients received gabapentin 400 mg tid for 3 days, 400 mg bid for 1 day, and finally 400 mg for 1 day. Withdrawal symptoms subsided and no adverse effects were observed. The possible effectiveness of gabapentin in the treatment of alcohol withdrawal warrants further investigation by systematic and well-designed studies.

  4. Withdrawal of inhaled corticosteroids in individuals with COPD - a systematic review and comment on trial methodology

    Directory of Open Access Journals (Sweden)

    Eldridge Sandra M

    2011-08-01

    Full Text Available Abstract Inhaled corticosteroids (ICS reduce COPD exacerbation frequency and slow decline in health related quality of life but have little effect on lung function, do not reduce mortality, and increase the risk of pneumonia. We systematically reviewed trials in which ICS have been withdrawn from patients with COPD, with the aim of determining the effect of withdrawal, understanding the differing results between trials, and making recommendations for improving methodology in future trials where medication is withdrawn. Trials were identified by two independent reviewers using MEDLINE, EMBASE and CINAHL, citations of identified studies were checked, and experts contacted to identify further studies. Data extraction was completed independently by two reviewers. The methodological quality of each trial was determined by assessing possible sources of systematic bias as recommended by the Cochrane collaboration. We included four trials; the quality of three was adequate. In all trials, outcomes were generally worse for patients who had had ICS withdrawn, but differences between outcomes for these patients and patients who continued with medication were mostly small and not statistically significant. Due to data paucity we performed only one meta-analysis; this indicated that patients who had had medication withdrawn were 1.11 (95% CI 0.84 to 1.46 times more likely to have an exacerbation in the following year, but the definition of exacerbations was not consistent between the three trials, and the impact of withdrawal was smaller in recent trials which were also trials conducted under conditions that reflected routine practice. There is no evidence from this review that withdrawing ICS in routine practice results in important deterioration in patient outcomes. Furthermore, the extent of increase in exacerbations depends on the way exacerbations are defined and managed and may depend on the use of other medication. In trials where medication is

  5. Oxidative stress and anxiety-like symptoms related to withdrawal of passive cigarette smoke in mice: beneficial effects of pecan nut shells extract, a by-product of the nut industry.

    Science.gov (United States)

    Reckziegel, P; Boufleur, N; Barcelos, R C S; Benvegnú, D M; Pase, C S; Muller, L G; Teixeira, A M; Zanella, R; Prado, A C P; Fett, R; Block, J M; Burger, M E

    2011-09-01

    The present study evaluated the role of pecan nut (Carya illinoensis) shells aqueous extract (AE) against oxidative damage induced by cigarette smoke exposure (CSE) and behavioral parameters of smoking withdrawal. Mice were passively exposed to cigarette smoke for 3 weeks (6, 10, and 14 cigarettes/day) and orally treated with AE (25 g/L). CSE induced lipid peroxidation in brain and red blood cells (RBC), increased catalase (CAT) activity in RBC, and decreased plasma ascorbic acid levels. AE prevented oxidative damage and increased antioxidant defenses of mice exposed to cigarette smoke. In addition, AE reduced the locomotor activity and anxiety symptoms induced by smoking withdrawal, and these behavioral parameters showed a positive correlation with RBC lipid peroxidation. Our results showed the beneficial effects of this by-product of the pecan industry, indicating its usefulness in smoking cessation.

  6. Practical management of adverse events related to apomorphine therapy

    DEFF Research Database (Denmark)

    Bhidayasiri, Roongroj; Garcia Ruiz, Pedro J; Henriksen, Tove

    2016-01-01

    The potential for adverse events is often cited as a barrier to the use of subcutaneous apomorphine therapy (intermittent injections and continuous infusion) in the management of Parkinson's disease. However, with proactive management most adverse effects are manageable if reported and tackled...... titration, initiation and long-term treatment, and discuss practical management strategies....

  7. Withdrawing benzodiazepines in primary care.

    Science.gov (United States)

    Lader, Malcolm; Tylee, Andre; Donoghue, John

    2009-01-01

    assisting in the discontinuation of benzodiazepines but the available data are insufficient for recommendations to be made regarding its use. Antidepressants can help if the patient is depressed before withdrawal or develops a depressive syndrome during withdrawal. The clearest strategy was to taper the medication; abrupt cessation can only be justified if a very serious adverse effect supervenes during treatment. No clear evidence suggests the optimum rate of tapering, and schedules vary from 4 weeks to several years. Our recommendation is to aim for withdrawal in benzodiazepine can be helpful, at least logistically, as diazepam is available in a liquid formulation.Psychological interventions range from simple support through counselling to expert cognitive-behavioural therapy (CBT). Group therapy may be helpful as it at least provides support from other patients. The value of counselling is not established and it can be quite time consuming. CBT needs to be administered by fully trained and experienced personnel but seems effective, particularly in obviating relapse.The outcome of successful withdrawal is gratifying, both in terms of improved functioning and abstinence from the benzodiazepine usage. Economic benefits also ensue.Some of the principles of withdrawing benzodiazepines are listed. Antidepressants may be helpful, as may some symptomatic remedies. Care must be taken not to substitute one drug dependence problem for the original one.

  8. European standardization for the management of space-related projects

    Directory of Open Access Journals (Sweden)

    Teresa IDZIKOWSKA

    2017-06-01

    Full Text Available A project is a temporary endeavour designed to produce a unique product, service or result, with a defined beginning and end (usually constrained by time, funding or deliverables, which is undertaken to meet unique goals and objectives, typically to bring about beneficial change or added value. Space projects involve a complex process and usually take many years to be developed. The development of complex project requires the cooperation of several organizations, which share a common goal: namely, to create a product that satisfies the consumer’s needs (technical performance within cost and schedule constraints. To reach this goal, corresponding technical activities, as well as human and financial resources, need to be organized and coordinated in a wellorganized manner. Project management is the discipline of initiating, planning, executing, controlling, and finalizing the work of a team in the achievement of specific goals and meeting specific success criteria. This involves the application of knowledge, skills, tools, and techniques to project activities in order to meet project requirements. The paper is a review of how issues related to space management requirements has been addressed in Europe.

  9. Attenuation of alcohol withdrawal syndrome and blood cortisol level with forced exercise in comparison with diazepam.

    OpenAIRE

    2015-01-01

    Relieving withdrawal and post-abstinence syndrome of alcoholism is one of the major strategies in the treatment of alcohol addicted patients. Diazepam, chlordiazepoxide, and topiramate are the approved medications that were used for this object. To assess the role of non-pharmacologic therapy in the management of alcohol withdrawal syndrome, we analyzed effects of forced exercise by treadmill on alcohol dependent mice as an animal model. A total of 60 adult male mice were divided into 5 group...

  10. Relational coordination and healthcare management in lung cancer

    Science.gov (United States)

    Romero, José Antonio Vinagre; Señarís, Juan Del Llano; Heredero, Carmen De Pablos; Nuijten, Mark

    2014-01-01

    In the current socio-economic scenario characterized by a growing shortage of resources and progressive budget constraints, the need to better coordinate processes in health institutions appears as a relevant aspect to ensure the future sustainability of system. In this sense, Relational Coordination (RC) provides a valuable opportunity for the reconfiguration of clinical guidelines concerning isolated single-level considerations. In this research the RC model has been applied to explain best results in the process of diagnosing and offering clinical treatments for lung cancer. Lung cancer presents the higher rates of tumor’s mortality worldwide. Through unstructured and informal interviews with clinicians at both levels (Primary/Specialist Care), a diagnosis of the situation in relation to joint management of lung cancer is provided. Solutions of continuity in terms of coordination are explained due to the observation of lack of effective knowledge transfer between the two levels. It is this disconnection which justifies the introduction of a modified model of RC for the study and implementation of transfer relations between the knowledge holders, in order to structure consolidated and cooperative evidence-based models that lead to a substantial shortening in the response times with a marked outcomes improvement. To our knowledge, the application of this model to a Public Health problem bringing together both levels of care, hasn’t been made till now. PMID:25516851

  11. Managing the relational character of public-private partnership contracts

    Directory of Open Access Journals (Sweden)

    Cvetković Predrag

    2015-01-01

    Full Text Available A public-private partnership contract has the character of a relational contract. Relational contracts are incomplete agreements governing transactions where the contracting parties have mutually agreed that it is impossible or economically inefficient to contractually define ex ante possible difficulties and contingencies in the contract implementation, nor the difficulties and contingencies underlying the ex post control of contract performance by a third entity (court or arbitration. Considering the methodology of managing relational contracts, it is essential that the theory of relational contracts does not advocate for the establishment of relational contracts as a separate category of contracts, with specifically designated contractual instruments. This theory defines the relational contract as a category which legitimizes 'the relational mode' of a particular contract. The methodology of relational contracts is important for contracts on public-private partnership as it ensures that the contractual relationship is aligned with the changes in the immediate environment where the PPP contract operates. The aforementioned alignment has two aspects. The first one is the ex ante aspect of the alignment which is primarily aimed at preventing the detrimental effect of such alignment to the public partner's interests. Therefore, the intent to prevent such an effect shall be taken into account when defining the criteria for the selection of the most favorable private partner and the best offer. At the same time, it is essential to establish verifiable standards for measuring the private partner performance in the phase of contract implementation. For this goal to be achieved, it is crucial to specify the subject matter of the private partner's obligations, to establish the priority rank of PPP project objectives, to elaborate on the specific requirements governing the eligibility of private partners to participate in the bidding process, to specify

  12. Resilient but addicted: The impact of resilience on the relationship between smoking withdrawal and PTSD.

    Science.gov (United States)

    Asnaani, Anu; Alpert, Elizabeth; McLean, Carmen P; Foa, Edna B

    2015-06-01

    Nicotine use is common among people with posttraumatic stress disorder (PTSD). Resilience, which is reflected in one's ability to cope with stress, has been shown to be associated with lower cigarette smoking and posttraumatic stress symptoms, but relationships among these three variables have not been examined. This study investigates the relationships of resilience and nicotine withdrawal with each other and in relation to PTSD symptoms. Participants were 118 cigarette smokers with PTSD seeking treatment for PTSD and nicotine use. Data were randomly cross-sectionally sampled from three time points: week 0, week 12, and week 27 of the study. Hierarchical multiple regression analyses revealed main effects of both resilience and nicotine withdrawal symptoms on PTSD severity, controlling for the sampled time point, negative affect, and expired carbon monoxide concentration. Consistent with prior research, PTSD severity was higher among individuals who were less resilient and for those who had greater nicotine withdrawal. There was an interaction between resilience and nicotine withdrawal on self-reported PTSD severity, such that greater resilience was associated with lower PTSD severity only among participants with low nicotine withdrawal symptoms. Among individuals with high nicotine withdrawal, PTSD severity was high, regardless of resilience level. These results suggest that resilience is a protective factor for PTSD severity for those with low levels of nicotine withdrawal, but at high levels of nicotine withdrawal, the protective function of resilience is mitigated.

  13. 42 CFR 457.170 - Withdrawal process.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Withdrawal process. 457.170 Section 457.170 Public... Plans for Child Health Insurance Programs and Outreach Strategies § 457.170 Withdrawal process. (a... amendment, or any portion of a proposed State plan or plan amendment, at any time during the review...

  14. Behavioral measures of anxiety during opiate withdrawal.

    Science.gov (United States)

    Grasing, K; Wang, A; Schlussman, S

    1996-10-01

    Heightened anxiety is a major component of the withdrawal syndromes associated with ethanol and sedative hypnotic medications. Because of similarities between the opiate and sedative-hypnotic withdrawal syndromes as well as data implicating heightened noradrenergic tone with opiate withdrawal, we investigated changes in anxiety measures identified by plus-maze and social interaction testing during opiate withdrawal. Because Sprague Dawley rats had very low levels of entry into plus-maze open arms, further studies were conducted using the Long-Evans strain. Long-Evans rats received continuous infusions of morphine sulfate at 44 mg/kg per day delivered by osmotic pump over 7 days while control animals received inert implants. During the first 3 days of withdrawal, the number and time of entries into open and closed arms of a plus-maze was recorded. Both social and aggressive behaviors were scored durings pairings of groups of two socially naive animals. Body weight was significantly reduced in morphine-treated animals prior to and during withdrawal. Both the number of entries into open plus-maze arms and the time spent in open areas increased over the 3 days of testing. However, no difference in plus-maze activity was detected between morphine-treated and control subjects. On the third day of withdrawal, social interaction time was greater in pairs of withdrawn and control subjects compared to pairs of two control subjects. In conclusion, behavioral measures of anxiety are not increased during opiate withdrawal.

  15. Takotsubo cardiomyopathy triggered by alcohol withdrawal.

    Science.gov (United States)

    Alexandre, Joakim; Benouda, Leila; Champ-Rigot, Laure; Labombarda, Fabien

    2011-07-01

    Takotsubo cardiomyopathy is a reversible cardiomyopathy frequently precipitated by a sudden emotional or physical stress. The exact physiopathology is still debated and may involve catecholamine-induced myocardial stunning. Alcohol withdrawal is associated with an hyperadrenergic state and may be a period at risk of cardiac events. We report a 56-year-old man with Takotsubo cardiomyopathy triggered by alcohol withdrawal.

  16. THE MAIN COST-RELATED FACTORS IN AIRLINES MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Olesya Suntsova

    2016-03-01

    Full Text Available This paper analyzes the main factors that affect the strategies to reduce airlines costs. These costs factors were presented to experts from the airline industry through two rounds of questionnaires in sense tobe weighed. It was applied a method based on the structure of the AHP (Analytic Hierarchy Process and the results show that the main important factors for a cost-related airlines strategy are, in importance: routestructure and mesh; type and characteristics of the aircraft; cost of labor and management quality. This hierarchycan help the decision maker when facing the need of defining priorities in reduction costs. past decades despitethe increase in air transportation and significant decrease in average operation costs, it is observed that airlineshave low profitability. The liberalization of the markets and increase opportunities for competition diminishesprices, even when airlines face increasing costs. Considering that advantage in costs is an important strategy forcarriers to remain in the market, this paper analyzes the main factors that affect the strategies to reduce airlinescosts. These costs factors were presented to experts from the airline industry through two rounds ofquestionnaires in sense to be weighed. It was applied a method based on the structure of the AHP (AnalyticHierarchy Process and the results show that the main important factors for a cost-related airlines strategy are, inorder of importance: route structure and mesh; type and characteristics ofthe aircraft; cost of labor andmanagement quality. This hierarchy can help the decision maker when facing the need of defining priorities inreduction costs.

  17. Manager-Educator Relations from a Critical Perspective.

    Science.gov (United States)

    Elliott, Carole; Reynolds, Michael

    2002-01-01

    Examines contrasting views of the relationship between business managers and management educators in critical management literature. Uses Gramsci's ideas to support a less-hierarchical relationship that emphasizes critical dialogue and negotiated meaning rather than transmitted knowledge. (Contains 41 references.) (SK)

  18. The logic of relations and the logic of management.

    Science.gov (United States)

    Buntinx, W

    2008-07-01

    Increasing emphasis on financial and administrative control processes is affecting service culture in support organisations for persons with intellectual disability. This phenomenon is currently obvious in Dutch service organisations that find themselves in transition towards more community care and at the same time under pressure from new administrative and funding managerial bureaucracy. As a result, the logic of management is becoming more dominant in direct support settings and risk to overshadow the logic of relationships between staff and clients. The article presents a reflection on this phenomenon, starting from a description of service team characteristics as found in the literature. Next, findings about direct support staff (DSS) continuity are summarised from four Dutch studies. Following up these findings, the concept of 'microsystems' is explored as a possible answer to the organisational challenges demonstrated in the studies. Team characteristics, especially team size and membership continuity for DSS, appear relevant factors for assuring supportive relationships and service quality in direct support teams. The structure of the primary support team shows to be of special interest. The organisational concept of 'microsystems' is explored with respect to transcending the present conflict between bureaucratic managerial pressure and the need for supportive relationships. Service organisations need to create structural conditions for the efficacy of direct support teams in terms of client relationships and relevant client outcomes. At the same time, the need for administrative and control processes can not be denied. The concept of 'microsystems', application of a Quality of Life framework and the use of new instruments, such as the Supports Intensity Scale, can contribute to an organisational solution for the present conflicting logic of relations and management.

  19. Diet influences cocaine withdrawal behaviors in the forced swimming test.

    Science.gov (United States)

    Loebens, M; Barros, H M T

    2003-01-01

    The effects of drugs of abuse might depend on several environmental factors, among them the individual's feeding habits. It was our objective to study the influence of the diet on cocaine acute behavioral effects and during the first 5 days of withdrawal after prolonged treatment. Rats were fed a balanced diet, high-protein diet, high-carbohydrate diet or high-fat diet from weaning to adulthood. Adult rats were injected with 15 mg/kg cocaine 24, 5 and 1 h before the forced swimming retest or the drug was administered daily during 15 days and the animals were evaluated in the forced swimming test on five daily occasions after drug withdrawal. Diets alone did not induce significant behavioral differences in locomotion, immobility, swimming, climbing or head shakes. Acute cocaine reduced immobility during the forced swimming test and increased locomotion demonstrating a nonspecific antiimmobility effect related to hyperactivity. Acute cocaine reduced head shakes of rats fed high-protein and high-carbohydrate diets. After cocaine withdrawal, head shakes were decreased for rats fed any of the diets and rats were more immobile if fed a high-fat diet and were less immobile if fed a high-protein or high-carbohydrate diet. In conclusion, differences in the amounts of macronutrients in the diet may cause different behavioral outcomes after acute cocaine and during cocaine withdrawal.

  20. Causes of withdrawal of duodenal levodopa infusion in advanced Parkinson disease.

    Science.gov (United States)

    Calandrella, Daniela; Romito, Luigi M; Elia, Antonio E; Del Sorbo, Francesca; Bagella, Caterina F; Falsitta, Massimo; Albanese, Alberto

    2015-04-21

    We performed a real-life observation of patients with Parkinson disease (PD) who received duodenal levodopa infusion (DLI) to determine which adverse events caused treatment discontinuation and when such events occurred. All consecutive patients with PD treated at the Carlo Besta Neurological Institute were included. The patients were evaluated at baseline and after DLI at regular intervals. Their motor condition was assessed and adverse events were recorded. Thirty-five patients with PD (15 men and 20 women) were included. They received DLI implants between October 2007 and September 2013. Four patients died of causes unrelated to the procedure. At the end of the study, 21 patients (60%) were still on treatment. DLI provided efficacious motor control in all patients. Discontinuation was most frequently caused by device- or infusion-related adverse events. Ten patients of the remaining 31 discontinued DLI. There were 2 main causes of withdrawal: stoma infection (4 patients), and worsening of dyskinesias not manageable with infusion reduction (3 patients). In most patients, discontinuations occurred during the first year after implant. Risk of discontinuation was related to age at implant, but no other demographic or clinical variables. We identified 2 main causes leading to DLI withdrawal during the first year postimplant and suggest adopting measures to prevent such occurrences. Elderly patients are at higher risk of treatment discontinuation. © 2015 American Academy of Neurology.

  1. Why Iranian married women use withdrawal instead of oral contraceptives? A qualitative study from Iran

    Directory of Open Access Journals (Sweden)

    Kazemnejad Anoushiravan

    2010-05-01

    Full Text Available Abstract Background Withdrawal as a method of birth control is still used in Iran. The aim of this study was to explore married women's perspectives and attitudes on withdrawal use instead of oral contraceptive (OC in Tehran, Iran. Methods This was a qualitative study. Participants were 50 married women, not currently pregnant, not desiring pregnancy and who had been using withdrawal for contraception. Face-to face interviews were conducted to collect data. Content analysis was performed to analyze the data. Results Four major themes were extracted from the interviews: advantages, disadvantages, barriers for OC use, and husband-related factors. Advantages of withdrawal use were identified as: easy to use, convenient, ease of access, natural. Even those participants who had experienced unwanted pregnancy while using withdrawal, relied on withdrawal as their contraceptive method. Disadvantages of OC included concerns about side effects. Barriers related to use of OC included the need for medical advice, vaginal examination and daily use. Husband-related factors included: the husband wanted to be the primary decision maker on the number of children and that he preferred withdrawal. Conclusion Health providers should address misunderstandings that exist about OC and highlight the non-contraceptive health benefits of OC to balance the information provided for women. We suggest that not only women but also their spouses be advised in family planning programs.

  2. Profitability recent open stock funds in Brazil: analysis of the performance of a management Funds Group active in relation to management fees charged for resource managers

    OpenAIRE

    Sergio Ricardo Mendes Vasconcelos; Silvana Festa Sabes; Alexandre Gonzales

    2016-01-01

    This paper aimed to evaluate the performance of a specific group of active management equity investments funds relating it to the management fees charged by managers in order to answer the following research problem: open equity funds with active management, that charge higher management fees, are those that provide the best returns for the investor? The objective was to test the hypothesis under which it is evident that the funds that charged the highest rates are those with the best perform...

  3. Customer Relations Management sebagai Salah Satu Upaya Public Relations Perusahaan Jasa Perbankan Menciptakan Good Image

    Directory of Open Access Journals (Sweden)

    Prima Ayu Rizqi Mahanani

    2017-01-01

    Full Text Available This article deals with marketing trends in the 21st century is shifting from a transactional approach to the relational approach with focus on the fulfillment of needs, satisfaction, and pleasure affect business banking customers are very dependent on the customer. Map business services banking services fickle demands creativity public relations in providing the best service to its customers get a good image. Service concept using the service paradigm leading to cultivate the power of the customer based on the customer satisfaction-oriented, widely used by business banking services at this time. Paradigms that focus on how to provide services to the customer so that the customer was satisfied, beyond what can be given to something that is important and not to be underestimated. Skills to understand and fulfill customer expectations should be every company’s business philosophy of banking services and customer relationship management is a strategy

  4. S100B and homocysteine in the acute alcohol withdrawal syndrome.

    Science.gov (United States)

    Wedekind, Dirk; Neumann, Karolin; Falkai, Peter; Malchow, Berend; Engel, Kirsten Rita; Jamrozinski, Katja; Havemann-Reinecke, Ursula

    2011-03-01

    Elevations of serum homocysteine levels are a consistent finding in alcohol addiction. Serum S100B levels are altered in different neuropsychiatric disorders but not well investigated in alcohol withdrawal syndromes. Because of the close connection of S100B to ACTH and glutamate secretion that both are involved in neurodegeneration and symptoms of alcoholism the relationship of S100B and homocysteine to acute withdrawal variables has been examined. A total of 22 male and 9 female inpatients (mean age 46.9 ± 9.7 years) with an ICD-10 diagnosis of alcohol addiction without relevant affective comorbidity were examined on admission and after 24, 48, and 120 h during withdrawal. S100B and homocysteine levels in serum were collected, and severity of withdrawal symptoms (AWS-scale), applied withdrawal medication, initial serum ethanol levels and duration of addiction were recorded. Serum S100B and homocysteine levels declined significantly (P < .05) over time. Both levels declined with withdrawal syndrome severity. Females showed a trend to a more intense decline in serum S100B levels compared to males at day 5 (P = .06). Homocysteine levels displayed a negative relationship to applied amount of clomethiazole (P < .05) and correlated with age of onset of addiction. No withdrawal seizures were recorded during the trial. As it is known for homocysteine, S100B revealed to decline rapidly over withdrawal treatment in alcoholism. This effect is more pronounced in female patients. S100B could be of relevance in the neurobiology of alcohol withdrawal syndromes. It may be indirectly related to the level of stress level or glutamatergic activity during alcohol withdrawal.

  5. Student teacher anxieties related to class management, pedagogy, evaluation, and staff relations.

    Science.gov (United States)

    Morton, L L; Vesco, R; Williams, N H; Awender, M A

    1997-03-01

    Anxiety is an important consideration in teaching, with implications for classroom success. We investigated the nature of anxiety in student teachers. Approximately 1000 student teachers in Canada were involved in four studies to explore education-related anxieties. Incorporating a cross-cultural focus, student teachers were tested on an anxiety measure designed for British student teachers, then examined for (1) the impact of practice teaching, (2) the value of instructional preparation, (3) demographic variables, and (4) models that predict anxiety. Anxiety factors (i.e., evaluation, pedagogical, class management, and staff relations), similar to those for British participants, emerged with evaluation anxiety being highest. A practice teaching experience generated reduced anxiety for both sexes, but more so for females, with the greatest reductions for evaluation and pedagogical anxiety. In one study, participants reported anxieties prior to instruction (PRETEST), following instruction (POST-INSTR) and following practice teaching (POST-TEACH). Females showed higher anxiety ratings than males (PRETEST and POST-INSTR) but were comparable to males after practice teaching. Females in the lower grades division showed higher anxiety scores. Anxiety decreased between PRE-TEST and POST-INSTR for all four scales, and between POST-INSTR and POST-TEACH for evaluation, pedagogy and staff relations; however, class management anxiety did not decrease after practice teaching. Also, anxiety increased as placement grade level decreased. All models (demographic, experiential, and dispositional) were predictive but the best predictor was the psychological disposition to feel overwhelmed. Student-teacher anxieties are related to demographic variables, experiential variables, and dispositional variables.

  6. Withdrawing to a virtual world: Associations between subtypes of withdrawal, media use, and maladjustment in emerging adults.

    Science.gov (United States)

    Nelson, Larry J; Coyne, Sarah M; Howard, Emily; Clifford, Brandon N

    2016-06-01

    An approach-avoidance model of social withdrawal (Asendorpf, 1990) identifies 3 types of social withdrawal including shyness, unsociability, and avoidance. Each appears to be uniquely associated with varying indicators of maladjustment in emerging adulthood (Nelson, 2013) but little, if any, work has been done to see how they might be linked to media use in the third decade of life. Therefore, the purpose of this study was to examine longitudinally the links between subtypes of social withdrawal, connective media (e.g., e-mail, social networking) and problematic (forms of media such as violent video games that, when used in high amounts, have been found to be linked to indices of maladjustment) media use, and internalizing and externalizing behaviors. The participants in the study (Mage = 20.70, SD = 1.98, range = 18-29 at Time 2) consisted of 204 undergraduate students (58% female) recruited from 2 large public universities in the United States who completed questionnaires at 2 points of time separated by 1 year. Results revealed that avoidant individuals use problematic forms of media more than average, unsociable, and shy individuals. Furthermore, problematic media use predicted more withdrawn behavior at Time 2 and mediated the relation between avoidance and externalizing behaviors over time. Few problems were found for unsociable behavior. The need to differentiate between multiple forms of withdrawal in emerging adulthood and their links with problematic forms of media and subsequent risk factors is discussed. (PsycINFO Database Record

  7. Treatment of acute alcohol withdrawal with gabapentin: results from a controlled two-center trial.

    Science.gov (United States)

    Bonnet, Udo; Banger, Markus; Leweke, F Markus; Specka, Michael; Müller, Bernhard W; Hashemi, Thilo; Nyhuis, Peter W; Kutscher, Sven; Burtscheidt, Wilhelm; Gastpar, Markus

    2003-10-01

    A few case reports and data from animal experiments point to a possible efficacy of gabapentin (GP) in the treatment of alcohol withdrawal syndrome (AWS). Because of ethical considerations, the efficacy of GP in acute AWS was tested in an add-on fashion to clomethiazole (CLO). Given that the symptom-triggered amount of CLO required to limit AWS within the first 24 hours is related to the severity of AWS, we tested this amount of CLO during placebo (P) or GP (400 mg qid) under double blind, randomized conditions. Sixty-one patients (P = 29/GP = 32) suffering from alcohol dependence (ICD-10) and without any other psychiatric condition or psychotropic medication were included. The groups were not significantly different in baseline characteristics (eg, demographic data, severity of AWS). Both ITT and completer analyses revealed no significant differences between the groups considering the primary effectiveness measure: amount of CLO required in the first 24 hours (P = 6.1 +/- 5.4/GP = 6.2 +/- 4.7 capsules). In addition, premature discontinuations (P = 3/GP = 2) and decreases in Mainz Alcohol Withdrawal Scores were not significantly different in the first 48 hours of AWS (secondary effectiveness measures). Tolerability of combined CLO/GP was studied throughout the whole treatment comprising a 5-day lasting reduction part subsequent to the first 48 hours. Throughout the whole 7-day treatment a total of 5 and 2 patients dropped out and 6 and 5 patients reported adverse clinical events in the P and GP groups, respectively. All together, GP (400 mg qid) was no better than P in saving initial consumption of CLO or decreasing initial Mainz Alcohol Withdrawal Scores suggesting that GP was ineffective in the management of acute AWS in this model. The combination of GP and CLO was safe.

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

    Science.gov (United States)

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

    2016-04-01

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

  9. Monitoring asthma in childhood: management-related issues

    Directory of Open Access Journals (Sweden)

    Bart L. Rottier

    2015-06-01

    Full Text Available Management-related issues are an important aspect of monitoring asthma in children in clinical practice. This review summarises the literature on practical aspects of monitoring including adherence to treatment, inhalation technique, ongoing exposure to allergens and irritants, comorbid conditions and side-effects of treatment, as agreed by the European Respiratory Society Task Force on Monitoring Asthma in Childhood. The evidence indicates that it is important to discuss adherence to treatment in a non-confrontational way at every clinic visit, and take into account a patient's illness and medication beliefs. All task force members teach inhalation techniques at least twice when introducing a new inhalation device and then at least annually. Exposure to second-hand tobacco smoke, combustion-derived air pollutants, house dust mites, fungal spores, pollens and pet dander deserve regular attention during follow-up according to most task force members. In addition, allergic rhinitis should be considered as a cause for poor asthma control. Task force members do not screen for gastro-oesophageal reflux and food allergy. Height and weight are generally measured at least annually to identify individuals who are susceptible to adrenal suppression and to calculate body mass index, even though causality between obesity and asthma has not been established. In cases of poor asthma control, before stepping up treatment the above aspects of monitoring deserve closer attention.

  10. Risk Management in Supply Chain using Consistent Fuzzy Preference Relations

    OpenAIRE

    Ahmad Jafarnejad; Mehran Ebrahimi; Mohammad Ali Abbaszadeh; Seyed Mehdi Abtahi

    2014-01-01

    Nowadays, supply chains are exposed to numerous risks. Thus, to success in risky business environment, it is imperative for firms to systematically manage supply chain risks. Risk management is the identification, assessment, and prioritization of supply chain risks. The purpose of this paper is to propose a comprehensive approach to risk management in supply chains. Thus, by an appropriate review of the literature, supply chain risk sources are identified in six areas. Then, a CFPR method is...

  11. Supply chain management and relational competitive advantage in footwear industry

    National Research Council Canada - National Science Library

    Fernando Luiz Emerenciano Viana; José de Paula Barros Neto; Miguel Eduardo Moreno Añez

    2014-01-01

    This work investigated the supply chain management contribution to competitive advantage for companies in the footwear industry, with a primary focus on the inter-organizational relationship analysis...

  12. Dexmedetomidine infusion to facilitate opioid detoxification and withdrawal in a patient with chronic opioid abuse

    Directory of Open Access Journals (Sweden)

    Surjya Prasad Upadhyay

    2011-01-01

    Full Text Available Many patients are admitted to the intensive care unit (ICU for acute intoxication, serious complication of overdose, or withdrawal symptoms of illicit drugs. An acute withdrawal of drugs with addiction potential is associated with a sympathetic overactivity leading to marked psychomimetic disturbances. Acute intoxication or withdrawal of such drugs is often associated with life-threatening complications which require ICU admission and necessitate prolonged sedative analgesic medications, weaning from which is often complicated by withdrawal and other psychomimetic symptoms. Dexmedetomidine, an alpha-2 (α2 agonist, has been used successfully to facilitate withdrawal and detoxification of various drugs and also to control delirium in ICU patients. Herein, we report a case of a chronic opioid abuse (heroin patient admitted with acute overdose complications leading to a prolonged ICU course requiring sedative-analgesic medication; the drug withdrawal-related symptoms further complicated the weaning process. Dexmedetomidine infusion was successfully used as a sedative-analgesic to control the withdrawal-related psychomimetic symptoms and to facilitate smooth detoxification and weaning from opioid and other sedatives.

  13. Sex- and hormone-dependent alterations in alcohol withdrawal-induced anxiety and corticolimbic endocannabinoid signaling.

    Science.gov (United States)

    Henricks, Angela M; Berger, Anthony L; Lugo, Janelle M; Baxter-Potter, Lydia N; Bieniasz, Kennedy V; Petrie, Gavin; Sticht, Martin A; Hill, Matthew N; McLaughlin, Ryan J

    2017-09-15

    Alcohol dependence is associated with anxiety during withdrawal. The endocannabinoid (ECB) system participates in the neuroendocrine and behavioral response to stress and changes in corticolimbic ECB signaling may contribute to alcohol withdrawal-induced anxiety. Moreover, symptoms of alcohol withdrawal differ between sexes and sexual dimorphism in withdrawal-induced ECB recruitment may be a contributing factor. Herein, we exposed intact male and female rats and ovariectomized (OVX) female rats with or without estradiol (E2) replacement to 6 weeks of chronic intermittent alcohol vapor and measured anxiety-like behavior, ECB content, and ECB-related mRNA in the basolateral amygdala (BLA) and ventromedial prefrontal cortex (vmPFC). Acute alcohol withdrawal increased anxiety-like behavior, produced widespread disturbances in ECB-related mRNA, and reduced anandamide (AEA) content in the BLA and 2-arachidonoylglycerol (2-AG) content in the vmPFC of male, but not female rats. Similar to males, alcohol-exposed OVX females showed reductions in Napepld mRNA in the BLA, decreased AEA content in the BLA and vmPFC, and reductions in all ECB-related genes measured in the vmPFC. Importantly, E2 replacement prevented withdrawal-induced alterations in ECB content (but not mRNA) in OVX females, and although alcohol-exposed OVX females failed to exhibit more anxiety compared to their respective control, chronic alcohol exposure abolished the anxiolytic properties of E2 in OVX rats. These data indicate that ovarian sex hormones (but not E2 alone) protect against withdrawal-induced alterations in corticolimbic ECB signaling but do not impart resilience to withdrawal-induced anxiety. Thus, the mechanisms implicated in the manifestation of alcohol withdrawal-induced anxiety are most likely sex-specific. This article is part of the Special Issue entitled "A New Dawn in Cannabinoid Neurobiology". Published by Elsevier Ltd.

  14. Industry withdrawal from psychiatric medication development

    Directory of Open Access Journals (Sweden)

    Donald F. Klein

    2014-09-01

    Full Text Available Between 1950 and 1969, on a serendipitous basis, psychiatric drug development flourished. However, there has been a steep decline in the development of new medication classes. Instead of new molecular entities, slight molecular modifications producing “me-too” drugs attempted to garner market share. With failing profitability, industry is now withdrawing from psychiatric medication development. Managed care drastically shortened contact between patients and clinicians, so the possible observation of unexpected benefits has been nullified. The randomized, parallel-groups design met FDA requirements for specific pharmacological efficacy. However, it does not determine whether a patient who improved while drug-treated required the drug or would have gotten better on his own. Further, pathophysiology benefit remains obscure. The major psychotropic drugs have no benefits for normal subjects. Their remarkable benefits must stem from a necessary interaction with a pathophysiological state. Therefore, understanding therapeutic benefit by treating normal subjects becomes unlikely. The claim that therapeutic knowledge in psychiatry proceeds from bench to bedside has proven vacuous, primarily because of our limited understanding of brain pathophysiology. The utility of the alternative intensive design for understanding diagnosis, therapeutic benefit, and pathophysiology is emphasized.

  15. Using Relative Humidity Forecasts to Manage Meningitis in the Sahel

    Science.gov (United States)

    Pandya, R. E.; Adams-Forgor, A.; Akweogno, P.; Awine, T.; Dalaba, M.; Dukic, V.; Dumont, A.; Hayden, M.; Hodgson, A.; Hopson, T. M.; Hugonnet, S.; Yoksas, T. C.

    2012-12-01

    the number cases of meningitis in the Sahel. Using currently available forecast models contributed through the WMO Thorpex-Tigge project, and applying quantile regression to enhance their accuracy, we can forecast the average weekly relative humidity to two weeks in advance which allows us to anticipate the end of an epidemic in a region of the Sahel up to four weeks in advance. This would allow public health officials to deploy vaccines to areas in which the epidemics are likely to persist due to continued dryness and avoid vaccinating in areas where the epidemics will end with higher humidity. Our presentation will conclude by introducing the relative humidity decision-information tool developed for use by public-health officials. We will also summarize the results of a weekly meningitis forecast exercise held during the 2011-2012 dry season with public health decision makers from several African countries and the World Health Organization. Finally, we highlight some results of concurrent socio-economic research that suggests other interventions for managing meningitis and helps quantify the economic impact of the disease in Ghana. Overall, while our research has demonstrated an actionable relationship between weather and disease, this relationship is only one factor in a complex and coupled human-natural system which merits continued investigation.

  16. [Gabapentin treatment in a female patient with panic disorder and adverse effects under carbamazepine during benzodiazepine withdrawal].

    Science.gov (United States)

    Himmerich, Hubertus; Nickel, Thomas; Dalal, Mira A; Müller, Marianne B

    2007-03-01

    Despite their addictive potential, benzodiazepines belong to the most often prescribed drugs. We report on a patient with alprazolam dependence, who initially was treated with carbamazepine because of severe withdrawal symptoms. Due to liver enzyme elevation related to carbamazepine, we had to stop this treatment and instead of that started gabapentin treatment. Under this new therapy, the patient showed a dramatic relief of withdrawal symptoms and of the panic attacks recurring during withdrawal. Hence, due to their effectiveness and tolerability, newer anticonvulsants could be considered as medication for benzodiazepine withdrawal and as an alternative for benzodiazepine treatment in panic disorders.

  17. High School Students' Time Management Skills in Relation to Research Anxiety

    Science.gov (United States)

    Akcoltekin, Alpturk

    2015-01-01

    This study aimed to determine the opinions of high school students relating to time management and present a correlation of their time management skills with demographic variables, as well as examining the relation between their level of research anxiety and time management skills. The study group composed 270 12th-grade students (127 males and…

  18. 48 CFR 52.251-2 - Interagency Fleet Management System Vehicles and Related Services.

    Science.gov (United States)

    2010-10-01

    ... Management System Vehicles and Related Services. 52.251-2 Section 52.251-2 Federal Acquisition Regulations... Services. As prescribed in 51.205, insert the following clause: Interagency Fleet Management System... to obtain interagency fleet management system vehicles and related services for use in the...

  19. 48 CFR 51.204 - Use of interagency fleet management system (IFMS) vehicles and related services.

    Science.gov (United States)

    2010-10-01

    ... management system (IFMS) vehicles and related services. 51.204 Section 51.204 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT USE OF GOVERNMENT SOURCES BY CONTRACTORS... system (IFMS) vehicles and related services. Contractors authorized to use interagency fleet management...

  20. 36 CFR 1237.10 - How must agencies manage their audiovisual, cartographic, and related records?

    Science.gov (United States)

    2010-07-01

    ... their audiovisual, cartographic, and related records? 1237.10 Section 1237.10 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT AUDIOVISUAL, CARTOGRAPHIC, AND RELATED RECORDS MANAGEMENT § 1237.10 How must agencies manage their audiovisual, cartographic, and...

  1. Community Relations: DOD’s Approach for Using Resources Reflects Sound Management Principles

    Science.gov (United States)

    2016-09-01

    COMMUNITY RELATIONS DOD’s Approach for Using Resources Reflects Sound Management Principles Report to...Sound Management Principles What GAO Found The Department of Defense’s (DOD) approach for determining which community relations activities to...undertake reflects sound management principles —both for activities requested by non-DOD entities and for activities initiated by the department. DOD and

  2. Treatment of alcohol withdrawal syndrome with gabapentin.

    Science.gov (United States)

    Bonnet, U; Banger, M; Leweke, F M; Maschke, M; Kowalski, T; Gastpar, M

    1999-05-01

    Four in-patients with moderate alcohol-withdrawal syndromes benefited from treatment with gabapentin administered in an add-on fashion to clomethiazole. In comparison with the amount of clomethiazole required as estimated using a specially developed score during previous detoxifications of these patients at our hospital, gabapentin (400 mg q.i.d.) clearly reduced the amount of clomethiazole needed now Gabapentin, an anticonvulsant with favorable pharmacokinetic properties and tolerability, and with no known risk of dependence, may therefore be a useful new drug in the treatment of alcohol withdrawal. We believe that the potential value of gabapentin in alcohol withdrawal deserves further controlled studies.

  3. Development of a Relational Database for Learning Management Systems

    Science.gov (United States)

    Deperlioglu, Omer; Sarpkaya, Yilmaz; Ergun, Ertugrul

    2011-01-01

    In today's world, Web-Based Distance Education Systems have a great importance. Web-based Distance Education Systems are usually known as Learning Management Systems (LMS). In this article, a database design, which was developed to create an educational institution as a Learning Management System, is described. In this sense, developed Learning…

  4. International Companies Withdrawal from Lithuania: Problematics and Alternative Solutions

    Directory of Open Access Journals (Sweden)

    Viktorija Tauraitė

    2017-06-01

    Full Text Available The main attention in this article is focused on the problematic of international companies’ withdrawal from Lithuania and presentation of alternative solutions of this problem. The macro(Sweden, Austria, Latvia, Lithuania, Estonia, Poland level analysis and micro (“Coca-Cola”, “Nordea” and DNB, “Orkla” level analysis showed that competitiveness, business conditions, employment relations, institutional environment and innovation should be improved and the corruption should be reduced in Lithuania. It is advisable that current Lithuanian Labour Code should be revised in order to increase the efficiency of labour relations. It is found out that the significance of “Coca-Cola”company is the highest in the context of the withdrawing companies from Lithuania. It is assumed that the most rational solution for each company is to move from Lithuania to another country.

  5. An Engineered Endomorphin-2 Gene for Morphine Withdrawal Syndrome

    Science.gov (United States)

    Wu, Fei-xiang; He, Yan; Di, Hui-ting; Sun, Yu-ming; Pan, Rui-rui; Yu, Wei-feng; Liu, Renyu

    2016-01-01

    An optimal therapeutics to manage opioid withdrawal syndrome is desired for opioid addiction treatment. Down-regulation of endogenous endomorphin-2 (EM2) level in the central nervous system after continuous morphine exposure was observed, which suggested that increase of EM2 could be an alternative novel method for opioid dependence. As a short peptide, the short half-life of EM2 limits its clinical usage through conventional administration. In the present study, we engineered an EM2 gene using a signal peptide of mouse growth factor for an out-secretory expression of EM2 and an adenovirus as a vector, which ultimately sustained the release of EM-2. After administration of the adenovirus in central nervous system, a sustained increase of EM2 level in the cerebral spinal fluid (CSF) was observed along with a reduction of morphine withdrawal syndrome. These findings suggest that the engineered EM2 gene delivered to the central nervous system could be a novel therapeutics for withdrawal syndrome in opioid dependent subjects. PMID:27003293

  6. 45 CFR 400.301 - Withdrawal from the refugee program.

    Science.gov (United States)

    2010-10-01

    ... exception of the following provisions: 45 CFR 400.5(d), 400.7, 400.51(b)(2)(i), 400.58(c), 400.94(a), 400.94... 45 Public Welfare 2 2010-10-01 2010-10-01 false Withdrawal from the refugee program. 400.301 Section 400.301 Public Welfare Regulations Relating to Public Welfare OFFICE OF REFUGEE...

  7. Simulation and Learning to Care for Patients: Acute Alcohol Withdrawal

    Directory of Open Access Journals (Sweden)

    Leighsa Sharoff

    2013-03-01

    Full Text Available This paper examines the development of a complex patient simulation scenario providing senior nursing students experiences in enhanced clinical judgment, clinical reasoning, problem-solving and communication skills. Unforeseen co-morbid conditions, such as alcohol withdrawal syndrome, can become pronounced upon hospitalization. Teaching-learning strategies to provide opportunities to experience all facets of possible work-related experiences promote excellent patient care. [J Contemp Med 2013; 3(1.000: 28-35

  8. Association between nicotine withdrawal and reward responsiveness in humans and rats.

    Science.gov (United States)

    Pergadia, Michele L; Der-Avakian, Andre; D'Souza, Manoranjan S; Madden, Pamela A F; Heath, Andrew C; Shiffman, Saul; Markou, Athina; Pizzagalli, Diego A

    2014-11-01

    Reward-related disturbances after withdrawal from nicotine are hypothesized to contribute to relapse to tobacco smoking but mechanisms underlying and linking such processes remain largely unknown. To determine whether withdrawal from nicotine affects reward responsiveness (ie, the propensity to modulate behavior as a function of prior reinforcement experience) across species using translational behavioral assessments in humans and rats. Experimental studies used analogous reward responsiveness tasks in both humans and rats to examine whether reward responsiveness varied in (1) an ad libitum smoking condition compared with a 24-hour acute nicotine abstinence condition in 31 human smokers with (n = 17) or without (n = 14) a history of depression; (2) rats 24 hours after withdrawal from chronic nicotine (n = 19) or saline (n = 20); and (3) rats following acute nicotine exposure after withdrawal from either chronic nicotine or saline administration. Performance on a reward responsiveness task under nicotine and nonnicotine conditions. In both human smokers and nicotine-treated rats, reward responsiveness was significantly reduced after 24-hour withdrawal from nicotine (P responsiveness were greater in those with a history of depression. In rats previously exposed to chronic nicotine, acute nicotine reexposure long after withdrawal potentiated reward responsiveness (P responsiveness to natural rewards and to experience potentiated nicotine-induced reward responsiveness. Moreover, demonstration of behavioral homology across humans and rodents provides a strong translational framework for the investigation and development of clinical treatments targeting reward responsiveness deficits during early withdrawal of nicotine.

  9. Alcohol withdrawal syndrome in medical patients.

    Science.gov (United States)

    Gortney, Justine S; Raub, Joshua N; Patel, Pragnesh; Kokoska, Lianne; Hannawa, Mae; Argyris, Amy

    2016-01-01

    The authors provide a critical review focusing on pharmacotherapy of alcohol withdrawal syndrome in hospitalized patients who are not critically ill. They outline recommendations for patient assessment and monitoring. Copyright © 2016 Cleveland Clinic.

  10. Factors relating to the perceived management of emergency situations

    DEFF Research Database (Denmark)

    Birkvad Rasmussen, Maria; Tolsgaard, Martin G; Dieckmann, Peter

    2014-01-01

    BACKGROUND: This study explored individual, team, and setting factors associated with the quality of management of in-hospital emergency situations experienced by former Advanced Life Support (ALS) course participants. METHODS: This study was a survey of former ALS course participants' long......-term experience of management of in-hospital, emergency situations. The survey was carried out in 2012 in Denmark and Norway. RESULTS: A questionnaire was send to 526 potential responders and (281/479 × 100) 58.7% responded. The results demonstrated that 75% of the emergency situations were perceived as "managed...... to apply ALS principles, the team atmosphere and communication. Responders' ratings of quality of management of emergency situations increased with intensity of setting. However, the 'clinical setting' was rated significantly lower as attributor to ability to apply ALS principles compared to 'co...

  11. Oshkosh Logistic Management and Public Relations Responsibilities at NASA Langley

    Science.gov (United States)

    Beck, Danielle

    1995-01-01

    The central focus of my study for the summer of 1995 was to provide logistical support to Margaret Hunt, the logistics manager of the OSHKOSH airshow. In this capacity responsibilities included making arrangements for participants from NASA centers and SBIR companies for their stay in Wisconsin, while visiting the airshow, and managing staff for exhibits and the aerospace theater. A secondary purpose was to serve in other public service capacities by writing news releases, fact sheets, announcements, and articles for the Researcher News.

  12. A Relative Comparison of Leading Supply Chain Management Software Packages

    OpenAIRE

    Zhongxian Wang; Ruiliang Yan; Kimberly Hollister; Ruben Xing

    2009-01-01

    Supply Chain Management (SCM) has proven to be an effective tool that aids companies in the development of competitive advantages. SCM Systems are relied on to manage warehouses, transportation, trade logistics and various other issues concerning the coordinated movement of products and services from suppliers to customers. Although in today’s fast paced business environment, numerous supply chain solution tools are readily available to companies, choosing the right SCM software is not an e...

  13. European Clearinghouse - Contributing Factors to Incidents Related to Reactivity Management

    OpenAIRE

    BRUYNOOGHE Christiane; NOEL MARC

    2009-01-01

    In this paper shortcomings in reactivity management reported to the IAEA Incident Reporting System in the period 1981-2008 are investigated and contributing factors to reactivity management incidents are analysed. The aim of theworkwas to identify the initiating factors and associated root causes. Five of the seven factors identified for all events were present in the 1999 Shika-1 event where criticality has been unexpectedly reached and maintained during fifteen minutes. Most of the events r...

  14. Healthcare Professionals’ Perception and Related Factors About Total Quality Management

    OpenAIRE

    Tapan, Birkan; ALICI, Selin; GAYEF, Albena; YILDIRIM, Nurdan; Sezen, Adem

    2015-01-01

    Quality defined as extent of features of any product or service to meet expectations of consumers enjoying such product or service. Although it was a concept first emerged in manufacturing industry, today, it has become an important competitive factor for service institutions as well. Total Quality Management approach is drawing more and more interest as international borders start to fade out in parallel with globalization and increasing competition. Total Quality Management is a ma...

  15. Severe Relapsing Clozapine-Withdrawal Catatonia

    Science.gov (United States)

    Shahrour, Tarek; Siddiq, Muez; Ghalib, Saad

    2015-01-01

    Catatonia as a clozapine-withdrawal syndrome has only been documented in the medical literature as case reports. We are reporting a case in which a 32-year-old man develops a catatonic state upon withdrawal of clozapine. The state was quite severe and needed ICU admission. The course was chronic and intermittent which we think was caused by the poor adherence to antipsychotics. The importance of identifying such cases early is underlined. PMID:26788394

  16. Severe Relapsing Clozapine-Withdrawal Catatonia

    Directory of Open Access Journals (Sweden)

    Tarek Shahrour

    2015-01-01

    Full Text Available Catatonia as a clozapine-withdrawal syndrome has only been documented in the medical literature as case reports. We are reporting a case in which a 32-year-old man develops a catatonic state upon withdrawal of clozapine. The state was quite severe and needed ICU admission. The course was chronic and intermittent which we think was caused by the poor adherence to antipsychotics. The importance of identifying such cases early is underlined.

  17. Overcoming approach and withdrawal habits: Approaching former enemies is easier than withdrawing from former friends.

    Science.gov (United States)

    Kuhbandner, Christof; Haager, Julia S

    2016-11-01

    Both everyday intuition and experimental evidence suggest that habits are difficult to change. However, despite the abundance of research, it is unknown whether the ease of habit breaking differs with respect to the most elementary forms of behavior, approach versus withdrawal. In the present study, we addressed this question by monitoring the formation and overriding of approach and withdrawal habits. In an initial habit-formation phase, participants intensely practiced approach or withdrawal behavior to neutral everyday objects (Experiments 1) and emotionally laden persons (Experiment 2) until strong behavioral habits were formed. In a subsequent habit-breaking phase, they were asked to change their behavior for half of the approach stimuli to withdrawal, and for half of the withdrawal stimuli to approach. Two intriguing results were observed. First, the results in the habit-formation phase showed that the typically observed speed advantage of approach over withdrawal cannot be diminished by practice. Second, the results in the habit-breaking phase showed that overriding a withdrawal habit by approach is easier than overriding an approach habit by withdrawal. In the latter case, participants were more often caught by their older habit, even when responses were bolstered by appropriate emotions. Thus, other than reflected in everyday thinking, approaching former enemies seems to be easier than withdrawing from former friends. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  18. Global-scale analysis of river flow alterations due to water withdrawals and reservoirs

    Science.gov (United States)

    Döll, P.; Fiedler, K.; Zhang, J.

    2009-12-01

    Global-scale information on natural river flows and anthropogenic river flow alterations is required to identify areas where aqueous ecosystems are expected to be strongly degraded. Such information can support the identification of environmental flow guidelines and a sustainable water management that balances the water demands of humans and ecosystems. This study presents the first global assessment of the anthropogenic alteration of river flow regimes, in particular of flow variability, by water withdrawals and dams/reservoirs. Six ecologically relevant flow indicators were quantified using an improved version of the global water model WaterGAP. WaterGAP simulated, with a spatial resolution of 0.5 degree, river discharge as affected by human water withdrawals and dams around the year 2000, as well as naturalized discharge without this type of human interference. Compared to naturalized conditions, long-term average global discharge into oceans and internal sinks has decreased by 2.7% due to water withdrawals, and by 0.8% due to dams. Mainly due to irrigation, long-term average river discharge and statistical low flow Q90 (monthly river discharge that is exceeded in 9 out of 10 months) have decreased by more than 10% on one sixth and one quarter of the global land area (excluding Antarctica and Greenland), respectively. Q90 has increased significantly on only 5% of the land area, downstream of reservoirs. Due to both water withdrawals and reservoirs, seasonal flow amplitude has decreased significantly on one sixth of the land area, while interannual variability has increased on one quarter of the land area mainly due to irrigation. It has decreased on only 8% of the land area, in areas downstream of reservoirs where consumptive water use is low. The impact of reservoirs is likely underestimated by our study as small reservoirs are not taken into account. Areas most affected by anthropogenic river flow alterations are the Western and Central USA, Mexico, the

  19. Global-scale analysis of river flow alterations due to water withdrawals and reservoirs

    Directory of Open Access Journals (Sweden)

    P. Döll

    2009-12-01

    Full Text Available Global-scale information on natural river flows and anthropogenic river flow alterations is required to identify areas where aqueous ecosystems are expected to be strongly degraded. Such information can support the identification of environmental flow guidelines and a sustainable water management that balances the water demands of humans and ecosystems. This study presents the first global assessment of the anthropogenic alteration of river flow regimes, in particular of flow variability, by water withdrawals and dams/reservoirs. Six ecologically relevant flow indicators were quantified using an improved version of the global water model WaterGAP. WaterGAP simulated, with a spatial resolution of 0.5 degree, river discharge as affected by human water withdrawals and dams around the year 2000, as well as naturalized discharge without this type of human interference. Compared to naturalized conditions, long-term average global discharge into oceans and internal sinks has decreased by 2.7% due to water withdrawals, and by 0.8% due to dams. Mainly due to irrigation, long-term average river discharge and statistical low flow Q90 (monthly river discharge that is exceeded in 9 out of 10 months have decreased by more than 10% on one sixth and one quarter of the global land area (excluding Antarctica and Greenland, respectively. Q90 has increased significantly on only 5% of the land area, downstream of reservoirs. Due to both water withdrawals and reservoirs, seasonal flow amplitude has decreased significantly on one sixth of the land area, while interannual variability has increased on one quarter of the land area mainly due to irrigation. It has decreased on only 8% of the land area, in areas downstream of reservoirs where consumptive water use is low. The impact of reservoirs is likely underestimated by our study as small reservoirs are not taken into account. Areas most affected by anthropogenic river flow

  20. Antiepileptic drug withdrawal in dogs with epilepsy

    Directory of Open Access Journals (Sweden)

    Felix Kaspar Gesell

    2015-08-01

    Full Text Available Epilepsy is one of the most common neurological disorders in dogs and is treated by chronic administration of antiepileptic drugs (AEDs. In humans with epilepsy, it is common clinical practice to consider drug withdrawal after a patient has been in remission (seizure free for three or more years, but withdrawal is associated with the risk of relapse. In the present study, the consequences of AED withdrawal were studied in dogs with epilepsy. Therefore, 200 owners of dogs with idiopathic or presumed idiopathic epilepsy were contacted by telephone interview, 138 cases could be enrolled. In 11 cases the therapy had been stopped after the dogs had become seizure free for a median time of 1 year. Reasons for AED withdrawal were appearance or fear of adverse side effects, financial aspects and the idea that the medication could be unnecessary. Following AED withdrawal, 4 of these dogs remained seizure free, 7 dogs suffered from seizure recurrence, of which only 3 dogs could regain seizure freedom after resuming AED therapy. Due to the restricted case number, an exact percentage of dogs with seizure recurrence after AED withdrawal cannot be given. However, the present study gives a hint that similar numbers as in human patients are found, and the data can help owners of epileptic dogs and the responsible clinician to decide when and why to stop antiepileptic medication.

  1. Antiepileptic Drug Withdrawal in Dogs with Epilepsy.

    Science.gov (United States)

    Gesell, Felix Kaspar; Hoppe, Sonja; Löscher, Wolfgang; Tipold, Andrea

    2015-01-01

    Epilepsy is one of the most common neurological disorders in dogs and is treated by chronic administration of antiepileptic drugs (AEDs). In human beings with epilepsy, it is common clinical practice to consider drug withdrawal after a patient has been in remission (seizure free) for three or more years, but withdrawal is associated with the risk of relapse. In the present study, the consequences of AED withdrawal were studied in dogs with epilepsy. Therefore, 200 owners of dogs with idiopathic or presumed idiopathic epilepsy were contacted by telephone interview, 138 cases could be enrolled. In 11 cases, the therapy had been stopped after the dogs had become seizure free for a median time of 1 year. Reasons for AED withdrawal were appearance or fear of adverse side effects, financial aspects, and the idea that the medication could be unnecessary. Following AED withdrawal, four of these dogs remained seizure free, seven dogs suffered from seizure recurrence, of which only three dogs could regain seizure freedom after resuming AED therapy. Due to the restricted case number, an exact percentage of dogs with seizure recurrence after AED withdrawal cannot be given. However, the present study gives a hint that similar numbers as in human patients are found, and the data can help owners of epileptic dogs and the responsible clinician to decide when and why to stop antiepileptic medication.

  2. 21 CFR 514.7 - Withdrawal of applications without prejudice.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Withdrawal of applications without prejudice. 514... Withdrawal of applications without prejudice. The sponsor may withdraw his pending application from.... Such withdrawal may be made without prejudice to a future filing. Upon resubmission, the...

  3. 19 CFR 144.27 - Withdrawal from warehouse by transferee.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Withdrawal from warehouse by transferee. 144.27...; DEPARTMENT OF THE TREASURY (CONTINUED) WAREHOUSE AND REWAREHOUSE ENTRIES AND WITHDRAWALS Transfer of Right To Withdraw Merchandise from Warehouse § 144.27 Withdrawal from warehouse by transferee. At any time...

  4. 48 CFR 752.7024 - Withdrawal of students.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Withdrawal of students... Withdrawal of students. For use in contracts for participant training with an educational institution. Withdrawal of Students (APR 1984) (a) The Government may, at its option and at any time, withdraw any...

  5. 19 CFR 144.38 - Withdrawal for consumption.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Withdrawal for consumption. 144.38 Section 144.38... Withdrawal for consumption. (a) Form. Withdrawals for consumption of merchandise in bonded warehouses shall... considered a withdrawal for consumption pursuant to § 181.53 of this chapter. (c) Information to be shown on...

  6. 29 CFR 2700.22 - Notice of contest of imminent danger withdrawal orders under section 107 of the Act.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 9 2010-07-01 2010-07-01 false Notice of contest of imminent danger withdrawal orders under section 107 of the Act. 2700.22 Section 2700.22 Labor Regulations Relating to Labor (Continued....22 Notice of contest of imminent danger withdrawal orders under section 107 of the Act. (a) Time...

  7. Determination of Screw and Nail Withdrawal Resistance of Some Important Wood Species

    Directory of Open Access Journals (Sweden)

    Alper Aytekin

    2008-04-01

    Full Text Available In this study, screw and nail withdrawal resistance of fir (Abies nordmanniana, oak (Quercus robur L. black pine (Pinus nigra Arnold and Stone pine (Pinus pinea L. wood were determined and compared. The data represent the testing of withdrawal resistance of three types of screws as smart, serrated and conventional and common nails. The specimens were prepared according to TS 6094 standards. The dimensions of the specimens were 5x5x15cm and for all of the directions. Moreover, the specimens were conditioned at ambient room temperature and 65±2% relative humidity. The screws and nails were installed according to ASTM-D 1761 standards. Nail dimensions were 2.5mm diameter and 50 mm length, conventional screws were 4x50mm, serrated screws were 4x45mm and smart screws were 4x50mm. Results show that the maximum screw withdrawal resistance value was found in Stone pine for the serrated screw. There were no significant differences between Stone pine and oak regarding screw withdrawal resistance values. Conventional screw yielded the maximum screw withdrawal resistance value in oak, followed by Stone pine, black pine and fir. Oak wood showed the maximum screw withdrawal resistance value for the smart screw, followed by Stone pine, black pine, and fir. Oak wood showed higher nail withdrawal resistances than softwood species. It was also determined that oak shows the maximum nail withdrawal resistance in all types. The nail withdrawal resistances at the longitudinal direction are lower with respect to radial and tangential directions.

  8. Behavioral expression of opiate withdrawal is altered after prefrontocortical dopamine depletion in rats: monoaminergic correlates.

    Science.gov (United States)

    Espejo, E F; Serrano, M I; Caillé, S; Stinus, L

    2001-08-01

    The objective of this study was to establish the effects of prefrontocortical dopamine depletion on opiate withdrawal and prefrontocortical neurochemical changes elicited by morphine dependence and withdrawal. The dopaminergic content was also measured in the nucleus accumbens during withdrawal, in order to detect reactive changes induced by prefrontocortical lesion. Withdrawal was induced by naloxone in morphine-dependent rats. Monoamine levels were analyzed post-mortem by high performance liquid cromatography. The results showed that chronic morphine dependence did not modify basal levels of monoamines in sham rats, revealing neuroadaptation of prefrontocortical dopamine, noradrenaline and serotonin systems to chronic morphine. The neuroadaptive phenomenon remained after prefrontocortical lesion (> 79% dopamine depletion). On the other hand, a strong increase of dopamine, noradrenaline, and serotonin contents in the medial prefrontal cortex of sham rats was detected during opiate withdrawal. However, in lesioned rats, the increase of prefrontocortical dopamine and serotonin content, but not that of noradrenaline, was much lower. In the nucleus accumbens, prefrontocortical lesion reactively enhanced the dopaminergic tone and, although opiate withdrawal reduced dopaminergic activity in both sham and lesioned rats, this reduction was less intense in the latter group. At a behavioral level, some symptoms of physical opiate withdrawal were exacerbated in lesioned rats (writhing, mastication, teeth-chattering, global score) and exploration was reduced. The findings hence indicate that: (i) prefrontocortical monoaminergic changes play a role in the behavioral expression of opiate withdrawal; (ii) the severity of some withdrawal signs are related to the dopaminergic and serotonergic tone of the medial prefrontal cortex rather than to the noradrenergic one, and (iii) an inverse relationship between mesocortical and mesolimbic dopaminergic systems exists.

  9. MEDICATION MANAGEMENT CAPACITY IN RELATION TO COGNITION AND SELF-MANAGEMENT SKILLS IN OLDER PEOPLE ON POLYPHARMACY

    NARCIS (Netherlands)

    Sino, C. G. M.; Sietzema, M.; Egberts, T. C. G.; Schuurmans, M. J.

    2014-01-01

    Objective: to determine the medication management capacity of independently living older people (>= 75 years) on polypharmacy (>= 5 medications) in relation to their cognitive- and self-management skills. Design: Cross-sectional study. Setting: two homecare organizations in the Netherlands. Particip

  10. Dexmedetomidine as an adjuvant in the treatment of alcohol withdrawal delirium: a case report.

    Science.gov (United States)

    Rovasalo, Aki; Tohmo, Harri; Aantaa, Riku; Kettunen, Eija; Palojoki, Riitta

    2006-01-01

    In this case report, even a moderate dose of dexmedetomidine, a very selective alpha(2)-adrenergic agent, resulted in a rapid response to alcohol withdrawal delirium after the standard treatment. Psychiatrists should be aware of this relatively new drug that provides advantages over clonidine, heavy sedation and secondary restraints. Dexmedetomidine should be further evaluated in the treatment of specific forms of aggressive behavior and complicated withdrawal states.

  11. Changes in biochemical markers and bone mass after withdrawal of ibandronate treatment

    DEFF Research Database (Denmark)

    Ravn, Pernille; Christensen, J O; Baumann, M

    1998-01-01

    :527-533;1996). In this study, we analyzed the biochemical markers as predictors of response in bone mass during ibandronate treatment, and report withdrawal data from the last year of the study, when ibandronate was discontinued. The relative change in the biochemical markers was significantly correlated to the response...... the response in bone mass during ibandronate treatment. The bone loss that resumes after withdrawal of ibandronate treatment is of a magnitude similar to that of normal postmenopausal bone loss....

  12. Agency relations and managed performance in public universities in Uganda

    Directory of Open Access Journals (Sweden)

    James R.K. Kagaari

    2013-01-01

    Full Text Available Orientation: This article focused on the need for improved employer-employee relationships in order for public universities in Uganda to achieve their intended objectives.Research purpose: The purpose of this article was to review the need for appropriate employer-employee relationships that will ensure quality services and service delivery in public universities in Uganda.Motivation for the study: The researchers set out to examine why managers of public universities in Uganda were continuously paying less attention to the needs of the employees.Research design, approach and method: A descriptive research design was employed and 12 respondents, purposively selected from 4 public universities, were interviewed. Data were recorded, transcribed and analysed using Nvivo software. This article is based on the perspective of agency theory, and discussed the contractual relationship between management and employees. The agency theory was deemed necessary because of its contribution to organisational literature.Main findings: There is a need to create and nurture a collegial working climate that promotes quality interactions through information sharing. This results in creating and retaining motivated and committed employees, and also helps to overcome the paradox of balancing the high demand for university education whilst offering quality services.Practical/managerial implications: Managers have to continuously monitor and accommodate employee needs and demands.Contribution/value-add: The potential value of the paper is its function as a guide for public universities to have visionary managers that will introduce new approaches to managing public universities in a competitive global environment.

  13. Factors Relating to Managerial Stereotypes: The Role of Gender of the Employee and the Manager and Management Gender Ratio.

    Science.gov (United States)

    Stoker, Janka I; Van der Velde, Mandy; Lammers, Joris

    2012-03-01

    PURPOSE: Several studies have shown that the traditional stereotype of a "good" manager being masculine and male still exists. The recent changes in the proportion of women and female managers in organizations could affect these two managerial stereotypes, leading to a stronger preference for feminine characteristics and female leaders. This study examines if the gender of an employee, the gender of the manager, and the management gender ratio in an organization are related to employees' managerial stereotypes. DESIGN/METHODOLOGY/APPROACH: 3229 respondents working in various organizations completed an electronic questionnaire. FINDINGS: The results confirm our hypotheses that, although the general stereotype of a manager is masculine and although most prefer a man as a manager, female employees, employees with a female manager, and employees working in an organization with a high percentage of female managers, have a stronger preference for feminine characteristics of managers and for female managers. Moreover, we find that proximal variables are much stronger predictors of these preferences than more distal variables. IMPLICATIONS: Our study suggests that managerial stereotypes could change as a result of personal experiences and changes in the organizational context. The results imply that increasing the proportion of female managers is an effective way to overcome managerial stereotyping. ORIGINALITY/VALUE: This study examines the influence on managerial stereotypes of various proximal and distal factors derived from theory among a large group of employees (in contrast to students).

  14. 29 CFR 541.201 - Directly related to management or general business operations.

    Science.gov (United States)

    2010-07-01

    ...; budgeting; auditing; insurance; quality control; purchasing; procurement; advertising; marketing; research; safety and health; personnel management; human resources; employee benefits; labor relations; public...

  15. The cannabis withdrawal syndrome: current insights

    Science.gov (United States)

    Bonnet, Udo; Preuss, Ulrich W

    2017-01-01

    The cannabis withdrawal syndrome (CWS) is a criterion of cannabis use disorders (CUDs) (Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition) and cannabis dependence (International Classification of Diseases [ICD]-10). Several lines of evidence from animal and human studies indicate that cessation from long-term and regular cannabis use precipitates a specific withdrawal syndrome with mainly mood and behavioral symptoms of light to moderate intensity, which can usually be treated in an outpatient setting. Regular cannabis intake is related to a desensitization and downregulation of human brain cannabinoid 1 (CB1) receptors. This starts to reverse within the first 2 days of abstinence and the receptors return to normal functioning within 4 weeks of abstinence, which could constitute a neurobiological time frame for the duration of CWS, not taking into account cellular and synaptic long-term neuroplasticity elicited by long-term cannabis use before cessation, for example, being possibly responsible for cannabis craving. The CWS severity is dependent on the amount of cannabis used pre-cessation, gender, and heritable and several environmental factors. Therefore, naturalistic severity of CWS highly varies. Women reported a stronger CWS than men including physical symptoms, such as nausea and stomach pain. Comorbidity with mental or somatic disorders, severe CUD, and low social functioning may require an inpatient treatment (preferably qualified detox) and post-acute rehabilitation. There are promising results with gabapentin and delta-9-tetrahydrocannabinol analogs in the treatment of CWS. Mirtazapine can be beneficial to treat CWS insomnia. According to small studies, venlafaxine can worsen the CWS, whereas other antidepressants, atomoxetine, lithium, buspirone, and divalproex had no relevant effect. Certainly, further research is required with respect to the impact of the CWS treatment setting on long-term CUD prognosis and with respect to

  16. The novel anticonvulsant, gabapentin, protects against both convulsant and anxiogenic aspects of the ethanol withdrawal syndrome.

    Science.gov (United States)

    Watson, W P; Robinson, E; Little, H J

    1997-10-01

    The effects of the anticonvulsant, gabapentin, were investigated, in mice, on the withdrawal convulsive behaviour and anxiety-related behaviour that are produced by cessation of prolonged intake of ethanol. When given at 50 or 100 mg/kg, this compound decreased the rise in handling-induced hyperexcitability which occurs during the withdrawal period; the effects were most pronounced for the first 4 hr after administration. Gabapentin also decreased the convulsive response to an audiogenic stimulus during the withdrawal period. The elevated plus-maze, with both traditional and ethological indices of activity was used as a test of anxiety-related behaviour after cessation of chronic ethanol treatment. Gabapentin, at 50 and 100 mg/kg, was found to decrease some, although not all, of the signs of withdrawal-induced anxiety. At doses up to and including 200 mg/kg, gabapentin had no effect on motor co-ordination or spontaneous locomotor activity in control animals. The results demonstrated that gabapentin has a selective action in decreasing both convulsive and anxiety-related aspects of withdrawal behaviour after chronic ethanol treatment. It is possible that further studies with this compound may shed further light on the mechanisms involved in the withdrawal syndrome.

  17. Map visualization of groundwater withdrawals at the sub-basin scale

    Science.gov (United States)

    Goode, Daniel J.

    2016-01-01

    A simple method is proposed to visualize the magnitude of groundwater withdrawals from wells relative to user-defined water-resource metrics. The map is solely an illustration of the withdrawal magnitudes, spatially centered on wells—it is not capture zones or source areas contributing recharge to wells. Common practice is to scale the size (area) of withdrawal well symbols proportional to pumping rate. Symbols are drawn large enough to be visible, but not so large that they overlap excessively. In contrast to such graphics-based symbol sizes, the proposed method uses a depth-rate index (length per time) to visualize the well withdrawal rates by volumetrically consistent areas, called “footprints”. The area of each individual well’s footprint is the withdrawal rate divided by the depth-rate index. For example, the groundwater recharge rate could be used as a depth-rate index to show how large withdrawals are relative to that recharge. To account for the interference of nearby wells, composite footprints are computed by iterative nearest-neighbor distribution of excess withdrawals on a computational and display grid having uniform square cells. The map shows circular footprints at individual isolated wells and merged footprint areas where wells’ individual footprints overlap. Examples are presented for depth-rate indexes corresponding to recharge, to spatially variable stream baseflow (normalized by basin area), and to the average rate of water-table decline (scaled by specific yield). These depth-rate indexes are water-resource metrics, and the footprints visualize the magnitude of withdrawals relative to these metrics.

  18. Leadership Behaviors and Its Relation with Principals' Management Experience

    Science.gov (United States)

    Mehdinezhad, Vali; Sardarzahi, Zaid

    2016-01-01

    This paper aims at studying the leadership behaviors reported by principals and observed by teachers and its relationship with management experience of principals. A quantitative method was used in this study. The target population included all principals and teachers of guidance schools and high schools in the Dashtiari District, Iran. A sample…

  19. Organisation of facilities management in relation to core business

    DEFF Research Database (Denmark)

    Jensen, Per Anker

    2011-01-01

    Purpose: The purpose of this article is to clarify the organisational relationships between Facilities Management (FM) and core business and how these relationships vary for strategic and operational support functions. Approach: The research takes a starting point in Michael Porter’s theory...

  20. Research in the Management of Learning, Change and Relations

    NARCIS (Netherlands)

    B. Nooteboom (Bart)

    2001-01-01

    textabstractThis note sketches opportunities for interdisciplinary research in management, and the distinctive contribution that might be made from a European perspective. It highlights a few major domains of research, conceptual issues, disciplines, and specific opportunities and needs in Europe.

  1. The Law of Federal Labor-Management Relations

    Science.gov (United States)

    2001-12-04

    because they are contrary to the provisions of the Mandatory Guidelines. In AFGE and Sierra Army Depot, 37 FLRA 1439 (1990) the union proposed...Human Services, Social Security Administration, Modesto , CA, 48 FLRA 489,496 (1993). Given the Authority’s interpretation of management’s right to

  2. Information technology - Telecommunications and information exchange between systems - Elements of management information related to OSI transport layer standards; Amendment 1: NCMS Management; Technical Corrigendum 1

    CERN Document Server

    International Organization for Standardization. Geneva

    1994-01-01

    Information technology - Telecommunications and information exchange between systems - Elements of management information related to OSI transport layer standards; Amendment 1: NCMS Management; Technical Corrigendum 1

  3. Effects of morphine dependence and withdrawal on levels of neurosteroids in rat brain

    Institute of Scientific and Technical Information of China (English)

    Cai-zhen YAN; Yan-ning HOU

    2004-01-01

    AIM: To investigate the effects of morphine dependence and withdrawal on the concentrations of neurosteroids in rat brain. METHODS: A method of simultaneous quantification of neurosteroids by gas chromatography-mass spectrometry (GC-MS) had been established. RESULTS: The chronic morphine administration (ip) resulted in a marked decrease in the brain concentrations of pregnenolone (PREG), progesterone (PROG), and pregenenolone sulfate (PREGS) in rats killed 6 h after the last treatment. In contrast, there were no significant effects of morphine dependence on the brain concentrations of allopregnanolone (AP), dihydroepiandrosterone (DHEA), and dihydroepiandrosterone sulfate (DHEAS). Naloxone-induced withdrawal produced a significant increase in the concentrations of PREG, PROG, AP, DHEA, PREGS, and DHEAS as compared with the control group.CONCLUSION: Morphine dependence and withdrawal affected the concentrations of neurosteroids in rat brain,which suggests that endogenous neurosteroids in brain might be related to the development of morphine dependence and withdrawal.

  4. The Director General withdraws its proposal to Council

    CERN Multimedia

    Staff Association

    2015-01-01

    Dear Colleagues, The Staff Association and the CERN-ESO Pensioners’ Association want to let you know that they are deeply worried. Decisions taken by CERN Council at its latest closed sessions attracted our attention.  Since these sessions took place behind closed doors, without the presence of the Association, we had to investigate, crossing several sources of information. Result: The attitude of some delegations shocked us and fills us with indignation. Let us recall the facts: the Management's action plan to compensate for the soaring Swiss franc against the euro, did not reach a consensus among the Member States, forcing Management to withdraw it. Strange, when one considers that CERN was the only international organization based in Switzerland to come forward with such an initiative. On the contrary, Council is once again using the Pension Fund as a “scape goat”. It should be recalled here, that past decisions by CERN Council on the Fund's manag...

  5. The Lost Creek Fire: managing social relations under disaster conditions.

    Science.gov (United States)

    Reimer, Bill; Kulig, Judith; Edge, Dana; Lightfoot, Nancy; Townshend, Ivan

    2013-04-01

    This paper examines some of the social processes associated with disaster conditions. Utilising an asset-based perspective of community capacity, it focuses on four types of normative systems to interpret the ability of communities to manage disasters through market-, bureaucratic-, associative-, and communal-based norms. Drawing on experience of a wildfire in the Crowsnest Pass region of southwest Alberta, Canada, in 2003, the tensions and compatibilities among these normative systems are evaluated through interviews with 30 community leaders. The results confirm the contributions of all types of social capital to resiliency, the necessity for rapid use of place-based knowledge, and the importance of communication among all types and levels of agents. In addition, they point to the value of identifying and managing potential conflicts among the normative systems as a means to maximising their contributions. The integration of local networks and groups into the more general disaster response minimised the impacts on health and property.

  6. The behaviour of enterprises in relation to managers continuous training

    Directory of Open Access Journals (Sweden)

    JON LANDETA RODRÍGUEZ

    2006-06-01

    Full Text Available The present paper aims at analysing firms’ behaviour of managerial training from the viewpoint of information economics. Asymmetric information between organizations and their management may lead to moral hazard and adverse selection. The theoretical literature allows proposing an explicative model that considers the expectations of generating managerial capacities, the expectations of appropriating the benefits of these capacities, the strategic value of managers for firms and finally, the firms’ perception of the efforts thatinvesting in managerial training entail. The above-mentioned model analyses variables’ influences from a cost-benefit oriented viewpoint by systemizing them in order to the degree of proclivity that firms show. In this way, it aims at explaining the existing contradiction between firms’ discourse in favour of firms-provided training and the real behaviour that they usually adopt in fact.

  7. Overcoming Organisational Challenges related to Agile Project Management Adoption

    OpenAIRE

    Hansenne, Rami; Hibner, Allan

    2011-01-01

    For the past few years, Agile methodologies have been hailed as the silver bullet which will successfully address the high project failure rate. Many organisations have been using a traditional project management methodology for years and are now either considering or in the progress of introducing a more agile approach as a substitute for the more rigid, inflexible and control oriented traditional methodologies. Potential benefits include, but are not limited to, faster return on investment,...

  8. Relative importance of professional practice and engineering management competencies

    Science.gov (United States)

    Pons, Dirk

    2016-09-01

    Problem: The professional practice of engineering always involves engineering management, but it is difficult to know what specifically to include in the undergraduate curriculum. Approach: The population of New Zealand practising engineers was surveyed to determine the importance they placed on specific professional practice and engineering management competencies. Findings: Results show that communication and project planning were the two most important topics, followed by others as identified. The context in which practitioners use communication skills was found to be primarily with project management, with secondary contexts identified. The necessity for engineers to develop the ability to use multiple soft skills in an integrative manner is strongly supported by the data. Originality: This paper is one of only a few large-scale surveys of practising engineers to have explored the soft skill attributes. It makes a didactic contribution of providing a ranked list of topics which can be used for designing the curriculum and prioritising teaching effort, which has not previously been achieved. It yields the new insight that combinations of topics are sometimes more important than individual topics.

  9. A Cluster Maintenance Algorithm Based on Relative Mobility for Mobile Ad Hoc Network Management

    Institute of Scientific and Technical Information of China (English)

    SHENZhong; CHANGYilin; ZHANGXin

    2005-01-01

    The dynamic topology of mobile ad hoc networks makes network management significantly more challenging than wireline networks. The traditional Client/Server (Manager/Agent) management paradigm could not work well in such a dynamic environment, while the hierarchical network management architecture based on clustering is more feasible. Although the movement of nodes makes the cluster structure changeable and introduces new challenges for network management, the mobility is a relative concept. A node with high relative mobility is more prone to unstable behavior than a node with less relative mobility, thus the relative mobility of a node can be used to predict future node behavior. This paper presents the cluster availability which provides a quantitative measurement of cluster stability. Furthermore, a cluster maintenance algorithm based on cluster availability is proposed. The simulation results show that, compared to the Minimum ID clustering algorithm, our algorithm successfully alleviates the influence caused by node mobility and make the network management more efficient.

  10. The Public Relations Specialist and his Role in the Management of a Private Company in Galati

    National Research Council Canada - National Science Library

    Daniela Tănase Popa; Ionica Pletea

    2016-01-01

    .... From the theoretical point of view, the paper focuses on definitions of public relations and analyses the role and functions of public relations in an institution and the management of a company...

  11. Neural effects of positive and negative incentives during marijuana withdrawal.

    Directory of Open Access Journals (Sweden)

    Francesca M Filbey

    Full Text Available In spite of evidence suggesting two possible mechanisms related to drug-seeking behavior, namely reward-seeking and harm avoidance, much of the addiction literature has focused largely on positive incentivization mechanisms associated with addiction. In this study, we examined the contributing neural mechanisms of avoidance of an aversive state to drug-seeking behavior during marijuana withdrawal. To that end, marijuana users were scanned while performing the monetary incentive delay task in order to assess positive and negative incentive processes. The results showed a group x incentive interaction, such that marijuana users had greater response in areas that underlie reward processes during positive incentives while controls showed greater response in the same areas, but to negative incentives. Furthermore, a negative correlation between withdrawal symptoms and response in the amygdala during negative incentives was found in the marijuana users. These findings suggest that although marijuana users have greater reward sensitivity and less harm avoidance than controls, that attenuated amygdala response, an area that underlies fear and avoidance, was present in marijuana users with greater marijuana withdrawal symptoms. This is concordant with models of drug addiction that involve multiple sources of reinforcement in substance use disorders, and suggests the importance of strategies that focus on respective mechanisms.

  12. Factors influencing exacerbation-related self-management in patients with COPD : A qualitative study

    OpenAIRE

    Korpershoek, Y. J. G.; Vervoort, S.C.J.M.; Nijssen, L. I T; Trappenburg, J.C.A.; Schuurmans, M. J.

    2016-01-01

    Background: In patients with COPD, self-management skills are important to reduce the impact of exacerbations. However, both detection and adequate response to exacerbations appear to be difficult for some patients. Little is known about the underlying process of exacerbation-related self-management. Therefore, the objective of this study was to identify and explain the underlying process of exacerbation-related self-management behavior. Methods: A qualitative study using semi-structured in-d...

  13. 5 CFR 2421.1 - Federal Service Labor-Management Relations Statute.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Federal Service Labor-Management... THIS SUBCHAPTER § 2421.1 Federal Service Labor-Management Relations Statute. The term Federal Service... COUNSEL OF THE FEDERAL LABOR RELATIONS AUTHORITY AND FEDERAL SERVICE IMPASSES PANEL FEDERAL LABOR...

  14. Socioeconomic factors relating to diabetes and its management in India.

    Science.gov (United States)

    Shrivastava, Usha; Misra, Anoop; Gupta, Rajeev; Viswanathan, Vijay

    2016-01-01

    Diabetes is an escalating problem in India and has major socioeconomic dimensions. Rapid dietary changes coupled with decreased levels of physical activity have resulted in increases in obesity and diabetes in rural and semi-urban areas, as well as in urban-based people living in resettlement colonies. Increasing risk has also been recorded in those who suffered from poor childhood nutrition and in rural-to-urban migrants. Social inequity manifests in disparities in socioeconomic status (SES), place of residence, education, gender, and level of awareness and affects prevention, care, and management. All these population subsets have major socioeconomic challenges: low levels of awareness regarding diabetes and prevention, inadequate resources, insufficient allotment of healthcare budgets, and lack of medical reimbursement. Unawareness and delays in seeking medical help lead to complications, resulting in many-fold increased costs in diabetes care. These costs plunge individuals and households into a vicious cycle of further economic hardship, inadequate management, and premature mortality, resulting in more economic losses. At the societal level, these are massive losses to national productivity and the exchequer. Overall, there is an immediate need to strengthen the healthcare delivery system to generate awareness and for the prevention, early detection, cost-effective management, and rehabilitation of patients with diabetes, with a focus on people belonging to the lower SES and women (with a particular focus on nutrition before and during pregnancy). Because of an enhanced awareness campaign spearheaded through the National Program on Prevention of Cardiovascular Disease, Cancer, Diabetes and Stroke (NCPCDS) initiated by Government of India, it is likely that the level of awareness and early detection of diabetes may increase. © 2015 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  15. Electrical amygdala kindling in alcohol-withdrawal kindled rats.

    Science.gov (United States)

    Ulrichsen, J; Woldbye, D P; Madsen, T M; Clemmesen, L; Haugbøl, S; Olsen, C H; Laursen, H; Bolwig, T G; Hemmingsen, R

    1998-01-01

    Repeated alcohol withdrawal has been shown to kindle seizure activity. The purpose of the present investigation was to study electrical amygdala kindling in rats previously exposed to alcohol-withdrawal kindling. In three independent experiments, male Wistar rats were subjected to multiple episodes each consisting of 2 days of severe alcohol intoxication and 5 days of alcohol withdrawal. In the first experiment, the alcohol-withdrawal kindled animals were divided into two groups depending on whether spontaneous alcohol-withdrawal seizures were observed in episodes 10-13. In the second and third experiments, the alcohol-withdrawal kindled animals were compared to a group in which alcohol-withdrawal kindling was prevented by diazepam treatment during the withdrawal reactions in order to discriminate between the effect of withdrawal and intoxication. Electrical kindling was initiated 28-35 days after the last alcohol dose by exposing the animals to daily electrical stimulations of the right amygdala. The results showed that amygdala kindling was facilitated in alcohol-withdrawal kindled animals which showed spontaneous withdrawal seizure activity, compared with animals exposed to multiple episodes of alcohol withdrawal which did not develop withdrawal seizures or with animals exposed to a single episode of alcohol intoxication. When compared to the control group, the alcohol-withdrawal kindled group with seizures also kindled at a faster rate, but the difference did not reach statistical significance and therefore the results must be regarded as preliminary at present.

  16. Genetic correlations with ethanol withdrawal severity.

    Science.gov (United States)

    Crabbe, J C; Young, E R; Kosobud, A

    1983-01-01

    A major goal of pharmacogenetic research on alcoholism remains the identification of some "marker" that could predict the liability of a particular individual for a genetic susceptibility to develop alcoholism. The present paper presents evidence that the severity of withdrawal from physical dependence on ethanol varies widely among inbred strains of mice, and that withdrawal severity is negatively genetically correlated with initial sensitivity and magnitude of tolerance to ethanol hypothermia. These correlations are supported by differences in hypothermic response between replicate lines of mice genetically selected for susceptibility and resistance to ethanol withdrawal seizures. The genetic relationships reported suggest that the effects of ethanol on thermoregulation in mice may offer a predictive marker for susceptibility to ethanol physical dependence.

  17. Benzodiazepine dependence: focus on withdrawal syndrome.

    Science.gov (United States)

    Authier, N; Balayssac, D; Sautereau, M; Zangarelli, A; Courty, P; Somogyi, A A; Vennat, B; Llorca, P-M; Eschalier, A

    2009-11-01

    Benzodiazepines are potentially addictive drugs: psychological and physical dependence can develop within a few weeks or years of regular or repeated use. The socioeconomic costs of the present high level of long-term benzodiazepine use are considerable. These consequences could be minimised if prescriptions for long-term benzodiazepines were decreased. However, many physicians continue to prescribe benzodiazepines and patients wishing to withdraw receive little advice or support. Particular care should be taken in prescribing benzodiazepines for vulnerable patients such as elderly persons, pregnant women, children, alcohol- or drug-dependent patients and patients with comorbid psychiatric disorders. The following update gives recent research results on the withdrawal pathophysiology and practical information in order to treat or prevent benzodiazepine withdrawal syndrome.

  18. Gabapentin for the treatment of ethanol withdrawal.

    Science.gov (United States)

    Voris, John; Smith, Nancy L; Rao, Subba M; Thorne, Diana L; Flowers, Queen J

    2003-06-01

    Benzodiazepines (BZDs) are the drug of choice for the suppression of alcohol withdrawal symptoms. Gabapentin, a drug approved for use as adjunctive therapy in the treatment of partial seizures, has none of the BZD-type difficulties (drug interactions, abuse potential). We retrospectively report on the use of gabapentin for ethanol withdrawal in 49 patients. Thirty-one patients were treated in the outpatient program and 18 in the general inpatient psychiatric unit. Positive outcomes as evidenced by completion of gabapentin therapy were achieved in 25 out of 31 outpatients and 17 out of 18 inpatients. Statistical significance was reached regarding the positive relationship between prior ethanol use and inpatient "as needed" benzodiazepine use. Both sets of data suggest that gabapentin works well for the mild to moderate alcohol withdrawal patient.

  19. Emergent management of malignancy-related acute airway obstruction.

    Science.gov (United States)

    Theodore, Pierre R

    2009-05-01

    Acute obstruction of the airway in the emergent situation results from a wide variety of malignant and benign disease processes. Acute management involves establishing a secure and patent route for adequate gas exchange. This requires rapid determination of the location of the obstruction and nature of the obstruction followed by a thoughtful management approach based on findings. Difficult anatomy, hemorrhage, dense secretions, inflammation, and bulky tumor mass can significantly complicate the task of clearing the airway. Obstruction of the central airways by malignant tumor is associated with poor prognosis, but quality of life is considerably improved by restoration of adequate central airways. For both the patient and the clinician, the presentation can be frightening, and advanced interventional pulmonary/endobronchial techniques are required to achieve prompt relief of symptoms. The alleviation of central airway obstruction by tumor is most often palliative, with improvement of quality of life the primary goal rather than cure. This review will cover covers an approach to the patient with airway obstruction that results from malignancy involving the trachea or proximal bronchial tree and affecting gas exchange.

  20. Simulation of groundwater flow to assess future withdrawals associated with Base Realignment and Closure (BRAC) at Fort George G. Meade, Maryland

    Science.gov (United States)

    Raffensperger, Jeff P.; Fleming, Brandon J.; Banks, William S.L.; Horn, Marilee A.; Nardi, Mark R.; Andreasen, David C.

    2010-01-01

    recharge represented in the earlier model. The calibrated model provides a tool for future forecasts of changes in the system under different management scenarios, and for simulating potential effects of withdrawals at Fort Meade and the surrounding area on water levels in the near-outcrop area and base flow in the outcrop area. Model error was assessed by comparing observed and simulated water levels from 62 wells (55 in the parent model and 7 in the child model). The root-mean-square error values for the parent and child model were 8.72 and 11.91 feet, respectively. Root-mean-square error values for the 55 parent model observation wells range from 0.95 to 30.31 feet; the range for the 7 child model observation wells is 5.00 to 24.17 feet. Many of the wells with higher root-mean-square error values occur at the perimeter of the child model and near large pumping centers, as well as updip in the confined aquifers. Root-mean-square error values decrease downdip and away from the large pumping centers. Both the parent and child models are sensitive to increasing withdrawal rates. The parent model is more sensitive than the child model to decreasing transmissivity of layers 3, 4, 5, and 6. The parent model is relatively insensitive to riverbed vertical conductance, however, the child model does exhibit some sensitivity to decreasing riverbed conductance. The overall water budget for the model included sources and sinks of water including recharge, surface-water bodies and rivers and streams, general-head boundaries, and withdrawals from permitted wells. Withdrawal from wells in 2005 was estimated to be equivalent to 8.5 percent of the total recharge rate.

  1. Manager relations, psychological need satisfaction and intention to leave in the agricultural sector

    Directory of Open Access Journals (Sweden)

    Sebastiaan Rothmann

    2013-03-01

    Full Text Available Orientation: If South African organisations are to retain talented and skilled staff, they need to consider the psychological needs of employees and their predictors.Research purpose: The aim of this study was to investigate the relationship between manager relations, the satisfaction of the psychological needs of employees and their intentions to leave.Motivation for the study: The effective retention of skilled employees is necessary in organisations in South Africa. However, studies on the psychological processes (and specifically the satisfaction of psychological needs, through which manager relations could promote the retention of staff, are necessary.Research design, approach and method: The authors used a cross-sectional survey design. They drew convenience samples of managers in agricultural organisations (N = 507 in South Africa. They administered the Manager Relations Scale, the Work-related Basic Need Satisfaction Scale and the Turnover Intention Scale. Main findings: The results confirmed a model in which manager relations affected the satisfaction of psychological needs and intentions to leave. Autonomy satisfaction mediated the relationship between manager relations and the intentions of employees to leave.Practical/managerial implications: Managers should participate in training on applying self determination theory to support the autonomy and the relatedness satisfaction of employees.Contribution/value add: This study contributes to the literature by exploring the processes through which manager relations influence the intentions of employees to leave.

  2. Managers' perceptions of the manager role in relation to physicians: a qualitative interview study of the top managers in Swedish healthcare.

    Science.gov (United States)

    von Knorring, Mia; de Rijk, Angelique; Alexanderson, Kristina

    2010-09-17

    This study focused on the manager role in the manager-physician relationship, considered from the manager perspective. The aim was to understand how top executives in Swedish healthcare regard management of physicians in their organisations, and what this implies for the manager role in relation to the medical profession. Abbott's theory of professional jurisdiction was used to inform thinking about managerial control and legitimacy in relation to physicians. Data from semi-structured individual interviews with 18 of the 20 county council chief executive officers (CEOs) in Sweden were subjected to qualitative analysis. The results show that, when asked about their views on management of physicians, the CEOs talked about "how physicians are" rather than describing their own or their subordinate managers' managerial behaviour or strategies. Three types of descriptions of physicians were identified: 1) they have high status and expertise; 2) they lack knowledge of the system; 3) they do what they want in the organisation. The CEOs seldom reported that general management strategies were used to manage physicians. Instead, they described four types of physician-specific management strategies that were used in their organisations: organisational separation of physicians; "nagging and arguing"; compensations; relying on the physician role. These strategies seemed to reflect pragmatic behaviour on behalf of the managers that helped them to maintain control over physicians in daily work. However, in a longer perspective, they seemed to decrease the legitimacy of the manager role and also contribute to weakening of that role in the organisation. Many CEOs seemed to regard the manager role in their organisations as weak and described difficulties in both taking and defining that role (for themselves or others) in relation to the physician role. Further research is needed to elucidate how managers in healthcare organisations assume the manager role in relation to the medical

  3. Managers' perceptions of the manager role in relation to physicians: a qualitative interview study of the top managers in Swedish healthcare

    Directory of Open Access Journals (Sweden)

    de Rijk Angelique

    2010-09-01

    Full Text Available Abstract Background This study focused on the manager role in the manager-physician relationship, considered from the manager perspective. The aim was to understand how top executives in Swedish healthcare regard management of physicians in their organisations, and what this implies for the manager role in relation to the medical profession. Abbott's theory of professional jurisdiction was used to inform thinking about managerial control and legitimacy in relation to physicians. Methods Data from semi-structured individual interviews with 18 of the 20 county council chief executive officers (CEOs in Sweden were subjected to qualitative analysis. Results The results show that, when asked about their views on management of physicians, the CEOs talked about "how physicians are" rather than describing their own or their subordinate managers' managerial behaviour or strategies. Three types of descriptions of physicians were identified: 1 they have high status and expertise; 2 they lack knowledge of the system; 3 they do what they want in the organisation. The CEOs seldom reported that general management strategies were used to manage physicians. Instead, they described four types of physician-specific management strategies that were used in their organisations: organisational separation of physicians; "nagging and arguing"; compensations; relying on the physician role. These strategies seemed to reflect pragmatic behaviour on behalf of the managers that helped them to maintain control over physicians in daily work. However, in a longer perspective, they seemed to decrease the legitimacy of the manager role and also contribute to weakening of that role in the organisation. Conclusions Many CEOs seemed to regard the manager role in their organisations as weak and described difficulties in both taking and defining that role (for themselves or others in relation to the physician role. Further research is needed to elucidate how managers in healthcare

  4. How I Manage Exercise-Related Menstrual Disturbances.

    Science.gov (United States)

    Shangold, Mona M.

    1986-01-01

    Amenorrhea and oligomenorrhea are often related to heavy exercise, but these conditions can signal a serious pathologic condition. Tests to pinpoint causes of menstrual dysfunctions are listed, and treatments to establish a proper hormone balance are described. (MT)

  5. 42 CFR 35.8 - Safekeeping of money and effects; withdrawals.

    Science.gov (United States)

    2010-10-01

    ... EXAMINATIONS HOSPITAL AND STATION MANAGEMENT General § 35.8 Safekeeping of money and effects; withdrawals. (a... hospital, and an itemized receipt therefor shall be furnished to the patient and to any other person who... dispose of his property (including the money and effects in the custody of the station or hospital), or...

  6. Amphetamine withdrawal differentially affects hippocampal and peripheral corticosterone levels in response to stress.

    Science.gov (United States)

    Bray, Brenna; Scholl, Jamie L; Tu, Wenyu; Watt, Michael J; Renner, Kenneth J; Forster, Gina L

    2016-08-01

    Amphetamine withdrawal is associated with heightened anxiety-like behavior, which is directly driven by blunted stress-induced glucocorticoid receptor-dependent serotonin release in the ventral hippocampus. This suggests that glucocorticoid availability in the ventral hippocampus during stress may be reduced during amphetamine withdrawal. Therefore, we tested whether amphetamine withdrawal alters either peripheral or hippocampal corticosterone stress responses. Adult male rats received amphetamine (2.5mg/kg, ip) or saline for 14 days followed by 2 weeks of withdrawal. Contrary to our prediction, microdialysis samples from freely-moving rats revealed that restraint stress-induced corticosterone levels in the ventral hippocampus are enhanced by amphetamine withdrawal relative to controls. In separate groups of rats, plasma corticosterone levels increased immediately after 20min of restraint and decreased to below stress-naïve levels after 1h, indicating negative feedback regulation of corticosterone following stress. However, plasma corticosterone responses were similar in amphetamine-withdrawn and control rats. Neither amphetamine nor stress exposure significantly altered protein expression or enzyme activity of the steroidogenic enzymes 11β-hydroxysteroid dehydrogenase (11β-HSD1) or hexose-6-phosphate dehydrogenase (H6PD) in the ventral hippocampus. Our findings demonstrate for the first time that amphetamine withdrawal potentiates stress-induced corticosterone in the ventral hippocampus, which may contribute to increased behavioral stress sensitivity previously observed during amphetamine withdrawal. However, this is not mediated by either changes in plasma corticosterone or hippocampal steroidogenic enzymes. Establishing enhanced ventral hippocampal corticosterone as a direct cause of greater stress sensitivity may identify the glucocorticoid system as a novel target for treating behavioral symptoms of amphetamine withdrawal. Copyright © 2016 Elsevier B

  7. Estimating pumping time and ground-water withdrawals using energy-consumption data. Water-Resources Investigation

    Energy Technology Data Exchange (ETDEWEB)

    Hurr, R.T.; Litke, D.W.

    1989-01-01

    Evaluation of the hydrology of an aquifer requires knowledge about the volume of ground water in storage and also about the volume of ground-water withdrawals. Totalizer flow meters may be installed at pumping plants to measure withdrawals; however, it generally is impractical to equip all wells in an area with meters. A viable alternative is the use of rate-time methods to estimate withdrawals. The relation between power demand and pumping rate at a pumping plant can be described through the use of the power-consumption coefficient. Where equipment and hydrologic conditions are stable, this coefficient can be applied to total energy consumption at a site to estimate total ground-water withdrawals. Random sampling of power-consumption coefficients can be used to estimate area-wide ground-water withdrawals.

  8. The relation between project management education and newer streams in project management research

    DEFF Research Database (Denmark)

    Leimbach, Timo; Goodall, Julie Bladt

    2017-01-01

    how the development of PM research is reflected in the education of project managers. On the basis of a short overview of the state of the art of PM education research and practices, the possible challenges for the development of PM education are discussed, and, finding that there is a lack......In the last decades, research in project management (PM) has experienced significant new inputs from a range of new PM methodologies and critical research streams. As a consequence, members of the more critical streams have called for the education of project managers to advance from...... that of training technicians, to fostering reflective practitioners that are better equipped to handle the increasing complexity of the profession. This paper is based on a recently commenced re-search project titled "Rethinking Project Management Education – the Role of Universities" that is aimed at analysing...

  9. Guidelines for the management of work-related asthma

    NARCIS (Netherlands)

    Baur, X.; Sigsgaard, T.; Aasen, T.B.; Burge, P.S.; Heederik, D.; Henneberger, P.; Maestrelli, P.; Rooyackers, J.M.; Schlünssen, V.; Vandenplas, O.; Wilken, D.

    2012-01-01

    Work-related asthma, which includes occupational asthma and work-aggravated asthma, has become one of the most prevalent occupational lung diseases. These guidelines aim to upgrade occupational health standards, contribute importantly to transnational legal harmonisation and reduce the high socio-ec

  10. European Insecurity: Managing Changing Relations at Home and Abroad

    Directory of Open Access Journals (Sweden)

    Julie Fraser interviews Dr. M Drent and Dr. B van Ginkel of the Clingendael Institute

    2012-02-01

    Full Text Available Interviews with Dr. Margriet Drent and Dr. Bibi van Ginkel of the Security and Conflict Programme of the Netherlands Institute of International Relations 'Clingendael' Dr. Margriet Drent is a Senior Research Fellow at the Security and Conflict Programme of the Netherlands Institute of International Relations 'Clingendael' and Assistant Professor at the International Relations and International Organisation Department of the University of Groningen. Dr. Drent's PhD on the 'Europeanisation of security' focused on what is now known as the Common Security and Defence Policy. She is also a member of the Peace and Security Committee of the Advisory Council on International Affairs. Dr. Bibi van Ginkel, LL.M. is a Senior Research Fellow at Security and Conflict Programme of the Netherlands Institute of International Relations 'Clingendael'. She is also a fellow at the International Centre on Counter-Terrorism. Her research concentrates on legal aspects of security issues. She received her doctorate at Utrecht University with a dissertation on the practice of the United Nations on combating terrorism. She is also a member of the Peace and Security Committee of the Advisory Council of International Affairs.   

  11. HIV-related movement disorders: epidemiology, pathogenesis and management.

    Science.gov (United States)

    Cardoso, Francisco

    2002-01-01

    Clinically relevant movement disorders are identified in 3% of patients with HIV infection seen at tertiary referral centres. In the same setting, prospective follow-up shows that 50% of patients with AIDS develop tremor, parkinsonism or other extrapyramidal features. Hemiballism-hemichorea and tremor are the most common hyperkinesias seen in patients who are HIV positive, but other movement disorders diagnosed in these patients include dystonia, chorea, myoclonus, tics, paroxysmal dyskinesias and parkinsonism. Patients with movement disorders usually present with other clinical features such as peripheral neuropathy, seizures, myelopathy and dementia. In the vast majority of patients, hyperkinesias result from lesions caused by opportunistic infections, particularly toxoplasmosis, which damage the basal ganglia connections. On the other hand, parkinsonism and tremor can result from dopaminergic dysfunction resulting from HIV itself or the use of antidopaminergic drugs. The management of patients who are HIV positive who present with movement disorders involves recognition and treatment of opportunistic infections, symptomatic treatment of the movement disorder and the use of highly active antiretroviral therapy (HAART). The most effective treatment of cerebral toxoplasmosis in patients with HIV infection is the combination of sulfadiazine and pyrimethamine. Symptomatic treatment of the movement disorder is often disappointing: hemiballism improves with antipsychotics, but tremor, parkinsonism and other phenomena usually fail to respond to available therapies. Preliminary data suggest that HAART may be helpful in the symptomatic control as well as prevention of movement disorders in patients who are HIV positive.

  12. Controversies relating to the management of acromioclavicular joint dislocations.

    Science.gov (United States)

    Modi, C S; Beazley, J; Zywiel, M G; Lawrence, T M; Veillette, C J H

    2013-12-01

    The aim of this review is to address controversies in the management of dislocations of the acromioclavicular joint. Current evidence suggests that operative rather than non-operative treatment of Rockwood grade III dislocations results in better cosmetic and radiological results, similar functional outcomes and longer time off work. Early surgery results in better functional and radiological outcomes with a reduced risk of infection and loss of reduction compared with delayed surgery. Surgical options include acromioclavicular fixation, coracoclavicular fixation and coracoclavicular ligament reconstruction. Although non-controlled studies report promising results for arthroscopic coracoclavicular fixation, there are no comparative studies with open techniques to draw conclusions about the best surgical approach. Non-rigid coracoclavicular fixation with tendon graft or synthetic materials, or rigid acromioclavicular fixation with a hook plate, is preferable to fixation with coracoclavicular screws owing to significant risks of loosening and breakage. The evidence, although limited, also suggests that anatomical ligament reconstruction with autograft or certain synthetic grafts may have better outcomes than non-anatomical transfer of the coracoacromial ligament. It has been suggested that this is due to better restoration horizontal and vertical stability of the joint. Despite the large number of recently published studies, there remains a lack of high-quality evidence, making it difficult to draw firm conclusions regarding these controversial issues.

  13. A Novel Strategy for Attenuating Opioid Withdrawal in Neonates

    Science.gov (United States)

    Santoro, Giovanni C; Shukla, Samarth; Patel, Krishna; Kaczmarzyk, Jakub; Agorastos, Stergiani; Scherrer, Sandra; Choi, Yoon Young; Veith, Christina; Carrion, Joseph; Silverman, Rebecca; Mullin, Danielle; Ahmed, Mohamed; Schiffer, Wynne K; Brodie, Jonathan D; Dewey, Stephen L

    2016-01-01

    The rate of Neonatal Abstinence Syndrome (NAS) has drastically increased over the past decade. The average hospital expense per NAS patient has tripled, while the number of babies born to opioid-dependent mothers has increased to 5 in 1000 births. Current treatment options are limited to opioid replacement and tapering. Consequently, we examined the efficacy of prenatal, low-dose and short-term vigabatrin (γ-vinyl GABA, GVG) exposure for attenuating these symptoms as well as the metabolic changes observed in the brains of these animals upon reaching adolescence. Pregnant Sprague-Dawley rats were treated in one of four ways: 1) saline; 2) morphine alone; 3) morphine+GVG at 25 mg/kg; 4) morphine+GVG at 50 mg/kg. Morphine was administered throughout gestation, while GVG administration occurred only during the last 5 days of gestation. On post-natal day 1, naloxone-induced withdrawal behaviours were recorded in order to obtain a gross behaviour score. Approximately 28 days following birth, 18FDG microPET scans were obtained on these same animals (Groups 1, 2, and 4). Morphine-treated neonates demonstrated significantly higher withdrawal scores than saline controls. However, GVG at 50 but not 25 mg/kg/day significantly attenuated them. Upon reaching adolescence, morphine treated animals showed regionally specific changes in 18FDG uptake. Again, prenatal GVG exposure blocked them. These data demonstrate that low-dose, short-term prenatal GVG administration blocks naloxone-induced withdrawal in neonates. Taken together, these preliminary findings suggest that GVG may provide an alternative and long-lasting pharmacologic approach for the management of neonatal and adolescent symptoms associated with NAS. PMID:28078167

  14. network: A Package for Managing Relational Data in R

    Directory of Open Access Journals (Sweden)

    Carter T. Butts

    2007-12-01

    Full Text Available Effective memory structures for relational data within R must be capable of representing a wide range of data while keeping overhead to a minimum. The network package provides an class which may be used for encoding complex relational structures composed a vertex set together with any combination of undirected/directed, valued/unvalued, dyadic/hyper, and single/multiple edges; storage requirements are on the order of the number of edges involved. Some simple constructor, interface, and visualization functions are provided, as well as a set of operators to facilitate employment by end users. The package also supports a C-language API, which allows developers to work directly with network objects within backend code.

  15. 19 CFR 10.61 - Withdrawal permit.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 1 2010-04-01 2010-04-01 false Withdrawal permit. 10.61 Section 10.61 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY... bond, when required, the port director shall issue a permit on Customs Form 7501 or 7512....

  16. Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo-controlled study.

    Science.gov (United States)

    Rosenson, Jonathan; Clements, Carter; Simon, Barry; Vieaux, Jules; Graffman, Sarah; Vahidnia, Farnaz; Cisse, Bitou; Lam, Joseph; Alter, Harrison

    2013-03-01

    Acute alcohol withdrawal syndrome (AAWS) is encountered in patients presenting acutely to the Emergency Department (ED) and often requires pharmacologic management. We investigated whether a single dose of intravenous (i.v.) phenobarbital combined with a standardized lorazepam-based alcohol withdrawal protocol decreases intensive care unit (ICU) admission in ED patients with acute alcohol withdrawal. This was a prospective, randomized, double-blind, placebo-controlled study. Patients were randomized to receive either a single dose of i.v. phenobarbital (10 mg/kg in 100 mL normal saline) or placebo (100 mL normal saline). All patients were placed on the institutional symptom-guided lorazepam-based alcohol withdrawal protocol. The primary outcome was initial level of hospital admission (ICU vs. telemetry vs. floor ward). There were 198 patients enrolled in the study, and 102 met inclusion criteria for analysis. Fifty-one patients received phenobarbital and 51 received placebo. Baseline characteristics and severity were similar in both groups. Patients that received phenobarbital had fewer ICU admissions (8% vs. 25%, 95% confidence interval 4-32). There were no differences in adverse events. A single dose of i.v. phenobarbital combined with a symptom-guided lorazepam-based alcohol withdrawal protocol resulted in decreased ICU admission and did not cause increased adverse outcomes. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. A Water-Withdrawal Input-Output Model of the Indian Economy.

    Science.gov (United States)

    Bogra, Shelly; Bakshi, Bhavik R; Mathur, Ritu

    2016-02-02

    Managing freshwater allocation for a highly populated and growing economy like India can benefit from knowledge about the effect of economic activities. This study transforms the 2003-2004 economic input-output (IO) table of India into a water withdrawal input-output model to quantify direct and indirect flows. This unique model is based on a comprehensive database compiled from diverse public sources, and estimates direct and indirect water withdrawal of all economic sectors. It distinguishes between green (rainfall), blue (surface and ground), and scarce groundwater. Results indicate that the total direct water withdrawal is nearly 3052 billion cubic meter (BCM) and 96% of this is used in agriculture sectors with the contribution of direct green water being about 1145 BCM, excluding forestry. Apart from 727 BCM direct blue water withdrawal for agricultural, other significant users include "Electricity" with 64 BCM, "Water supply" with 44 BCM and other industrial sectors with nearly 14 BCM. "Construction", "miscellaneous food products"; "Hotels and restaurants"; "Paper, paper products, and newsprint" are other significant indirect withdrawers. The net virtual water import is found to be insignificant compared to direct water used in agriculture nationally, while scarce ground water associated with crops is largely contributed by northern states.

  18. 15 CFR 10.13 - Withdrawal of a published standard.

    Science.gov (United States)

    2010-01-01

    ... DEVELOPMENT OF VOLUNTARY PRODUCT STANDARDS § 10.13 Withdrawal of a published standard. (a) Standards published... advantages and disadvantages of amendment, revision, development of a new standard, or withdrawal with the...

  19. Analysis of Medical Equipment Management in Relation to the Mandatory Medical Equipment Safety Manager (MESM in Japan

    Directory of Open Access Journals (Sweden)

    Kai Ishida

    2014-01-01

    Full Text Available Half a decade has passed since the fifth revision of the medical law and mandatory appointment of a medical equipment safety manager (MESM in hospitals in Japan. During this period, circumstances have changed regarding maintenance of medical equipment (ME. We conducted a survey to examine these changes and the current situation in ME management. Maintenance of ME and related work were found to have increased in many hospitals, but the number of clinical engineering technologists (CETs has only slightly increased. The appointed MESM was a CET or physician in most hospitals. In hospitals where physicians were appointed as the MESM, 81% had operation managers. Many respondents commented that it was difficult for one person to cover all the tasks required by the MESM, due to a lack of knowledge, too much work, or other reasons. This suggests the importance of an operation manager for ME to work under the MESM.

  20. BOSS: A FORTRAN Code for a Relational Database Manager.

    Science.gov (United States)

    2014-09-26

    of data are appropriate as categories is not addEessed in this report,3and therefore the reader is urged to consult Kent or Neely and Steward for very...category "COURSES". TABLE 1. COURSES Title Number Credits Calculus I 120 4 Calculus II 121 4 Linear Algebra 235 3 Probability 250 3 Statistics 251 3...pp. 120-126. 3. Neely, J., and Steward , S., "Fundamentals of Relational Data Organization," BYTE, Nov 1981, pp. 51-60. 4. Stout, Q., and Woodworth, P

  1. Relative Physical Position as an Impression-Management Strategy: Sex Differences in Its Use and Implications.

    Science.gov (United States)

    Makhanova, Anastasia; McNulty, James K; Maner, Jon K

    2017-05-01

    People's physical position relative to others may shape how those others perceive them. The research described here suggests that people use relative physical position to manage impressions by strategically positioning themselves either higher or lower relative to ostensible observers. Five studies supported the prediction that women take and display photographs portraying themselves in a low relative physical position to highlight their youthful features and appear attractive, whereas men take and display photographs portraying themselves in a high relative physical position to highlight their size and appear dominant. The effectiveness of these strategies was confirmed in two studies that measured social perceptions of male and female targets who varied in their relative position. In sum, as do members of other social species, people use relative physical position to manage social impressions, and although these impression-management strategies may have deep ancestral roots, they appear to manifest themselves through a contemporary human modality-photographs.

  2. Obesity-related hypertension: epidemiology, pathophysiology, and clinical management.

    Science.gov (United States)

    Kotchen, Theodore A

    2010-11-01

    The prevalence of obesity, including childhood obesity, is increasing worldwide. Weight gain is associated with increases in arterial pressure, and it has been estimated that 60-70% of hypertension in adults is attributable to adiposity. Centrally located body fat, associated with insulin resistance and dyslipidemia, is a more potent determinant of blood pressure elevation than peripheral body fat. Obesity-related hypertension may be a distinct hypertensive phenotype with distinct genetic determinants. Mechanisms of obesity-related hypertension include insulin resistance, sodium retention, increased sympathetic nervous system activity, activation of renin-angiotensin-aldosterone, and altered vascular function. In overweight individuals, weight loss results in a reduction of blood pressure, however, this effect may be attenuated in the long term. An increasing number of community-based programs (including school programs and worksite programs) are being developed for the prevention and treatment of obesity. Assessment and treatment of the obese hypertensive patient should address overall cardiovascular disease (CVD) risk. There are no compelling clinical trial data to indicate that any one class of antihypertensive agents is superior to others, and in general the principles of pharmacotherapy for obese hypertensive patients are not different from nonobese patients. Future research directions might include: (i) development of effective, culturally sensitive strategies for the prevention and treatment of obesity; (ii) clinical trials to identify the most effective drug therapies for reducing CVD in obese, hypertensive patients; (iii) continued search for the genetic determinants of the obese, hypertensive phenotype.

  3. A psychometric validation of the Short Alcohol Withdrawal Scale (SAWS)

    DEFF Research Database (Denmark)

    Elholm, Bjarne; Larsen, Klaus; Hornnes, Nete

    2011-01-01

    The study aimed to evaluate psychometrically a Danish translation of the Short Alcohol Withdrawal Scale (SAWS) in an outpatient setting in patients with Alcohol Dependence (AD) and Alcohol Withdrawal Symptoms/Syndrome (AWS).......The study aimed to evaluate psychometrically a Danish translation of the Short Alcohol Withdrawal Scale (SAWS) in an outpatient setting in patients with Alcohol Dependence (AD) and Alcohol Withdrawal Symptoms/Syndrome (AWS)....

  4. Effects of Nicotine Withdrawal in Adult Male and Female Rats

    Science.gov (United States)

    2008-01-01

    withdrawal symptoms in women (e.g., Shiffman et aI., 1979). An animal model of nicotine withdrawal provides a means of conducting a true experiment and ruling...in humans lasts for approximately ten days, and symptoms include tension, irritability, headaches, and increased appetite and weight gain ( Shiffman et...withdrawal symptoms in women than men (e.g., Shiffman , 1979). It is noteworthy that there are no reports of greater withdrawal symptoms in men than women

  5. Update on the Neurobiology of Alcohol Withdrawal Seizures

    OpenAIRE

    2005-01-01

    Abrupt cessation of alcohol intake after prolonged heavy drinking may trigger alcohol withdrawal seizures. Generalized tonic–clonic seizures are the most characteristic and severe type of seizure that occur in this setting. Generalized seizures also occur in rodent models of alcohol withdrawal. In these models, the withdrawal seizures are triggered by neuronal networks in the brainstem, including the inferior colliculus; similar brainstem mechanisms may contribute to alcohol withdrawal seizur...

  6. Love withdrawal predicts electrocortical responses to emotional faces with performance feedback: a follow-up and extension

    National Research Council Canada - National Science Library

    Huffmeijer, Renske; Bakermans-Kranenburg, Marian J; Alink, Lenneke R A; van IJzendoorn, Marinus H

    2014-01-01

    .... The current study follows-up on our previous results by attempting to confirm and extend previous findings indicating that experiences of maternal love withdrawal are related to electrocortical...

  7. Schizophrenia and the Other: A Phenomenological Approach to 'Positive Withdrawal'.

    Science.gov (United States)

    Herning, Stefan

    Schizophrenia, in phenomenological psychopathology, is often described as a self disturbance and sometimes as a disturbance of the self-world relation. This study seeks to elaborate on these concepts by examining the significance of the Other in relation to these disturbances. Levinas' account of the 'home' will be employed to interpret the phenomenon of 'positive withdrawal'. Positive withdrawal can be conceptualized as a means to domesticate the Other, and schizophrenia can be described as an alteration or absence of the normal mode of being at home in the world. Furthermore, the theoretic approach seems to suggest that self- and intersubjective disturbances are intimately related. Further elaboration on the phenomenon of the Other and on his relation to schizophrenic illness might provide phenomenological psychopathology with important insights into the nature of schizophrenia and the way the person with schizophrenia experiences himself, the world and Others. This analysis also suggests that psychotherapy could become more effective by developing methods of making the patient feel more at home in the world with Others, and that these methods might need to address the fundamental conditions upon which the patient communicates with and listens to Others. © 2016 S. Karger AG, Basel.

  8. Management of Complex Industrial Supplier Relations - a Case of Customer Attractiveness

    DEFF Research Database (Denmark)

    Ellegaard, Chris

    Companies are increasingly relying on suppliers when developing and manufacturing industrial products. Therefore the supplier relationships of the company need to be managed. This dissertation looks at existing theoretical approaches to supplier relationship management. By studying a number...... term value creation in the relation....

  9. Keeping Track of Our Treasures: Managing Historical Data with Relational Database Software.

    Science.gov (United States)

    Gutmann, Myron P.; And Others

    1989-01-01

    Describes the way a relational database management system manages a large historical data collection project. Shows that such databases are practical to construct. States that the programing tasks involved are not for beginners, but the rewards of having data organized are worthwhile. (GG)

  10. Factors influencing exacerbation-related self-management in patients with COPD : A qualitative study

    NARCIS (Netherlands)

    Korpershoek, Y. J G; Vervoort, S. C J M; Nijssen, L. I T; Trappenburg, J. C A; Schuurmans, M. J.

    2016-01-01

    Background: In patients with COPD, self-management skills are important to reduce the impact of exacerbations. However, both detection and adequate response to exacerbations appear to be difficult for some patients. Little is known about the underlying process of exacerbation-related self-management

  11. Assessment of Groups Influence on Management Style as Related to University Governance

    Science.gov (United States)

    Irtwange, S. V.; Orsaah, S.

    2010-01-01

    The study was undertaken with the objective of assessing groups influence on management style as related to University governance with University of Agriculture, Makurdi as a case study from academic staff perspective. The management style of the Vice Chancellor of the University of Agriculture, Makurdi between the period September 3, 1996 to…

  12. Assessment of Groups Influence on Management Style as Related to University Governance

    Science.gov (United States)

    Irtwange, S. V.; Orsaah, S.

    2010-01-01

    The study was undertaken with the objective of assessing groups influence on management style as related to University governance with University of Agriculture, Makurdi as a case study from academic staff perspective. The management style of the Vice Chancellor of the University of Agriculture, Makurdi between the period September 3, 1996 to…

  13. FEATURES OF INNOVATIVE MANAGEMENT OF REFORMATORY CHANGES IN SYSTEM OF THE LAND RELATIONS

    Directory of Open Access Journals (Sweden)

    Tatyana ZAVOLICHNA

    2017-06-01

    Full Text Available In the article the authors investigated the state of land reform in Ukraine evaluated the prospects of its development following on from the experience of Bulgaria, Romania and Hungary. An innovative algorithm of change management in the system of administration of land relations was suggested, which role is to provide opportunities to expeditiously manage land conversion, effectively overcome resistance to change.

  14. Simulation of groundwater flow and hydrologic effects of groundwater withdrawals from the Kirkwood-Cohansey aquifer system in the Pinelands of southern New Jersey

    Science.gov (United States)

    Charles, Emmanuel G.; Nicholson, Robert S.

    2012-01-01

    The Kirkwood-Cohansey aquifer system is an important source of present and future water supply in southern New Jersey. Because this unconfined aquifer system also supports sensitive wetland and aquatic habitats within the New Jersey Pinelands (Pinelands), water managers and policy makers need up-to-date information, data, and projections that show the effects of potential increases in groundwater withdrawals on these habitats. Finite-difference groundwater flow models (MODFLOW) were constructed for three drainage basins (McDonalds Branch Basin, 14.3 square kilometers (km2); Morses Mill Stream Basin, 21.63 km2; and Albertson Brook Basin, 52.27 km2) to estimate the effects of potential increases in groundwater withdrawals on water levels and the base-flow portion of streamflow, in wetland and aquatic habitats. Three models were constructed for each drainage basin: a transient model consisting of twenty-four 1-month stress periods (October 2004 through September 2006); a transient model to simulate the 5- to 10-day aquifer tests that were performed as part of the study; and a high-resolution, steady-state model used to assess long-term effects of increased groundwater withdrawals on water levels in wetlands and on base flow. All models were constructed with the same eight-layer structure. The smallest horizontal cell dimensions among the three model areas were 150 meters (m) for the 24-month transient models, 10 m for the steady-state models, and 3 m for the transient aquifer-test models. Boundary flows of particular interest to this study and represented separately are those for wetlands, streams, and evapotranspiration. The final variables calibrated from both transient models were then used in steady-state models to assess the long-term effects of increased groundwater withdrawals on water levels in wetlands and on base flow. Results of aquifer tests conducted in the three study areas illustrate the effects of withdrawals on water levels in wetlands and on base

  15. 5 CFR 330.1001 - Withdrawal from competition.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Withdrawal from competition. 330.1001... RECRUITMENT, SELECTION, AND PLACEMENT (GENERAL) Prohibited Practices § 330.1001 Withdrawal from competition... applicant or eligible to withdraw from competition or eligibility, for a position in the competitive...

  16. 47 CFR 1.8 - Withdrawal of papers.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 1 2010-10-01 2010-10-01 false Withdrawal of papers. 1.8 Section 1.8 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRACTICE AND PROCEDURE General Rules of Practice and Procedure General § 1.8 Withdrawal of papers. The granting of a request to dismiss or withdraw...

  17. 21 CFR 171.7 - Withdrawal of petition without prejudice.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 3 2010-04-01 2009-04-01 true Withdrawal of petition without prejudice. 171.7... Withdrawal of petition without prejudice. (a) In some cases the Commissioner will notify the petitioner that... clarification or the obtaining of additional data. This withdrawal will be without prejudice to a future...

  18. 21 CFR 571.7 - Withdrawal of petition without prejudice.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Withdrawal of petition without prejudice. 571.7... Withdrawal of petition without prejudice. (a) In some cases the Commissioner will notify the petitioner that... clarification or the obtaining of additional data. This withdrawal will be without prejudice to a future...

  19. 20 CFR 408.355 - Can you withdraw your application?

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Can you withdraw your application? 408.355 Section 408.355 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR... be repaid. (c) Effect of withdrawal. If we approve your request to withdraw your application, we...

  20. Relative Position Indicator Concept for Managing Mixed RNAV and Vectored Arrival Traffic Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Mosaic ATM proposes to study a Relative Position Indicator (RPI) concept for managing mixed RNAV and traditionally vectored arrival traffic, to enable increased...

  1. Work-related stress management between workplace and occupational health care.

    Science.gov (United States)

    Kinnunen-Amoroso, Maritta; Liira, Juha

    2016-06-13

    Work-related stress has been evaluated as one of the most important health risks in Europe. Prevention of work related stress and interventions to reduce risk factors for stress in the workplace are conducted together by the enterprise and occupational health services. The aim of the study was to examine the experiences of Finnish occupational physicians on the stress management with enterprises. From the Finnish Association of Occupational Health Physicians membership list 207 physicians responded to self-administered anonymous questionnaire. The data were analysed using SPSS 17.0. The client enterprises contacted occupational health services frequently about work-related stress. Collaboration between occupational health and enterprises was strongest in companies' own occupational health services and generally with most experienced physicians. Occupational health services and enterprises shared responsibility for managing work-related stress. Professional experience and close contact with organisation management favours successful stress management between occupational health and enterprises.

  2. Study on the Estimation of Groundwater Withdrawals Based on Groundwater Flow Modeling and Its Application in the North China Plain

    Institute of Scientific and Technical Information of China (English)

    Jingli Shao; Yali Cui; Qichen Hao; Zhong Han; Tangpei Cheng

    2014-01-01

    The amount of water withdrawn by wells is one of the quantitative variables that can be applied to estimate groundwater resources and further evaluate the human influence on ground-water systems. The accuracy for the calculation of the amount of water withdrawal significantly in-fluences the regional groundwater resource evaluation and management. However, the decentralized groundwater pumping, inefficient management, measurement errors and uncertainties have resulted in considerable errors in the groundwater withdrawal estimation. In this study, to improve the esti-mation of the groundwater withdrawal, an innovative approach was proposed using an inversion method based on a regional groundwater flow numerical model, and this method was then applied in the North China Plain. The principle of the method was matching the simulated water levels with the observation ones by adjusting the amount of groundwater withdrawal. In addition, uncertainty analysis of hydraulic conductivity and specific yield for the estimation of the groundwater with-drawal was conducted. By using the proposed inversion method, the estimated annual average groundwater withdrawal was approximately 24.92×109 m3 in the North China Plain from 2002 to 2008. The inversion method also significantly improved the simulation results for both hydrograph and the flow field. Results of the uncertainty analysis showed that the hydraulic conductivity was more sensitive to the inversion results than the specific yield.

  3. Prevention and management of work-related cardiovascular disorders

    Directory of Open Access Journals (Sweden)

    Akizumi Tsutsumi

    2015-02-01

    Full Text Available Cardiovascular disorders (CVDs constitute a major burden for health of working populations throughout the world with as much as 50% of all causes of death and at least 25% of work disability. There are some changes in CVD risk factors among occupational classes. This is mainly due to the new types of work-related causes of morbidity associated with the recent developments in global work life, particularly in the industrialized countries. Meanwhile, in the developing countries or those in transition (e.g., in Eastern Europe, CVD mortality is increasing due to major socioeconomic changes, the demographic transition and rapid industrialisation and urbanisation, all leading to growing challenges to cardiovascular health. Better control of known risk factors (i.e., smoking, obesity, physical inactivity, high cholesterol, high blood pressure, and high blood glucose is effective to prevent CVD incidence. But the expected improvement has not been achieved. The obstacles of achieving such impact are due to lack of awareness, lack of policies and their implementation into practice and shortage of infrastructures and human resources. These are needed for wide-scale and long-term programme implementation. Considering the WHO Global Strategy on Occupational Health for All, the WHO Global Action Plan on Workers’ Health, the WHO Programme on Prevention of Non-communicable Diseases and the ILO Decent Work agenda, the 6th ICOH International Conference on Work Environment and Cardiovascular Diseases adopted the Tokyo Declaration.

  4. How to avoid reputation damage in financial restatement? The role of investor relations management

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    In order to examine the effects of avoiding reputation damage by investor relations management under certain corporate governance structures and mechanisms, samples of 1120 listed companies are used to research the influence on financial restatements by corporate governance. Then the moderating effects of investor relations management on financial restatements are analyzed. The result is that the more dispersed the equity, the higher the probability of financial restatements will be (This includes the gover...

  5. Portfolio Management Decision Support Tools Analysis Relating to Management Value Metrics

    Science.gov (United States)

    2007-03-01

    operating environment. The intangible asset , management, which is required to ensure these important activities are executed at the appropriate time and... intangible asset . An important concept that is stressed in this literature is the assumption that there is a direct relationship between knowledge and...an intangible asset such as knowledge and utilizes this asset in decision making to increase the value of an organization. The next step is to lay

  6. 75 FR 26788 - Public Land Order No. 7742; Withdrawal of Public Land for the Manning Canyon Tailings Repository; UT

    Science.gov (United States)

    2010-05-12

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE INTERIOR Bureau of Land Management Public Land Order No. 7742; Withdrawal of Public Land for the Manning Canyon Tailings Repository; UT AGENCY: Bureau of Land Management, Interior. ACTION: Public Land Order....

  7. A theoretical examination of the relative importance of evolution management and drug development for managing resistance.

    Science.gov (United States)

    McClure, Nathan S; Day, Troy

    2014-12-22

    Drug resistance is a serious public health problem that threatens to thwart our ability to treat many infectious diseases. Repeatedly, the introduction of new drugs has been followed by the evolution of resistance. In principle, there are two complementary ways to address this problem: (i) enhancing drug development and (ii) slowing the evolution of drug resistance through evolutionary management. Although these two strategies are not mutually exclusive, it is nevertheless worthwhile considering whether one might be inherently more effective than the other. We present a simple mathematical model that explores how interventions aimed at these two approaches affect the availability of effective drugs. Our results identify an interesting feature of evolution management that, all else equal, tends to make it more effective than enhancing drug development. Thus, although enhancing drug development will necessarily be a central part of addressing the problem of resistance, our results lend support to the idea that evolution management is probably a very significant component of the solution as well.

  8. Behavioral, biochemical and molecular indices of stress are enhanced in female versus male rats experiencing nicotine withdrawal

    Directory of Open Access Journals (Sweden)

    OSCAR VALENTIN TORRES

    2013-05-01

    Full Text Available Stress is a major factor that promotes tobacco use and relapse during withdrawal. Although women are more vulnerable to tobacco use than men, the manner in which stress contributes to tobacco use in women versus men is unclear. Thus, the goal of this study was to compare behavioral and biological indices of stress in male and female rats during nicotine withdrawal. Since the effects of nicotine withdrawal are age-dependent, this study also included adolescent rats. An initial study was conducted to provide comparable nicotine doses across age and sex during nicotine exposure and withdrawal. Rats received sham surgery or an osmotic pump that delivered nicotine. After 14 days of nicotine, the pumps were removed and controls received a sham surgery. Twenty-four hours later, anxiety-like behavior and plasma corticosterone were assessed. The nucleus accumbens (NAcc, amygdala, and hypothalamus were examined for changes in corticotropin-releasing factor (CRF gene expression. In order to differentiate the effects of nicotine withdrawal from exposure to nicotine, a cohort of rats did not have their pumps removed. The major finding is that during nicotine withdrawal, adult females display higher levels of anxiety-like behavior, plasma corticosterone, and CRF mRNA expression in the NAcc relative to adult males. However, during nicotine exposure, adult males exhibited higher levels of corticosterone and CRF mRNA in the amygdala relative to females. Adolescents displayed less nicotine withdrawal than adults. Moreover, adolescent males displayed an increase in anxiety-like behavior and an up-regulation of CRF mRNA in the amygdala during nicotine exposure and withdrawal. These findings are likely related to stress produced by the high doses of nicotine that were administered to adolescents to produce equivalent levels of cotinine as adults. In conclusion, these findings suggest that intense stress produced by nicotine withdrawal may contribute to tobacco use

  9. Wet age related macular degeneration management and follow-up.

    Science.gov (United States)

    Alexandru, Malciolu Radu; Alexandra, Nica Maria

    2016-01-01

    Age-related macular degeneration (AMD) is referred to as the leading cause of irreversible visual loss in developed countries, with a profound effect on the quality of life. The neovascular form of AMD is characterized by the formation of subretinal choroidal neovascularization, leading to sudden and severe visual loss. Research has identified the vascular endothelial growth factor (VEGF) as an important pathophysiological component in neovascular AMD and its intraocular inhibition as one of the most efficient therapies in medicine. The introduction of anti-VEGF as a standard treatment in wet AMD has led to a great improvement in the prognosis of patients, allowing recovery and maintenance of visual function in the vast majority of cases. However, the therapeutic benefit is accompanied by a difficulty in maintaining the treatment schedule due to the increase in the amount of patients, stress of monthly assessments, as well as the associated economic burden. Therefore, treatment strategies have evolved from fixed monthly dosing, to individualized regimens, aiming for comparable results, with fewer injections. One such protocol is called "pro re nata", or "treat and observe". Patients are given a loading dose of 3 monthly injections, followed by an as-needed decision to treat, based on the worsening of visual acuity, clinical evidence of the disease activity on fundoscopy, or OCT evidence of retinal thickening in the presence of intra or subretinal fluid. A different regimen is called "treat and extend", in which the interval between injections is gradually increased, once the disease stabilization is achieved. This paper aims to review the currently available anti-VEGF agents--bevacizumab, ranibizumab, aflibercept, and the aforementioned treatment strategies.

  10. Global-scale analysis of river flow alterations due to water withdrawals and reservoirs

    Directory of Open Access Journals (Sweden)

    P. Döll

    2009-07-01

    Full Text Available Global-scale information on natural river flows and anthropogenic river flow alterations is required to identify areas where aqueous ecosystems are expected to be strongly degraded. Such information can support the identification of environmental flow guidelines and a sustainable water management that balances the water demands of humans and ecosystems. This study presents the first global assessment of the anthropogenic alteration of river flow regimes by water withdrawals and dams, focusing in particular on the change of flow variability. Six ecologically relevant flow indicators were quantified using an improved version of the global water model WaterGAP. WaterGAP simulated, with a spatial resolution of 0.5 degree, river discharge as affected by human water withdrawals and dams, as well as naturalized discharge without this type of human interference. Mainly due to irrigation, long-term average river discharge and statistical low flow Q90 (monthly river discharge that is exceeded in 9 out of 10 months have decreased by more than 10% on one sixth and one quarter of the global land area (excluding Antarctica and Greenland, respectively. Q90 has increased significantly on only 5% of the land area, downstream of reservoirs. Due to both water withdrawals and dams, seasonal flow amplitude has decreased significantly on one sixth of the land area, while interannual variability has increased on one quarter of the land area mainly due to irrigation. It has decreased on only 8% of the land area, in areas with little consumptive water use that are downstream of dams. Areas most affected by anthropogenic river flow alterations are the western and central USA, Mexico, the western coast of South America, the Mediterranean rim, Southern Africa, the semi-arid and arid countries of the Near East and Western Asia, Pakistan and India, Northern China and the Australian Murray-Darling Basin, as well as some Arctic rivers. Due

  11. Withdrawal of inhaled corticosteroids in people with COPD in primary care: a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Wedzicha Jadwiga A

    2007-12-01

    Full Text Available Abstract Background Guidelines recommend inhaled corticosteroids (ICS for patients with severe chronic obstructive pulmonary disease (COPD. Most COPD patients are managed in primary care and receive ICS long-term and irrespective of severity. The effect of withdrawing ICS from COPD patients in primary care is unknown. Methods In a pragmatic randomised, double-blind, placebo-controlled trial in 31 practices, 260 COPD patients stopped their usual ICS (median duration of use 8 years and were allocated to 500 mcg fluticasone propionate twice daily (n = 128, or placebo (n = 132. Follow-up assessments took place at three monthly intervals for a year at the patients' practice. Our primary outcome was COPD exacerbation frequency. Secondary outcomes were time to first COPD exacerbation, reported symptoms, peak expiratory flow rate and reliever inhaler use, and lung function and health related quality of life. Results In patients randomised to placebo, COPD exacerbation risk over one year was RR: 1.11 (CI: 0.91–1.36. Patients taking placebo were more likely to return to their usual ICS following exacerbation, placebo: 61/128 (48%; fluticasone: 34/132 (26%, OR: 2.35 (CI: 1.38–4.05. Exacerbation risk whilst taking randomised treatment was significantly raised in the placebo group 1.48 (CI: 1.17–1.86. Patients taking placebo exacerbated earlier (median time to first exacerbation: placebo (days: 44 (CI: 29–59; fluticasone: 63 (CI: 53–74, log rank 3.81, P = 0.05 and reported increased wheeze. In a post-hoc analysis, patients with mild COPD taking placebo had increased exacerbation risk RR: 1.94 (CI: 1.20–3.14. Conclusion Withdrawal of long-term ICS in COPD patients in primary care increases risk of exacerbation shortens time to exacerbation and causes symptom deterioration. Patients with mild COPD may be at increased risk of exacerbation after withdrawal. Trial Registration ClinicalTrials.gov NCT00440687

  12. “Real-life” inhaled corticosteroid withdrawal in COPD: a subgroup analysis of DACCORD

    Directory of Open Access Journals (Sweden)

    Vogelmeier C

    2017-02-01

    that ICS withdrawal is possible with no increased risk of exacerbations in patients with COPD managed in the primary and secondary care. Keywords: COPD exacerbations, chronic obstructive pulmonary disease exacerbations, health-related quality of life, inhaled steroids

  13. Methods for Estimating Water Withdrawals for Aquaculture in the United States, 2005

    Science.gov (United States)

    Lovelace, John K.

    2009-01-01

    Aquaculture water use is associated with raising organisms that live in water - such as finfish and shellfish - for food, restoration, conservation, or sport. Aquaculture production occurs under controlled feeding, sanitation, and harvesting procedures primarily in ponds, flow-through raceways, and, to a lesser extent, cages, net pens, and tanks. Aquaculture ponds, raceways, and tanks usually require the withdrawal or diversion of water from a ground or surface source. Most water withdrawn or diverted for aquaculture production is used to maintain pond levels and/or water quality. Water typically is added for maintenance of levels, oxygenation, temperature control, and flushing of wastes. This report documents methods used to estimate withdrawals of fresh ground water and surface water for aqua-culture in 2005 for each county and county-equivalent in the United States, Puerto Rico, and the U.S. Virgin Islands by using aquaculture statistics and estimated water-use coefficients and water-replacement rates. County-level data for commercial and noncommercial operations compiled for the 2005 Census of Aquaculture were obtained from the National Agricultural Statistics Service. Withdrawals of water used at commercial and noncommercial operations for aquaculture ponds, raceways, tanks, egg incubators, and pens and cages for alligators were estimated and totaled by ground-water or surface-water source for each county and county equivalent. Use of the methods described in this report, when measured or reported data are unavailable, could result in more consistent water-withdrawal estimates for aquaculture that can be used by water managers and planners to determine water needs and trends across the United States. The results of this study were distributed to U.S. Geological Survey water-use personnel in each State during 2007. Water-use personnel are required to submit estimated withdrawals for all categories of use in their State to the U.S. Geological Survey National

  14. The role of eltrombopag in the management of hepatitis C virus-related thrombocytopenia.

    Science.gov (United States)

    Danish, Fazal-I-Akbar; Yasmin, Saeeda

    2013-01-01

    Eltrombopag is a 2nd generation thrombopoietin-receptor agonist. It binds with the thrombopoietin-receptors found on the surfaces of the megakaryocytes & increases platelet production. Many recent studies have suggested a potential role for this novel agent in the treatment of thrombocytopenia associated with hepatitis-C infection. Studies have shown that adjunct treatment with Eltrombopag can help avoid dose reductions/withdrawals of pegylated interferon secondary to thrombocytopenia. It may also have a role in priming up platelet levels to help initiate antiviral therapy. Similarly, chronic liver disease patients with thrombocytopenia who need to undergo an invasive procedure may be potential candidates for short two-week courses of eltrombopag in the periprocedural period to help reduce the risk of bleeding. Besides the price (deemed very expensive and probably not cost-effective), there are some legitimate concerns about the safety profile of this novel agent (most importantly, portal vein thrombosis, bone marrow fibrosis and hepatotoxicity). In this article, the potential role of eltrombopag in the context of hepatitis C virus (HCV)-related thrombocytopenia is reviewed. To write this article, a MEDLINE search was conducted (1990 to November 2012) using the search terms "eltrombopag," "HCV," and "thrombocytopenia."

  15. The role of eltrombopag in the management of hepatitis C virus-related thrombocytopenia

    Directory of Open Access Journals (Sweden)

    Danish FA

    2013-03-01

    Full Text Available Fazal-i-Akbar Danish,1 Saeeda Yasmin21James Paget University Hospital, Great Yarmouth, Norfolk, United Kingdom; 2Shifa International Hospital, Islamabad, PakistanAbstract: Eltrombopag is a 2nd generation thrombopoietin-receptor agonist. It binds with the thrombopoietin-receptors found on the surfaces of the megakaryocytes & increases platelet production. Many recent studies have suggested a potential role for this novel agent in the treatment of thrombocytopenia associated with hepatitis-C infection. Studies have shown that adjunct treatment with Eltrombopag can help avoid dose reductions/withdrawals of pegylated interferon secondary to thrombocytopenia. It may also have a role in priming up platelet levels to help initiate antiviral therapy. Similarly, chronic liver disease patients with thrombocytopenia who need to undergo an invasive procedure may be potential candidates for short two-week courses of eltrombopag in the periprocedural period to help reduce the risk of bleeding. Besides the price (deemed very expensive and probably not cost-effective, there are some legitimate concerns about the safety profile of this novel agent (most importantly, portal vein thrombosis, bone marrow fibrosis and hepatotoxicity. In this article, the potential role of eltrombopag in the context of hepatitis C virus (HCV-related thrombocytopenia is reviewed. To write this article, a MEDLINE search was conducted (1990 to November 2012 using the search terms “eltrombopag,” “HCV,” and “thrombocytopenia.”Keywords: liver disease, chronic immune thrombocytopenic purpura, thrombopoietin-receptor agonist, romiplostim

  16. Why Do Students Withdraw from Online Graduate Nursing and Health Studies Education?

    Directory of Open Access Journals (Sweden)

    Margaret Edwards

    2008-01-01

    Full Text Available Why do nursing and health studies graduate students who are enrolled in online programs decide to withdraw? The qualitative study reported in this paper investigated students’ self-identified reasons for withdrawing from an online graduate program in nursing and health studies. The focus of the study was Athabasca Universities’ Centre for Nursing and Health Studies (CNHS online graduate program. Data were collected from program students who initiated withdrawal between the years 1999-2004. Using Rovai’s (2002 Composite Persistence Model as a framework for analysis, themes identified from withdrawing students’ notice of withdrawal letters are discussed. The major reasons for leaving can be placed into two categories, personal reasons (often related to life or work commitments and program reasons (usually related to learning style and fit with career. These findings, and the resulting analysis, have implications for online program design and delivery and student support programs. With a better understanding of student reasons for leaving a program of studies, it will be possible to explore which program elements might be altered to improve the experience of online learning.

  17. Fast-conducting mechanoreceptors contribute to withdrawal behavior in normal and nerve injured rats.

    Science.gov (United States)

    Boada, M Danilo; Martin, Thomas J; Peters, Christopher M; Hayashida, Kenichiro; Harris, Michael H; Houle, Timothy T; Boyden, Edward S; Eisenach, James C; Ririe, Douglas G

    2014-12-01

    Fast-conducting myelinated high-threshold mechanoreceptors (AHTMR) are largely thought to transmit acute nociception from the periphery. However, their roles in normal withdrawal and in nerve injury-induced hyperalgesia are less well accepted. Modulation of this subpopulation of peripheral neurons would help define their roles in withdrawal behaviors. The optically active proton pump, ArchT, was placed in an adeno-associated virus-type 8 viral vector with the CAG promoter and was administered by intrathecal injection resulting in expression in myelinated neurons. Optical inhibition of peripheral neurons at the soma and transcutaneously was possible in the neurons expressing ArchT, but not in neurons from control animals. Receptive field characteristics and electrophysiology determined that inhibition was neuronal subtype-specific with only AHTMR neurons being inhibited. One week after nerve injury the AHTMR are hyperexcitable, but can still be inhibited at the soma and transcutaneously. Withdrawal thresholds to mechanical stimuli in normal and in hyperalgesic nerve-injured animals also were increased by transcutaneous light to the affected hindpaw. This suggests that AHTMR neurons play a role not only in threshold-related withdrawal behavior in the normal animal, but also in sensitized states after nerve injury. This is the first time this subpopulation of neurons has been reversibly modulated to test their contribution to withdrawal-related behaviors before and after nerve injury. This technique may prove useful to define the role of selective neuronal populations in different pain states.

  18. Withdrawal of repeated morphine enhances histamine-induced scratching responses in mice.

    Science.gov (United States)

    Abe, Kenji; Kobayashi, Kanayo; Yoshino, Saori; Taguchi, Kyoji; Nojima, Hiroshi

    2015-04-01

    An itch is experientially well known that the scratching response of conditions such as atopic dermatitis is enhanced under psychological stress. Morphine is typical narcotic drug that induces a scratching response upon local application as an adverse drug reaction. Although long-term treatment with morphine will cause tolerance and dependence, morphine withdrawal can cause psychologically and physiologically stressful changes in humans. In this study, we evaluated the effects of morphine withdrawal on histamine-induced scratching behavior in mice. Administration of morphine with progressively increasing doses (10-50 mg/kg, i.p.) was performed for 5 consecutive days. At 3, 24, 48, and 72 hr after spontaneous withdrawal from the final morphine dose, histamine was intradermally injected into the rostral part of the back and then the number of bouts of scratching in 60 min was recorded and summed. We found that at 24 hr after morphine withdrawal there was a significant increase in histamine-induced scratching behavior. The spinal c-Fos positive cells were also significantly increased. The relative adrenal weight increased and the relative thymus weight decreased, both significantly. Moreover, the plasma corticosterone levels changed in parallel with the number of scratching bouts. These results suggest that morphine withdrawal induces a stressed state and enhances in histamine-induced scratching behavior. Increased reaction against histamine in the cervical vertebrae will participate in this stress-induced itch enhancement.

  19. Intramammary antibiotics in dairy goats : effect of stage of lactation, parity and milk volume on withdrawal periods, and the effect of treatment on milk compositional quality

    Directory of Open Access Journals (Sweden)

    J. Karzis

    2007-09-01

    Full Text Available The length of the antibiotic withdrawal period after intramammary treatment was influenced by the milk yield of dairy goats during this trial. Shorter withdrawal periods were seen in relatively high yielding dairy goats (production above 1.5 ℓ per day compared to low producers (less than 1.3 ℓ per day. High yielding goats treated with Curaclox LC (Norbrook [Pharmacia AH] had a withdrawal period of 42 h, while low yielding goats, treated with the same product, had a withdrawal period of 74 h. The recommended withdrawal period for Curaclox LC for use in cattle is 72 h. Relatively high yielding goats treated with Rilexine 200 LC (Logos Agvet [Virbac] had a significantly shorter withdrawal period (37 h than that recommended for use in cattle (96 h. Low yielding goats treated with Spectrazol Milking Cow (Schering-Plough Animal Health had a significantly longer (95 h withdrawal period than that recommended for use in cattle (60 h. Withdrawal periods were also influenced by stage of lactation and parity. There was a moderate positive correlation between lactation number and withdrawal period, as measured by TRIS (R2 = 0.621, and a moderate negative correlation between stage of lactation and withdrawal period (R2 = -0.669. In Trials 1, 2 and 3 combined there was a moderate negative correlation between withdrawal period and volume (R2 = -0.511 and a strong positive correlation between withdrawal period and lactation number (R2 = 0.720. The differences in percentage milk fat, protein and lactose before, during and after treatment were not statistically significant except in Trial 3 (Curaclox LC and Rilexine 200 LC where protein and lactose differed significantly. In Trial 2 (Spectrazol Milking Cow milk fat percentages differed significantly between treatment and control groups as did protein percentages in Trial 3. These differences are however, not biologically meaningful.

  20. Health Related Quality Management Values and Key Principles of Communicative Leadership - Are They the Same?

    Directory of Open Access Journals (Sweden)

    Ingela Backstrom

    2014-07-01

    Full Text Available The purpose of this paper is to compare health related values within Quality Management with Key Principles of Communicative Leadership in order to see if Communicative leaders also promote healthy co-workers.  A literature review was conducted within the area of Communicative Leadership and within the values of health related Quality Management. The principles within Communicative leadership were compared with the underlying dimensions within the health related values ‘Leadership Commitment’ and Participation of everybody’. The analysis shows that the underlying dimensions within both of the health related Quality Management values ‘Participation of everybody’ and ‘Leadership commitment’ were related to some of the Key Principles of Communicative Leadership. The results can help Communicative Leaders to emphasize the Key Principles that also promote healthy co-workers. The results can also help leaders that already have healthy co-workers to increase leaders’ communication competence within organizations.

  1. Negotiated dying: a grounded theory of how nurses shape withdrawal of treatment in hospital critical care units.

    Science.gov (United States)

    Long-Sutehall, Tracy; Willis, Helen; Palmer, Rachel; Ugboma, Debra; Addington-Hall, Julia; Coombs, Maureen

    2011-12-01

    The process of withdrawal of treatment in critical care environments has created ethical and moral dilemmas in relation to end of life care in the UK and elsewhere. Common within this discourse is the differing demands made on health professionals as they strive to provide care for the dying patient and family members. Despite reports that withdrawal of treatment is a source of tension between those nurses and doctors involved in the process, the role of the nurse in facilitating withdrawal of treatment has received relatively little attention. To illustrate how differing dying trajectories impact on decision-making underpinning withdrawal of treatment processes, and what nurses do to shape withdrawal of treatment. Qualitative methods of enquiry using clinical vignettes and applying Charmaz's grounded theory method. Single audio-recorded qualitative interviews with thirteen critical care nurses from four intensive care specialities: cardiac; general; neurological and renal were carried out. Interviews were facilitated by an end-of-life vignette developed with clinical collaborators. Across critical care areas four key dying trajectories were identified. These trajectories were shaped by contested boundaries associated with delayed or stalled decision-making around how withdrawal of treatment should proceed. Nurses provided end of life care (including collaborative and action-oriented skills) to shape the dying trajectory of patients so as to satisfy the wishes of the patient and family, and their own professional aims. Differing views as to when withdrawal of treatment should commence and how it should be operationalised appeared to be underpinned by the requirements of the role that health professionals fulfil, with doctors focusing on making withdrawal of treatment decisions, and nurse's being tasked with operationalising the processes that constitute it. Multidisciplinary teams need a 'shared' understanding of each other's roles, responsibilities, aims, and

  2. Scaling at the selective withdrawal transition

    CERN Document Server

    Cohen, I; Cohen, Itai; Nagel, Sidney R.

    2002-01-01

    In the selective withdrawal experiment fluid is withdrawn through a tube with its tip suspended a distance S above an unperturbed two-fluid interface. At low withdrawal rates, Q, the interface forms a steady state hump and only the upper fluid is withdrawn. When Q is increased (or S decreased), the interface undergoes a transition so that the lower fluid is entrained with the upper one, forming a thin steady-state spout. Near this discontinuous transition the hump curvature becomes very large and displays power-law scaling behavior. This scaling is used to show that steady-state profiles for humps at different flow rates and tube heights can all be scaled onto a single similarity profile.

  3. Gabapentin withdrawal presenting as status epilepticus.

    Science.gov (United States)

    Barrueto, Fermin; Green, Jonah; Howland, Mary Ann; Hoffman, Robert S; Nelson, Lewis S

    2002-01-01

    A 34-year-old male with lumbar disc disease and surgery was placed on gabapentin daily for chronic back pain. He remained on a steady dose of 8000 mg/day for 9 months, almost doubled what is considered therapeutic. He ran out of medication, was unable to refill his prescription for 2 days and presented to the emergency department in status epilepticus. There was no previous history of seizure disorder and he was on no other medications. A medical evaluation for an alternative etiology of his seizures was negative. Although gabapentin withdrawal has been previously reported and usually consists of anxiety, diaphoresis, and palpitations, this is the first reported patient with generalized seizures and status epilepticus secondary to gabapentin withdrawal.

  4. Transdermal Scopolamine Withdrawal Syndrome Case Report in the Pediatric Cerebral Palsy Population.

    Science.gov (United States)

    Chowdhury, Nasim A; Sewatsky, Mary Laura; Kim, Heakyung

    2017-08-01

    Sialorrhea in children with cerebral palsy (CP) results in aspiration, decreased social integration, and poor quality of life. Management options include transdermal anticholinergics such as the scopolamine patch. A controlled clinical trial has proven botulinum toxin (BTX) injections into the salivary glands are an effective alternative to transdermal anticholinergics with a safer side effect profile. Multiple studies of the injections in diverse populations demonstrate reduction in saliva production with improvement in quality of life and decrease in hospitalization-associated costs. The authors describe a 15-year-old boy with spastic quadriplegic CP who developed emesis, nausea, and lethargy 1 day after the first injection of botulinum toxin A (BTX-A) to his salivary glands for sialorrhea management. The authors ascribed his symptoms to scopolamine withdrawal. Given the lack of exposure in the medical literature, there is minimal awareness of the withdrawal syndrome from transdermal scopolamine in children with or without CP, resulting in delayed diagnosis and potential complications. Treatment of the withdrawal syndrome has been successful with meclizine though safety and efficacy has not been established in children younger than 12 despite frequent clinical and over-the-counter use. Prompt diagnosis of the transdermal scopolamine withdrawal syndrome can result in quicker treatment and a shorter hospital stay.

  5. Contributions of Relational Coordination to Care Management in ACOs: Views of Managerial and Clinical Leaders

    Science.gov (United States)

    Rundall, Thomas G.; Wu, Frances M.; Lewis, Valerie A.; Schoenherr, Karen E.; Shortell, Stephen M.

    2017-01-01

    Background The accountable care organization (ACO) is a new type of health care organization incentivized to improve quality of care, improve population health, and reduce the total cost of care. An ACO’s success in meeting these objectives will depend greatly upon its ability to improve patient care management. Numerous studies have found relational coordination to be positively associated with key measures of organizational performance in health care organizations, including quality and efficiency. Purpose The purpose of this paper is twofold: (1) identify the extent to which ACO leaders are aware of the dimensions of relational coordination, and (2) identify the ways these leaders believe the dimensions influenced care management practices in their organization. Methodology/Approach We performed content analysis of interviews with managerial and clinical leaders from a diverse group of 11 ACOs to assess awareness of relational coordination and identify the ways that dimensions of relational coordination were perceived to influence development of care management practices. Findings ACO leaders mentioned four relational coordination dimensions: shared goals, frequency of communication, timeliness of communication, and problem solving communication. Three dimensions – shared knowledge of team members’ tasks, mutual respect, and accuracy of communication – were not mentioned. Our analysis identified numerous ways leaders believed the four mentioned dimensions contributed to the development of care management, including contributions to standardization of care, patient engagement, coordination of care, and care planning. Discussion We propose two hypotheses for future research on relational coordination and care management. Practice Implications If relational coordination is to have a beneficial influence on ACO performance, organizational leaders must become more aware of relational coordination and its various dimensions and become cognizant of relational

  6. Mapping current and future European public water withdrawals and consumption

    Science.gov (United States)

    Vandecasteele, I.; Bianchi, A.; Silva, F. Batista e.; Lavalle, C.; Batelaan, O.

    2014-02-01

    In Europe, public water withdrawals make up on average 30% and in some cases up to 60% of total water withdrawals. These withdrawals are becoming increasingly important with growing population density; hence there is a need to understand the spatial and temporal trends involved. Pan-European public/municipal water withdrawals and consumption were mapped for 2006 and forecasted for 2030. Population and tourism density were assumed to be the main driving factors for withdrawals. Country-level statistics on public water withdrawals were disaggregated to a combined population and tourism density map (the "user" density map) computed for 2006. The methodology was validated using actual regional withdrawal statistics from France for 2006. The total absolute error (TAE) calculated was proven to be reduced by taking into account the tourism density in addition to the population density. In order to forecast the map to 2030 we considered a reference scenario where per capita withdrawals were kept constant in time. Although there are large variations from region to region, this resulted in a European average increase of water withdrawals of 16%. If we extrapolate the average reduction in per capita withdrawals seen between 2000 and 2008, we forecast a reduction in average total water withdrawals of 4%. Considering a scenario where all countries converge to an optimal water use efficiency, we see an average decrease of 28%.

  7. Cardless Withdrawal System for Mobile Banking Applications

    OpenAIRE

    Calin Mihai Istrate

    2014-01-01

    With the whole world going mobile and with the threats represented by third party mobile payments, the banks need to react and offer their clients innovative integrated solutions for payments and money transfer. Mobile banking applications are more and more used, and the possibilities to expand are still open.A cardless withdrawal solution integrated in an already developed smartphone mobile banking application might just give an edge in the fight with other competitors. By using SMS technolo...

  8. Cardiovascular collapse with attempted pericardial drain withdrawal

    Directory of Open Access Journals (Sweden)

    Molly B Kraus

    2016-01-01

    Full Text Available Cardiac tamponade is a rare but serious emergency condition in the pediatric population. As treatment, a pericardial drain is often placed to evacuate the fluid. We present a case of a 4-year-old girl with cardiac tamponade secondary to renal failure. After the tamponade resolved, she suffered cardiovascular collapse upon attempted drain withdrawal. This case highlights an unusual cause for cardiovascular collapse, which occurred on blind removal of a pericardial drain.

  9. Cardiovascular collapse with attempted pericardial drain withdrawal

    OpenAIRE

    Molly B Kraus; Spitznagel, Rachel A; Kugler, Jane A

    2016-01-01

    Cardiac tamponade is a rare but serious emergency condition in the pediatric population. As treatment, a pericardial drain is often placed to evacuate the fluid. We present a case of a 4-year-old girl with cardiac tamponade secondary to renal failure. After the tamponade resolved, she suffered cardiovascular collapse upon attempted drain withdrawal. This case highlights an unusual cause for cardiovascular collapse, which occurred on blind removal of a pericardial drain.

  10. Dynamic tables: an architecture for managing evolving, heterogeneous biomedical data in relational database management systems.

    Science.gov (United States)

    Corwin, John; Silberschatz, Avi; Miller, Perry L; Marenco, Luis

    2007-01-01

    Data sparsity and schema evolution issues affecting clinical informatics and bioinformatics communities have led to the adoption of vertical or object-attribute-value-based database schemas to overcome limitations posed when using conventional relational database technology. This paper explores these issues and discusses why biomedical data are difficult to model using conventional relational techniques. The authors propose a solution to these obstacles based on a relational database engine using a sparse, column-store architecture. The authors provide benchmarks comparing the performance of queries and schema-modification operations using three different strategies: (1) the standard conventional relational design; (2) past approaches used by biomedical informatics researchers; and (3) their sparse, column-store architecture. The performance results show that their architecture is a promising technique for storing and processing many types of data that are not handled well by the other two semantic data models.

  11. Effect of Pharmacological Modulation of the Endocannabinoid System on Opiate Withdrawal: A Review of the Preclinical Animal Literature.

    Science.gov (United States)

    Wills, Kiri L; Parker, Linda A

    2016-01-01

    Over the years, animal studies have revealed a role for the endocannabinoid system in the regulation of multiple aspects of opiate addiction. The current review provides an overview of this literature in regards to opiate withdrawal. The opiate withdrawal syndrome, hypothesized to act as a negative reinforcer in mediating continued drug use, can be characterized by the emergence of spontaneous or precipitated aversive somatic and affective states following the termination of drug use. The behaviors measured to quantify somatic opiate withdrawal and the paradigms employed to assess affective opiate withdrawal (e.g., conditioned place aversion) in both acutely and chronically dependent animals are discussed in relation to the ability of the endocannabinoid system to modulate these behaviors. Additionally, the brain regions mediating somatic and affective opiate withdrawal are elucidated with respect to their modulation by the endocannabinoid system. Ultimately, a review of these findings reveals dissociations between the brain regions mediating somatic and affective opiate withdrawal, and the ability of cannabinoid type 1 (CB1) receptor agonism/antagonism to interfere with opiate withdrawal within different brain sub regions.

  12. 48 CFR 252.251-7001 - Use of Interagency Fleet Management System (IFMS) vehicles and related services.

    Science.gov (United States)

    2010-10-01

    ... Management System (IFMS) vehicles and related services. 252.251-7001 Section 252.251-7001 Federal Acquisition... Fleet Management System (IFMS) vehicles and related services. As prescribed in 251.205, use the following clause: Use of Interagency Fleet Management System (IFMS) Vehicles and Related Services (DEC 1991...

  13. Career involvement and family involvement as moderators of relationships between work-family conflict and withdrawal from a profession.

    Science.gov (United States)

    Greenhaus, J H; Parasuraman, S; Collins, K M

    2001-04-01

    This study extended prior analyses by J. H. Greenhaus, K. M. Collins, R. Singh, and S. Parasuraman (1997) by examining relationships between 2 directions of work-family conflict (work-to-family conflict and family-to-work conflict) and withdrawal from public accounting. The sample consisted of 199 members of the American Institute of Certified Public Accountants (135 men and 64 women) who were married or in a long-term relationship and who had 1 or more children. It was found that work-to-family conflict (but not family-to-work conflict) was positively related to withdrawal intentions. In addition, relationships of work-to-family conflict with withdrawal intentions and withdrawal behavior were stronger for individuals who were relatively uninvolved in their careers than for those who were highly involved in their careers. The implications of the findings for future research are discussed.

  14. Employee perceptions of management relations as influences on job satisfaction and quit intentions

    NARCIS (Netherlands)

    Frenkel, S.; Sanders, K.; Bednall, T.

    2013-01-01

    In this paper we use a relational approach to investigate how employee perceptions of their relationships with three types of managers—senior, line, and human resource managers—are related to employees’ job satisfaction and intention to quit. Based on an employee survey (n = 1,533), and manager netw

  15. 75 FR 66125 - Federal Land Managers' Air Quality Related Values Work Group (FLAG)

    Science.gov (United States)

    2010-10-27

    ... National Park Service Federal Land Managers' Air Quality Related Values Work Group (FLAG) AGENCY: National...' Air Quality Related Values Work Group (FLAG) was formed (1) to develop a more consistent and objective... constituencies (e.g., State air regulatory agencies, concerned citizens, environmental groups,...

  16. Organizational Justice as a Framework for Understanding Union-Management Relations in Education

    Science.gov (United States)

    Poole, Wendy L.

    2007-01-01

    In this article, I have conceptualized union-management relations using an organizational justice framework. I consider organizational justice theory, including distributive, procedural, interactional, and what I call relational justice perspectives. Utilizing examples from my experience and research, I illustrate and discuss various forms of…

  17. Management of mining-related damages in abandoned underground coal mine areas using GIS

    Energy Technology Data Exchange (ETDEWEB)

    Lee, U.J.; Kim, J.A.; Kim, S.S. [Coal Industry Promotion Board, Seoul (Korea, Republic of); Kim, W.K.; Yoon, S.H.; Choi, J.K. [Ssangyong Information and Communication Corp., Seoul (Korea, Republic of)

    2005-07-01

    The mining-related damages such as ground subsidence, acid mine drainage (AMD), and deforestation in the abandoned underground coal mine areas become an object of public concern. Therefore, the system to manage the mining-related damages is needed for the effective drive of rehabilitation activities. The management system for Abandoned Underground Coal Mine using GIS includes the database about mining record and information associated with the mining-related damages and application programs to support mine damage prevention business. Also, this system would support decision-making policy for rehabilitation and provide basic geological data for regional construction works in abandoned underground coal mine areas. (authors)

  18. Simulation of groundwater flow and hydrologic effects of groundwater withdrawals from the Kirkwood-Cohansey aquifer system in the Pinelands of southern New Jersey

    Science.gov (United States)

    Charles, Emmanuel G.; Nicholson, Robert S.

    2012-01-01

    The Kirkwood-Cohansey aquifer system is an important source of present and future water supply in southern New Jersey. Because this unconfined aquifer system also supports sensitive wetland and aquatic habitats within the New Jersey Pinelands (Pinelands), water managers and policy makers need up-to-date information, data, and projections that show the effects of potential increases in groundwater withdrawals on these habitats. Finite-difference groundwater flow models (MODFLOW) were constructed for three drainage basins (McDonalds Branch Basin, 14.3 square kilometers (km2); Morses Mill Stream Basin, 21.63 km2; and Albertson Brook Basin, 52.27 km2) to estimate the effects of potential increases in groundwater withdrawals on water levels and the base-flow portion of streamflow, in wetland and aquatic habitats. Three models were constructed for each drainage basin: a transient model consisting of twenty-four 1-month stress periods (October 2004 through September 2006); a transient model to simulate the 5- to 10-day aquifer tests that were performed as part of the study; and a high-resolution, steady-state model used to assess long-term effects of increased groundwater withdrawals on water levels in wetlands and on base flow. All models were constructed with the same eight-layer structure. The smallest horizontal cell dimensions among the three model areas were 150 meters (m) for the 24-month transient models, 10 m for the steady-state models, and 3 m for the transient aquifer-test models. Boundary flows of particular interest to this study and represented separately are those for wetlands, streams, and evapotranspiration. The final variables calibrated from both transient models were then used in steady-state models to assess the long-term effects of increased groundwater withdrawals on water levels in wetlands and on base flow. Results of aquifer tests conducted in the three study areas illustrate the effects of withdrawals on water levels in wetlands and on base

  19. The discourse of health managers on aspects related to the delay in tuberculosis diagnosis

    Directory of Open Access Journals (Sweden)

    Lenilde Duarte de Sa

    2013-10-01

    Full Text Available The aim of this study was to analyze the discourse of health managers on aspects related to delay in tuberculosis diagnosis. This was a qualitative research study, conducted with 16 Family Health Unit managers. The empirical data were obtained through semi-structured interviews. The analysis was based on the theoretical framework of the French school of discourse analysis. According to the managers’ statements, the delay in tuberculosis diagnosis is related to patient and health service aspects. As for patient aspects, managers report fear, prejudice and lack of information as factors that may promote a delayed diagnosis. Regarding health service aspects, structural problems and lack of professional skills were reported. The discourse of managers should be considered to qualify tuberculosis control actions and to prevent delays in diagnosis.

  20. Gabapentin Effect on Pain Associated with Heroin Withdrawal in Iranian Crack: a Randomized Double-blind Clinical Trial

    OpenAIRE

    Behnam, Behnaz; Semnani, Vahid; Saghafi, Nadia; Ghorbani, Raheb; Dianak Shori, Mina; Ghooshchian Choobmasjedi, Samaneh

    2012-01-01

    Gabapentin seems to be a safe and well tolerated medication for treating heroine dependence. This study examined the efficacy of gabapentin for relieving withdrawal-related pain due to heroin use. Sixty men were recruited from an inpatient psychiatric ward of Fatemieh hospital in Semnan and randomized to receive either placebo (n = 30) or gabapentin (1800 mg/day) (n = 30) for 7 days. Subjective Opioid Withdrawal Scale (SOWS) was measured as a self-administered scale for grading body pain at b...

  1. A costly separation between withdrawing and withholding treatment in intensive care.

    Science.gov (United States)

    Wilkinson, Dominic; Savulescu, Julian

    2014-03-01

    Ethical analyses, professional guidelines and legal decisions support the equivalence thesis for life-sustaining treatment: if it is ethical to withhold treatment, it would be ethical to withdraw the same treatment. In this paper we explore reasons why the majority of medical professionals disagree with the conclusions of ethical analysis. Resource allocation is considered by clinicians to be a legitimate reason to withhold but not to withdraw intensive care treatment. We analyse five arguments in favour of non-equivalence, and find only relatively weak reasons to restrict rationing to withholding treatment. On the contrary, resource allocation provides a strong argument in favour of equivalence: non-equivalence causes preventable death in critically ill patients. We outline two proposals for increasing equivalence in practice: (1) reduction of the mortality threshold for treatment withdrawal, (2) time-limited trials of intensive care. These strategies would help to move practice towards more rational treatment limitation decisions.

  2. Withholding or withdrawing therapy in intensive care units: improving interdisciplinary cooperation

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene; Ammentorp, Jette; Ørding, Helle

    and profit of the audits were evaluated in writing at the end of the sessions and by a short questionnaire three months later. RESULTS. In all three audits the discussions were engaged. In the immediate evaluation 61% assessed this type of audit as “To a great extent” usable to promote interdisciplinary......INTRODUCTION. Decisions regarding withholding or withdrawing therapy are common in the intensive care units. The health care professionals involved in the decision-making process do not always assess the situation identically, leading to potential conflicts. Studies have suggested that improving......) where withholding and withdrawing therapy decisions had been made. The participants were first asked to assess the cases and subsequently, based on the discussions, to formulate quality goals for withholding and withdrawing therapy decision-making, cooperation and care for patients and relatives. Form...

  3. University woodwind students’ experiences with playing-related injuries and their management: a pilot study

    OpenAIRE

    Stanhope J; Milanese S; Grimmer K

    2014-01-01

    Jessica Stanhope,1 Steve Milanese,2 Karen Grimmer1 1International Centre for Allied Health Evidence, 2School of Health Sciences, University of South Australia, Adelaide, SA, Australia Background: This study aimed to determine the experiences of university classical woodwind students with playing-related injuries (PRIs), the impact of these PRIs, the management selected by students with PRIs, and the perceived effectiveness of this management. Materials and methods: All classical woodwind stu...

  4. Baseline geophysical data for hazard management in coastal areas in relation to earthquakes and tsunamis

    Digital Repository Service at National Institute of Oceanography (India)

    Murthy, K.S.R.

    to favourable seabed morphology, which in turn is the result of the faulted basement structure. Conclusion Hazard management of coastal areas requires systematic data collection and continuous monitoring of different oceanographic processes and their impact... is another factor for some of the intraplate earthquakes in the South Indian Shield, which includes the Eastern and Western Continental Margins of India. Baseline geophysical data for hazard management in coastal areas in relation to earthquakes...

  5. Intravenous phenytoin in the management of crescendo pelvic cancer-related pain.

    Science.gov (United States)

    Chang, V T

    1997-04-01

    Rapidly progressive pain, or "crescendo" pain, can be a difficult management problem. A cancer patient is presented who experienced crescendo neuropathic pain due to progressive pelvic disease. This patient reported significant pain relief with the administration of intravenous phenytoin. The case illustrates the type of therapeutic approach that may be considered for crescendo pain and highlights a potential role for intravenous phenytoin in the management of patients with crescendo cancer-related neuropathic pain.

  6. First Approximations of Prescribed Fire Risks Relative to Other Management Techniques Used on Private Lands.

    Directory of Open Access Journals (Sweden)

    Dirac Twidwell

    Full Text Available Fire is widely recognized as a critical ecological and evolutionary driver that needs to be at the forefront of land management actions if conservation targets are to be met. However, the prevailing view is that prescribed fire is riskier than other land management techniques. Perceived risks associated with the application of fire limits its use and reduces agency support for prescribed burning in the private sector. As a result, considerably less cost-share support is given for prescribed fire compared to mechanical techniques. This study tests the general perception that fire is a riskier technique relative to other land management options. Due to the lack of data available to directly test this notion, we use a combination of approaches including 1 a comparison of fatalities resulting from different occupations that are proxies for techniques employed in land management, 2 a comparison of fatalities resulting from wildland fire versus prescribed fire, and 3 an exploration of causal factors responsible for wildland fire-related fatalities. This approach establishes a first approximation of the relative risk of fatality to private citizens using prescribed fire compared to other management techniques that are readily used in ecosystem management. Our data do not support using risks of landowner fatalities as justification for the use of alternative land management techniques, such as mechanical (machine-related equipment, over prescribed fire. Vehicles and heavy machinery are consistently leading reasons for fatalities within occupations selected as proxies for management techniques employed by ranchers and agricultural producers, and also constitute a large proportion of fatalities among firefighters. Our study provides the foundation for agencies to establish data-driven decisions regarding the degree of support they provide for prescribed burning on private lands.

  7. Study on Alcoholic Withdrawal Score, with Questionnaire Based Session Conducted on Acute and Chronic Alcoholic Liver Disease Patients

    Directory of Open Access Journals (Sweden)

    Bandi Navyatha

    2016-07-01

    Full Text Available Alcohol liver disease is damage to the Liver and its function due to alcohol abuse. It occurs after years of heavy drinking and by through which cirrhosis can occur and which leads to the final phase of Alcoholic liver disease. It not only occurs in heavy drinkers but also there is a chance of getting liver disease go up the longer of been drinking and more alcohol consumption. A study was observational, prospective and descriptive; and was carried out one hundred and nine patients [n=109] who were with suffering from an Alcoholic liver disease, to determine the alcohol withdrawal score and there symptoms involved after they were kept on alcohol withdrawal therapy. An observational, prospective and randomized study was conducted in the hospital from March 2014-March 2016. Questionnaire based session with 10 scaled questions were framed according to CIWA (assessment and management of alcohol withdrawal and the score was noted with their symptoms occurrence after the alcohol cessation plan. CIWA score with moderate severity were found to be highest. 7 patients out of 33 patients in severe category of CIWA score were admitted in the hospital with alcohol withdrawal syndrome and psychological disturbances. Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA helps clinicians assess and treat potential alcohol withdrawal.

  8. GENDER RELATIONS AND POWER: A STUDY WITH MANAGERS-PROFESSORS AT A PUBLIC UNIVERSITY

    Directory of Open Access Journals (Sweden)

    Adílio Renê Almeida Miranda

    2015-04-01

    Full Text Available This study aimed to understand how power relations are manifested daily in women who are professors and managersmanagers-professors – of a public university. We used a qualitative approach and the method of life story. The subjects of the research were five women who occupied/occupy management positions at a public university. Among the difficulties faced by them, there are power asymmetries exposed in a symbolic way, cases of moral harassment, the “glass ceiling” phenomenon and the discrimination and prejudice, mainly through discourse and humor.

  9. Organizational needs for managing and preserving geospatial data and related electronic records

    Directory of Open Access Journals (Sweden)

    R R Downs

    2006-01-01

    Full Text Available Government agencies and other organizations are required to manage and preserve records that they create and use to facilitate future access and reuse. The increasing use of geospatial data and related electronic records presents new challenges for these organizations, which have relied on traditional practices for managing and preserving records in printed form. This article reports on an investigation of current and future needs for managing and preserving geospatial electronic records on the part of localand state-level organizations in the New York City metropolitan region. It introduces the study and describes organizational needs observed, including needs for organizational coordination and interorganizational cooperation throughout the entire data lifecycle.

  10. Boundary condition effects on maximum groundwater withdrawal in coastal aquifers.

    Science.gov (United States)

    Lu, Chunhui; Chen, Yiming; Luo, Jian

    2012-01-01

    Prevention of sea water intrusion in coastal aquifers subject to groundwater withdrawal requires optimization of well pumping rates to maximize the water supply while avoiding sea water intrusion. Boundary conditions and the aquifer domain size have significant influences on simulating flow and concentration fields and estimating maximum pumping rates. In this study, an analytical solution is derived based on the potential-flow theory for evaluating maximum groundwater pumping rates in a domain with a constant hydraulic head landward boundary. An empirical correction factor, which was introduced by Pool and Carrera (2011) to account for mixing in the case with a constant recharge rate boundary condition, is found also applicable for the case with a constant hydraulic head boundary condition, and therefore greatly improves the usefulness of the sharp-interface analytical solution. Comparing with the solution for a constant recharge rate boundary, we find that a constant hydraulic head boundary often yields larger estimations of the maximum pumping rate and when the domain size is five times greater than the distance between the well and the coastline, the effect of setting different landward boundary conditions becomes insignificant with a relative difference between two solutions less than 2.5%. These findings can serve as a preliminary guidance for conducting numerical simulations and designing tank-scale laboratory experiments for studying groundwater withdrawal problems in coastal aquifers with minimized boundary condition effects.

  11. Mapping current and future European public water withdrawals and consumption

    Directory of Open Access Journals (Sweden)

    I. Vandecasteele

    2013-07-01

    Full Text Available In Europe, public water withdrawals make up on average 30%, and in some cases up to 60% of total water withdrawals. These withdrawals are becoming increasingly important with growing population density; hence there is a need to understand the spatial and temporal trends involved. Pan-European public/municipal water withdrawals and consumption were mapped for 2006 and forecasted for 2030. Population and tourism density were assumed to be the main driving factors for withdrawals. Country-level statistics on public water withdrawals were disaggregated to a combined population and tourism density map (the "user" density map computed for 2006. In order to forecast the map to 2030 we assumed the water withdrawals per user to remain constant in time, so that the future withdrawals reflected the projected population and tourism trends. The methodology was validated using actual regional withdrawal statistics from France for 2006. The Total Absolute Error (TAE calculated was proven to be reduced by taking into account the tourism density in addition to the population density. Our results show that although there are large variations from region to region, in general public water withdrawals will increase significantly over the period 2006 to 2030. The European average increase is 16%, with a maximal increase of 53% in Ireland.

  12. Extrapolated withdrawal-interval estimator (EWE) algorithm: a quantitative approach to establishing extralabel withdrawal times.

    Science.gov (United States)

    Martín-Jiménez, Tomás; Baynes, Ronald E; Craigmill, Arthur; Riviere, Jim E

    2002-08-01

    The extralabel use of drugs can be defined as the use of drugs in a manner inconsistent with their FDA-approved labeling. The passage of the Animal Medicinal Drug Use Clarification Act (AMDUCA) in 1994 and its implementation by the FDA-Center for Veterinary Medicine in 1996 has allowed food animal veterinarians to use drugs legally in an extralabel manner, as long as an appropriate withdrawal period is established. The present study introduces and validates with simulated and experimental data the Extrapolated Withdrawal-Period Estimator (EWE) Algorithm, a procedure aimed at predicting extralabel withdrawal intervals (WDIs) based on the label and pharmacokinetic literature data contained in the Food Animal Residue Avoidance Databank (FARAD). This is the initial and first attempt at consistently obtaining WDI estimates that encompass a reasonable degree of statistical soundness. Data on the determination of withdrawal times after the extralabel use of the antibiotic oxytetracycline were obtained both with simulated disposition data and from the literature. A withdrawal interval was computed using the EWE Algorithm for an extralabel dose of 25 mg/kg (simulation study) and for a dose of 40 mg/kg (literature data). These estimates were compared with the withdrawal times computed with the simulated data and with the literature data, respectively. The EWE estimates of WDP for a simulated extralabel dose of 25 mg/kg was 39 days. The withdrawal time (WDT) obtained for this dose on a tissue depletion study was 39 days. The EWE estimate of WDP for an extralabel intramuscular dose of 40 mg/kg in cattle, based on the kinetic data contained in the FARAD database, was 48 days. The withdrawal time experimentally obtained for similar use of this drug was 49 days. The EWE Algorithm can obtain WDI estimates that encompass the same degree of statistical soundness as the WDT estimates, provided that the assumptions of the approved dosage regimen hold for the extralabel dosage regimen

  13. Computerized Cognitive Testing in the Management of Youth Sports-Related Concussion.

    Science.gov (United States)

    De Marco, Anthony P; Broshek, Donna K

    2016-01-01

    Computerized neurocognitive testing has become a growing practice across medical populations, but particularly within sports medicine and the management of sports-related concussion. Although traditional neuropsychological measures are solely administered and interpreted by neuropsychologists, computerized cognitive tests are marketed to and utilized by a wide range of professionals involved in the management of sports-related concussions, many of whom lack specialized psychometric training. Although the benefits of computerized testing allow for many youth athletes to be evaluated quickly, professionals implementing their use should be aware of the potential pitfalls and the high potential for misuse. After briefly reviewing the recommended guidelines set forth by the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology, we review the benefits/limitations of computerized testing in the management of sports-related concussion and the basic psychometric properties of some of the more widely used computerized measures. Lastly, we discuss the practical application of these devices.

  14. Implementation of public management of social relations in the face of social changes

    Directory of Open Access Journals (Sweden)

    Andrii Leonidovych Prokopenko

    2013-11-01

    Full Text Available The article considers the problems of regulation of social relations in Ukraine, particularly in the economic, political and humanitarian sphere. Based on the analysis of works of Western social theorists, as well as international experience, defines the basic directions of modernization of public management of social relations in the conditions of social changes. Deals with the historical background of review governance model and consider it as a system that creates and develops the potential of self-government of private and public, individual and collective social actors. Highlights the role of the implementation of public management approaches that stimulate engagement of public institutions, individual and organized public services users to develop policy initiatives for better public management of social relations.

  15. Profitability recent open stock funds in Brazil: analysis of the performance of a management Funds Group active in relation to management fees charged for resource managers

    Directory of Open Access Journals (Sweden)

    Sergio Ricardo Mendes Vasconcelos

    2016-10-01

    Full Text Available This paper aimed to evaluate the performance of a specific group of active management equity investments funds relating it to the management fees charged by managers in order to answer the following research problem: open equity funds with active management, that charge higher management fees, are those that provide the best returns for the investor? The objective was to test the hypothesis under which it is evident that the funds that charged the highest rates are those with the best performances evaluated according to the average yield of the last five years. To achieve this objective, a study of descriptive nature was carried out with a quantitative approach having as object of study the profitability of Brazilian Equity Fund ranked by the Brazilian Association of Financial and Capital Markets (Anbima as IBX Active Equity Funds in the period 2010 to 2014. The analyzed returns were calculated from the Information ratio index, which measures the risk-adjusted return of the asset class. The study found no correlation between the performance of the funds and charged management fees.

  16. Factors influencing emergency medicine physicians' management of sports-related concussions: a community-wide study.

    Science.gov (United States)

    Giebel, Stephen; Kothari, Rashmi; Koestner, Amy; Mohney, Gretchen; Baker, Robert

    2011-12-01

    Numerous guidelines to grade and manage sports-related concussions have been published. However, little is known about how frequently they are implemented in the emergency department. This study evaluates the current practices of emergency physicians (EPs) in managing sports-related concussions. To evaluate the current practice of EP evaluation and management of sports-related concussions. All EPs and emergency medicine residents in Kalamazoo County were surveyed regarding their management of sports-related concussions. The surveys obtained demographic data, participants' use of guidelines, and the importance of clinical and non-clinical factors in deciding when to allow a player to return to play. Of the 73 EP respondents, only 23% used a nationally recognized guideline, with no significant difference between attending and resident EPs. The symptomatic complaints of loss of consciousness, amnesia of the event, and difficulty concentrating were ranked most important by EPs in assessing patients with sports-related concussions. Among non-clinical factors, residents were significantly more likely than attendings to report that medical-legal, parental, and players' concerns were more likely to influence their decision in allowing a patient to return to play. EPs take into consideration important clinical factors in assessing patients with sports-related concussion. However, almost 75% do not use any nationally recognized guideline in their evaluation. Residents are more likely than attendings to be influenced by non-clinical factors. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. Perspectives of patients, close relatives, nurses, and physicians on end-of-life medication management.

    Science.gov (United States)

    Dees, Marianne K; Geijteman, Eric C T; Dekkers, Wim J M; Huisman, Bregje A A; Perez, Roberto S G M; van Zuylen, Lia; van der Heide, Agnes; van Leeuwen, Evert

    2017-08-14

    Our aim was to gain insight into the perspectives of patients, close relatives, nurses, and physicians on medication management for patients with a life expectancy of less than 3 months. We conducted an empirical multicenter study with a qualitative approach, including in-depth interviews with patients, relatives, nurses, specialists, and general practitioners (GPs). We used the constant comparative method and ATLAS.ti (v. 7.1) software for our analysis. Saturation occurred after 18 patient cases (76 interviews). Some 5 themes covering 18 categories were identified: (1) priorities in end-of-life care, such as symptom management and maintaining hope; (2) appropriate medication use, with attention to unnecessary medication and deprescription barriers; (3) roles in decision making, including physicians in the lead, relatives' advocacy, and pharmacists as suppliers; (4) organization and communication (e.g., transparency of tasks and end-of-life conversations); and (5) prerequisites about professional competence, accessibility and quality of medical records, and financial awareness. Patients, relatives, nurses, specialists, and GPs varied in their opinions about these themes. This study adds to our in-depth understanding of the complex practice of end-of-life medication management. It provides knowledge about the diversity of the perspectives of patients, close relatives, nurses, and physicians regarding beliefs, attitudes, knowledge, skills, behavior, work setting, the health system, and cultural factors related to the matter. Our results might help to draw an interdisciplinary end-of-life medication management guide aimed at stimulating a multidisciplinary and patient-centered pharmacotherapeutic care approach.

  18. 44 CFR 60.5 - Flood plain management criteria for flood-related erosion-prone areas.

    Science.gov (United States)

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Flood plain management criteria for flood-related erosion-prone areas. 60.5 Section 60.5 Emergency Management and Assistance... National Flood Insurance Program CRITERIA FOR LAND MANAGEMENT AND USE Requirements for Flood...

  19. University woodwind students’ experiences with playing-related injuries and their management: a pilot study

    Directory of Open Access Journals (Sweden)

    Stanhope J

    2014-03-01

    Full Text Available Jessica Stanhope,1 Steve Milanese,2 Karen Grimmer1 1International Centre for Allied Health Evidence, 2School of Health Sciences, University of South Australia, Adelaide, SA, Australia Background: This study aimed to determine the experiences of university classical woodwind students with playing-related injuries (PRIs, the impact of these PRIs, the management selected by students with PRIs, and the perceived effectiveness of this management. Materials and methods: All classical woodwind students enrolled in vocational education training or undergraduate courses at a university were sent an email with a link to an online survey. Only those aged 18 years and older were eligible. The survey obtained data regarding demographic information, details of PRI experienced (location, if they lasted for more than 3 months, and if they were current, and the impact of these, as well as the types of management strategies tried and their perceived effectiveness. Data were analyzed using descriptive statistics, and comments were reported descriptively. Results: Fourteen students returned the survey; however, one of these only completed the questions regarding demographics, and was therefore excluded. A total of 62% of participants reported having experienced a PRI. Common locations for PRI were the wrist/hand/fingers, lower back, and neck. Reducing practice time by half and missing playing commitments were the most commonly reported consequences of PRIs. Playing-related management strategies were most frequently trialed, with these and passive nonplaying-related strategies perceived to be the most effective. Conclusion: PRIs are common in this population, with a range of consequences reported. While it is encouraging that students had tried and found effective playing-related management strategies, active nonplaying-related strategies should be encouraged, particularly in preference to passive nonplaying-related strategies. This was a small-scale study, and the

  20. Progressive left ventricular hypertrophy after withdrawal of long-term ACE inhibition following experimental myocardial infarction

    NARCIS (Netherlands)

    Westendorp, B; Schoemaker, RG; Buikema, H; Boomsma, F; van Veldhuisen, DJ; van Gilsta, WH

    2006-01-01

    Background: Although discontinuation of chronic ACE inhibitor (ACEi) therapy after myocardial infarction (MI) is common in clinical practice, some clinical studies reported an increased incidence of ischemia-related events after withdrawal. To further address this issue, we assessed hemodynamic, neu

  1. Influence of caffeine and caffeine withdrawal on headache and cerebral blood flow velocities

    NARCIS (Netherlands)

    Couturier, EGM; Laman, DM; vanDuijn, MAJ; vanDuijn, H

    Caffeine consumption may cause headache, particularly migraine. Its withdrawal also produces headaches and may be related to weekend migraine attacks. Transcranial Doppler sonography (TCD) has shown changes in cerebral blood flow velocities (BFV) during and between attacks of migraine. In order to

  2. Influence of caffeine and caffeine withdrawal on headache and cerebral blood flow velocities

    NARCIS (Netherlands)

    Couturier, EGM; Laman, DM; vanDuijn, MAJ; vanDuijn, H

    1997-01-01

    Caffeine consumption may cause headache, particularly migraine. Its withdrawal also produces headaches and may be related to weekend migraine attacks. Transcranial Doppler sonography (TCD) has shown changes in cerebral blood flow velocities (BFV) during and between attacks of migraine. In order to e

  3. Modulators of drug dependence phenomena : factors affecting morphine withdrawal syndrome and cocaine-intake in rodents

    NARCIS (Netherlands)

    S.L.T. Cappendijk (Susanne)

    1995-01-01

    textabstractThis thesis compiles the experimental studies on several drugs, which modulate drug dependence phenomena in rodents. The main part of the studies is related to the morphine withdrawal (chapters 3-7), while a minor part is dealing with cocaine psychic dependence (chapter 9).

  4. Modulators of drug dependence phenomena : factors affecting morphine withdrawal syndrome and cocaine-intake in rodents

    NARCIS (Netherlands)

    S.L.T. Cappendijk (Susanne)

    1995-01-01

    textabstractThis thesis compiles the experimental studies on several drugs, which modulate drug dependence phenomena in rodents. The main part of the studies is related to the morphine withdrawal (chapters 3-7), while a minor part is dealing with cocaine psychic dependence (chapter 9).

  5. 29 CFR 4219.31 - Overdue and defaulted withdrawal liability; overpayment.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 9 2010-07-01 2010-07-01 false Overdue and defaulted withdrawal liability; overpayment. 4219.31 Section 4219.31 Labor Regulations Relating to Labor (Continued) PENSION BENEFIT GUARANTY... initiation of arbitration; or (iii) If arbitration is timely initiated either by the plan, the employer or...

  6. THE EFFECT OF KNOWLEDGE ECONOMY ON THE MANAGEMENT AND LABOR RELATIONS

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    With the emergence of Knowledge Economy and its penetration intoevery aspect of society,many industrial functions have been changing,including management and labor relations.In this paper,the author first presents a system view of management and labor relations under Knowledge Economy,and then based on it,elaborates on effect of Knowledge Economy on them,using the case of HP as demonstration.In the end,conclusion is made that new dynamic equilibration will develop,depending upon the dynamic power contrast of the above two subjects under dynamic changing circumstances of Knowledge Economy.

  7. A CONSOLIDATED MODEL OF ANALYSIS OF THE RELATIONS BETWEEN POLITICS AND MANAGEMENT WITHIN PUBLIC ORGANIZATIONS

    Directory of Open Access Journals (Sweden)

    Catalina Maria GEORGESCU

    2011-01-01

    Full Text Available An interdisciplinary approach which combines the theoretical, empirical andconceptual dimensions, the present study tries to offer a new workperspective on the assessment and modeling of the relation between themanagement of public organizations and the political environment. Thetheoretical research was centered on reviewing the literature on the relationbetween the management of public organizations and the politicalenvironment. The empirical research was materialized by modeling with theregression technique of several aspects integrated to the relations betweenthe management of human resources within public organizations in theeducation field and the external political environment.

  8. Inhibitory effect of bacopasides on spontaneous morphine withdrawal induced depression in mice.

    Science.gov (United States)

    Rauf, Khalid; Subhan, Fazal; Abbas, Muzaffar; Ali, Syed Mobasher; Ali, Gowhar; Ashfaq, Muhammad; Abbas, Ghulam

    2014-06-01

    Bacopa monnieri is a perennial herb with a world known image as a nootropic. We investigated the effect of Bacopa monnieri methanolic extract (Mt Ext BM) 10, 20, and 30 mg/kg body weight (b.w) on acquisition and expression of morphine withdrawal induced depression in mice. Locally available Bacopa monnieri (BM) was screened for contents of Bacoside A3, Bacopasaponin C, and Bacopaside II using HPLC with UV. Morphine dependence was induced in mice using twice daily escalating chronic morphine treatments (20-65 mg/kg b.w) for eight consecutive days. Morphine withdrawal induced depression was assayed in animals using forced swimming test (FST), three days after last morphine injection. The HPLC analysis revealed that Mt-ext BM contained Bacoside A3 as major component, i.e. 4 µg in each mg of extract. The chronic treatment with Met Ext BM 10, 20, and 30 mg/kg b.w. dosing significantly inhibited opioid withdrawal induced depression in mice. These findings imply a newer potential role of Bacopa monnieri in the clinical management of opioid withdrawal induced depression which can be attributed to Bacoside A3.

  9. Neural mechanisms underlying morphine withdrawal in addicted patients: a review

    Directory of Open Access Journals (Sweden)

    Nima Babhadiashar

    2015-06-01

    Full Text Available Morphine is one of the most potent alkaloid in opium, which has substantial medical uses and needs and it is the first active principle purified from herbal source. Morphine has commonly been used for relief of moderate to severe pain as it acts directly on the central nervous system; nonetheless, its chronic abuse increases tolerance and physical dependence, which is commonly known as opiate addiction. Morphine withdrawal syndrome is physiological and behavioral symptoms that stem from prolonged exposure to morphine. A majority of brain regions are hypofunctional over prolonged abstinence and acute morphine withdrawal. Furthermore, several neural mechanisms are likely to contribute to morphine withdrawal. The present review summarizes the literature pertaining to neural mechanisms underlying morphine withdrawal. Despite the fact that morphine withdrawal is a complex process, it is suggested that neural mechanisms play key roles in morphine withdrawal.

  10. Reliable Diameter Control of Carbon Nanotube Nanobundles Using Withdrawal Velocity

    Science.gov (United States)

    Shin, Jung Hwal; Kim, Kanghyun; An, Taechang; Choi, WooSeok; Lim, Geunbae

    2016-09-01

    Carbon nanotube (CNT) nanobundles are widely used in nanoscale imaging, fabrication, and electrochemical and biological sensing. The diameter of CNT nanobundles should be controlled precisely, because it is an important factor in determining electrode performance. Here, we fabricated CNT nanobundles on tungsten tips using dielectrophoresis (DEP) force and controlled their diameters by varying the withdrawal velocity of the tungsten tips. Withdrawal velocity pulling away from the liquid-air interface could be an important, reliable parameter to control the diameter of CNT nanobundles. The withdrawal velocity was controlled automatically and precisely with a one-dimensional motorized stage. The effect of the withdrawal velocity on the diameter of CNT nanobundles was analyzed theoretically and compared with the experimental results. Based on the attachment efficiency, the withdrawal velocity is inversely proportional to the diameter of the CNT nanobundles; this has been demonstrated experimentally. Control of the withdrawal velocity will play an important role in fabricating CNT nanobundles using DEP phenomena.

  11. Spontaneous reduction of prolactinoma post cabergoline withdrawal

    Directory of Open Access Journals (Sweden)

    Sampath Kumar Venkatesh

    2012-01-01

    Full Text Available Prolactinomas are common pituitary tumors usually highly responsive to dopamine agonists. Around 70-90% of the prolactinomas exhibit decrease in tumor size, though variably with these agents. Uncommonly, there may be little or no shrinkage in pituitary tumor. In the absence of medical therapy, pituitary apoplexy may also result in tumor shrinkage, albeit rarely. We report here a case showing only modest reduction in prolactinoma with cabergoline given for a period of one and a half years. Surprisingly, this tumor showed a 40% reduction in the tumor size 3 months after cabergoline withdrawal in the absence of clinical or radiological evidence of apoplexy.

  12. New Drugs of Abuse and Withdrawal Syndromes.

    Science.gov (United States)

    Andrabi, Sara; Greene, Spencer; Moukaddam, Nidal; Moukkadam, Nidal; Li, Benjamin

    2015-11-01

    New drugs of abuse continue to emerge, including synthetic cannabinoids, synthetic cathinones, and hallucinogens. It is important to recognize their individual psychopharmacologic properties, symptoms of intoxication, and symptoms of withdrawal. Providers must be vigilant of acute medical or psychiatric complications that may arise from use of these substances. Treatment of the patient also includes recognition of any substance use disorders as well as comorbid psychiatric disorders. Although pharmacologic treatments for substance use disorder (of the drugs included in this article) are limited, there are a variety of psychotherapeutic modalities that may be of some benefit.

  13. Establishing a clinical service for the management of sports-related concussions.

    Science.gov (United States)

    Reynolds, Erin; Collins, Michael W; Mucha, Anne; Troutman-Ensecki, Cara

    2014-10-01

    The clinical management of sports-related concussions is a specialized area of interest with a lack of empirical findings regarding best practice approaches. The University of Pittsburgh Medical Center Sports Concussion Program was the first of its kind; 13 years after its inception, it remains a leader in the clinical management and research of sports-related concussions. This article outlines the essential components of a successful clinical service for the management of sports-related concussions, using the University of Pittsburgh Medical Center Sports Concussion Program as a case example. Drawing on both empirical evidence and anecdotal conclusions from this high-volume clinical practice, this article provides a detailed account of the inner workings of a multidisciplinary concussion clinic with a comprehensive approach to the management of sports-related concussions. A detailed description of the evaluation process and an in-depth analysis of targeted clinical pathways and subtypes of sports-related concussions effectively set the stage for a comprehensive understanding of the assessment, treatment, and rehabilitation model used in Pittsburgh today.

  14. Client-Oriented Approach: Forming the System of Management of the Bank Relations with Clients

    Directory of Open Access Journals (Sweden)

    Zavadska Diana V.

    2015-03-01

    Full Text Available The aim of the article is to develop the theoretical principles of forming the bank relations with clients as part of the client-oriented strategy implementation. As a result of the conducted research there has been presented the definition of client-orientation, mechanism and system of management. The system of management of the bank relations with clients, the purpose and objectives of its formation have been substantiated. The hierarchy of subjects of forming and managing the process of the bank relations with client has been presented. The ways of implementing in practice the functions of the mechanism of managing relations with clients have been revealed. It has been proved that for implementation of the client-oriented approach the banking institution should have a comprehensive view of its clients’ behavior, which detailed understanding will allow for a more accurate segmentation and building individualized partnership relations. Implementing the principle of totality of client relationships level and comprehensive knowledge, development of employee behavior techniques and special techniques for working with the most valuable clients, the use of analytics and forecasting tools will provide targeting of marketing campaigns and lead to minimization of additional costs, satisfaction of every client, loyalty, increase in the market share, growth of sales volume, increase in profits of the banking institution.

  15. Relational experiences of power and gender for nurse-managers of private hospitals.

    Science.gov (United States)

    Brito, Maria José Menezes; Montenegro, Lívia Cozer; Alves, Marília

    2010-01-01

    Influenced by increased technology and globalization, Brazilian hospitals are undergoing significant changes. The managerial models focused on the male model are being slowly and gradually replaced, with an expressive participation of female nurses in management positions. Thus, we aimed to uncover some aspects of the relational experiences of power and gender of nine female nurse-managers working in four large and medium-sized private hospitals in Belo Horizonte, MG, Brazil, through a qualitative case study. The results show that management discourses value a managerial style focused on the organizations' humanized aspects, where authoritative styles have no space. In this scenario, the work of female nurse-managers strengthens teamwork, which improves their image and contributes to forming their identity.

  16. Cancer-Related Pain Management and the Optimal Use of Opioids.

    Science.gov (United States)

    Reis-Pina, Paulo; Lawlor, Peter G; Barbosa, António

    2015-01-01

    Pain relief is vital to the treatment of cancer. Despite the widespread use and recognition of clinical recommendations for the management of cancer-related pain, avoidable suffering is still prevalent in patients with malignant disease. A gap exists between what is known about pain medical management and actual practices of patients, caregivers, healthcare professionals and institutions. Opioids are the pillar of the medical management of moderate to severe pain. The prescription of opioid analgesics - by a registered medical practitioner for absolute pain control - is a legitimate practice. In this article we look at patients' fears and physicians' general hesitations towards morphine and alike. We examine misconceptions that yield fallacies on the therapeutically use of opioids and, therefore, sustain inadequate pain management.

  17. Is nurse managers' leadership style related to Japanese staff nurses' affective commitment to their hospital?

    Science.gov (United States)

    Kodama, Yoshimi; Fukahori, Hiroki; Sato, Kana; Nishida, Tomoko

    2016-10-01

    To determine if nurse managers' leadership style is related to Japanese staff nurses' affective commitment to their hospital. In Western countries, nurse managers' transformational leadership style has been found to increase staff nurses' affective commitment to their hospital. However, there are few studies examining this relationship in the context of acute care hospitals in Japan. Staff nurses completed measures of their nurse managers' perceived leadership style and factors related to their own affective commitment. The association between affective commitment and perception of leadership style was assessed with multiple logistic regression. Of 736 questionnaires distributed, 579 (78.9%) were returned, and data from 396 (53.8%) fully completed questionnaires were analysed. The intellectual stimulation aspect of transformational leadership positively increased staff nurses' affective commitment (odds ratio: 2.23). Nurse managers' transactional and laissez-faire leadership styles were not related to affective commitment among staff nurses. The intellectual stimulation aspect of transformational leadership may increase the retention of staff nurses through enhanced affective commitment. To increase staff nurses' affective commitment to their hospital, we suggest that hospital administrators equip nurse managers with intellectual stimulation skills. © 2016 John Wiley & Sons Ltd.

  18. The interpersonal process model of demand/withdraw behavior.

    Science.gov (United States)

    Baucom, Brian R; Dickenson, Janna A; Atkins, David C; Baucom, Donald H; Fischer, Melanie S; Weusthoff, Sarah; Hahlweg, Kurt; Zimmermann, Tanja

    2015-02-01

    The demand/withdraw interaction pattern is a destructive cycle of relationship communication behavior that is associated with negative individual and relationship outcomes. Demand/withdraw behavior is thought to be strongly linked to partners' emotional reactions, but current theories are inconsistent with empirical findings. The current study proposes the interpersonal process model of demand/withdraw behavior, which includes linkages between each partners' emotional reactions and the interpersonal behavior of demanding and withdrawing. Data come from problem solving discussions of 55 German couples with observationally coded demand/withdraw behavior and fundamental frequency (f₀) to measure vocally encoded emotional arousal. Actor-partner interdependence models (Kenny, Kashy, & Cook, 2006) were used to examine associations among demand/withdraw behavior and f₀ in the overall discussion and 5-min segments. Significant cross-partner associations emerged for demanding and withdrawing behavior across the whole conversation as well as within 5-min segments, and these associations are partially accounted for by each individual's f₀. When behaviorally coded demanders expressed more vocal arousal, they demanded more and withdrew less while their partners withdrew more. In contrast, when behaviorally coded withdrawers expressed more vocal arousal, their partners demanded less and withdrew more. Findings demonstrate that demand/withdraw behavior varies between couples (i.e., some couples engage in a stronger demand/withdraw cycle than others) and between segments (i.e., when 1 partner increases demanding, the other increases withdrawing). Findings support key elements of the interpersonal process model, showing intra- and interpersonal pathways linking demand/withdraw behavior and emotion and demonstrate the importance of partners' behavioral roles in these linkages.

  19. [Takotsubo cardiomyopathy: a novel beta-adrenergic blocker withdrawal syndrome].

    Science.gov (United States)

    Tomcsányi, János; Jávor, Kinga; Arabadzisz, Hrisula; Zsoldos, András; Wagner, Vince; Sármán, Balázs

    2013-02-17

    The authors describe two cases of takotsubo cardiomyopathy developing after an abrupt withdrawal of carvedilol and bisoprolol. Takotsubo or stress cardiomyopathy is characterized by acute and reversible cardiac dysfunction without coronary artery disease. It is triggered by acute emotional or physical stress, drugs or drug withdrawal. The immediate discontinuation of the long acting vasodilator beta-blocker, carvedilol has not yet been described to cause takotsubo cardiomyopathy. The authors recommend cautious withdrawal of beta-blockers.

  20. National Athletic Trainers' Association Position Statement: Preventing and Managing Sport-Related Dental and Oral Injuries

    Science.gov (United States)

    Gould, Trenton E.; Piland, Scott G.; Caswell, Shane V.; Ranalli, Dennis; Mills, Stephen; Ferrara, Michael S.; Courson, Ron

    2016-01-01

    Objective: To provide athletic trainers, health care professionals, and all those responsible for the care of athletes with clinical recommendations for preventing and managing sport-related dental and oral injuries. Background: Participation in competitive sports continues to grow at both the interscholastic and intercollegiate levels. Therefore, exposure to, and the incidence of athletic-related injury, including orofacial injury, will also likely increase. At the time of this writing, the leading governing agencies for interscholastic (National Federation of State High School Associations) and intercollegiate (National Collegiate Athletic Association) sports require only protective orofacial equipment (eg, mouthguards) for 5 and 4, respectively, of their sanctioned sports. Although orofacial injuries represent a small percentage of all sport-related injuries, the financial burden associated with these injuries (eg, tooth avulsion) can exceed $15 000 over an adult life. Therefore, effective management of sport-related dental injuries is critical to the long-term financial, physical, and emotional health of people who have experienced dental trauma. Recommendations: Based upon the current evidence regarding sport-related orofacial injury, we provide recommendations related to planning considerations, education, and mouthguard efficacy, material, fabrication, and care considerations. Additionally, suggested best practices for managing sport-related dental injury are also given for athletic trainers and other health care professionals. PMID:27875057

  1. Reasons for not applying safe contraceptive methods in women using withdrawal method in Amol city, 2003

    Directory of Open Access Journals (Sweden)

    S. Amir ali akbari

    2005-01-01

    Full Text Available Background and purpose : Withdrawal method is one of the most common contraceptive ways (% 23 nationwide. With regard to its relatively high failure rate (% 4-23 with unwanted pregnancies as well as resulted complications, this descriptive study was conducted to find out the reasons for not applying safe contraceptive methods.Materials and methods: Subject population consisted of 379 married women between 15 and 45 living in Amol city and using withdrawal method. The subjects were selected through different stages with final randomization Data were collected by a questionnaire in which personal, social, and obstetrical history, and reasons for using withdrawal method as well as for not applying other methods were documented. The validity and reliability of the tool were determined by content validity and test-re test method respectively. Pearson coefficient of correlation as well as t-test and ANOVA were used for quantitative and qualitative variables respectively.Results : Findings showed that the mean age of subjects was 28.1 ± 6.4, who had used withdrawal method at least for 3 months. Mean duration in using withdrawal method was 53.6 ± 6.6 months. Health care workers were considered the most frequent source of information (%26.6 and the main reasons for not applying safe contraceptive methods included fear of side effects (% 28.2, husband opposition (% 28.2, contraindication (% 9 Lactation (% 8.7 and indifference to conception (% 7.7. The most common reasons for applying withdrawal method were husband preference (% 25.1, having less complications (% 20.3, availability (% 19.5 and being safer than other methods (% 12.7.Conclusion : It can be concluded that much more efforts should be made to devise and perform family planning programs correctly, and training health care workers continuously and finally educating people either by mass media or by professionals to encourage applying safe contraceptive methods.

  2. An Investigative Study of Safety Management Practices in Chemical-Related Industries

    Science.gov (United States)

    Lewers, Sarah Grace

    Industrial chemicals are a major part of the United States economic growth and impact every product that we use in everyday life. Some of the major products produced by chemical-related industries are plastics, textiles, petroleum, paper and important metals. Governmental regulations like those created by the Occupational Safety and Health Organization (OSHA), Environmental Protection Agency (EPA) and the U.S. Chemical Safety and Hazard Investigation Board are vital to a chemical-related industries' safety management. Contributing to and helping to drive economic growth, the enforcement of proper safety practices is a necessity. This study was conducted to investigate and assess various safety management practices in selected chemical-related industries. The research design involved the use of a questionnaire/survey method in which a random sample of participants completed a questionnaire related to the variables of interest. Random sampling helps to ensure the generalizability of the survey results. The target population consisted of a subset of employees currently working for plants, businesses and organizations in chemical-related industries. To collect the data, surveys were given to employees in various positions at chemical-related industries such as basic chemicals, specialty chemicals, agricultural chemicals, pharmaceuticals and consumer products. A set of criteria was created to establish the qualification to be recognized as a chemical-related industry. The questionnaire/survey was reviewed by the Institutional Review Board at NC A&T State University to meet necessary regulation guidelines for research involving human subjects. The results showed that 60.22% or more than half of the respondents have worked with their company and organization for over thirty years providing the ability to see the progression of chemical-related industry safety management practices over time. Over eighty percent (80.66%) or 146 respondents agreed that their company or

  3. Withdrawal symptoms in internet gaming disorder: A systematic review.

    Science.gov (United States)

    Kaptsis, Dean; King, Daniel L; Delfabbro, Paul H; Gradisar, Michael

    2016-02-01

    Internet gaming disorder (IGD) is currently positioned in the appendix of the DSM-5 as a condition requiring further study. The aim of this review was to examine the state of current knowledge of gaming withdrawal symptomatology, given the importance of withdrawal in positioning the disorder as a behavioral addiction. A total of 34 studies, including 10 qualitative studies, 17 research reports on psychometric instruments, and 7 treatment studies, were evaluated. The results indicated that the available evidence on Internet gaming withdrawal is very underdeveloped. Internet gaming withdrawal is most consistently referred to as 'irritability' and 'restlessness' following cessation of the activity. There exists a concerning paucity of qualitative studies that provide detailed clinical descriptions of symptoms arising from cessation of internet gaming. This has arguably compromised efforts to quantify withdrawal symptoms in empirical studies of gaming populations. Treatment studies have not reported on the natural course of withdrawal and/or withdrawal symptom trajectory following intervention. It is concluded that many more qualitative clinical studies are needed, and should be prioritised, to develop our understanding of gaming withdrawal. This should improve clinical descriptions of problematic internet gaming and in turn improve the quantification of IGD withdrawal and thus treatments for harmful internet gaming.

  4. L-type calcium channels and calcium/calmodulin-dependent kinase II differentially mediate behaviors associated with nicotine withdrawal in mice.

    Science.gov (United States)

    Jackson, K J; Damaj, M I

    2009-07-01

    Smoking is a widespread health problem. Because the nicotine withdrawal syndrome is a major contributor to continued smoking and relapse, it is important to understand the molecular and behavioral mechanisms of nicotine withdrawal to generate more effective smoking cessation therapies. Studies suggest a role for calcium-dependent mechanisms, such as L-type calcium channels and calcium/calmodulin-dependent protein kinase II (CaMKII), in the effects of nicotine dependence; however, the role of these mechanisms in nicotine-mediated behaviors is unclear. Thus, the goal of this study was to elucidate the role of L-type calcium channels and CaMKII in nicotine withdrawal behaviors. Using both pharmacological and genetic methods, our results show that L-type calcium channels are involved in physical, but not affective, nicotine withdrawal behaviors. Although our data do provide evidence of a role for CaMKII in nicotine withdrawal behaviors, our pharmacological and genetic assessments yielded different results concerning the specific role of the kinase. Pharmacological data suggest that CaMKII is involved in somatic signs and affective nicotine withdrawal, and activity level is decreased after nicotine withdrawal, whereas the genetic assessments yielded results suggesting that CaMKII is involved only in the anxiety-related response, yet the kinase activity may be increased after nicotine withdrawal; thus, future studies are necessary to clarify the precise behavioral specifics of the relevance of CaMKII in nicotine withdrawal behaviors. Overall, our data show that L-type calcium channels and CaMKII are relevant in nicotine withdrawal and differentially mediate nicotine withdrawal behaviors.

  5. Moblogging Type and Its Relation with Usability and Development of Knowledge Management Skills for Blind Students

    Science.gov (United States)

    Mostafa, Akram Fathy

    2015-01-01

    The aim of the research is to explore the relation of mobile Blogging (Moblogging -MB) on the usability and development of Knowledge Management skills for Blind Students. The research followed a pretest and posttest quasi experimental design. Participants were 17 blind students from the third semester of the academic year 2015 in the course of…

  6. Managing the strategic network relations between corporate R&D and business

    NARCIS (Netherlands)

    Fortuin, F.T.J.M.; Omta, S.W.F.

    2006-01-01

    The present paper addresses the important issue of the management of the strategic network relations between corporate R&D and business. In a large technology-based multinational company (+/- 30,000 employees) an instrument that provides regular feedback to both corporate R&D and business ab

  7. The Correlates and Influences of Career-Related Continuous Learning: Implications for Management Professionals

    Science.gov (United States)

    Kuznia, Kevin D.; Kerno, Steven J., Jr.; Gilley, Ann

    2010-01-01

    Management personnel are increasingly aware that career success depends on the ability to continuously learn and adapt to the environment. However, scant attention has been paid to how learning activities contribute to managerial success. This study examines the degree to which involvement in career-related continuous learning affects managerial…

  8. Teaching Public Relations Management: Bringing "The Ideal" and "The Real" Closer Together.

    Science.gov (United States)

    Turk, Judy VanSlyke; Russell, Maria P.

    A study examined the technical versus managerial roles of public relations practitioners. The study investigated what it takes to be a manager, what skills and perspectives are needed by entry-level practitioners as they climb the ladder, and what actions educators should take to ensure that students learn the critical skills. Three hundred…

  9. Vegetation succession in a floating mire in relation to management and hydrology

    NARCIS (Netherlands)

    vanDiggelen, R; Molenaar, WJ; Kooijman, AM

    1996-01-01

    The vegetation succession in a floating mire was studied in relation to management and hydrological conditions in a former peat cutting area in the northern part of the Netherlands. An existing map showed that in 1956 the vegetation consisted mainly of meadows, reedbeds and rich fen vegetation while

  10. Factors Related to Faculty Members' Attitude and Adoption of a Learning Management System

    Science.gov (United States)

    Wichadee, Saovapa

    2015-01-01

    Learning Management Systems (LMS) play a crucial role in organizing the course contents. However, some instructors use LMS in their classes while some do not. This study aimed to discover the factors in relation to the instructors' attitude toward LMS and adoption of LMS in their course. A survey was administered to 62 instructors to follow up the…

  11. Managing the strategic network relations between corporate R&D and business

    NARCIS (Netherlands)

    Fortuin, F.T.J.M.; Omta, S.W.F.

    2006-01-01

    The present paper addresses the important issue of the management of the strategic network relations between corporate R&D and business. In a large technology-based multinational company (+/- 30,000 employees) an instrument that provides regular feedback to both corporate R&D and business ab

  12. Policy-level interventions and work-related psychosocial risk management in the European Union

    NARCIS (Netherlands)

    Leka, S.; Jain, A.; Zwetsloot, G.I.J.M.; Cox, T.

    2010-01-01

    There exists a substantial degree of diversity across strategies to prevent and manage work- related psychosocial risks and their associated health effects. Whereas it is common to distinguish between organizational and individual interventions, the important level of policy- level interventions has

  13. Moblogging Type and Its Relation with Usability and Development of Knowledge Management Skills for Blind Students

    Science.gov (United States)

    Mostafa, Akram Fathy

    2015-01-01

    The aim of the research is to explore the relation of mobile Blogging (Moblogging -MB) on the usability and development of Knowledge Management skills for Blind Students. The research followed a pretest and posttest quasi experimental design. Participants were 17 blind students from the third semester of the academic year 2015 in the course of…

  14. The Relative Efficacy of Negative Practice and Anxiety Management Training in the Treatment of Mathematics Anxiety.

    Science.gov (United States)

    Streim, Leonard; O'Brien, Richard M.

    Mathematics anxiety involves feelings of tension and stress that interfere with the solving of mathematical problems in academic and daily life situations. To investigate the relative effectiveness of group negative practice and group anxiety management training in reducing mathematics anxiety, 72 math-anxious high school students were divided…

  15. The determinants of relational governance and performance: how to manage business relationships?

    NARCIS (Netherlands)

    Claro, D.P.; Hagelaar, J.L.F.; Omta, S.W.F.

    2003-01-01

    It is the aim of this study to assess the influence of the determinants of the transaction, dyadic, and business environment level on relational governance and ultimately performance. We build an integrated framework for relationship management drawing from literature of transaction cost economics,

  16. Managing XML Data to optimize Performance into Object-Relational Databases

    Directory of Open Access Journals (Sweden)

    Iuliana BOTHA

    2011-06-01

    Full Text Available This paper propose some possibilities for manage XML data in order to optimize performance into object-relational databases. It is detailed the possibility of storing XML data into such databases, using for exemplification an Oracle database and there are tested some optimizing techniques of the queries over XMLType tables, like indexing and partitioning tables.

  17. Characteristics of the USA dairy herd as related to management and demographic elements

    Science.gov (United States)

    The data characteristics of the United States dairy herd related to animals enrolled in milk recording (dairy herd improvement) are the basic foundation and important influencers for the management and genetic progress achieved in a population or animal production unit. The amount, characteristics ...

  18. Factors influencing exacerbation-related self-management in patients with COPD : A qualitative study

    NARCIS (Netherlands)

    Korpershoek, Y. J G; Vervoort, S. C J M; Nijssen, L. I T; Trappenburg, J. C A; Schuurmans, M. J.

    2016-01-01

    Background: In patients with COPD, self-management skills are important to reduce the impact of exacerbations. However, both detection and adequate response to exacerbations appear to be difficult for some patients. Little is known about the underlying process of exacerbation-related

  19. Developing a Safety Management System for Fatigue Related Risks in easyJet

    NARCIS (Netherlands)

    Stewart, S.; Koornneef, F.; Akselsson, R.; Turner, C.

    2009-01-01

    Chapter 5: Developing a Safety Management System for Fatigue Related Risks in easyJet The European Commission HILAS project (Human Integration into the Lifecycle of Aviation Systems - a project supported by the European Commission’s 6th Framework between 2005-2009) was focused on using human factor

  20. Managing the strategic network relations between corporate R&D and business

    NARCIS (Netherlands)

    Fortuin, F.T.J.M.; Omta, S.W.F.

    2006-01-01

    The present paper addresses the important issue of the management of the strategic network relations between corporate R&D and business. In a large technology-based multinational company (+/- 30,000 employees) an instrument that provides regular feedback to both corporate R&D and business

  1. Experiences related to the role of a cost centre manager in a public ...

    African Journals Online (AJOL)

    Experiences related to the role of a cost centre manager in a public hospital in Limpopo Province, ... Log in or Register to get access to full text downloads. ... The purpose of a cost centre is to control clinical and administrative costs, as well as ...

  2. A Relational/Object-Oriented Database Management System: R/OODBMS

    Science.gov (United States)

    1992-09-01

    Corporation produces GemStone17 [BM089][HW911, a disk-based storage manager designed for commercial and engineering markets [BOS911. The designers of...key’,reiatic~n_key); idi -bind("relation~print*,reiation~print); idi_bind(*create~tuple*~,create_tuole); idi-bind) *ck-union- comnatability ",ck

  3. Psychopathy-related personality traits and shame management strategies in adolescents.

    Science.gov (United States)

    Nyström, Markus B T; Mikkelsen, Fredrik

    2013-02-01

    The purpose of this study was to examine whether there is a correlation between the amount of psychopathy-related personality traits and the type of shame management in adolescents. Two hypotheses were examined; first, that there is a positive correlation between psychopathy-related personality traits and more unconscious and externalized shame management strategies, and second, that there is a negative correlation between psychopathy-related personality traits and more conscious and internalized shame management strategies. Gender differences were also examined. In total, 236 participants were available for the study. All were secondary-level students, aged 16 to 21 years. Of these, 196 were examined: 96 were male and 100 female. The study used two self-assessment forms-the Youth Psychopathic traits Inventory (YPI) and the Compass of Shame Scale (CoSS)-to measure the relevant personality characteristics. The results indicated gender differences, which led to all the analyses being conducted separately for males and females. Support was found for the study's first hypothesis, but not for the second, which was true for both males and females. Our results may have implications for the treatment of adolescents with a high percentage of psychopathy-related personality traits; they also indicate the need for more research on the association between psychopathy and shame management.

  4. Impact of drought on U.S. steam electric power plant cooling water intakes and related water resource management issues.

    Energy Technology Data Exchange (ETDEWEB)

    Kimmell, T. A.; Veil, J. A.; Environmental Science Division

    2009-04-03

    ) and type of plant (nuclear vs. fossil fuel). This is accomplished in Chapter 3. In Chapter 4, the nature of any compacts or agreements that give priority to users (i.e., which users must stop withdrawing water first) is examined. This is examined on a regional or watershed basis, specifically for western water rights, and also as a function of federal and state water management programs. Chapter 5 presents the findings and conclusions of this study. In addition to the above, a related intent of this study is to conduct preliminary modeling of how lowered surface water levels could affect generating capacity and other factors at different regional power plants. If utility managers are forced to take some units out of service or reduce plant outputs, the fuel mix at the remaining plants and the resulting carbon dioxide emissions may change. Electricity costs and other factors may also be impacted. Argonne has conducted some modeling based on the information presented in the database described in Chapter 2 of this report. A separate report of the modeling effort has been prepared (Poch et al. 2009). In addition to the U.S. steam electric power plant fleet, this modeling also includes an evaluation of power production of hydroelectric facilities. The focus of this modeling is on those power plants located in the western United States.

  5. Patterns of daily energy management at work: relations to employee well-being and job characteristics.

    Science.gov (United States)

    Kinnunen, Ulla; Feldt, Taru; de Bloom, Jessica; Korpela, Kalevi

    2015-11-01

    The present study aimed at identifying subgroups of employees with similar daily energy management strategies at work and finding out whether well-being indicators and job characteristics differ between these subgroups. The study was conducted by electronic questionnaire among 1122 Finnish employees. First, subgroups of employees with unique and distinctive patterns of energy management strategies were identified using latent profile analysis. Second, differences in well-being indicators and job characteristics between the subgroups were investigated by means of ANCOVA. Four subgroups (i.e., patterns) were identified and named: Passives (n = 371), Averages (n = 390), Casuals (n = 272) and Actives (n = 89). Passives used all three (i.e., work-related, private micro-break and physical micro-break) strategies less frequently than other subgroups, whereas Actives used work-related and physical energy management strategies more frequently than other subgroups. Averages used all strategies on an average level. Casuals' use of all strategies came close to that of Actives, notably in a shared low use of private micro-break strategies. Active and Casual patterns maintained vigor and vitality. Autonomy and social support at work played a significant role in providing opportunities for the use of beneficial energy management strategies. Autonomy and support at work seem to support active and casual use of daily energy management, which is important in staying energized throughout the working day.

  6. Assessment, management and knowledge of sport-related concussion: systematic review.

    Science.gov (United States)

    King, Doug; Brughelli, Matt; Hume, Patria; Gissane, Conor

    2014-04-01

    Sport-related concussions are a subset of mild traumatic brain injuries and are a concern for many sporting activities worldwide. To review and update the literature in regard to the history, pathophysiology, recognition, assessment, management and knowledge of concussion. Searches of electronic literature databases were performed to identify studies published up until April 2013. 292 publications focussing on concussion met the inclusion criteria, and so they were quality rated and reviewed. Concussion is hard to recognize and diagnose. Initial sideline assessment via the Sports Concussion Assessment Tool 3 (SCAT3), Child-SCAT3 or King-Devick test should be undertaken to identify athletes with concussion as part of a continuum of assessment modalities and athlete management. Sports medicine practitioners should be cognisant of the definition, extent and nature of concussion, and should work with coaches, athletes and trainers to identify and manage concussions. The most common reason for variations in management of concussion is lack of awareness of-and confusion about-the many available published guidelines for concussion. Future research should focus on better systems and tools for recognition, assessment and management of concussion. Sport participants' knowledge of concussion should be evaluated more rigorously, with interventions for sports where there is little knowledge of recognition, assessment and appropriate management of concussion.

  7. Investigating and analyzing the management manners in the agricultural organisations and related administrations in Kerman Province

    Directory of Open Access Journals (Sweden)

    Samira Behroozeh

    2016-09-01

    Full Text Available This study is a part of achievements of a research that has been done on the investigation and analysis of management manners in agricultural organizations and related administrations in order to determine the effect of a series of management manner on human management. This study in respect of purpose is applied and in terms of collecting data is a descriptive survey research. The research statistic population consists of all managers and experts of the agricultural organizations of Kerman province that based on Cochran formula 300 people were randomly selected for the infinite population. A questionnaire was used for the data collection. Data analysis via method of path analysis was performed with SPSS version 19. Results of the path analysis showed that in the administrations under investigation the attention to the motivation and hygienic issues has been faded in the work environment; while in the above administrations to the task-orientedness has been paid more attention by managers than to relationship-orientedness. Therefore it is appropriate that through correct and timely dissemination of information and training managers and organizational staff to use the appropriate leadership styles according to the requirement of organizational and administrative conditions their productivity is increased.

  8. 77 FR 58867 - Public Land Order No. 7799; Withdrawal of Public Land for the Rock Springs Administrative Site...

    Science.gov (United States)

    2012-09-24

    ... Bureau of Land Management Public Land Order No. 7799; Withdrawal of Public Land for the Rock Springs... the Rock Springs Administrative Site addition. DATES: Effective Date: September 24, 2012. FOR FURTHER... the Rock Springs Administrative Site addition. The land has been and will remain open to...

  9. The broiler's last day of life. Influences of feed withdrawal, catching and transport on physiology and losses of broilers

    NARCIS (Netherlands)

    Nijdam, Edwin

    2006-01-01

    Before slaughter, broilers are subjected to several preslaughter management events such as feed withdrawal, catching, crating, transport, and lairage. The aim of this study was to gain insight into factors which influence mortality, stress, energy metabolism, and meat quality of the broilers on the

  10. Galanin negatively modulates opiate withdrawal via galanin receptor 1

    Science.gov (United States)

    Holmes, Fiona E.; Armenaki, Athena; Iismaa, Tiina P.; Einstein, Emily B.; Shine, John; Picciotto, Marina R.; Wynick, David; Zachariou, Venetia

    2012-01-01

    Rationale The neuropeptide galanin has been shown to modulate opiate dependence and withdrawal. These effects could be mediated via activation of one or more of three distinct G-protein coupled receptors, namely GalR1, GalR2 and GalR3. Objectives In this study, we used several transgenic mouse lines to further define the mechanisms underlying the role played by galanin and its receptors in the modulation of morphine dependence. Firstly, transgenic mice expressing β-galactosidase under the control of the galanin promoter were used to assess the regulation of galanin expression in response to chronic morphine administration and withdrawal. Next, the behavioural responses to chronic morphine administration and withdrawal were tested in mice that over-express galanin, lack the GalR1 gene or lack the GalR2 gene. Methods Transgenic and matched wild-type mice were given increasing doses of morphine followed by precipitation of withdrawal by naloxone and behavioral responses to withdrawal assessed. Results Both morphine administration and withdrawal increases galanin gene transcription in the locus coerulus (LC). Increasing galanin levels in the brain reduced signs of opiate withdrawal. Mice lacking GalR1 undergo more severe opiate withdrawal, whereas mice lacking GalR2 show no significant difference in withdrawal signs, compare to matched wild type controls. Conclusions Opiate administration and withdrawal increase galanin expression in the LC. Galanin opposes the actions of morphine which lead to opiate dependence and withdrawal, an effect that is mediated via GalR1. PMID:21969124

  11. Attenuation of alcohol withdrawal syndrome and blood cortisol level with forced exercise in comparison with diazepam.

    Directory of Open Access Journals (Sweden)

    Majid Motaghinejad

    2015-05-01

    Full Text Available Relieving withdrawal and post-abstinence syndrome of alcoholism is one of the major strategies in the treatment of alcohol addicted patients. Diazepam, chlordiazepoxide, and topiramate are the approved medications that were used for this object. To assess the role of non-pharmacologic therapy in the management of alcohol withdrawal syndrome, we analyzed effects of forced exercise by treadmill on alcohol dependent mice as an animal model. A total of 60 adult male mice were divided into 5 groups, from which 4 groups became dependent to alcohol (2 g/kg/day for 15 days. From day 16, treatment groups were treated by diazepam (0.5mg/kg, forced exercise, and diazepam (0.5 mg/kg concurrent with forced exercise for two weeks; And the positive control group received same dose of alcohol (2 g/kg/day for two weeks. The negative control group received normal saline for four weeks. Finally, on day 31, all animals were observed for withdrawal signs, and Alcohol Total Withdrawal Score (ATWS was determined. Blood cortisol levels were measured in non-fasting situations as well. Present findings showed that ATWS significantly decrease in all treatment groups in comparison with positive control group (P<0.05 for groups received diazepam and treated by forced exercise and P<0.001 for group under treatment diazepam + forced exercise. Moreover, blood cortisol level significantly decreased in all treatment groups (P<0.001. This study suggested that forced exercise and physical activity can be useful as adjunct therapy in alcoholism and can ameliorate side effects and stress situation of withdrawal syndrome periods.

  12. Attenuation of alcohol withdrawal syndrome and blood cortisol level with forced exercise in comparison with diazepam.

    Science.gov (United States)

    Motaghinejad, Majid; Bangash, Mohammad Yasan; Motaghinejad, Ozra

    2015-01-01

    Relieving withdrawal and post-abstinence syndrome of alcoholism is one of the major strategies in the treatment of alcohol addicted patients. Diazepam, chlordiazepoxide, and topiramate are the approved medications that were used for this object. To assess the role of non-pharmacologic therapy in the management of alcohol withdrawal syndrome, we analyzed effects of forced exercise by treadmill on alcohol dependent mice as an animal model. A total of 60 adult male mice were divided into 5 groups, from which 4 groups became dependent to alcohol (2 g/kg/day) for 15 days. From day 16, treatment groups were treated by diazepam (0.5mg/kg), forced exercise, and diazepam (0.5 mg/kg) concurrent with forced exercise for two weeks; And the positive control group received same dose of alcohol (2 g/kg/day) for two weeks. The negative control group received normal saline for four weeks. Finally, on day 31, all animals were observed for withdrawal signs, and Alcohol Total Withdrawal Score (ATWS) was determined. Blood cortisol levels were measured in non-fasting situations as well. Present findings showed that ATWS significantly decrease in all treatment groups in comparison with positive control group (Pdiazepam and treated by forced exercise and Pdiazepam + forced exercise). Moreover, blood cortisol level significantly decreased in all treatment groups (P<0.001). This study suggested that forced exercise and physical activity can be useful as adjunct therapy in alcoholism and can ameliorate side effects and stress situation of withdrawal syndrome periods.

  13. Adrenergic Inhibition with Dexmedetomidine to Treat Stress Cardiomyopathy during Alcohol Withdrawal: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Zachary M. Harris

    2016-01-01

    Full Text Available Stress (Takotsubo cardiomyopathy is a form of reversible left ventricular dysfunction with a heightened risk of ventricular arrhythmia thought to be caused by high circulating catecholamines. We report a case of stress cardiomyopathy that developed during severe alcohol withdrawal successfully treated with dexmedetomidine. The case involves a 53-year-old man with a significant history of alcohol abuse who presented to a teaching hospital with new-onset seizures. His symptoms of acute alcohol withdrawal were initially treated with benzodiazepines, but the patient later developed hypotension, and stress cardiomyopathy was suspected based on ECG and echocardiographic findings. Adjunctive treatment with the alpha-2-adrenergic agonist, dexmedetomidine, was initiated to curtail excessive sympathetic outflow of the withdrawal syndrome, thereby targeting the presumed pathophysiology of the cardiomyopathy. Significant clinical improvement was observed within one day of initiation of dexmedetomidine. These findings are consistent with other reports suggesting that sympathetic dysregulation during alcohol withdrawal produces ideal pathobiology for stress cardiomyopathy and leads to ventricular arrhythmogenicity. Stress cardiomyopathy should be recognized as a complication of alcohol withdrawal that significantly increases cardiac-related mortality. By helping to correct autonomic dysregulation of the withdrawal syndrome, dexmedetomidine may be useful in the treatment of stress-induced cardiomyopathy.

  14. Adrenergic Inhibition with Dexmedetomidine to Treat Stress Cardiomyopathy during Alcohol Withdrawal: A Case Report and Literature Review.

    Science.gov (United States)

    Harris, Zachary M; Alonso, Alvaro; Kennedy, Thomas P

    2016-01-01

    Stress (Takotsubo) cardiomyopathy is a form of reversible left ventricular dysfunction with a heightened risk of ventricular arrhythmia thought to be caused by high circulating catecholamines. We report a case of stress cardiomyopathy that developed during severe alcohol withdrawal successfully treated with dexmedetomidine. The case involves a 53-year-old man with a significant history of alcohol abuse who presented to a teaching hospital with new-onset seizures. His symptoms of acute alcohol withdrawal were initially treated with benzodiazepines, but the patient later developed hypotension, and stress cardiomyopathy was suspected based on ECG and echocardiographic findings. Adjunctive treatment with the alpha-2-adrenergic agonist, dexmedetomidine, was initiated to curtail excessive sympathetic outflow of the withdrawal syndrome, thereby targeting the presumed pathophysiology of the cardiomyopathy. Significant clinical improvement was observed within one day of initiation of dexmedetomidine. These findings are consistent with other reports suggesting that sympathetic dysregulation during alcohol withdrawal produces ideal pathobiology for stress cardiomyopathy and leads to ventricular arrhythmogenicity. Stress cardiomyopathy should be recognized as a complication of alcohol withdrawal that significantly increases cardiac-related mortality. By helping to correct autonomic dysregulation of the withdrawal syndrome, dexmedetomidine may be useful in the treatment of stress-induced cardiomyopathy.

  15. Evaluation of relational and NoSQL database architectures to manage genomic annotations.

    Science.gov (United States)

    Schulz, Wade L; Nelson, Brent G; Felker, Donn K; Durant, Thomas J S; Torres, Richard

    2016-12-01

    While the adoption of next generation sequencing has rapidly expanded, the informatics infrastructure used to manage the data generated by this technology has not kept pace. Historically, relational databases have provided much of the framework for data storage and retrieval. Newer technologies based on NoSQL architectures may provide significant advantages in storage and query efficiency, thereby reducing the cost of data management. But their relative advantage when applied to biomedical data sets, such as genetic data, has not been characterized. To this end, we compared the storage, indexing, and query efficiency of a common relational database (MySQL), a document-oriented NoSQL database (MongoDB), and a relational database with NoSQL support (PostgreSQL). When used to store genomic annotations from the dbSNP database, we found the NoSQL architectures to outperform traditional, relational models for speed of data storage, indexing, and query retrieval in nearly every operation. These findings strongly support the use of novel database technologies to improve the efficiency of data management within the biological sciences.

  16. NETMARK: A Schema-less Extension for Relational Databases for Managing Semi-structured Data Dynamically

    Science.gov (United States)

    Maluf, David A.; Tran, Peter B.

    2003-01-01

    Object-Relational database management system is an integrated hybrid cooperative approach to combine the best practices of both the relational model utilizing SQL queries and the object-oriented, semantic paradigm for supporting complex data creation. In this paper, a highly scalable, information on demand database framework, called NETMARK, is introduced. NETMARK takes advantages of the Oracle 8i object-relational database using physical addresses data types for very efficient keyword search of records spanning across both context and content. NETMARK was originally developed in early 2000 as a research and development prototype to solve the vast amounts of unstructured and semi-structured documents existing within NASA enterprises. Today, NETMARK is a flexible, high-throughput open database framework for managing, storing, and searching unstructured or semi-structured arbitrary hierarchal models, such as XML and HTML.

  17. Migraine with Aura or Sports-Related Concussion: Case Report, Pathophysiology, and Multidisciplinary Approach to Management.

    Science.gov (United States)

    Ellis, Michael J; Cordingley, Dean; Girardin, Richard; Ritchie, Lesley; Johnston, Janine

    The evaluation and management of athletes presenting with clinical features of migraine headache with aura in the setting of sports-related head trauma is challenging. We present a case report of a 15-yr-old boy with a history of migraine with visual aura that developed acute visual disturbance and headache after a head injury during an ice hockey game. The patient underwent comprehensive assessment at a multidisciplinary concussion program, including neuro-ophthalmological examination, neurocognitive testing, and graded aerobic treadmill testing. Clinical history and multidisciplinary assessment was consistent with the diagnosis of coexisting sports-related concussion and migraine with brainstem aura. The authors discuss the pearls and pitfalls of managing patients who develop migraine headache with visual aura after sports-related head injury and the value of a comprehensive multidisciplinary approach to this unique patient population.

  18. Anticonvulsants for the treatment of alcohol withdrawal syndrome and alcohol use disorders.

    Science.gov (United States)

    Hammond, Christopher J; Niciu, Mark J; Drew, Shannon; Arias, Albert J

    2015-04-01

    Alcoholic patients suffer from harmful allostatic neuroplastic changes in the brain causing an acute withdrawal syndrome upon cessation of drinking followed by a protracted abstinence syndrome and an increased risk of relapse to heavy drinking. Benzodiazepines have long been the treatment of choice for detoxifying patients and managing alcohol withdrawal syndrome (AWS). Non-benzodiazepine anticonvulsants (NBACs) are increasingly being used both for alcohol withdrawal management and for ongoing outpatient treatment of alcohol dependence, with the goal of either abstinence or harm reduction. This expert narrative review summarizes the scientific basis and clinical evidence supporting the use of NBACs in treating AWS and for reducing harmful drinking patterns. There is less evidence in support of NBAC therapy for AWS, with few placebo-controlled trials. Carbamazepine and gabapentin appear to be the most promising adjunctive treatments for AWS, and they may be useful as monotherapy in select cases, especially in outpatient settings and for the treatment of mild-to-moderate low-risk patients with the AWS. The body of evidence supporting the use of the NBACs for reducing harmful drinking in the outpatient setting is stronger. Topiramate appears to have a robust effect on reducing harmful drinking in alcoholics. Gabapentin is a potentially efficacious treatment for reducing the risk of relapse to harmful drinking patterns in outpatient management of alcoholism. Gabapentin's ease of use, rapid titration, good tolerability, and efficacy in both the withdrawal and chronic phases of treatment make it particularly appealing. In summary, several NBACs appear to be beneficial in treating AWS and alcohol use disorders.

  19. Relating management practices and nutrient export in agricultural watersheds of the United States

    Science.gov (United States)

    Sprague, Lori A.; Gronberg, Jo Ann M.

    2012-01-01

    Relations between riverine export (load) of total nitrogen (N) and total phosphorus (P) from 133 large agricultural watersheds in the United States and factors affecting nutrient transport were evaluated using empirical regression models. After controlling for anthropogenic inputs and other landscape factors affecting nutrient transport-such as runoff, precipitation, slope, number of reservoirs, irrigated area, and area with subsurface tile drains-the relations between export and the area in the Conservation Reserve Program (CRP) (N) and conservation tillage (P) were positive. Additional interaction terms indicated that the relations between export and the area in conservation tillage (N) and the CRP (P) progressed from being clearly positive when soil erodibility was low or moderate, to being close to zero when soil erodibility was higher, to possibly being slightly negative only at the 90th to 95th percentile of soil erodibility values. Possible explanations for the increase in nutrient export with increased area in management practices include greater transport of soluble nutrients from areas in conservation tillage; lagged response of stream quality to implementation of management practices because of nitrogen transport in groundwater, time for vegetative cover to mature, and/or prior accumulation of P in soils; or limitations in the management practice and stream monitoring data sets. If lags are occurring, current nutrient export from agricultural watersheds may still be reflecting the influence of agricultural land-use practices that were in place before the implementation of these management practices.

  20. Can mindfulness influence weight management related eating behaviors? If so, how?

    Science.gov (United States)

    Tapper, Katy

    2017-04-01

    Mindfulness is increasingly being used for weight management. However, the strength of the evidence for such an approach is unclear; although mindfulness-based weight management programs have had some success, it is difficult to conclude that the mindfulness components were responsible. Research in this area is further complicated by the fact that the term 'mindfulness' is used to refer to a range of different practices. Additionally, we have little understanding of the mechanisms by which mindfulness might exert its effects. This review addresses these issues by examining research that has looked at the independent effects of mindfulness and mindfulness-related strategies on weight loss and weight management related eating behaviors. As well as looking at evidence for effects, the review also considers whether effects may vary with different types of strategy, and the kinds of mechanisms that may be responsible for any change. It is concluded that there is some evidence to support the effects of (a) present moment awareness, when applied to the sensory properties of food, and (b) decentering. However, research in these areas has yet to be examined in a controlled manner in relation to weight management. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  1. On the Relation Between Management and Economics from the Perspective of Institutional Statistics

    Directory of Open Access Journals (Sweden)

    Dan Yang

    2007-10-01

    Full Text Available Every country's economic development affects all levels of its society and thus the results of its social science research. To make social science research better serve their economic development, many countries have established social science research institutes, among which are management research institutes more related to economic research institutes. Through comparative research of the locations and founding dates of the institutes in different countries, this article analyses the development trends and the relationship between economics and management research, providing us with the relevant experience and background for planning purposes.

  2. The gendered trouble with alcohol: young people managing alcohol related violence.

    Science.gov (United States)

    Lindsay, Jo

    2012-05-01

    Alcohol related violence is a troubling backdrop to the social lives and relationships of many young people in post-industrial societies. The development of the night-time economy where young people are encouraged to drink heavily in entertainment precincts has increased the risk of violence. This paper reports on 60 individual structured in-depth interviews about the drinking biographies of young people (aged 20-24) living in Victoria, Australia. Twenty-six males and 34 females participated in the research. The participants discussed their experiences with alcohol over their life course to date. The material on alcohol related violence is analysed in this paper. Just over half of the participants (33/60) recounted negative experiences with alcohol related violence. The findings demonstrate the continuing gendered nature of experiences of perpetration and victimization. Participants reported that aggression and violence perpetrated by some men was fuelled by alcohol consumption and required ongoing management. Experiences of violence were also spatialized. Men were more likely to report managing and avoiding violence in particular public settings whilst more women than men discussed managing violence in domestic settings. The central argument of this paper is that incidents of alcohol related violence and reactions to it are specific gender performances that occur in specific socio-cultural contexts. In contrast to research which has found some young people enjoy the adventure and excitement of alcohol related violence the mainstream participants in this study saw violence as a negative force to be managed and preferably avoided. Understanding violence as a dynamic gender performance complicates the development of policy measures designed to minimize harm but also offers a more holistic approach to developing effective policy in this domain. There is a need for greater acknowledgement that alcohol related violence in public venues and in families is primarily about

  3. 39 CFR 955.27 - Withdrawal of attorney.

    Science.gov (United States)

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Withdrawal of attorney. 955.27 Section 955.27 Postal Service UNITED STATES POSTAL SERVICE PROCEDURES RULES OF PRACTICE BEFORE THE POSTAL SERVICE BOARD OF CONTRACT APPEALS § 955.27 Withdrawal of attorney. Any attorney for either party who has filed a...

  4. 40 CFR 180.8 - Withdrawal of petitions without prejudice.

    Science.gov (United States)

    2010-07-01

    ... prejudice. 180.8 Section 180.8 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... § 180.8 Withdrawal of petitions without prejudice. In some cases the Administrator will notify the... clarification or the obtaining of additional data. This withdrawal may be without prejudice to a future...

  5. 7 CFR 28.68 - Withdrawal of application for review.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Withdrawal of application for review. 28.68 Section 28.68 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Reviews § 28.68 Withdrawal of application for review. Any application for review may be withdrawn by...

  6. 37 CFR 2.68 - Express abandonment (withdrawal) of application.

    Science.gov (United States)

    2010-07-01

    ... 37 Patents, Trademarks, and Copyrights 1 2010-07-01 2010-07-01 false Express abandonment (withdrawal) of application. 2.68 Section 2.68 Patents, Trademarks, and Copyrights UNITED STATES PATENT AND... Action by Applicants § 2.68 Express abandonment (withdrawal) of application. (a) Written...

  7. The Relationship of Personality Variables to Organizational Withdrawal

    Science.gov (United States)

    Bernardin, H. John

    1977-01-01

    Investigates the relationship of personality characteristics to organizational withdrawal and tests the Porter and Steers "polar" hypothesis, i.e., employees with high levels of emotional instability, anxiety, achievement orientation, aggression, independence, self-confidence and sociability were more apt to withdraw from organizations…

  8. 17 CFR 242.405 - Withdrawal of margin.

    Science.gov (United States)

    2010-04-01

    ...) REGULATIONS M, SHO, ATS, AC, AND NMS AND CUSTOMER MARGIN REQUIREMENTS FOR SECURITY FUTURES Customer Margin Requirements for Security Futures § 242.405 Withdrawal of margin. (a) By the customer. Except as otherwise... account after such withdrawal is sufficient to satisfy the required margin for the security futures...

  9. 27 CFR 19.997 - Withdrawal of fuel alcohol.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Withdrawal of fuel alcohol. 19.997 Section 19.997 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU... and Transfers § 19.997 Withdrawal of fuel alcohol. For each shipment or other removal of fuel...

  10. Withdrawal of nonfutile life support after attempted suicide.

    Science.gov (United States)

    Brown, Samuel M; Elliott, C Gregory; Paine, Robert

    2013-01-01

    End-of-life decision making is fraught with ethical challenges. Withholding or withdrawing life support therapy is widely considered ethical in patients with high treatment burden, poor premorbid status, or significant projected disability even when such treatment is not "futile." Whether such withdrawal of therapy in the aftermath of attempted suicide is ethical is not well established in the literature. We provide a clinical vignette and propose criteria under which such withdrawal would be ethical. We suggest that it is appropriate to withdraw life support, regardless of the cause of the critical illness or disability, when the following criteria are met: (1) Surrogates request withdrawal of care and the adequacy of surrogates is confirmed, (2) an external reasonability standard is met, (3) passage of time, perhaps 72 hours, to allow certainty regarding the patient's wishes, and (4) psychiatric morbidity should be considered as grounds for withdrawal only in truly treatment-refractory cases. Fundamentally, we believe the question to ask is, "If this were not an attempted suicide, would a request to withdraw care be reasonable?" We believe that under these circumstances, such withdrawal of life support, even in an individual who has attempted suicide, does not constitute physician assistance with suicide and is distinct from physician aid-in-dying in several important respects.

  11. Socio-technical aspects of the use of health related personal information for management and research.

    Science.gov (United States)

    Iversen, K R; Grøtan, T O

    1996-10-01

    This paper focuses on the organisational, technical and ethical aspects related to the use of person identifiable health information for various health care management, administration, finance, research and educational purposes. It is based on the ethical standpoint that to the individuals in question, the identifiable health information represents the uttermost sensitive and critical information. In addition, nobody, possibly apart from the patients themselves, may claim ownership of such information. Thus identifiable health information should be (per individual) kept as collected and protected as possible, within the scope of the patient provider relationship. Identifiable health information should, whenever possible and reasonable, be restricted to the health care professionals providing the treatment and care to the patient, and only be made available to others, e.g. for management, research or educational purposes, either in anonymous or pseudonymous form. Secure information management (SIM) is presented as the socio-technical means to facilitate our ethical standpoint in a practical health care environment.

  12. Endovascular management of immediate procedure-related complications of failed hemodialysis access recanalization

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dong Hun [Chosun University Hospital, Kwangju (Korea, Republic of); Goo, Dong Erk; Yang, Seung Boo; Choi, Deuk Lin; Moon Cheul [Soonchunhyang University Hospital, Chunan (Korea, Republic of)

    2005-09-15

    Endovascular procedures are becoming the standard type of care for the management of hemodialysis vascular access dysfunction. As with any type of medical procedure, these techniques can result in procedure-related complications, although the expected number of complications is low. The clinical extent of these complications varies from case to case. Management of these cases depends on the clinical presentation. Major complications such as vein rupture, arterial embolism, remote site bleeding or hematoma, symptomatic pulmonary embolism and puncture site complications necessitating treatment require major therapy. Minor complications such as non-flow compromising small puncture site hematoma or pseudoaneurysms require little or no therapy. It is essential that the interventionist be prepared to manage these complications appropriately when they arise.

  13. Nonsteroidal, antiinflammatory drug-induced gastrointestinal injuries and related adverse reactions: Epidemiology, pathogenesis and management

    Directory of Open Access Journals (Sweden)

    Al Mofleh Ibrahim

    2007-01-01

    Full Text Available A large proportion of the population all over the world consumes acetylsalicylic acid (ASA: aspirin or other nonsteroidal, antiinflammatory drugs (NSAIDs. This is associated with a considerable morbidity and mortality. Elderly patients, patients with prior history of peptic ulcer disease (PUD or its complications, those who require high doses of NSAIDs and those undergoing concomitant therapy with corticosteroids or anticoagulants, are at particularly high risk of developing gastroduodenal injuries and related adverse reactions. Gastroduodenal mucosal injuries induced by NSAIDs vary from subtle microscopic to gross macroscopic changes including ulcers. These injuries are induced by both topical and systemic actions of NSAIDs. Inhibition of gastroduodenal cyclooxygenase (COX enzyme by NSAIDs is considered to be a major pathogenetic factor. Reactive oxygen species (ROS appear also to play a significant role in the pathogenesis of mucosal injury. Withdrawal of NSAIDs is preferably the first therapeutic option; however, it is not feasible in the majority of patients. Therefore, several drugs including antisecretory drugs (ASDs-proton pump inhibitors and Histamine-2 receptor antagonists and misoprostol, a prostaglandin analog are used for the prevention and treatment of NSAID-induced gastroduodenal injuries. Among ASDs, proton pump inhibitors (PPIs are the most commonly used drugs. The antiulcerogenic effect of PPIs is similar to that of misoprostol and superior to standard doses of histamine-2 receptor antagonists (H2-RAs. The adverse effects of m,isoprostol such as diarrhea, abdominal pain, nausea, flatulence, headache, dyspepsia, vomiting, constipation, abortifacient and teratogenicity limit its general use. Aside from their antisecretory action, PPIs also possess an antioxidative effect. PPI maintenance is recommended in chronic NSAID treatment in those with an increased risk of complications and is more effective than Helicobacter pylori

  14. Clinical Manifestations of the Opiate Withdrawal Syndrome

    Directory of Open Access Journals (Sweden)

    Faniya Shigakova

    2015-09-01

    Full Text Available Currently, substance abuse is one of the most serious problems facing our society. The aim of this study was to investigate the clinical manifestations of the opiate withdrawal syndrome (OWS. The study included 112 patients (57 women and 55 men aged from 18 to 64 years with opium addiction according to the DSM-IV. To study the clinical manifestation of OWS, the special 25-score scale with four sections to assess severity of sleep disorders, pain syndrome, autonomic disorders, and affective symptoms was used. Given the diversity of the OWS symptoms, attention was focused on three clinical variants, affective, algic and mixed. The OWS affective variant was registered more frequently in women, while the mixed type of OWS was more typical of men.

  15. Cardless Withdrawal System for Mobile Banking Applications

    Directory of Open Access Journals (Sweden)

    Calin Mihai Istrate

    2014-03-01

    Full Text Available With the whole world going mobile and with the threats represented by third party mobile payments, the banks need to react and offer their clients innovative integrated solutions for payments and money transfer. Mobile banking applications are more and more used, and the possibilities to expand are still open.A cardless withdrawal solution integrated in an already developed smartphone mobile banking application might just give an edge in the fight with other competitors. By using SMS technologies for sending money to other people the appeal of such an application will rise considerably and will attract more and more clients. It is very important to keep the mobile payment endorsers as clients of the bank and not some other provider.

  16. Moxonidine for tramadol withdrawal symptoms during detoxification.

    Science.gov (United States)

    Talih, Farid; Ghossoub, Elias

    2015-07-08

    It is well documented in the literature that noradrenergic pathways are key in the manifestation of opioid withdrawal symptoms, which is why clonidine is used as an off-label agent in opioid detoxification regimens given its anti-sympathetic properties. Moxonidine is a selective I1-imidazoline receptor agonist, similar to clonidine but with no α2-adrenergic agonist activity and subsequently fewer side effects. We report the case of a 33-year-old woman with a 15-year history of tramadol use who was admitted voluntarily for detoxification. She was started on moxonidine and had an uneventful detoxification. Two months after discharge, the patient maintained tramadol abstinence with good tolerability to moxonidine. To the best of our knowledge, this has not been previously reported in the medical literature.

  17. Selective Withdrawal with an Inverted Viscosity Ratio

    Science.gov (United States)

    Case, Sarah

    2005-03-01

    In the selective withdrawal experiment, fluid is withdrawn, at rate Q, through a tube with its tip suspended a distance S above an unperturbed interface separating two immiscible fluids. For high Q, the lower fluid is entrained along with the upper one while for low Q only the upper fluid is withdrawn. We have studied the situation where the ratio of lower to the upper fluid viscosities, η>1. For low Q, the interface forms a steady-state hump and only the upper fluid is withdrawn. When Q is increased, or S is decreased, the interface undergoes a two-stage transition: first the hump forms an unsteady, thin spout which then expands into a second thicker steady-state structure with distinct flow patterns in the lower fluid. This thick-spout structure is not observed for ηCohen and S. R. Nagel, Phys. Rev. Lett. 88, 074501 1- 4 (2002).

  18. Using selective withdrawal to coat microparticles.

    Science.gov (United States)

    Cohen, I; Li, H; Hougland, J L; Mrksich, M; Nagel, S R

    2001-04-13

    We report a method that uses the process of selective withdrawal of one fluid through a second immiscible fluid to coat small particles with polymer films. Fluid is withdrawn through a tube with its orifice slightly above a water-oil interface. Upon increasing the flow rate, there is a transition from a state where only oil is withdrawn to a state where the water, containing the particles to be coated and appropriate prepolymer reagents, is entrained in a thin spout along with the oil. The entrained particles eventually cause the spout interface to break, producing a thin coat of controllable thickness around each particle, which can be subsequently polymerized using chemical reagents, light, or heat. This method allows flexibility in the chemical composition and thickness of the conformal coatings.

  19. Opiate withdrawal complicated by tetany and cardiac arrest.

    Science.gov (United States)

    Kugasia, Irfanali R; Shabarek, Nehad

    2014-01-01

    Patients with symptoms of opiate withdrawal, after the administration of opiate antagonist by paramedics, are a common presentation in the emergency department of hospitals. Though most of opiate withdrawal symptoms are benign, rarely they can become life threatening. This case highlights how a benign opiate withdrawal symptom of hyperventilation led to severe respiratory alkalosis that degenerated into tetany and cardiac arrest. Though this patient was successfully resuscitated, it is imperative that severe withdrawal symptoms are timely identified and immediate steps are taken to prevent catastrophes. An easier way to reverse the severe opiate withdrawal symptom would be with either low dose methadone or partial opiate agonists like buprenorphine. However, if severe acid-base disorder is identified, it would be safer to electively intubate these patients for better control of their respiratory and acid-base status.

  20. Opiate Withdrawal Complicated by Tetany and Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Irfanali R. Kugasia

    2014-01-01

    Full Text Available Patients with symptoms of opiate withdrawal, after the administration of opiate antagonist by paramedics, are a common presentation in the emergency department of hospitals. Though most of opiate withdrawal symptoms are benign, rarely they can become life threatening. This case highlights how a benign opiate withdrawal symptom of hyperventilation led to severe respiratory alkalosis that degenerated into tetany and cardiac arrest. Though this patient was successfully resuscitated, it is imperative that severe withdrawal symptoms are timely identified and immediate steps are taken to prevent catastrophes. An easier way to reverse the severe opiate withdrawal symptom would be with either low dose methadone or partial opiate agonists like buprenorphine. However, if severe acid-base disorder is identified, it would be safer to electively intubate these patients for better control of their respiratory and acid-base status.

  1. Acute coronary ischemia during alcohol withdrawal: a case report

    Directory of Open Access Journals (Sweden)

    Sriram Ganeshalingam

    2011-08-01

    Full Text Available Abstract Introduction The potential of alcohol withdrawal to cause acute coronary events is an area that needs the urgent attention of clinicians and researchers. Case presentation We report the case of a 52-year-old heavy-alcohol-using Sri Lankan man who developed electocardiogram changes suggestive of an acute coronary event during alcohol withdrawal. Despite the patient being asymptomatic, subsequent echocardiogram showed evidence of ischemic myocardial dysfunction. We review the literature on precipitation of myocardial ischemia during alcohol withdrawal and propose possible mechanisms. Conclusions Alcohol withdrawal is a commonly observed phenomenon in hospitals. However, the number of cases reported in the literature of acute coronary events occurring during withdrawal is few. Many cases of acute ischemia or sudden cardiac deaths may be attributed to other well known complications of delirium tremens. This is an area needing the urgent attention of clinicians and epidemiologists.

  2. Not so ‘invisible’: A Qualitative Case Study Exploring Gender Relations and Farm Management Software

    Directory of Open Access Journals (Sweden)

    Dale Carolyn Mackrell

    2010-01-01

    Full Text Available This qualitative case study explored farm management practices by women cotton growers who used computer-based information systems, most particularly the agricultural farm management software, CottonLOGIC, within the Australian cotton industry. This study found that, although gender differences and inequalities persist in rural parts of the region, the agency of women cotton growers ensures not only a sustainable future for themselves and their families, but also for the broader cotton industry as a whole. The use of farm management software by women cotton farmers was informed by Connell’s theoretical framework of gender relations (2002. The findings suggested that, women’s active participation in family farm partnerships and their acquisition of technological skills through the use of farm management software like CottonLOGIC, meant that all cotton growers benefit through the feminizing of specific farm management practices in family farm enterprises. This, therefore, has significant implications for developing the cotton industry into a truly sustainable entity.

  3. Basic problems of management in the sphere of forest relations in retrospect of public prosecutor

    Directory of Open Access Journals (Sweden)

    I. A. Kuzmin

    2016-08-01

    Full Text Available Public administration of forests is one of the most important sectors of ecological public administration at the national and local levels. Forest legislation is the legal basis for management, whose quality and regulatory capacity ensure the effectiveness of state power activities aimed at sustainable use, protection and regeneration of forests. The need for reforming and properly updating forest legislation and law enforcement is long overdue, which is confirmed by scientific studies and actual facts. A basic problem of forest management is the absence of an official definition of «forest» and «urban forest». Problems of forest fire protection and management problems in the forest sector (e.g. related to the provision of forest plots and the sale and purchase of forest stands are widespread. Management problems also cover a mismatch of legislative activity of the competent entities regarding the regulation of forestry relations, the one-time combination of regulatory and supervisory functions in the same bodies, as well as the lack of a single current and objective system of state cadastral registration. The paper mentions peculiarities of identifying legal responsibility for forest offenses. It is noted that office of public prosecutor, being a central supervisory agency of the state due to the nature of its job and position in a system of separation of powers, has vast (if compared with other subjects of administrative relations opportunities to identify, overcome and eliminate the problems of management of forests. The paper considers separate case materials that show an active role of the national public prosecutor’s office in supporting law and order in the examined field. Generalized conclusions are drawn based on the results of the study.

  4. Is plant temporal beta diversity of field margins related to changes in management practices?

    Science.gov (United States)

    Alignier, Audrey; Baudry, Jacques

    2016-08-01

    Field margins have considerable ecological significance in agriculture-dominated landscapes by supporting biodiversity and associated services. However, agricultural changes during mid-20th century led to their drastic loss with a serious threat for biodiversity. Using time-series data, we aimed to get better insights into processes underlying plant patterns of field margins through time by i) quantifying plant temporal beta diversity components, ii) assessing whether the observed changes in plant communities can be related to changes in management practices applied to field margins. During the springs of 1994, 1998 and 2001, we surveyed plant communities and management practices of the same 116 field margins in three contrasted landscapes. We estimated temporal beta diversity in plant communities and partitioned it into its two dissimilarity resultant components, accounting for replacement of species (i.e. turnover) and for the nested gain or loss of species (i.e. nestedness). We then tested whether the observed changes in plant communities between 1994 and 1998 and, between 1998 and 2001 were related to changes in management practices using linear models. Plant communities of field margins exhibited strong temporal beta diversity dominated by turnover. Temporal turnover in plant communities was partly related to changes in management practices, i.e., a decrease of grazing concomitant to an increase of herbicide spraying. However, relationships were not consistent between all landscape contexts nor time period, suggesting that other unmeasured deterministic or stochastic processes could be driving the observed plant patterns. Taken together, our results suggest that maintaining a wide diversity of field margins with contrasted management contribute to maintaining plant diversity at a landscape scale. They underline the value of investigating plant temporal diversity patterns using time-series data and thus, the need to develop long-term studies making it possible

  5. Social Relation between Businessman and Community in Management of Intensive Shrimp Pond

    Science.gov (United States)

    Gumay Febryano, Indra; Sinurat, James; Lovinia Salampessy, Messalina

    2017-02-01

    Expansion of aquaculture, especially shrimp culture, is the primary cause of deforestation of mangrove along coastal zone. This phenomenon is pretty much related to social relation between businessman of intensive shrimp pond and community around coastal zone. The objective of this research is to explain social relation between businessman and community in managing intensive shrimp pond. This research is a kind of qualitative research and the method used is a case study. The result of this research shows that the behaviour of the majority of businessman of intensive shrimp pond is not accordingly with environmental concerns as they compelled conversion of mangrove and they disposed waste of shrimp pond into the sea. Such kind of behaviour caused degradation of water ecosystem and marginalizing local community. Corporate Social Responsibility (CSR) which was implemented by businessman of intensive shrimp pond in the area of social, religion, and education can downgrade the coming up of social turbulence. Otherwise, CSR in enabling economic community and environmental management was not conducted yet. CSR in environmental management can be conducted by businessman of intensive shrimp pond by considering the existence of mangrove and pond management and waste in a better way, so that environment around ponds is not polluted and the sustainability of shrimp pond business as well as income of community can be guaranteed. Accordingly with the result of this research, CSR is not only involving businessman of intensive shrimp pond and community, but also involving local government in terms of right and responsibility of citizen as well as management and development of community.

  6. Methods for Estimating Water Withdrawals for Mining in the United States, 2005

    Science.gov (United States)

    Lovelace, John K.

    2009-01-01

    The mining water-use category includes groundwater and surface water that is withdrawn and used for nonfuels and fuels mining. Nonfuels mining includes the extraction of ores, stone, sand, and gravel. Fuels mining includes the extraction of coal, petroleum, and natural gas. Water is used for mineral extraction, quarrying, milling, and other operations directly associated with mining activities. For petroleum and natural gas extraction, water often is injected for secondary oil or gas recovery. Estimates of water withdrawals for mining are needed for water planning and management. This report documents methods used to estimate withdrawals of fresh and saline groundwater and surface water for mining during 2005 for each county and county equivalent in the United States, Puerto Rico, and the U.S. Virgin Islands. Fresh and saline groundwater and surface-water withdrawals during 2005 for nonfuels- and coal-mining operations in each county or county equivalent in the United States, Puerto Rico, and the U.S. Virgin Islands were estimated. Fresh and saline groundwater withdrawals for oil and gas operations in counties of six states also were estimated. Water withdrawals for nonfuels and coal mining were estimated by using mine-production data and water-use coefficients. Production data for nonfuels mining included the mine location and weight (in metric tons) of crude ore, rock, or mineral produced at each mine in the United States, Puerto Rico, and the U.S. Virgin Islands during 2004. Production data for coal mining included the weight, in metric tons, of coal produced in each county or county equivalent during 2004. Water-use coefficients for mined commodities were compiled from various sources including published reports and written communications from U.S. Geological Survey National Water-use Information Program (NWUIP) personnel in several states. Water withdrawals for oil and gas extraction were estimated for six States including California, Colorado, Louisiana, New

  7. Does audit quality influence the relation between earnings management and internal control weakness in the post - SOX period?

    NARCIS (Netherlands)

    van Ravenstein, J.; Georgakopoulos, G.; Kalantonis, P.; Kaldis, P.

    2013-01-01

    Material weaknesses in the internal control system of a company create more opportunities for managers to engage in opportunistic earnings management. In this study the authors investigate the relation between earnings management and disclosed material weaknesses in the internal controls, both under

  8. Does audit quality influence the relation between earnings management and internal control weakness in the post - SOX period?

    NARCIS (Netherlands)

    van Ravenstein, J.; Georgakopoulos, G.; Kalantonis, P.; Kaldis, P.

    2013-01-01

    Material weaknesses in the internal control system of a company create more opportunities for managers to engage in opportunistic earnings management. In this study the authors investigate the relation between earnings management and disclosed material weaknesses in the internal controls, both under

  9. Self-care behaviors and activities for managing HIV-related anxiety.

    Science.gov (United States)

    Kemppainen, Jeanne K; Wantland, Dean; Voss, Joachim; Nicholas, Patrice; Kirksey, Kenn M; Corless, Inge B; Willard, Suzanne; Holzemer, William L; Robinson, Linda; Hamilton, Mary Jane; Sefcik, Elizabeth; Eller, Lucille Sanzero; Huang, Emily; Arudo, John; Moezzi, Shahnaz; Rivero-Mendez, Marta; Rosa, Maria; Human, Sarie; Cuca, Yvette; Lindgren, Terri; Portillo, Carmen J; Maryland, Mary

    2012-01-01

    The goal of this study was to identify the baseline prevalence and effectiveness of anxiety self-management strategies in a convenience sample of persons living with HIV (PLWH; n = 343) in the United States, Puerto Rico, Kenya, and South Africa who reported HIV-related anxiety symptoms. Relationships between demographics and anxiety characteristics were determined, as was the effectiveness of self-care activities/behaviors to reduce anxiety. We found that the use of anxiety self-management strategies varied by gender and that ratings of effectiveness varied by country. Highest anxiety intensity scores were found in participants who were taking antiretroviral medications and who had undetectable viral loads. Forty-five percent of the persons with a diagnosis of AIDS reported anxiety symptoms. As HIV increases in areas of the world where self-care is the primary approach to managing HIV, additional research will be needed to address the effectiveness of cross-cultural differences in strategies for self-managing HIV-related anxiety.

  10. Health-related behaviour among managers of Slovenian hospitals and institutes of public health

    Directory of Open Access Journals (Sweden)

    Jerneja Farkas

    2015-12-01

    Full Text Available Aim: Behavioural risk factors have a significant impact on health. We aimed to assess health-related behaviour, health status, and use of healthcare services among managers of Slovenian hospitals and institutes of public health. Methods: This was a cross-sectional study which included management (directors, scientific directors, directors’ deputies of Slovenian hospitals and institutes of public health (63 respondents; 57% women; overall mean age: 51±7 years; response rate: 74%. Data were obtained using an anonymous self-administered questionnaire. Results: About 35% of respondents were directors. More than half of the respondents were overweight or obese (52%, the majority were not sufficiently physically active (59% and overloaded with stress (87%. Hypercholesterolemia (36%, spinal disease (17%, and arterial hypertension (16% were most common chronic diseases. Whilst only few participants visited their general practitioner due their health complaints, blood pressure (76%, cholesterol (51%, and glucose (54% were measured within last year in most of the respondents. Conclusion: Our findings point to a high prevalence of overweight and obesity as well as workplace-related stress among Slovenian public health managers. Therefore, effective preventive strategies should be focused on stress management along with promotion of healthy behavioural patterns.

  11. [Non-withdrawal-related delirium : Evidence on prevention and therapy].

    Science.gov (United States)

    Haussmann, R; Bauer, M; Donix, M

    2016-05-01

    Delirium is a severe and common yet under-diagnosed disorder in the clinical routine. Multiple factors may contribute to the development of delirium, which is associated with increased mortality and high healthcare costs. Treatment of delirium is often provided with delay and limited to pharmacological interventions. This article summarizes the key symptoms for delirium as well as risk factors and highlights the pharmacological and non-pharmacological options for treatment and prevention.

  12. Sugar withdrawal and differential reinforcement of low rate (DRL) performance in rats.

    Science.gov (United States)

    Mangabeira, Victor; Garcia-Mijares, Miriam; Silva, M Teresa A

    2015-02-01

    Sugar consumption is assumed to induce a behavioral state that is similar to the one provoked by addictive substances. Drug withdrawal increases impulsivity, assessed by differential reinforcement of low rate (DRL) performance. The present study investigated the effect of withdrawal from a prolonged period of sugar consumption on DRL performance. Water-deprived rats were trained under a DRL 20s (DRL 20) schedule. The animals were allowed to choose between plain water and a sucrose solution (E group) or water only (C group) for 30 days. The sucrose solution was then removed, and measures of DRL 20 performance were obtained on 3 consecutive days. Results showed that DRL performance in the C group improved after sugar withdrawal, whereas performance in the E group led to the loss of reinforcers. An analysis of variance-type analysis showed that the E group had higher response rates per reinforcer, lower IRTs, and greater differences between baseline and abstinence than the C group after 3 days of sugar withdrawal. Thus, sugar abstinence after a relatively long consumption period resulted in impairment of DRL performance, confirming the parallel effects of addictive drugs and sugar and suggesting an increase in impulsivity as a consequence of sugar deprivation.

  13. Phenolic Compounds Protect Cultured Hippocampal Neurons against Ethanol-Withdrawal Induced Oxidative Stress

    Directory of Open Access Journals (Sweden)

    Marianna E. Jung

    2009-04-01

    Full Text Available Ethanol withdrawal is linked to elevated oxidative damage to neurons. Here we report our findings on the contribution of phenolic antioxidants (17β-estradiol, p-octyl-phenol and 2,6-di-tert-butyl-4-methylphenol to counterbalance sudden ethanol withdrawal-initiated oxidative events in hippocampus-derived cultured HT-22 cells. We showed that ethanol withdrawal for 4 h after 24-h ethanol treatment provoked greater levels of oxidative damage than the preceding ethanol exposure. Phenolic antioxidant treatment either during ethanol exposure or ethanol withdrawal only, however, dose-dependently reversed cellular oxidative damage, as demonstrated by the significantly enhanced cell viability, reduced malondialdehyde production and protein carbonylation, compared to untreated cells. Interestingly, the antioxidant treatment schedule had no significant impact on the observed neuroprotection. In addition, the efficacy of the three phenolic compounds was practically equipotent in protecting HT-22 cells in spite of predictions based on an in silico study and a cell free assay of lipid peroxidation. This finding implies that free-radical scavenging may not be the sole factor responsible for the observed neuroprotection and warrants further studies to establish, whether the HT-22 line is indeed a suitable model for in vitro screening of antioxidants against EW-related neuronal damage.

  14. Resistance to alcohol withdrawal-induced behaviour in Fyn transgenic mice and its reversal by ifenprodil.

    Science.gov (United States)

    Stork, Oliver; Kojima, Nobuhiko; Stork, Simone; Kume, Nobuko; Obata, Kunihiko

    2002-09-30

    Recent studies suggest that the protein tyrosine kinase Fyn constitutes a determinant of fear and anxiety as well as alcohol sensitivity in mice. We investigated these functions and their relatedness in mice with transgenic over-expression of native or mutated, constitutively active Fyn. Fear- and anxiety-related behaviour of these animals were normal under varying levels of stress, but under withdrawal from alcohol both types of transgenic mice failed to show any increase of anxiety-like behaviour or reduction of exploratory activity as seen in their wild-type littermates. This apparent lack of alcohol withdrawal-induced behavioural effects was associated with increased Fyn activity and tyrosine phosphorylation of several proteins including the NMDA receptor subunit NR2B in the different mutant lines. NR2B phosphorylation itself remained unaffected by the chronic alcohol ingestion and subsequent withdrawal, but challenge with an NR2B antagonist, ifenprodil, restored a normal behavioural response in alcohol-withdrawn fyn mutants. Moreover, both types of transgenic mice showed a reduction of voluntary alcohol consumption compared to their wild-type littermates. Together, these results suggest that Fyn can modulate alcohol consumption and prevent behavioural changes during alcohol withdrawal, possibly via phosphorylation of NR2B.

  15. A Review Study on the Effect of Iranian Herbal Medicines on Opioid Withdrawal Syndrome.

    Science.gov (United States)

    Ebrahimie, Marzieh; Bahmani, Mahmoud; Shirzad, Hedayatollah; Rafieian-Kopaei, Mahmoud; Saki, Kourosh

    2015-10-01

    Addiction is a chronic and recurring disease that recurrence phenomenon is the most important challenge in treatment of this disease. Recent experiences have shown that synthetic drugs have undesirable side effects. Recent studies on medicinal plants have shown that they might be effective in treatment of different stages of addiction with lower side effects and costs. The aim of this study was to review the effects of medicinal plants in the treatment of morphine addiction in experimental animals. In this review article, by using keywords of morphine, withdrawal, and plants or herbal medicine in databases of indexing cites, desired articles were obtained since 1994. Inclusion criteria for selecting articles were the articles related to application of medicinal plants in decreasing symptoms resulting from morphine withdrawal were selected. Results of this study on experimental studies have shown that medicinal plants such as Trachyspermum copticum L and Melissa officinalis decrease the symptoms of withdrawal syndrome in a dose-dependent. Also, medicinal plants like Avena sativa, Hypericum perforatu, Passiflora incarnate, Valeriana officinalis, Satureja hortensis L, and Mentha piperita can have effects on behavior, emotions, and other problems of addicts, decreasing withdrawal symptoms. Results of this study showed that medicinal plants can be effective in controlling deprivation, decreasing dependency creation, and possibly DETOXIFICATION: of opioid addicts.

  16. Withdrawing and withholding medical treatment: a comparative study between the Malaysian, English and Islamic law.

    Science.gov (United States)

    Kassim, Puteri Nemie Jahn; Adeniyi, Omipidan Bashiru

    2010-09-01

    The permissibility and lawfulness of withdrawing and withholding medical treatment has attracted considerable debates and criticisms, as the legal issues are drawn into entering the slippery slope of euthanasia. Proponents of "sanctity of life" views that withdrawing and withholding medical treatment with knowledge that death would result is still within the sphere of euthanasia, whereas proponents of "quality of life" argue that it is not, as death is not intended. Their arguments maintain that for patients who are totally dependant on machines to ensure the work of some bodily functions, living may amount to little more than survival as dying is prolonged. Furthermore, the prolonging of life of the dying patient has profound implications on patients themselves, their relatives, dependants and medical providers. Thus, withdrawing and withholding medical treatment would not only respect a patient's right to self-determination, by allowing them to die in their underlying condition, but will ensure that medical providers are able to concentrate on more worthwhile treatments. This paper discusses the intractable difficulties with the moral distinction between withholding and withdrawing treatment and euthanasia, as well as makes a comparative study between the present state of law in Malaysia and England on this issue. The paper further highlights the differences between civil law and Islamic law in this controversial area.

  17. 76 FR 31295 - Nectarines and Peaches Grown in California; Notice of Withdrawal

    Science.gov (United States)

    2011-05-31

    ...; ] DEPARTMENT OF AGRICULTURE Agricultural Marketing Service Nectarines and Peaches Grown in California; Notice of Withdrawal AGENCY: Agricultural Marketing Service, USDA. ACTION: Notice; withdrawal. SUMMARY: The Agricultural Marketing Service (AMS) is withdrawing the notice soliciting comments on its request for...

  18. CRF₂ receptor-deficiency reduces recognition memory deficits and vulnerability to stress induced by cocaine withdrawal.

    Science.gov (United States)

    Morisot, Nadège; Le Moine, Catherine; Millan, Mark J; Contarino, Angelo

    2014-12-01

    Psychostimulant drug abuse, dependence and withdrawal are associated with cognitive dysfunction and impact stress-sensitive systems. The corticotropin-releasing factor (CRF) system orchestrates stress responses via CRF1 and CRF2 receptors and is implicated in substance use disorders. However, CRF2 role in psychostimulant drug-induced cognitive dysfunction remains to be elucidated. In the present study, wild-type and CRF2-/- mice are injected with cocaine and memory assessed by the novel object recognition (NOR) task throughout relatively long periods of drug withdrawal. Following recovery from the drug-induced memory deficits, the mice are stressed prior to the NOR task and brain gene expression evaluated by in situ hybridization. Cocaine impairs NOR memory in wild-type and CRF2-/- mice. However, following cocaine withdrawal NOR memory deficits last less time in CRF2-/- than in wild-type mice. Furthermore, a relatively mild stressor induces the re-emergence of NOR deficits in long-term cocaine-withdrawn wild-type but not CRF2-/- mice. Cocaine-withdrawn mice show a genotype-independent higher c-fos expression in the NOR memory-relevant perirhinal cortex than drug-naïve mice. However neither genotype nor drug withdrawal affect the expression of tyrosine hydroxylase in the ventral tegmental area or the locus coeruleus and CRF in the central nucleus of the amygdala or the paraventricular nucleus of the hypothalamus, brain regions implicated in stress and drug responses. These data indicate a new role for the CRF2 receptor in cognitive deficits induced by cocaine withdrawal, both as regards to their duration and their re-induction by stress. Interestingly, prototypical brain stress systems other than CRF do not appear to be involved.

  19. [Assessing work-related stress: an Italian adaptation of the HSE Management Standards Work-Related Stress Indicator Tool].

    Science.gov (United States)

    Marcatto, Francesco; D'Errico, Giuseppe; Di Blas, Lisa; Ferrante, Donatella

    2011-01-01

    The aim of this paper is to present a preliminary validation of an Italian adaptation of the HSE Management Standards Work-Related Stress Indicator Tool (IT), an instrument for assessing work-related stress at the organizational level, originally developed in Britain by the Health and Safety Executive. A scale that assesses the physical work environment has been added to the original version of the IT. 190 employees of the University of Trieste have been enrolled in the study. A confirmatory analysis showed a satisfactory fit of the eight-factors structure of the instrument. Further psychometric analysis showed adequate internal consistency of the IT scales and good criterion validity, as evidenced by the correlations with self-perception of stress, work satisfaction and motivation. In conclusion, the Indicator Tool proved to be a valid and reliable instrument for the assessment of work-related stress at the organizational level, and it is also compatible with the instructions provided by the Ministry of Labour and Social Policy (Circular letter 18/11/2010).

  20. The Successful Treatment of Opioid Withdrawal-Induced Refractory Muscle Spasms with 5-HTP in a Patient Intolerant to Clonidine.

    Science.gov (United States)

    Dais, Jennifer; Khosia, Ankur; Doulatram, Gulshan

    2015-01-01

    Instituting drug holidays for chronic opioid using patients is becoming commonplace for pain practitioners initiating procedures such as intrathecal pump or spinal cord stimulator trials. As such, pain practitioners need to be adept in their management of acute opioid withdrawal. Successfully weaning an opioid dependent patient off of chronic opioids requires a thorough knowledge of the available adjuvants to assist in this process. However, that selection can become exhausted by adjuvant side effects or by ineffective attenuation of opioid withdrawal symptoms. In that case, novel drugs, or novel application of currently available medications must be sought after to assist in the drug holiday. We present a case in which refractory muscle spasms secondary to opioid withdrawal were successfully treated with an over-the-counter supplement that is not typically used for the attenuation of opioid withdrawal symptoms. In a patient intolerant to the side effects of clonidine, we were able to successfully wean chronic opiates by treating refractory muscle spasms with the serotonin precursor, 5-hydroxytryptophan (5-HTP). We hypothesize that our success with this medication gives further credence to the role of serotonin in opioid withdrawal somatic symptomatology, and supports the need for future research to clarify the role of serotonin precursors or serotonin modulating drugs as potential alternatives in those unable to follow standard treatment protocols.

  1. Appropriate use of inhaled corticosteroids in COPD: the candidates for safe withdrawal

    Science.gov (United States)

    Yawn, Barbara P; Suissa, Samy; Rossi, Andrea

    2016-01-01

    International guidance on chronic obstructive pulmonary disease (COPD) management recommends the use of inhaled corticosteroids (ICS) in those patients at increased likelihood of exacerbation. In spite of this guidance, ICS are prescribed in a large number of patients who are unlikely to benefit. Given the evidence of the risks associated with ICS and the limited indications for their use, there is interest in understanding the effects of withdrawing ICS when prescribed inappropriately. In this review, we discuss the findings of large ICS withdrawal trials, with primary focus on the more recent trials using active comparators. Data from these trials indicate that ICS may be withdrawn without adverse impact on exacerbation risk and patient-reported outcomes in patients with moderate COPD and no history of frequent exacerbations. Considering the safety concerns associated with ICS use, these medications should be withdrawn in patients for whom they are not recommended, while maintaining adequate bronchodilator therapy. PMID:27684954

  2. Estimation of the effects of land use and groundwater withdrawals on streamflow for the Pomperaug River, Connecticut

    Science.gov (United States)

    Bjerklie, David M.; Starn, J. Jeffrey; Tamayo, Claudia

    2010-01-01

    A precipitation runoff model for the Pomperaug River watershed, Connecticut was developed to address issues of concern including the effect of development on streamflow and groundwater recharge, and the implications of water withdrawals on streamflow. The model was parameterized using a strategy that requires a minimum of calibration and optimization by establishing basic relations between the parameter value and physical characteristics of individual hydrologic response units (HRUs) that comprise the model. The strategy was devised so that the information needed can be obtained from Geographic Information System and other general databases for Connecticut. Simulation of groundwater recharge enabled evaluation of the temporal and spatial mapping of recharge variation across the watershed and the spatial effects of changes in land cover on base flow and surface runoff. The modeling indicated that over the course of a year, groundwater provides between 60 and 70 percent of flow in the Pomperaug River; the remainder is generated by more rapid flow through the shallow subsurface and runoff from impermeable surfaces and saturated ground. Groundwater is recharged primarily during periods of low evapotranspiration in the winter, spring, and fall. The largest amount of recharge occurs in the spring in response to snowmelt. During floods, the Weekeepeemee and Nonnewaug Rivers (tributaries that form the Pomperaug River) respond rapidly with little flood peak attenuation due to flood-plain storage. In the Pomperaug River, flood-plain storage is more important in attenuating floods; abandoned quarry ponds (O&G ponds) adjacent to the river provide substantial flood storage above specific river stages when flow from the river spills over the banks and fills the ponds. Discharge from the ponds also helps to sustain low flows in the Pomperaug River. Similarly, releases from the Bronson-Lockwood reservoir sustain flow in the Nonnewaug River and tend to offset the effect of

  3. Physician-related barriers to cancer pain management with opioid analgesics

    DEFF Research Database (Denmark)

    Jacobsen, Ramune; Sjøgren, Per; Møldrup, Claus

    2007-01-01

    OBJECTIVE: The purpose of this review is to summarize the results of studies on physician-related barriers to cancer pain management with opioid analgesics. METHODS: A literature search was conducted in PUBMED, using a combined text word and MeSH heading search strategy. Those articles whose full...... of drug prescribing documents. The results of the articles found were analyzed with respect to (a) knowledge, beliefs, concerns, problems endorsed or acknowledged by physicians treating cancer pain, (b) physicians' skills in pain assessment, and (c) adequacy of opioid prescription. CONCLUSIONS......: This review revealed mostly general and common physician-related barriers to cancer pain management: concerns about side effects to opioids, prescription of not efficient doses of opioids, and very poor prescription for the treatment of side effects from opioids. In the future, the evaluation of the influence...

  4. Alcohol withdrawal syndrome--an auto-immune disease? A neuroimmunologic model for pathogenesis of alcohol withdrawal symptoms.

    Science.gov (United States)

    Schubert, S

    1990-08-01

    A neuroimmunologic model of alcohol withdrawal symptoms is developed according to which these may be considered as an idiopathic auto-immune disease. During the alcohol abuse period of non-addicts, homeostasis may alter pathologically by gradual adaptation of the organism: auto-sensitisation develops and finally leads to the breakdown of auto-immune tolerance of the structural modifications set by alcohol withdrawal. The immunosystem regards the existing assimilation of alcohol as self, the withdrawal of alcohol as non-self. Alcohol withdrawal may be considered as an acknowledged physical stressor, and physical stressors as potential triggers of auto-immune diseases. Some so-called alcohol-induced diseases may originate in the pathogenic effects of preceding auto-immune responses to repeated alcohol withdrawals. Neuroimmunologic preconditions of potential auto-immune diseases exactly fit the alcohol withdrawal situation. Neuroimmunologic diseases themselves show close analogies respectively to alcohol withdrawal symptoms as well as to some alcohol-induced diseases. The myelin basis protein is assumed to be a potential auto-allergen. Finally withdrawal symptoms being the expression of physical dependence on alcohol, the model may highlight the very nature of physical dependence.

  5. Efficacy of Tramadol Extended-Release for Opioid Withdrawal: A Randomized Clinical Trial.

    Science.gov (United States)

    Dunn, Kelly E; Tompkins, D Andrew; Bigelow, George E; Strain, Eric C

    2017-09-01

    Opioid use disorder (OUD) is a significant public health problem. Supervised withdrawal (ie, detoxification) from opioids using clonidine or buprenorphine hydrochloride is a widely used treatment. To evaluate whether tramadol hydrochloride extended-release (ER), an approved analgesic with opioid and nonopioid mechanisms of action and low abuse potential, is effective for use in supervised withdrawal settings. A randomized clinical trial was conducted in a residential research setting with 103 participants with OUD. Participants' treatment was stabilized with morphine, 30 mg, administered subcutaneously 4 times daily. A 7-day taper using clonidine (n = 36), tramadol ER (n = 36), or buprenorphine (n = 31) was then instituted, and patients were crossed-over to double-blind placebo during a post-taper period. The study was conducted from October 25, 2010, to June 23, 2015. Retention, withdrawal symptom management, concomitant medication utilization, and naltrexone induction. Results were analyzed over time and using area under the curve for the intention-to-treat and completer groups. Of the 103 participants, 88 (85.4%) were men and 43 (41.7%) were white; mean (SD) age was 28.9 (10.4) years. Buprenorphine participants (28 [90.3%]) were significantly more likely to be retained at the end of the taper compared with clonidine participants (22 [61.1%]); tramadol ER retention was intermediate and did not differ significantly from that of the other groups (26 [72.2%]; χ2 = 8.5, P = .01). Time-course analyses of withdrawal revealed significant effects of phase (taper, post taper) for the Clinical Opiate Withdrawal Scale (COWS) score (taper mean, 5.19 [SE, .26]; post-taper mean, 3.97 [SE, .23]; F2,170 = 3.6, P = .03) and Subjective Opiate Withdrawal Scale (SOWS) score (taper mean,8.81 [SE, .40]; post-taper mean, 4.14 [SE, .30]; F2,170 = 15.7, P tramadol ER (taper mean, 7.4; post-taper mean, 2.8; P = .03), but not buprenorphine (taper mean

  6. Do managed alcohol programs change patterns of alcohol consumption and reduce related harm? A pilot study

    OpenAIRE

    Vallance, Kate; Stockwell, Tim; Pauly, Bernie; Chow, Clifton; Gray, Erin; Krysowaty, Bonnie; Perkin, Kathleen; Zhao, Jinhui

    2016-01-01

    Background Managed alcohol programs (MAPs) are a harm reduction strategy for people with severe alcohol dependence and unstable housing. MAPs provide controlled access to alcohol usually alongside accommodation, meals, and other supports. Patterns of alcohol consumption and related harms among MAP participants and controls from a homeless shelter in Thunder Bay, Ontario, were investigated in 2013. Methods Structured interviews were conducted with 18 MAP and 20 control participants assessed as...

  7. An Evaluation on Effects of Total Quality Applications in Customer Relations Management

    OpenAIRE

    Pinar Altiok

    2014-01-01

    The concept of globalization inherently necessitated knowing management technics that could adapt to fast changes. Assuming all other financial aspects are almost equal for companies, the only factor “that can create difference” within the global competition environment is “the human factor”. It draws attention in the way that among companies who set out with the same technical equipment, the companies who are successful in customer relations are able to render the global competition sustaina...

  8. Management of neovascular Age-related macular degeneration: A review on landmark randomized controlled trials

    OpenAIRE

    Aniruddha Agarwal; Kanika Aggarwal; Vishali Gupta

    2016-01-01

    In the last decade, a number of prospective clinical trials with carefully designed study protocols have been conducted for the treatment of neovascular age-related macular degeneration (AMD). These landmark clinical trials such as ANCHOR and MARINA and, more recently, the Comparison of AMD Treatment Trials and VIEW studies have revolutionized the management of neovascular AMD. While AMD continues to remain a leading cause of severe visual loss worldwide, advances in pharmacotherapeutics have...

  9. From Industrial Relations to Human Resource Management: The Changing Role of the Personnel Function

    OpenAIRE

    Bryson, A.; D. Guest

    2008-01-01

    The evidence from 25 years of the Workplace Employment Relations Surveys shows that a growing number of workplaces have a personnel specialist in place and that an increasing proportion of these specialists have relevant qualifications. Personnel management is becoming more embedded and more professionalised. It is reasonable to assume that personnel specialists are hired to apply contemporary best practice and thereby, perhaps indirectly, to improve performance. Our analysis fails to support...

  10. Mexican-origin male perspectives of diet-related behaviors associated with weight management.

    Science.gov (United States)

    Valdez, L A; Amezquita, A; Hooker, S P; Garcia, D O

    2017-07-31

    Prevalence rates of obesity and related diseases are quickly reaching epidemic proportions among Hispanic males in the United States. Hispanic males suffer from the highest prevalence of obesity-related diseases when compared to all other racial/ethnic groups. Despite evidence showing that weight loss can significantly reduce the risk of obesity-related health implications, literature informing best practices to engage Hispanic males in weight management programs is scarce. The purpose of the current study was to engage Spanish-speaking, Mexican-origin males with overweight or obesity to examine their perspectives of diet-related behaviors related to weight management. Demographic and acculturation data were collected using questionnaires. Fourteen semistructured interviews were completed with an all-Spanish-speaking cohort of men (age: 45.0±9.8 years; BMI: 34.2±6.5 kg m(-)(2)) who were born outside of the United States. We conducted a thematic analysis using a hybrid deductive-inductive analysis strategy using a previously developed codebook that was updated during iterative analysis of interview transcripts. Participants reported that healthful eating habits were hindered, among other factors, by lack of knowledge, sociocultural norms and conceptualizations of masculinity. Viable diet-related intervention approaches also surfaced, including building consciousness, promotion of traditional knowledge and the integration of the family in interventions. Findings suggest that Spanish-speaking, Mexican-origin men have interest in actively engaging in behavior changes that improve their dietary habits and engage in weight management. Our findings yield valuable insights that can be used to formulate tailored intervention strategies to improve obesity prevention and treatment programs for this vulnerable subgroup.International Journal of Obesity advance online publication, 15 August 2017; doi:10.1038/ijo.2017.173.

  11. Adding Hierarchical Objects to Relational Database General-Purpose XML-Based Information Managements

    Science.gov (United States)

    Lin, Shu-Chun; Knight, Chris; La, Tracy; Maluf, David; Bell, David; Tran, Khai Peter; Gawdiak, Yuri

    2006-01-01

    NETMARK is a flexible, high-throughput software system for managing, storing, and rapid searching of unstructured and semi-structured documents. NETMARK transforms such documents from their original highly complex, constantly changing, heterogeneous data formats into well-structured, common data formats in using Hypertext Markup Language (HTML) and/or Extensible Markup Language (XML). The software implements an object-relational database system that combines the best practices of the relational model utilizing Structured Query Language (SQL) with those of the object-oriented, semantic database model for creating complex data. In particular, NETMARK takes advantage of the Oracle 8i object-relational database model using physical-address data types for very efficient keyword searches of records across both context and content. NETMARK also supports multiple international standards such as WEBDAV for drag-and-drop file management and SOAP for integrated information management using Web services. The document-organization and -searching capabilities afforded by NETMARK are likely to make this software attractive for use in disciplines as diverse as science, auditing, and law enforcement.

  12. Family-health professional relations in pediatric weight management: an integrative review.

    Science.gov (United States)

    Farnesi, B C; Ball, G D C; Newton, A S

    2012-06-01

    In this integrative review, we examined contemporary literature in pediatric weight management to identify characteristics that contribute to the relationship between families and health professionals and describe how these qualities can inform healthcare practices for obese children and families receiving weight management care. We searched literature published from 1980 to 2010 in three electronic databases (MEDLINE, PsycINFO and CINAHL). Twenty-four articles identified family-health professional relationships were influenced by the following: health professionals' weight-related discussions and approaches to care; and parents' preferences regarding weight-related terminology and expectations of healthcare delivery. There was considerable methodological heterogeneity in the types of reports (i.e. qualitative studies, review articles, commentaries) included in this review. Overall, the findings have implications for establishing a positive clinical relationship between families and health professionals, which include being sensitive when discussing weight-related issues, using euphemisms when talking about obesity, demonstrating a non-judgmental and supportive attitude and including the family (children and parents) in healthcare interactions. Experimental research, clinical interventions and longitudinal studies are needed to build on the current evidence to determine how best to establish a collaborative partnership between families and health professionals and whether such a partnership improves treatment adherence, reduces intervention attrition and enhances pediatric weight management success.

  13. Effect of variations in treatment regimen and liver cirrhosis on exposure to benzodiazepines during treatment of alcohol withdrawal syndrome

    OpenAIRE

    Gershkovich, Pavel; Wasan, Kishor M.; Ribeyre, Charles; Ibrahim, Fady; McNeill, John H

    2015-01-01

    Purpose: Benzodiazepines (BDZs) are the drugs of choice to prevent the symptoms of alcohol withdrawal syndrome (AWS). Various treatment protocols are published and have been shown to be effective in both office-managed and facility-managed treatment of AWS. The aim of this scientific commentary is to demonstrate the differences in the expected exposure to BDZs during AWS treatment using different treatment regimens available in the literature, in patients with or without alcoholic liver cirrh...

  14. Management of ERCP-related small bowel perforations: the pivotal role of physical investigation

    Science.gov (United States)

    Dubecz, Attila; Ottmann, Jürgen; Schweigert, Michael; Stadlhuber, Rudolf J.; Feith, Marcus; Wiessner, Volkmar; Muschweck, Herbert; Stein, Hubert J.

    2012-01-01

    Background Management of endoscopic retrograde cholangiopancreatography (ERCP)–associated duodenal perforation remains controversial. Some recommend surgery, while others recommend conservative treatment. Methods A retrospective chart review was conducted to identify patients treated at our institution for ERCP-related duodenal perforations. Study variables included indication for ERCP, clinical presentation, diagnostic procedures, time to diagnosis and treatment, location of injury, management, length of stay in hospital and survival. Results Between January 2000 and October 2009, 12 232 ERCP procedures were performed at our centre, and perforation occured in 11 patients (0.08%; 5 men, 6 women, mean age 71 yr). Six of the perforations were discovered during ERCP; 5 required radiologic imaging for diagnosis. Three perforations were diagnosed incidentally by follow-up ERCP. In 1 patient, perforation occurred 3 years after the procedure owing to a dislocated stent. Four of 11 perforations were stent-related; in 2 patients ERCP was performed in a nonanatomic situation (Billroth II gastroenterostomy). Free peritoneal perforation occurred in 4 patients; 1 was successfully managed conservatively. Four patients (36%) were treated surgically and none died. Five patients were managed conservatively with a successful outcome, and 2 patients died after conservative treatment (18%). Operative treatment included hepaticojejunostomy and duodenostomy (1 patient), suture of the perforation with T-drain (1 patient) and suture only (2 patients). The mean length of stay in hospital for all patients was 20 days. Conclusion Post-ERCP duodenal perforations are associated with significant morbidity and mortality. Immediate surgical evaluation and close monitoring is needed. Management should be individually tailored based on clinical findings only. PMID:22564521

  15. Systematic review: work-related stress and the HSE management standards.

    Science.gov (United States)

    Brookes, K; Limbert, C; Deacy, C; O'Reilly, A; Scott, S; Thirlaway, K

    2013-10-01

    The Health and Safety Executive (HSE) has defined six management standards representing aspects of work that, if poorly managed, are associated with lower levels of employee health and productivity, and increased sickness absence. The HSE indicator tool aims to measure organizations' performance in managing the primary stressors identified by the HSE management standards. The aims of the study are to explore how the HSE indicator tool has been implemented within organizations and to identify contexts in which the tool has been used, its psychometric properties and relationships with alternative measures of well-being and stress. Studies that matched specific criteria were included in the review. Abstracts were considered by two researchers to ensure a reliable process. Full texts were obtained when abstracts met the inclusion criteria. Thirteen papers were included in the review. Using factor analysis and measures of reliability, the studies suggest that the HSE indicator tool is a psychometrically sound measure. The tool has been used to measure work-related stress across different occupational groups, with a clear relationship between the HSE tool and alternative measures of well-being. Limitations of the tool and recommendations for future research are discussed. The HSE indicator tool is a psychometrically sound measure of organizational performance against the HSE management standards. As such it can provide a broad overview of sources of work-related stress within organizations. More research is required to explore the use of the tool in the design of interventions to reduce stress, and its use in different contexts and with different cultural and gender groups.

  16. Dealing with Drought: Decoupling Climatic and Management-Related Drivers of Water Conservation Behavior

    Science.gov (United States)

    Hemati, A.; Rippy, M.; Grant, S. B.

    2015-12-01

    As global populations grow, cities in drought prone regions of the world such as California and South East Australia are faced with escalating water scarcity and water security challenges. The management approaches geared towards addressing these challenges are diverse. Given the myriad of possible approaches and the tendency to apply them in combination, successful management actions can be difficult to identify. Background climactic variability further complicates the story, making transfer of management lessons from one drought stressed region to another difficult. Here we use Melbourne, a city of 4.3 million people in South East Australia that recently faced and overcame a > 10 year "Millennium" drought, as a test case for evaluating the relative importance of various management-related and climactic factors in driving reductions in municipal water consumption (~60% in 12 years). Our analysis suggests that Melbourne's declining municipal consumption cannot be explained by potable substitution alone, as reductions in municipal consumption were not matched by increased use of alternative sources (e.g., urban rain or recycled water). Thus, water conservation behavior (not source switching) may be responsible for the majority of demand reduction in Melbourne. Interestingly, while voluntary or mandatory water restrictions appear to have substantially altered the rate of change of consumption near the end of Melbourne's Millennium drought (e.g., forcing a period of intense conservation), overall conservation behavior precedes these restrictions. This suggests that other rapidly implemented (and hither too unquantified) management approaches such as advertising or newspapers may have driven water conservation behavior early in the drought. Climatic factors, particularly precipitation may also have influenced conservation behavior; changes in precipitation were significantly positively correlated with changes in water consumption at a lag of 18 months. Similar

  17. Kazakhstan can achieve ambitious HIV targets despite expected donor withdrawal by combining improved ART procurement mechanisms with allocative and implementation efficiencies

    Science.gov (United States)

    Benedikt, Clemens; Bokazhanova, Aliya; Đurić, Predrag; Petrenko, Irina; Ganina, Lolita; Kelly, Sherrie L.; Stuart, Robyn M.; Kerr, Cliff C.; Vinichenko, Tatiana; Zhang, Shufang; Hamelmann, Christoph; Manova, Manoela; Masaki, Emiko; Wilson, David P.; Gray, Richard T.

    2017-01-01

    Background Despite a non-decreasing HIV epidemic, international donors are soon expected to withdraw funding from Kazakhstan. Here we analyze how allocative, implementation, and technical efficiencies could strengthen the national HIV response under assumptions of future budget levels. Methodology We used the Optima model to project future scenarios of the HIV epidemic in Kazakhstan that varied in future antiretroviral treatment unit costs and management expenditure—two areas identified for potential cost-reductions. We determined optimal allocations across HIV programs to satisfy either national targets or ambitious targets. For each scenario, we considered two cases of future HIV financing: the 2014 national budget maintained into the future and the 2014 budget without current international investment. Findings Kazakhstan can achieve its national HIV targets with the current budget by (1) optimally re-allocating resources across programs and (2) either securing a 35% [30%–39%] reduction in antiretroviral treatment drug costs or reducing management costs by 44% [36%–58%] of 2014 levels. Alternatively, a combination of antiretroviral treatment and management cost-reductions could be sufficient. Furthermore, Kazakhstan can achieve ambitious targets of halving new infections and AIDS-related deaths by 2020 compared to 2014 levels by attaining a 67% reduction in antiretroviral treatment costs, a 19% [14%–27%] reduction in management costs, and allocating resources optimally. Significance With Kazakhstan facing impending donor withdrawal, it is important for the HIV response to achieve more with available resources. This analysis can help to guide HIV response planners in directing available funding to achieve the greatest yield from investments. The key changes recommended were considered realistic by Kazakhstan country representatives. PMID:28207809

  18. Kazakhstan can achieve ambitious HIV targets despite expected donor withdrawal by combining improved ART procurement mechanisms with allocative and implementation efficiencies.

    Science.gov (United States)

    Shattock, Andrew J; Benedikt, Clemens; Bokazhanova, Aliya; Đurić, Predrag; Petrenko, Irina; Ganina, Lolita; Kelly, Sherrie L; Stuart, Robyn M; Kerr, Cliff C; Vinichenko, Tatiana; Zhang, Shufang; Hamelmann, Christoph; Manova, Manoela; Masaki, Emiko; Wilson, David P; Gray, Richard T

    2017-01-01

    Despite a non-decreasing HIV epidemic, international donors are soon expected to withdraw funding from Kazakhstan. Here we analyze how allocative, implementation, and technical efficiencies could strengthen the national HIV response under assumptions of future budget levels. We used the Optima model to project future scenarios of the HIV epidemic in Kazakhstan that varied in future antiretroviral treatment unit costs and management expenditure-two areas identified for potential cost-reductions. We determined optimal allocations across HIV programs to satisfy either national targets or ambitious targets. For each scenario, we considered two cases of future HIV financing: the 2014 national budget maintained into the future and the 2014 budget without current international investment. Kazakhstan can achieve its national HIV targets with the current budget by (1) optimally re-allocating resources across programs and (2) either securing a 35% [30%-39%] reduction in antiretroviral treatment drug costs or reducing management costs by 44% [36%-58%] of 2014 levels. Alternatively, a combination of antiretroviral treatment and management cost-reductions could be sufficient. Furthermore, Kazakhstan can achieve ambitious targets of halving new infections and AIDS-related deaths by 2020 compared to 2014 levels by attaining a 67% reduction in antiretroviral treatment costs, a 19% [14%-27%] reduction in management costs, and allocating resources optimally. With Kazakhstan facing impending donor withdrawal, it is important for the HIV response to achieve more with available resources. This analysis can help to guide HIV response planners in directing available funding to achieve the greatest yield from investments. The key changes recommended were considered realistic by Kazakhstan country representatives.

  19. Consequences of amygdala kindling and repeated withdrawal from ethanol on amphetamine-induced behaviours.

    Science.gov (United States)

    Ripley, Tamzin L; Dunworth, Sarah J; Stephens, David N

    2002-09-01

    relatively mild chronic ethanol treatment modulates neuronal systems that may also be involved in PTZ-induced kindling but not those involved in either the acute stimulant effects of amphetamine or behavioural sensitization or appetitive conditioning following repeated amphetamine administration. Behavioural changes following amygdala kindling differed from those following repeated ethanol withdrawal, suggesting that withdrawal kindling from a mild ethanol treatment differs in its effects from amygdala kindling.

  20. Differential effects of two chronic diazepam treatment regimes on withdrawal anxiety and AMPA receptor characteristics.

    Science.gov (United States)

    Allison, Claire; Pratt, Judith A

    2006-03-01

    Withdrawal from chronic benzodiazepines is associated with increased anxiety and seizure susceptibility. Neuroadaptive changes in neural activity occur in limbo-cortical structures although changes at the level of the GABA(A) receptor do not provide an adequate explanation for these functional changes. We have employed two diazepam treatment regimes known to produce differing effects on withdrawal aversion in the rat and examined whether withdrawal-induced anxiety was accompanied by changes in AMPA receptor characteristics. Rats were given 28 days treatment with diazepam by the intraperitoneal (i.p.) route (5 mg/kg) and the subcutaneous (s.c.) route (15 mg/kg). Withdrawal anxiety in the elevated plus maze was evident in the group withdrawn from chronic s.c. diazepam (relatively more stable plasma levels) but not from the chronic i.p. group (fluctuating daily plasma levels). In the brains of these rats, withdrawal anxiety was accompanied by increased [3H]Ro48 8587 binding in the hippocampus and thalamus, and decreased GluR1 and GluR2 subunit mRNA expression in the amygdala (GluR1 and GluR2) and cortex (GluR1). The pattern of changes was different in the chronic i.p. group where in contrast to the chronic s.c. group, there was reduced [3H]Ro48 8587 binding in the hippocampus and no alterations in GluR1 and GluR2 subunit expression in the amygdala. While both groups showed reduced GluR1 mRNA subunit expression in the cortex overall, only the agranular insular cortex exhibited marked reductions following chronic i.p. diazepam. Striatal GluR2 mRNA expression was increased in the i.p. group but not the s.c. group. Taken together, these data are consistent with differential neuroadaptive processes in AMPA receptor plasticity being important in withdrawal from chronic benzodiazepines. Moreover, these processes may differ both at a regional and receptor function level according to the behavioral manifestations of withdrawal.