WorldWideScience

Sample records for management long-term stewardship

  1. Environmental Management Long-Term Stewardship Transition Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Kristofferson, Keith

    2001-11-01

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

  2. Long-Term Stewardship Baseline Report and Transition Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Kristofferson, Keith

    2001-11-01

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

  3. Idaho National Laboratory Site Long-Term Stewardship Implementation Plan

    Energy Technology Data Exchange (ETDEWEB)

    B. E. Olaveson

    2006-07-27

    The U.S. Department of Energy has established long-term stewardship programs to protect human health and the environment at sites where residual contamination remains after site cleanup. At the Idaho National Laboratory Site, Comprehensive Environmental Response, Compensation, and Liability Act (CERLA) long-term stewardship activities performed under the aegis of regulatory agreements, the Federal Facility Agreement and Consent Order for the Idaho National Laboratory, and state and federal requirements are administered primarily under the direction of the Idaho Cleanup Project. It represents a subset of all on-going environmental activity at the Idaho National Laboratory Site. This plan provides a listing of applicable CERCLA long-term stewardship requirements and their planned and completed implementation goals. It proffers the Long-Term Stewardship Environmental Data Warehouse for Sitewide management of environmental data. This plan will be updated as needed over time, based on input from the U.S. Department of Energy, its cognizant subcontractors, and other local and regional stakeholders.

  4. Long-Term Stewardship Program Science and Technology Requirements

    Energy Technology Data Exchange (ETDEWEB)

    Joan McDonald

    2002-09-01

    Many of the United States’ hazardous and radioactively contaminated waste sites will not be sufficiently remediated to allow unrestricted land use because funding and technology limitations preclude cleanup to pristine conditions. This means that after cleanup is completed, the Department of Energy will have long-term stewardship responsibilities to monitor and safeguard more than 100 sites that still contain residual contamination. Long-term stewardship encompasses all physical and institutional controls, institutions, information, and other mechanisms required to protect human health and the environment from the hazards remaining. The Department of Energy Long-Term Stewardship National Program is in the early stages of development, so considerable planning is still required to identify all the specific roles and responsibilities, policies, and activities needed over the next few years to support the program’s mission. The Idaho National Engineering and Environmental Laboratory was tasked with leading the development of Science and Technology within the Long-Term Stewardship National Program. As part of that role, a task was undertaken to identify the existing science and technology related requirements, identify gaps and conflicts that exist, and make recommendations to the Department of Energy for future requirements related to science and technology requirements for long-term stewardship. This work is summarized in this document.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-09-01

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

  6. Collaborative Establishment of a Long-Term Archive for Stewardship of Interdisciplinary Scientific Data

    Science.gov (United States)

    Downs, R. R.; Chen, R. S.; Cartolano, R. T.; Bose, R.

    2008-12-01

    Much of the scientific data that are being collected today cannot be recreated if they are not properly preserved and documented. Establishment of reliable long-term digital archives is essential to preserving these data and associated documentation beyond the working lifetimes of current scientists. Numerous challenges, both technical and institutional, need to be addressed before these data or their documentation become lost or inaccessible. Direct collaboration between university research libraries and active scientific data centers is one approach to addressing these challenges. We report here on the collaboration between the Columbia Libraries / Information Services and the Center for International Earth Science Information Network (CIESIN) to establish an interdisciplinary long-term archive for data from the NASA Socioeconomic Data and Applications Center (SEDAC). The SEDAC long-term archive serves as a trustworthy digital repository to support preparation, submission, appraisal, ingest, discovery, integration, and interoperability of scientific data that are expected to be of long-term interest to both natural and social scientists. Significant progress has been made in establishing the necessary policies and procedures, implementing needed standards and technologies, and assessing strengths and possible weaknesses in the long-term sustainability of the archive. Benefits have included sharing approaches and best practices for information technology solutions and scientific data stewardship. A key issue is the expected future integration of this specialized archive into the long-term digital repository currently being developed by the University. Planned activities include testing the migration of selected data from the SEDAC long-term archive to the forthcoming Libraries repository and the development of interfaces between the digital object management systems being implemented by SEDAC and the Libraries, which are both based on the Flexible Extensible

  7. Long Term Stewardship Challenges at the St. Louis District FUSRAP Sites

    Energy Technology Data Exchange (ETDEWEB)

    Dell' Orco, L.; Chambers, D.

    2002-02-27

    Non-Federally owned radioactively contaminated sites in St. Louis, Missouri are currently being remediated by the St. Louis District Corps of Engineers under the Formerly Utilized Sites Remedial Action Program (FUSRAP). When FUSRAP remediation is complete, inaccessible soils which have levels of contamination greater than unrestricted use standards, will remain. The purpose of this paper is to document the initial challenges facing the project team during its development of the Long Term Stewardship plan for the management of these soils. These soils are located under buildings, roads, railroads and bridges. The Long Term Stewardship plan for the majority of the sites is being developed simultaneously with the remedy selection process. A living document, it will ultimately document the remedial action end state and location of inaccessible soils and implement the plan for ensuring these soils are not a threat to human health and the environment. Although these soils are protective in their current configuration, at some point in time, when activities such as maintenance, utility or property improvement occur, the soils will become accessible and need to be addressed by the federal government. Up until that point in time they will need to be effectively managed to ensure they remain protective. The St. Louis District is in the process of collaboratively developing this plan with its regulators, affected stakeholders and interested parties.

  8. Strategic Program Planning Lessons Learned In Developing The Long-Term Stewardship Science and Technology Roadmap

    Energy Technology Data Exchange (ETDEWEB)

    Dixon, B.W.; Hanson, D.J.; Matthern, G.E.

    2003-04-24

    Technology roadmapping is a strategic planning method used by companies to identify and plan the development of technologies necessary for new products. The U.S. Department of Energy's Office of Environmental Management has used this same method to refine requirements and identify knowledge and tools needed for completion of defined missions. This paper describes the process of applying roadmapping to clarify mission requirements and identify enhancing technologies for the Long-Term Stewardship (LTS) of polluted sites after site cleanup has been completed. The nature of some contamination problems is such that full cleanup is not achievable with current technologies and some residual hazards remain. LTS maintains engineered contaminant barriers and land use restriction controls, and monitors residual contaminants until they no longer pose a risk to the public or the environment. Roadmapping was used to clarify the breadth of the LTS mission, to identify capability enhancements needed to improve mission effectiveness and efficiency, and to chart out the research and development efforts to provide those enhancements. This paper is a case study of the application of roadmapping for program planning and technical risk management. Differences between the planned and actual application of the roadmapping process are presented along with lessons learned. Both the process used and lessons learned should be of interest for anyone contemplating a similar technology based planning effort.

  9. Local Government Implementation of Long-Term Stewardship at Two DOE Facilities

    Energy Technology Data Exchange (ETDEWEB)

    John Pendergrass; Roman Czebiniak; Kelly Mott; Seth Kirshenberg; Audrey Eidelman; Zachary Lamb; Erica Pencak; Wendy Sandoz

    2003-08-13

    The Department of Energy (DOE) is responsible for cleaning up the radioactive and chemical contamination that resulted from the production of nuclear weapons. At more than one hundred sites throughout the country DOE will leave some contamination in place after the cleanup is complete. In order to protect human health and the environment from the remaining contamination DOE, U.S. Environmental Protection Agency (EPA), state environmental regulatory agencies, local governments, citizens and other entities will need to undertake long-term stewardship of such sites. Long-term stewardship includes a wide range of actions needed to protect human health in the environment for as long as the risk from the contamination remains above acceptable levels, such as barriers, caps, and other engineering controls and land use controls, signs, notices, records, and other institutional controls. In this report the Environmental Law Institute (ELI) and the Energy Communities Alliance (ECA) examine how local governments, state environmental agencies, and real property professionals implement long-term stewardship at two DOE facilities, Losa Alamos National Laboratory and Oak Ridge Reservation.

  10. A Report to Congress on Long-Term Stewardship. Volume I - Summary Report

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    2001-01-01

    During World War II and the Cold War, the Federal government developed and operated a vast network of industrial facilities for the research, production, and testing of nuclear weapons, as well as for other scientific and engineering research. These processes left a legacy of radioactive and chemical waste, environmental contamination, and hazardous facilities and materials at well over a 100 sites in 30 States and one U.S. Territory. Hundreds of thousands of acres of residually contaminated soils, contaminated groundwater, surface water and sediment contamination, and contaminated buildings are present at many sites across the country. These sites range in size from less than one acre, containing only a single facility, to large sites spanning over 100,000 acres with huge uranium enrichment plants and plutonium processing canyons. Since 1989, the U.S. Department of Energy’s (DOE) Environmental Management (EM) program has made significant progress in addressing this environmental legacy. Millions of cubic meters of waste have been removed, stabilized, or disposed of, resulting in significant risk and cost reduction. In addition, DOE began disposing of transuranic (i.e., plutonium-contaminated) waste in the nation’s first deep geologic repository – the Waste Isolation Pilot Plant in New Mexico. DOE is now carrying out its long-term stewardship obligations at dozens of sites, including smaller sites where DOE has completed cleanup work for the entire site and many larger sites where DOE has remediated portions of the site.

  11. A Report to Congress on Long-Term Stewardship. Volume II, Site Summaries

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    2001-01-01

    During World War II and the Cold War, the Federal government developed and operated a vast network of industrial facilities for the research, production, and testing of nuclear weapons, as well as for other scientific and engineering research. These processes left a legacy of radioactive and chemical waste, environmental contamination, and hazardous facilities and materials at well over a 100 sites in 30 States and one U.S. Territory. Hundreds of thousand of acres of residually contaminated soils, contaminated groundwater, surface water and sediment contamination, and contaminated buildings are present at many sites across the country. These sites range in size from less than one acre, containing only a single facility, to large sites spanning over 100,000 acres with huge uranium enrichment plants and plutonium processing canyons. Since 1989, the U.S. Department of Energy’s (DOE) Environmental Management (EM) program has made significant progress in addressing this environmental legacy. Millions of cubic meters of waste have been removed, stabilized, or disposed of, resulting in significant risk and cost reduction. In addition, DOE began disposing of transuranic (i.e., plutonium-contaminated) waste in the nation’s first deep geologic repository – the Waste Isolation Pilot Plant in New Mexico. DOE is now carrying out its long-term stewardship obligations at dozens of sites, including smaller sites where DOE has completed cleanup work for the entire site and many larger sites where DOE has remediated portions of the site.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-04-05

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2005-06-01

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

  14. Designing Program Roadmaps to Catalyze Community Formation: A Case Study of the Long-Term Stewardship Science and Technology Roadmapword

    Energy Technology Data Exchange (ETDEWEB)

    Dixon, Brent; Hanson, Duane; Matthern, Gretchen

    2003-02-27

    A number of broad perspective technology roadmaps have been developed in the last few years as tools for coordinating nation-wide research in targeted areas. These roadmaps share a common characteristic of coalescing the associated stakeholder groups into a special-interest community that is willing to work cooperatively in achieving the roadmap goals. These communities are key to roadmap implementation as they provide the collaborative energy necessary to obtain the political support and funding required for identified science and technology development efforts. This paper discusses the relationship between roadmaps and special-interest communities, using the recently drafted Department of Energy's Long-Term Stewardship Science and Technology Roadmap as a case study. Specific aspects this roadmap's design facilitated the development of a long-term stewardship community while specific realities during roadmap development impacted the realization of the design.

  15. Long-Term Stewardship at a Former Uranium Mill Tailings Site in Riverton, Wyoming WM2017-17090

    Energy Technology Data Exchange (ETDEWEB)

    Dam, William [USDOE Office of Legacy Management, Washington, DC (United States); Gil, Dr. April [USDOE Office of Legacy Management, Washington, DC (United States); Johnson, Raymond H. [Navarro Research and Engineering, Oak Ridge, TN (United States); Campbell, Sam [Navarro Research and Engineering, Oak Ridge, TN (United States)

    2017-03-01

    The US Department of Energy Office of Legacy Management (LM) is responsible for maintaining protective public health and environmental conditions at former uranium mill tailings sites nationwide via long-term stewardship. One of these sites, a former uranium mill near Riverton, Wyoming, is within the boundary of the Wind River Indian Reservation and operated from 1958 to 1963. Tailings and contaminated material associated with mill operations were removed and transported to an offsite disposal cell in 1989. The remedial action was completed under Title I of the Uranium Mill Tailings Radiation Control Act of 1978. Milling operations, which included an unlined tailings impoundment and an unlined evaporation pond, contaminated the shallow groundwater, resulting in a downgradient groundwater plume that discharges to the Little Wind River. A natural flushing compliance strategy was implemented in 1998. This strategy allows contaminants of concern to naturally flush from the groundwater, provided that contaminants flush below US Environmental Protection Agency maximum concentration limits within 100 years. As part of the compliance strategy, LM has implemented a groundwater monitoring program along with institutional controls that include the installation of an alternate water supply, continued sampling of private wells, and restrictions on well drilling and gravel pit construction. LM works closely with local stakeholders and community members to ensure that these institutional controls are in place and maintained. The Riverton site provides an interesting case study where contaminant remobilization due to river flooding prompted a reevaluation of the conceptual site model to verify if the current compliance strategy would remain protective of human health and the environment. Concentrations of groundwater contaminants, which include sulfate, molybdenum, and uranium, were transiently elevated following flooding of the Little Wind River in 2010 and 2016. These flood

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

    African Journals Online (AJOL)

    The long-term consequences of anaesthetic management. ... AFRICAN JOURNALS ONLINE (AJOL) · Journals · Advanced Search · USING AJOL · RESOURCES ... of age.1 In other words, mortality in the year after surgery is approximately 10 ...

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

    Science.gov (United States)

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

    2015-12-01

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

  18. FY 2015 - Stockpile Stewardship and Management Plan

    Energy Technology Data Exchange (ETDEWEB)

    None

    2014-04-01

    This Department of Energy’s (DOE) National Nuclear Security Administration (NNSA) Fiscal Year Stockpile Stewardship and Management Plan (SSMP) is a key planning document for the nuclear security enterprise.

  19. FY 2016 - Stockpile Stewardship and Management Plan

    Energy Technology Data Exchange (ETDEWEB)

    None

    2015-03-01

    This Department of Energy’s (DOE) National Nuclear Security Administration (NNSA) Fiscal Year Stockpile Stewardship and Management Plan (SSMP) is a key planning document for the nuclear security enterprise.

  20. Issues for the long term management of radioactive waste

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-07-01

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

  1. San Francisco Bay Long Term Management Strategy for Dredging

    Science.gov (United States)

    The San Francisco Bay Long Term Management Strategy (LTMS) is a cooperative effort to develop a new approach to dredging and dredged material disposal in the San Francisco Bay area. The LTMS serves as the Regional Dredging Team for the San Francisco area.

  2. Stewardship of NASA's Earth Science Data and Ensuring Long-Term Active Archives

    Science.gov (United States)

    Ramapriyan, H.; Behnke, J.

    2016-12-01

    NASA's Earth Observing System Data and Information System (EOSDIS) has been in operation since 1994. EOSDIS manages data from pre-EOS missions dating back to 1960s, EOS missions that started in 1997, and missions from the post-EOS era. Its data holdings come from many different sources - satellite and airborne instruments, in situ measures, field experiments, science investigations, etc. Since the beginning of the EOS Program, NASA has followed an open data policy, with non-discriminatory access to data with no period of exclusive access. NASA has well-established processes for assigning and/or accepting datasets into one of 12 Distributed Active Archive Centers (DAACs) that are parts of EOSDIS. EOSDIS has been evolving through several information technology cycles, adapting to hardware and software changes in the commercial sector. NASA is responsible for maintaining Earth science data as long as users are interested in using them for research and applications, which is well beyond the life of the data gathering missions. For science data to remain useful over long periods of time, steps must be taken to preserve: 1. Data bits with no corruption, 2. Discoverability and access, 3. Readability, 4. Understandability, 5. Usability and 6. Reproducibility of results. NASA's Earth Science data and Information System (ESDIS) Project, along with the 12 EOSDIS Distributed Active Archive Centers (DAACs), has made significant progress in each of these areas over the last decade, and continues to evolve its active archive capabilities. Particular attention is being paid in recent years to ensure that the datasets are "published" in an easily accessible and citable manner through a unified metadata model, a common metadata repository (CMR), a coherent view through the earthdata.gov website, and assignment of Digital Object Identifiers (DOI) with well-designed landing/product information pages.

  3. Hanford long-term high-level waste management program

    Energy Technology Data Exchange (ETDEWEB)

    Wodrich, D.D.

    1976-06-24

    An overview of the Hanford Long-Term High-Level Waste Management Program is presented. Four topics are discussed: first, the kinds and quantities of waste that will exist and are included in this program; second, how the plan is structured to solve this problem; third, the alternative waste management methods being considered; and fourth, the technology program that is in progress to carry out this plan. (LK)

  4. Long-term nuclear waste management: Present status and alternatives

    Science.gov (United States)

    Schapira, J. P.

    1989-08-01

    Long-term nuclear waste management deals with the final and irreversible stage of waste disposal, on surface and in deep geological formations (according to the waste type), when institutional surveillance is over. There are presently two main options available to deal with the wastes generated by spent nuclear fuel unloaded from reactors and containing most of the radiotoxicity produced all along the nuclear fuel cycle. Since the end of Word War II, spent-fuel reprocessing technology has gone through three different stages, ending up with considerable technical achievements and large investments (construction of large facilities, UP3 in France and THORP in the UK). However, having to face spent-fuel risings and lack of reprocessing capacities, since the mid-seventies some countries are considering the possibility of direct spent-fuel disposal without reprocessing. These two options are discussed in terms of long-term waste management. Because of the types of waste conditioning and packaging adopted with present reprocessing technology, in that case long-term safety, after a few centuries, relies completely on the geological barriers. On the other hand, long-term safety with the second option is based essentially on the retention properties of uranium oxide with respect to actinides. Finally, alternatives such as chemical partitioning of minor actinides followed by their transmutation, either in reactors or using high-energy particle accelerators, are under discussion. Apart from the standard reprocessing (after a cooling period of 3-5 years), all the other options called for a long period (50 years) of interim storage, preventing the adoption of irreversible, costly and not well proved waste management solutions, and leaving time to develop and assess these alternative methods.

  5. General practitioners' management of the long-term sick role.

    Science.gov (United States)

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

    2014-04-01

    In this paper, we use qualitative research techniques to examine the role of general practitioners in the management of the long-term sickness absence. In order to uncover the perspectives of all the main agents affected by the actions of general practitioners, a case study approach focussing on one particular employment sector, the public health service, is adopted. The role of family physicians is viewed from the perspectives of health service managers, occupational health physicians, employees/patients, and general practitioners. Our argument is theoretically framed by Talcott Parsons's model of the medical contribution to the sick role, along with subsequent conceptualisations of the social role and position of physicians. Sixty one semi-structured interviews and three focus group interviews were conducted in three Health and Social Care Trusts in Northern Ireland between 2010 and 2012. There was a consensus among respondents that general practitioners put far more weight on the preferences and needs of their patients than they did on the requirements of employing organisations. This was explained by respondents in terms of the propinquity and longevity of relationships between doctors and their patients, and by the ideology of holistic care and patient advocacy that general practitioners viewed as providing the foundations of their approach to patients. The approach of general practitioners was viewed negatively by managers and occupational health physicians, and more positively by general practitioners and patients. However, there is some evidence that general practitioners would be prepared to forfeit their role as validators of sick leave. Given the imperatives of both state and capital to reduce the financial burden of long-term sickness, this preparedness puts into doubt the continued role of general practitioners as gatekeepers to legitimate long-term sickness absence. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. Acute and long-term management of food allergy

    DEFF Research Database (Denmark)

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

    2014-01-01

    BACKGROUND: Allergic reactions to food can have serious consequences. This systematic review summarizes evidence about the immediate management of reactions and longer-term approaches to minimize adverse impacts. METHODS: Seven bibliographic databases were searched from their inception to September...... management for non-life-threatening reactions. H1-antihistamines may be of benefit, but this evidence was in part derived from studies on those with cross-reactive birch pollen allergy. Regarding long-term management, avoiding the allergenic food or substituting an alternative was commonly recommended...... helpful, but allergen-specific immunotherapy may be disease modifying and therefore warrants further exploration. CONCLUSIONS: Food allergy can be debilitating and affects a significant number of people. However, the evidence base about acute and longer-term management is weak and needs to be strengthened...

  7. Change Ahead: Transient Scenarios for Long-term Water Management

    Science.gov (United States)

    Haasnoot, Marjolijn; Beersma, Jules; Schellekens, Jaap

    2013-04-01

    While the use of an ensemble of transient scenarios is common in climate change studies, they are rarely used in water management studies. Present planning studies on long-term water management often use a few plausible futures for one or two projection years, ignoring the dynamic aspect of adaptation through the interaction between the water system and society. Over the course of time society experiences, learns and adapts to changes and events, making policy responses part of a plausible future, and thus the success of a water management strategy. Exploring transient scenarios and policy options over time can support decision making on water management strategies in an uncertain and changing environment. We have developed and applied such a method, called exploring adaptation pathways (Haasnoot et al., 2012; Haasnoot et al., 2011). This method uses multiple realisations of transient scenarios to assess the efficacy of policy actions over time. In case specified objectives are not achieved anymore, an adaptation tipping point (Kwadijk et al., 2010) is reached. After reaching a tipping point, additional actions are needed to reach the objectives. As a result, a pathway emerges. In this presentation we describe the development of transient scenarios for long term water management, and how these scenarios can be used for long term water management under uncertainty. We illustrate this with thought experiments, and results from computational modeling experiment for exploring adaptation pathways in the lower Rhine delta. The results and the thought experiments show, among others, that climate variability is at least just as important as climate change for taking decisions in water management. References Haasnoot, M., Middelkoop, H., Offermans, A., Beek, E., Deursen, W.A.v. (2012) Exploring pathways for sustainable water management in river deltas in a changing environment. Climatic Change 115, 795-819. Haasnoot, M., Middelkoop, H., van Beek, E., van Deursen, W

  8. Complications and management of forgotten long-term biliary stents.

    Science.gov (United States)

    Sohn, Se Hoon; Park, Jae Hyun; Kim, Kook Hyun; Kim, Tae Nyeun

    2017-01-28

    To evaluate complications and management outcomes of retained long-term plastic biliary stents. Endoscopic plastic biliary stent placement was performed in 802 patients at Yeungnam University Hospital between January 2000 and December 2014. Follow-up loss with a subsequently forgotten stent for more than 12 mo occurred in 38 patients. We retrospectively examined the cause of biliary stent insertion, status of stents, complications associated with biliary stents and management outcomes of long-term plastic biliary stents. Continuous variables were analyzed using the t test. Observed frequencies in subsets of the study population were compared using Fisher's exact test and χ(2) tests. Statistical significance was defined as P < 0.05 (two-tailed). Mean age of patients was 73.7 ± 12 years and male-to-female ratio was 2.2:1. Indications of plastic biliary stent insertion were bile duct stones (63.2%, 24/38) and benign bile duct stricture (52.6%, 20/38). Mean duration of retained plastic stent was 22.6 ± 12.2 mo, and in 10 cases (26.3%), stents were retained for more than 24 mo. Common bile duct (CBD) stones or sludge were found in most cases (92.1%, 35/38). The most common complication was acute cholangitis (94.7%, 36/38). Stent removal by endoscopic approach was successfully performed in 92.1% (35/38) of the cases. In 3 cases, an additional plastic stent was inserted alongside the previous stent due to failure of the stent removal. Endoscopic removal of bile duct stones was successful in 73.7% (28/38) of the cases. When patients were divided into two groups by duration of stent placement (12 to 24 mo vs over 24 mo), there were no differences in the development of cholangitis, presence of biliary stones, and success rate of endoscopic removal of stones and biliary stents. The most common complication of retained long-term plastic biliary stents was acute cholangitis associated with CBD stones. Endoscopic management was successfully performed in most cases.

  9. Long-term experiences with pluvial flood risk management

    Directory of Open Access Journals (Sweden)

    Fritsch Kathrina

    2016-01-01

    Full Text Available The awareness of pluvial (rain-related flood risk has grown significantly in the past few years but pluvial flooding is not handled with the same intensity throughout Europe. A variety of methods and modelling technologies are used to assess pluvial flood hazard and risk and to develop suggestions for flood mitigation measures. A brief overview of current model approaches is followed by the description of a modelling methodology that has been developed throughout the last 15 years with the focus on processing large scale areas. Experiences from several projects show that only high quality models of whole catchment areas yield results with enough accuracy to gain credibility among stakeholders, planners and the public. As a best practice example shows, the model approach also helps to plan effective decentral flood protection measures. To ensure successful flood risk management, a long-term preservation of flood risk awareness among local authorities and the public is necessary.

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

    Science.gov (United States)

    Guimarães, Cristina Machado; Carvalho, José Crespo de

    2012-05-01

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

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

    Directory of Open Access Journals (Sweden)

    Moawad NS

    2013-11-01

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

  12. Antimicrobial stewardship.

    Science.gov (United States)

    Allerberger, F; Mittermayer, H

    2008-03-01

    The aim of antimicrobial management or stewardship programmes is to ensure proper use of antimicrobial agents in order to provide the best treatment outcomes, to lessen the risk of adverse effects (including antimicrobial resistance), and to promote cost-effectiveness. Increasingly, long-term sustainability is found to be the major focus of antimicrobial stewardship. Implementing structural measures in healthcare institutions is therefore a major, but not the sole, focus of attention in promoting prudent use of antibiotics. The problem of antimicrobial resistance requires common strategies at all levels--for the prescribers and at ward, departmental, hospital, national and international levels.

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

    Science.gov (United States)

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

    2017-02-20

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

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

    Science.gov (United States)

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

    2013-12-01

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

  15. Designing long-term policy: rethinking transition management

    NARCIS (Netherlands)

    Voß, J.P.; Smith, A.; Grin, J.

    2009-01-01

    Long-term policy is enjoying something of a come-back in connection with sustainable development. The current revival tries to avoid the pitfalls of an earlier generation of positivistic long-range planning and control approaches. Instead, this new generation of policy design emphasises reflexive go

  16. The Basics of Long-Term Debt Issuance and Management

    Science.gov (United States)

    Van Meter, Christine M.

    2011-01-01

    Issuing long-term debt can be a complex, multifaceted process. Although the process varies by stare, typically the school business official and the district solicitor work with the financing ream, which includes a financial adviser, bond counsel, underwriter, raring agency, and possibly a bond insurance agent, paying agent, and architect.…

  17. Designing long-term policy: rethinking transition management

    NARCIS (Netherlands)

    Voß, J.P.; Smith, A.; Grin, J.

    2009-01-01

    Long-term policy is enjoying something of a come-back in connection with sustainable development. The current revival tries to avoid the pitfalls of an earlier generation of positivistic long-range planning and control approaches. Instead, this new generation of policy design emphasises reflexive

  18. The Basics of Long-Term Debt Issuance and Management

    Science.gov (United States)

    Van Meter, Christine M.

    2011-01-01

    Issuing long-term debt can be a complex, multifaceted process. Although the process varies by stare, typically the school business official and the district solicitor work with the financing ream, which includes a financial adviser, bond counsel, underwriter, raring agency, and possibly a bond insurance agent, paying agent, and architect.…

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

    Data.gov (United States)

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

  20. Improving self-management for patients with long-term conditions.

    Science.gov (United States)

    Davies, Nicola J

    An increasing number of people are living with long-term conditions. These conditions cannot be cured, but can be managed through education, health promotion, medication, therapy and self-management. Self-management involves people taking responsibility for their own health and wellbeing, as well as learning to manage any long-term illnesses. Nurses play a pivotal role in providing advice, guidance, education and support to people living with long-term conditions. Self-management is important as it not only benefits the patient, but also provides wider opportunities for community and specialist nurses to use and develop their clinical and interpersonal skills.

  1. Hepatocellular carcinoma: Advances in diagnosis, management, and long term outcome.

    Science.gov (United States)

    Bodzin, Adam S; Busuttil, Ronald W

    2015-05-28

    Hepatocellular carcinoma (HCC) remains a common and lethal malignancy worldwide and arises in the setting of a host of diseases. The incidence continues to increase despite multiple vaccines and therapies for viruses such as the hepatitis B and C viruses. In addition, due to the growing incidence of obesity in Western society, there is anticipation that there will be a growing population with HCC due to non-alcoholic fatty liver disease. Due to the growing frequency of this disease, screening is recommended using ultrasound with further imaging using magnetic resonance imaging and multi-detector computed tomography used for further characterization of masses. Great advances have been made to help with the early diagnosis of small lesions leading to potential curative resection or transplantation. Resection and transplantation maybe used in a variety of patients that are carefully selected based on underlying liver disease. Using certain guidelines and clinical acumen patients may have good outcomes with either resection or transplantation however many patients are inoperable at time of presentation. Fortunately, the use of new locoregional therapies has made down staging patients a potential option making them potential surgical candidates. Despite a growing population with HCC, new advances in viral therapies, chemotherapeutics, and an expanding population of surgical and transplant candidates might all contribute to improved long-term survival of these patients.

  2. FY 2014 - Stockpile and Stewardship and Management Plan

    Energy Technology Data Exchange (ETDEWEB)

    None

    2013-06-01

    This Department of Energy’s (DOE) National Nuclear Security Administration (NNSA) Fiscal Year Stockpile Stewardship and Management Plan (SSMP) is a key planning document for the nuclear security enterprise.

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

    NARCIS (Netherlands)

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

    2003-01-01

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

  4. Urban Ecological Stewardship: Understanding the Structure, Function and Network of Community-based Urban Land Management

    Directory of Open Access Journals (Sweden)

    Lindsay K. Campbell

    2008-01-01

    Full Text Available Urban environmental stewardship activities are on the rise in cities throughout the Northeast. Groups participating in stewardship activities range in age, size, and geography and represent an increasingly complex and dynamic arrangement of civil society, government and business sectors. To better understand the structure, function and network of these community-based urban land managers, an assessment was conducted in 2004 by the research subcommittee of the Urban Ecology Collaborative. The goal of the assessment was to better understand the role of stewardship organizations engaged in urban ecology initiatives in selected major cities in the Northeastern U.S.: Boston, New Haven, New York City, Pittsburgh, Baltimore, and Washington, D.C. A total of 135 active organizations participated in this assessment. Findings include the discovery of a dynamic social network operating within cities, and a reserve of social capital and expertise that could be better utilized. Although often not the primary land owner, stewardship groups take an increasingly significant responsibility for a wide range of land use types including street and riparian corridors, vacant lots, public parks and gardens, green roofs, etc. Responsibilities include the delivery of public programs as well as daily maintenance and fundraising support. While most of the environmental stewardship organizations operate on staffs of zero or fewer than ten, with small cohorts of community volunteers, there is a significant difference in the total amount of program funding. Nearly all respondents agree that committed resources are scarce and insufficient with stewards relying upon and potentially competing for individual donations, local foundations, and municipal support. This makes it a challenge for the groups to grow beyond their current capacity and to develop long-term programs critical to resource management and education. It also fragments groups, making it difficult for planners and

  5. Decreasing Stress among Nurse Managers: A Long-Term Solution.

    Science.gov (United States)

    Judkins, Sharon K.; Ingram, Melba

    2002-01-01

    Hospital nursing managers (n=31) in a rural Texas hospital completed a self-paced module on stress and hardiness (beliefs related to control, commitment, and challenge). Pre/posttest scores showed the module had a significant effect on understanding of stress and coping and increased their hardiness levels. (Contains 25 references.) (SK)

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

    Science.gov (United States)

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

  7. Long term commitments concerning decommissioning and waste management. French perspective

    Energy Technology Data Exchange (ETDEWEB)

    Milliat, Charles [EDF/CIDEN, 35/37, rue Louis-Guerin, BP 1212, 69611 Villeurbanne Cedex (France); Decobert, Guy [COGEMA/AREVA, 1 rue des Herons BP 302, Montigny-le-Bretonneux 78054 Saint Quentin en Yvelines (France); Pochon, Etienne [CEA/DEN/DPA, Centre de Saclay 91191 Gif sur Yvette Cedex (France)

    2006-07-01

    The majority of France decommissioning activities is occurring in two sectors: the civilian nuclear facilities and the nuclear facilities dedicated to deterrent. In France there are four major civilian operators: EDF (Electricite de France), AREVA, CEA (Commissariat a l'Energie Atomique) and ANDRA (Agence Nationale pour les Dechets Radioactifs). Nuclear energy provides France nearly 80% of its electricity. Presently there are 58 EDF's operating nuclear power plants (PWR), all the gas cooled graphite nuclear power plant (6 units) have been definitively shutdown as well as Superphenix, a fast breeder reactor. The fuel cycle industry belongs to AREVA which is operating all the industrial installations from uranium ore prospecting and mining till used fuel reprocessing. In France, most of the nuclear R and D installations belong to the CEA. Many installations have already been dismantled, are presently being dismantled or are on a waiting list (research reactors, laboratories, pilot plant, etc). ANDRA is in charge since 1991 of the studies and the operation of waste disposal centres (LLW, MLW, HLW and VLLW). The first repository for waste containing short lived radio nuclides (CM, Centre de la Manche) has been closed in 1994 after 25 years of operation, more of 530 000 m{sup 3} have been disposed, the Aube centre (CA) comes into operation in 1991 and has a capacity of 1 000 000 m{sup 3}, ANDRA has opened a disposal for very low level waste (VLLW), close to the Aube centre, in september 2003. The contents of the paper is as follows: I. Current status; II. National policy; III. Decommissioning technique and Inspection; IV. Radioactive waste management; V. Organisations and responsibilities; VI. Funding; VII. Competent bodies.

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

    Science.gov (United States)

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

    2007-08-01

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

  9. Long-term management of liver transplant recipients: A review for the internist.

    Science.gov (United States)

    Issa, Danny H; Alkhouri, Naim

    2015-06-01

    Outcomes and long-term survival rates after liver transplantation have significantly improved over the last 5 decades, but the improved longevity is accompanied by long-term complications such as metabolic syndrome, obesity, cardiovascular disease, cancer, and bone disease. After the first year, the primary care physician assumes a greater role and provides most of the patient's care. This review provides a source for primary care physicians in managing the long-term medical complications seen in these patients. Copyright © 2015 Cleveland Clinic.

  10. Self-management for people with long-term neurological conditions.

    Science.gov (United States)

    Chaplin, Hema; Hazan, Jill; Wilson, Patricia

    2012-06-01

    Although English government policy has encouraged the implementation of self-management programmes in services for people with long-term conditions, the evidence for their efficacy has been limited. People with long-term neurological conditions use community-based health services including community nursing, and have particular needs in regards to self-management. This article provides an overview of the evidence for the effectiveness of self-management interventions for people with long-term neurological conditions, in particular those with stroke, Parkinson's disease and multiple sclerosis. The current need for better interventions is highlighted, particularly the importance of providing condition-specific information and deliverance of interventions in a group setting to improve self-management outcomes. In response to weaknesses of previous self-management interventions for this population, an innovative Hertfordshire Neurological Service self-management programme is discussed, and the implications for future research are described.

  11. Surgical management of acromegaly: Long term functional outcome analysis and assessment of recurrent/residual disease

    OpenAIRE

    Banerji, Deepu; Das, Nitu K.; Sharma, Siddhiraj; Jindal, Yogesh; Vijendra K Jain; Behari, Sanjay

    2016-01-01

    Context: Functional growth hormone producing adenomas have long-term deleterious effects on the visual apparatus, the cardiovascular and musculoskeletal systems, and often predispose to malignancies. Since persistence of acromegaly affects outcome and quality of life, therapeutic interventions become mandatory. Aim: This study represents an analysis of long-term clinical and endocrinal outcome of 115 patients of acromegaly after surgical management. Setting and Design: Tertiary care retrospec...

  12. 78 FR 23548 - Draft Supplemental Environmental Impact Statement for the Long-Term Management and Storage of...

    Science.gov (United States)

    2013-04-19

    ... Supplemental Environmental Impact Statement for the Long- Term Management and Storage of Elemental Mercury... (DOE) announces the availability of the Draft Long-Term Management and Storage of Elemental Mercury... identify a facility or facilities for the long-term management and storage of elemental mercury...

  13. Spent fuel, plutonium and nuclear waste: long-term management; Le combustible use et le plutonium en tant que dechets nucleaires: gestion a long terme

    Energy Technology Data Exchange (ETDEWEB)

    Collard, G

    1998-11-01

    Different options for the management of nuclear waste arising from the nuclear fuel cycle are discussed. Special emphasis is on reprocessing followed by geological disposal, geological disposal of reprocessing waste, direct geological disposal of spent nuclear fuel, long term storage. Particular emphasis is on the management of plutonium including recycling, immobilisation and disposal, partitioning and transmutation.

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

    DEFF Research Database (Denmark)

    Dhami, Sangeeta; Sheikh, Aadam; Muraro, Antonella

    2017-01-01

    is challenging. Quality indicators have the potential to support guideline implementation efforts. OBJECTIVE: To identify quality indicators to support the acute and long-term management of anaphylaxis. METHODS: We conducted a systematic review of the literature that involved searching Medline, EMBASE and CINAHL......) and long-term (n = 27) management of anaphylaxis. The majority of indicators were developed through expert consensus with relatively few of these having been formally piloted or tested to demonstrate that they could discriminate between variations in practice and/or that they were sensitive to change....... CONCLUSIONS: There is a need for a comprehensive set of quality indicators for anaphylaxis management. We have however identified some indicators for the acute and long-term management of anaphylaxis that could with relatively little additional work support efforts to translate guideline recommendations...

  15. On the consequences of a long-term perspective for coastal management

    NARCIS (Netherlands)

    Horstman, Erik; Wijnberg, Kathelijne Mariken; Smale, Alfons J.; Hulscher, Suzanne J.M.H.

    2009-01-01

    The potential impacts of climate change on coastal zones combined with the ever increasing number of people living in these areas, motivate a more long-term perspective in coastal management. To explore whether such a perspective raises the need for developing coastal management strategies at larger

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

    NARCIS (Netherlands)

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

    2017-01-01

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

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

    Science.gov (United States)

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

    2017-04-01

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

  18. Long-term management of GERD in the elderly with pantoprazole

    Directory of Open Access Journals (Sweden)

    Carlo Calabrese

    2007-04-01

    Full Text Available Carlo Calabrese, Anna Fabbri, Giulio Di FeboDepartment of Internal Medicine and Gastroenterology, University of Bologna, ItalyAbstract: The prevalence of gastroesophageal reflux disease (GERD increases with age and elderly are more likely to develop severe disease. Older patients often complain of less severe or frequent heartburn than younger patients and they may present with atypical symptoms such as dysphagia, weight loss, or extraesophageal symptoms. Proton pump inhibitors (PPIs are central in the management of GERD and are unchallenged with regards to their efficacy. They are considered safe and more effective than histamine receptor antagonists for healing esophagitis and for preventing its recurrence using a long term maintenance treatment. PPI have minimal side effects and few slight drug interactions and are considered safe for long term treatment. Pantoprazole is significantly effective both for acute and long-term treatment with excellent control of relapse and symptoms. It is well tolerated even for long-term therapy and its tolerability is optimal. Pantoprazole shows to have minimal interactions with other drugs because of a lower affinity for cytocrome P450 than older PPIs. Although the majority of elderly has concomitant illnesses and receive other drugs, this does not adversely effect the efficacy of pantoprazole because of its pharmacokinetics, which are independent of patient age. Clinical practice suggests that a low dose maintenance of PPIs should be used in older patients with GERD.Keywords: GERD, long-term management, pantoprazole, safety, efficacy, tolerability

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

    NARCIS (Netherlands)

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

    2010-01-01

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

  20. Model validation through long-term promising sustainable maize/pigeon pea residue management in Malawi

    NARCIS (Netherlands)

    Mwale, C.D.; Kabambe, V.H.; Sakale, W.D.; Giller, K.E.; Kauwa, A.A.; Ligowe, I.; Kamalongo, D.

    2013-01-01

    In the 2005/2006 season, the Model Validation Through Long-Term Promising Sustainable Maize/Pigeon Pea Residue Management experiment was in the 11th year at Chitedze and Chitala, and in the 8th year at Makoka and Zombwe. The experiment was a split-plot design with cropping system as the main plot an

  1. Dynamic Management of Digital Rights for Long-term Preservation:the Expert System Approach

    Institute of Scientific and Technical Information of China (English)

    Frédéric MARTIN

    2008-01-01

    This presentation focuses on the complex issue of managing digital rights for long-term preservation.It describes the strategy and the methodology adopted within the SPAR project(French National Library),which rely on a special kind of knowledge-based system.

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

    Science.gov (United States)

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

    2014-07-01

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

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

    Science.gov (United States)

    Bach, Laura J

    2014-01-01

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

  4. A long-term risk management tool for electricity markets using swarm intelligence

    Energy Technology Data Exchange (ETDEWEB)

    Azevedo, F.; Vale, Z.A.; Khodr, H.M. [GECAD - Knowledge Engineering and Decision-Support Research Center of the Polytechnic Institute of Porto (ISEP/IPP), Rua Dr. Antonio Bernardino de Almeida 431, 4200-072 Porto (Portugal); Oliveira, P.B. Moura [University of Tras-os-Montes e Alto Douro, Vila Real (Portugal)

    2010-04-15

    This paper addresses the optimal involvement in derivatives electricity markets of a power producer to hedge against the pool price volatility. To achieve this aim, a swarm intelligence meta-heuristic optimization technique for long-term risk management tool is proposed. This tool investigates the long-term opportunities for risk hedging available for electric power producers through the use of contracts with physical (spot and forward contracts) and financial (options contracts) settlement. The producer risk preference is formulated as a utility function (U) expressing the trade-off between the expectation and the variance of the return. Variance of return and the expectation are based on a forecasted scenario interval determined by a long-term price range forecasting model. This model also makes use of particle swarm optimization (PSO) to find the best parameters allow to achieve better forecasting results. On the other hand, the price estimation depends on load forecasting. This work also presents a regressive long-term load forecast model that make use of PSO to find the best parameters as well as in price estimation. The PSO technique performance has been evaluated by comparison with a Genetic Algorithm (GA) based approach. A case study is presented and the results are discussed taking into account the real price and load historical data from mainland Spanish electricity market demonstrating the effectiveness of the methodology handling this type of problems. Finally, conclusions are dully drawn. (author)

  5. Minimally Invasive Long-Term Management of Direct Restorations: the '5 Rs'.

    Science.gov (United States)

    Green, David; Mackenzie, Louis; Banerjee, Avijit

    2015-06-01

    The assessment and operative long-term management of direct restorations is a complex and controversial subject in conservative dentistry. Employing a minimally invasive (MI) approach helps preserve natural tooth structure and maintain endodontic health for as long as possible during the restorative cycle. This paper discusses how minimally invasive techniques may be applied practically to reviewing, resealing, refurbishing, repairing or replacing deteriorating/failed direct coronal restorations (the'5 Rs') and provides an update of contemporary MI clinical procedures. CPD/CLINICAL RELEVANCE: The assessment and long-term clinical management of deteriorating/failing direct restorations is a major component of the general dental practice workload and NHS UK budget expenditure for operative dentistry.

  6. Long-term management of an idiopathic gingival fibromatosis patient with the primary dentition.

    Science.gov (United States)

    Kamolmatyakul, S; Kietthubthew, S; Anusaksathien, O

    2001-01-01

    Gingival fibromatosis is usually seen as an isolated finding or occasionally in association with other features as part of a syndrome. The combination of gingival enlargement, hypertrichosis, epilepsy and mental retardation is also a commonly reported syndrome that features gingival fibromatosis. The following report is about a mentally retarded patient who has shown no sign of hypertrichosis, but has been taking phenobarbital as a long-term therapy drug for anti-convulsion. Long-term management of this patient has been carried out from the age of one-and-a-half years to 14 years old. The patient's clinical features, treatment received, histopathologic presentation of gingival fibromatosis and proper management of the condition are discussed.

  7. Degradation of drinking water sludge for long-term waste management

    OpenAIRE

    WATANABE, Yasutaka / KOMINE, Hideo / YASUHARA, Kazuya / MURAKAMI, Satoshi / TOYODA, Kazuhiro

    2008-01-01

    Drinking water sludge is industrial waste which is discharged during water purification, and it is presentlyanticipated to reuse drinking water sludge as geotechnical material. However, degradation has not been investigated. Tokeep strength, stability, and safety on long -term waste management, it is important to apply degradation characteristicsto designing and maintenance. As an aspect of degradation on drinking water sludge, variation of consolidationproperties induced interaction with wat...

  8. Impact of transesophageal Echocardiography on Long Term Management of Ischemic Strike : Experience from a University Hospital

    Directory of Open Access Journals (Sweden)

    Kaul S

    1999-01-01

    Full Text Available Despite the unquestionable superiority of Transesophageal echocardiography (TEE over Transthoracic echocardiography (TTE, the impact of TEE on the long term management of cardio-embolic strokes remains uncertain. The purpose of present study was to determine the extent to which TEE, influenced the decision regarding long-term anticoagulant management of patients with ischemic stroke in a University Hospital. Between January 1992 and May 1995, TEE was performed in 122 out of 485 consecutive patients with ischemic stroke enrolled in the Maryland Stroke Data Bank. The indication to perform TEE was unexplained cerebral infarction. Twenty five patients had a possible cardiac source of embolism (CSOE detected only after a TEE out of whom 17 were placed on anticoagulant therapy. From the remaining 8 patients, 2 expired, 2 were already receiving anticoagulants for different reasons and 4 were managed with antiplatelet agents. To conclude, in 17 of 122 ischemic stroke patients (14% who underwent TEE, the decision regarding long term anticoagulation was made only because TEE revealed a cardioembolic source.

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

    Energy Technology Data Exchange (ETDEWEB)

    1979-02-01

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

  10. Personnel Management: Stewardship of Human Resources

    Science.gov (United States)

    MacLean, Douglas G.

    1976-01-01

    The personnel function of top management is examined by first studying the environment in which top management functions. The basic skills required to perform the function are discussed. Against this background, six elements of personnel management in colleges and universities are considered: goals and objectives, organization for personnel…

  11. Termite and earthworm abundance and taxonomic richness under long-term conservation soil management in Saria, Burkina Faso, West Africa

    NARCIS (Netherlands)

    Zida, Z.; Ouedraogo, E.; Mando, A.; Stroosnijder, L.

    2011-01-01

    Unsustainable crop and soil management practices are major causes of soil degradation and declining soil biodiversity in West Africa. Identifying soil management practices that favor macrofauna abundance is highly desirable for long-term soil health. This study investigates the effects of long-term

  12. Approaching the concept of self-managing illness in long term illness. A review of literature.

    Directory of Open Access Journals (Sweden)

    Stavrou V

    2014-04-01

    Full Text Available Abstract: The management of long term illness is globally challenging and the common concerns are mainly found in developed, developing and transitory countries as the increase in the ageing of the population deteriorates the problems. For patients who are suffering from long term illnesses, there is an interest for programs of self managing the disease, which highlight the core essence of educating patients on managing the disease. Purpose: The purpose of the current study is to a present the basic definitions of self managing the disease, b identify the current situation and c discuss and support nursing staff in educating the patient on self managing the illness. Materials- Methods: A review of relevant articles was conducted on the electronic database Medline/ Pubmed as well as through Scholar Google search engine and a secondary search on the references found on the articles. This occurred irrespective of the publication time.Conclusions The role of the nurse as a member of the interdisciplinary group is important because it helps the patient to develop skills of self care. Complete programs of self-managing the illness with the participation of the nurses in the planning, application and evaluation of the results, will contribute significantly to the patient, notwithstanding the professional benefit for the nurses.

  13. Health psychology: supporting the self-management of long-term conditions.

    Science.gov (United States)

    Barley, Elizabeth; Lawson, Victoria

    2016-11-10

    This article considers how knowledge of health psychology can help nurses support patients in managing their long-term conditions. The concept of 'self-management' is defined and the need for self-efficacy-the patient's confidence in their ability to manage-and social support is highlighted. Patients' 'illness perceptions', or beliefs about the nature of their condition, also have an impact on their self-management. This is discussed in particular relation to adherence to treatment. A distinction is made between intentional and non-intentional non-adherence. Understanding of the many factors, other than lack of knowledge, that influence self-management success will help nurses and patients work together to develop an effective self-management plan.

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

    Directory of Open Access Journals (Sweden)

    Wolfgang Wilkes

    2011-03-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Catherine S. Jarnevich

    2015-05-01

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

  17. Disability management outcomes in the Ontario long-term care sector.

    Science.gov (United States)

    Mustard, C A; Kalcevich, C; Steenstra, I A; Smith, P; Amick, B

    2010-12-01

    Optimal disability management practices supporting early and safe return-to-work involve the workplace adoption of formal policies and procedures to ensure the quality of disability management outcomes. In the Canadian province of Ontario, there are approximately 60,000 health care workers in 600 licensed facilities providing long-term residential care to approximately 75,000 elderly residents. Workers in this sector are exposed to high biomechanical demands arising from care-giving tasks and have a substantial risk of work-related disability. Over the period 2000-2006, many long-term care facilities in Ontario adopted disability management practices that encourage modified work arrangements. The objective of this study was to describe differences in modified work arrangements and disability outcomes in long-term care facilities in Ontario. Measures of disability episode outcomes are described for a representative sample of 32 Ontario long-term care facilities for two consecutive years 2005 and 2006. Data were obtained from a questionnaire survey of facilities, a survey of a representative sample of caregivers and administrative records from the provincial workers' compensation agency. A total of 28,747 days of disability attributed to work-related conditions were experienced by 3,271 full-time equivalent staff in 2005 (28,034 days in 2006). Average total disability days were 922 per 100 full-time equivalent staff in 2005 and 889 per 100 full-time equivalent staff in 2006. Disability compensation expenditures, measured as wage replacement benefits received by disabled workers, were estimated to be $72,332 per 100 full-time equivalent staff in 2005 and $64,619 per 100 full-time equivalent staff in 2006. On average, approximately 60% of all disability days were managed by modified duty arrangements and the proportion of total disability days managed by modified duty arrangements for each facility was correlated between the two observation years. Across facilities

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Yulius Jogi Christiawan

    2014-01-01

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

  20. Chemical restrictions of roots in Ultisol subsoils lessened by long-term management

    Science.gov (United States)

    Hardy, D. H.; Raper, C. D. Jr; Miner, G. S.; Raper CD, J. r. (Principal Investigator)

    1990-01-01

    Exchangeable Al in subsoils of Ultisols in the southeastern USA can restrict rooting depth. Downward movement of basic cations (Ca, Mg, and K), applied as lime and fertilizer, may diminish that restriction over time. Materials from the argillic horizon were collected from three paired sites, having managed (long-term cropping) and nonmanaged topsoils (Typic Paleudults and Hapludults). One managed site was cropped continuously for 15 yr while the others were cultivated for more than 30 yr. Concentrations of extractable cations and other nutrients from the paired sites were compared to determine the magnitude of change due to management. The ability of the subsoils to support plant growth was evaluated in a missing-nutrient greenhouse experiment with sorghum [Sorghum bicolor (L.) Moench]. Subsoils of managed sites had greater effective cation-exchange capacity (CEC) and base saturation than those of non-managed sites. While availabilities of Ca, Mg, and K in subsoils of nonmanaged sites were inadequate to support maximal plant growth, they were adequate in subsoils of managed sites. Compared with nonmanaged sites, KCl-exchangeable Al in subsoils of managed sites was 23% lower at the 15-yr location and 65 and 100% lower at the two other locations. In the absence of lime, sorghum growth was almost totally inhibited on nonmanaged subsoils amended with optimum nutrients. On the managed subsoils, where 100, 65, and 23% of the nonmanaged exchangeable Al had been neutralized by topsoil fertilization and liming, growth reductions under the same conditions were 0, 50, and 100%, respectively. Thus, relatively long-term management had improved these Ultisol subsoils for root growth and development.

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

    Energy Technology Data Exchange (ETDEWEB)

    2011-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    2011-01-01

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

  3. Long-Term Engagement with Health-Management Technology: a Dynamic Process in Diabetes.

    Science.gov (United States)

    Klasnja, Predrag; Kendall, Logan; Pratt, Wanda; Blondon, Katherine

    2015-01-01

    Diabetes management is a complex, dynamic process that is largely incumbent on patient choices and behavior. We explore how health-management needs-and the needs for technological support-change over time for individuals with diabetes. Through interviews and a focus group, we found that after initial diagnosis, individuals face acute information needs and chiefly turn to mobile applications and Internet resources to help understand the diabetes-specific factors that affect their health. Over time their focus shifts from highly regimented routines to more flexible ones that enable them to maintain a quality of life. Our results suggest that long-term engagement with health technology does not necessarily require continuous, sustained use: routine disease management could lead to a decrease in use, until a new event occurs. Our findings point to a need for tools that help patients with diabetes to effectively manage their health as their bodies, treatment and circumstances change over time.

  4. Refurbishment implications on long-term waste management strategies at Point Lepreau

    Energy Technology Data Exchange (ETDEWEB)

    Hickman, C. [New Brunswick Power Nuclear, Fredericton, NB (Canada)

    2011-07-01

    This paper discusses Point Lepreau Generating Station's waste management experiences during the Refurbishment outage. In short, Point Lepreau GS has been challenged during the outage due to the amount of low and intermediate level waste that has been generated compared to that which was expected, which has driven the need to develop a new waste management strategy in the middle of the outage. The paper presents an overview of pre-outage waste handling, what process changes and schedule changes occurred during the outage, and provides a discussion of the operational and financial consequences of those changes. Key issues highlighted by the paper include the need for adequate provision of waste management facilities during large outages, the importance of ensuring that contractors have a stake in waste minimization activities, and long term waste management implications that need to be considered for large outages.

  5. Challenges Associated With Managing Suicide Risk in Long-Term Care Facilities

    Science.gov (United States)

    O'Riley, Alisa; Nadorff, Michael R.; Conwell, Yeates; Edelstein, Barry

    2016-01-01

    Little information about suicidal ideation and behavior in long-term care (LTC) facilities is available. Nonetheless, the implementation of the Minimum Data Set 3.0 requires that LTC facilities screen their residents for suicide risk and have protocols in place to effectively manage residents’ responses. In this article, the authors briefly discuss the risk factors of suicide in the elderly and the problems that suicidal ideation and behavior pose in the LTC environment. The authors explain issues that arise when trying to manage suicide risk in the elderly LTC population with general, traditional approaches. These inherent issues make it difficult to develop an effective protocol for managing suicide risk in LTC facilities, leading the authors to propose their own framework for assessing and managing suicide risk in the LTC setting. PMID:27610048

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

    Science.gov (United States)

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

    2017-01-01

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

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

    Science.gov (United States)

    2010-06-01

    material size are shown in Figure 28. Figure 28. P ipe lin e Pump ing Dis tances in Rela tion to Materia l S ize From RM 0.1 to 2.0...calculate erosion or deposition by balancing sediment supply and transport capacity calculated from reach-averaged hydraulics. There are a variety of...aspect of dike design is to balance the need for increased Mount St. Helens Long-Term Sediment Management Plan Progress Report Final June 2010 C-60

  8. Towards sustainable groundwater use: setting long-term goals, backcasting, and managing adaptively.

    Science.gov (United States)

    Gleeson, Tom; Alley, William M; Allen, Diana M; Sophocleous, Marios A; Zhou, Yangxiao; Taniguchi, Makoto; VanderSteen, Jonathan

    2012-01-01

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

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

    Science.gov (United States)

    Lynch, Amanda; Bisogni, Carole A

    2014-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Ashley Kingsborough

    2017-01-01

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

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

    Science.gov (United States)

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

    2016-12-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2017-03-15

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

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

    Energy Technology Data Exchange (ETDEWEB)

    1977-01-01

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

  14. Long-Term Biological Monitoring of an Impaired Stream: Implications for Environmental Management [Special Issue

    Energy Technology Data Exchange (ETDEWEB)

    Adams, Marshall [ORNL; Brandt, Craig C [ORNL; Christensen, Sigurd W [ORNL; Efroymson, Rebecca Ann [ORNL; Greeley Jr, Mark Stephen [ORNL; Ham, Kenneth [ORNL; Kszos, Lynn A [ORNL; Loar, James M [ORNL; McCracken, Kitty [ORNL; Morris, Gail Wright [ORNL; Peterson, Mark J [ORNL; Ryon, Michael G [ORNL; Smith, John G [ORNL; Southworth, George R [ORNL; Stewart, Arthur J [ORNL

    2011-01-01

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

  15. Long-term Biological Monitoring of an Impaired Stream: Synthesis and Environmental Management Implications

    Energy Technology Data Exchange (ETDEWEB)

    Peterson, Mark J [ORNL; Efroymson, Rebecca Ann [ORNL; Adams, Marshall [ORNL

    2011-01-01

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

  16. Long-term management of type 2 diabetes with glucagon-like peptide-1 receptor agonists

    Science.gov (United States)

    Courtney, Hamish; Nayar, Rahul; Rajeswaran, Chinnadorai; Jandhyala, Ravi

    2017-01-01

    Continuously reducing excess blood glucose is a primary goal for the management of type 2 diabetes (T2D). Most patients with T2D require glucose-lowering medications to achieve and maintain adequate glycemic control; however, treatment failure may occur, limiting treatment options. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are an emerging therapeutic class that can be prescribed for patients instead of basal insulin after the failure of oral therapies. Recent studies have focused on the durability and tolerability of long-term GLP-1RA therapy. This review summarizes the key efficacy and safety findings from prospective phase 3 clinical studies of at least 76 weeks’ duration for the GLP-1RAs currently approved in the United States and the European Union (albiglutide, dulaglutide, exenatide twice daily [BID], exenatide once weekly [QW], liraglutide, and lixisenatide). Currently, most of the long-term data are from uncontrolled extension studies, and continuous patient benefit has been observed for up to 3 years with multiple GLP-1RAs. Four-year comparative data demonstrated a longer time to treatment failure for exenatide BID than for sulfonylurea, and 3-year comparative extension data demonstrated greater glycated hemoglobin (HbA1c) reductions and weight loss with exenatide QW than with insulin glargine. Currently, the longest extension study for a GLP-1RA is the DURATION-1 study of exenatide QW, with >7 years of clinical data available. Data from DURATION-1 demonstrated that continuous HbA1c reductions and weight loss were observed for the patients continuing on the treatment, with no unexpected adverse events. Taken together, these data support GLP-1RAs as a long-term noninsulin treatment option after the failure of oral therapies.

  17. Improving Pain Management and Long-Term Outcomes Following High-Energy Orthopaedic Trauma (Pain Study).

    Science.gov (United States)

    Castillo, Renan C; Raja, Srinivasa N; Frey, Katherine P; Vallier, Heather A; Tornetta, Paul; Jaeblon, Todd; Goff, Brandon J; Gottschalk, Allan; Scharfstein, Daniel O; OʼToole, Robert V

    2017-04-01

    Poor pain control after orthopaedic trauma is a predictor of physical disability and numerous negative long-term outcomes. Despite increased awareness of the negative consequences of poorly controlled pain, analgesic therapy among hospitalized patients after orthopaedic trauma remains inconsistent and often inadequate. The Pain study is a 3 armed, prospective, double-blind, multicenter randomized trial designed to evaluate the effect of standard pain management versus standard pain management plus perioperative nonsteroidal anti-inflammatory drugs or pregabalin in patients of ages 18-85 with extremity fractures. The primary outcomes are chronic pain, opioid utilization during the 48 hours after definitive fixation and surgery for nonunion in the year after fixation. Secondary outcomes include preoperative and postoperative pain intensity, adverse events and complications, physical function, depression, and post-traumatic stress disorder. One year treatment costs are also compared between the groups.

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

    LENUS (Irish Health Repository)

    Butler, J S

    2010-10-01

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

  19. Potential of "lure and kill" in long-term pest management and eradication of invasive species.

    Science.gov (United States)

    El-Sayed, A M; Suckling, D M; Byers, J A; Jang, E B; Wearing, C H

    2009-06-01

    "Lure and kill" technology has been used for several decades in pest management and eradication of invasive species. In lure and kill, the insect pest attracted by a semiochemical lure is not "entrapped" at the source of the attractant as in mass trapping, but instead the insect is subjected to a killing agent, which eliminates affected individuals from the population after a short period. In past decades, a growing scientific literature has been published on this concept. This article provides the first review on the potential of lure and kill in long-term pest management and eradication of invasive species. We present a summary of lure and kill, either when used as a stand-alone control method or in combination with other methods. We discuss its efficacy in comparison with other control methods. Several case studies in which lure and kill has been used with the aims of long-term pest management (e.g., pink bollworm, Egyptian cotton leafworm, codling moth, apple maggot, biting flies, and bark beetles) or the eradication of invasive species (e.g., tephritid fruit flies and boll weevils) are provided. Subsequently, we identify essential knowledge required for successful lure and kill programs that include lure competitiveness with natural odor source; lure density; lure formulation and release rate; pest population density and risk of immigration; and biology and ecology of the target species. The risks associated with lure and kill, especially when used in the eradication programs, are highlighted. We comment on the cost-effectiveness of this technology and its strengths and weaknesses, and list key reasons for success and failure. We conclude that lure and kill can be highly effective in controlling small, low-density, isolated populations, and thus it has the potential to add value to long-term pest management. In the eradication of invasive species, lure and kill offers a major advantage in effectiveness by its being inverse density dependent and it provides

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

    Data.gov (United States)

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

  1. Metyrapone for Long-Term Medical Management of Cushing’s Syndrome

    Directory of Open Access Journals (Sweden)

    Andrea N. Traina

    2013-01-01

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

  2. Contemporary In-Hospital and Long-Term Outcomes of Surgical Management for Fungal Endocarditis.

    Science.gov (United States)

    Chen, Jinmiao; Li, Jun; Zhou, Tianyu; Hu, Kui; Yang, Zhaohua; Wang, Yao; Zhu, Kai; Hong, Tao; Lai, Hao; Wang, Chunsheng

    2017-08-03

    Fungal endocarditis (FE) is a rare and fatal disease. The contemporary in-hospital and long-term surgical outcomes of FE have not been adequately evaluated. This study describes our experience with the surgical management of FE.Eight FE patients who underwent surgery in our center from January 2004 to November 2016 were included in this study. Seven had fungal prosthetic valve endocarditis (PVE) and one fungal native valve endocarditis (NVE). The Bentall operation, Cabrol operation, and mitral valve replacement were performed in 4, 3, and 1 patient, respectively. The overall in-hospital mortality rate was 25% (2/8). The follow-up was completed in all surviving patients and the mean follow-up time was 55.5 ± 63.3 (range, 1-154) months. Two late deaths occurred at 2 months and 4 months after discharge. The other patients recovered well during the follow-up.FE is a devastating disease and surgical treatment has acceptable in-hospital and long-term mortality rates.

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

    Science.gov (United States)

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

    2015-04-01

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

  4. Prognosis of intractable epilepsy: is long-term seizure freedom possible with medical management?

    Science.gov (United States)

    Munger Clary, Heidi; Choi, Hyunmi

    2011-08-01

    Until recently, very little data existed on long-term seizure prognosis of patients with intractable epilepsy. We review recent work that assessed seizure remission in patients with intractable epilepsy during medical management. Recent prevalence cohort studies among adults with longstanding intractable epilepsy have demonstrated notable proportions of patients attaining at least 1-year seizure freedom, ranging from more than 10% to nearly 30% of patients, when followed for mean duration of 18 months to 6 years. Additionally, a recent prospective cohort study of pediatric-onset intractable epilepsy (followed prospectively for seizure outcome from onset of intractability) revealed minimum 1-year seizure remission among more than half of study patients. Despite the notable rates of remission seen among patients with intractable epilepsy, many individuals experienced subsequent seizure relapse. These findings highlight the continued importance of surgical therapy for those who are good candidates and the need for further development of effective therapeutic interventions.

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

    Science.gov (United States)

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

    2008-01-01

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

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

    Science.gov (United States)

    Wong, Wei Ning Zechariah

    2009-11-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Berger, Matthew T.

    1994-01-01

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

  8. Congestion management in power systems. Long-term modeling framework and large-scale application

    Energy Technology Data Exchange (ETDEWEB)

    Bertsch, Joachim; Hagspiel, Simeon; Just, Lisa

    2015-06-15

    In liberalized power systems, generation and transmission services are unbundled, but remain tightly interlinked. Congestion management in the transmission network is of crucial importance for the efficiency of these inter-linkages. Different regulatory designs have been suggested, analyzed and followed, such as uniform zonal pricing with redispatch or nodal pricing. However, the literature has either focused on the short-term efficiency of congestion management or specific issues of timing investments. In contrast, this paper presents a generalized and flexible economic modeling framework based on a decomposed inter-temporal equilibrium model including generation, transmission, as well as their inter-linkages. Short and long-term effects of different congestion management designs can hence be analyzed. Specifically, we are able to identify and isolate implicit frictions and sources of inefficiencies in the different regulatory designs, and to provide a comparative analysis including a benchmark against a first-best welfare-optimal result. To demonstrate the applicability of our framework, we calibrate and numerically solve our model for a detailed representation of the Central Western European (CWE) region, consisting of 70 nodes and 174 power lines. Analyzing six different congestion management designs until 2030, we show that compared to the first-best benchmark, i.e., nodal pricing, inefficiencies of up to 4.6% arise. Inefficiencies are mainly driven by the approach of determining cross-border capacities as well as the coordination of transmission system operators' activities.

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

    Science.gov (United States)

    Reid, M C; O’Neil, Kevin W.; Dancy, JaNeen; Berry, Carolyn A.; Stowell, Stephanie A.

    2015-01-01

    Pain is underrecognized and undertreated in the long-term care (LTC) setting. To improve the management of pain for LTC residents, the authors implemented a quality improvement (QI) initiative at one LTC facility. They conducted a needs assessment to identify areas for improvement and designed a 2-hour educational workshop for facility staff and local clinicians. Participants were asked to complete a survey before and after the workshop, which showed significant improvement in their knowledge of pain management and confidence in their ability to recognize and manage residents’ pain. To measure the effectiveness of the QI initiative, the authors performed a chart review at baseline and at 3 and 8 months after the workshop and evaluated relevant indicators of adequate pain assessment and management. The post-workshop chart reviews showed significant improvement in how consistently employees documented pain characteristics (ie, location, intensity, duration) in resident charts and in their use of targeted pain assessments for residents with cognitive dysfunction. The proportion of charts that included a documented plan for pain assessment was high at baseline and remained stable throughout the study. Overall, the findings suggest a QI initiative is an effective way to improve pain care practices in the LTC setting. PMID:25949232

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2012-12-12

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

  12. The long-term mechanically ventilated patient. An outcomes management approach.

    Science.gov (United States)

    Burns, S M

    1998-03-01

    model, we recognize that other models may also result in comparable, favorable outcomes. It is important that those who adopt similar models of care delivery for managing patients requiring prolonged ventilation be scientific in their approach. Long-term studies of the efficacy of these models are essential if we are to truly provide quality care for our patients in the future. Unfortunately, as noted earlier, bias will be hard to overcome. Hospitals vested in rapidly establishing a stable financial bottom-line are likely to embrace quick applications. Projects with a true experimental design to evaluate efficacy, such as this one, will be rare in these organizations. Finally, it is critical that variables of interest be inclusive of specific quality indicators such as ventilator duration and complications rather than global institutional markers such as LOS. Standardization of variables of interest is imperative if outcomes are to be compared. For example, patients requiring long-term mechanical ventilation are identified by the AACN's Third National Study Group on weaning as those who require mechanical ventilation for more than 3 days. If we are to compare other variables of interest such as total ventilator duration, such as definition is essential or we will be comparing apples and oranges in the future. Provision of quality, cost-effective care for patients requiring prolonged ventilation is a true clinical challenge. Outcomes management is a multidisciplinary method of care delivery that is systematic and comprehensive in approach. Although little science exists related to the application of the model for patients requiring prolonged ventilation, preliminary reports are promising and warrant future applications and evaluation of the same.

  13. Practical management of NSCLC patients with long-term bevacizumab treatment: a report of four cases

    Directory of Open Access Journals (Sweden)

    Herder GJM

    2013-10-01

    Full Text Available GJM Herder,1 H Codrington,2 CD Colder,3 JG Aerts4,51St Antonius Hospital, Nieuwegein, The Netherlands; 2Haga Hospital, The Hague, The Netherlands; 3St Jansdal Hospital, Harderwijk, The Netherlands; 4Amphia Hospital, Breda; 5Erasmus MC Rotterdam, The NetherlandsIntroduction: Previous research showed that the addition of bevacizumab (a monoclonal antibody against vascular endothelial growth factor [VEGF] to chemotherapy resulted in a significant efficacy benefit in the treatment of selected patients with advanced nonsquamous non–small cell lung cancer (NSCLC. However, the occurrence and management of adverse events (AEs during long-term maintenance treatment with bevacizumab is not well known.Methods: This report presents a descriptive analysis, including the management of AEs, of four patients with advanced NSCLC, who received a relatively long period of bevacizumab maintenance treatment.Results: In patient 1, a 72-year-old retired man with stage cT2N2M1b NSCLC, the only AE related to bevacizumab was a grade 1 rhinorrhea. Treatment resulted in a stable disease, with duration of response of 38 months. Patient 2 had NSCLC stage cT4N3M1b and developed a cavitation and infection after the first cycle of chemotherapy and bevacizumab, which caused a temporary decrease of her quality of life. Bevacizumab therapy resulted in a partial response, with duration of response of 15 months. A 52-year-old female (patient 3 with stage T2bN2M1a NSCLC is currently under treatment and has so far received 42 cycles of maintenance bevacizumab, with stabilized response (duration of response of 29 months and no noteworthy AEs. The last patient is a 74-year-old male farmer with NSCLC T1N0M1, whose response has lasted for more than 3 years, with until now, no AEs.Conclusion: Our retrospective findings of these four patients show the long-term efficacy and safety of bevacizumab treatment in a real-life setting.Keywords: lung cancer, non–small cell lung cancer

  14. Long-Term Surveillance and Maintenance Plan for the Gnome-Coach, New Mexico, Site

    Energy Technology Data Exchange (ETDEWEB)

    Kreie, Ken [USDOE Office of Legacy Management, Grand Junction, CO (United States); Findlay, Rick [Navarro Research and Engineering, Inc., Grand Junction, CO (United States)

    2016-06-08

    The U.S. Department of Energy (DOE) Office of Legacy Management (LM) prepared this Long-Term Surveillance and Maintenance Plan (LTSMP) for the Gnome-Coach, New Mexico, Site (the Gnome site). The Gnome site is approximately 25 miles east of Carlsbad in Eddy County, New Mexico (Figure 1). The site was the location of a 3-kiloton-yield underground nuclear test and radioisotope groundwater tracer test. The tests resulted in residual contamination and post-detonation features that require long-term oversight. Long-term responsibility for the site was transferred from the DOE National Nuclear Security Administration Nevada Site Office to LM on October 1, 2006. Responsibilities include surveillance, monitoring, and maintenance of institutional controls (ICs) as part of the long-term stewardship of the site. Long-term stewardship is designed to ensure protection of human health and the environment.

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

    Science.gov (United States)

    Schalm, Corinne

    2008-01-01

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

  16. Predicting Agricultural Management Influence on Long-Term Soil Organic Carbon Dynamics: Implications for Biofuel Production

    Energy Technology Data Exchange (ETDEWEB)

    Gollany, H. T. [USDA ARS; Rickman, R. W. [USDA ARS; Albrecht, S. L. [USDA ARS; Liang, Y. [University of Arkansas; Kang, Shujiang [ORNL; Machado, S. [Oregon State University, Corvallis

    2011-01-01

    Long-term field experiments (LTE) are ideal for predicting the influence of agricultural management on soil organic carbon (SOC) dynamics and examining biofuel crop residue removal policy questions. Our objectives were (i) to simulate SOC dynamics in LTE soils under various climates, crop rotations, fertilizer or organic amendments, and crop residue managements using the CQESTR model and (ii) to predict the potential of no-tillage (NT) management to maintain SOC stocks while removing crop residue. Classical LTEs at Champaign, IL (1876), Columbia, MO (1888), Lethbridge, AB (1911), Breton, AB (1930), and Pendleton, OR (1931) were selected for their documented history of management practice and periodic soil organic matter (SOM) measurements. Management practices ranged from monoculture to 2- or 3-yr crop rotations, manure, no fertilizer or fertilizer additions, and crop residue returned, burned, or harvested. Measured and CQESTR predicted SOC stocks under diverse agronomic practices, mean annual temperature (2.1 19 C), precipitation (402 973 mm), and SOC (5.89 33.58 g SOC kg 1) at the LTE sites were significantly related (r 2 = 0.94, n = 186, P < 0.0001) with a slope not significantly different than 1. The simulation results indicated that the quantities of crop residue that can be sustainably harvested without jeopardizing SOC stocks were influenced by initial SOC stocks, crop rotation intensity, tillage practices, crop yield, and climate. Manure or a cover crop/intensified crop rotation under NT are options to mitigate loss of crop residue C, as using fertilizer alone is insufficient to overcome residue removal impact on SOC stocks

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-07-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2006-07-01

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

  19. Defense Nuclear Material Stewardship Integrated Inventory Information Management System (IIIMS).

    Energy Technology Data Exchange (ETDEWEB)

    Aas, Christopher A.; Lenhart, James E.; Bray, Olin H.; Witcher, Christina Jenkin

    2004-11-01

    Sandia National Laboratories was tasked with developing the Defense Nuclear Material Stewardship Integrated Inventory Information Management System (IIIMS) with the sponsorship of NA-125.3 and the concurrence of DOE/NNSA field and area offices. The purpose of IIIMS was to modernize nuclear materials management information systems at the enterprise level. Projects over the course of several years attempted to spearhead this modernization. The scope of IIIMS was broken into broad enterprise-oriented materials management and materials forecasting. The IIIMS prototype was developed to allow multiple participating user groups to explore nuclear material requirements and needs in detail. The purpose of material forecasting was to determine nuclear material availability over a 10 to 15 year period in light of the dynamic nature of nuclear materials management. Formal DOE Directives (requirements) were needed to direct IIIMS efforts but were never issued and the project has been halted. When restarted, duplicating or re-engineering the activities from 1999 to 2003 is unnecessary, and in fact future initiatives can build on previous work. IIIMS requirements should be structured to provide high confidence that discrepancies are detected, and classified information is not divulged. Enterprise-wide materials management systems maintained by the military can be used as overall models to base IIIMS implementation concepts upon.

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

    Science.gov (United States)

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

    2010-05-01

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

  1. 75 FR 4801 - Notice of Availability of the Draft Long-Term Management and Storage of Elemental Mercury...

    Science.gov (United States)

    2010-01-29

    ... of Availability of the Draft Long-Term Management and Storage of Elemental Mercury Environmental... Management and Storage of Elemental Mercury Environmental Impact Statement (DOE/EIS-0423D, ``Draft Mercury... effects of storing a projected total of up to 10,000 metric tons (11,000 tons) of elemental mercury....

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

    Energy Technology Data Exchange (ETDEWEB)

    Burger, J.

    2000-10-01

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

  3. Pentoxifylline as adjunct therapy to long-term clinical management of a right-to-left patent ductus arteriosus.

    Science.gov (United States)

    Turner, Elizabeth

    2016-06-01

    Management of a right-to-left ("reversed") patent ductus arteriosus (PDA) focuses on control of clinical signs associated with hyperviscosity due to erythrocytosis. Pentoxifylline therapy is presented as an adjunct to routine phlebotomies for the long-term clinical management of reversed PDA in a 10-year-old Chihuahua.

  4. The surgical management of urogenital tuberculosis our experience and long-term follow-up

    Directory of Open Access Journals (Sweden)

    Punit Bansal

    2015-01-01

    Full Text Available Introduction: Urogenital tuberculosis (TB is common in developing countries. We present our experience of surgically managed cases of genitourinary TB (GUTB. Materials and Methods: We retrospectively reviewed 60 cases GUTB who underwent surgery at our center from January 2003 to January 2010. Mode of presentation, organ involvement, investigation, surgical treatment and follow-up were studied. Results: There were 38 males and 22 females with a mean age of 32.5 years. The most common symptom was irritative voiding symptoms. The most common organ involved was bladder in 33 cases, and next most common was kidney in 30 cases. Preoperative bacteriologic diagnosis was confirmed in only 19 cases. A total of 66 procedures were performed as some patients needed more than one procedure. These included 35 ablative procedures and 31 reconstructive procedures. All the patients were followed-up with renal function test (RFT at 3, 6 and 12 months. The intravenous urography and diethylenetriamine pentaacetic acid scan were performed at 3 months when indicated. Then the patients were followed with RFT and ultrasonography 6 monthly for 3 years and then annual RFT. Conclusion: Many patients of urogenital TB present late with cicatrisation sequelae. Multidrug chemotherapy with judicious surgery as and when indicated is the ideal treatment. The results of reconstructive surgery are good and should be done when possible. Rigorous and long term follow-up is necessary in patients undergoing reconstructive surgery.

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

    Science.gov (United States)

    McCorquodale, Donald; Pucillo, Evan M; Johnson, Nicholas E

    2016-01-01

    Charcot–Marie–Tooth (CMT) disease is the most common inherited neuropathy and one of the most common inherited diseases in humans. The diagnosis of CMT is traditionally made by the neurologic specialist, yet the optimal management of CMT patients includes genetic counselors, physical and occupational therapists, physiatrists, orthotists, mental health providers, and community resources. Rapidly developing genetic discoveries and novel gene discovery techniques continue to add a growing number of genetic subtypes of CMT. The first large clinical natural history and therapeutic trials have added to our knowledge of each CMT subtype and revealed how CMT impacts patient quality of life. In this review, we discuss several important trends in CMT research factors that will require a collaborative multidisciplinary approach. These include the development of large multicenter patient registries, standardized clinical instruments to assess disease progression and disability, and increasing recognition and use of patient-reported outcome measures. These developments will continue to guide strategies in long-term multidisciplinary efforts to maintain quality of life and preserve functionality in CMT patients. PMID:26855581

  6. Long-term management of patients with epilepsy. Organization of a service in the Tyumen Region

    Directory of Open Access Journals (Sweden)

    E. V. Levitina

    2016-01-01

    Full Text Available Epilepsy is a chronic brain disease that requires a long-term or lifelong follow-up of patients. The factors that influence the outcome of therapy are various; moreover, the key factors of them are the organization of care and the mode of patient follow-up. The necessity of optimizing the specialized health care to this category of patients stems from the poorer quality of life in the patients and their families and from the more frequentdevelopment of mental disorders and drug-resistant forms of the disease during ineffective therapy. These and other issues are considered in this paper with emphasis on the specific area – the south of the Tyumen Region. This underlines the importance of setting up not only highlevel epileptologic centers, but also a whole network that provides access to specialized epileptologic care. It seems today that it is more appropriate to solve problems in the organization of management for epileptic patients at the level of an administrative region, for this state structure has all necessary conditions for rapidly and rationally implementing the most successful developments of specialized care to the population.

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

    Directory of Open Access Journals (Sweden)

    McCorquodale D

    2016-01-01

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

  8. Use of opioids in long-term management of temporomandibular joint dysfunction.

    Science.gov (United States)

    Bouloux, Gary F

    2011-07-01

    The long-term treatment of patients with chronic temporomandibular joint dysfunction has been challenging. The long-term use of opioids in these patients can be neither supported nor refuted based on current evidence. However, evidence is available to support the long-term use of opioids in other chronic noncancer pain states with reduced pain, improved function, and improved quality of life. One group of patients with chronic temporomandibular joint pain, for whom both noninvasive and invasive treatment has failed, might benefit from long-term opioid medication. The choices include morphine, fentanyl, oxycodone, tramadol, hydrocodone, and methadone. Adjunct medication, including antidepressant and anticonvulsant drugs, can also be used. The safety of these medications has been well established, but the potential for adverse drug-related behavior does exist, requiring appropriate patient selection, adequate monitoring, and intervention when needed.

  9. Risk Based Requirements for Long Term Stewardship: A Proof-of-Principle Analysis of an Analytic Method Tested on Selected Hanford Locations

    Energy Technology Data Exchange (ETDEWEB)

    GM Gelston; JW Buck; LR Huesties; MS Peffers; TB Miley; TT Jarvis; WB Andrews

    1998-12-03

    Since 1989, the Department of Energy's (DOE) Environmental Management (EM) Program has managed the environmental legacy of US nuclear weapons production research and testing at 137 facilities in 31 states and one US territory. The EM program has conducted several studies on the public risks posed by contaminated sites at these facilities. In Risks and the Risk Debate DOE, 1995a, the Department analyzed the risks at sites before, during, and after remediation work by the EM program. The results indicated that aside from a few urgent risks, most hazards present little inherent risk because physical and active site management controls limit both the releases of site contaminants, and public access to these hazards. Without these controls, these sites would pose greater risks to the public. Past risk reports, however, provided little irdiormation about post- cleanup risk, primarily because of uncertainty about fiture site uses and site characteristics at the end of planned cleanup activities. This is of concern because in many cases current cleanup technologies, and remedies, will last a shorter period of time than the waste itself and the resulting contamination will remain hazardous.

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

    Science.gov (United States)

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

    2011-01-01

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

  11. Service developments for managing people with long-term conditions using case management approaches, an example from the UK

    Directory of Open Access Journals (Sweden)

    Michelle Russell

    2009-02-01

    Full Text Available Introduction: This research has considered current developments in the provision of services for people with long-term conditions within the NHS of England. Community Matrons are being employed and by adopting a case management approach they are aiming to improve patient care and reduce their demands for acute hospital care. Description: Qualitative research was undertaken to explore experiences of community matrons and service leads on the development, implementation and provision of services for people with long-term conditions. Conclusions: This research provides evidence of what is being done to meet the challenge of long-term conditions and provides lessons for similar challenges and service development for different areas of care and in other countries. Continual system and role change has had effects on service delivery and on the whole care. These effects relate to; defining the role of community matron and structure of service, training staff, identifying patients, providing infrastructure, demonstrating benefits, identifying gaps in services, ability to reduce avoidable admissions and identifying the advantages and difficulties of the role.

  12. Threshold responses of songbirds to long-term timber management on an active industrial forest

    Science.gov (United States)

    Becker, D.A.; Wood, P.B.; Keyser, P.D.; Wigley, T.B.; Dellinger, R.; Weakland, C.A.

    2011-01-01

    Forest managers often seek to balance economic benefits from timber harvesting with maintenance of habitat for wildlife, ecosystem function, and human uses. Most research on the relationship between avian abundance and active timber management has been short-term, lasting one to two years, creating the need to investigate long-term avian responses and to identify harvest thresholds when a small change in habitat results in a disproportionate response in relative abundance and nest success. Our objectives were to identify trends in relative abundance and nest success and to identify landscape-scale disturbance thresholds for avian species and habitat guilds in response to a variety of harvest treatments (clear-cuts, heavy and light partial harvests) over 14 years. We conducted point counts and monitored nests at an industrial forest in the central Appalachians of West Virginia during 1996-1998, 2001-2003, and 2007-2009. Early successional species increased in relative abundance across all three time periods, whereas interior-edge and forest-interior guilds peaked in relative abundance mid-study after which the forest-interior guild declined. Of 41 species with >10 detections, four (10%) declined significantly, 13 (32%) increased significantly (only three species among all periods), and 9 (22%) peaked in abundance mid-study (over the entire study period, four species had no significant change in abundance, four declined, and one increased). Based on piecewise linear models, forest-interior and interior-edge guilds' relative abundance harvest thresholds were 28% total harvests (all harvests combined), 10% clear-cut harvests, and 18% light partial harvests, after which abundances declined. Harvest thresholds for the early successional guild were 42% total harvests, 11% clear-cut harvest, and 10% light partial harvests, and relative abundances increased after surpassing thresholds albeit at a reduced rate of increase after the clear-cut threshold. Threshold confidence

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2002-02-27

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2002-02-27

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

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

    Science.gov (United States)

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

    2016-12-14

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

  16. Strategic Plan for Sustainable Energy Management and Environmental Stewardship for Los Angeles Unified School District

    Energy Technology Data Exchange (ETDEWEB)

    Walker, A.; Beattie, D.; Thomas, K.; Davis, K.; Sim, M.; Jhaveri, A.

    2007-11-01

    This Strategic Plan for Sustainable Energy Management and Environmental Stewardship states goals, measures progress toward goals and how actions are monitored to achieve continuous improvement for the Los Angeles Unified School District.

  17. Specific side effects of long-term imipramine management of panic disorder.

    Science.gov (United States)

    Mavissakalian, Matig; Perel, James; Guo, Shenyang

    2002-04-01

    In a recent study, the authors suggested that tachycardia, dry mouth, and sweating continued to burden patients with panic disorder with agoraphobia who have shown marked and stable response to 6 months of imipramine treatment at the fixed, weight-adjusted dose of 2.25 mg/kg/day. Although sexual dysfunction and weight gain were not a significant burden in that study, they are important problems in long-term treatment with antidepressant drugs. In the present study, in the context of a randomized, double-blind, placebo-controlled, 1-year discontinuation and maintenance study of 53 patients with panic disorder with agoraphobia who respond to imipramine, the authors examine the extent and the specificity of these five side effects of imipramine maintenance using data at pretreatment, at the end of 24 weeks of open imipramine treatment (or month 0 of randomization), and at months 2, 4, 6, 8, 10, and 12 of randomized treatment. Hierarchical linear modeling and repeated measures of analyses of variance in subsamples of completers confirmed that dry mouth, sweating, and increased heart rate constitute a significant and specific enduring burden of imipramine maintenance treatment. The data also revealed that weight gain is a significant and specific side effect of 1-year imipramine maintenance treatment; however, the likelihood of reporting sexual dysfunction decreased over time, with no difference between the placebo and imipramine maintenance conditions. The results are discussed in the context of previous studies of imipramine side effects in the management of depression and the available literature of sexual and weight side effects of antidepressant medications in the treatment of anxiety disorders.

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

    Science.gov (United States)

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

    2016-12-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    NARCIS (Netherlands)

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

    2015-01-01

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

  1. 76 FR 5145 - Notice of Availability of the Final Long-Term Management and Storage of Elemental Mercury...

    Science.gov (United States)

    2011-01-28

    ... of Availability of the Final Long-Term Management and Storage of Elemental Mercury Environmental... Mercury Environmental Impact Statement (DOE/ ] EIS-0423, ``Mercury Storage FEIS'' or ``FEIS''). This FEIS... tons (11,000 tons) of elemental mercury at each of seven alternative sites across the U.S. The...

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

    NARCIS (Netherlands)

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

    2016-01-01

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

  3. Surgical management of acromegaly: Long term functional outcome analysis and assessment of recurrent/residual disease

    Science.gov (United States)

    Banerji, Deepu; Das, Nitu K.; Sharma, Siddhiraj; Jindal, Yogesh; Jain, Vijendra K.; Behari, Sanjay

    2016-01-01

    Context: Functional growth hormone producing adenomas have long-term deleterious effects on the visual apparatus, the cardiovascular and musculoskeletal systems, and often predispose to malignancies. Since persistence of acromegaly affects outcome and quality of life, therapeutic interventions become mandatory. Aim: This study represents an analysis of long-term clinical and endocrinal outcome of 115 patients of acromegaly after surgical management. Setting and Design: Tertiary care retrospective study. Materials and Methods: One hundred and fifteen patients (male:female ratio: 1:1.09) with acromegalic features were studied. Apart from acromegalic features, their main clinical presentation also included headache, diminution of vision, field defects, ptosis, irregular menstruation, diabetes insipidus, diabetes mellitus and hypertension. Six of them presented with apoplexy. Their preoperative endocrinal evaluation included basal and suppressed growth hormone (GH), prolactin and thyroid levels. On the basis of axial and coronal CT scan or multiplanar MR imaging or both, the tumors were classified according to their suprasellar and parasellar extension (Hardy's grade). Transnasal trans-sphenoidal surgery (TSS) (n = 37) and sublabial, rhinoseptal TSS (n = 72) were the preferred approaches. Six patients with significant parasellar extensions underwent trans-cranial explorations. The patients were followed up at 6 and 12 weeks and then at 6 monthly intervals. Hormonal and CT/MR evaluation were also done. Attainment of random GH value less than 2.5 µg/L, and the nadir GH value after oral glucose tolerance test (OGTT) less than 1 µg/L were used as the criteria of cure. Findings: The patients were preoperatively in Hardy's tumor grade 0 (29), A (21), A+E (3), B (21), B+E (5), C (9), C+E (10), D (1) D+E (11), E (5), respectively. One hundred and one patients were available for follow-up (FU; median FU duration: 84 months; range: 6 to 132 months). Surgical cure was achieved

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

    Directory of Open Access Journals (Sweden)

    G. Willy Davila

    2011-01-01

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

  5. FY 2017 Stockpile Stewardship and Management Plan - Biennial Plan Summary

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    2016-03-01

    This year’s summary report updates the Fiscal Year 2016 Stockpile Stewardship and Management Plan (FY 2016 SSMP), the 25-year strategic program of record that captures the plans developed across numerous NNSA programs and organizations to maintain and modernize the scientific tools, capabilities, and infrastructure necessary to ensure the success of NNSA’s nuclear weapons mission. The SSMP is a companion to the Prevent, Counter, and Respond: A Strategic Plan to Reduce Global Nuclear Threats (FY 2017-2021) report, the planning document for NNSA’s nuclear threat reduction mission. New versions of both reports are published each year in response to new requirements and challenges. Much was accomplished in FY 2015 as part of the program of record described in this year’s SSMP. The science-based Stockpile Stewardship Program allowed the Secretaries of Energy and Defense to certify for the twentieth time that the stockpile remains safe, secure, and effective without the need for underground nuclear explosive testing. The talented scientists, engineers, and technicians at the three national security laboratories, the four nuclear weapons production plants, and the national security site are primarily responsible for this continued success. Research, development, test, and evaluation programs have advanced NNSA’s understanding of weapons physics, component aging, and material properties through first-of-a-kind shock physics experiments, along with numerous other critical experiments conducted throughout the nuclear security enterprise. The multiple life extension programs (LEPs) that are under way made progress toward their first production unit dates. The W76-1 LEP is past the halfway point in total production, and the B61-12 completed three development flight tests. Critical to this success is the budget. The Administration’s budget request for NNSA’s Weapons Activities has increased for all but one of the past seven years, resulting in a total increase of

  6. Current readings: long-term management of patients undergoing successful pediatric cardiac surgery.

    Science.gov (United States)

    DiBardino, Daniel J; Jacobs, Jeffrey P

    2014-01-01

    in all patients; and (3) concomitant procedures to treat associated lesions. The need for pulmonary valve replacement is increasing for many adults with congenital heart disease. In the past, chronic pulmonary regurgitation following repair of tetralogy of Fallot was considered benign. Current evidence demonstrates that chronic pulmonary regurgitation causes significant morbidity by producing right ventricular dilatation and dysfunction, exercise intolerance, arrhythmias, and sudden death. Multiple options exist for pulmonary valve replacement including several recent developments such as pulmonary valve replacement with a hand-sewn polytetrafluoroethylene bicuspid valve and percutaneous pulmonary valve replacement. Reoperative cardiac surgery is common in adults with congenital heart disease. Although a history of previous cardiac surgery does not independently confer a significant incremental risk of operative mortality, patients with the greatest number of previous surgeries appear to be a higher risk group. Multi-institutional data about adults with congenital heart disease from The Society of Thoracic Surgeons Congenital Heart Surgery Database can be used to estimate prognosis and council patients and their families. The six manuscripts reviewed in this article have been selected to give a flavor of the state of the art in the domain of caring for adults with congenital heart disease and to provide important information about the long term management of patients undergoing successful pediatric cardiac surgery.

  7. Generalizable principles for ecosystem stewardship-based management of social-ecological systems: lessons learned from Alaska

    OpenAIRE

    Winslow D. Hansen

    2014-01-01

    Human pressure could compromise the provision of ecosystem services if we do not implement strategies such as ecosystem stewardship to foster sustainable trajectories. Barriers to managing systems based on ecosystem stewardship principles are pervasive, including institutional constraints and uncertain system dynamics. However, solutions to help managers overcome these barriers are less common. How can we better integrate ecosystem stewardship into natural resource management practices? I dr...

  8. Seasonal-Spatial Distribution and Long-Term Variation of Transparency in Xin'anjiang Reservoir: Implications for Reservoir Management.

    Science.gov (United States)

    Wu, Zhixu; Zhang, Yunlin; Zhou, Yongqiang; Liu, Mingliang; Shi, Kun; Yu, Zuoming

    2015-08-12

    Water transparency is a useful indicator of water quality or productivity and is widely used to detect long-term changes in the water quality and eutrophication of lake ecosystems. Based on short-term spatial observations in the spring, summer, and winter and on long-term site-specific observation from 1988 to 2013, the spatial, seasonal, long-term variations, and the factors affecting transparency are presented for Xin'anjiang Reservoir (China). Spatially, transparency was high in the open water but low in the bays and the inflowing river mouths, reflecting the effect of river runoff. The seasonal effects were distinct, with lower values in the summer than in the winter, most likely due to river runoff and phytoplankton biomass increases. The transparency decreased significantly with a linear slope of 0.079 m/year, indicating a 2.05 m decrease and a marked decrease in water quality. A marked increase occurred in chlorophyll a (Chla) concentration, and a significant correlation was found between the transparency and Chla concentration, indicating that phytoplankton biomass can partially explain the long-term trend of transparency in Xin'anjiang Reservoir. The river input and phytoplankton biomass increase were associated with soil erosion and nutrient loss in the catchment. Our study will support future management of water quality in Xin'anjiang Reservoir.

  9. Seasonal-Spatial Distribution and Long-Term Variation of Transparency in Xin’anjiang Reservoir: Implications for Reservoir Management

    Directory of Open Access Journals (Sweden)

    Zhixu Wu

    2015-08-01

    Full Text Available Water transparency is a useful indicator of water quality or productivity and is widely used to detect long-term changes in the water quality and eutrophication of lake ecosystems. Based on short-term spatial observations in the spring, summer, and winter and on long-term site-specific observation from 1988 to 2013, the spatial, seasonal, long-term variations, and the factors affecting transparency are presented for Xin’anjiang Reservoir (China. Spatially, transparency was high in the open water but low in the bays and the inflowing river mouths, reflecting the effect of river runoff. The seasonal effects were distinct, with lower values in the summer than in the winter, most likely due to river runoff and phytoplankton biomass increases. The transparency decreased significantly with a linear slope of 0.079 m/year, indicating a 2.05 m decrease and a marked decrease in water quality. A marked increase occurred in chlorophyll a (Chla concentration, and a significant correlation was found between the transparency and Chla concentration, indicating that phytoplankton biomass can partially explain the long-term trend of transparency in Xin’anjiang Reservoir. The river input and phytoplankton biomass increase were associated with soil erosion and nutrient loss in the catchment. Our study will support future management of water quality in Xin’anjiang Reservoir.

  10. Modeled effects of soil acidification on long-term ecological and economic outcomes for managed forests in the Adirondack region (USA)

    Science.gov (United States)

    Caputo, Jesse PhD.; Beier, Colin M.; Sullivan, Timothy J.; Lawrence, Gregory B.

    2016-01-01

    Sugar maple (Acer saccharum) is among the most ecologically and economically important tree species in North America, and its growth and regeneration is often the focus of silvicultural practices in northern hardwood forests. A key stressor for sugar maple (SM) is acid rain, which depletes base cations from poorly-buffered forest soils and has been associated with much lower SM vigor, growth, and recruitment. However, the potential interactions between forest management and soil acidification – and their implications for the sustainability of SM and its economic and cultural benefits – have not been investigated. In this study, we simulated the development of 50 extant SM stands in the western Adirondack region of NY (USA) for 100 years under different soil chemical conditions and silvicultural prescriptions. We found that interactions between management prescription and soil base saturation will strongly shape the ability to maintain SM in managed forests. Below 12% base saturation, SM did not regenerate sufficiently after harvest and was replaced mainly by red maple (Acer rubrum) and American beech (Fagus grandifolia). Loss of SM on acid-impaired sites was predicted regardless of whether the shelterwood or diameter-limit prescriptions were used. On soils with sufficient base saturation, models predicted that SM will regenerate after harvest and be sustained for future rotations. We then estimated how these different post-harvest outcomes, mediated by acid impairment of forest soils, would affect the potential monetary value of ecosystem services provided by SM forests. Model simulations indicated that a management strategy focused on syrup production – although not feasible across the vast areas where acid impairment has occurred – may generate the greatest economic return. Although pollution from acid rain is declining, its long-term legacy in forest soils will shape future options for sustainable forestry and ecosystem stewardship in the northern

  11. Living Well With a Long-Term Condition: Service Users' Perspectives of a Self-Management Intervention.

    Science.gov (United States)

    Stenberg, Nicola; Furness, Penny J

    2017-03-01

    The outcomes of self-management interventions are commonly assessed using quantitative measurement tools, and few studies ask people with long-term conditions to explain, in their own words, what aspects of the intervention they valued. In this Grounded Theory study, a Health Trainers service in the north of England was evaluated based on interviews with eight service-users. Open, focused, and theoretical coding led to the development of a preliminary model explaining participants' experiences and perceived impact of the service. The model reflects the findings that living well with a long-term condition encompassed social connectedness, changed identities, acceptance, and self-care. Health trainers performed four related roles that were perceived to contribute to these outcomes: conceptualizer, connector, coach, and champion. The evaluation contributes a grounded theoretical understanding of a personalized self-management intervention that emphasizes the benefits of a holistic approach to enable cognitive, behavioral, emotional, and social adjustments.

  12. Guidelines for screening and management of late and long-term consequences of myeloma and its treatment.

    Science.gov (United States)

    Snowden, John A; Greenfield, Diana M; Bird, Jennifer M; Boland, Elaine; Bowcock, Stella; Fisher, Abigail; Low, Eric; Morris, Monica; Yong, Kwee; Pratt, Guy

    2017-03-01

    A growing population of long-term survivors of myeloma is now accumulating the 'late effects' not only of myeloma itself, but also of several lines of treatment given throughout the course of the disease. It is thus important to recognise the cumulative burden of the disease and treatment-related toxicity in both the stable and active phases of myeloma, some of which is unlikely to be detected by routine monitoring. We summarise here the evidence for the key late effects in long-term survivors of myeloma, including physical and psychosocial consequences (in Parts 1 and 2 respectively), and recommend the use of late-effects screening protocols in detection and intervention. The early recognition of late effects and effective management strategies should lead to an improvement in the management of myeloma patients, although evidence in this area is currently limited and further research is warranted. © 2017 John Wiley & Sons Ltd.

  13. The Long-Term Effective Mechanism of Rural Poverty Alleviation in China from the Perspective of Ecological Management

    OpenAIRE

    Liang, Jun-Si

    2010-01-01

    Based on the ecological environmental situation of poverty-stricken areas in China and the domestic and foreign research results, the long-term effective mechanism of sustainable poverty alleviation in China is established(the ideological premise is ecological culture, the material base is ecological economy and the basic guarantee is ecological system ) from the perspective of ecological management. To be specific, ecological culture, the ideological premise of rural sustainable poverty alle...

  14. [Dysphagia management of acute and long-term critically ill intensive care patients].

    Science.gov (United States)

    Zielske, J; Bohne, S; Axer, H; Brunkhorst, F M; Guntinas-Lichius, O

    2014-10-01

    Dysphagia is a severe complication in critically ill patients and affects more than half the patients in an intensive care unit. Dysphagia also has a strong impact on morbidity and mortality. Risk factors for the development of dysphagia are neurological diseases, age >55-70 years, intubation >7 days and sepsis. With increasing numbers of long-term survivors chronic dysphagia is becoming an increasing problem. There is not much knowledge on the influence of specific diseases, including the direct impact of sepsis on the development of dysphagia. Fiberoptic evaluation of swallowing is a standardized tool for bedside evaluation, helping to plan swallowing training during the acute phase and to decrease the rate of chronic dysphagia. For evaluation of chronic dysphagia even more extensive diagnostic tools as well as several options of stepwise rehabilitation using restitution, compensation and adaption strategies for swallowing exist. Currently it seems that these options are not being sufficiently utilized. In general, there is a need for controlled clinical trials analyzing specific swallowing rehabilitation concepts for former critically ill patients and long-term survivors.

  15. Long-term health consequences of premature or early menopause and considerations for management

    Science.gov (United States)

    Faubion, Stephanie S.; Kuhle, Carol L.; Shuster, Lynne T.; Rocca, Walter A.

    2015-01-01

    Aim To review the current evidence concerning the long-term harmful effects of premature or early menopause, and to discuss some of the clinical implications. Material and methods Narrative review of the literature. Results Women undergoing premature or early menopause, either following bilateral salpingo-oophorectomy or because of primary ovarian insufficiency, experience the early loss of estrogen and other ovarian hormones. The long-term consequences of premature or early menopause include adverse effects on cognition, mood, cardiovascular, bone, and sexual health, as well as an increased risk of early mortality. The use of hormone therapy has been shown to lessen some, although not all of these risks. Therefore, multiple medical societies recommend providing hormone therapy at least until the natural age of menopause. It is important to individualize hormone therapy for women with early estrogen deficiency, and higher dosages may be needed to approximate physiological concentrations found in premenopausal women. It is also important to address the psychological impact of early menopause and to review the options for fertility and the potential need for contraception, if the ovaries are intact. Conclusions Women who undergo premature or early menopause should receive individualized hormone therapy and counseling. PMID:25845383

  16. From Cleanup to Stewardship. A companion report to Accelerating Cleanup: Paths to Closure and background information to support the scoping process required for the 1998 PEIS Settlement Study

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    1999-10-01

    Long-term stewardship is expected to be needed at more than 100 DOE sites after DOE's Environmental Management program completes disposal, stabilization, and restoration operations to address waste and contamination resulting from nuclear research and nuclear weapons production conducted over the past 50 years. From Cleanup to stewardship provides background information on the Department of Energy (DOE) long-term stewardship obligations and activities. This document begins to examine the transition from cleanup to long-term stewardship, and it fulfills the Secretary's commitment to the President in the 1999 Performance Agreement to provide a companion report to the Department's Accelerating Cleanup: Paths to Closure report. It also provides background information to support the scoping process required for a study on long-term stewardship required by a 1998 Settlement Agreement.

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

    Science.gov (United States)

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

    2014-12-01

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

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

    Science.gov (United States)

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

    2014-01-08

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1998-03-01

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

  20. Endovascular Management of the Arteria Profunda Femoralis: Long-Term Angiographic and Clinical Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Karnabatidis, Dimitrios, E-mail: karnaby@med.upatras.gr; Spiliopoulos, Stavros; Pastromas, Georgios; Katsanos, Kostantinos; Siablis, Dimitrios [Patras University Hospital, School of Medicine, Department of Diagnostic and Interventional Radiology (Greece)

    2012-10-15

    Purpose: This study was designed to investigate the long-term angiographic and clinical outcomes of percutaneous transluminal angioplasty (PTA) of the arteria profunda femoralis (PFA), in a series of patients suffering from critical limb ischemia (CLI) or severe intermittent claudication (IC). Methods: Our department's database was searched to identify patients who underwent PTA or bail-out stenting of the PFA. Among the study's inclusion criteria were Rutherford categories 3-6 and {>=}70% stenosis of the PFA. Only de novo stenotic lesions were assessed. Primary endpoints were technical success, angiographic lesion primary patency, angiographic binary in-lesion restenosis, and target lesion recanalization (TLR) rates. Secondary endpoints included patient survival, limb salvage, and complication rates. Patient's baseline demographics, lesion, and procedural details were analyzed. Results: Between 2001 and 2011, 20 consecutive patients (17 males) with a mean age of 73 {+-} 9 (range 53-87) years underwent PTA or bail-out stenting in 23 PFA lesions. Critical limb ischemia was the indication in eight of 20 patients (40%). The mean lesion length was 31 {+-} 9.5 mm. The procedural technical success was 100% (23/23), whereas mean time angiographic and clinical follow-up was 26.8 {+-} 24.6 months. According to the Kaplan-Meier analysis, primary patency and binary restenosis rate were 95 and 86.1% respectively up to 8 years follow-up. No TLR procedures were performed. The 8-year patient survival and limb salvage rates were 87.5 and 84.7% respectively. Conclusions: PTA or stenting of focal, stenotic, PFA lesions, in patients suffering from CLI or IC, exhibit high long-term primary patency rates, as well as low binary restenosis and TLR rates. Large, multicenter studies are required to validate these results.

  1. Dementia in patients undergoing long-term dialysis: aetiology, differential diagnoses, epidemiology and management.

    Science.gov (United States)

    Rob, P M; Niederstadt, C; Reusche, E

    2001-01-01

    Dementia in patients undergoing long-term dialysis has not been clearly defined; however, four different entities have been described. Uraemic encephalopathy is a complication of uraemia and responds well to dialysis. Dialysis encephalopathy syndrome, the result of acute intoxication of aluminium caused by the use of an aluminium-containing dialysate, was a common occurrence prior to 1980. However, using modern techniques of water purification, such acute intoxication can now be avoided. Dialysis-associated encephalopathy/dementia (DAE) is always associated with elevated serum aluminium levels. Pathognomonic morphological changes in the brain have been described, but the mechanism for the entry of aluminium into the CNS is incompletely understood. The mechanisms involved in the pathogenesis of the neurotoxicity associated with aluminium are numerous. Although only a very small fraction of ingested aluminium is absorbed, the continuous oral aluminium intake from aluminium-based phosphate binders, and also of dietary or environmental origin, is responsible for aluminium overload in dialysis patients. Age-related dementia, especially vascular dementia, occurs in patients undergoing long-term dialysis as frequently as it does in the general population. The differential diagnoses of dialysis-associated dementias should include investigation for metabolic encephalopathies, heavy metal or trace element intoxications, and distinct structural neurological lesions such as subdural haematoma, normal pressure hydrocephalus, stroke and, particularly, hypertensive encephalopathy and multi-infarct dementia. To prevent DAE, dietary training programmes should aim to achieve the lowest phosphate intake and pharmacological tools should be used to keep serum phosphate levels below 2 mmol/L. To prevent vascular dementia, lifestyle modification should be undertaken, including optimal physical activity and fat intake, nicotine abstinence, and targeting optimal blood glucose, cholesterol

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

    Science.gov (United States)

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

    2016-01-07

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

  3. Of trophies and pillars: exploring the terror management functions of short-term and long-term relationship partners.

    Science.gov (United States)

    Kosloff, Spee; Greenberg, Jeff; Sullivan, Daniel; Weise, David

    2010-08-01

    Prior terror management research shows that mortality salience (MS) motivates both self-esteem striving and worldview bolstering. The present research examined these processes in the context of dating preferences. It was hypothesized that in short-term romantic contexts, MS-induced self-esteem striving motivates interest in dating a physically attractive other, whereas in long-term romantic contexts, MS-induced motives for worldview validation heighten interest in dating a same-religion other. Study 1 showed that in a short-term dating context, MS increased preference for an attractive but religiously dissimilar person, whereas in a long-term dating context, MS increased preference for a religiously similar, less attractive person. Study 2 clarified that MS motivates preference for attractive short-term partners for their self-enhancing properties rather than their potential sexual availability. Study 3 supported the theorized processes, showing that under MS, self-esteem-relevant constructs became spontaneously accessible in short-term dating contexts, whereas worldview-relevant constructs became spontaneously accessible in long-term dating contexts.

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

    Science.gov (United States)

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

    2017-04-01

    The Long Term Ecological Research (LTER) network aims to provide the scientific community, policy makers, and society with the knowledge and predictive understanding necessary to conserve, protect, and manage the ecosystems. LTER is organized into networks ranging from the global to national scale. In the top of network, the International Long Term Ecological Research (ILTER) Network coordinates among ecological researchers and LTER research networks at local, regional and global scales. In Spain, the Spanish Long Term Ecological Research (LTER-Spain) network was built to foster the collaboration and coordination between longest-lived ecological researchers and networks on a local scale. Currently composed by nine nodes, this network facilitates the data exchange, documentation and preservation encouraging the development of cross-disciplinary works. However, most nodes have no specific information systems, tools or qualified personnel to manage their data for continued conservation and there are no harmonized methodologies for long-term monitoring protocols. Hence, the main challenge is to place the nodes in its correct position in the network, providing the best tools that allow them to manage their data autonomously and make it easier for them to access information and knowledge in the network. This work proposes a connected structure composed by four LTER nodes located in southern Spain. The structure is built considering hierarchical approach: nodes that create information which is documented using metadata standards (such as Ecological Metadata Language, EML); and others nodes that gather metadata and information. We also take into account the capacity of each node to manage their own data and the premise that the data and metadata must be maintained where it is generated. The current state of the nodes is a follows: two of them have their own information management system (Sierra Nevada-Granada and Doñana Long-Term Socio-ecological Research Platform) and

  5. Long-term management of the fearful adult patient using behavior modification and other modalities.

    Science.gov (United States)

    Berggren, U

    2001-12-01

    This paper reviews reports on the treatment of fearful adult dental patients with special emphasis on behavioral and cognitive methods and long-term followup. A number of such treatment methods are available that can be used by dentists for the alleviation of fear and anxiety in their patients. At an "intuitive" level, many dentists probably use these methods frequently as a comprehensive part of everyday praxis. Considering the high number of fearful individuals visiting dentists regularly, a better knowledge of such methods would improve dental care for the majority of these patients. It would also help prevent aggravation of fears among individuals at risk. However, despite the success of treatment methods performed by specially trained dentists, it seems reasonable that there should be limits to what can be expected of a dentist in terms of psychological, diagnostic, and therapeutic competence. Dental phobia may constitute a complex psychological and odontological problem with far-reaching consequences for a relatively large proportion of fearful individuals. It therefore seems likely that optimal care of such patients can best be achieved by cross-disciplinary efforts involving both dentists and psychologists.

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

    Directory of Open Access Journals (Sweden)

    B. G. Dranitsyna

    2015-01-01

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

  7. Application of principal components analysis to long-term reservoir management

    Energy Technology Data Exchange (ETDEWEB)

    Saad, M.

    1988-07-01

    Determining the optimal long-term operating policy of a multi-reservoir power system requires solution of a stochastic nonlinear programming problem. For small systems, the solution can be found by dynamic programming, but for large systems no direct solution method exists at present, so recource to mathematical manipulations is required. A very efficient procedure for the case where high correlation exists between the state variables is presented. The procedure consists of performing principle components analysis on the trajectories to find a reduced model of the system. The reduced model is then substituted into the operating problem and the resulting problem is solved by stochastic dynamic programming. The reservoir trajectories on which principle components analysis are performed can be obtained by solving the operating problem deterministically for a large number of equally likely flow sequences. The results of applying the manipulation to Quebec's La Grande river, which has four reservoirs, are reported. A comparison with classical dynamic programming without any reduction is presented which demonstrates the efficiency of the principle components approach. 73 refs., 71 figs., 36 tabs.

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

    Science.gov (United States)

    Moran, Steven M.; Zak, Victor J.

    1996-01-01

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

  9. Management Communication Training: The Need for Long-Term Effectiveness Studies.

    Science.gov (United States)

    Mattox, Robert J.; Smith, Robert L.

    Currently, training programs for management are an integral part of most organizations. One of the concerns about training programs has been the lack of research supporting change in management training. Recently, counselors have become involved in Human Resources Management (HRM). Organizations have been criticized for making few attempts to…

  10. Management Communication Training: The Need for Long-Term Effectiveness Studies.

    Science.gov (United States)

    Mattox, Robert J.; Smith, Robert L.

    Currently, training programs for management are an integral part of most organizations. One of the concerns about training programs has been the lack of research supporting change in management training. Recently, counselors have become involved in Human Resources Management (HRM). Organizations have been criticized for making few attempts to…

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

    Energy Technology Data Exchange (ETDEWEB)

    2011-01-01

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

  12. The prevalence of uncontrolled pain in long-term care: a pilot study examining outcomes of pain management processes.

    Science.gov (United States)

    Good, Heidi; Riley-Doucet, Cheryl K; Dunn, Karen S

    2015-02-01

    Pain in long-term care (LTC) is common among older residents despite the vast options available for optimal pain management. Inadequate pain management affects individual health care outcomes. Researcher evidence has shown that nurse practitioners (NPs) improve the quality of care in LTC but are challenged by multiple barriers that inhibit optimal pain control. The purpose of the current pilot study was to explore both the pain management processes used by nurses in LTC and the documented patient outcomes that come from these processes. In addition, factors were identified that may impact the NP role in providing adequate pain control in LTC. This descriptive study used a retrospective, case-controlled research design that incorporated reviewing 55 LTC resident medical records. Results show how the process of pain management in LTC can be improved by expanding the professional role of the NP.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    The decline in organic matter of arable land, induced and accelerated by modern agriculture, has been identified as a threat to sustained soil quality. In this article, we studied strategies to counter this decrease by building up soil organic carbon (SOC) levels in the soils using several...... on preferential flow and loss of colloids during heavy irrigation events. The field sites were all under long-term management and therefore represent up to 30 years of pairwise different management strategies. One field in each field pair was managed with a more C-repleting strategy (HighC) than the other (Low......C). Only small differences in SOC contents were identified, and none of the management strategies had succeeded in building up SOC pools large enough to saturate the soil with C. Only at one field site was the content of water-dispersible colloids lower in the HighC than the LowC treatment. Preferential...

  14. Long-term outcomes for women versus men with unstable angina/non-ST-segment elevation myocardial infarction managed medically without revascularization

    DEFF Research Database (Denmark)

    Clemmensen, Peter; Roe, Matthew T.; Hochman, Judith S.;

    2015-01-01

    BACKGROUND: Women with acute coronary syndromes (ACS) are less likely to undergo invasive revascularization than men, but sex-specific differences in long-term outcomes and platelet reactivity among medically managed ACS patients remain uncertain. We examined sex-specific differences in long-term...

  15. The farmer as a landscape steward: Comparing local understandings of landscape stewardship, landscape values, and land management actions.

    Science.gov (United States)

    Raymond, Christopher M; Bieling, Claudia; Fagerholm, Nora; Martin-Lopez, Berta; Plieninger, Tobias

    2016-03-01

    We develop a landscape stewardship classification which distinguishes between farmers' understanding of landscape stewardship, their landscape values, and land management actions. Forty semi-structured interviews were conducted with small-holder (100 acres) in South-West Devon, UK. Thematic analysis revealed four types of stewardship understandings: (1) an environmental frame which emphasized the farmers' role in conserving or restoring wildlife; (2) a primary production frame which emphasized the farmers' role in taking care of primary production assets; (3) a holistic frame focusing on farmers' role as a conservationist, primary producer, and manager of a range of landscape values, and; (4) an instrumental frame focusing on the financial benefits associated with compliance with agri-environmental schemes. We compare the landscape values and land management actions that emerged across stewardship types, and discuss the global implications of the landscape stewardship classification for the engagement of farmers in landscape management.

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

    Science.gov (United States)

    Triantafillidis, John K; Malgarinos, George

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Triantafillidis JK

    2014-04-01

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

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

    Science.gov (United States)

    Rozenberg, J.

    2015-12-01

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

  19. Long-term sediment yield from small catchment in southern Brazil affected by land use and soil management changes.

    Science.gov (United States)

    Gomes Minella, Jean Paolo; Henrique Merten, Gustavo; Alessandra Peixoto de Barros, Claudia; Dalbianco, Leandro; Ramon, Rafael; Schlesner, Alexandre

    2015-04-01

    Soil erosion and sediment yield are the main cause of soil degradation in Brazil. Despite this, there is a lack of information about the effects of the soil management on the hydrology and sediment yield at catchment scale. This study aimed to investigate the long-term relationship between the land use and sediment yield in a small catchment with significant changes in soil management, and its impacts on soil erosion and sediment yield. To account the anthropogenic and climatic effects on sediment yield were monitored precipitation, stream flow and suspended sediment concentration during thirteen years (2002 and 2014) at 10 minutes interval and the changes that occurred each year in the land use and soil management. Despite the influence of climate on the sediment yield, the results clearly show three distinct periods affected by the land use and soil management changes during this this period. In the first four years (2002-2004) the predominant land use was the tobacco with traditional soil management, where the soils are plough every year and without winter cover crop. In this period the sediment yield reached the order of 160 t.ha-1.y-1. In the period of 2005-2009, a soil conservation program introduced the adoption of minimum tillage in the catchment and the sediment yield decrease to 70 t.ha-1.y-1. In the last period (2010-2014) there was a partial return to the traditional soil management practices with an increase trend in sediment yield. However, there was also an increase in reforestation areas with positive effect in reducing erosion and sediment yield. The magnitude order of sediment yield in this period was 100 t.ha-1.y-1. The long term sediment yield data was able to demonstrate the impact of the improved management practices in reducing soil erosion and sediment yield. The results allowed a good understanding of the changing sediment dynamics and soil erosion at catchment scale.

  20. Treatment Modalities and Antimicrobial Stewardship Initiatives in the Management of Intra-Abdominal Infections

    Science.gov (United States)

    Hoffmann, Charles; Zak, Matthew; Avery, Lisa; Brown, Jack

    2016-01-01

    Antimicrobial stewardship programs (ASPs) focus on improving the utilization of broad spectrum antibiotics to decrease the incidence of multidrug-resistant Gram positive and Gram negative pathogens. Hospital admission for both medical and surgical intra-abdominal infections (IAIs) commonly results in the empiric use of broad spectrum antibiotics such as fluoroquinolones, beta-lactam beta-lactamase inhibitors, and carbapenems that can select for resistant organisms. This review will discuss the management of uncomplicated and complicated IAIs as well as highlight stewardship initiatives focusing on the proper use of broad spectrum antibiotics. PMID:27025526

  1. Treatment Modalities and Antimicrobial Stewardship Initiatives in the Management of Intra-Abdominal Infections

    Directory of Open Access Journals (Sweden)

    Charles Hoffmann

    2016-02-01

    Full Text Available Antimicrobial stewardship programs (ASPs focus on improving the utilization of broad spectrum antibiotics to decrease the incidence of multidrug-resistant Gram positive and Gram negative pathogens. Hospital admission for both medical and surgical intra-abdominal infections (IAIs commonly results in the empiric use of broad spectrum antibiotics such as fluoroquinolones, beta-lactam beta-lactamase inhibitors, and carbapenems that can select for resistant organisms. This review will discuss the management of uncomplicated and complicated IAIs as well as highlight stewardship initiatives focusing on the proper use of broad spectrum antibiotics.

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

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2005-07-01

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

  3. The scenic impact of key forest attributes and long-term management alternatives for hardwood forests

    Science.gov (United States)

    R.G. Ribe

    1991-01-01

    The problem of identifying the scenic value of forest attributes and management plans is empirically explored. A sample of hardwood forests in Wisconsin, representing a diversity of management histories, is analyzed through photographs and field inventories. Scenic beauty judgements of the photographs by a diversity of respondents yield general scenic beauty estimates...

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

    Science.gov (United States)

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

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

    NARCIS (Netherlands)

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

    2013-01-01

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

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

    NARCIS (Netherlands)

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

    2013-01-01

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

  7. NOAA's Scientific Data Stewardship Program

    Science.gov (United States)

    Bates, J. J.

    2004-12-01

    The NOAA mission is to understand and predict changes in the Earth's environment and conserve and manage coastal and marine resources to meet the Nation's economic, social and environmental needs. NOAA has responsibility for long-term archiving of the United States environmental data and has recently integrated several data management functions into a concept called Scientific Data Stewardship. Scientific Data Stewardship a new paradigm in data management consisting of an integrated suite of functions to preserve and exploit the full scientific value of NOAA's, and the world's, environmental data These functions include careful monitoring of observing system performance for long-term applications, the generation of authoritative long-term climate records from multiple observing platforms, and the proper archival of and timely access to data and metadata. NOAA has developed a conceptual framework to implement the functions of scientific data stewardship. This framework has five objectives: 1) develop real-time monitoring of all satellite observing systems for climate applications, 2) process large volumes of satellite data extending up to decades in length to account for systematic errors and to eliminate artifacts in the raw data (referred to as fundamental climate data records, FCDRs), 3) generate retrieved geophysical parameters from the FCDRs (referred to as thematic climate data records TCDRs) including combining observations from all sources, 4) conduct monitoring and research by analyzing data sets to uncover climate trends and to provide evaluation and feedback for steps 2) and 3), and 5) provide archives of metadata, FCDRs, and TCDRs, and facilitate distribution of these data to the user community. The term `climate data record' and related terms, such as climate data set, have been used for some time, but the climate community has yet to settle on a concensus definition. A recent United States National Academy of Sciences report recommends using the

  8. Angling into the Future: Ten Commandments for Recreational Fisheries Science, Management, and Stewardship in a Good Anthropocene

    Science.gov (United States)

    Elmer, Laura K.; Kelly, Lisa A.; Rivest, Stephanie; Steell, S. Clay; Twardek, William M.; Danylchuk, Andy J.; Arlinghaus, Robert; Bennett, Joseph R.; Cooke, Steven J.

    2017-08-01

    A new geological epoch, the "Anthropocene", has been defined as the period in which humans have had substantial geological and ecological influence on the planet. A positive future for this epoch can be referred to as the "good Anthropocene" and would involve effective management strategies and changes in human behavior that promote the sustainability and restoration of ecosystems. Recreational fisheries hold significant social, cultural, and economic value and can generate many benefits when managed sustainably and thus be an integral part of a "good Anthropocene". Here, we list ten commandments to facilitate persistence and long-term sustainability of recreational fisheries in the "good Anthropocene". This list includes fostering aquatic stewardship, promoting education, using appropriate capture gear, adopting evidence-based management approaches, promoting the concept of resilience, obtaining and using effort data in management, embracing the ecosystem approach, engaging in multilevel collaboration, enhancing accessibility, and embracing optimism. When used singly, or simultaneously, these ten commandments will contribute to the harmonization of sustainable fish populations and angling practices, to create recreational fisheries' "bright spots".

  9. Management of complicated ureteroceles: Different modalities of treatment and long-term outcome

    Directory of Open Access Journals (Sweden)

    Sujit K Chowdhary

    2014-01-01

    Full Text Available The presentation and management of ureterocele has been rarely reported from India and is limited to an odd case report. They can be detected antenatally, may have incidental diagnosis or present with consequences of obstructive uropathy. They always present with secondary complications in adulthood, if the diagnosis and treatment is missed in early years of life. The natural history may be particularly disastrous in cases of bilateral obstructing ureterocele. The complications secondary to obstructive ureterocele can be urinary retention, pyonephrosis, urosepsis, stones and even chronic renal failure. Each of these patients needs an individualized treatment plan. In the period 2003-2013, we managed 36 consecutive patients with varied presentation of this entity. All were managed on the basis of a fixed protocol of investigation and operative intervention. Ultrasound, micturating cystourethrogram, isotope renogram were done preoperatively in all the babies. Those with asymptomatic, unobstructed ureteroceles were left without any intervention. Simple or complex intravesical ureteroceles underwent examination under anesthesia and endoscopic deroofing and DJ stenting for 3 weeks. Of a total of 36 children, 6 were presented with acute complications of ureterocele. They have been managed on an individualized optimum management plan. Their management approach with follow-up is being reported as there is no previous reported series on ureterocele in children from our country.

  10. Specialist Community Nurses: A Critical Analysis of Their Role in the Management of Long-Term Conditions

    Directory of Open Access Journals (Sweden)

    Karen A. Luker

    2009-09-01

    Full Text Available The aim of this narrative review is to identify strategies in use by specialist community and public health nurses in the prevention, care and management of individuals with long-term conditions, specifically chronic obstructive pulmonary disease (COPD and musculoskeletal disorders. These conditions have been selected as they are highly prevalent; a burden on health services globally and a major public health issue. From a UK policy perspective, specialist community nurses have been placed at the forefront of taking a lead role in the coordination and delivery of more responsive services for individuals with long-term conditions; whether this has been an effective use of skills and resource is questionable. We systematically searched relevant databases between 1999–2009 to identify interventions used by specialist community nurses and critically appraised the studies. This review reports on impact and value of interventions used by specialist community nurses in the prevention and management of COPD and musculoskeletal conditions, and makes recommendations for improving services.

  11. Management of Facial Nerve in Surgical Treatment of Previously Untreated Fisch Class C Tympanojugular Paragangliomas: Long-Term Results

    Science.gov (United States)

    Bacciu, Andrea; Ait Mimoune, Hassan; D'Orazio, Flavia; Vitullo, Francesca; Russo, Alessandra; Sanna, Mario

    2013-01-01

    The aim of this study was to evaluate the long-term facial nerve outcome according to management of the facial nerve in patients undergoing surgery for Fisch class C tympanojugular paragangliomas. The study population consisted of 122 patients. The infratemporal type A approach was the most common surgical procedure. The facial nerve was left in place in 2 (1.6%) of the 122 patients, anteriorly rerouted in 97 (79.5%), anteriorly rerouted with segmental resection of the epineurium in 7 (5.7%), and sacrificed and reconstructed in 15 (12.3%). One patient underwent cross-face nerve grafting. At last follow-up, House-Brackmann grade I to II was achieved in 51.5% of patients who underwent anterior rerouting and in 28.5% of those who underwent anterior rerouting with resection of the epineurium. A House-Brackmann grade III was achieved in 73.3% of patients who underwent cable nerve graft interposition. The two patients in whom the facial nerve was left in place experienced grade I and grade III, respectively. The patient who underwent cross-face nerve grafting had grade III. Gross total resection was achieved in 105 cases (86%). Management of the facial nerve in tympanojugular paraganglioma surgery can be expected to ensure satisfactory facial function long-term outcome. PMID:24498582

  12. Soil phosphorus depletion and shifts in plant communities change bacterial community structure in a long-term grassland management trial.

    Science.gov (United States)

    Adair, Karen L; Wratten, Steve; Lear, Gavin

    2013-06-01

    Agricultural systems rely on healthy soils and their sustainability requires understanding the long-term impacts of agricultural practices on soils, including microbial communities. We examined the impact of 17 years of land management on soil bacterial communities in a New Zealand randomized-block pasture trial. Significant variation in bacterial community structure related to mowing and plant biomass removal, while nitrogen fertilizer had no effect. Changes in soil chemistry and legume abundance described 52% of the observed variation in the bacterial community structure. Legumes (Trifolium species) were absent in unmanaged plots but increased in abundance with management intensity; 11% of the variation in soil bacterial community structure was attributed to this shift in the plant community. Olsen P explained 10% of the observed heterogeneity, which is likely due to persistent biomass removal resulting in P limitation; Olsen P was significantly lower in plots with biomass removed (14 mg kg(-1) ± 1.3SE) compared with plots that were not mown, or where biomass was left after mowing (32 mg kg(-1) ± 1.6SE). Our results suggest that removal of plant biomass and associated phosphorus, as well as shifts in the plant community, have greater long-term impacts on soil bacterial community structure than application of nitrogen fertilizers.

  13. Projected long-term response of Southeastern birds to forest management

    Science.gov (United States)

    Mitchell, M.S.; Reynolds-Hogland, M. J.; Smith, M.L.; Wood, P.B.; Beebe, J.A.; Keyser, P.D.; Loehle, C.; Reynolds, C.J.; Van Deusen, P.; White, D.

    2008-01-01

    Numerous studies have explored the influence of forest management on avian communities empirically, but uncertainty about causal relationships between landscape patterns and temporal dynamics of bird communities calls into question how observed historical patterns can be projected into the future, particularly to assess consequences of differing management alternatives. We used the Habplan harvest scheduler to project forest conditions under several management scenarios mapped at 5-year time steps over a 40-year time span. We used empirical models of overall avian richness, richness of selected guilds, and probability of presence for selected species to predict avian community characteristics for each of the mapped landscapes generated for each 5-year time step for each management scenario. We then used time series analyses to quantify relationships between changes in avian community characteristics and management-induced changes to forest landscapes over time. Our models of avian community and species characteristics indicated habitat associations at multiple spatial scales, although landscape-level measures of habitat were generally more important than stand-level measures. Our projections showed overall avian richness, richness of Neotropical migrants, and the presence of Blue-gray Gnatcatchers and Eastern Wood-pewees varied little among management scenarios, corresponding closely to broad, overall landscape changes over time. By contrast, richness of canopy nesters, richness of cavity nesters, richness of scrub-successional associates, and the presence of Common Yellowthroats showed high temporal variability among management scenarios, likely corresponding to short-term, fine-scale changes in the landscape. Predicted temporal variability of both interior-forest and early successional birds was low in the unharvested landscape relative to that in the harvested landscape. Our results also suggested that early successional species can be sensitive to both

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

    Directory of Open Access Journals (Sweden)

    Ajai Singh

    2011-01-01

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

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

    NARCIS (Netherlands)

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

    2014-01-01

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

  16. Climate Change and Long-Term Fire Management Impacts on Australian Savanna

    Science.gov (United States)

    Scheiter, S.; Higgins, S. I.; Beringer, J.; Hutley, L. B.

    2014-12-01

    Tropical savannas cover a large proportion of the Earth's land surface and many people are dependent on the ecosystem services that savannas supply. Their sustainable management is therefore crucial. Due to the complexity of vegetation dynamics, the impacts of climate change and land use on savannas are highly uncertain. Here, we use a dynamic vegetation model, the aDGVM, to project how climate change and fire management influence vegetation in northern Australian savannas in 2100. We show that under future climate conditions, vegetation can store more carbon than under ambient conditions, despite substantial changes in fire regimes. Changes in rainfall seasonality influence future carbon storage but do not turn vegetation into a carbon source, suggesting that CO2 fertilization is the main driver of vegetation change. The application of prescribed fires with varying return intervals and burning season, influences vegetation dynamics and fire induced carbon and greenhouse gas emissions. Carbon sequestration is maximized with early dry season fires and long fire return intervals, grass productivity is maximized with late dry season fires at an intermediate fire return intervals. The study has implications for management policy across Australian savannas because it can contribute to identifying fire management strategies that optimize grazing yield, carbon sequestration and greenhouse gas emissions. This knowledge is crucial to maintain important ecosystem services of Australian savannas.

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

    NARCIS (Netherlands)

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

    2008-01-01

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

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    Soil aggregate properties, such as strength, shape and porosity, influence a range of essential soil functions and there is a need for more detailed understanding of the effect of soil management on these aggregate properties. There is also a need for improved knowledge on the link between aggreg...

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

    NARCIS (Netherlands)

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

    2008-01-01

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

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

    NARCIS (Netherlands)

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

    2008-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Gilly eKoritzky

    2015-12-01

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

  2. Change management and partnership: achieving a solution to provide peritoneal dialysis in a long-term care setting.

    Science.gov (United States)

    Yang, Charlie; Campbell, Jill

    2009-01-01

    Health care organizations must respond quickly to today's volatile and changing environment. This article describes how St. Michael's Hospital (acute care hospital) and the Drs. Paul and John Rekai Centre (long-term care facility) collaborated to use an innovative approach to address pressures of change affecting peritoneal dialysis (PD) care delivery for the elderly. The collaborative applied Galpin's (1996) nine-stage Change Management Model to implement the organizational change. Both organizations generated a shared vision to improve timely access to nursing homes for patients requiring both placement and ongoing peritoneal dialysis. They analyzed their current status and committed resources for the collaboration. Both organizations generated general and detailed recommendations for PD care delivery processes. A pilot was implemented and refinement of the collaboration occurred prior to formal roll out. This application of a change management model to establish organizational partnership may be of interest to those seeking to establish similar collaborations.

  3. DENTAL MANAGEMENT AND BLEEDING COMPLICATIONS OF PATIENTS ON LONG-TERM ORAL ANTIPLATELET THERAPY. REVIEW OF EXISTING STUDIES AND GUIDELINES.

    Directory of Open Access Journals (Sweden)

    Atanaska Dinkova

    2013-06-01

    Full Text Available Antiplatelet drugs are currently widely used in primary and especially secondary prevention of cardiovascular events. Dental management of patients on antiplatelet therapy is still not clearly defined: the discontinuation of antiplatelet therapy increases the risk of thrombotic complications, whereas uninterrupted antiplatelet therapy is assumed to increase the bleeding complications after dental surgical procedures. The aim of this article is to review the main antiplatelet drugs used for long-term oral antiplatelet therapy, the laboratory methods for evaluating effectiveness of this therapy, to identify the studies and guidelines available for dental management of patients on antiplatelet drugs and to summarize their conclusions and recommendations.The methodology used through the research for the literature review includes the following sources: Medscape, Pubmed - Medline database, Science Direct, and EBSCO host, the data base of Medical University Plovdiv and specialised published books in general medicine and dentistry.

  4. The surgical management of urogenital tuberculosis our experience and long-term follow-up

    OpenAIRE

    Punit Bansal; Neeru Bansal

    2015-01-01

    Introduction: Urogenital tuberculosis (TB) is common in developing countries. We present our experience of surgically managed cases of genitourinary TB (GUTB). Materials and Methods: We retrospectively reviewed 60 cases GUTB who underwent surgery at our center from January 2003 to January 2010. Mode of presentation, organ involvement, investigation, surgical treatment and follow-up were studied. Results: There were 38 males and 22 females with a mean age of 32.5 years. The most common...

  5. Long-Term Response of Groundwater Nitrate Concentrations to Management Regulations in Nebraska's Central Platte Valley

    Directory of Open Access Journals (Sweden)

    Mary E. Exner

    2010-01-01

    Full Text Available The impact of 16 years (1988–2003 of management practices on high groundwater nitrate concentrations in Nebraska's central Platte River valley was assessed in a 58,812-ha (145,215-ac groundwater quality management area intensively cropped to irrigated corn (Zea mays L.. Crop production and groundwater nitrate data were obtained from ~23,800 producer reports. The terrace, comprising ~56% of the study area, is much more intensively cropped to irrigated corn than the bottomland. From 1987 to 2003, average groundwater nitrate concentrations in the primary aquifer beneath the bottomland remained static at ~8 mg N/l. During the same period, average groundwater nitrate concentrations in the primary aquifer beneath the terrace decreased from 26.4 to 22.0 mg N/l at a slow, but significant (p < 0.0001, rate of 0.26 mg N/l/year. Approximately 20% of the decrease in nitrate concentrations can be attributed to increases in the amount of N removed from fields as a consequence of small annual increases in yield. During the study, producers converted ~15% of the ~28,300 furrow-irrigated terrace hectares (~69,800 ac to sprinkler irrigation. The conversion is associated with about an additional 50% of the decline in the nitrate concentration, and demonstrates the importance of both improved water and N management. Average N fertilizer application rates on the terrace were essentially unchanged during the study. The data indicate that groundwater nitrate concentrations have responded to improved management practices instituted by the Central Platte Natural Resources District.

  6. Sustainable Confined Disposal Facilities for Long-term Management of Dredged Material

    Science.gov (United States)

    2010-07-01

    Availability of adjacent lands may limit lateral expansion and foundation stability may limit vertical expansion. ERDC TN-DOER-D10 July 2010...cofferdams and vertical sheet pile retaining wall structures and soil-cement mixing. Managing to Minimize In-CDF Volume. When sediments are removed...580, 106 Stat. 4797, 33 U.S.C. 2201 et seq. 4. Agriculture, Forestry, Horticulture , and Aquaculture: Using dredged material to replace eroded

  7. Long-term impact of farm management and crops on soil microorganisms assessed by combined DGGE and PLFA analyses

    Directory of Open Access Journals (Sweden)

    Fabio eStagnari

    2014-12-01

    Full Text Available In the present study, long-term organic and conventional managements were compared at the experimental field of Monsampolo del Tronto (Marche region, Italy with the aim of investigating soil chemical fertility and microbial community structure. A polyphasic approach, combining soil fertility indicators with microbiological analyses (plate counts, PCR-denaturing gradient gel electrophoresis [DGGE] and phospholipid fatty acid analysis [PLFA] was applied. Organic matter, N as well as some important macro and micronutrients (K, P, Mg, Mn, Cu and Zn for crop growth, were more available under organic management. Bacterial counts were higher in organic management. A significant influence of management system and management x crop interaction was observed for total mesophilic bacteria, nitrogen fixing bacteria and actinobacteria. Interestingly, cultivable fungi were not detected in all analyzed samples. PLFA biomass was higher in the organic and Gram positive bacteria dominated the microbial community in both systems. Even if fungal biomass was higher in organic management, fungal PCR-DGGE fingerprinting revealed that the two systems were very similar in terms of fungal species suggesting that 10 years were not enough to establish a new dynamic equilibrium among ecosystem components. A better knowledge of soil biota and in particular of fungal community structure will be useful for the development of sustainable management strategies.

  8. Predicting survival in pulmonary arterial hypertension: insights from the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL)

    National Research Council Canada - National Science Library

    Benza, Raymond L; Miller, Dave P; Gomberg-Maitland, Mardi; Frantz, Robert P; Foreman, Aimee J; Coffey, Christopher S; Frost, Adaani; Barst, Robyn J; Badesch, David B; Elliott, C Gregory; Liou, Theodore G; McGoon, Michael D

    2010-01-01

    .... A quantitative survival prediction tool has not been established for research or clinical use. Data from 2716 patients with PAH enrolled consecutively in the US Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL...

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

    Data.gov (United States)

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

  10. Efficacy of a Conservative Weight Loss Program in the Long-Term Management of Chronic Upper Airway Obstruction

    Directory of Open Access Journals (Sweden)

    Ryan C. Case

    2009-01-01

    Full Text Available Objective. Obesity is a significant contributor to oxygen demand and dynamic airway obstruction. The objective of the current study is to determine the long-term success of conservative measures directed toward weight reduction on airway management without respect to specific airway disease etiology. Methods. Patients with chronic airway obstruction secondary anatomic lesions or obstructive sleep apnea were recruited and followed prospectively. Demographics, initial and final weights, diagnosis, and followup information were recorded. Patients were referred to a registered dietician, provided counseling, and started on a weight-loss regimen. Outcome measures were change in body mass index (BMI and rate of decannulation from weight loss alone. Results. Of fourteen patients, ten remained tracheostomy-dependent and four had high-grade lesions with the potential for improvement in oxygen demand and dynamic airway collapse with weight loss. The mean follow up period was 25 months. The mean change in BMI was an increase of 1.4 kg/m2 per patient. Conclusions. Conservative measures alone were not effective in achieving weight reduction in the population studied. This may be due to comorbid disease and poor compliance. The promise of decannulation was an insufficient independent motivator for weight loss in this study. Although the theoretical benefits of weight loss support its continued recommendation, the long-term success rate of conservative measures is low. More aggressive facilitated interventions including pharmacotherapy or bariatric surgery should be considered early in the course of treating airway disease complicated by obesity.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2017-02-01

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

  12. Hemiacidrin irrigation in the management of struvite calculi: long-term results.

    Science.gov (United States)

    Sant, G R; Blaivas, J G; Meares, E M

    1983-12-01

    Renacidin (10 per cent hemiacidrin) irrigation has been used in the management of renal struvite calculi in 25 patients. Of these patients 22 were free of stone after irrigation: 16 after dissolution of residual stone fragments postoperatively, 4 after prophylactic postoperative irrigation and 2 after primary, nonsurgical percutaneous dissolution. Recurrent urinary tract infections owing to the original urease-producing bacteria occurred in 14 per cent of these patients and recurrent nephrolithiasis occurred in 9 per cent during an average followup period of 66 months.

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

    Energy Technology Data Exchange (ETDEWEB)

    1992-03-01

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

  14. SERDP and ESTCP Workshop on Long Term Management of Contaminated Groundwater Sites

    Science.gov (United States)

    2013-11-01

    attenuation EACO Enhanced Attenuation: Chlorinated Organics EDB ethylene dibromide EI/EC Emerging Issues and Emerging Contaminants ESTCP Environmental...Plumes of Chlorinated Ethylenes Frank Schwartz (The Ohio State University) 1685-09 Coupled Diffusion & Reaction Processes in Rock Matrices...Potential Impact of Changes in the Toxicity and Regulatory Standards of  Chlorinated  Solvents on Long Term Site Management, Remediation Efficiency and Cost

  15. Conservative surgical management of in situ subungual melanoma: long-term follow-up*

    Science.gov (United States)

    Anda-Juárez, Mariana Catalina De; Martínez-Velasco, María Abril; Fonte-Ávalos, Verónica; Toussaint-Caire, Sonia; Domínguez-Cherit, Judith

    2016-01-01

    Subungual melanoma represents 20% of all melanomas in Hispanic population. Here, we report the outcome of 15 patients with in situ subungual melanoma treated with resection of the nail unit with a 5-mm margin without amputation, followed up for 55.93 ± 43.08 months. The most common complications included inclusion cysts and nail spicules. We found no evidence of local or distant recurrences at the last visit of our follow up. Functional outcome was good, with only one patient reporting persistent mild pain. These results support functional, non-amputative surgical management of in situ subungual melanomas. PMID:28099619

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

    Science.gov (United States)

    Heller, Sebastian; Müller, Jürgen; Kayser, Manfred

    2017-04-01

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

  17. Long-term effects of soil management on ecosystem services and soil loss estimation in olive grove top soils.

    Science.gov (United States)

    Parras-Alcántara, Luis; Lozano-García, Beatriz; Keesstra, Saskia; Cerdà, Artemi; Brevik, Eric C

    2016-11-15

    Soil management has important effects on soil properties, runoff, soil losses and soil quality. Traditional olive grove (OG) management is based on reduced tree density, canopy size shaped by pruning and weed control by ploughing. In addition, over the last several decades, herbicide use has been introduced into conventional OG management. These management strategies cause the soil surface to be almost bare and subsequently high erosion rates take place. To avoid these high erosion rates several soil management strategies can be applied. In this study, three strategies were assessed in OG with conventional tillage in three plots of 1ha each. Soil properties were measured and soil erosion rates were estimated by means of the RUSLE model. One plot was managed with no amendments (control), and the other two were treated with olive leaves mulch and oil mill pomace applied yearly from 2003 until 2013. The control plot experienced the greatest soil loss while the use of olive leaves as mulch and olive mill pomace as an amendment resulted in a soil loss reduction of 89.4% and 65.4% respectively (assuming a 5% slope). In addition, the chemical and physical soil properties were improved with the amendments. This combined effect will created a higher quality soil over the long term that it is more resilient to erosion and can provide better ecosystem services, as its functions are improved.

  18. Long-term environmental drivers of DOC fluxes: Linkages between management, hydrology and climate in a subtropical coastal estuary

    Science.gov (United States)

    Regier, Peter; Briceño, Henry; Jaffé, Rudolf

    2016-12-01

    Urban and agricultural development of the South Florida peninsula has disrupted historic freshwater flow in the Everglades, a hydrologically connected ecosystem stretching from central Florida to the Gulf of Mexico, USA. Current system-scale restoration efforts aim to restore natural hydrologic regimes to reestablish pre-drainage ecosystem functioning through increased water availability, quality and timing. Aquatic transport of carbon in this ecosystem, primarily as dissolved organic carbon (DOC), plays a critical role in biogeochemical cycling and food-web dynamics, and will be affected both by water management policies and climate change. To better understand DOC dynamics in South Florida estuaries and how hydrology, climate and water management may affect them, 14 years of monthly data collected in the Shark River estuary were used to examine DOC flux dynamics in a broader environmental context. Multivariate statistical methods were applied to long-term datasets for hydrology, water quality and climate to untangle the interconnected environmental drivers that control DOC export at monthly and annual scales. DOC fluxes were determined to be primarily controlled by hydrology but also by seasonality and long-term climate patterns and episodic weather events. A four-component model (salinity, rainfall, inflow, Atlantic Multidecadal Oscillation) capable of predicting DOC fluxes (R2 = 0.84, p < 0.0001, n = 155) was established and applied to potential climate change scenarios for the Everglades to assess DOC flux response to climate and restoration variables. The majority of scenario runs indicated that DOC export from the Everglades is expected to decrease due to future changes in rainfall, water management and salinity.

  19. Temporomandibular joint osteoarthritis: diagnosis and long-term conservative management: a topic review.

    Science.gov (United States)

    Kalladka, Mythili; Quek, Samuel; Heir, Gary; Eliav, Eli; Mupparapu, Muralidhar; Viswanath, Archana

    2014-03-01

    Degenerative joint disease (DJD), a common osteoarthritic problem encountered in clinical practice presents as a chronic debilitating disease resulting in altered joint structure due to degradation and loss of articular cartilage, along with changes in the subchondral bone and other soft tissues. DJD is a frequent finding in the Temporomandibular joints (TMJs). Consequently, a good understanding of the use of a diagnostic algorithm will lead to a better control of DJD in the TMJ. The etiopathogenesis of osteoarthritis is complex, and it is associated with multiple risk factors. The condition progresses slowly through different phases with periods of remission and activity finally reaching the burnout phase. Conservative management forms the cornerstone for the treatment of most of these cases. This review attempts to acquaint the dentist with the diagnosis, pathogenesis and general characteristics of the disease while highlighting and updating them with the current conservative treatment algorithms in order to assist in the formulation of a treatment plan for these patients.

  20. RENAL DUPLEX SYSTEM IN PEDIATRIC POPULATION: MANAGEMENT AND LONG-TERM FOLLOW-UP

    Directory of Open Access Journals (Sweden)

    F. Scipioni

    2012-08-01

    Full Text Available Duplex system is a duplication of renal parenchyma, pelvis and collecting system. It could be complete, if ureters lead to bladder separately or incomplete, if they joint before coming out. This study aims duplex system management evaluation, defining indications of conservative or demolitive therapy, and results. Materials and methods. At the section of pediatric surgery of University of Siena we have observed 27 patients with duplex system from January 1980 to May 2011: 7 male (26% and 20 female (74%, 18 (67% with complete duplicity, 9 (33% with incomplete one. Patients were divided into 2 groups: the first one was composed by 12 children (44%, they had negative diagnostic exams for alterations of renal function and associated diseases and no symptoms;the second group had 15 children (56% whose diagnostic-therapeutic iter was based on associated malformations and symptoms of each case. We found: 5 RVU (33% with 1 Hutch diverticulum; 5 ureteroceles (33%; 3 ectopic ureters (20%; 4 megaureters (26%, 6 renal dysplasia and upper pole function <10% (40%. Results. Children belonging to second group were treated in different ways. 5 babies (33% with RVU were approached with submeatal infiltration; 1 baby (7% with ureterocele was treated with excision of the malformation and Cohen reimplatation; 2 ureteroceles (13% were incised by transurethral approach and RVU appeared, 1 of them was then treated with eminephroureterectomy; in 1 case of ureterocele (7%and 1 of ectopic ureter (7% no treatment was undertaken and 1 baby with ureterocele (7% needed eminephoureterectomy; 4 kidneys (26% with upper pole impaired function required em- inephroureterectomy. All second group patients, except 3, had a 2-16 years follow-up and they showed normal growth and no symptoms. First group children had negative exams and excellent clinic conditions. Conclusions. Our results suggest that management should be decided on patient’s age, clinic presentation and associated

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

    Science.gov (United States)

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

    2016-04-01

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

  2. Acromegaly: the disease, its impact on patients, and managing the burden of long-term treatment

    Directory of Open Access Journals (Sweden)

    Adelman DT

    2013-01-01

    Full Text Available Daphne T Adelman1, Karen JP Liebert2, Lisa B Nachtigall2, Michele Lamerson3, Bert Bakker31Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, 2Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, 3Endocrinology Medical Affairs, Ipsen Biopharmaceuticals, Inc, Basking Ridge, NJ, USAAbstract: Acromegaly is a rare disease most often caused by the prolonged secretion of excess growth hormone from a pituitary adenoma. The disease is associated with multiple significant comorbidities and increased mortality. The delay to diagnosis is often long. This may be because of low disease awareness among health care professionals, the insidious onset of differentiating features, and because patients are likely to present with complaints typical of other conditions more frequently seen in primary care. Early identification of acromegaly facilitates prompt treatment initiation and may minimize the permanent effects of excess growth hormone. The primary treatment for many patients will be pituitary surgery, although not all patients will be eligible for surgery or achieve a surgical cure. If biochemical control is not achieved following surgery, other treatment options include medical therapy and radiation therapy. Improved biochemical control may only alleviate rather than reverse the associated comorbidities. Thus, lifelong monitoring of patient health is needed, with particular attention to the management of cardiovascular risk factors. It is additionally important to consider the impact of both disease and treatment on patients' quality of life and minimize that impact where possible, but particularly for chronic therapies. For the majority of patients, chronic therapy is likely to include somatostatin analog injections. In some circumstances, it may be possible to extend the dosing interval of the analog once good biochemical control is achieved. Additional convenience

  3. Management attitudes and technology adoption in long-term care facilities.

    Science.gov (United States)

    Bezboruah, Karabi C; Paulson, Darla; Smith, Jason

    2014-01-01

    The purpose of this paper is to explore the attitudes of nursing home administrators and key managerial staff toward health information technology (health IT). This research is exploratory in nature, and applies qualitative case-study methodology to further understand health IT adoption by nursing homes through multiple in-depth semi-structured interviews of management, and direct observations of employee behavior at each participating facility. A modified Technology Acceptance Model is used to examine the attitudes and perceptions of administrators. This study finds that there are differences in the level of health IT adoption by nursing homes. While some administrators are aware of health IT and are implementing or updating their IT systems in a gradual but haphazard manner, others exhibited a lack of interest in implementing change. Overall, there is a lack of systematic planning and decision-making toward health IT adoption. Adoption is not evidence-based, instead driven primarily by real and perceived regulatory requirements combined with a lack of information about, or consideration of, the real costs and benefits of implementing health IT. Including six in-depth case studies, the sample for this study is small for generalizing the findings. Yet, it contributes to the literature on the slow process of health IT adoption by nursing homes. Moreover, the findings provide guidelines for future research. This study demonstrates that nursing home administrators must systematically plan the adoption of health IT, and such decision making should be evidenced-based and participatory so that employees can voice their opinions that could prevent future resistance. This study is original and advances knowledge on the reasons for the slow adoption of health IT in nursing homes. It finds that lack of adequate information regarding the utility and benefits of health IT in management adoption decisions can result in haphazard implementation or no adoption at all. This

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

    Science.gov (United States)

    Kishore, Kamal

    2016-01-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Elisabeth Schauppenlehner-Kloyber

    2016-07-01

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

  7. Long-term monitoring of UK river basins: the disconnections between the timescales of hydrological processes and watershed management planning

    Science.gov (United States)

    Howden, N. J. K.; Burt, T.; Worrall, F.

    2016-12-01

    The UK has a wealth of hydrological monitoring data that has both good coverage in space since the early 1970s, and also a few locations where records have been kept continuously for almost 150 years. Such datasets offer unique opportunities for the hydrologist to consider how the concepts of stationarity, change, and definitions of "baseline" resources should be used to shape how we build models of these systems, and how we devise appropriate and sustainable watershed management strategies. In this paper we consider some of the UK's longest hydrological and biogeochemical records, to explore how long records can be used to shape such understanding and, in some cases, how they can be used to identify new modes of behaviour that need to be incorporated into management planning, from the scale of individual watersheds right up to the national scale. We also consider how key timescales of hydrological responses that are evident within the data may pose major problems for watershed management unless appropriate attention is paid to the potential impacts of processes that work over decadal timescales - much longer than sub-decadal water industry investment cycles or short-term projects for watershed management planning. We use our long-term records to show how key processes can be identified, and to illustrate how careful interpretation of shorter term records will improve decision-making for water resource management.

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

    Science.gov (United States)

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

    2015-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Kamal Kishore

    2016-09-01

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

  10. Long-term outcome of operative management of delayed acetabular fractures

    Institute of Scientific and Technical Information of China (English)

    ZHU Shi-wen; SUN Xu; YANG Ming-hui; LI Yu-neng; ZHAO Chun-peng; WU Hong-hua; CAO Qi-yong

    2013-01-01

    Background Surgical treatment of acetabular fracture has long been a challenging area in the field of orthopedic trauma.The aim of this research was to investigate the operative methods for delayed acetabular fractures and to assess the operation results.Methods The operative approaches,procedures,results,and complications of the delayed acetabular fractures between 1995 and 2005 were retrospectively evaluated at Beijing Jishuitan Hospital.Quality of life was assessed for each patient with the Merle d'Aubingne and Postel fracture function rating scale and the radiological result was assessed using the Matta radiological score.Results Sixty-eight cases (70 hips) were followed up with a minimal duration of five years (average of 5.8 years).Excellent functional results were observed in 10 hip joints,good results in 40,fair results in 11,and poor results in nine.The risks of poor prognosis include impact fracture or osteochondral fracture of femoral head,a time beyond 42 days from injury to operative management,and dislocation of femoral head during the injury.Some of the problems,which were observed included postoperative infection in two hips,iatrogenic sciatic nerve injury in eight hips,traumatic arthritis in 15 hips,heterotopic ossification in 17 hips,and necrosis of the femoral head in six hips.Conclusion A careful selection of operative indications for delayed acetabular fractures in combination with a proper ooerative aPProach and appropriate reduction and fixation could guarantee relatively good results.

  11. Reforming Management of Behavior Symptoms and Psychiatric Conditions in Long-Term Care Facilities: A Different Perspective.

    Science.gov (United States)

    Levenson, Steven A; Desai, Abhilash K

    2017-02-24

    Despite much attention including national initiatives, concerns remain about the approaches to managing behavior symptoms and psychiatric conditions across all settings, including in long-term care settings such as nursing homes and assisted living facilities. One key reason why problems persist is because most efforts to "reform" and "correct" the situation have failed to explore or address root causes and instead have promoted inadequate piecemeal "solutions." Further improvement requires jumping off the bandwagon and rethinking the entire issue, including recognizing and applying key concepts of clinical reasoning and the care delivery process to every situation. The huge negative impact of cognitive biases and rote approaches on related clinical problem solving and decision making and patient outcomes also must be addressed.

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

    Science.gov (United States)

    Khayat, Mohammad G.; Kempler, Steven J.

    2015-01-01

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

  13. Long-Term Monitoring Research Needs: A DOE Perspective

    Science.gov (United States)

    Moore, B.; Davis, C. B.

    2002-05-01

    The U.S. Department of Energy's Office of Environmental Management is responsible for dealing with the nation's legacy of Cold War radioactive and hazardous waste and contamination. Major efforts are underway to deal with this legacy; these are expected to last up to decades and cost up to billions of dollars at some sites. At all sites, however, active remediation must eventually cease; if hazards then remain, the site must enter into a long-term stewardship mode. In this talk we discuss aspects of long-term monitoring pertinent to DOE sites, focusing on challenges to be faced, specific goals or targets to be met, and research needs to be addressed in order to enable DOE to meet its long-term stewardship obligations. DOE LTM research needs fall into three major categories: doing what we can do now much more efficiently; doing things we cannot do now; and proving the validity of our monitoring programs. Given the enormity of the DOE obligations, it will be highly desirable to develop much more efficient monitoring paradigms. Doing so will demand developing autonomous, remote monitoring networks of in situ sensors capable of replacing (or at least supplementing to a large extent) conventional groundwater and soil gas sampling and analysis programs. The challenges involved range from basic science (e.g., inventing in situ sensors for TCE that do not demand routine maintenance) to engineering (attaining superior reliability in data reporting in remote networks) to ergonomics (developing decent ways of selecting and presenting the "right" information from the monitoring network) to regulatory affairs (presenting convincing evidence that the more efficient systems actually provide superior monitoring). We explore these challenges in some detail, focusing on the "long" in long-term monitoring as it applies to DOE sites. Monitoring system performance validation and, ultimately, regulator and stakeholder acceptance of site closure and long-term stewardship plans depend

  14. Pain Management Programmes for Non-English-Speaking Black and Minority Ethnic Groups With Long-Term or Chronic Pain.

    Science.gov (United States)

    Burton, A E; Shaw, R L

    2015-12-01

    Increasing ethnic diversity in the UK means that there is a growing need for National Health Service care to be delivered to non-English-speaking patients. The aims of the present systematic review were to: (1) better understand the outcomes of chronic pain management programmes (PMPs) for ethnic minority and non-English-speaking patients and (2) explore the perspectives on and experiences of chronic pain for these groups. A systematic review identified 26 papers meeting the inclusion criteria; no papers reported on the outcomes of PMPs delivered in the UK. Of the papers obtained, four reported on PMPs conducted outside the UK; eight reported on ethnic differences in patients seeking support from pain management services in America; and the remaining papers included literature reviews, an experimental pain study, a collaborative enquiry, and a survey of patient and clinician ratings of pain. The findings indicate a lack of research into UK-based pain management for ethnic minorities and non-English-speaking patients. The literature suggests that effective PMPs must be tailored to meet cultural experiences of pain and beliefs about pain management. There is a need for further research to explore these cultural beliefs in non-English-speaking groups in the UK. Culturally sensitive evaluations of interpreted PMPs with long-term follow-up are needed to assess the effectiveness of current provision. Copyright © 2015 John Wiley & Sons, Ltd.

  15. On the need to manage long-term diffuse memory controls of hydrological mass loads and water quality

    Science.gov (United States)

    Destouni, G.; Cvetkovic, V.

    2011-12-01

    Water management requires understanding and handling of water quality changes and their cause-effect relations, including the source inputs in and hydrological mass transport through catchments that load tracers, nutrients, pollutants and other anthropogenic and geogenic constituents to downstream waters and ecosystems. Costly abatement is often required to protect water resources and ecosystems from excessive nutrient and pollutant loads, and to maintain and restore good ecological status and vital ecosystem services of water systems. But what controls then the magnitudes and dynamics of the hydrological mass loads to the downstream waters and ecosystems? Erroneous understanding of these controls may undermine and mislead resource demanding water management efforts. To support and improve this understanding we have analyzed data from 15-23 year time series of chloride, commonly used as an effective chemical tracer of water movement, in daily rainfall and runoff of two comparative Swedish catchments. We show that long-term catchment memory in form of diffuse internal subsurface sources that have developed from earlier mass inputs controls current load dynamics. In the chloride tracer example the internal memory sources contribute 75-90% of the total stream load, while contemporary source inputs at the surface contribute only 10-25%, with these ranges being consistently determined from scenario analysis of chloride travel time distributions in both catchment cases. While the loading from contemporary surface inputs is hydrologically controlled and dependent on the variability of transport pathways and travel times through a catchment, the average net mass release rate from internal memory sources depends primarily on mean travel time. For the chloride tracer example the release rate is in the range of 1.3*10E-4 - 4.5*10E-3 g/m2/day in both catchment cases. The present quantification approach provides a relatively simple, testable and general management tool for

  16. The effects of long-term management on patterns of carbon storage in a northern highbush blueberry production system.

    Science.gov (United States)

    Nemeth, Denise; Lambrinos, John G; Strik, Bernadine C

    2017-02-01

    Perennial crops potentially provide a sink for atmospheric carbon. However, there is a poor understanding of how perennial crops differ in their carbon allocation patterns, and few studies have tested how agronomic practices such as fertilization influence long-term patterns of carbon allocation in actual production systems. In this study, we report results of a long-term field experiment that tested the individual and combined effects of organic matter incorporation and nitrogen fertilization on carbon allocation. The mature (nine-year-old) blueberry plants in this study had an average standing carbon stock of 1147gCm(-2) and average annual Net Primary Production (NPP) of 523gCm(-2)yr(-1), values that are similar to those reported for other woody crops. Forty-four percent of blueberry annual NPP was sequestered in persistent biomass, 19% was exported as harvested fruit, and 37% entered the detrital pathway. Nitrogen applied at rates typical for blueberry production throughout the span of the study had no significant effect on total plant or soil C. However, pre-planting organic matter incorporation and periodic mulching with sawdust significantly increased both soil organic matter and soil C. Pre-planting organic matter incorporation also increased total standing plant C nine years later at maturity. At the field scale, we estimate that fields receiving pre-planting organic matter incorporation would have 4.8% (4.5Mgha(-1)) more standing C relative to non-amended fields, although the difference is within the range of uncertainty of the estimated values. These results suggest that blueberry production can provide a valuable medium-term carbon store that is comparable in magnitude to that of temperate tree crops, but overall carbon budgets are influenced by management practices over the first decade after planting.

  17. Acute upper gastrointestinal bleeding in patients on long-term oral anticoagulation therapy: Endoscopic findings, clinical management and outcome

    Institute of Scientific and Technical Information of China (English)

    Konstantinos C Thomopoulos; Konstantinos P Mimidis; George J Theocharis; Anthie G Gatopoulou; Georgios N Kartalis; Vassiliki N Nikolopoulou

    2005-01-01

    AIM: Acute gastrointestinal bleeding is a severe complication in patients receiving long-term oral anticoagulant therapy.The purpose of this study was to describe the causes and clinical outcome of these patients.METHODS: From January 1999 to October 2003, 111patients with acute upper gastrointestinal bleeding (AUGIB)were hospitalized while on oral anticoagulants. The causes and clinical outcome of these patients were compared with those of 604 patients hospitalized during 2000-2001with AUGIB who were not taking warfarin.RESULTS: The most common cause of bleeding was peptic ulcer in 51 patients (45%) receiving anticoagulants compared to 359/604 (59.4%) patients not receiving warfarin (P<0.05). No identifiable source of bleeding could be found in 33 patients (29.7%) compared to 31/604(5.1%) patients not receiving anticoagulants (P= 0.0001).The majority of patients with concurrent use of non-steroidal anti-inflammatory drugs (NSATDs) (26/35, 74.3%) had a peptic ulcer as a cause of bleeding while 32/76 (40.8%)patients not taking a great dose of NSATDs had a negative upper and lower gastrointestinal endoscopy. Endoscopic hemostasis was applied and no complication was reported.Six patients (5.4%) were operated due to continuing or recurrent hemorrhage, compared to 23/604 (3.8%) patients not receiving anticoagulants. Four patients died, the overall mortality was 3.6% in patients with AUGIB due to anticoagulants, which was not different from that in patients not receiving anticoagulant therapy.CONCLUSION: Patients with AUGIB while on long-term anticoagulant therapy had a clinical outcome, which is not different from that of patients not taking anticoagulants.Early endoscopy is important for the management of these patients and endoscopic hemostasis can be safely applied.

  18. How do soil quality indicators (SOC and nutrients) change with long-term different crop residue management?

    Science.gov (United States)

    Spiegel, Heide; Lehtinen, Taru; Dersch, Georg; Baumgarten, Andreas

    2016-04-01

    Leaving the crop residues (cereal grain straw, maize stover, sugar beet leaves) on the field may enhance SOC and soil nutrient contents (e.g. P, K, Mg). In contrast, harvesting crop residues for livestock bedding or energy production are often connected with a loss of soil fertility (Lehtinen et al., 2014). We have evaluated the effects of different management of crop residues on selected soil parameters of the upper soil (0-25 cm) in two long-term field experiments in Austria focused on P-dynamics (Marchfeld, since 1982 and Alpenvorland, since 1986). In four P-fertilisation stages (0, 75, 150, 300 kg P2O5 ha-1y-1) all crop residues were incorporated in one treatment and all removed in the other one, respectively. The results show that the effects are different at the two investigated sites. At the site Marchfeld, a medium textured soil, on average SOC was significantly higher with the incorporation of crop residues (21.6 g kg-1) compared to the removal (19.9 g kg-1) after 32 years. In the long run, SOC levels could be maintained, if crop residues remained at the field, whereas the constant removal of crop residues resulted in a SOC decline. At the site Alpenvorland, SOC was only slightly higher with the incorporation of the crop residues after 28 years. In this case, in the long run, even with this management practice and, moreover, with the residue removal, SOC tended to decrease generally. At the Marchfeld, crop residue incorporation resulted in a significant increase of "plant available" phosphorus (P-CAL) only with very high P fertilization. However, "plant available" Mg (according to Schachtschabel) and potassium (K-CAL) were significantly higher in all P fertilisation stages compared to the residue removal treatments. At the site Alpenvorland, the soils are rich in silt and clay and with long-term incorporation of crop residues a significant increase only of „plant available" K of about 50% occurred. This indicates the necessity of taking into account the

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-11-01

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

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

    Directory of Open Access Journals (Sweden)

    Chew-Graham Carolyn

    2010-07-01

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

  1. Embedding Data Stewardship in Geoscience Australia

    Science.gov (United States)

    Bastrakova, I.; Fyfe, S.

    2013-12-01

    Ten years of technological innovation now enable vast amounts of data to be collected, managed, processed and shared. At the same time, organisations have witnessed government legislative and policy requirements for open access to public sector data, and a demand for flexibility in access to data by both machine-to-machine and human consumption. Geoscience Australia (GA) has adopted Data Stewardship as an organisation-wide initiative to improve the way we manage and share our data. The benefits to GA including: - Consolidated understanding of GA's data assets and their value to the Agency; - Recognition of the significant role of data custodianship and data management; - Well-defined governance, policies, standards, practices and accountabilities that promote the accessibility, quality and interoperability of GA's data; - Integration of disparate data sets into cohesive information products available online in real time and equally accessible to researchers, government, industry and the public. Although the theory behind data stewardship is well-defined and accepted and the benefits are generally well-understood, practical implementation requires an organisation to prepare for a long-term commitment of resources, both financial and human. Fundamentally this involves: 1. Raising awareness in the organisation of the need for data stewardship and the challenges this entails; 2. Establishing a data stewardship framework including a data governance office to set policy and drive organisational change; and 3. Embedding the functions and a culture of data stewardship into business as usual operations. GA holds a vast amount of data ranging from petabytes of Big Data to significant quantities of relatively small ';long tail' geoscientific observations and measurements. Over the past four years, GA has undertaken strategic activities that prepare us for Data Stewardship: - Organisation-wide audits of GA's data holdings and identification of custodians for each dataset

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

    Directory of Open Access Journals (Sweden)

    Thomas Hadjistavropoulos

    2016-01-01

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

  3. Application of Hydrometeorological Information for Short-term and Long-term Water Resources Management over Ungauged Basin in Korea

    Science.gov (United States)

    Kim, Ji-in; Ryu, Kyongsik; Suh, Ae-sook

    2016-04-01

    In 2014, three major governmental organizations that are Korea Meteorological Administration (KMA), K-water, and Korea Rural Community Corporation have been established the Hydrometeorological Cooperation Center (HCC) to accomplish more effective water management for scarcely gauged river basins, where data are uncertain or non-consistent. To manage the optimal drought and flood control over the ungauged river, HCC aims to interconnect between weather observations and forecasting information, and hydrological model over sparse regions with limited observations sites in Korean peninsula. In this study, long-term forecasting ensemble models so called Global Seasonal forecast system version 5 (GloSea5): a high-resolution seasonal forecast system, provided by KMA was used in order to produce drought outlook. Glosea5 ensemble model prediction provides predicted drought information for 1 and 3 months ahead with drought index including Standardized Precipitation Index (SPI3) and Palmer Drought Severity Index (PDSI). Also, Global Precipitation Measurement and Global Climate Observation Measurement - Water1 satellites data products are used to estimate rainfall and soil moisture contents over the ungauged region.

  4. The effectiveness of a nurse practitioner-led pain management team in long-term care: A mixed methods study.

    Science.gov (United States)

    Kaasalainen, Sharon; Wickson-Griffiths, Abigail; Akhtar-Danesh, Noori; Brazil, Kevin; Donald, Faith; Martin-Misener, Ruth; DiCenso, Alba; Hadjistavropoulos, Thomas; Dolovich, Lisa

    2016-10-01

    Considering the high rates of pain as well as its under-management in long-term care (LTC) settings, research is needed to explore innovations in pain management that take into account limited resource realities. It has been suggested that nurse practitioners, working within an inter-professional model, could potentially address the under-management of pain in LTC. This study evaluated the effectiveness of implementing a nurse practitioner-led, inter-professional pain management team in LTC in improving (a) pain-related resident outcomes; (b) clinical practice behaviours (e.g., documentation of pain assessments, use of non-pharmacological and pharmacological interventions); and, (c) quality of pain medication prescribing practices. A mixed method design was used to evaluate a nurse practitioner-led pain management team, including both a quantitative and qualitative component. Using a controlled before-after study, six LTC homes were allocated to one of three groups: 1) a nurse practitioner-led pain team (full intervention); 2) nurse practitioner but no pain management team (partial intervention); or, 3) no nurse practitioner, no pain management team (control group). In total, 345 LTC residents were recruited to participate in the study; 139 residents for the full intervention group, 108 for the partial intervention group, and 98 residents for the control group. Data was collected in Canada from 2010 to 2012. Implementing a nurse practitioner-led pain team in LTC significantly reduced residents' pain and improved functional status compared to usual care without access to a nurse practitioner. Positive changes in clinical practice behaviours (e.g., assessing pain, developing care plans related to pain management, documenting effectiveness of pain interventions) occurred over the intervention period for both the nurse practitioner-led pain team and nurse practitioner-only groups; these changes did not occur to the same extent, if at all, in the control group

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

    Science.gov (United States)

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

    2017-04-01

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

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

    Science.gov (United States)

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

    2016-02-01

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

  7. Sustaining complex interventions in long-term care: a qualitative study of direct care staff and managers.

    Science.gov (United States)

    Colón-Emeric, Cathleen; Toles, Mark; Cary, Michael P; Batchelor-Murphy, Melissa; Yap, Tracey; Song, Yuting; Hall, Rasheeda; Anderson, Amber; Burd, Andrew; Anderson, Ruth A

    2016-07-16

    Little is known about the sustainability of behavioral change interventions in long-term care (LTC). Following a cluster randomized trial of an intervention to improve staff communication (CONNECT), we conducted focus groups of direct care staff and managers to elicit their perceptions of factors that enhance or reduce sustainability in the LTC setting. The overall aim was to generate hypotheses about how to sustain complex interventions in LTC. In eight facilities, we conducted 15 focus groups with 83 staff who had participated in at least one intervention session. Where possible, separate groups were conducted with direct care staff and managers. An interview guide probed for staff perceptions of intervention salience and sustainability. Framework analysis of coded transcripts was used to distill insights about sustainability related to intervention features, organizational context, and external supports. Staff described important factors for intervention sustainability that are particularly challenging in LTC. Because of the tremendous diversity in staff roles and education level, interventions should balance complexity and simplicity, use a variety of delivery methods and venues (e.g., group and individual sessions, role-play/storytelling), and be inclusive of many work positions. Intervention customizability and flexibility was particularly prized in this unpredictable and resource-strapped environment. Contextual features noted to be important include addressing the frequent lack of trust between direct care staff and managers and ensuring that direct care staff directly observe manager participation and support for the program. External supports suggested to be useful for sustainability include formalization of changes into facility routines, using "train the trainer" approaches and refresher sessions. High staff turnover is common in LTC, and providing materials for new staff orientation was reported to be important for sustainability. When designing or

  8. Validation of the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) pulmonary hypertension prediction model in a unique population and utility in the prediction of long-term survival.

    Science.gov (United States)

    Cogswell, Rebecca; Kobashigawa, Erin; McGlothlin, Dana; Shaw, Robin; De Marco, Teresa

    2012-11-01

    The Registry to Evaluate Early and Long-Term Pulmonary Arterial (PAH) Hypertension Disease Management (REVEAL) model was designed to predict 1-year survival in patients with PAH. Multivariate prediction models need to be evaluated in cohorts distinct from the derivation set to determine external validity. In addition, limited data exist on the utility of this model in the prediction of long-term survival. REVEAL model performance was assessed to predict 1-year and 5-year outcomes, defined as survival or composite survival or freedom from lung transplant, in 140 patients with PAH. The validation cohort had a higher proportion of human immunodeficiency virus (7.9% vs 1.9%, p model to predict survival was 0.765 at 1 year and 0.712 at 5 years of follow-up. The C-index of the model to predict composite survival or freedom from lung transplant was 0.805 and 0.724 at 1 and 5 years of follow-up, respectively. Prediction by the model, however, was weakest among patients with intermediate-risk predicted survival. The REVEAL model had adequate discrimination to predict 1-year survival in this small but clinically distinct validation cohort. Although the model also had predictive ability out to 5 years, prediction was limited among patients of intermediate risk, suggesting our prediction methods can still be improved. Copyright © 2012. Published by Elsevier Inc.

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

    Science.gov (United States)

    Dunne, Patrick J; Macintyre, Neil R; Schmidt, Ulrich H; Haas, Carl F; Jones-Boggs Rye, Kathy; Kauffman, Garry W; Hess, Dean R

    2012-04-01

    For the busy clinician, educator, or manager, it is becoming an increasing challenge to filter the literature to what is relevant to one's practice and then update one's practice based on the current evidence. The purpose of this paper is to review the recent literature related to long-term oxygen therapy, pulmonary rehabilitation, airway management, acute lung injury and acute respiratory distress syndrome, respiratory care education, and respiratory care management. These topics were chosen and reviewed in a manner that is most likely to have interest to the readers of Respiratory Care.

  10. The Long-Term Effective Mechanism of Rural Poverty Alleviation in China from the Perspective of Ecological Management

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Based on the ecological environmental situation of poverty-stricken areas in China and the domestic and foreign research results,the long-term effective mechanism of sustainable poverty alleviation in China is established(the ideological premise is ecological culture,the material base is ecological economy and the basic guarantee is ecological system) from the perspective of ecological management.To be specific,ecological culture,the ideological premise of rural sustainable poverty alleviation in China,includes two aspects:the first one is upholding the Marxism,passing on the Chinese traditional ecological wisdom and fostering ecological consciousness;the second one is mirroring the thought of western modern ecological ethics,emphasizing ecological criticism and redoubling the ecological education.As for ecological economy,the material guarantee for sustainable poverty alleviation in Chinese rural poverty-stricken areas,also contents two aspects.The first one is promoting the way of "clean production" and developing ecological industry;the second one is building ecological concept of consumption and establishing the ecological lifestyle.In addition,ecological system,the basic guarantee of sustainable poverty alleviation in Chinese rural poverty-stricken areas,covers three terms.The first one is implementing the ecological policies and stipulating ecological plan;the second one is establishing perfect ecological legislation and ecological system and intensifying their implementation;the third one is enforcing ecological management in the process of sustainable poverty alleviation.Through the establishment of the above mechanism,we look forward to realizing sustainability of economic development and poverty alleviation effects in the process of poverty alleviation in Chinese rural areas,as well as ecological management of the poverty-stricken areas.

  11. Long-term impact of reduced tillage and residue management on soil carbon stabilization: Implications for conservation agriculture on contrasting soil

    NARCIS (Netherlands)

    Chivenge, P.P.; Murwira, H.K.; Giller, K.E.; Mapfumo, P.; Six, J.

    2007-01-01

    Residue retention and reduced tillage are both conservation agricultural management options that may enhance soil organic carbon (SOC) stabilization in tropical soils. Therefore, we evaluated the effects of long-term tillage and residue management on SOC dynamics in a Chromic Luvisol (red clay soil)

  12. Talking about depression: a qualitative study of barriers to managing depression in people with long term conditions in primary care.

    Science.gov (United States)

    Coventry, Peter A; Hays, Rebecca; Dickens, Chris; Bundy, Christine; Garrett, Charlotte; Cherrington, Andrea; Chew-Graham, Carolyn

    2011-03-22

    The risk of depression is increased in people with long term conditions (LTCs) and is associated with poorer patient outcomes for both the depressive illness and the LTC, but often remains undetected and poorly managed. The aim of this study was to identify and explore barriers to detecting and managing depression in primary care in people with two exemplar LTCs: diabetes and coronary heart disease (CHD). Qualitative in-depth interviews were conducted with 19 healthcare professionals drawn predominately from primary care, along with 7 service users and 3 carers (n = 29). One focus group was then held with a set of 6 healthcare professionals and a set of 7 service users and 1 carer (n = 14). Interviews and the focus group were digitally recorded, transcribed verbatim, and analysed independently. The two data sets were then inspected for commonalities using a constant comparative method, leading to a final thematic framework used in this paper. Barriers to detecting and managing depression in people with LTCs in primary care exist: i) when practitioners in partnership with patients conceptualise depression as a common and understandable response to the losses associated with LTCs - depression in the presence of LTCs is normalised, militating against its recognition and treatment; ii) where highly performanced managed consultations under the terms of the Quality and Outcomes Framework encourage reductionist approaches to case-finding in people with CHD and diabetes, and iii) where there is uncertainty among practitioners about how to negotiate labels for depression in people with LTCs in ways that might facilitate shared understanding and future management. Depression was often normalised in the presence of LTCs, obviating rather than facilitating further assessment and management. Furthermore, structural constraints imposed by the QOF encouraged reductionist approaches to case-finding for depression in consultations for CHD and diabetes. Future work might focus on

  13. Stepped care model of pain management and quality of pain care in long-term opioid therapy.

    Science.gov (United States)

    Moore, Brent A; Anderson, Daren; Dorflinger, Lindsey; Zlateva, Ianita; Lee, Allison; Gilliam, Wesley; Tian, Terrence; Khatri, Khushbu; Ruser, Christopher B; Kerns, Robert D

    2016-01-01

    Successful organizational improvement processes depend on application of reliable metrics to establish targets and to monitor progress. This study examined the utility of the Pain Care Quality (PCQ) extraction tool in evaluating implementation of the Stepped Care Model for Pain Management at one Veterans Health Administration (VHA) healthcare system over 4 yr and in a non-VHA Federally qualified health center (FQHC) over 2 yr. Two hundred progress notes per year from VHA and 150 notes per year from FQHC primary care prescribers of long-term opioid therapy (>90 consecutive days) were randomly sampled. Each note was coded for the presence or absence of key dimensions of PCQ (i.e., pain assessment, treatment plans, pain reassessment/outcomes, patient education). General estimating equations controlling for provider and facility were used to examine changes in PCQ items over time. Improvements in the VHA were noted in pain reassessment and patient education, with trends in positive directions for all dimensions. Results suggest that the PCQ extraction tool is feasible and may be responsive to efforts to promote organizational improvements in pain care. Future research is indicated to improve the reliability of the PCQ extraction tool and enhance its usability.

  14. Stepped care model for pain management and quality of pain care in long-term opioid therapy

    Directory of Open Access Journals (Sweden)

    Brent A. Moore, PhD

    2016-02-01

    Full Text Available Successful organizational improvement processes depend on application of reliable metrics to establish targets and to monitor progress. This study examined the utility of the Pain Care Quality (PCQ extraction tool in evaluating implementation of the Stepped Care Model for Pain Management at one Veterans Health Administration (VHA healthcare system over 4 yr and in a non-VHA Federally qualified health center (FQHC over 2 yr. Two hundred progress notes per year from VHA and 150 notes per year from FQHC primary care prescribers of long-term opioid therapy (>90 consecutive days were randomly sampled. Each note was coded for the presence or absence of key dimensions of PCQ (i.e., pain assessment, treatment plans, pain reassessment/outcomes, patient education. General estimating equations controlling for provider and facility were used to examine changes in PCQ items over time. Improvements in the VHA were noted in pain reassessment and patient education, with trends in positive directions for all dimensions. Results suggest that the PCQ extraction tool is feasible and may be responsive to efforts to promote organizational improvements in pain care. Future research is indicated to improve the reliability of the PCQ extraction tool and enhance its usability.

  15. Managing the risk of lithium-induced nephropathy in the long-term treatment of patients with recurrent affective disorders.

    Science.gov (United States)

    Severus, Emanuel; Bauer, Michael

    2013-02-11

    Lithium has been the most effective psychopharmacological drug in the long-term treatment of patients with recurrent unipolar and bipolar affective illness. As a result of its widespread and longtime use in patients with recurrent affective disorders, psychiatrists have become increasingly aware of the whole spectrum of lithium's potential side effects. One of the side effects associated with its chronic use is lithium-induced nephropathy. In a recent cross-sectional study published in BMC Medicine, Alberto Bocchetta et al. add further information to this topic, demonstrating that duration of lithium treatment is associated with impaired glomerular function in patients with recurrent or chronic affective disorders. The present paper will discuss the implications of this and other related recent research on our management of patients with recurrent affective disorders. In this context the importance of shared decision making and close monitoring of kidney function is highlighted, including the regular assessment of the glomerular filtration rate, to provide best possible care to our patients maintained on lithium treatment.See related research article here http://www.biomedcentral.com/1741-7015/11/33.

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

    Science.gov (United States)

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

    2017-04-01

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

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

    LENUS (Irish Health Repository)

    Smith, Myles J F

    2014-01-07

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

  18. Predictors of Short- and Long-Term Attrition From the Parents as Agents of Change Randomized Controlled Trial for Managing Pediatric Obesity.

    Science.gov (United States)

    Spence, Nicholas D; Newton, Amanda S; Keaschuk, Rachel A; Ambler, Kathryn A; Jetha, Mary M; Holt, Nicholas L; Rosychuk, Rhonda J; Spence, John C; Sharma, Arya M; Ball, Geoff D C

    Attrition in pediatric weight management is a substantial problem. This study examined factors associated with short- and long-term attrition from a lifestyle and behavioral intervention for parents of children with overweight or obesity. Fifty-two families with children ages 6 to 12 years old and body mass index at or above the 85th percentile participated in a randomized controlled trial focused on parents, comparing parent-based cognitive behavioral therapy with parent-based psychoeducation for pediatric weight management. We examined program attrition using two clinical phases of the intervention: short-term and long-term attrition, modeled using the general linear model. Predictors included intervention type, child/parent weight status, sociodemographic factors, and health of the family system. Higher self-assessed health of the family system was associated with lower short-term attrition; higher percentage of intervention sessions attended by parents was associated with lower long-term attrition. Different variables were significant in our short- and long-term models. Attrition might best be conceptualized based on short- and long-term phases of clinical, parent-based interventions for pediatric weight management. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  19. Stakeholder-led science: engaging resource managers to identify science needs for long-term management of floodplain conservation lands

    Science.gov (United States)

    Bouska, Kristin L.; Lindner, Garth; Paukert, Craig; Jacobson, Robert B.

    2016-01-01

    Floodplains pose challenges to managers of conservation lands because of constantly changing interactions with their rivers. Although scientific knowledge and understanding of the dynamics and drivers of river-floodplain systems can provide guidance to floodplain managers, the scientific process often occurs in isolation from management. Further, communication barriers between scientists and managers can be obstacles to appropriate application of scientific knowledge. With the coproduction of science in mind, our objectives were the following: (1) to document management priorities of floodplain conservation lands, and (2) identify science needs required to better manage the identified management priorities under nonstationary conditions, i.e., climate change, through stakeholder queries and interactions. We conducted an online survey with 80 resource managers of floodplain conservation lands along the Upper and Middle Mississippi River and Lower Missouri River, USA, to evaluate management priority, management intensity, and available scientific information for management objectives and conservation targets. Management objectives with the least information available relative to priority included controlling invasive species, maintaining respectful relationships with neighbors, and managing native, nongame species. Conservation targets with the least information available to manage relative to management priority included pollinators, marsh birds, reptiles, and shore birds. A follow-up workshop and survey focused on clarifying science needs to achieve management objectives under nonstationary conditions. Managers agreed that metrics of inundation, including depth and extent of inundation, and frequency, duration, and timing of inundation would be the most useful metrics for management of floodplain conservation lands with multiple objectives. This assessment provides guidance for developing relevant and accessible science products to inform management of highly

  20. Long term fluctuations of groundwater mine pollution in a sulfide mining district with dry Mediterranean climate: Implications for water resources management and remediation.

    Science.gov (United States)

    Caraballo, Manuel A; Macías, Francisco; Nieto, José Miguel; Ayora, Carlos

    2016-01-01

    Water resources management and restoration strategies, and subsequently ecological and human life quality, are highly influenced by the presence of short and long term cycles affecting the intensity of a targeted pollution. On this respect, a typical acid mine drainage (AMD) groundwater from a sulfide mining district with dry Mediterranean climate (Iberian Pyrite Belt, SW Spain) was studied to unravel the effect of long term weather changes in water flow rate and metal pollutants concentration. Three well differentiated polluting stages were observed and the specific geochemical, mineralogical and hydrological processes involved (pyrite and enclosing rocks dissolution, evaporitic salts precipitation-redisolution and pluviometric long term fluctuations) were discussed. Evidencing the importance of including longer background monitoring stage in AMD management and restoration strategies, the present study strongly advise a minimum 5-years period of AMD continuous monitoring previous to the design of any AMD remediation system in regions with dry Mediterranean climate. Copyright © 2015 Elsevier B.V. All rights reserved.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1995-06-30

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1995-06-30

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

  3. Spatiotemporal variation of long-term drought propensity through reliability-resilience-vulnerability based Drought Management Index

    Science.gov (United States)

    Chanda, Kironmala; Maity, Rajib; Sharma, Ashish; Mehrotra, Rajeshwar

    2014-10-01

    This paper characterizes the long-term, spatiotemporal variation of drought propensity through a newly proposed, namely Drought Management Index (DMI), and explores its predictability in order to assess the future drought propensity and adapt drought management policies for a location. The DMI was developed using the reliability-resilience-vulnerability (RRV) rationale commonly used in water resources systems analysis, under the assumption that depletion of soil moisture across a vertical soil column is equivalent to the operation of a water supply reservoir, and that drought should be managed not simply using a measure of system reliability, but should also take into account the readiness of the system to bounce back from drought to a normal state. Considering India as a test bed, 5 year long monthly gridded (0.5° Lat × 0.5° Lon) soil moisture data are used to compute the RRV at each grid location falling within the study domain. The Permanent Wilting Point (PWP) is used as the threshold, indicative of transition into water stress. The association between resilience and vulnerability is then characterized through their joint probability distribution ascertained using Plackett copula models for four broad soil types across India. The joint cumulative distribution functions (CDF) of resilience and vulnerability form the basis for estimating the DMI as a five-yearly time series at each grid location assessed. The status of DMI over the past 50 years indicate that drought propensity is consistently low toward northern and north eastern parts of India but higher in the western part of peninsular India. Based on the observed past behavior of DMI series on a climatological time scale, a DMI prediction model comprising deterministic and stochastic components is developed. The predictability of DMI for a lead time of 5 years is found to vary across India, with a Pearson correlation coefficient between observed and predicted DMI above 0.6 over most of the study area

  4. Long-term follow-up of long and flat bone eosinophilic granulomas managed only with biopsy.

    Science.gov (United States)

    Erol, Bülent; Sofulu, Ömer; Topkar, Mert Osman; Çalışkan, Emrah; Türköz, Hüseyin Kemal

    2015-01-01

    We evaluated long-term clinical and radiological follow-up results of patients with long and flat bone eosinophilic granulomas managed only with biopsy. Seventeen patients [11 male, 6 female; average age 8.5 years (range: 3.5 to 14 years)] with long and flat bone eosinophilic granulomas were followed after biopsy. Involved bones were femur (5), tibia (3), humerus (2), ulna (1), pelvis (3), scapula (1) and clavicle (1). After confirmation of diagnosis by biopsy, no further surgical intervention was performed. Clinical follow-up was done with preoperative and postoperative MSTS and VAS scores. The healing process was followed with periodic radiographs. Limb-length discrepancy, deformity, and lesion progression or recurrence were recorded. Average follow-up was 65 months (range: 28 to 115 months). Average preoperative MSTS score was 45% (range: 30 to 56.6%), while postoperative 6, 12 and 24 months scores were measured as 76% (range: 70 to 83.3%), 88% (range: 73.3 to 93.3%) and 94% (range: 86.6 to 100%) respectively. Average VAS score, which was 8.4 (range: 6 to 10) preoperatively, had a tendency to decrease postoperatively, and was measured as 3.5 (range: 2 to 5), 2.2 (range: 1 to 3.5) and 1.1 (range: 0 to 2) at 3, 6, and 12 months. Even though the majority of lesions demonstrated complete radiographic healing at 12 months, the healing process extended to 24 months for flat bones. No patients experienced limb-length discrepancy or deformity. All lesions regressed following biopsy and no recurrence was seen. Eosinophilic granuloma has a spontaneous healing potential, and confirming the diagnosis by biopsy is sufficient to obtain good functional and radiological results without any further intervention.

  5. Are Established Methods of Physiotherapeutic Management for Long-term Neurological Conditions Applicable to 'Orphan' Conditions such as Syringomyelia?

    Science.gov (United States)

    Smith, Rebecca; Jones, Gareth; Curtis, Alexandra; Murphy, Hollie; Flint, Graham

    2016-03-01

    Syringomyelia is a rare or 'orphan' condition with the potential to cause significant disability and detrimental effects to quality of life. Syringomyelia shares similar symptoms to those common in other long-term neurological conditions, including spinal cord injury and multiple sclerosis. In these more prevalent conditions, physiotherapy is utilized widely and is effective in optimizing physical, psychological and social parameters. Therefore, we theorized that physiotherapy might be transferable to, and beneficial to syringomyelia patients. As a paucity of literature exists in this area, we aimed to evaluate the existing uptake and perceived efficacy of physiotherapy. An exploratory, mixed methodology was selected to derive sufficient qualitative data for analysis. Specifically designed questionnaires and semi-structured interviews yielded data on uptake and perceived physiotherapy efficacy. One hundred patients from a National Health Service tertiary syringomyelia service were invited to participate. The questionnaire and interviews were completed by 49 and 20 patients, respectively. Of the small number of patients receiving physiotherapy, the majority reported beneficial effects on pain modulation and quality of life. Stretching and hydrotherapy were deemed effective for relief of pain and stiffness. Additionally, physiotherapy was reported to provide similar benefits to surgical intervention. Syringomyelia patients report physiotherapy to provide benefits for symptom management and quality of life. Such findings suggest that established rehabilitation techniques in more common conditions may be transferable to those less prevalent. Uptake of physiotherapy was limited, seemingly because of inadequate information, knowledge and resources. To address these deficiencies, further studies should be planned investigating the effectiveness of physiotherapy modalities, such as hydrotherapy, in parallel or in conjunction with surgery and/or pharmacology. Additionally

  6. Long-term trends in the structure of eastern Adriatic littoral fish assemblages: Consequences for fisheries management

    Science.gov (United States)

    Stagličić, N.; Matić-Skoko, S.; Pallaoro, A.; Grgičević, R.; Kraljević, M.; Tutman, P.; Dragičević, B.; Dulčić, J.

    2011-09-01

    Long-term interannual changes in abundance, biomass, diversity and structure of littoral fish assemblages were examined between 1993 and 2009 by experimental trammel net fishing up to six times per year, within the warm period - May to September, at multiple areas along the eastern Adriatic coast with the aim of testing for the consistency of patterns of change across a large spatial scale (˜600 km). The results revealed spatially consistent increasing trends of total fish abundance and biomass growing at an average rate of 15 and 14% per year, respectively. Of the diversity indices analysed, the same pattern of variability was observed for Shannon diversity, while Pielou evenness and average taxonomic distinctness measures Δ ∗ and Δ + showed spatial variability with no obvious temporal trends. Multivariate fish assemblage structure underwent a directional change displaying a similar pattern through time for all the areas. The structural change in fish assemblages generally involved most of the species present in trammel net catches. A large pool of fish species responsible for producing the temporal pattern of assemblage change was relatively different in each of the areas reflecting a large geographic range covered by the study. An analysis of 4 fish species ( Symphodus tinca, Pagellus erythrinus, Mullus surmuletus, Scorpaena porcus) common to each of the study areas as the ones driving the temporal change indicated that there were clear increasing trends of their mean catches across the years at all the study areas. A common pattern among time trajectories across the spatial scale studied implies that the factor affecting the littoral fish assemblages is not localised but regional in nature. As an underlying factor having the potential to induce such widespread and consistent improvements in littoral fish assemblages, a more restrictive artisanal fishery management that has progressively been put in place during the study period, is suggested and discussed.

  7. Long-Term Study of Children With ROME III Functional Gastrointestinal Disorders Managed Symptomatically in a Biopsychosocial Model.

    Science.gov (United States)

    Madani, Shailender; Parikh, Suchi; Madani, Rohit S; Krasaelap, Amornluck

    2017-04-01

    Our study evaluated progression of and identified potential factors contributing to outcomes of ROME III defined-functional gastrointestinal disorders (FGIDs) in children treated symptomatically in a biopsychosocial model of care with a long-term follow-up. We performed a retrospective review of pediatric patients who were diagnosed with ROME III defined-FGIDs including functional abdominal pain, functional dyspepsia, irritable bowel syndrome and abdominal migraine. Patients were managed symptomatically in a biopsychosocial model of care from the time of initial diagnosis. Demographics, management, progression and response to treatment assessed as complete, partial, and no improvement were reviewed. Two hundred fifty-eight patients were included with mean age of 10.6 years, female 55.4%, mean number of encounters 3.3 visits, and mean follow-up was 18.7 months (range 2 - 59, SD 15.8). Diagnoses were functional abdominal pain 45%, irritable bowel syndrome 20.9%, multiple 13.2%, functional dyspepsia 12.8%, and abdominal migraine 8.1%. Investigations were performed in most patients: laboratory studies in 93.4% (non-contributory abnormal 23.6%), imaging studies in 45.3% (non-contributory abnormal 5%) and endoscopies in 43.0% (non-contributory abnormal 1.2%). Treatment included medication in 93.7%, and surgery in 1.9% (normal pathology). There were new functional gastrointestinal diagnosis in 11.6%, evolution of FGIDs, from one to another in 12.0%, and recurrence found in 35.7% of patients. There were 60.1% patients in the complete improvement group (CIG) and 39.1% in the partial/no improvement group (PIG/NIG). No statistical difference was found between CIG and PIG/NIG regarding demographics or evaluation. PIG/NIG had more encounters (mean 3.63 vs. 3.11; P = 0.03), had non-contributory lab abnormalities (34.4% vs. 20.0%; P = 0.01), needed more endoscopies (52.4% vs. 36.8%; P = 0.02), required more treatment changes (mean 1.41 vs. 0.81; P ROME III defined-FGIDs who

  8. Long-term modeling of the forest-grassland ecotone in the French Alps: implications for land management and conservation.

    Science.gov (United States)

    Carlson, Bradley Z; Renaud, Julien; Biron, Pierre Eymard; Choler, Philippe

    2014-07-01

    Understanding decadal-scale land-cover changes has the potential to inform current conservation policies. European mountain landscapes that include numerous protected areas provide a unique opportunity to weigh the long-term influences of land-use practices and climate on forest-grassland ecotone dynamics. Aerial photographs from four dates (1948, 1978, 1993, and 2009) were used to quantify the extent of forest and grassland cover at 5-m resolution across a 150-km2 area in a protected area of the southwestern French Alps. The study area included a grazed zone and a nongrazed zone that was abandoned during the 1970s. We estimated time series of a forestation index (FI) and analyzed the effects of elevation and grazing on FI using a hierarchical linear mixed effect model. Forest extent (composed primarily of mountain pine, Pinus uncinata) expanded from 50.6 km2 in 1948 to 85.5 km2 in 2009, i.e., a 23% increase in relative cover at the expense of grassland communities. Over the sixty-year period, the treeline rose by 118 m, from 1564 to 1682 m. Rapid forest expansion within the nongrazed zone followed the cessation of logging activities and was likely accelerated by climate warming during the 1980s. Within the grazed zone, the maintained presence of sheep did not fully counteract mountain pine expansion and led to highly contrasting rates of land-cover change based on the location of shepherds' cabins and water sources. Projections of FI for 2030 showed remnant patches of intensively used grasslands interspersed in a densely forested matrix. Our analysis of mountain land-cover dynamics provided strong evidence for forest encroachment into grassland habitat despite consistent grazing pressure. This pattern may be attributed to the disappearance of traditional land-use practices such as shrub burning and removal. Our findings prompt land managers to reconsider their initial conservation priority (i.e., the protection of a renowned mountain pine forest) and to implement

  9. Short- and Long-Term Theory-Based Predictors of Physical Activity in Women Who Participated in a Weight-Management Program

    Science.gov (United States)

    Wasserkampf, A.; Silva, M. N.; Santos, I. C.; Carraça, E. V.; Meis, J. J. M.; Kremers, S. P. J.; Teixeira, P. J.

    2014-01-01

    This study analyzed psychosocial predictors of the Theory of Planned Behavior (TPB) and Self-Determination Theory (SDT) and evaluated their associations with short- and long-term moderate plus vigorous physical activity (MVPA) and lifestyle physical activity (PA) outcomes in women who underwent a weight-management program. 221 participants (age…

  10. Implementation of Medicaid Managed Long-Term Services and Supports for Adults with Intellectual And/Or Developmental Disabilities in Kansas

    Science.gov (United States)

    Williamson, Heather J.; Perkins, Elizabeth A.; Levin, Bruce L.; Baldwin, Julie A.; Lulinski, Amie; Armstrong, Mary I.; Massey, Oliver T.

    2017-01-01

    Many adults with intellectual and/or developmental disabilities (IDD) can access health and long-term services and supports (LTSS) through Medicaid. States are reforming their Medicaid LTSS programs from a fee-for-service model to a Medicaid managed LTSS (MLTSS) approach, anticipating improved quality of care and reduced costs, although there is…

  11. Short- and Long-Term Theory-Based Predictors of Physical Activity in Women Who Participated in a Weight-Management Program

    Science.gov (United States)

    Wasserkampf, A.; Silva, M. N.; Santos, I. C.; Carraça, E. V.; Meis, J. J. M.; Kremers, S. P. J.; Teixeira, P. J.

    2014-01-01

    This study analyzed psychosocial predictors of the Theory of Planned Behavior (TPB) and Self-Determination Theory (SDT) and evaluated their associations with short- and long-term moderate plus vigorous physical activity (MVPA) and lifestyle physical activity (PA) outcomes in women who underwent a weight-management program. 221 participants (age…

  12. Travelling beyond the current frontiers: Perioperative and long-term cardiac risk assessment and management of patients undergoing major vascular surgery

    NARCIS (Netherlands)

    M.D. Kertai (Miklos)

    2004-01-01

    textabstractIn this thesis, the prognostic value of clinical risk factors, the use of noninvasive testing for risk stratification, and pharmacologic risk reduction strategies are described for the perioperative and long-term management of patients undergoing major vascular surgery.

  13. Kamp K’aana, a 2-week residential weight management summer camp, shows long-term improvement in body mass index z scores

    Science.gov (United States)

    Long-term effects of Kamp K'aana, a 2-week residential weight management camp, on body mass index (BMI) measures were evaluated on 71 of 108 (66%) obese youth 10 to 14 years of age. Measures were obtained at 11-month study follow-up (n=38) or extracted from medical record (n=33). Compared with basel...

  14. Influences of Long-Term Fertilizer and Tillage Management on Soil Fertility of the North China Plain

    Institute of Scientific and Technical Information of China (English)

    NIU Ling-An; HAO Jin-Min; ZHANG Bao-Zhong; NIU Xin-Sheng

    2011-01-01

    In the North China Plain,fertilizer management and tillage practices have been changing rapidly during the last three decades; however,the influences of long-term fertilizer applications and tillage systems on fertility of salt-affected soils have not been well understood under a winter wheat (Triticum aestivum L.)-maize (Zea mays L.) annual double cropping system.A field experiment was established in 1985 on a Cambosol at the Quzhou Experimental Station,China Agricultural University,to investigate the responses of soil fertility to fertilizer and tillage practices.The experiment was established as an orthogonal design with nine treatments of different tillage methods and/or fertilizer applications.In October 2001,composite soil samples were collected from the 0-20 and 20-40 cm layers and analyzed for soil fertility indices.The results showed that after 17 years of nitrogen (N) and phosphorous (P) fertilizer and straw applications,soil organic matter (SOM) in the top layer was increased significantly from 7.00 to 9.30-13.14 g kg-1 in the 0-20 cm layer and from 4.00 to 5.48-7.75 g kg-1 in the 20-40 cm layer.Soil total N (TN) was increased significantly from 0.37 and 0.22 to 0.79-1.11 and 0.61-0.73 g N kg-1 in the 0-20 and 20-40 cm layers,respectively,with N fertilizer application; however,there was no apparent effect of straw application on TN content.The amounts of soil total P (TP) and rapidly available P (RP) were increased significantly from 0.60 to 0.67-1.31 g kg-1 in the 0-20 cm layer and from 0.52 to 0.60-0.73 g kg-1 in the 20-40 cm layer with P fertilizer application,but were decreased with combined N and P fertilizer applications.The applications of N and P fertilizers significantly increased the crop yields,but decreased the rapidly available potassium (RK) in the soil.Straw return could only meet part of the crop potassium requirements.Our results also suggested that though some soil fertility parameters were maintained or enhanced under the long-term

  15. Significant alteration of soil bacterial communities and organic carbon decomposition by different long-term fertilization management conditions of extremely low-productivity arable soil in South China.

    Science.gov (United States)

    Xun, Weibing; Zhao, Jun; Xue, Chao; Zhang, Guishan; Ran, Wei; Wang, Boren; Shen, Qirong; Zhang, Ruifu

    2016-06-01

    Different fertilization managements of red soil, a kind of Ferralic Cambisol, strongly affected the soil properties and associated microbial communities. The association of the soil microbial community and functionality with long-term fertilization management in the unique low-productivity red soil ecosystem is important for both soil microbial ecology and agricultural production. Here, 454 pyrosequencing analysis of 16S recombinant ribonucleic acid genes and GeoChip4-NimbleGen-based functional gene analysis were used to study the soil bacterial community composition and functional genes involved in soil organic carbon degradation. Long-term nitrogen-containing chemical fertilization-induced soil acidification and fertility decline and significantly altered the soil bacterial community, whereas long-term organic fertilization and fallow management improved the soil quality and maintained the bacterial diversity. Short-term quicklime remediation of the acidified soils did not change the bacterial communities. Organic fertilization and fallow management supported eutrophic ecosystems, in which copiotrophic taxa increased in relative abundance and have a higher intensity of labile-C-degrading genes. However, long-term nitrogen-containing chemical fertilization treatments supported oligotrophic ecosystems, in which oligotrophic taxa increased in relative abundance and have a higher intensity of recalcitrant-C-degrading genes but a lower intensity of labile-C-degrading genes. Quicklime application increased the relative abundance of copiotrophic taxa and crop production, although these effects were utterly inadequate. This study provides insights into the interaction of soil bacterial communities, soil functionality and long-term fertilization management in the red soil ecosystem; these insights are important for improving the fertility of unique low-productivity red soil.

  16. Managing competition in the countryside: Non-profit and for-profit perceptions of long-term care in rural Ontario.

    Science.gov (United States)

    Skinner, Mark W; Rosenberg, Mark W

    2006-12-01

    This paper contributes to the current debates surrounding private delivery of health care services by addressing the distinctive challenges, constraints and opportunities facing for-profit and non-profit providers of long-term care in rural and small town settings. It focuses on the empirical case of Ontario, Canada where extensive restructuring of long-term care, under the rubric of managed competition, has been underway since the mid-1990s. In-depth interviews with 72 representatives from local governments, public health institutions and authorities, for-profit and non-profit organisations, and community groups during July 2003 to December 2003 form the platform for a qualitative analysis of the implications of managed competition as it relates to the provision of long-term care in the countryside. The results suggest that the introduction and implementation of managed competition has accentuated the problems of service provision in rural communities, and that the long-standing issues of caregiving in rural situations transcend the differences, perceived or otherwise, between for-profit and non-profit provision. Understanding the implications of market-oriented long-term care restructuring initiatives for providers, and their clients, in rural situations requires a re-focussing of research beyond the for- versus non-profit dichotomy.

  17. Carbon stewardship: land management decisions and the potential for carbon sequestration in Colorado, USA

    Science.gov (United States)

    Failey, Elisabeth L.; Dilling, Lisa

    2010-04-01

    Land use and its role in reducing greenhouse gases is a key element of policy negotiations to address climate change. Calculations of the potential for enhanced terrestrial sequestration have largely focused on the technical characteristics of carbon stocks, such as vegetation type and management regime, and to some degree, on economic incentives. However, the actual potential for carbon sequestration critically depends on who owns the land and additional land management decision drivers. US land ownership patterns are complex, and consequently land use decision making is driven by a variety of economic, social and policy incentives. These patterns and incentives make up the 'carbon stewardship landscape'—that is, the decision making context for carbon sequestration. We examine the carbon stewardship landscape in the US state of Colorado across several public and private ownership categories. Achieving the full potential for land use management to help mitigate carbon emissions requires not only technical feasibility and financial incentives, but also effective implementing mechanisms within a suite of often conflicting and hard to quantify factors such as multiple-use mandates, historical precedents, and non-monetary decision drivers.

  18. Endovascular management of patients with coronary artery disease and diabetic foot syndrome:A long-term follow-up

    Institute of Scientific and Technical Information of China (English)

    Gianluca Rigatelli; Paolo Cardaioli; Fabio dell'Avvocata; Massimo Giordan; Giovanna Lisato; Francesco Mollo

    2011-01-01

    Background To investigate the long-term results of global coronary and peripheral interventional treatment of diabetic foot patients.Methods We retrospectively included 220 diabetic patients (78.5±15.8 years,107 females,all with Fontaine III or IV class) who were referred to our centre for diabetic foot syndrome and severe limb ischemia from January 2006 to December 2010.Patients were evaluated by a team of interventional cardiologists and diabetologists in order to assess presence of concomitant coronary artery disease (CAD) and eventual need for coronary revascularization. Stress-echo was performed in all patients before diagnostic peripheral angiography. Patients with indications for coronary angiography were submitted to combined diagnostic angiography and then to eventual staged peripheral and coronary interventions.Doppler ultrasonography and foot transcutaneous oximetry of transcutaneous oxygen pressure (TcPO2) before and after the procedure were performed as well as stressechocardiography and combined cardiologic and diabetic examination at 1 and 6 month and yearly.Results Stress-echocardiography was performed in 94/220 patients and resulted positive in 56 patients who underwent combined coronary and peripheral angiography.In the rest of 126 patients,combined coronary and peripheral angiography was performed directly for concomitant signs and symptoms of coronary heart disease in 35 patients.Coronary revascularization was judged necessary in 85/129 patients and was performed percutaneously after peripheral interventions in 72 patients and surgically in 13 patients.For Diabetic foot interventions the preferred approach was ipsilateral femoral antegrade in 170/220 patients (77.7%) and contralateral cross-over in 40/220 patients (18.8%) and popliteal retrograde+femoral antegrade in 10/220 patients (4.5%).Balloon angioplasty was performed in 252 legs (32 patients had bilateral disease):the procedure was successful in 239/252 legs with an immediate success rate

  19. VISIONARY THINKER: LEADERSHIP AND MANAGEMENT IN WORKS OF MARY P. FOLLETT – LONG-TERM PERSPECTIVE IN THE COMPANIES OF THE REPUBLIC OF SERBIA

    OpenAIRE

    Srdjan Nikezic; Radmila Mikovic; Dejana Prodanovic

    2014-01-01

    In her lectures, Mary P. Follett pointed to key moments of leadership, management, group membership, coordination and participation as relevant elements for the exploration of human relations that are of interest today in the same way as they were eighty years ago. Model of thinking applied by Mary P. Follett is deeply linked to current strong needs for the creation of leadership and management professions that are linked to changes and long term strategic goals of big companies and world eco...

  20. Fluoroscopically guided caudal epidural steroid injection for management of degenerative lumbar spinal stenosis: short-term and long-term results

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Joon Woo; Myung, Jae Sung; Kang, Heung Sik [Seoul National University Bundang Hospital, Department of Radiology, Seong Nam, Gyeongi-do (Korea); Park, Kun Woo; Yeom, Jin S. [Seoul National University Bundang Hospital, Department of Orthopaedic Surgery, Seong Nam, Gyeongi-do (Korea); Kim, Ki-Jeong; Kim, Hyun-Jib [Seoul National University Bundang Hospital, Department of Neurosurgery, Seong Nam, Gyeongi-do (Korea)

    2010-07-15

    To evaluate the short-term and long-term effects of fluoroscopically guided caudal epidural steroid injection (ESI) for the management of degenerative lumbar spinal stenosis (DLSS) and to analyze outcome predictors. All patients who underwent caudal ESI in 2006 for DLSS were included in the study. Response was based on chart documentation (aggravated, no change, slightly improved, much improved, no pain). In June 2009 telephone interviews were conducted, using formatted questions including the North American Spine Society (NASS) patient satisfaction scale. For short-term and long-term effects, age difference was evaluated by the Mann-Whitney U test, and gender, duration of symptoms, level of DLSS, spondylolisthesis, and previous operations were evaluated by Fisher's exact test. Two hundred and sixteen patients (male: female = 75:141; mean age 69.2 years; range 48{proportional_to}91 years) were included in the study. Improvements (slightly improved, much improved, no pain) were seen in 185 patients (85.6%) after an initial caudal ESI and in 189 patients (87.5%) after a series of caudal ESIs. Half of the patients (89/179, 49.8%) replied positively to the NASS patient satisfaction scale (1 or 2). There were no significant outcome predictors for either the short-term or the long-term responses. Fluoroscopically guided caudal ESI was effective for the management of DLSS (especially central canal stenosis) with excellent short-term and good long-term results, without significant outcome predictors. (orig.)

  1. Sharing Responsibility for Data Stewardship Between Scientists and Curators

    Science.gov (United States)

    Hedstrom, M. L.

    2012-12-01

    Data stewardship is becoming increasingly important to support accurate conclusions from new forms of data, integration of and computation across heterogeneous data types, interactions between models and data, replication of results, data governance and long-term archiving. In addition to increasing recognition of the importance of data management, data science, and data curation by US and international scientific agencies, the National Academies of Science Board on Research Data and Information is sponsoring a study on Data Curation Education and Workforce Issues. Effective data stewardship requires a distributed effort among scientists who produce data, IT staff and/or vendors who provide data storage and computational facilities and services, and curators who enhance data quality, manage data governance, provide access to third parties, and assume responsibility for long-term archiving of data. The expertise necessary for scientific data management includes a mix of knowledge of the scientific domain; an understanding of domain data requirements, standards, ontologies and analytical methods; facility with leading edge information technology; and knowledge of data governance, standards, and best practices for long-term preservation and access that rarely are found in a single individual. Rather than developing data science and data curation as new and distinct occupations, this paper examines the set of tasks required for data stewardship. The paper proposes an alternative model that embeds data stewardship in scientific workflows and coordinates hand-offs between instruments, repositories, analytical processing, publishers, distributors, and archives. This model forms the basis for defining knowledge and skill requirements for specific actors in the processes required for data stewardship and the corresponding educational and training needs.

  2. Long-term collections

    CERN Multimedia

    Collectes à long terme

    2007-01-01

    The Committee of the Long Term Collections (CLT) asks for your attention for the following message from a young Peruvian scientist, following the earthquake which devastated part of her country a month ago.

  3. DoD Financial Management: Important Steps Underway But Reform Will Require a Long-term Commitment

    Science.gov (United States)

    2007-11-02

    barriers had kept the department from meeting its specific time frames and goals. The most notable barrier was institutional resistance to change in an...problems; • deeply embedded cultural resistance to change , including military service parochialism and stovepiped operations; • a lack of results...to hinder long-term planning and follow-through. Cultural Resistance and Parochialism Cultural resistance to change and military service

  4. Educational Needs of Health Care Providers Working in Long-Term Care Facilities with Regard to Pain Management

    Directory of Open Access Journals (Sweden)

    Yannick Tousignant-Laflamme

    2012-01-01

    Full Text Available BACKGROUND: The prevalence of chronic pain ranges from 40% to 80% in long-term care facilities (LTCF, with the highest proportion being found among older adults and residents with dementia. Unfortunately, pain in older adults is underdiagnosed, undertreated, inadequately treated or not treated at all. A solution to this problem would be to provide effective and innovative interdisciplinary continuing education to health care providers (HCPs.

  5. Managing the risk of lithium-induced nephropathy in the long-term treatment of patients with recurrent affective disorders

    OpenAIRE

    Severus, Emanuel; Bauer, Michael

    2013-01-01

    Lithium has been the most effective psychopharmacological drug in the long-term treatment of patients with recurrent unipolar and bipolar affective illness. As a result of its widespread and longtime use in patients with recurrent affective disorders, psychiatrists have become increasingly aware of the whole spectrum of lithium's potential side effects. One of the side effects associated with its chronic use is lithium-induced nephropathy. In a recent cross-sectional study published in BMC Me...

  6. Coordination of short-term and long-term mitigation measures of hydro-meteorological risks: the importance of establishing a link between emergency management and spatial planning

    Science.gov (United States)

    Prenger-Berninghoff, Kathrin; Cortes, V. Juliette; Aye, Zar Chi; Sprague, Teresa

    2013-04-01

    The management of natural hazards involves, as generally known, the four stages of the risk management cycle: Prevention, preparedness, response and recovery. Accordingly, the mitigation of disasters can be performed in terms of short-term and long-term purposes. Whereas emergency management or civil protection helps to strengthen a community's capacity to be better prepared for natural hazards and to better respond in case a disaster strikes, thus addressing the short-term perspective, spatial planning serves long-term planning goals and can therefore implement long-term prevention measures. A purposefully applied risk mitigation strategy requires coordination of short-term and long-term mitigation measures and thus an effective coordination of emergency management and spatial planning. Several actors are involved in risk management and should consequently be linked throughout the whole risk management cycle. However, these actors, partly because of a historically fragmented administrative system, are hardly connected to each other, with spatial planning only having a negligible role compared to other actors1, a problem to which Young (2002) referred to as the "problem of interplay". In contrast, information transfer and decision-taking happen at the same time and are not coordinated among different actors. This applies to the prevention and preparedness phase as well as to the recovery phase, which basically constitutes the prevention phase for the next disaster2. Since investments in both risk prevention and emergency preparedness and response are considered necessary, a better coordination of the two approaches is required. In this regard, Decision Support Systems (DSS) can be useful in order to provide support in the decision-making aspect of risk management. The research work currently undertaken examines the problem of interplay in the four case study areas of the Marie Curie ITN, CHANGES3. The link between different risk management actors will be explored

  7. Generalizable principles for ecosystem stewardship-based management of social-ecological systems: lessons learned from Alaska

    Directory of Open Access Journals (Sweden)

    Winslow D. Hansen

    2014-12-01

    Full Text Available Human pressure could compromise the provision of ecosystem services if we do not implement strategies such as ecosystem stewardship to foster sustainable trajectories. Barriers to managing systems based on ecosystem stewardship principles are pervasive, including institutional constraints and uncertain system dynamics. However, solutions to help managers overcome these barriers are less common. How can we better integrate ecosystem stewardship into natural resource management practices? I draw on examples from the literature and two broadly applicable case studies from Alaska to suggest some generalizable principles that can help managers redirect how people use and view ecosystems. These include (1 accounting for both people and ecosystems in management actions; (2 considering historical and current system dynamics, but managing flexibly for the future; (3 identifying interactions between organizational, temporal, and spatial scales; (4 embracing multiple causes in addition to multiple objectives; and (5 acknowledging that there are no panaceas and that success will be incremental. I also identify next steps to rigorously evaluate the broad utility of these principles and quickly move principles from theory to application. The findings of this study suggest that natural resource managers are poised to overcome the barriers to implementing ecosystem stewardship and to develop innovative adaptations to social-ecological problems.

  8. Performance improvement in managed long-term care: physician communication in managing community-dwelling older adults.

    Science.gov (United States)

    Kogan, Polina; Underwood, Susan; Desmond, Donna; Hayes, Marjorie; Lucien, Gina

    2010-02-01

    This performance improvement initiative focused on the nurse consultant's communication with the physician about care management of community-dwelling older adults. Three defined areas were measured: (1) changes in clinical setting, (2) reporting adverse effects from medications that can contribute to falls, and (3) HbA1c results >9. Physicians were informed of our quality initiative; nurse practitioners led workshops addressing barriers to effective communication; and portable reference cards were created to assist staff in organizing information prior to contacting a physician. The Project Goal of 10% improvement for all three indicators was achieved. Staff identified best practices for communicating with physicians.

  9. Social networks, work and network-based resources for the management of long-term conditions: a framework and study protocol for developing self-care support.

    Science.gov (United States)

    Rogers, Anne; Vassilev, Ivaylo; Sanders, Caroline; Kirk, Susan; Chew-Graham, Carolyn; Kennedy, Anne; Protheroe, Joanne; Bower, Peter; Blickem, Christian; Reeves, David; Kapadia, Dharmi; Brooks, Helen; Fullwood, Catherine; Richardson, Gerry

    2011-05-29

    Increasing the effective targeting and promotion of self-care support for long-term conditions requires more of a focus on patient contexts and networks. The aim of this paper is to describe how within a programme of research and implementation, social networks are viewed as being centrally involved in the mobilisation and deployment of resources in the management of a chronic condition. This forms the basis of a novel approach to understanding, designing, and implementing new forms of self-management support. Drawing on evidence syntheses about social networks and capital and the role of information in self-management, we build on four conceptual approaches to inform the design of our research on the implementation of self-care support for people with long-term conditions. Our approach takes into consideration the form and content of social networks, notions of chronic illness work, normalisation process theory (NPT), and the whole systems informing self-management engagement (WISE) approach to self-care support. The translation and implementation of a self-care agenda in contemporary health and social context needs to acknowledge and incorporate the resources and networks operating in patients' domestic and social environments and everyday lives. The latter compliments the focus on healthcare settings for developing and delivering self-care support by viewing communities and networks, as well as people suffering from long-term conditions, as a key means of support for managing long-term conditions. By focusing on patient work and social-network provision, our aim is to open up a second frontier in implementation research, to translate knowledge into better chronic illness management, and to shift the emphasis towards support that takes place outside formal health services.

  10. Earthworm Populations in Savannas of the Orinoco Basin. A Review of Studies in Long-Term Agricultural-Managed and Protected Ecosystems

    Directory of Open Access Journals (Sweden)

    Danilo López-Hernández

    2012-04-01

    Full Text Available Earthworm biomass and production in savannas are limited by seasonal precipitation and the lack of organic and nutrient resources; I hypothesize that after a long-term protection of savanna from fire and agricultural activities drastic changes in the physical and chemical characteristics of the soil occur with a concomitant increase in earthworm abundance and activities. Similar changes might occur after a long-term fertilization of savannas with manure. This review article considers the earthworm communities and other soil quality indices in Trachypogon savannas of the Orinoco Basin in an organic agricultural forestal savanna (OAFS amended with compost over forty years in Puerto Ayacucho, Venezuela, and in an Experimental Station long-term protected (PS from fire and cattle raising from more than four decades in Central Llanos, Venezuela, comparison is made with results from similar savannas. Long-term additions of organic manure or a long protection have induced significant changes in the soil physical and chemical properties of the natural savanna (NS soils that induce a significant increase in the density and biomass of earthworm populations. On the other hand, the protection of the savanna promotes an improvement in the physical and chemical properties of the soil, which favors an increase in the density and biomass of earthworms in the PS compared with the NS subjected to recurrent burning and grazing. The results emphasize the importance of appropriate organic matter management and the relevance of earthworms in such agroecosystems.

  11. Treatments for post-menopausal osteoporotic women, what's new? How can we manage long-term treatment?

    Science.gov (United States)

    Herrero, Soledad; Pico, Yolanda

    2016-05-15

    Since the mid-1980s, postmenopausal osteoporosis (PMO) has been considered a serious public health concern because of the associated fractures. Pharmacological therapies that effectively reduce the number of fractures by improving bone mass have been and are being developed continuously. Most current agents inhibit bone loss by reducing bone resorption, but emerging therapies may increase bone mass by stimulating bone formation. Furthermore, nowadays, the most representative pharmaceuticals have been prescribed long enough to include the reporting of some adverse effects. This review discusses osteoporotic drugs that are approved or are under investigation for the treatment of post-menopausal women (PMW), paying particular attention to long-term treatments.

  12. A job description for the effective self-management of a long-term condition: experiences of living with difficult asthma.

    Science.gov (United States)

    Deacon, Maureen; Rickards, Emma

    2013-04-01

    This paper concerns a study exploring the salience of a 'job description' for the effective self-management of a long-term condition to the experiences of a group of women living with difficult asthma. This is a life-threatening disease. It has been claimed that sufferers are a marginalised, misunderstood, mistreated and vulnerable group. The method involved secondary analysis of focus group data. The job description has been developed as a tool to enable nurses to facilitate and support effective self-management. This study was designed to examine the application of this tool to a particular case. Long-term conditions are a growing feature of the developed world and are strongly implicated in health inequalities. They are more prevalent in socially and economically disadvantaged populations and therefore add further burden to already vulnerable people. Effective self-management is critical to adapting and adjusting to the experience of a long-term condition and nurses have a responsibility to promote this process.

  13. Long-term safety, efficacy, and patient acceptability of teriparatide in the management of glucocorticoid-induced osteoporosis

    Directory of Open Access Journals (Sweden)

    Dore RK

    2013-05-01

    Full Text Available Robin K DoreDavid Geffen School of Medicine, University of California, Los Angeles, CA, USAAbstract: Glucocorticoids are commonly prescribed medications to treat multiple diseases across many medical specialties. One of the most common yet largely unappreciated side effect of glucocorticoid use is increased risk of fracture. Many different therapies are indicated to prevent and treat this condition; many guidelines exist that suggest appropriate use of both glucocorticoids and the medications approved to prevent this common side effect of glucocorticoid therapy. Nevertheless, 30%–50% of patients on long-term glucocorticoid therapy sustain a fracture. Teriparatide, recombinant human parathyroid hormone (1–34, is a daily self-injectable therapy for 24 months approved for use in patients taking long-term glucocorticoids. Teriparatide has been shown to increase bone mineral density and reduce vertebral fracture risk in glucocorticoid-treated patients. Glucocorticoids have many adverse effects on bone that teriparatide has been shown to prevent or negate. Given the fact that preventive therapy for glucocorticoid-induced osteoporosis is often not prescribed, one wonders whether a daily self-injectable therapy for this condition would be prescribed by physicians and accepted by patients. This article reviews the epidemiology, pathophysiology, treatment, guidelines, and persistence data (when available for patients with glucocorticoid-induced osteoporosis treated with teriparatide.Keywords: glucocorticoid-induced osteoporosis, teriparatide, anabolic, PTH, parathyroid hormone

  14. Long-Term Weight-Loss Maintenance by a Meal Replacement Based Weight Management Program in Primary Care

    Directory of Open Access Journals (Sweden)

    Renate Kruschitz

    2017-04-01

    Full Text Available Objective: Structured obesity treatment programs at primary care level are becoming increasingly important. However, evidence from current treatment approaches in the long term is lacking. In view of this fact we evaluated a standardized, meal replacement-based weight loss program (myLINE®; AENGUS, Graz, Austria according to the currently applicable guidelines. Methods: Data of overweight and obese individuals (n = 70 who participated at least 36 months in the program were analyzed. Data were collected at baseline (T0 as well as after 1, 3, 6, 12, 24, and 36 (T1-T36 months. Body composition was measured by conventional anthropometry and bioelectrical impedance analysis. Results: Compared to T0, a maximum weight, BMI, fat mass, absolute body cell mass (BCM reduction and an increase of relative BCM could be seen at T6. Subsequently, the findings reveal a significant reduction of body weight and body fat and a satisfying development of body cell mass during the observation period of 36 months. Conclusion: The evaluated program complies with national and international guidelines for the therapy of obesity in adults and is efficient and meaningful for a long-term therapeutic use in primary care..

  15. Long-term management of sevelamer hydrochloride-induced metabolic acidosis aggravation and hyperkalemia in hemodialysis patients.

    Science.gov (United States)

    Sonikian, Macroui; Metaxaki, Polyxeni; Iliopoulos, Anastasios; Marioli, Stamatia; Vlassopoulos, Dimosthenis

    2006-01-01

    Sevelamer hydrochloride use in hemodialysis patients is complicated by metabolic acidosis aggravation and hyperkalemia. Rare reports about a short-term correction of this complication have been published. The current authors investigated the long-term correction of metabolic acidosis and hyperkalemia in sevelamer hydrochloride-treated patients at doses adequate to achieve serum phosphate levels within K/DOQI recommendations. The authors followed 20 hemodialysis patients for 24 months in an open-label prospective study. The dialysate bicarbonate concentration was increased stepwise to a maximum 40 mEq/L and adjusted to reach patient serum bicarbonate levels of 22 mEq/L, according to K/DOQI recommendations. Laboratory results for serum bicarbonate, potassium, calcium, phosphate, albumin, alkaline phosphatase, iPTH, cholesterol (HDL-LDL), triglycerides, Kt/V, systolic-diastolic arterial pressure were recorded. Sevelamer hydrochloride-induced metabolic acidosis aggravation and hyperkalemia in hemodialysis patients were corrected, on the long-term, by an increase in dialysate bicarbonate concentration. Further improvement in bone biochemistry was noted with this adequate acidosis correction and parallel sevelamer hydrochloride administration, in sufficiently large doses to achieve K/DOQI phosphate recommendations.

  16. [Combined arterial bypass operation and coumarin therapy--a concept for long-term management and its conditions].

    Science.gov (United States)

    Kühnel, L; Heinrichs, C; Wache, I; Neugebauer, J

    1991-01-01

    Antithrombotics of cumarin type or with antiplatelet effect are preferred to obtain results from vascular surgical interventions in arterial occlusion disease. In our experience the combination with cumarin long term therapy seems to be the better method, especially if the following conditions can be achieved: very good compliance of patients respectively strict consideration of absolute and relative contraindications, a sufficient number of patients who are treated and a long enough experience of therapeutists followed by using the recommendations of the WHO expert committee for the worldwide application of standardization in measuring the anticoagulation effect, using reagents and calibration materials, and the expression of results in INR. Further in our anticoagulation behaviour we are used influencing risk factors, having a good cooperation between patients and doctors during secondary diseases and new drug intake. For dental surgery we prefer a Quick test between 30 and 35% activity or 1, 9 and 2, 1 INR. With Phenprocoumon (Falithrom, Markumar) we use the long term anticoagulation effect without several daily applications. Since September 1987 there has been the possibility of a computer assisted programme for dose prediction.

  17. Long-Term Spatial Data Preservation and Archiving: What Are the Issues?

    Energy Technology Data Exchange (ETDEWEB)

    BLEAKLY, DENISE R.

    2002-01-01

    The Department of Energy (DOE) is moving towards Long-Term Stewardship (LTS) of many environmental restoration sites that cannot be released for unrestricted use. One aspect of information management for LTS is geospatial data archiving. This report discusses the challenges facing the DOE LTS program concerning the data management and archiving of geospatial data. It discusses challenges in using electronic media for archiving, overcoming technological obsolescence, data refreshing, data migration, and emulation. It gives an overview of existing guidance and policy and discusses what the United States Geological Service (USGS), National Oceanic and Atmospheric Administration (NOAA) and the Federal Emergency Management Agency (FEMA) are doing to archive the geospatial data that their agencies are responsible for. In the conclusion, this report provides issues for further discussion around long-term spatial data archiving.

  18. Long-Term Collections

    CERN Multimedia

    Comité des collectes à long terme

    2011-01-01

    It is the time of the year when our fireman colleagues go around the laboratory for their traditional calendars sale. A part of the money of the sales will be donated in favour of the long-term collections. We hope that you will welcome them warmly.

  19. Life after the NNU: the long term effects on mothers' lives, managing a child at home with broncho-pulmonary dysplasia and on home oxygen.

    Science.gov (United States)

    Manns, Sarah V

    2004-12-01

    This study investigated the long-term influences on mothers' lives having managed an infant with bronchopulmonary dysplasia (BPD), on home oxygen. 16 mothers UK wide, whose children had been at home for over a year, formed this project, and completed a semi-structured questionnaire. All mothers displayed a high standard of literacy and were English/British by their own description with no indication of cross cultural or ethnic differences. Mothers, giving up jobs and careers to remain home, were the primary carers for their child, and experienced long term emotional distress, suffered from lowered self-esteem over many years, self-blame in some cases and grieved over many aspects of pregnancy, birth, babyhood and early childhood. The fear of infection led to these mothers keeping themselves and their children isolated, compounded for half the mothers who faced negative reactions from the community when they did go out with their child.

  20. Mobile Phone and Tablet Apps to Support Young People's Management of Their Physical Long-Term Conditions: A Systematic Review Protocol.

    Science.gov (United States)

    Majeed-Ariss, Rabiya; Hall, Andrew G; McDonagh, Janet; Fallon, Deborah; Swallow, Veronica

    2015-04-07

    The prevalence of long-term or chronic conditions that limit activity and reduce quality of life in young people aged 10-24 years is rising. This group has distinct health care needs and requires tailored support strategies to facilitate increasing personal responsibility for the management of their condition wherever possible, as they mature. Mobile phone and tablet mobile technologies featuring software program apps are already well used by young people for social networking or gaming. They have also been utilized in health care to support personal condition management, using condition-specific and patient-tailored software. Such apps have much potential, and there is an emerging body of literature on their use in a health context making this review timely. The objective of this paper is to develop a systematic review protocol focused on identifying and assessing the effectiveness of mobile phone and tablet apps that support young people's management of their chronic conditions. The search strategy will include a combination of standardized indexed search terms and free-text terms related to the key concepts of young people; long-term conditions and mobile technology. Peer-reviewed journal articles published from 2003 that meet the inclusion and exclusion criteria will be identified through searching the generated hits from 5 bibliographical databases. Two independent reviewers will screen the titles and abstracts to determine which articles focus on testing interventions identified as a mobile phone or tablet apps, and that have been designed and delivered to support the management of long-term conditions in young people aged 10-24 years. Data extraction and quality assessment tools will be used to facilitate consistent analysis and synthesis. It is anticipated that several studies will meet the selection criteria but that these are likely to be heterogeneous in terms of study design, reported outcomes, follow-up times, participants' age, and health condition

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

    Energy Technology Data Exchange (ETDEWEB)

    1982-09-01

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

  2. VISIONARY THINKER: LEADERSHIP AND MANAGEMENT IN WORKS OF MARY P. FOLLETT – LONG-TERM PERSPECTIVE IN THE COMPANIES OF THE REPUBLIC OF SERBIA

    Directory of Open Access Journals (Sweden)

    Srdjan Nikezic

    2014-06-01

    Full Text Available In her lectures, Mary P. Follett pointed to key moments of leadership, management, group membership, coordination and participation as relevant elements for the exploration of human relations that are of interest today in the same way as they were eighty years ago. Model of thinking applied by Mary P. Follett is deeply linked to current strong needs for the creation of leadership and management professions that are linked to changes and long term strategic goals of big companies and world economy as a whole.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-05-01

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

  4. LONG-TERM MONITORING SENSOR NETWORK

    Energy Technology Data Exchange (ETDEWEB)

    Stephen P. Farrington; John W. Haas; Neal Van Wyck

    2003-10-16

    Long-term monitoring (LTM) associated with subsurface contamination sites is a key element of Long Term Stewardship and Legacy Management across the Department of Energy (DOE) complex. However, both within the DOE and elsewhere, LTM is an expensive endeavor, often exceeding the costs of the remediation phase of a clean-up project. The primary contributors to LTM costs are associated with labor. Sample collection, storage, preparation, analysis, and reporting can add a significant financial burden to project expense when extended over many years. Development of unattended, in situ monitoring networks capable of providing quantitative data satisfactory to regulatory concerns has the potential to significantly reduce LTM costs. But survival and dependable operation in a difficult environment is a common obstacle to widespread use across the DOE complex or elsewhere. Deploying almost any sensor in the subsurface for extended periods of time will expose it to chemical and microbial degradation. Over the time-scales required for in situ LTM, even the most advanced sensor systems may be rendered useless. Frequent replacement or servicing (cleaning) of sensors is expensive and labor intensive, offsetting most, if not all, of the cost savings realized with unattended, in situ sensors. To enable facile, remote monitoring of contaminants and other subsurface parameters over prolonged periods, Applied Research Associates, Inc has been working to develop an advanced LTM sensor network consisting of three key elements: (1) an anti-fouling sensor chamber that can accommodate a variety of chemical and physical measurement devices based on electrochemical, optical and other techniques; (2) two rapid, cost effective, and gentle means of emplacing sensor packages either at precise locations directly in the subsurface or in pre-existing monitoring wells; and (3) a web browser-based data acquisition and control system (WebDACS) utilizing field-networked microprocessor-controlled smart

  5. Urban ecological stewardship: understanding the structure, function and network of community-based urban land management

    Science.gov (United States)

    Erika s. Svendsen; Lindsay K. Campbell

    2008-01-01

    Urban environmental stewardship activities are on the rise in cities throughout the Northeast. Groups participating in stewardship activities range in age, size, and geography and represent an increasingly complex and dynamic arrangement of civil society, government and business sectors. To better understand the structure, function and network of these community-based...

  6. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association.

    Science.gov (United States)

    McCrindle, Brian W; Rowley, Anne H; Newburger, Jane W; Burns, Jane C; Bolger, Anne F; Gewitz, Michael; Baker, Annette L; Jackson, Mary Anne; Takahashi, Masato; Shah, Pinak B; Kobayashi, Tohru; Wu, Mei-Hwan; Saji, Tsutomu T; Pahl, Elfriede

    2017-04-25

    Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and long-term outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances. © 2017 American Heart Association, Inc.

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

    Science.gov (United States)

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

    2016-04-01

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

  8. Meeting current and future conservation challenges through the synthesis of long-term silviculture and range management research

    Science.gov (United States)

    Mary Beth Adams; Joe NcNeel; Carlos. Rodriguez-Franco

    2010-01-01

    The Experimental Forests and Ranges (EFRs) of the Forest Service, U.S. Department of Agriculture were established to represent major forest vegetation types of the United States, to provide guidelines for management of those forests and ranges, and to serve as "outdoor classrooms" for land managers to learn how to better manage their forests. Research data...

  9. Care plans and care planning in the management of long-term conditions in the UK: a controlled prospective cohort study.

    Science.gov (United States)

    Reeves, David; Hann, Mark; Rick, Jo; Rowe, Kelly; Small, Nicola; Burt, Jenni; Roland, Martin; Protheroe, Joanne; Blakeman, Tom; Richardson, Gerry; Kennedy, Anne; Bower, Peter

    2014-09-01

    In the UK, the use of care planning and written care plans has been proposed to improve the management of long-term conditions, yet there is limited evidence concerning their uptake and benefits. To explore the implementation of care plans and care planning in the UK and associations with the process and outcome of care. A controlled prospective cohort study among two groups of patients with long-term conditions who were similar in demographic and clinical characteristics, but who were registered with general practices varying in their implementation of care plans and care planning. Implementation of care plans and care planning in general practice was assessed using the 2009-2010 GP Patient Survey, and relationships with patient outcomes (self-management and vitality) were examined using multilevel, mixed effects linear regression modelling. The study recruited 38 practices and 2439 patients. Practices in the two groups (high and low users of written documents) were similar in structural and population characteristics. Patients in the two groups of practices were similar in demographics and baseline health. Patients did demonstrate significant differences in reported experiences of care planning, although the differences were modest. Very few patients in the cohort reported a written plan that could be confirmed. Analysis of outcomes suggested that most patients show limited change over time in vitality and self-management. Variation in the use of care plans at the practice level was very limited and not related to patient outcomes over time. The use of written care plans in patients with long-term conditions is uncommon and unlikely to explain a substantive amount of variation in the process and outcome of care. More proactive efforts at implementation may be required to provide a rigorous test of the potential of care plans and care planning. © British Journal of General Practice 2014.

  10. Topical report on release scenario analysis of long-term management of high-level defense waste at the Hanford Site

    Energy Technology Data Exchange (ETDEWEB)

    Wallace, R.W.; Landstrom, D.K.; Blair, S.C.; Howes, B.W.; Robkin, M.A.; Benson, G.L.; Reisenauer, A.E.; Walters, W.H.; Zimmerman, M.G.

    1980-11-01

    Potential release scenarios for the defense high-level waste (HLW) on the Hanford Site are presented. Presented in this report are the three components necessary for evaluating the various alternatives under consideration for long-term management of Hanford defense HLW: identification of scenarios and events which might directly or indirectly disrupt radionuclide containment barriers; geotransport calculations of waste migration through the site media; and consequence (dose) analyses based on groundwater and air pathways calculations. The scenarios described in this report provide the necessary parameters for radionuclide transport and consequence analysis. Scenarios are categorized as either bounding or nonbounding. Bounding scenarios consider worst case or what if situations where an actual and significant release of waste material to the environment would happen if the scenario were to occur. Bounding scenarios include both near-term and long-term scenarios. Near-term scenarios are events which occur at 100 years from 1990. Long term scenarios are potential events considered to occur at 1000 and 10,000 years from 1990. Nonbounding scenarios consider events which result in insignificant releases or no release at all to the environment. Three release mechanisms are described in this report: (1) direct exposure of waste to the biosphere by a defined sequence of events (scenario) such as human intrusion by drilling; (2) radionuclides contacting an unconfined aquifer through downward percolation of groundwater or a rising water table; and (3) cataclysmic or explosive release of radionuclides by such mechanisms as meteorite impact, fire and explosion, criticality, or seismic events. Scenarios in this report present ways in which these release mechanisms could occur at a waste management facility. The scenarios are applied to the two in-tank waste management alternatives: in-situ disposal and continued present action.

  11. The long-term outcomes of interventions for the management of attention-deficit hyperactivity disorder in children and adolescents: a systematic review of randomized controlled trials

    Science.gov (United States)

    Parker, Jack; Wales, Gill; Chalhoub, Nevyne; Harpin, Val

    2013-01-01

    Purpose To systematically identify and review the currently available evidence on the long-term outcomes of recommended attention-deficit hyperactivity disorder (ADHD) interventions following randomized controlled trials with children and young people. Method A systematic search was conducted to identify trials >1 year in length using the following databases: CINAHL (January 1982– July 2012), MEDLINE (Ovid and Cambridge Scientific Abstracts [CSA]), Psych info, Science Direct (Elsevier), and Cochrane Library. Hand searches of key journals in the subject, book chapters, and conference proceedings were also carried out. Relevant papers were critically appraised using the Cochrane risk of bias tool. Results Eight controlled trials were identified as being relevant, of duration ranging from 1 year to 8 years (at follow up). The total number of participants in the studies was 1,057, of whom 579 (54.7%) were from one cohort and included 26 different outcome measures. Results suggest there is moderate-to-high-level evidence that combined pharmacological and behavioral interventions, and pharmacological interventions alone can be effective in managing the core ADHD symptoms and academic performance at 14 months. However, the effect size may decrease beyond this period. Conclusion This review has highlighted the paucity and limitations of the evidence investigating the long-term outcomes of recommended interventions for managing ADHD symptoms. There is little evidence to suggest that the effects observed over the relatively short term are maintained throughout longer periods of impairment. Furthermore, much of the existing evidence examining effectiveness beyond 12 months does not include newer medications currently available or consider significant contextual and cultural differences, such as UK/European and Asian populations. Longitudinal studies are required to examine the long-term outcomes for children and young people with ADHD managed with currently recommended

  12. Participation in voluntary and community organisations in the United Kingdom and the influences on the self-management of long-term conditions.

    Science.gov (United States)

    Jeffries, Mark; Mathieson, Amy; Kennedy, Anne; Kirk, Susan; Morris, Rebecca; Blickem, Christian; Vassilev, Ivalyo; Rogers, Anne

    2015-05-01

    Voluntary and community organisations (VCOs) have health benefits for those who attend and are viewed as having the potential to support long-term condition management. However, existing community-level understandings of participation do not explain the involvement with VCOs at an individual level, or the nature of support, which may elicit health benefits. Framing active participation as 'doing and experiencing', the aim of this qualitative study was to explore why people with long-term vascular conditions join VCOs, maintain their membership and what prevents participation. Twenty participants, self-diagnosed as having diabetes, chronic heart disease or chronic kidney disease, were purposefully sampled and recruited from a range of VCOs in the North West of England identified from a mapping of local organisations. In semi-structured interviews, we explored the nature of their participation. Analysis was thematic and iterative involving a continual reflection on the data. People gave various reasons for joining groups. These included health and well-being, the need for social contact and pursuing a particular hobby. Barriers to participation included temporal and spatial barriers and those associated with group dynamics. Members maintained their membership on the basis of an identity and sense of belonging to the group, developing close relationships within it and the availability of support and trust. Participants joined community groups often in response to a health-related event. Our findings demonstrate the ways in which the social contact associated with continued participation in VCOs is seen as helping with long-term condition management. Interventions designed at improving chronic illness management might usefully consider the role of VCOs. © 2014 John Wiley & Sons Ltd.

  13. Protocol liver biopsies in long-term management of patients transplanted for hepatitis B-related liver disease

    Institute of Scientific and Technical Information of China (English)

    Stefano Targhetta; Patrizia Burra; Federico Villamil; Paolo Inturri; Patrizia Pontisso; Stefano Fagiuoli; Umberto Cillo; Attilio Cecchetto; Simona Gianni; Remo Naccarato

    2006-01-01

    AIM:To evaluate the long-term histological outcome of patients transplanted for HBV-related liver disease and given HBIg prophylaxis indefinitely after LT.METHODS: Forty-two consecutive patients transplanted for hepatitis B were prospectively studied. HBsAg, HBV-DNA and liver function tests were evaluated in the serum 3, 6 and 12 mo after LT and then yearly. LB was obtained 6 and 12 mo after LT and yearly thereafter. Chronic hepatitis (CH) B after LT was classified as minimal, mild,moderate or severe.RESULTS: HBV recurred in 7/42 (16.6%) patients after 6-96 mo of follow-up. A hundred and eightyseven LB were evaluated. Four of 7 patients with graft reinfection, all with unknown HBV DNA status before LT, developed cirrhosis at 12-36 mo of follow-up. Of the 122 LB obtained from 28 HBsAg+/HCV- recipients with no HBV recurrence after LT, all biopsies were completely normal in only 2 patients (7.1%), minimal/non-specific changes were observed in 18 (64.2%), and at least 1 biopsy showed CH in the remaining 8 (28.5%). Twentynine LB obtained from 7 patients transplanted for HBV-HCV cirrhosis and remaining HBsAg- after LT revealed recurrent CH-C. Actuarial survival was similar in patients with HBsAg+ or HBsAg- liver diseases.CONCLUSION: Though protocol biopsies may enablethe detection of graft dysfunction at an early stage, the risk of progression and the clinical significance of these findings remains to be determined.

  14. Long-Term Results of Percutaneous Management of Liver Hydatid Cysts: - Experience of a University Hospital in Endemic Region –

    Directory of Open Access Journals (Sweden)

    Younès Cherradi

    2016-12-01

    Full Text Available Background and objective: Surgery was considered for years the standard treatment for all stages of liver hydatid cysts (LHC. Percutaneous treatment has becomes a fast, reliable and more efficient method in selected cases. The purpose of this study is to evaluate the effectiveness of percutaneous treatment of LHC on the basis of our department long-term results. Patients and Methods: This study includes all patients who benefited from percutaneous treatment for LHC from December 1998 to April 2012. Puncture aspiration, injection, and re-aspiration (PAIR were used for hydatid cysts smaller than 6 cm. Larger cysts, infected cysts and those with biliary fistula were treated by puncture associated to drainage (PA-PD. Absolute alcohol was used as sclerosing agent. Reduction of the size of the cyst more than 50%, pseudo-tumour echo pattern and disappearance of the cyst at the follow-up were retained as criteria of treatment efficacy. Results: Two hundred thirty patients (136 female and 94 male; mean age: 35 years old with 278 LHC underwent percutaneous treatment. Mean initial cyst diameter was 76.8 mm [20-180 mm]. According to Gharbi’s classification, types I and II LHC accounted for 74% and 25% respectively. Fourteen patients (6% presented with an infected cavity and 27 patients (12% had a biliary fistula at diagnosis (12%. PA-PD was initially performedin 23 patients. No mortality, abdominal dissemination, or tract seeding occurred. Minor complications like urticaria, cutaneous rash and fever were reported in 24 patients (10%. One case of anaphylactic shock was reported with good evolution. Mean hospitalization time was 3 days ± 1.5 for uncomplicated cases and 16.5 days± 4.2 for complicated cases. 229 out of 230 patients were cured, whereas one recurrence has been reported. Conclusion: Percutaneous treatmentis efficient and safe and offers complete cure in selected patients with the advantage of short hospitalization.

  15. Management of post-biopsy renal allograft arteriovenous fistulas with selective arterial embolization: immediate and long-term outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Loffroy, R. [Department of Diagnostic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon (France)], E-mail: loffroy.romaric@neuf.fr; Guiu, B.; Lambert, A. [Department of Diagnostic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon (France); Mousson, C.; Tanter, Y. [Department of Nephrology and Renal Transplantation (France); Martin, L. [Department of Pathology, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon (France); Cercueil, J.-P.; Krause, D. [Department of Diagnostic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon (France)

    2008-06-15

    Aim: To evaluate the outcomes after transcatheter embolization of percutaneous biopsy-related arteriovenous fistulas in renal allografts. Materials and methods: All post-biopsy renal-transplant vascular injuries referred for embolization between June 1999 and October 2006 were reviewed retrospectively. There were six male and six female patients with a mean age of 49.8 years (range 25-67 years); nine patients were symptomatic, three asymptomatic. Colour Doppler ultrasound (CDUS) and angiography showed one intra-renal arteriovenous fistula in 10 patients and two in two patients, combined with a pseudoaneurysm in six patients. Superselective embolization using a single catheter or coaxial microcatheter was performed with 0.035'' coils or 0.018''microcoils, respectively, in all 12 cases. 24-h creatinine clearance values before (the day of biopsy) and after (7-14 days; 3 months) the procedure were compared using the Wilcoxon signed-rank test. Physical examination and CDUS were performed after 1, 6, and 12 months, and yearly thereafter. Mean follow-up was 33.6 months. Results: Complete definitive occlusion of the fistula was achieved consistently with a single procedure. No procedure-related complications occurred. Renal infarction was minor in all patients (0-10% in nine and 10-20% in three). Symptoms resolved completely. Creatinine clearance values obtained before and after embolization were not statistically different (p = 0.168;.889 respectively). No late recurrences were reported. Conclusion: Transcatheter embolization with coaxial or single-catheter techniques was effective and safe for treating post-biopsy arteriovenous fistulas in renal transplants. The loss of renal parenchyma was minimal and no mid-term deterioration of allograft function was noted. The long-term survival of the renal allograft seemed to be not affected by embolization.

  16. Effect of short-term versus long-term grassland management and seasonal variation in organic and conventional dairy farming on the composition of bulk tank milk

    DEFF Research Database (Denmark)

    Adler, S A; Jensen, Søren Krogh; Govasmark, E

    2013-01-01

    Bulk tank milk from 28 dairy farms was sampled every second month for 2 yr to assess the effects of grassland management, production system and season on milk fatty acid (FA) composition, concentrations of fat-soluble vitamins, Se, and milk sensory quality. Grassland management varied in terms...... of time since establishment. Short-term grassland management (SG) was defined as establishment or reseeding every fourth year or more often, and long-term grassland management (LG) was defined as less frequent establishment or reseeding. Fourteen organic (ORG) dairy farms with either short-term or long...... associated with grazing and higher forage proportions. Milk concentrations of α-tocopherol and β-carotene were lower during the grazing periods. Inclusion of fishmeal in organic concentrates may explain higher Se concentrations in organically produced milk. Milk sensory quality was not affected in this study...

  17. The connection between long-term and short-term risk management strategies: examples from land-use planning and emergency management in four European case studies

    Science.gov (United States)

    Prenger-Berninghoff, K.; Cortes, V. J.; Sprague, T.; Aye, Z. C.; Greiving, S.; Głowacki, W.; Sterlacchini, S.

    2014-04-01

    The need for continuous adaptation to complex and unforeseen events requires enhancing the links between planning and preparedness phases to reduce future risks in the most efficient way. In this context, the legal-administrative and cultural context has to be taken into account. This is why four case study areas of the CHANGES1 project (Nehoiu Valley in Romania, Ubaye Valley in France, Val Canale in Italy, and Wieprzówka catchment in Poland) serve as examples to highlight currently implemented risk management strategies for land-use planning and emergency preparedness. The strategies described in this paper were identified by means of exploratory and informal interviews in each study site. Results reveal that a dearth or, in very few cases, a weak link exists between spatial planners and emergency managers. Management strategies could benefit from formally intensifying coordination and cooperation between emergency services and spatial planning authorities. Moreover, limited financial funds urge for a more efficient use of resources and better coordination towards long-term activities. The research indicates potential benefits to establishing or, in some cases, strengthening this link and provides suggestions for further development in the form of information and decision support systems as a key connection point. Aside from the existent information systems for emergency management, it was found that a common platform, which integrates involvement of these and other relevant actors could enhance this connection and address expressed stakeholder needs. 1 Marie Curie ITN CHANGES - Changing Hydro-meteorological Risks as Analyzed by a New Generation of European Scientists.

  18. Projecting marine fish production and catch potential in Bangladesh in the 21st century under long-term environmental change and management scenarios

    OpenAIRE

    Jose A Fernandes; Kay, Susan; Hossain, Mostafa A.R.; Ahmed, Munir; William W L Cheung; Lazar, Attila; Barange, Manuel

    2016-01-01

    The fisheries sector is crucial to the Bangladeshi economy and wellbeing, accounting for 4.4% of national gross domestic product and 22.8% of agriculture sector production, and supplying ca. 60% of the national animal protein intake. Fish is vital to the 16 million Bangladeshis living near the coast, a number that has doubled since the 1980s. Here, we develop and apply tools to project the long-term productive capacity of Bangladesh marine fisheries under climate and fisheries management scen...

  19. Adapting Advances in Remediation Science to Long-Term Surveillance

    Energy Technology Data Exchange (ETDEWEB)

    Peterson, Dave [S.M. Stoller Corporation

    2006-03-01

    Several facets of groundwater remediation stand to gain from the advances made during recent years in disciplines that contribute to remediation science. Engineered remedies designed to aggressively remove subsurface contamination should benefit from this progress, and more passive cleanup methods and the long-term monitoring of such passive approaches may benefit equally well if not more. The U.S. Department of Energy Office of Legacy Management (LM) has adopted a strategic plan that is designed to take advantage of technological improvements in the monitoring and assessment of both active and passive groundwater remedies. Flexible adaptation of new technologies, as they become available, to long-term surveillance at LM sites is expected to reduce site stewardship costs while ensuring the future protection of human health and the environment. Some of the technologies are expected to come from government initiatives that focus on the needs of subsurface monitoring. Additional progress in monitoring science will likely result from continual improvements in our understanding of contaminant fate-and-transport processes in the groundwater and the vadose zone.

  20. Carbon Dioxide Emissions as Affected by Alternative Long-Term Irrigation and Tillage Management Practices in the Lower Mississippi River Valley

    Directory of Open Access Journals (Sweden)

    S. F. Smith

    2014-01-01

    Full Text Available Ensuring the sustainability of cultivated soils is an ever-increasing priority for producers in the Lower Mississippi River Valley (LMRV. As groundwater sources become depleted and environmental regulations become more strict, producers will look to alternative management practices that will ensure the sustainability and cost-effectiveness of their production systems. This study was conducted to assess the long-term (>7 years effects of irrigation (i.e., irrigated and dryland production and tillage (conventional and no-tillage on estimated carbon dioxide (CO2 emissions from soil respiration during two soybean (Glycine max L. growing seasons from a wheat- (Triticum aestivum L.- soybean, double-cropped production system in the LMRV region of eastern Arkansas. Soil surface CO2 fluxes were measured approximately every two weeks during two soybean growing seasons. Estimated season-long CO2 emissions were unaffected by irrigation in 2011 (P>0.05; however, during the unusually dry 2012 growing season, season-long CO2 emissions were 87.6% greater (P=0.044 under irrigated (21.9 Mg CO2 ha−1 than under dryland management (11.7 Mg CO2 ha−1. Contrary to what was expected, there was no interactive effect of irrigation and tillage on estimated season-long CO2 emissions. Understanding how long-term agricultural management practices affect soil respiration can help improve policies for soil and environmental sustainability.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-04-01

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

  2. Long-Term Impact of Soil Management on Microbial Biomass C, N and P in Rice-Based Cropping System

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    A 12-year field experiment was conducted to investigate the effect of different tillage methods and fertilization systems on microbial biomass C, N and P of a gray fluvo-aguic soil in rice-based cropping system. Five fertilization treatments were designed under conventional tillage (CT) or no tillage (NT) system: no fertilizer (CK); chemical fertilizer only (CF); combining chemical fertilizer with pig manure (PM); combining chemical fertilizer with crop straw (CS) and fallow (F). The results showed that biomass C, N and P were enriched in the surface layer of no-tilled soil, whereas they distributed relatively evenly in the tilled soil, which might result from enrichment of crop residue, organic manure and mineral fertilizer, and surficial development of root systems under NT. Under the cultivation system, NT had slightly greater biomass C, N and P at 0~5 cm depth, significantly less biomass C, N and P at 5~15 cm depth, less microbial biomass C, N and equivalent biomass P at 15~30 cm depth as compared to CT, indicating that tillage was beneficial for the multiplication of organisms in the plowed layer of soil. Under the fallow system, biomass C, N and P in the surface layer were significantly greater for NT than CT while their differences between the two tillage methods were negligible in the deeper layers. In the surface layer, biomass C, N and P in the soils amended with organic manure combined with mineral fertilizers were significantly greater than those of the treatments only with mineral fertilizers and the control. Soils without fertilizer had the least biomass nutrient contents among the five fertilization treatments. Obviously, the long-term application of organic manure could maintain the higher activity of microorganisms in soils. The amounts of biomass C, N and P in the fallowed soils varied with the tillage methods; they were much greater under NT than under CT, especially in the surface layer, suggesting that the frequent plowing could decrease

  3. Long-term efficacy of excimer laser in situ keratomileusis in the management of children with high anisometropic amblyopia

    Institute of Scientific and Technical Information of China (English)

    LIN Xiao-ming; YAN Xiao-he; WANG Zheng; YANG Bin; CHEN Qi-wen; SU Jin-ai; YE Xue-lian

    2009-01-01

    Background Children with anisometropic amblyopia are often noncompliant with traditional treatment including spectacules and contact lenses.This study was to evaluate the long-term efficacy of excimer laser in situ keratomileusis (LASIK) for children with high anisometropic amblyopia.Methods A retrospective analysis of 24 children with high unilateral anisometropic amblyopia,who underwent LASIK during the period between August 2000 and September 2005 in our hospital,was conducted.The mean age of these children was (7.4±1.9) years (range 5-14 years) and the mean follow-up period was (33.3±14.2) months (range 18.5-74.2 months).After LASIK,visual acuity,refraction and far or near stereoacuity were analyzed.Near stereoacuity was measured by the random-dot butterfly stereogram and the pre-school random-dot stereogram,while far stereoacuity was measured by the synoptophore with Yan's random-dot stereogram.Results Mean preoperative uncorrected visual acuity was 0.06±0.05,while mean postoperative uncorrected visual acuity was elevated to 0.43±0.33.Mean preoperative best-corrected visual acuity was 0.26±0.22,while mean postoperative best-corrected visual acuity was elevated to 0.67±0.40.For patients with myopic anisometropia,preoperative mean spherical equivalent refraction was (-8.01±2.70) D while postoperative value significantly reduced to (-1.32±2.47) D.For patients with hyperopic anisometropia,preoperative mean spherical equivalent refraction was (+7.35±1.55) D while postoperative value significantly reduced to (+3.30±0.86) D.These results demonstrated that there was statistical difference in these parameters between preoperative and postoperative tests.At the last follow-up,20 patients had near stereoacuity,and the mean near stereoacuities measured by the random-dot butterfly stereogram and the preschool random-dot stereogram were (149.00±152.93)" and (201.05±235.94)",respectively.In contrast,11 patients had far stereoacuity,and the mean far stereoacuity

  4. The Howling Prescribed Natural Fire - long-term effects on the modernization of planning and implementation of wildland fire management

    Science.gov (United States)

    Tom Zimmerman; Laurie Kurth; Mitchell Burgard

    2011-01-01

    Wildland fire management policy and practices have long been driven by the occurrence of significant events. The Howling Prescribed Natural Fire in Glacier National Park in 1994 is a prime example of a significant historical fire event that provided the impetus for program changes and modifications that modernized wildland fire management at the local, regional, and...

  5. Long-term effects of soil management on ecosystem services and soil loss estimation in olive grove top soils

    NARCIS (Netherlands)

    Parras-Alcántara, Luis; Lozano-García, Beatriz; Keesstra, Saskia; Cerdà, Artemi; Brevik, Eric C.

    2016-01-01

    Soil management has important effects on soil properties, runoff, soil losses and soil quality. Traditional olive grove (OG) management is based on reduced tree density, canopy size shaped by pruning and weed control by ploughing. In addition, over the last several decades, herbicide use has been

  6. Long-Term Collections

    CERN Multimedia

    Staff Association

    2016-01-01

    45 years helping in developing countries! CERN personnel have been helping the least fortunate people on the planet since 1971. How? With the Long-Term Collections! Dear Colleagues, The Staff Association’s Long-Term Collections (LTC) Committee is delighted to share this important milestone in the life of our Laboratory with you. Indeed, whilst the name of CERN is known worldwide for scientific discoveries, it also shines in the many humanitarian projects which have been supported by the LTC since 1971. Several schools and clinics, far and wide, carry its logo... Over the past 45 years, 74 projects have been supported (9 of which are still ongoing). This all came from a group of colleagues who wanted to share a little of what life offered them here at CERN, in this haven of mutual understanding, peace and security, with those who were less fortunate elsewhere. Thus, the LTC were born... Since then, we have worked as a team to maintain the dream of these visionaries, with the help of regular donat...

  7. Long-Term Collection

    CERN Document Server

    Staff Association

    2016-01-01

    Dear Colleagues, As previously announced in Echo (No. 254), your delegates took action to draw attention to the projects of the Long-Term Collections (LTC), the humanitarian body of the CERN Staff Association. On Tuesday, 11 October, at noon, small Z-Cards were widely distributed at the entrances of CERN restaurants and we thank you all for your interest. We hope to have achieved an important part of our goal, which was to inform you, convince you and find new supporters among you. We will find out in the next few days! An exhibition of the LTC was also set up in the Main Building for the entire week. The Staff Association wants to celebrate the occasion of the Long-Term Collection’s 45th anniversary at CERN because, ever since 1971, CERN personnel have showed great support in helping the least fortunate people on the planet in a variety of ways according to their needs. On a regular basis, joint fundraising appeals are made with the Directorate to help the victims of natural disasters around th...

  8. Collectes à long terme

    CERN Document Server

    Collectes à long terme

    2014-01-01

    En cette fin d’année 2014 qui approche à grands pas, le Comité des Collectes à Long Terme remercie chaleureusement ses fidèles donatrices et donateurs réguliers pour leurs contributions à nos actions en faveur des plus démunis de notre planète. C’est très important, pour notre Comité, de pouvoir compter sur l’appui assidu que vous nous apportez. Depuis plus de 40 ans maintenant, le modèle des CLT est basé principalement sur des actions à long terme (soit une aide pendant 4-5 ans par projet, mais plus parfois selon les circonstances), et sa planification demande une grande régularité de ses soutiens financiers. Grand MERCI à vous ! D’autres dons nous parviennent au cours de l’année, et ils sont aussi les bienvenus. En particulier, nous tenons à remercier...

  9. Analysis of social recognition and disposal time for the long-term management scenario of high-level waste

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kang Myong; Jeong, Jin Yeop; Ha, Gyu Man [Korea Energy Technology and Emergency Management Institute, Seoul (Korea, Republic of)

    2009-02-15

    Recently, the need of high-level radioactive waste policy including spent fuel management becomes serious due to the rapid increase in oil price, the nationalism of natural resources, and the environmental issues such as Tokyo protocol. Also, the policy should be established urgently to prepare the saturation of on-site storage capacity of spent fuel, the revision of 'Agreement for Cooperation-Concerning Civil Uses of Atomic Energy' between Korea and US, the anxiety for nuclear weapon proliferation, and R and D to reduce the amount of waste to be disposed. In this study, we performed case study of US, Japan, Canada and Finland, which have special laws and plans/roadmaps for high-level waste management, to draw the policy requirements to be considered in HLW management. Also, we reviewed social conflict issues experienced in our society, and summarized the factors affecting the political and social environment. These policy requirements and factors summarized in this study should be considered seriously in the process for public consensus and the policy making regarding HLW management. Finally, the following 4 action items were drawn to manage HLW successfully : - Continuous and systematic R and D activities to obtain reliable management technology - Promoting companies having specialty in HLW management - Nurturing experts and workforce - Drive the public consensus process

  10. Using Private Rights to Manage Natural Resources: Is Stewardship Linked to Ownership?

    Directory of Open Access Journals (Sweden)

    Peter D. Dwyer

    2012-09-01

    Full Text Available There is increasing interest in privatizing natural resource systems to promote sustainability and conservation goals. Though economic theory suggests owners of private property rights have an incentive to act as resource stewards, few studies have tested this empirically. This paper asks whether private rights-owners were more conservative with respect to their management opinions than nonrights-owners in five Australian abalone (Haliotis spp. fisheries. Multiple regression analyses were used to link opinions to demographic, economic, and attitudinal variables. In contrast to standard economic assumptions, nonrights-owners suggested more conservative catch limits than did rights-owners, confirming qualitative observations of behavior in management workshops. Differing views about the condition of the resource and differing levels of experience contributed to these results. The first of its kind, this study directly demonstrates that private rights do not necessarily promote the greatest level of stewardship. This has substantial implications for how natural resources are governed globally, but also warns against applying simplistic behavioral assumptions to complex social-ecological systems.

  11. Neuro-orthopaedic conditions in spina bifida: natural course and their management and long-term outcomes.

    Science.gov (United States)

    Kumar, Raj; Mehrotra, Anant; Banerjee, Sumit

    2013-09-01

    Management of spina bifida is a complex issue with various systems of the body involved either directly or indirectly. Deformities of the bone and joints (especially spine and lower limbs) play a significant role in causation of deficits in the child. Management of these deficits require a focused, specialised and multidisciplinary approach with orthopaedician, physiotherapist, intensivist and psychologist apart from neurosurgeon playing an important part. To manage these deformities, one needs to understand the pathophysiology of causation of these defects. The corrective surgical intervention ranges from a simple release of contracture to highly complex spinal instrumentations. We reviewed the literature and have shared our experience on this aspect of spina bifida.

  12. Decision support for on-farm water management and long-term agricultural sustainability in a semi-arid region of India

    Science.gov (United States)

    Singh, Ajay

    2010-09-01

    SummaryThe long-term success of irrigated agriculture for sustainable crop production in India depends largely on the careful management of land and water resources. Currently, some serious environmental problems of waterlogging and soil salinization are burgeoning in parts of Haryana State of India; half a million hectare area of the State is already waterlogged. Poor irrigation and drainage management and inadequate exploitation of saline ground water are the main factors responsible for this phenomenon. In order to prevent further degradation and to maintain the food production for the growing population, judicious use of natural resources is a must. A wide range of solutions could be considered to address the problems. But the effectiveness of all the solutions and their combinations cannot be verified with on-farm experiments. Simulation models by way of their predictive capability are often the only viable means of providing input to management decisions. These models can help to forecast the likely impacts of a particular alternative management strategy. In the present study a physical based one-dimensional simulation model SWASALT was employed to evaluate on-farm irrigation water management options. After successful calibration and validation with field experimentation data, several scenario building exercises have been conducted under different crop, soil and rainfall conditions. The water and salt balance component obtained for each simulation run were used to derive water management response indicators. The simulation study revealed that in most conditions, saline water of up to 7.5 dS/m can be used safely on long term basis for crop production. The simulation study further revealed that alternative use of canal and saline water had an edge over mix use. Several alternatives have been suggested for sustainable agricultural production in the region. The strategies suggested, if followed, would lend sustainability to the agricultural production besides

  13. Impact of Managers' Coaching Conversations on Staff Knowledge Use and Performance in Long-Term Care Settings.

    Science.gov (United States)

    Cummings, Greta G; Hewko, Sarah J; Wang, Mengzhe; Wong, Carol A; Laschinger, Heather K Spence; Estabrooks, Carole A

    2017-07-29

    Extended lifespans and complex resident care needs have amplified resource demands on nursing homes. Nurse managers play an important role in staff job satisfaction, research use, and resident outcomes. Coaching skills, developed through leadership skill-building, have been shown to be of value in nursing. To test a theoretical model of nursing home staff perceptions of their work context, their managers' use of coaching conversations, and their use of instrumental, conceptual and persuasive research. Using a two-group crossover design, 33 managers employed in seven Canadian nursing homes were invited to attend a 2-day coaching development workshop. Survey data were collected from managers and staff at three time points; we analyzed staff data (n = 333), collected after managers had completed the workshop. We used structural equation modeling to test our theoretical model of contextual characteristics as causal variables, managers' characteristics, and coaching behaviors as mediating variables and staff use of research, job satisfaction, and burnout as outcome variables. The theoretical model fit the data well (χ(2) = 58, df = 43, p = .06) indicating no significant differences between data and model-implied matrices. Resonant leadership (a relational approach to influencing change) had the strongest significant relationship with manager support, which in turn influenced frequency of coaching conversations. Coaching conversations had a positive, non-significant relationship with staff persuasive use of research, which in turn significantly increased instrumental research use. Importantly, coaching conversations were significantly, negatively related to job satisfaction. Our findings add to growing research exploring the role of context and leadership in influencing job satisfaction and use of research by healthcare practitioners. One-on-one coaching conversations may be difficult for staff not used to participating in such conversations. Resonant leadership, as

  14. Forest Stewardship Council (FSC) pesticide policy and integrated pest management in certified tropical plantations.

    Science.gov (United States)

    Lemes, Pedro Guilherme; Zanuncio, José Cola; Serrão, José Eduardo; Lawson, Simon A

    2017-01-01

    The Forest Stewardship Council (FSC) was the first non-governmental organization composed of multi-stakeholders to ensure the social, environmental, and economic sustainability of forest resources. FSC prohibits certain chemicals and active ingredients in certified forest plantations. A company seeking certification must discontinue use of products so listed and many face problems to comply with these constraints. The aim of this study was to assess the impacts of certification on pest management from the perspective of Brazilian private forestry sector. Ninety-three percent of Brazilian FSC-certified forest companies rated leaf-cutting ants as "very important" pests. Chemical control was the most important management technique used and considered very important by 82 % of respondents. The main chemical used to control leaf-cutting ants, sulfluramid, is in the derogation process and was classified as very important by 96.5 % of the certified companies. Certified companies were generally satisfied in relation to FSC certification and the integrated management of forest pests, but 27.6 % agreed that the prohibitions of pesticides for leaf-cutting ant and termite control could be considered as a non-tariff barrier on high-productivity Brazilian forest plantations. FSC forest certification has encouraged the implementation of more sustainable techniques and decisions in pest management in forest plantations in Brazil. The prohibition on pesticides like sulfluramid and the use of alternatives without the same efficiency will result in pest mismanagement, production losses, and higher costs. This work has shown that the application of global rules for sustainable forest management needs to adapt to each local reality.

  15. The contribution of social networks to the health and self-management of patients with long-term conditions: a longitudinal study.

    Directory of Open Access Journals (Sweden)

    David Reeves

    Full Text Available Evidence for the effectiveness of patient education programmes in changing individual self-management behaviour is equivocal. More distal elements of personal social relationships and the availability of social capital at the community level may be key to the mobilisation of resources needed for long-term condition self-management to be effective.To determine how the social networks of people with long-term conditions (diabetes and heart disease are associated with health-related outcomes and changes in outcomes over time.Patients with chronic heart disease (CHD or diabetes (n = 300 randomly selected from the disease registers of 19 GP practices in the North West of England. Data on personal social networks collected using a postal questionnaire, alongside face-to-face interviewing. Follow-up at 12 months via postal questionnaire using a self-report grid for network members identified at baseline.Multiple regression analysis of relationships between health status, self-management and health-economics outcomes, and characteristics of patients' social networks.Findings indicated that: (1 social involvement with a wider variety of people and groups supports personal self-management and physical and mental well-being; (2 support work undertaken by personal networks expands in accordance with health needs helping people to cope with their condition; (3 network support substitutes for formal care and can produce substantial saving in traditional health service utilisation costs. Health service costs were significantly (p<0.01 reduced for patients receiving greater levels of illness work through their networks.Support for self-management which achieves desirable policy outcomes should be construed less as an individualised set of actions and behaviour and more as a social network phenomenon. This study shows the need for a greater focus on harnessing and sustaining the capacity of networks and the importance of social involvement with community

  16. Long-term effectiveness of a multifaceted intervention on pain management in a walk-in clinic.

    Science.gov (United States)

    Junod Perron, N; Piguet, V; Bovier, P A

    2007-04-01

    Pain is a common complaint of patients attending walk-in clinics, but timely and appropriate pain management is often lacking. To evaluate the impact of a multifaceted intervention on pain management. Prospective interventional study. Three cross-sectional surveys were conducted: before, 4 months after and 14 months after a multifaceted intervention at the medical walk-in clinic of a university hospital. The intervention included both educational activities and structural changes. Use of recommended pain management procedures, pain relief and overall assessments of pain treatment and health professionals' attitudes were assessed using patient questionnaires, collected by mail. History of pain, records of pain intensity and use of pain medication were extracted from medical files. We analysed 1409 medical files and 695 questionnaires of patients presenting with pain. Documentation of pain intensity and administration of pain medication at the walk-in clinic improved significantly 14 months after the intervention (7% vs. 53% and 17% vs. 27%, respectively, ppain medication was more often administered by the oral route (14% vs. 23%, ppain relief (40% vs. 39%, p=0.92) or patients' overall assessments of pain management. The intervention improved adherence to recommended procedures, even in the longer term, but did not result in better patient outcomes. Continuing efforts are needed to help health professionals improve pain management in out-patient care.

  17. Numerical long-term assessment of managed aquifer recharge from a reservoir into a karst aquifer in Jordan

    Science.gov (United States)

    Xanke, Julian; Jourde, Hervé; Liesch, Tanja; Goldscheider, Nico

    2016-09-01

    In semi-arid regions with high seasonal variability of water availability, adaptive management strategies and technical measures are required to ensure the sustainable use of water resources. In this study, managed recharge of storm water into a karst aquifer and the water level fluctuations related to pumping in a nearby wellfield were simulated at Wadi Wala, Jordan. We used a numerical equivalent porous medium (EPM) approach with specific adaptations to account for the heterogeneity and anisotropy of the karst aquifer. The model domain was vertically projected along the wadi course, resulting in a 2-dimensional model, and subdivided into hydraulic zones representing the karst-specific flow pattern of fast flow and slow depletion. Results show satisfying agreement of measured and simulated groundwater tables from 2002 to 2012 and predict a lowering of the average groundwater table until 2022 of around 2.7 m in the immediate surroundings of the reservoir and an increased depletion towards the wellfield, mainly caused by sedimentation in the reservoir and an associated decrease in infiltration. Abstraction at the wellfield changed considerably over the regarded time period and strongly influences the groundwater fluctuations, which shows the need of improved pumping management and monitoring. The results can serve as a basis for decision makers regarding an optimization of water management at the reservoir and wellfield. Furthermore, the presented numerical approach can be transferred to karst regions with similar physio-geographical conditions to assess managed aquifer recharge.

  18. Understanding the use of strategic intelligence as a strategic management tool in the long-term insurance industry in South Africa

    Directory of Open Access Journals (Sweden)

    René Pellissier

    2011-03-01

    Full Text Available The purpose of this research paper was to explore the extent to which strategic intelligence is utilised within the South African long-term insurance industry and whether it could be used to identify opportunities or threats within the global environment to remain competitive, create greater innovation, and corporate advantage.The paper obtained the qualitative views and opinions of strategic decision makers, on an executive managerial level within the South African long-term insurance industry, on their organisations use of strategic intelligence. It was found that there are marked differences in the conformity and usage of strategic intelligence and its components between the organisations surveyed, with a measurable difference between large and small organisations. It is, however, generally viewed that the use of a strategic intelligence framework could greatly enhance decision-making.Data collection for the research undertaken was limited to the 82 long-term insurance companies, which were registered with the South African Financial Services Board. More specifically the focus was on the organisations listed on the Johannesburg Securities Exchange within the Life Assurance sector, within which a final response rate of 36.1% was achieved, including the 100% response rate from the six listed organisations.By understanding the extent to which strategic intelligence is utilised in the South African longterminsurance industry, and the benefits or problems that are experienced by implementing and using strategic intelligence as an input to the strategic management process we can comprehend the value that strategic intelligence adds in the decision making process. The originality of this work concludes in the identification and utilisation of the most important factors of a strategic intelligence framework that will greatly enhance global corporate decisionmakingand result in competitive advantage and constant innovation within the South African

  19. Long-term medical management of primary open-angle glaucoma and ocular hypertension in the UK: optimizing cost-effectiveness and clinic resources by minimizing therapy switches.

    Science.gov (United States)

    Orme, Michelle; Collins, Sarah; Loftus, Jane

    2012-09-01

    The objective was to assess the long-term economic consequences of the medical management of glaucoma in the UK. The economic evaluation was conducted using the results from a 10-year Markov model based around 3 key triggers for a switch in medical therapy for glaucoma, namely: lack of tolerance (using hyperemia as a proxy); intraocular pressure (IOP) not meeting treatment benchmark; and glaucoma progression. Clinical data from a comprehensive systematic literature review and meta-analysis were used. Direct costs associated with glaucoma treatment are considered (at 2008/9 prices) from the perspective of the UK NHS as payer (outpatient/secondary care setting). Using this model, the economic consequences of 3 prostaglandin-based treatment sequences were compared. Drug acquisition costs account for around 8% to 13% of the total cost of glaucoma and, if ophthalmologist visits are included, amount to approximately £0.80 to £0.90 per day of medical therapy. The total long-term costs of all prostaglandin strategies are similar because of a shift in resources: increased drug costs are offset by fewer clinic visits to instigate treatment switches, and by avoiding surgery or costs associated with managing low vision. Under the latanoprost-based strategy, patients would have longer intervals between the need to switch therapies, which is largely due to a reduction in hyperemia, seen as a proxy for tolerance. This leads to a delay in glaucoma progression of 12 to 13 months. For every 1000 clinic appointments, 719 patients can be managed for 1 year with a latanoprost-based strategy compared with 586 or 568 with a bimatoprost or travoprost-based strategy. Drug acquisition costs are not a key driver of the total cost of glaucoma management and the cost of medical therapy is offset by avoiding the cost of managing low vision. Economic models of glaucoma should include the long-term consequences of treatment as these will affect cost-effectiveness. This analysis supports the

  20. Long-term follow-up of home-based behavioral management training provided by migraine patients

    NARCIS (Netherlands)

    Voerman, J.S.; de Klerk, C.; Mérelle, S.Y.M.; Aartsen, E.; Timman, R.; Sorbi, M.J.; Passchier, J.

    2014-01-01

    Background Behavioral migraine approaches are effective in reducing headache attacks. Availability of treatment might be increased by using migraine patients as trainers. Therefore, Mérelle and colleagues developed and evaluated a home-based behavioral management training (BMT) by lay trainers (1).

  1. Self-Management Training With Families of Insulin-Dependent Diabetic Children: A Controlled Long-Term Investigation.

    Science.gov (United States)

    Gross, Alan M.; And Others

    1985-01-01

    Insulin-dependent diabetic children and their parents were trained in behavioral self management and conducted behavior change projects designed to enhance compliance with the medical regimen and reduce diabetes-related conflicts. Participating families experienced fewer arguments concerning diabetes, and the children displayed an increase in…

  2. Impact of chronic kidney disease on long-term ischemic and bleeding outcomes in medically managed patients with acute coronary syndromes

    DEFF Research Database (Denmark)

    Melloni, Chiara; Cornel, Jan H; Hafley, Gail

    2016-01-01

    AIMS: We aimed to study the relationship of chronic kidney disease stages with long-term ischemic and bleeding outcomes in medically managed acute coronary syndrome patients and the influence of more potent antiplatelet therapies on platelet reactivity by chronic kidney disease stage. METHODS...... disease vs. normal/mild chronic kidney disease were estimated. Platelet reactivity at 30 days was assessed in a subset of patients (n = 1947). The majority of patients were in the normal/mild chronic kidney disease group (67%), followed by moderate chronic kidney disease (29%) and severe chronic kidney.......26; 95% confidence interval 1.09-1.46; severe vs. normal/mild: hazard ratio 1.60; 95% confidence interval 1.25-2.04). Platelet reactivity was lower in patients treated with prasugrel compared with clopidogrel, across all three chronic kidney disease stages. CONCLUSIONS: Among medically managed acute...

  3. Late presentation of an anomalous left coronary artery from the pulmonary artery treated with conservative surgical management with long-term cardiac magnetic resonance imaging follow-up

    Science.gov (United States)

    Gouda, Pishoy; Gouda, John; Butler, Craig; Welsh, Robert C

    2017-01-01

    Anomalous origin of the left coronary artery from the pulmonary artery is rare congenital abnormality that most commonly presents in childhood and is associated with a high mortality. In the elderly, patients may present acutely with arrhythmias or signs of ischemia or with vague chronic presentations of shortness of breath and fatigue. In the high-risk elderly population, it is unclear as to whether conservative surgical management by means of suture ligation of the left coronary artery is associated with positive long-term outcomes. We present a case of a 69-year-old patient diagnosed with anomalous origin of the left coronary artery from the pulmonary artery, which was treated with conservative surgical management and followed up for 15 years with cardiovascular magnetic resonance imaging, with positive outcomes.

  4. Deep Space Ka-band Link Management and the MRO Demonstration: Long-term Weather Statistics Versus Forecasting

    Science.gov (United States)

    Davarian, Faramaz; Shambayati, Shervin; Slobin, Stephen

    2004-01-01

    During the last 40 years, deep space radio communication systems have experienced a move toward shorter wavelengths. In the 1960s a transition from L- to S-band occurred which was followed by a transition from S- to X-band in the 1970s. Both these transitions provided deep space links with wider bandwidths and improved radio metrics capability. Now, in the 2000s, a new change is taking place, namely a move to the Ka-band region of the radio frequency spectrum. Ka-band will soon replace X-band as the frequency of choice for deep space communications providing ample spectrum for the high data rate requirements of future missions. The low-noise receivers of deep space networks have a great need for link management techniques that can mitigate weather effects. In this paper, three approaches for managing Ka-band Earth-space links are investigated. The first approach uses aggregate annual statistics, the second one uses monthly statistics, and the third is based on the short-term forecasting of the local weather. An example of weather forecasting for Ka-band link performance prediction is presented. Furthermore, spacecraft commanding schemes suitable for Ka-band link management are investigated. Theses schemes will be demonstrated using NASA's Mars Reconnaissance Orbiter (MRO) spacecraft in the 2007 to 2008 time period, and the demonstration findings will be reported in a future publication.

  5. Enabling Long-Term Earth Science Research: Changing Data Practices (Invited)

    Science.gov (United States)

    Baker, K. S.

    2013-12-01

    Data stewardship plans are shaped by our shared experiences. As a result, community engagement and collaborative activities are central to the stewardship of data. Since modes and mechanisms of engagement have changed, we benefit from asking anew: ';Who are the communities?' and ';What are the lessons learned?'. Data stewardship with its long-term care perspective, is enriched by reflection on community experience. This presentation draws on data management issues and strategies originating from within long-term research communities as well as on recent studies informed by library and information science. Ethnographic case studies that capture project activities and histories are presented as resources for comparative analysis. Agency requirements and funding opportunities are stimulating collaborative endeavors focused on data re-use and archiving. Research groups including earth scientists, information professionals, and data systems designers are recognizing the possibilities for new ways of thinking about data in the digital arena. Together, these groups are re-conceptualizing and reconfiguring for data management and data curation. A differentiation between managing data for local use and production of data for re-use remotely in locations and fields remote from the data origin is just one example of the concepts emerging to facilitate development of data management. While earth scientists as data generators have the responsibility to plan new workflows and documentation practices, data and information specialists have responsibility to promote best practices as well as to facilitate the development of community resources such as controlled vocabularies and data dictionaries. With data-centric activities and changing data practices, the potential for creating dynamic community information environments in conjunction with development of data facilities exists but remains elusive.

  6. Long-term management of patients with hormone receptor-positive metastatic breast cancer: Concepts for sequential and combination endocrine-based therapies.

    Science.gov (United States)

    Brufsky, Adam M

    2017-09-01

    Treatment options for hormone receptor-positive (HR-positive) metastatic breast cancer (MBC) continue to increase in parallel with expanding knowledge about the complex biology of breast cancer subtypes and resistance mechanisms to endocrine therapy. For patients with HR-positive MBC, there are now an unprecedented number of endocrine-based treatment options that can improve long-term outcomes, while preserving or optimizing quality of life, and that can be used before selecting more cytotoxic chemotherapeutic regimens. In addition to antiestrogens, steroidal and nonsteroidal aromatase inhibitors, the selective estrogen-receptor degrader, fulvestrant, and new endocrine-based combinations provide significant and clinically meaningful improvements in outcomes in the first line setting and beyond. Also, new clinical scenarios and indications for monotherapy endocrine and targeted therapies continue to be explored. Patients have several therapeutic options when their disease progresses or becomes resistant, although the optimal sequencing of these therapies remains unclear. Ongoing research in the resistant/refractory setting is anticipated to continue improving the outlook for these patients. This review will discuss current and investigational approaches to sequential single-agent endocrine and endocrine-based combination therapy for the long-term management of patients with HR-positive, human epidermal growth factor receptor 2-negative MBC. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Complications of long-term opioid therapy for management of chronic pain: the paradox of opioid-induced hyperalgesia.

    Science.gov (United States)

    Brush, D Eric

    2012-12-01

    While opioids remain a valid and effective analgesic strategy for patients suffering from a wide variety of painful conditions, they are not a panacea. Increasingly, physicians must balance patient expectations of adequate pain control with known limitations of opioid pharmaceuticals including adverse effects, tolerance, addiction, withdrawal, and drug diversion. Further complicating the issue over the last decade is a growing body of evidence suggesting chronic opioid use may unexpectedly worsen the perception of pain in some individuals. This syndrome, termed opioid-induced hyperalgesia (OIH), fundamentally changes our understanding of opioid pharmacodynamics and may influence our approach to management of chronic pain. This manuscript describes the concept OIH and provides an overview of basic science and clinical research to date attempting to characterize this syndrome, as well as ascertain its clinical relevance. The potential existence of OIH in humans is framed within the context of our current understanding of opioids and our prescribing patterns so that physicians may begin to incorporate these ideas into their philosophy of pain management as further information develops. Animal studies reliably validate OIH in controlled models. Rigorous research protocols in humans are lacking, and we cannot yet confidently conclude that OIH manifests in clinically significant ways. However, clinicians should consider the possibility of OIH when evaluating outcomes of patients on chronic opioid therapy.

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

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

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

  9. Generalised versus Regional Odontodysplasia: Diagnosis, Transitional Management, and Long-Term Followup—A Report of 2 Cases

    Science.gov (United States)

    Ibrahim Mostafa, Mostafa; Samir Taha, Nehad; Ismail Mehrez, Mennat Allah

    2013-01-01

    Background. Odontodysplasia is an uncommon condition. It can be localised or generalised, isolated or part of a syndrome. Case Report. We first report the case of an 8.5-year-old boy who presented with abnormally shaped teeth and multiple intraoral abscesses. Findings of clinical and radiographic examinations were consistent with those of generalised odontodysplasia. A 2-step, conservative treatment plan was executed with a 10-year followup. Step 1 was root canal treatment of nonvital teeth. Step 2 was crowning without preparation of new vital, erupted, and malformed teeth. The second case is that of a 12-year-old girl who presented with lack of teeth in the upper-left quadrant. The impacted teeth were exposed surgically, and fixed restoration was performed for temporary aesthetic improvement. Conclusion. Instead of tooth extraction, an approach previously used in similar cases, conservative management is feasible and offers better prosthetic treatment options for the future. PMID:23476815

  10. Generalised versus Regional Odontodysplasia: Diagnosis, Transitional Management, and Long-Term Followup—A Report of 2 Cases

    Directory of Open Access Journals (Sweden)

    Mostafa Ibrahim Mostafa

    2013-01-01

    Full Text Available Background. Odontodysplasia is an uncommon condition. It can be localised or generalised, isolated or part of a syndrome. Case Report. We first report the case of an 8.5-year-old boy who presented with abnormally shaped teeth and multiple intraoral abscesses. Findings of clinical and radiographic examinations were consistent with those of generalised odontodysplasia. A 2-step, conservative treatment plan was executed with a 10-year followup. Step 1 was root canal treatment of nonvital teeth. Step 2 was crowning without preparation of new vital, erupted, and malformed teeth. The second case is that of a 12-year-old girl who presented with lack of teeth in the upper-left quadrant. The impacted teeth were exposed surgically, and fixed restoration was performed for temporary aesthetic improvement. Conclusion. Instead of tooth extraction, an approach previously used in similar cases, conservative management is feasible and offers better prosthetic treatment options for the future.

  11. Techniques and long-term outcomes of cotton-clipping and cotton-augmentation strategies for management of cerebral aneurysms.

    Science.gov (United States)

    Safavi-Abbasi, Sam; Moron, Felix; Sun, Hai; Oppenlander, Mark E; Kalani, M Yashar S; Mulholland, Celene B; Zabramski, Joseph M; Nakaji, Peter; Spetzler, Robert F

    2016-09-01

    OBJECTIVE To address the challenges of microsurgically treating broad-based, frail, and otherwise complex aneurysms that are not amenable to direct clipping, alternative techniques have been developed. One such technique is to use cotton to augment clipping ("cotton-clipping" technique), which is also used to manage intraoperative aneurysm neck rupture, and another is to reinforce unclippable segments or remnants of aneurysm necks with cotton ("cotton-augmentation" technique). This study reviews the natural history of patients with aneurysms treated with cotton-clipping and cotton-augmentation techniques. METHODS The authors queried a database consisting of all patients with aneurysms treated at Barrow Neurological Institute in Phoenix, Arizona, between January 1, 2004, and December 31, 2014, to identify cases in which cotton-clipping or cotton-augmentation strategies had been used. Management was categorized as the cotton-clipping technique if cotton was used within the blades of the aneurysm clip and as the cotton-clipping technique if cotton was used to reinforce aneurysms or portions of the aneurysm that were unclippable due to the presence of perforators, atherosclerosis, or residual aneurysms. Data were reviewed to assess patient outcomes and annual rates of aneurysm recurrence or hemorrhage after the initial procedures were performed. RESULTS The authors identified 60 aneurysms treated with these techniques in 57 patients (18 patients with ruptured aneurysms and 39 patients with unruptured aneurysms) whose mean age was 53.1 years (median 55 years; range 24-72 years). Twenty-three aneurysms (11 cases of subarachnoid hemorrhage) were treated using cotton-clipping and 37 with cotton-augmentation techniques (7 cases of subarachnoid hemorrhage). In total, 18 patients presented with subarachnoid hemorrhage. The mean Glasgow Outcome Scale (GOS) score at the time of discharge was 4.4. At a mean follow-up of 60.9 ± 35.6 months (median 70 months; range 10-126 months

  12. Long-Term Effect of Organic and Mineral Fertilization on Soil Physical Properties Under Greenhouse and Outdoor Management Practices

    Institute of Scientific and Technical Information of China (English)

    J. F. HERENCIA; P. A. GARC(I)A-GALAV(I)S; C. MAQUEDA

    2011-01-01

    To evaluate the use of organic amendments as an alternative to conventional fertilization,a 10-year experiment on a loam soil was conducted under a crop rotation system in both greenhouse and outdoor plots applied with chemical fertilizers (NPK) and vegetal compost (organic fertilizer) in the Guadalquivir River Valley,Spain.The effect of these two different fertilization regimes on the soil physical properties was evaluated.Soil organic carbon (OC),soil bulk density (BD),soil water retention (WR),available water content (AWC),aggregate stability (AS),and soil physical quality (Dexter's index,S) were determined.The use of organic fertilizer increased OC and resulted in a significant increase in AS and a decrease in BD compared to the mineral fertilizer application in both greenhouse and outdoor plots.The outdoor plots showed the lowest BD values whereas the greenhouse plots showed the highest AS values.In the last years of the 10-year experiment the S parameter was significantly higher in organic fertilizer plots,especially for greenhouse plots.At the end of the study period,there were no significant differences in WR at field capacity (FC) between treatments in both systems; the AWC was also similar in the greenhouse plots but higher in the mineral outdoor plots.In mineral fertilizer treatments,a small improvement in the physical properties was also observed due to the utilization of less aggressive tillage compared with the previous intensive cropping system.Physical soil properties were correlated with soil OC.The sustainable management techniques such as the use of organic amendments and low or no tillage improved soil physical properties,despite the differences in management that logically significantly affected the results.

  13. Incorporating patient preferences in the management of multiple long-term conditions: is this a role for clinical practice guidelines?

    Directory of Open Access Journals (Sweden)

    Charlotte E. Young

    2015-11-01

    Full Text Available Background: Clinical practice guidelines provide an evidence-based approach to managing single chronic conditions, but their applicability to multiple conditions has been actively debated. Incorporating patient-preference recommendations and involving consumers in guideline development may enhance their applicability, but further understanding is needed. Objectives: To assess guidelines that include recommendations for comorbid conditions to determine the extent to which they incorporate patient-preference recommendations; use consumer-engagement processes during development, and, if so, whether these processes produce more patient-preference recommendations; and meet standard quality criteria, particularly in relation to stakeholder involvement. Design: A review of Australian guidelines published from 2006 to 2014 that incorporated recommendations for managing comorbid conditions in primary care. Document analysis of guidelines examined the presence of patient-preference recommendations and the consumer-engagement processes used. The Appraisal of Guidelines for Research and Evaluation instrument was used to assess guideline quality. Results: Thirteen guidelines were reviewed. Twelve included at least one core patient-preference recommendation. Ten used consumer-engagement processes, including participation in development groups (seven guidelines and reviewing drafts (ten guidelines. More extensive consumer engagement was generally linked to greater incorporation of patient-preference recommendations. Overall quality of guidelines was mixed, particularly in relation to stakeholder involvement. Conclusions: Guidelines do incorporate some patient-preference recommendations, but more explicit acknowledgement is required. Consumer-engagement processes used during guideline development have the potential to assist in identifying patient preferences, but further research is needed. Clarification of the consumer role and investment in consumer training

  14. Soil zinc and cadmium availability and uptake by wheat (Triticum aestivum L.) as affected by long-term organic matter management

    Science.gov (United States)

    Grüter, Roman; Costerousse, Benjamin; Mayer, Jochen; Mäder, Paul; Thonar, Cécile; Frossard, Emmanuel; Schulin, Rainer; Tandy, Susan

    2017-04-01

    Zinc (Zn) deficiency is a widespread problem in human mineral nutrition. It is mainly caused by imbalanced diets with low contents of bioavailable Zn. This is in particular a problem in populations depending on cereals such as wheat (Triticum aestivum L.) as a major source of this essential micronutrient element. Increasing Zn concentrations in wheat grains (biofortification) is therefore an important challenge. At the same time, increased uptake of the toxic heavy metal cadmium (Cd) must be prevented. Agronomic practises influence soil properties such as pH and soil organic carbon and thus also have an indirect effect on phytoavailable soil Zn and Cd concentrations and the uptake of these metals by wheat in addition to direct inputs with fertilizers and other amendments. This study investigated the effects of long-term organic matter management on the phytoavailability of soil Zn and Cd and their uptake by wheat on plots of two Swiss long-term field trials. In one trial (DOK), a farming system comparison trial established in 1978, we compared plots under conventional management with mineral fertilization either in combination or not with farmyard manure application to plots under biodynamic organic management and control plots with no fertilizer application. In the second trial (ZOFE), established in 1949, we compared different fertilizer regimes on conventionally managed plots, including plots with application of mineral fertilizers only, farmyard manure, or compost and control plots with no fertilizer application. Soil physico-chemical and biological properties were determined at the beginning of the growing season. Soil Zn and Cd availabilities were assessed by the Diffusive Gradients in Thin Films (DGT) method and by DTPA extraction before and after wheat cultivation. Additionally, various wheat yield components and element concentrations in shoots and grains were measured at harvest. In the ZOFE trial, soil Zn and Cd concentrations were lowest in the mineral

  15. LONG TERM COLLECTIONS

    CERN Multimedia

    STAFF ASSOCIATION

    2010-01-01

    ACKNOWLEDGMENTS The Long-Term Collections (CLT) committee would like to warmly thank its faithful donors who, year after year, support our actions all over the world. Without you, all this would not be possible. We would like to thank, in particular, the CERN Firemen’s Association who donated 5000 CHF in the spring thanks to the sale of their traditional calendar, and the generosity of the CERN community. A huge thank you to the firemen for their devotion to our cause. And thank you to all those who have opened their door, their heart, and their purses! Similarly, we warmly thank the CERN Yoga Club once again for its wonderful donation of 2000 CHF we recently received. We would also like to tell you that all our projects are running well. Just to remind you, we are currently supporting the activities of the «Réflexe-Partage» Association in Mali; the training centre of «Education et Développement» in Abomey, Benin; and the orphanage and ...

  16. A review of international trends in mercury management and available options for permanent or long-term mercury storage.

    Science.gov (United States)

    Lee, Keun Jeong; Lee, Tai Gyu

    2012-11-30

    Although mercury (Hg) is a poisonous substance that has harmful effects on the environment and in humans, it is widely used in industrial facilities and in goods for daily use. Given the recent recognition of the risk posed by Hg exposure, the international society is trying to reduce the use of and demand for Hg by implementing more stringent regulations. Relevant policies and laws recommend alternatives to Hg or prohibit the use of Hg in certain applications. In addition, it is recommended that the amount of Hg used in Hg-containing products be reduced or that manufacturers discontinue such products. Disposal methods for elemental Hg include landfill, incineration, stabilization/solidification, and permanent storage. In this review, the major sources of Hg and expected amount of surplus Hg are described after summarizing international policies and plans for Hg management. In addition, a study on the establishment of proper storage facilities was performed by comparing existing Hg storage technologies with newly designed technologies for facilities where surplus Hg may be stored permanently. Copyright © 2012 Elsevier B.V. All rights reserved.

  17. Profiling Patients’ Healthcare Needs to Support Integrated, Person-Centered Models for Long-Term Disease Management (Profile: Research Design

    Directory of Open Access Journals (Sweden)

    Arianne MJ Elissen

    2016-04-01

    Full Text Available Background: This article presents the design of PROFILe, a study investigating which (biomedical and non-(biomedical patient characteristics should guide more tailored chronic care. Based on this insight, the project aims to develop and validate ‘patient profiles’ that can be used in practice to determine optimal treatment strategies for subgroups of chronically ill with similar healthcare needs and preferences. Methods/Design: PROFILe is a practice-based research comprising four phases. The project focuses on patients with type 2 diabetes. During the first study phase, patient profiles are drafted based on a systematic literature research, latent class growth modeling, and expert collaboration. In phase 2, the profiles are validated from a clinical, patient-related and statistical perspective. Phase 3 involves a discrete choice experiment to gain insight into the patient preferences that exist per profile. In phase 4, the results from all analyses are integrated and recommendations formulated on which patient characteristics should guide tailored chronic care. Discussion: PROFILe is an innovative study which uses a uniquely holistic approach to assess the healthcare needs and preferences of chronically ill. The patient profiles resulting from this project must be tested in practice to investigate the effects of tailored management on patient experience, population health and costs.

  18. Long-Term Urban Growth and Land Use Efficiency in Southern Europe: Implications for Sustainable Land Management

    Directory of Open Access Journals (Sweden)

    Marco Zitti

    2015-03-01

    Full Text Available The present study illustrates a multidimensional analysis of an indicator of urban land use efficiency (per-capita built-up area, LUE in mainland Attica, a Mediterranean urban region, along different expansion waves (1960–2010: compaction and densification in the 1960s, dispersed growth along the coasts and on Athens’ fringe in the 1970s, fringe consolidation in the 1980s, moderate re-polarization and discontinuous expansion in the 1990s and sprawl in remote areas in the 2000s. The non-linear trend in LUE (a continuous increase up to the 1980s and a moderate decrease in 1990 and 2000 preceding the rise observed over the last decade reflects Athens’ expansion waves. A total of 23 indicators were collected by decade for each municipality of the study area with the aim of identifying the drivers of land use efficiency. In 1960, municipalities with low efficiency in the use of land were concentrated on both coastal areas and Athens’ fringe, while in 2010, the lowest efficiency rate was observed in the most remote, rural areas. Typical urban functions (e.g., mixed land uses, multiple-use buildings, vertical profile are the variables most associated with high efficiency in the use of land. Policies for sustainable land management should consider local and regional factors shaping land use efficiency promoting self-contained expansion and more tightly protecting rural and remote land from dispersed urbanization. LUE is a promising indicator reflecting the increased complexity of growth patterns and may anticipate future urban trends.

  19. Pan-Britain, mixed-methods study of multidisciplinary teams teaching parents to manage children's long-term kidney conditions at home: Study protocol

    Directory of Open Access Journals (Sweden)

    Swallow Veronica M

    2012-02-01

    Full Text Available Abstract Background Care of children and young people (children with long-term kidney conditions is usually managed by multidisciplinary teams. Published guidance recommends that whenever possible children with long-term conditions remain at home, meaning parents may be responsible for performing the majority of clinical care-giving. Multidisciplinary team members, therefore, spend considerable time promoting parents' learning about care-delivery and monitoring care-giving. However, this parent-educative aspect of clinicians' role is rarely articulated in the literature so little evidence exists to inform professionals' parent-teaching interventions. Methods/Design This ongoing study addresses this issue using a combination of quantitative and qualitative methods involving the twelve children's kidney units in England, Scotland and Wales. Phase I involves a survey of multidisciplinary team members' parent-teaching interventions using: i A telephone-administered questionnaire to determine: the numbers of professionals from different disciplines in each team, the information/skills individual professionals relay to parents and the teaching strategies/interventions they use. Data will be managed using SPSS to produce descriptive statistics ii Digitally-recorded, qualitative group or individual interviews with multidisciplinary team members to explore their accounts of the parent-teaching component of their role. Interviews will be transcribed anonymously and analysed using Framework Technique. Sampling criteria will be derived from analysis to identify one/two unit(s for subsequent in-depth study Phase II involves six prospective, ethnographic case-studies of professional-parent interactions during parent-teaching encounters. Parents of six children with a long-term kidney condition will be purposively sampled according to their child's age, diagnosis, ethnicity and the clinical care-giving required; snowball sampling will identify the

  20. Pan-Britain, mixed-methods study of multidisciplinary teams teaching parents to manage children's long-term kidney conditions at home: study protocol.

    Science.gov (United States)

    Swallow, Veronica M; Allen, Davina; Williams, Julian; Smith, Trish; Crosier, Jean; Lambert, Heather; Qizalbash, Leila; Wirz, Lucy; Webb, Nicholas J A

    2012-02-14

    Care of children and young people (children) with long-term kidney conditions is usually managed by multidisciplinary teams. Published guidance recommends that whenever possible children with long-term conditions remain at home, meaning parents may be responsible for performing the majority of clinical care-giving. Multidisciplinary team members, therefore, spend considerable time promoting parents' learning about care-delivery and monitoring care-giving. However, this parent-educative aspect of clinicians' role is rarely articulated in the literature so little evidence exists to inform professionals' parent-teaching interventions. This ongoing study addresses this issue using a combination of quantitative and qualitative methods involving the twelve children's kidney units in England, Scotland and Wales. Phase I involves a survey of multidisciplinary team members' parent-teaching interventions using:i) A telephone-administered questionnaire to determine: the numbers of professionals from different disciplines in each team, the information/skills individual professionals relay to parents and the teaching strategies/interventions they use. Data will be managed using SPSS to produce descriptive statisticsii) Digitally-recorded, qualitative group or individual interviews with multidisciplinary team members to explore their accounts of the parent-teaching component of their role. Interviews will be transcribed anonymously and analysed using Framework Technique. Sampling criteria will be derived from analysis to identify one/two unit(s) for subsequent in-depth studyPhase II involves six prospective, ethnographic case-studies of professional-parent interactions during parent-teaching encounters. Parents of six children with a long-term kidney condition will be purposively sampled according to their child's age, diagnosis, ethnicity and the clinical care-giving required; snowball sampling will identify the professionals involved in each case-study. Participants will

  1. Integration of Education and Technology - A Long-term Study about Possibilities and Adequacy of a Learning Management System for Education

    Directory of Open Access Journals (Sweden)

    Michael Henninger

    2010-06-01

    Full Text Available Use of technology in educational scenarios has become self evident especially in contexts of higher or further education. But it still lacks a systematically and integrative discussion about how to exhaust all possible benefits of this integration enduringly. The study at hand aims at evaluating two different learning management systems in use at the University of Education (UE Weingarten with regard to all perspectives on this topic in a long-term study over a period of three years. In the context of the implementation of a media-affine program of study the two systems moodle and DistanceLearningSystem® get surveyed. The basic functions of the systems are investigated for their adequacy for maximum benefits in didactic, organisational and curricular [1] tenor.

  2. Temporal variability of CO2 and N2O emissions in an agricultural long-term field trial regarding effects of different management practices and extreme weather effects

    Science.gov (United States)

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

    2016-04-01

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

  3. Effect of short-term versus long-term grassland management and seasonal variation in organic and conventional dairy farming on the composition of bulk tank milk.

    Science.gov (United States)

    Adler, S A; Jensen, S K; Govasmark, E; Steinshamn, H

    2013-09-01

    Bulk tank milk from 28 dairy farms was sampled every second month for 2 yr to assess the effects of grassland management, production system and season on milk fatty acid (FA) composition, concentrations of fat-soluble vitamins, Se, and milk sensory quality. Grassland management varied in terms of time since establishment. Short-term grassland management (SG) was defined as establishment or reseeding every fourth year or more often, and long-term grassland management (LG) was defined as less frequent establishment or reseeding. Fourteen organic (ORG) dairy farms with either short-term or long-term grassland management were paired with 14 conventional (CON) farms with respect to grassland management. Within ORG farms, SG farms differed from LG farms in herbage botanical composition, but not in concentrate FA concentrations, dry matter intake, or milk yield. Within CON farms, herbage composition, concentrate FA concentrations, dry matter intake, and milk yield showed no or insignificant variations. The ORG farms differed from CON farms in herbage botanical composition, concentrate FA concentrations, concentrate intake, and milk yield. Compared with ORG-LG farms, ORG-SG farms produced milk fat with higher proportions of C10:0 and C12:0 associated with higher herbage proportions of legumes (Fabaceae) and lower proportions of other dicotyledon families. Compared with milk from CON farms, milk fat from ORG farms had higher proportions of most saturated FA and all n-3 FA, but lower proportions of C18:0 and C18:1 cis-9 associated with higher forage proportion and differences in concentrations of FA in concentrates. Compared with the outdoor-feeding periods, the indoor feeding periods yielded milk fat with higher proportions of most short-chain and medium-chain FA and lower proportions of most C18-FA associated with grazing and higher forage proportions. Milk concentrations of α-tocopherol and β-carotene were lower during the grazing periods. Inclusion of fishmeal in

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

    Science.gov (United States)

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

    2017-06-01

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

  5. Challenges in pediatric transplantation: the impact of chronic kidney disease and cardiovascular risk factors on long-term outcomes and recommended management strategies.

    Science.gov (United States)

    Filler, Guido

    2011-02-01

    Barriers to successful outcomes following pediatric transplantation have shifted from ischemic reperfusion injury and rejection to more long-term complications. Of particular concern is the high prevalence of CKD owing to preexisting damage and nephrotoxicity, as well as other CV complications such as hypertension and cardiomyopathy. All of these contribute to graft loss and shortened life expectancy, thereby limiting the success story of solid-organ transplantation. Managing CKD and related CV morbidity should be integral to the care of pediatric transplant patients, and timely detection of any irregularities would increase the chances of restoring lost kidney function. GFR is still the widely accepted indicator of renal function, and nuclear medicine techniques are the gold standard measurement methods. These methods are limited by costs, radiation exposure and substrate injection, and current practice still uses the Schwartz estimate, despite its well-documented limitations. Newer endogenous markers of GFR, such as cystatin C clearance, give a more accurate measure of true GFR but have not been embraced in the management of pediatric transplant recipients. Furthermore, indirect markers (e.g., microalbuminuria and hypertension) could also aid early detection of renal damage. The effects of mainstay immunosuppressants on kidney and heart function are varied, with available data indicating favorable outcomes with tacrolimus compared with ciclosporin. There is a need for appropriately designed and powered randomized controlled trials to validate innovative concepts for tailored immunosuppression in the pediatric population. To date, very few studies have generated long-term data in pediatric renal transplant patients - results of 1-4-yr study favored tacrolimus over ciclosporin, but other immunosuppressive agents also need to be evaluated.

  6. Managerial Long-Term Responsibility in Family-Controlled Firms

    Directory of Open Access Journals (Sweden)

    Dietmar Sternad

    2013-01-01

    Full Text Available Evidence suggests that long-term orientation (LTO as a dominantstrategic logic contributes to the sustainable performance offamily-controlled firms (FCFS. Combining a review of the literatureon lto with stewardship theory and upper echelons theoryreasoning, this article presents a typology of managerial responsibilityand introduces the concept of long-term responsibility as amanagerial characteristic constituting a major driving force behindcreating lto. The antecedents of long-term responsibilityunder family firm-specific conditions (stemming from the familysystem, the governance system, and family-firm managers’ personalcharacteristics are also identified and presented in an integratedmodel. The paper contributes to a more comprehensiveunderstanding of intertemporal choice in fcfs and explains whythey tend to be more long-term oriented than other types of firms.

  7. Temporal Variation in Honey Production by the Stingless Bee Melipona subnitida (Hymenoptera: Apidae): Long-Term Management Reveals its Potential as a Commercial Species in Northeastern Brazil.

    Science.gov (United States)

    Koffler, Sheina; Menezes, Cristiano; Menezes, Paulo Roberto; Kleinert, Astrid de Matos Peixoto; Imperatriz-Fonseca, Vera Lucia; Pope, Nathaniel; Jaffé, Rodolfo

    2015-06-01

    Even though stingless beekeeping has a great potential as a sustainable development tool, the activity remains essentially informal, technical knowledge is scarce, and management practices lack the sophistication and standardization found in apiculture. Here, we contributed to the further development of stingless beekeeping by investigating the long-term impact of management and climate on honey production and colony survival in the stingless bee Melipona subnitida Ducke (1910). We analyzed a 10-yr record of 155 M. subnitida colonies kept by a commercial honey producer of northeastern Brazil. This constitutes the longest and most accurate record available for a stingless bee. We modeled honey production in relation to time (years), age, management practices (colony division and food supplementation), and climatic factors (temperature and precipitation), and used a model selection approach to identify which factors best explained honey production. We also modeled colony mortality in relation to climatic factors. Although the amount of honey produced by each colony decreased over time, we found that the probability of producing honey increased over the years. Colony divisions decreased honey production, but did not affect honey presence, while supplementary feeding positively affected honey production. In warmer years, the probability of producing honey decreased and the amount of honey produced was lower. In years with lower precipitation, fewer colonies produced honey. In contrast, colony mortality was not affected by climatic factors, and some colonies lived up to nine years, enduring extreme climatic conditions. Our findings provide useful guidelines to improve management and honey production in stingless bees.

  8. The National Wind Erosion Research Network: Building a standardized long-term data resource for aeolian research, modeling and land management

    Science.gov (United States)

    Webb, Nicholas P.; Herrick, Jeffrey E.; Van Zee, Justin W.; Courtright, Ericha M.; Hugenholtz, Christopher H.; Zobeck, Ted M.; Okin, Gregory S.; Barchyn, Thomas E.; Billings, Benjamin J.; Boyd, Robert; Clingan, Scott D.; Cooper, Brad F.; Duniway, Michael C.; Derner, Justin D.; Fox, Fred A.; Havstad, Kris M.; Heilman, Philip; LaPlante, Valerie; Ludwig, Noel A.; Metz, Loretta J.; Nearing, Mark A.; Norfleet, M. Lee; Pierson, Frederick B.; Sanderson, Matt A.; Sharratt, Brenton S.; Steiner, Jean L.; Tatarko, John; Tedela, Negussie H.; Toledo, David; Unnasch, Robert S.; Van Pelt, R. Scott; Wagner, Larry

    2016-09-01

    The National Wind Erosion Research Network was established in 2014 as a collaborative effort led by the United States Department of Agriculture's Agricultural Research Service and Natural Resources Conservation Service, and the United States Department of the Interior's Bureau of Land Management, to address the need for a long-term research program to meet critical challenges in wind erosion research and management in the United States. The Network has three aims: (1) provide data to support understanding of basic aeolian processes across land use types, land cover types, and management practices, (2) support development and application of models to assess wind erosion and dust emission and their impacts on human and environmental systems, and (3) encourage collaboration among the aeolian research community and resource managers for the transfer of wind erosion technologies. The Network currently consists of thirteen intensively instrumented sites providing measurements of aeolian sediment transport rates, meteorological conditions, and soil and vegetation properties that influence wind erosion. Network sites are located across rangelands, croplands, and deserts of the western US.

  9. Ocean Acidification Scientific Data Stewardship: An approach for end-to-end data management and integration

    Science.gov (United States)

    Arzayus, K. M.; Garcia, H. E.; Jiang, L.; Michael, P.

    2012-12-01

    As the designated Federal permanent oceanographic data center in the United States, NOAA's National Oceanographic Data Center (NODC) has been providing scientific stewardship for national and international marine environmental and ecosystem data for over 50 years. NODC is supporting NOAA's Ocean Acidification Program and the science community by providing end-to-end scientific data management of ocean acidification (OA) data, dedicated online data discovery, and user-friendly access to a diverse range of historical and modern OA and other chemical, physical, and biological oceanographic data. This effort is being catalyzed by the NOAA Ocean Acidification Program, but the intended reach is for the broader scientific ocean acidification community. The first three years of the project will be focused on infrastructure building. A complete ocean acidification data content standard is being developed to ensure that a full spectrum of ocean acidification data and metadata can be stored and utilized for optimal data discovery and access in usable data formats. We plan to develop a data access interface capable of allowing users to constrain their search based on real-time and delayed mode measured variables, scientific data quality, their observation types, the temporal coverage, methods, instruments, standards, collecting institutions, and the spatial coverage. In addition, NODC seeks to utilize the existing suite of international standards (including ISO 19115-2 and CF-compliant netCDF) to help our data producers use those standards for their data, and help our data consumers make use of the well-standardized metadata-rich data sets. These tools will be available through our NODC Ocean Acidification Scientific Data Stewardship (OADS) web page at http://www.nodc.noaa.gov/oceanacidification. NODC also has a goal to provide each archived dataset with a unique ID, to ensure a means of providing credit to the data provider. Working with partner institutions, such as the

  10. Hair as a long-term retrospective cortisol calendar in orang-utans (Pongo spp.): new perspectives for stress monitoring in captive management and conservation.

    Science.gov (United States)

    Carlitz, Esther H D; Kirschbaum, Clemens; Stalder, Tobias; van Schaik, Carolus P

    2014-01-01

    This study examined whether the method of hair cortisol analysis is applicable to orang-utans (Pongo spp.) and can help to advance the objective monitoring of stress in non-human primates. Specifically, we examined whether fundamental prerequisites for hair cortisol analysis are given in orang-utans and, subsequently, whether segmental hair analysis may provide a retrospective calendar of long-term cortisol levels. For this, hair samples were examined from 71 zoo-living orang-utans (38 males, mean age=22.5years; 33 females, mean age=24years) for which detailed records of past living conditions were available. Hair samples were cut from defined body regions and were analyzed either in full length or in segments. Results showed that hair cortisol concentrations (HCC) were unrelated to age or sex of the individual animal. HCC were found to be higher in orang-utans, with perceived long-term stressful periods (mean HCC=43.6±26.5pg/mg, n=13) compared to animals without perceived stressful periods (19.3±5.5pg/mg, n=55, P40cm. The possibility of obtaining a retrospective calendar of stress-related cortisol changes through hair analysis was further supported by data of three case studies showing close correspondence between the segmental HCC results and keeper reports of stress exposure during the respective time periods. Finally, low within-animal variation in HCC from different body regions (CV%: 14.3) suggested that this method may also be applicable to naturally shed hair, e.g., as found in nests of wild orang-utans and other great apes. Therefore, using HCC may provide an ideal non-invasive tool for both captive management as well as conservation in orang-utans and potentially other great apes.

  11. Long-term results of the surgical management of insulinoma patients with MEN1: a Groupe d'étude des Tumeurs Endocrines (GTE) retrospective study.

    Science.gov (United States)

    Vezzosi, Delphine; Cardot-Bauters, Catherine; Bouscaren, Nicolas; Lebras, Maëlle; Bertholon-Grégoire, Mireille; Niccoli, Patricia; Levy-Bohbot, Nathalie; Groussin, Lionel; Bouchard, Philippe; Tabarin, Antoine; Chanson, Philippe; Lecomte, Pierre; Guilhem, Isabelle; Carrere, Nicolas; Mirallié, Eric; Pattou, François; Peix, Jean Louis; Goere, Diane; Borson-Chazot, Françoise; Caron, Philippe; Bongard, Vanina; Carnaille, Bruno; Goudet, Pierre; Baudin, Eric

    2015-03-01

    Management of insulinomas in the context of MEN1 remains poorly studied. The aim of this study was to evaluate long-term results of various surgical approaches in a large cohort of insulinoma-MEN1 patients. Consecutive insulinoma-MEN1 patients operated on for a nonmetastatic insulinoma between 1957 and 2010 were retrospectively selected from the MEN1 database of the French Endocrine Tumor Group. The type of surgery was categorized as distal pancreatectomy (DP), total pancreatectomy/cephalic duodenopancreatectomy (TP/CDP), or enucleation (E). Primary endpoint was time until recurrence of hypoglycemia after initial surgery. Secondary endpoints were post-operative complications. The study included 73 patients (median age=28 years). Surgical procedures were DP (n=46), TP/CDP (n=9), or E (n=18). After a median post-operative follow-up of 9.0 years (inter-quartile range (IQR): 2.5-16.5 years), 60/73 patients (82.2%) remained hypoglycemia free. E and TP/CDP were associated with a higher risk of recurrent hypoglycemia episodes (unadjusted hazard ratio: 6.18 ((95% CI: 1.54-24.8); P=0.010) for E vs DP and 9.51 ((95% CI: 1.85-48.8); P=0.007) for TP/CDP vs DP. After adjustment for International Union against Cancer pTNM classification, enucleation remained significantly associated with a higher probability of recurrence. Long-term complications had occurred in 20 (43.5%) patients with DP, five (55.6%) with TP/CDP, but in none of the patients who have undergone E (P=0.002). In the French Endocrine database, DP is associated with a lower risk for recurrent hypoglycemia episodes. Due to lower morbidity, E alone might be considered as an alternative. © 2015 European Society of Endocrinology.

  12. Patient self-management of oral anticoagulation with vitamin K antagonists in everyday practice: efficacy and safety in a nationwide long-term prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Michael Nagler

    Full Text Available Patient self-management (PSM of oral anticoagulation is under discussion, because evidence from real-life settings is missing. Using data from a nationwide, prospective cohort study in Switzerland, we assessed overall long-term efficacy and safety of PSM and examined subgroups. Data of 1140 patients (5818.9 patient-years were analysed and no patient were lost to follow-up. Median follow-up was 4.3 years (range 0.2-12.8 years. Median age at the time of training was 54.2 years (range 18.2-85.2 and 34.6% were women. All-cause mortality was 1.4 per 100 patient-years (95% CI 1.1-1.7 with a higher rate in patients with atrial fibrillation (2.5; 1.6-3.7; p50 years of age (2.0; 1.6-2.6; p<0.001, and men (1.6; 1.2-2.1; p = 0.036. The rate of thromboembolic events was 0.4 (0.2-0.6 and independent from indications, sex and age. Major bleeding were observed in 1.1 (0.9-1.5 per 100 patient-years. Efficacy was comparable to standard care and new oral anticoagulants in a network meta-analysis. PSM of properly trained patients is effective and safe in a long-term real-life setting and robust across clinical subgroups. Adoption in various clinical settings, including those with limited access to medical care or rural areas is warranted.

  13. Signaling Cost Analysis of Location Management in Long Term Evolution%LTE位置管理中信令开销的分析

    Institute of Scientific and Technical Information of China (English)

    马俊超; 王献

    2014-01-01

    In order to tackle the defects of the Location Management (LM) scheme used in second generation (2G) and third generation (3G) mobile networks, forth generation (4G) network Long Term Evolution (LTE) uses a new LM scheme, which is called a Tracking Area List (TAL)-based LM scheme and the signaling cost of the TAL-based LM scheme is determined by the allocation of TALs. This paper develops a mathematical model of embedded Markov chain to analyze the signaling cost of the TAL-based scheme for a local User Equipment (UE) whose activity region is relatively fixed. Mathematical formulas for the LU cost and the paging cost are derived. With these formulas, an optimal TAL allocation strategy that can minimize the signaling cost can be found.%为了克服2G和3G移动通信网络位置管理方案的缺陷,4G长期演进(Long Term Evolution, LTE)采用了基于跟踪区列表(Tracking Area List, TAL)的位置管理方案。基于TAL的位置管理方案的性能取决于TAL分配方案。考虑到本地移动设备(User Equipment, UE)的活动区域相对固定,该文提出一种嵌入式马尔科夫链模型,用于分析本地UE的基于TAL的位置管理方案的信令开销。推导得到位置更新开销和寻呼开销的数学公式。利用这些公式,可搜索得到能使信令开销最低化的最佳TAL分配方案。

  14. Total fistulectomy with simple closure of the internal opening in the management of complex cryptoglandular fistulas: long-term results and functional outcome.

    Science.gov (United States)

    Tobisch, Alexander; Stelzner, Sigmar; Hellmich, Gunter; Jackisch, Thomas; Witzigmann, Helmut

    2012-07-01

    Total fistulectomy with simple closure of the internal opening has been used for the management of complex anal fistulas. This approach involves complete removal of the fistula tract and closure of the internal opening with sutures. This study aimed to report long-term outcomes in patients with complex cryptoglandular fistulas who undergo this procedure. This is a retrospective review of a prospectively collected consecutive series. This study was conducted at a community-based hospital with a specialized colorectal unit. : Patients included in this study had cryptoglandular fistulas and underwent total fistulectomy with simple closure of the internal opening between 1997 and 2007. The main outcome measures were success rate and postoperative continence (Cleveland Clinic Florida Fecal Incontinence Scale). Treatment was considered successful if the external opening was closed and no drainage was present at the last follow-up. Success was achieved in 187 (74%) patients with a median follow-up time of 70 (range, 14-141) months. Patients with posterior transsphincteric or suprasphincteric fistulas had a higher success rate than those with other types of fistulas (82% vs 67%;p = 0.014), and patients for whom the procedure failed were significantly younger than those for whom the procedure was a success (mean, 45 vs 50 years; p = 0.010). Of 160 patients with success who had no previous surgery, 89 (56%) had normal continence postoperatively (CCF-FI score = 0). The limitations of this study include its retrospective nature, the potential for selection bias, and the lack of preoperative continence scores. Total fistulectomy with simple closure of the internal opening is effective for the long-term closure of complex cryptoglandular fistulas.However, this procedure may affect continence despite its sphincter-sparing quality. Nonetheless, the high success rate in patients with posterior transsphincteric or suprasphincteric fistulas renders this procedure a reasonable option

  15. Integrating care for people with mental illness: the Care Programme Approach in England and its implications for long-term conditions management

    Science.gov (United States)

    Goodwin, Nick; Lawton-Smith, Simon

    2010-01-01

    Introduction This policy paper considers what the long-term conditions policies in England and other countries could learn from the experience of the Care Programme Approach (CPA). The CPA was introduced in England in April 1991 as the statutory framework for people requiring support in the community for more severe and enduring mental health problems. The CPA approach is an example of a long-standing ‘care co-ordination’ model that seeks to develop individualised care plans and then attempt to integrate care for patients from a range of providers. Policy description The CPA experience is highly relevant to both the English and international debates on the future of long-term conditions management where the agenda has focused on developing co-ordinated care planning and delivery between health and social care; to prioritise upstream interventions that promote health and wellbeing; and to provide for a more personalised service. Conclusion This review of the CPA experience suggests that there is the potential for better care integration for those patients with multiple or complex needs where a strategy of personalised care planning and pro-active care co-ordination is provided. However, such models will not reach their full potential unless a number of preconditions are met including: clear eligibility criteria; standardised measures of service quality; a mix of governance and incentives to hold providers accountable for such quality; and genuine patient involvement in their own care plans. Implications Investment and professional support to the role of the care co-ordinator is particularly crucial. Care co-ordinators require the requisite skills and competencies to act as a care professional to the patient as well as to have the power to exert authority among other care professionals to ensure multidisciplinary care plans are implemented successfully. Attention to inter-professional practice, culture, leadership and organisational development can also help

  16. Integrating care for people with mental illness: the Care Programme Approach in England and its implications for long-term conditions management

    Directory of Open Access Journals (Sweden)

    Nick Goodwin

    2010-03-01

    Full Text Available Introduction: This policy paper considers what the long-term conditions policies in England and other countries could learn from the experience of the Care Programme Approach (CPA. The CPA was introduced in England in April 1991 as the statutory framework for people requiring support in the community for more severe and enduring mental health problems. The CPA approach is an example of a long-standing 'care co-ordination' model that seeks to develop individualised care plans and then attempt to integrate care for patients from a range of providers. Policy description: The CPA experience is highly relevant to both the English and international debates on the future of long-term conditions management where the agenda has focused on developing co-ordinated care planning and delivery between health and social care; to prioritise upstream interventions that promote health and wellbeing; and to provide for a more personalised service. Conclusion: This review of the CPA experience suggests that there is the potential for better care integration for those patients with multiple or complex needs where a strategy of personalised care planning and pro-active care co-ordination is provided. However, such models will not reach their full potential unless a number of preconditions are met including: clear eligibility criteria; standardised measures of service quality; a mix of governance and incentives to hold providers accountable for such quality; and genuine patient involvement in their own care plans. Implications: Investment and professional support to the role of the care co-ordinator is particularly crucial. Care co-ordinators require the requisite skills and competencies to act as a  care professional  to the patient as well as to have the power to exert authority among other care professionals to ensure multidisciplinary care plans are implemented successfully. Attention to inter-professional practice, culture, leadership and organisational

  17. Integrating care for people with mental illness: the Care Programme Approach in England and its implications for long-term conditions management

    Directory of Open Access Journals (Sweden)

    Nick Goodwin

    2010-03-01

    Full Text Available Introduction: This policy paper considers what the long-term conditions policies in England and other countries could learn from the experience of the Care Programme Approach (CPA. The CPA was introduced in England in April 1991 as the statutory framework for people requiring support in the community for more severe and enduring mental health problems. The CPA approach is an example of a long-standing 'care co-ordination' model that seeks to develop individualised care plans and then attempt to integrate care for patients from a range of providers.Policy description: The CPA experience is highly relevant to both the English and international debates on the future of long-term conditions management where the agenda has focused on developing co-ordinated care planning and delivery between health and social care; to prioritise upstream interventions that promote health and wellbeing; and to provide for a more personalised service.Conclusion: This review of the CPA experience suggests that there is the potential for better care integration for those patients with multiple or complex needs where a strategy of personalised care planning and pro-active care co-ordination is provided. However, such models will not reach their full potential unless a number of preconditions are met including: clear eligibility criteria; standardised measures of service quality; a mix of governance and incentives to hold providers accountable for such quality; and genuine patient involvement in their own care plans.Implications: Investment and professional support to the role of the care co-ordinator is particularly crucial. Care co-ordinators require the requisite skills and competencies to act as a  care professional  to the patient as well as to have the power to exert authority among other care professionals to ensure multidisciplinary care plans are implemented successfully. Attention to inter-professional practice, culture, leadership and organisational

  18. Long-Term Ownership by Industrial Foundations

    DEFF Research Database (Denmark)

    Børsting, Christa Winther; Kuhn, Johan Moritz; Poulsen, Thomas

    2016-01-01

    Short-termism has become a serious concern for businesses and policy makers and this has inspired a search for governance arrangement to promote long term decision making. In this paper we study a particularly long-term ownership structure, which is fairly common in Northern Europe, particularly...... in Denmark. Industrial foundations are independent legal entities without owners or members typically with the dual objective of preserving the company and using excess profits for charity. We use a unique Danish data set to examine the governance of foundation-owned companies. We show that they are long-term...... in several respects. Foundations hold on to their shares for longer. Foundation-owned companies replace managers less frequently. They have more conservative capital structures with less leverage. Their companies survive longer. Their business decisions appear to be more long term. This paper supports...

  19. Integrated Weed Control for Land Stewardship at Legacy Management's Rocky Flats Site in Colorado - 13086

    Energy Technology Data Exchange (ETDEWEB)

    Nelson, Jody K. [Stoller LMS Team, Contractor to the U.S. Department of Energy Office of Legacy Management, 11025 Dover Street, Suite 1000, Westminster, Colorado 80021 (United States)

    2013-07-01

    Land stewardship is one of nine sustainability programs in the U.S. Department of Energy's Environmental Management System. Land stewardship includes maintaining and improving ecosystem health. At the Rocky Flats Site near Westminster, Colorado, land stewardship is an integral component of the Office of Legacy Management's post-closure monitoring and management at the site. Nearly 263 hectares (650 acres) were disturbed and re-vegetated during site cleanup and closure operations. Proactive management of revegetation areas is critical to the successful reestablishment of native grasslands, wetlands, and riparian communities. The undisturbed native plant communities that occur at the site also require active management to maintain the high-quality wetlands and other habitats that are home to numerous species of birds and other wildlife such as elk and deer, rare plant communities, and the federally listed threatened Preble's meadow jumping mouse. Over the past several decades, an increase of Noxious weeds has impacted much of Colorado's Front Range. As a result, weed control is a key component of the land stewardship program at Rocky Flats. Thirty-three species of state-listed Noxious weeds are known to occur in the Central and Peripheral Operable Units at Rocky Flats, along with another five species that are considered invasive at the site. Early detection and rapid response to control new invasive species is crucial to the program. An integrated weed control/vegetation management approach is key to maintaining healthy, sustainable plant communities that are able to resist Noxious weed invasions. Weed mapping, field surveys, and field-staff training sessions (to learn how to identify new potential problem species) are conducted to help detect and prevent new weed problems. The integrated approach at Rocky Flats includes administrative and cultural techniques (prevention), mechanical controls, biological controls, and chemical controls. Several

  20. Science framework for conservation and restoration of the sagebrush biome: Linking the Department of the Interior’s Integrated Rangeland Fire Management Strategy to long-term strategic conservation actions

    Science.gov (United States)

    J.C. Chambers; J.L. Beck; J.B. Bradford; J. Bybee; S. Campbell; J. Carlson; T.J. Christiansen; K.J. Clause; G. Collins; M.R. Crist; J.B. Dinkins; K.E. Doherty; F. Edwards; S. Espinosa; K.A. Griffin; P. Griffin; J.R. Haas; S.E. Hanser; D.W. Havlina; K.F. Henke; J.D. Hennig; L.A. Joyce; F.M. Kilkenny; S.M. Kulpa; L.L. Kurth; J.D. Maestas; M. Manning; K.E. Mayer; B.A. Mealor; C. McCarthy; M. Pellant; M.A. Perea; K.L. Prentice; D.A. Pyke; L.A. Wiechman; A. Wuenschel

    2017-01-01

    The Science Framework is intended to link the Department of the Interior’s Integrated Rangeland Fire Management Strategy with long-term strategic conservation actions in the sagebrush biome. The Science Framework provides a multiscale approach for prioritizing areas for management and determining effective management strategies within the sagebrush biome. The emphasis...

  1. Stressors in Teens with Type 1 Diabetes and Their Parents: Immediate and Long-Term Implications for Transition to Self-Management.

    Science.gov (United States)

    Ersig, Anne L; Tsalikian, Eva; Coffey, Julie; Williams, Janet K

    2016-01-01

    Teens with Type 1 diabetes and their parents experience every day and illness-related stress; however, understanding of how these stressors relate to the transition to adulthood is limited. The purpose of this study was to identify stressors of teens with Type 1 diabetes (T1DM) and their parents related to the impending transition to adulthood. This study used open-ended questions to identify every day and illness-related stressors among 15 teens with T1DM and 25 parents seen in one pediatric diabetes clinic. Qualitative descriptive analysis identified themes in interview transcripts. The primary teen stressor related to impending transition centered on ineffective self-management, often when they were taking over responsibility for T1DM management. Parents' concerns included immediate and long-term negative outcomes of teen self-management as well as financial resources and health insurance for the teen. Teens and parents both expressed specific concerns about outcomes and prevention of nocturnal hypoglycemia, and identified uncertainties related to teen health and diabetes-focused health care when no longer living in the parent's home. Teens with Type 1 diabetes and their parents understand that independent teen self-management is a component of transition to adulthood, but worry about teen self-management outcomes. Concerns specific to health care transition included health insurance, T1DM resources, and teens' abilities to handle new situations. Identifying current and future self-management concerns of individuals and families can facilitate targeted education and interventions to support successful transition to adulthood. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. The National Wind Erosion Research Network: Building a standardized long-term data resource for aeolian research, modeling and land management

    Science.gov (United States)

    Webb, Nicholas P.; Herrick, Jeffrey E.; Van Zee, Justin W; Courtright, Ericha M; Hugenholtz, Ted M; Zobeck, Ted M; Okin, Gregory S.; Barchyn, Thomas E; Billings, Benjamin J; Boyd, Robert A.; Clingan, Scott D; Cooper, Brad F; Duniway, Michael C.; Derner, Justin D; Fox, Fred A; Havstad, Kris M.; Heilman, Philip; LaPlante, Valerie; Ludwig, Noel A; Metz, Loretta J; Nearing, Mark A; Norfleet, M Lee; Pierson, Frederick B; Sanderson, Matt A; Sharrat, Brenton S; Steiner, Jean L; Tatarko, John; Tedela, Negussie H; Todelo, David; Unnasch, Robert S; Van Pelt, R Scott; Wagner, Larry

    2016-01-01

    The National Wind Erosion Research Network was established in 2014 as a collaborative effort led by the United States Department of Agriculture’s Agricultural Research Service and Natural Resources Conservation Service, and the United States Department of the Interior’s Bureau of Land Management, to address the need for a long-term research program to meet critical challenges in wind erosion research and management in the United States. The Network has three aims: (1) provide data to support understanding of basic aeolian processes across land use types, land cover types, and management practices, (2) support development and application of models to assess wind erosion and dust emission and their impacts on human and environmental systems, and (3) encourage collaboration among the aeolian research community and resource managers for the transfer of wind erosion technologies. The Network currently consists of thirteen intensively instrumented sites providing measurements of aeolian sediment transport rates, meteorological conditions, and soil and vegetation properties that influence wind erosion. Network sites are located across rangelands, croplands, and deserts of the western US. In support of Network activities, http://winderosionnetwork.org was developed as a portal for information about the Network, providing site descriptions, measurement protocols, and data visualization tools to facilitate collaboration with scientists and managers interested in the Network and accessing Network products. The Network provides a mechanism for engaging national and international partners in a wind erosion research program that addresses the need for improved understanding and prediction of aeolian processes across complex and diverse land use types and management practices.

  3. Problems identified by dual sensory impaired older adults in long-term care when using a self-management program : A qualitative study

    NARCIS (Netherlands)

    Roets-Merken, Lieve; Zuidema, Sytse; Vernooij-Dassen, Myrra; Dees, Marianne; Hermsen, Pieter; Kempen, Gertrudis; Graff, Maud

    2017-01-01

    OBJECTIVE: To gain insights into the problems of dual sensory impaired older adults in long-term care. Insights into these problems are essential for developing adequate policies which address the needs of the increasing population of dual sensory impaired older adults in long-term care. METHODS: A

  4. Emerging communities of child-healthcare practice in the management of long-term conditions such as chronic kidney disease: qualitative study of parents’ accounts

    Science.gov (United States)

    2014-01-01

    Background Parents of children and young people with long-term conditions who need to deliver clinical care to their child at home with remote support from hospital-based professionals, often search the internet for care-giving information. However, there is little evidence that the information available online was developed and evaluated with parents or that it acknowledges the communities of practice that exist as parents and healthcare professionals share responsibility for condition management. Methods The data reported here are part of a wider study that developed and tested a condition-specific, online parent information and support application with children and young people with chronic-kidney disease, parents and professionals. Semi-structured interviews were conducted with 19 fathers and 24 mothers who had recently tested the novel application. Data were analysed using Framework Analysis and the Communities of Practice concept. Results Evolving communities of child-healthcare practice were identified comprising three components and several sub components: (1) Experiencing (parents making sense of clinical tasks) through Normalising care, Normalising illness, Acceptance & action, Gaining strength from the affected child and Building relationships to formalise a routine; (2) Doing (Parents executing tasks according to their individual skills) illustrated by Developing coping strategies, Importance of parents’ efficacy of care and Fear of the child’s health failing; and (3) Belonging/Becoming (Parents defining task and group members’ worth and creating a personal identity within the community) consisting of Information sharing, Negotiation with health professionals and Achieving expertise in care. Parents also recalled factors affecting the development of their respective communities of healthcare practice; these included Service transition, Poor parent social life, Psycho-social affects, Family chronic illness, Difficulty in learning new procedures

  5. Emerging communities of child-healthcare practice in the management of long-term conditions such as chronic kidney disease: qualitative study of parents' accounts.

    Science.gov (United States)

    Carolan, Ian; Smith, Trish; Hall, Andy; Swallow, Veronica M

    2014-07-07

    Parents of children and young people with long-term conditions who need to deliver clinical care to their child at home with remote support from hospital-based professionals, often search the internet for care-giving information. However, there is little evidence that the information available online was developed and evaluated with parents or that it acknowledges the communities of practice that exist as parents and healthcare professionals share responsibility for condition management. The data reported here are part of a wider study that developed and tested a condition-specific, online parent information and support application with children and young people with chronic-kidney disease, parents and professionals. Semi-structured interviews were conducted with 19 fathers and 24 mothers who had recently tested the novel application. Data were analysed using Framework Analysis and the Communities of Practice concept. Evolving communities of child-healthcare practice were identified comprising three components and several sub components: (1) Experiencing (parents making sense of clinical tasks) through Normalising care, Normalising illness, Acceptance & action, Gaining strength from the affected child and Building relationships to formalise a routine; (2) Doing (Parents executing tasks according to their individual skills) illustrated by Developing coping strategies, Importance of parents' efficacy of care and Fear of the child's health failing; and (3) Belonging/Becoming (Parents defining task and group members' worth and creating a personal identity within the community) consisting of Information sharing, Negotiation with health professionals and Achieving expertise in care. Parents also recalled factors affecting the development of their respective communities of healthcare practice; these included Service transition, Poor parent social life, Psycho-social affects, Family chronic illness, Difficulty in learning new procedures, Shielding and avoidance, and

  6. Knowledge Confidence and Desire for Further Diabetes-Management Education among Nurses and Personal Support Workers in Long-Term Care.

    Science.gov (United States)

    Vincent, Corita; Hall, Peter; Ebsary, Sally; Hannay, Scott; Hayes-Cardinal, Lynn; Husein, Nadira

    2016-06-01

    Diabetes care in the long-term care (LTC) setting is complicated by increased prevalence of comorbidities, age-related changes in medication tolerance, frailty and limited resources. Registered nurses (RNs), registered practical nurses (RPNs) and personal support workers (PSWs) are responsible for front-line diabetes care; however, there is limited formal diabetes education in this setting. The current study aimed to assess the knowledge confidence and desire for additional diabetes education among nurses and PSWs in the LTC setting. We studied 89 RNs, RPNs and PSWs (Mage=43.6, 94.3% female) in 2 LTC facilities in the Kitchener-Waterloo area who participated in an online survey assessing knowledge and confidence in 6 key areas of diabetes care (nutrition, insulin, oral medications, hypoglycemia, hyperglycemia and sick-day management). Interest in further diabetes education was also explored. Self-rated knowledge and confidence were generally moderate to high, ranging from 46% to 79% being moderately to very knowledgeable and from 61% to 74% being moderately to very confident. Knowledge and confidence was highest for nutrition and management of hypo- and hyperglycemia and lower for sick-day management, oral medications and insulin. There were significant differences between clinicians such that PSWs reported less knowledge and confidence than RNs and RPNs on most parameters. Among the whole sample, 85% wanted education about diabetes, and this rate did not vary by occupation. The most commonly reported areas for additional education concerning diabetes were for management of hypo- and hyperglycemia (30% to 31%) and insulin (31%). Overall, the findings indicate moderate levels of self-rated knowledge across diabetes care areas; however, most clinicians feel there is room for more diabetes-care education, particularly regarding insulin and management of hypo- and hyperglycemia. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights

  7. Management of iatrogenic ureteric injury with retrograde ureteric stenting: an analysis of factors affecting technical success and long-term outcome.

    Science.gov (United States)

    Chung, Daniel; Briggs, James; Turney, Benjamin W; Tapping, Charles Ross

    2017-02-01

    Background Iatrogenic ureteral injuries arise as serious complication following obstetrics, gynecological, general, and urological surgery with incidence in the range of 0.5-10%. Retrograde placement of double-J ureteric stent is a possible treatment option if the injury is not recognized at the time of surgery. Purpose To assess technical success and long-term outcome associated with retrograde ureteric stent insertion for iatrogenic ureteric injury. Material and Methods Between 1999 and 2011, 26 patients with initially unrecognized iatrogenic ureteric injury underwent initial management with retrograde ureteric stenting. Full case-notes were available for review in 25 patients. Results The mean interval from injury to attempted stenting was 19.4 days. Successful retrograde ureteric stenting was achieved in 21/25 patients (81%). Retrograde stenting failed in four patients, and nephrostomy followed by alternative procedures were performed instead. At a median follow-up interval of 9.7 months, normal anatomy was demonstrated on 12/21 patients (57%) and a stricture was observed in 6/21 patients (28%) with three requiring surgical intervention. Conclusion Retrograde stenting is a safe and efficient initial management in patients with iatrogenic ureteric injuries.

  8. Apps and Adolescents: A Systematic Review of Adolescents' Use of Mobile Phone and Tablet Apps That Support Personal Management of Their Chronic or Long-Term Physical Conditions.

    Science.gov (United States)

    Majeed-Ariss, Rabiya; Baildam, Eileen; Campbell, Malcolm; Chieng, Alice; Fallon, Debbie; Hall, Andrew; McDonagh, Janet E; Stones, Simon R; Thomson, Wendy; Swallow, Veronica

    2015-12-23

    The prevalence of physical chronic or long-term conditions in adolescents aged 10-24 years is rising. Mobile phone and tablet mobile technologies featuring software program apps are widely used by these adolescents and their healthy peers for social networking or gaming. Apps are also used in health care to support personal condition management and they have considerable potential in this context. There is a growing body of literature on app use in health contexts, thereby making a systematic review of their effectiveness very timely. To systematically review the literature on the effectiveness of mobile apps designed to support adolescents' management of their physical chronic or long-term conditions. We conducted a review of the English-language literature published since 2003 in five relevant bibliographical databases using key search terms. Two independent reviewers screened titles and abstracts using data extraction and quality assessment tools. The search returned 1120 hits. Of the 19 eligible full-text papers, four met our review criteria, reporting one pilot randomized controlled trial and three pretest/post-test studies. Samples ranged from 4 to 18 participants, with a combined sample of 46 participants. The apps reported were targeted at type 1 diabetes, asthma, and cancer. Two papers provided data for calculating effect size. Heterogeneity in terms of study design, reported outcomes, follow-up times, participants' ages, and health conditions prevented meta-analyses. There was variation in whether adolescents received guidance in using the app or were solely responsible for navigating the app. Three studies reported some level of patient involvement in app design, development, and/or evaluation. Health professional involvement in the modelling stages of apps was reported in all studies, although it was not always clear whether specific clinical (as opposed to academic) expertise in working with adolescents was represented. The dearth of studies and the

  9. Long-term field data and climate-habitat models show that orangutan persistence depends on effective forest management and greenhouse gas mitigation.

    Directory of Open Access Journals (Sweden)

    Stephen D Gregory

    Full Text Available BACKGROUND: Southeast Asian deforestation rates are among the world's highest and threaten to drive many forest-dependent species to extinction. Climate change is expected to interact with deforestation to amplify this risk. Here we examine whether regional incentives for sustainable forest management will be effective in improving threatened mammal conservation, in isolation and when combined with global climate change mitigation. METHODOLOGY/PRINCIPAL FINDINGS: Using a long time-series of orangutan nest counts for Sabah (2000-10, Malaysian Borneo, we evaluated the effect of sustainable forest management and climate change scenarios, and their interaction, on orangutan spatial abundance patterns. By linking dynamic land-cover and downscaled global climate model projections, we determine the relative influence of these factors on orangutan spatial abundance and use the resulting statistical models to identify habitat crucial for their long-term conservation. We show that land-cover change the degradation of primary forest had the greatest influence on orangutan population size. Anticipated climate change was predicted to cause reductions in abundance in currently occupied populations due to decreased habitat suitability, but also to promote population growth in western Sabah by increasing the suitability of presently unoccupied regions. CONCLUSIONS/SIGNIFICANCE: We find strong quantitative support for the Sabah government's proposal to implement sustainable forest management in all its forest reserves during the current decade; failure to do so could result in a 40 to 80 per cent regional decline in orangutan abundance by 2100. The Sabah orangutan is just one (albeit iconic example of a forest-dependent species that stands to benefit from sustainable forest management, which promotes conservation of existing forests.

  10. Long-Term Field Data and Climate-Habitat Models Show That Orangutan Persistence Depends on Effective Forest Management and Greenhouse Gas Mitigation

    Science.gov (United States)

    Gregory, Stephen D.; Brook, Barry W.; Goossens, Benoît; Ancrenaz, Marc; Alfred, Raymond; Ambu, Laurentius N.; Fordham, Damien A.

    2012-01-01

    Background Southeast Asian deforestation rates are among the world’s highest and threaten to drive many forest-dependent species to extinction. Climate change is expected to interact with deforestation to amplify this risk. Here we examine whether regional incentives for sustainable forest management will be effective in improving threatened mammal conservation, in isolation and when combined with global climate change mitigation. Methodology/Principal Findings Using a long time-series of orangutan nest counts for Sabah (2000–10), Malaysian Borneo, we evaluated the effect of sustainable forest management and climate change scenarios, and their interaction, on orangutan spatial abundance patterns. By linking dynamic land-cover and downscaled global climate model projections, we determine the relative influence of these factors on orangutan spatial abundance and use the resulting statistical models to identify habitat crucial for their long-term conservation. We show that land-cover change the degradation of primary forest had the greatest influence on orangutan population size. Anticipated climate change was predicted to cause reductions in abundance in currently occupied populations due to decreased habitat suitability, but also to promote population growth in western Sabah by increasing the suitability of presently unoccupied regions. Conclusions/Significance We find strong quantitative support for the Sabah government’s proposal to implement sustainable forest management in all its forest reserves during the current decade; failure to do so could result in a 40 to 80 per cent regional decline in orangutan abundance by 2100. The Sabah orangutan is just one (albeit iconic) example of a forest-dependent species that stands to benefit from sustainable forest management, which promotes conservation of existing forests. PMID:22970145

  11. Long-term urethral catheterisation.

    Science.gov (United States)

    Turner, Bruce; Dickens, Nicola

    This article discusses long-term urethral catheterisation, focusing on the relevant anatomy and physiology, indications for the procedure, catheter selection and catheter care. It is important that nurses have a good working knowledge of long-term catheterisation as the need for this intervention will increase with the rise in chronic health conditions and the ageing population.

  12. Desirable Components for a Customized, Home-Based, Digital Care-Management App for Children and Young People With Long-Term, Chronic Conditions: A Qualitative Exploration.

    Science.gov (United States)

    Nightingale, Ruth; Hall, Andrew; Gelder, Carole; Friedl, Simone; Brennan, Eileen; Swallow, Veronica

    2017-07-04

    Mobile apps for mobile phones and tablet devices are widely used by children and young people aged 0-18 years with long-term health conditions, such as chronic kidney disease (CKD), and their healthy peers for social networking or gaming. They are also poised to become a major source of health guidance. However, app development processes that are coproduced, rigorously developed, and evaluated to provide tailored, condition-specific, practical advice on day-to-day care management are seldom systematic or sufficiently described to enable replication. Furthermore, attempts to extrapolate to the real world are hampered by a poor understanding of the effects of key elements of app components. Therefore, effective and cost-effective novel, digital apps that will effectively and safely support care management are critical and timely. To inform development of such an app for children with CKD, a user requirements-gathering exercise was first needed. To explore the views of children with CKD, their parents, and health care professionals to inform future development of a child-focused, care-management app. Using age- and developmentally appropriate methods, we interviewed 36 participants: 5-10-year-olds (n=6), 11-14-year-olds (n=6), 15-18-year-olds (n=5), mothers (n=10), fathers (n=2), and health care professionals (n=7). Data were analyzed using Framework Analysis and behavior change theories. Of the 27 interviews, 19 (70%) interviews were individual and 8 (30%) were joint-5 out of 8 (63%) joint interviews were with a child or young person and their parent, 1 out of 8 (13%) were with a child and both parents, and 2 out of 8 (25%) were with 2 professionals. Three key themes emerged to inform development of a software requirement specification for a future home-based, digital care-management app intervention: (1) Gaps in current online information and support, (2) Difficulties experienced by children with a long-term condition, and (3) Suggestions for a digital care-management

  13. Desirable Components for a Customized, Home-Based, Digital Care-Management App for Children and Young People With Long-Term, Chronic Conditions: A Qualitative Exploration

    Science.gov (United States)

    Hall, Andrew; Gelder, Carole; Friedl, Simone; Brennan, Eileen; Swallow, Veronica

    2017-01-01

    Background Mobile apps for mobile phones and tablet devices are widely used by children and young people aged 0-18 years with long-term health conditions, such as chronic kidney disease (CKD), and their healthy peers for social networking or gaming. They are also poised to become a major source of health guidance. However, app development processes that are coproduced, rigorously developed, and evaluated to provide tailored, condition-specific, practical advice on day-to-day care management are seldom systematic or sufficiently described to enable replication. Furthermore, attempts to extrapolate to the real world are hampered by a poor understanding of the effects of key elements of app components. Therefore, effective and cost-effective novel, digital apps that will effectively and safely support care management are critical and timely. To inform development of such an app for children with CKD, a user requirements-gathering exercise was first needed. Objective To explore the views of children with CKD, their parents, and health care professionals to inform future development of a child-focused, care-management app. Methods Using age- and developmentally appropriate methods, we interviewed 36 participants: 5-10-year-olds (n=6), 11-14-year-olds (n=6), 15-18-year-olds (n=5), mothers (n=10), fathers (n=2), and health care professionals (n=7). Data were analyzed using Framework Analysis and behavior change theories. Results Of the 27 interviews, 19 (70%) interviews were individual and 8 (30%) were joint—5 out of 8 (63%) joint interviews were with a child or young person and their parent, 1 out of 8 (13%) were with a child and both parents, and 2 out of 8 (25%) were with 2 professionals. Three key themes emerged to inform development of a software requirement specification for a future home-based, digital care-management app intervention: (1) Gaps in current online information and support, (2) Difficulties experienced by children with a long-term condition, and (3

  14. Distributed simulation of long-term hydrological processes in a medium-sized periurban catchment under changing land use and rainwater management.

    Science.gov (United States)

    Labbas, Mériem; Braud, Isabelle; Branger, Flora; Kralisch, Sven

    2013-04-01

    Growing urbanization and related anthropogenic processes have a high potential to influence hydrological process dynamics. Typical consequences are an increase of surface imperviousness and modifications of water flow paths due to artificial channels and barriers (combined and separated system, sewer overflow device, roads, ditches, etc.). Periurban catchments, at the edge of large cities, are especially affected by fast anthropogenic modifications. They usually consist of a combination of natural areas, rural areas with dispersed settlements and urban areas mostly covered by built zones and spots of natural surfaces. In the context of the European Water Framework Directive (2000) and the Floods Directive (2007), integrated and sustainable solutions are needed to reduce flooding risks and river pollution at the scale of urban conglomerations or whole catchments. Their thorough management requires models able to assess the vulnerability of the territory and to compare the impact of different rainwater management options and planning issues. To address this question, we propose a methodology based on a multi-scale distributed hydrological modelling approach. It aims at quantifying the impact of ongoing urbanization and stormwater management on the long-term hydrological cycle in medium-sized periurban watershed. This method focuses on the understanding and formalization of dominant periurban hydrological processes from small scales (few ha to few km2) to larger scales (few hundred km2). The main objectives are to 1) simulate both urban and rural hydrological processes and 2) test the effects of different long-term land use and water management scenarios. The method relies on several tools and data: a distributed hydrological model adapted to the characteristics of periurban areas, land use and land cover maps from different dates (past, present, future) and information about rainwater management collected from local authorities. For the application of the method, the

  15. Differential long-term effects of climate change and management on stocks and distribution of soil organic carbon in productive grasslands

    Directory of Open Access Journals (Sweden)

    A. M. G. De Bruijn

    2012-06-01

    Full Text Available We studied the impact of climate change on the dynamics of soil organic carbon (SOC stocks in productive grassland systems undergoing two types of management, an intensive type with frequent harvests and fertilizer applications and an extensive system without fertilization and fewer harvests. Simulations were conducted with a dedicated newly developed model, the Oensingen Grassland Model. It was calibrated using measurements taken in a recently established permanent sward in Central Switzerland, and run to simulate SOC dynamics over 2001–2100 under various climate change scenarios assuming different elements of IPCC A2 emission scenarios. We found that: (1 management intensity dominates SOC until approximately 20 years after grassland establishment. Differences in SOC between climate scenarios become significant after 20 years and climate effects dominate SOC dynamics from approximately 50 years after establishment. (2 Carbon supplied through manure contributes about 60 % to measured organic C increase in fertilized grassland. (3 Soil C accumulates particularly in the top 10 cm of the soil until 5 years after establishment. In the long-term, C accumulation takes place in the top 15 cm of the soil profile, while C content decreases below this depth. The transitional depth between gains and losses of C mainly depends on the vertical distribution of root senescence and root biomass. We discuss the importance of previous land use on carbon sequestration potentials that are much lower at the Oensingen site under ley-arable rotation with much higher SOC stocks than most soils under arable crops. We further discuss the importance of biomass senescence rates, because C balance estimations indicate that these may differ considerably between the two management systems.

  16. Can videoconferencing affect older people's engagement and perception of their social support in long-term conditions management: a social network analysis from the Telehealth Literacy Project.

    Science.gov (United States)

    Banbury, Annie; Chamberlain, Daniel; Nancarrow, Susan; Dart, Jared; Gray, Len; Parkinson, Lynne

    2017-05-01

    Social support is a key component in managing long-term conditions. As people age in their homes, there is a greater risk of social isolation, which can be ameliorated by informal support networks. This study examined the relationship between changes in social support networks for older people living in a regional area following weekly videoconference groups delivered to the home. Between February and June 2014, we delivered 44 weekly group meetings via videoconference to participants in a regional town in Australia. The meetings provided participants with education and an opportunity to discuss health issues and connect with others in similar circumstances. An uncontrolled, pre-post-test methodology was employed. A social network tool was completed by 45 (87%) participants either pre- or post-intervention, of which 24 (46%) participants completed the tool pre- and post-intervention. In addition, 14 semi-structured interviews and 4 focus groups were conducted. Following the intervention, participants identified increased membership of their social networks, although they did not identify individuals from the weekly videoconference groups. The most important social support networks remained the same pre- and post-intervention namely, health professionals, close family and partners. However, post-intervention participants identified friends and wider family as more important to managing their chronic condition compared to pre-intervention. Participants derived social support, in particular, companionship, emotional and informational support as well as feeling more engaged with life, from the weekly videoconference meetings. Videoconference education groups delivered into the home can provide social support and enhance self-management for older people with chronic conditions. They provide the opportunity to develop a virtual social support network containing new and diverse social connections.

  17. Changes in soil physical and chemical properties in long term improved natural and traditional agroforestry management systems of cacao genotypes in Peruvian Amazon.

    Science.gov (United States)

    Arévalo-Gardini, Enrique; Canto, Manuel; Alegre, Julio; Loli, Oscar; Julca, Alberto; Baligar, Virupax

    2015-01-01

    Growing cacao (Theobroma cacao L.) in an agroforestry system generates a productive use of the land, preserves the best conditions for physical, chemical and biological properties of tropical soils, and plays an important role in improving cacao production and fertility of degraded tropical soils. The aim of this study was to evaluate the impact of two long term agroforestry systems of cacao management on soil physical and chemical properties in an area originally inhabited by 30 years old native secondary forest (SF). The two agroforestry systems adapted were: improved natural agroforestry system (INAS) where trees without economic value were selectively removed to provide 50% shade and improved traditional agroforestry system (ITAS) where all native trees were cut and burnt in the location. For evaluation of the changes of soil physical and chemical properties with time due to the imposed cacao management systems, plots of 10 cacao genotypes (ICS95, UF613, CCN51, ICT1112, ICT1026, ICT2162, ICT2171, ICT2142, H35, U30) and one plot with a spontaneous hybrid were selected. Soil samples were taken at 0-20, 20-40 and 40-60 cm depths before the installation of the management systems (2004), and then followed at two years intervals. Bulk density, porosity, field capacity and wilting point varied significantly during the years of assessment in the different soil depths and under the systems assessed. Soil pH, CEC, exchangeable Mg and sum of the bases were higher in the INAS than the ITAS. In both systems, SOM, Ext. P, K and Fe, exch. K, Mg and Al+H decreased with years of cultivation; these changes were more evident in the 0-20 cm soil depth. Overall improvement of SOM and soil nutrient status was much higher in the ITAS than INAS. The levels of physical and chemical properties of soil under cacao genotypes showed a marked difference in both systems.

  18. Long-Term Treatment of Restless Legs Syndrome (RLS): An Approach to Management of Worsening Symptoms, Loss of Efficacy, and Augmentation.

    Science.gov (United States)

    Mackie, Susan; Winkelman, John W

    2015-05-01

    Restless legs syndrome (RLS) is a common, frequently chronic, sensorimotor neurological disorder characterized by nocturnal leg dysesthesias and an irresistible urge to move the legs, usually resulting in sleep disturbance. Dopaminergic agonists, alpha-2-delta calcium-channel ligands, and opioids have all demonstrated efficacy to relieve symptoms of RLS and improve sleep. However, long-term treatment with dopamine agonists (the most commonly prescribed agents) is often characterized by worsening symptoms and loss of efficacy. A more worrisome complication of dopaminergic agents is augmentation, an iatrogenic worsening of RLS symptoms that can produce progressively more severe symptoms resulting in around-the-clock restlessness and near sleeplessness. Recent research has yielded consensus regarding a precise definition of augmentation and has contributed to improved knowledge regarding strategies for preventing this complication. When RLS symptoms worsen during the course of treatment, the clinician must consider the myriad of environmental, medical, pharmacologic, and psychiatric factors that can exacerbate RLS. In the absence of fully developed, evidence-based guidelines there remains uncertainty regarding the optimal management strategy if augmentation develops. However, we discuss several key principles based on the available published data and the authors' clinical experience. We also explore the recent increasing interest in alternative initial treatment strategies that avoid dopamine agonists and their associated complications altogether.

  19. Self-management interventions in patients with long-term conditions: a structured review of approaches to reporting inclusion, assessment, and outcomes in multimorbidity

    Directory of Open Access Journals (Sweden)

    Cassandra Kenning

    2014-08-01

    Full Text Available Background: Multimorbidity has many potential implications for healthcare delivery, but a particularly important impact concerns the validity of trial evidence underpinning clinical guidelines for individual conditions. Objective: To review how authors of published trials of self-management interventions reported inclusion criteria, sample descriptions, and consideration of the impact of multimorbidity on trial outcomes. Methods: We restricted our analysis to a small number of exemplar long-term conditions: type 2 diabetes mellitus, coronary heart disease, and chronic obstructive pulmonary disease. We focussed our search on published Cochrane reviews. Data were extracted from the trials on inclusion/exclusion, sample description, and impact on outcomes. Results: Eleven reviews consisting of 164 unique trials were identified. Sixty percent of trials reported excluding patients with forms of multimorbidity. Reasons for exclusion were poorly described or defined. Reporting of multimorbidity within the trials was poor, with only 35% of trials reporting on multimorbidity in their patient samples. Secondary analyses, exploring the impact of multimorbidity, were very rare. Conclusions: The importance of multimorbidity in trials is only going to become more important over time, but trials often exclude patients with multimorbidity, and reporting of multimorbidity in trials including such patients is generally poor. This limits judgements about the external validity of the results for clinical populations. A consistent approach to the conduct and reporting of secondary analyses of the effects of multimorbidity on outcomes, using current best-practice guidance, could lead to a rapid development of the evidence base.

  20. Phosphocalcium ceramics are efficient in the management of severe acetabular loss in revision hip arthroplasties. A 22 cases long-term follow-up study.

    Science.gov (United States)

    Schwartz, C; Vautrin, M

    2015-02-01

    Management of bone loss in revision total hip replacement remains a challenge. To eliminate any immunological or infectious problem and so to try to improve the long-term results obtained with allografts, the authors used synthetic ceramics as bone substitutes since 1995. We reviewed 13 of the patients of our study, we previously reported in 2005 (Schwartz and Bordei in Eur J Orthop Surg Traumatol 15: 191 2005), which was a prospective cohort of thirty-two cases of acetabular revision reconstruction, with a mean follow-up of 14.4 years yet (from 9 to 16 years). Clinical results were assessed according to Oxford scale and Postel and Merle d'Aubigne (PMA) scale. Since 2005, no specific complications were noted. The average PMA functional hip score was 14.9 (vs. 9.2 before revision) at follow-up over 9 years. Nine patients still alive in 2013 were seen again by a surgeon, which was not the operator, with a mean follow-up of 15.3 years: Their Oxford average score was 40.3. Radiological assessment affirmed a good integration of the substitutes in bone without any edging in all cases. A progressive invasion of the ceramics by bone can be seen on the X-ray. We conclude that about 15 years of average delay, which is a significant follow-up in orthopedic surgery, the outcomes without specific complications are satisfactory and allow one to go with these materials in total hip revision surgery.

  1. Exploring Long-Term Impact of Grazing Management on Land Degradation in the Socio-Ecological System of Asteroussia Mountains, Greece

    Directory of Open Access Journals (Sweden)

    Costas Kosmas

    2015-07-01

    Full Text Available The socio-ecological system dominated by pastureland in the Asteroussia Mountains (Crete, Greece was analyzed over a long time interval (1945–2010 to identify the most relevant system’s characteristics and changes. Vegetation cover and land-uses have been quantified by analyzing aerial photographs exploring the whole study period. Soil characteristics have been assessed by carrying out an extensive field survey for the last reference year (2010 and by estimating the average soil loss for the past period using the PESERA soil erosion model validated by field measurements. Based on environmental, social and economic attributes, three major periods characterizing the socio-ecological system of Asteroussia Mountains have been distinguished. During the first and second period, the land was satisfactorily managed with moderate–low soil erosion rates despite the adverse (prevailing soil, topographic and climate conditions for vegetation growth. The third time interval featured a rapid growth in the livestock density causing increased soil erosion rates, loss in plant productivity, and a generalized over-exploitation of natural resources. As a consequence, the desertification process has significantly increased in the last period. The analysis of the long-term evolution of socio-ecological system provided evidence to understand the main drivers of land degradation and to recommend mitigation policies specifically addressing Mediterranean pastureland.

  2. Comprehensive monitoring and management of a long-term thermophilic CSTR treating coffee grounds, coffee liquid, milk waste, and municipal sludge.

    Science.gov (United States)

    Shofie, Mohammad; Qiao, Wei; Li, Qian; Takayanagi, Kazuyuki; Li, Yu-You

    2015-09-01

    The CSTR process has previously not been successfully applied to treat coffee residues under thermophilic temperature and long term operation. In this experiment, the CSTR was fed with mixture substrate (TS ∼ 70 g/L) of coffee grounds, coffee wastewater, milk waste and municipal sludge and it was operated under 55 °C for 225 days. A steady state was achieved under HRT 30 days and OLR 4.0 kg-COD/m(3)/d. However, there was an 35 days inhibition with VFA accumulation (propionic acid 700-1900 mg/L) when doubling the OLR by shortening HRT to 15 days. But, an addition of microelements and sulfate (0.5 g/L) in feedstock increased reactor resilience and stability under high loading rate and propionic acid stress. Continuous monitoring of hydrogen in biogas indicated the imbalance of acetogenesis. The effectiveness of comprehensive parameters (total VFA, propionic acid, IA/PA, IA/TA and CH4 content) was proved to manage the thermophilic system.

  3. A cluster randomised controlled trial of the clinical and cost-effectiveness of a 'whole systems' model of self-management support for the management of long- term conditions in primary care: trial protocol

    Directory of Open Access Journals (Sweden)

    Bower Peter

    2012-01-01

    Full Text Available Abstract Background Patients with long-term conditions are increasingly the focus of quality improvement activities in health services to reduce the impact of these conditions on quality of life and to reduce the burden on care utilisation. There is significant interest in the potential for self-management support to improve health and reduce utilisation in these patient populations, but little consensus concerning the optimal model that would best provide such support. We describe the implementation and evaluation of self-management support through an evidence-based 'whole systems' model involving patient support, training for primary care teams, and service re-organisation, all integrated into routine delivery within primary care. Methods The evaluation involves a large-scale, multi-site study of the implementation, effectiveness, and cost-effectiveness of this model of self-management support using a cluster randomised controlled trial in patients with three long-term conditions of diabetes, chronic obstructive pulmonary disease (COPD, and irritable bowel syndrome (IBS. The outcome measures include healthcare utilisation and quality of life. We describe the methods of the cluster randomised trial. Discussion If the 'whole systems' model proves effective and cost-effective, it will provide decision-makers with a model for the delivery of self-management support for populations with long-term conditions that can be implemented widely to maximise 'reach' across the wider patient population. Trial registration number ISRCTN: ISRCTN90940049

  4. Long-term monitoring for conservation management: Lessons from a case study integrating remote sensing and field approaches in floodplain forests.

    Science.gov (United States)

    Rodríguez-González, Patricia María; Albuquerque, António; Martínez-Almarza, Miguel; Díaz-Delgado, Ricardo

    2017-02-09

    Implementing long-term monitoring programs that effectively inform conservation plans is a top priority in environmental management. In floodplain forests, historical pressures interplay with the complex multiscale dynamics of fluvial systems and require integrative approaches to pinpoint drivers for their deterioration and ecosystem services loss. Combining a conceptual framework such as the Driver-Pressure-State-Impact-Response (DPSIR) with the development of valid biological indicators can contribute to the analysis of the driving forces and their effects on the ecosystem in order to formulate coordinated conservation measures. In the present study, we evaluate the initial results of a decade (2004-2014) of floodplain forest monitoring. We adopted the DPSIR framework to summarize the main drivers in land use and environmental change, analyzed the effects on biological indicators of foundation trees and compared the consistency of the main drivers and their effects at two spatial scales. The monitoring program was conducted in one of the largest and best preserved floodplain forests in SW Europe located within Doñana National Park (Spain) which is dominated by Salix atrocinerea and Fraxinus angustifolia. The program combined field (in situ) surveys on a network of permanent plots with several remote sensing sources. The accuracy obtained in spectral classifications allowed shifts in species cover across the whole forest to be detected and assessed. However, remote sensing did not reflect the ecological status of forest populations. The field survey revealed a general decline in Salix populations, especially in the first five years of sampling -a factor probably associated with a lag effect from past human impact on the hydrology of the catchment and recent extreme climatic episodes (drought). In spite of much reduced seed regeneration, a resprouting strategy allows long-lived Salix individuals to persist in complex spatial dynamics. This suggests the beginning

  5. Long-term effects of wildfire on greater sage-grouse - integrating population and ecosystem concepts for management in the Great Basin

    Science.gov (United States)

    Coates, Peter S.; Ricca, Mark A.; Prochazka, Brian G.; Doherty, Kevin E.; Brooks, Matthew L.; Casazza, Michael L.

    2015-09-10

    periods of high precipitation. Based on 30-year projections of burn and recovery rates, our population model predicted steady and substantial long-term declines in population size across the Great Basin. Further, example management scenarios that may help offset adverse wildfire effects are provided by models of varying levels of fire suppression and post-wildfire restoration that focus on areas especially important to sage-grouse populations. These models illustrate how sage-grouse population persistence likely will be compromised as sagebrush ecosystems and sage-grouse habitat are degraded by wildfire, especially in a warmer and drier climate, and by invasion of annual grasses that can increase wildfire frequency and size in the Great Basin.

  6. A stewardship intervention program for safe medication management and use of antidiabetic drugs

    Directory of Open Access Journals (Sweden)

    Zhao RY

    2015-07-01

    Full Text Available Rui-yi Zhao,1 Xiao-wen He,1 Yan-min Shan,1 Ling-ling Zhu,2 Quan Zhou3 1Clinical Nurse Specialist Section, Division of Nursing, 2Geriatric VIP Care Ward, Division of Nursing, 3Department of Pharmacy, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of China Background: Diabetes patients are complex due to considerations of polypharmacy, multimorbidities, medication adherence, dietary habits, health literacy, socioeconomic status, and cultural factors. Meanwhile, insulin and oral hypoglycemic agents are high-alert medications. Therefore it is necessary to require a multidisciplinary team’s integrated endeavors to enhance safe medication management and use of antidiabetic drugs.Methods: A 5-year stewardship intervention program, including organizational measures and quality improvement activities in storage, prescription, dispensing, administration, and monitoring, was performed in the Second Affiliated Hospital of Zhejiang University, People’s Republic of China, a 3,200-bed hospital with 3.5 million outpatient visits annually.Results: The Second Affiliated Hospital of Zhejiang University has obtained a 100% implementation rate of standard storage of antidiabetic drugs in the Pharmacy and wards since August 2012. A zero occurrence of dispensing errors related to highly “look-alike” and “sound-alike” NovoMix 30® (biphasic insulin aspart and NovoRapid® (insulin aspart has been achieved since October 2011. Insulin injection accuracy among ward nurses significantly increased from 82% (first quarter 2011 to 96% (fourth quarter 2011 (P<0.05. The number of medication administration errors related to insulin continuously decreased from 20 (2011 to six (2014. The occurrence rate of hypoglycemia in non–endocrinology ward diabetes inpatients during 2011–2013 was significantly less than that in 2010 (5.03%–5.53% versus 8.27% (P<0.01. Percentage of correct management of

  7. Cost tradeoffs in consequence management at nuclear power plants: A risk based approach to setting optimal long-term interdiction limits for regulatory analyses

    Energy Technology Data Exchange (ETDEWEB)

    Mubayi, V.

    1995-05-01

    The consequences of severe accidents at nuclear power plants can be limited by various protective actions, including emergency responses and long-term measures, to reduce exposures of affected populations. Each of these protective actions involve costs to society. The costs of the long-term protective actions depend on the criterion adopted for the allowable level of long-term exposure. This criterion, called the ``long term interdiction limit,`` is expressed in terms of the projected dose to an individual over a certain time period from the long-term exposure pathways. The two measures of offsite consequences, latent cancers and costs, are inversely related and the choice of an interdiction limit is, in effect, a trade-off between these two measures. By monetizing the health effects (through ascribing a monetary value to life lost), the costs of the two consequence measures vary with the interdiction limit, the health effect costs increasing as the limit is relaxed and the protective action costs decreasing. The minimum of the total cost curve can be used to calculate an optimal long term interdiction limit. The calculation of such an optimal limit is presented for each of five US nuclear power plants which were analyzed for severe accident risk in the NUREG-1150 program by the Nuclear Regulatory Commission.

  8. Managing aging effects on dry cask storage systems for extended long-term storage and transportation of used fuel - rev. 0

    Energy Technology Data Exchange (ETDEWEB)

    Chopra, O.K.; Diercks, D.; Fabian, R.; Ma, D.; Shah, V.; Tam, S.W.; Liu, Y. (Decision and Information Sciences); ( EVS); ( NE)

    2012-07-06

    The cancellation of the Yucca Mountain repository program in the United States raises the prospect of extended long-term storage (i.e., >120 years) and deferred transportation of used fuel at operating and decommissioned nuclear power plant sites. Under U.S. federal regulations contained in Title 10 of the Code of Federal Regulations (CFR) 72.42, the initial license term for an Independent Spent Fuel Storage Installation (ISFSI) must not exceed 40 years from the date of issuance. Licenses may be renewed by the U.S. Nuclear Regulatory Commission (NRC) at the expiration of the license term upon application by the licensee for a period not to exceed 40 years. Application for ISFSI license renewals must include the following: (1) Time-limited aging analyses (TLAAs) that demonstrate that structures, systems, and components (SSCs) important to safety will continue to perform their intended function for the requested period of extended operation; and (2) a description of the aging management program (AMP) for management of issues associated with aging that could adversely affect SSCs important to safety. In addition, the application must also include design bases information as documented in the most recent updated final safety analysis report as required by 10 CFR 72.70. Information contained in previous applications, statements, or reports filed with the Commission under the license may be incorporated by reference provided that those references are clear and specific. The NRC has recently issued the Standard Review Plan (SRP) for renewal of used-fuel dry cask storage system (DCSS) licenses and Certificates of Compliance (CoCs), NUREG-1927, under which NRC may renew a specific license or a CoC for a term not to exceed 40 years. Both the license and the CoC renewal applications must contain revised technical requirements and operating conditions (fuel storage, surveillance and maintenance, and other requirements) for the ISFSI and DCSS that address aging effects that

  9. Geologic processes in the RWMC area, Idaho National Engineering Laboratory: Implications for long term stability and soil erosion at the radioactive waste management complex

    Energy Technology Data Exchange (ETDEWEB)

    Hackett, W.R.; Tullis, J.A.; Smith, R.P. [and others

    1995-09-01

    The Radioactive Waste Management Complex (RWMC) is the disposal and storage facility for low-level radioactive waste at the Idaho National Engineering Laboratory (INEL). Transuranic waste and mixed wastes were also disposed at the RWMC until 1970. It is located in the southwestern part of the INEL about 80 km west of Idaho Falls, Idaho. The INEL occupies a portion of the Eastern Snake River Plain (ESRP), a low-relief, basalt, and sediment-floored basin within the northern Rocky Mountains and northeastern Basin and Range Province. It is a cool and semiarid, sagebrush steppe desert characterized by irregular, rolling terrain. The RWMC began disposal of INEL-generated wastes in 1952, and since 1954, wastes have been accepted from other Federal facilities. Much of the waste is buried in shallow trenches, pits, and soil vaults. Until about 1970, trenches and pits were excavated to the basalt surface, leaving no sediments between the waste and the top of the basalt. Since 1970, a layer of sediment (about 1 m) has been left between the waste and the basalt. The United States Department of Energy (DOE) has developed regulations specific to radioactive-waste disposal, including environmental standards and performance objectives. The regulation applicable to all DOE facilities is DOE Order 5820.2A (Radioactive Waste Management). An important consideration for the performance assessment of the RWMC is the long-term geomorphic stability of the site. Several investigators have identified geologic processes and events that could disrupt a radioactive waste disposal facility. Examples of these {open_quotes}geomorphic hazards{close_quotes} include changes in stream discharge, sediment load, and base level, which may result from climate change, tectonic processes, or magmatic processes. In the performance assessment, these hazards are incorporated into scenarios that may affect the future performance of the RWMC.

  10. Long-term follow-up of pediatric moyamoya disease treated by combined direct-indirect revascularization surgery: single institute experience with surgical and perioperative management.

    Science.gov (United States)

    Rashad, Sherif; Fujimura, Miki; Niizuma, Kuniyasu; Endo, Hidenori; Tominaga, Teiji

    2016-10-01

    Moyamoya disease (MMD) is a rare occlusive cerebrovascular disease that mainly presents in children as cerebral ischemia. Prompt treatment with either a direct or indirect revascularization procedure is necessary for children with MMD in order to prevent repeated ischemic events. We herein present our experience with combined direct and indirect bypass surgery for the treatment of pediatric MMD as well as our uniquely designed perioperative protocol. Twenty-three patients with MMD, aged between 2 and 16 years old (mean 9.36), underwent 38 combined bypass procedures between 2008 and 2015. All patients underwent single superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis combined with encephalo-duro-myo-synangiosis (EDMS). The perioperative management protocol was stratified into two unique eras: the first era with normotensive care and the second era with strict blood pressure control (systolic 100-130 mmHg) and routine aspirin administration. Patients were followed after surgery for a period ranging between 3 and 131 months (mean 77 months) in yearly clinical and radiological follow-ups. Three postoperative complications were observed: two cases of cerebral hyperperfusion (2/38, 5.3 %) and one case of perioperative minor stroke (1/38, 2.6 %), two of which were in the first era. No strokes, either ischemic or hemorrhagic, were observed in the follow-up period, and the activity of daily living as shown by the modified Rankin Scale improved in 20 patients, with no deterioration being observed in any of our patients. STA-MCA bypass with EDMS is safe and effective for the management of pediatric MMD and provides long-term favorable outcomes. Perioperative care with blood pressure control combined with the administration of aspirin may reduce the potential risk of surgical complications.

  11. Long-term follow-up of antithrombotic management patterns in patients with acute coronary syndrome in Russia: an observational study (EPICOR-RUS study).

    Science.gov (United States)

    Ruda, Mikhail Ya; Averkov, Oleg V; Khomitskaya, Yunona V

    2017-07-01

    This study sought to describe the short- and long-term (up to 2 years) antithrombotic management patterns in a real-life setting for patients hospitalized for an acute coronary syndrome (ACS) event, and to document clinical outcomes. EPICOR-RUS was a multicenter (34 centers), prospective, observational, longitudinal cohort study conducted across Russia on antithrombotic management in hospitalized (within 24 hours of symptom onset) ACS patients with 2 year follow-up. NCT01373957. A total of 600 ACS patients (71.1% male, mean age 60 years) were enrolled; 599 were included for analysis. Diagnosis comprised STEMI (n = 375, 62.6%), NSTEMI (n = 147, 24.5%), and unstable angina (UA) (n = 77, 12.9%). Percutaneous coronary intervention (PCI) was conducted in 64.3% of patients with STEMI (with or without thrombolysis), 36.7% with NSTEMI, and 58.4% with UA. There was undertreatment with dual antiplatelet therapy (DAPT) for STEMI, NSTEMI, and UA: 14.7%, 25.9% and 16.9% of patients, respectively, were not receiving DAPT during hospitalization, and 10.1%, 21.8% and 16.9% at discharge. Post-discharge, of the STEMI group, only 72.4% of patients who were managed by PCI and 39.8% of conservatively treated patients received DAPT at 12 months. The respective figures in the NSTEMI group were 77.3% and 26.4%. In the STEMI cohort the cumulative incidence of all-cause mortality was 3.2% at 1 year and 5.1% at 2 years of follow-up; in the NSTEMI cohort this was 2.7% and 4.8%, respectively. There were no deaths by 12 months and one death by 24 months (1.3%) in the UA population. Despite evidence-based guidelines for the management of ACS, the real-world setting in Russia shows discrepancies in clinical practice, highlighting the need for improvements for the optimal management of high-risk patients with ACS.

  12. Continuity and change?: Exploring reactions to a guided self-management intervention in a randomised controlled trial for IBS with reference to prior experience of managing a long term condition

    Science.gov (United States)

    Rogers, Anne; Lee, Victoria; Kennedy, Anne

    2007-01-01

    Self-care interventions are promoted as effective strategies for improving the quality of life and health outcomes for individuals with long-term health conditions. Outcome measures used in evaluations using Randomised Controlled Trials (RCTs) are not designed to consider patients' prior management strategies and experience of illness. Yet the experience of illness literature suggests that adjusting to living with chronic illness, together with broader contextual influences, are likely to be relevant to understanding responses to self-management initiatives. Using group and individual interview data we attempt to illuminate the transposition of IBS from a condition unsatisfactorily managed by medicine to one successfully managed within the life worlds of individuals. If routine embedding of complex interventions depends on the accomplishment of integration and workability in patients' everyday lives then the design and evaluation of such interventions should view participation as part of a process of continuity as well as change. Responses to formal self-management can be extended beyond psychological and other quantitatively measured outcomes. A useful addendum to trial outcomes for self-management education is an understanding of change as being inextricably linked to people's previous attempts to, and experience of, managing long-term conditions. We suggest that the benefits of understanding the prior experience of managing illness and contact with health services include the acceptability and workability of complex interventions in patients' everyday lives. PMID:17316438

  13. Water Stewardship and Corporate Sustainability

    Directory of Open Access Journals (Sweden)

    Peter JONES

    2014-12-01

    Full Text Available The aim of this paper is to provide an exploratory review of the extent to which some of the world’s leading companies are publicly addressing water stewardship as part of their corporate sustainability strategies. The paper begins with an outline of the growing importance of corporate sustainability and water stewardship. The paper draws its empirical material from the most recent information on sustainability posted on the top twelve ‘Consumer Superbrands’ corporate websites. The findings reveal that a majority of the selected companies address a number of elements concerning water stewardship as part of their more general approach to corporate sustainability. However corporate commitments to water stewardship can be interpreted as being driven as much by business imperatives as by any concerns for environmental sustainability or a desire to maintain the viability and integrity of natural ecosystems. More critically the authors suggest that the selected companies’ commitments to water stewardship are framed within existing business models focused on technological improvements in eco-efficiency and continuing economic growth. The paper provides an accessible review of the water stewardship issues being pursued by some of the world’s leading companies and as such it will interest academics, students, political commentators and business managers interested in water stewardship and corporate sustainability.

  14. Uncertainty functions of modelled soil organic carbon changes in response to crop management derived from a French long term experiments dataset

    Science.gov (United States)

    Dimassi, Bassem; Guenet, Bertrand; Mary, Bruno; Trochard, Robert; Bouthier, Alain; Duparque, Annie; Sagot, Stéphanie; Houot, Sabine; Morel, Christian; Martin, Manuel

    2016-04-01

    The land use, land-use change and forestry (LULUCF) activities and crop management (CM) in Europe could be an important carbon sink through soil organic carbon (SOC) sequestration. Recently, the (EU decision 529/2013) requires European Union's member states to assess modalities to include greenhouse gas (GHG) emissions and removals resulting from activities relating to LULUCF and CM into the Union's (GHG) emissions reduction commitment and their national inventories reports (NIR). Tier 1, the commonly used method to estimate emissions for NIR, provides a framework for measuring SOC stocks changes. However, estimations have high uncertainty, especially in response to crop management at regional and specific national contexts. Understanding and quantifying this uncertainty with accurate confidence interval is crucial for reliably reporting and support decision-making and policies that aims to mitigate greenhouse gases through soil C storage. Here, we used the Tier 3 method, consisting of process-based modelling, to address the issue of uncertainty quantification at national scale in France. Specifically, we used 20 Long-term croplands experiments (LTE) in France with more than 100 treatments taking into account different agricultural practices such as tillage, organic amendment, inorganic fertilization, cover crops, etc. These LTE were carefully selected because they are well characterized with periodic SOC stocks monitoring overtime and covered a wide range of pedo-climatic conditions. We applied linear mixed effect model to statistically model, as a function of soil, climate and cropping system characteristics, the uncertainty resulting from applying this Tier 3 approach. The model was fitted on the dataset yielded by comparing the simulated (with the Century model V 4.5) to the observed SOC changes on the LTE at hand. This mixed effect model will then be used to derive uncertainty related to the simulation of SOC stocks changes of the French Soil Monitoring

  15. Short- and Long-Term Effects of Wholegrain Oat Intake on Weight Management and Glucolipid Metabolism in Overweight Type-2 Diabetics: A Randomized Control Trial

    Directory of Open Access Journals (Sweden)

    Xue Li

    2016-09-01

    Full Text Available Glycemic control and weight reduction are primary goals for the management of overweight and obese type 2 diabetes mellitus (T2DM. Effective management cannot be achieved without an appropriate diet. Our study aimed to evaluate the short- and long-term effects of oat intake and develop a reasonable dietary plan for overweight T2DM patients. A randomized control trial, registered under ClinicalTrials.gov (Identification code: NCT01495052, was carried out among adult T2DM patients. A subgroup of 298 overweight subjects was selected and received a 30-day centralized intervention and 1-year free-living follow-up. Participants were randomly allocated to one of the following four groups. The usual care group (n = 60 received no intervention; the healthy diet group (n = 79 received a low-fat and high-fiber diet (“healthy diet”; the 50 g-oats group (n = 80 and 100 g-oats group (n = 79 received the “healthy diet” with the same amount of cereals replaced by 50 g and 100 g oats respectively. Anthropometric, blood glycemic and lipid variables were measured. For the 30-day intervention, significant differences in the changes of FPG (fasting plasma glucose, PPG (postprandial plasma glucose, HbA1c (glycosylated hemoglobin, HOMA-IR (homeostasis model assessment of insulin resistance, TC (total cholesterol, TG (total triglycerides, and LDL-c (low-density lipoprotein cholesterol were observed among the four groups. Compared to the healthy diet group, the 50 g-oats group had a bigger reduction in PPG (mean difference (MD: −1.04 mmol/L; 95% CI: −2.03, −0.05 and TC (MD: −0.24 mmol/L; 95% CI: −0.47, −0.01; the 100 g-oats group had a bigger reduction in PPG (MD: −1.48 mmol/L; 95% CI: −2.57, −0.39, HOMA-IR (MD: −1.77 mU·mol/L2; 95% CI: −3.49, −0.05, TC (MD: −0.33 mmol/L; 95% CI: −0.56, −0.10 and LDL-c (MD: −0.22 mmol/L; 95% CI: −0.41, −0.03. In the 1-year follow-up, greater effects in reducing weight (MD: −0.89 kg; 95% CI

  16. Short- and Long-Term Effects of Wholegrain Oat Intake on Weight Management and Glucolipid Metabolism in Overweight Type-2 Diabetics: A Randomized Control Trial

    Science.gov (United States)

    Li, Xue; Cai, Xiaxia; Ma, Xiaotao; Jing, Lulu; Gu, Jiaojiao; Bao, Lei; Li, Jun; Xu, Meihong; Zhang, Zhaofeng; Li, Yong

    2016-01-01

    Glycemic control and weight reduction are primary goals for the management of overweight and obese type 2 diabetes mellitus (T2DM). Effective management cannot be achieved without an appropriate diet. Our study aimed to evaluate the short- and long-term effects of oat intake and develop a reasonable dietary plan for overweight T2DM patients. A randomized control trial, registered under ClinicalTrials.gov (Identification code: NCT01495052), was carried out among adult T2DM patients. A subgroup of 298 overweight subjects was selected and received a 30-day centralized intervention and 1-year free-living follow-up. Participants were randomly allocated to one of the following four groups. The usual care group (n = 60) received no intervention; the healthy diet group (n = 79) received a low-fat and high-fiber diet (“healthy diet”); the 50 g-oats group (n = 80) and 100 g-oats group (n = 79) received the “healthy diet” with the same amount of cereals replaced by 50 g and 100 g oats respectively. Anthropometric, blood glycemic and lipid variables were measured. For the 30-day intervention, significant differences in the changes of FPG (fasting plasma glucose), PPG (postprandial plasma glucose), HbA1c (glycosylated hemoglobin), HOMA-IR (homeostasis model assessment of insulin resistance), TC (total cholesterol), TG (total triglycerides), and LDL-c (low-density lipoprotein cholesterol) were observed among the four groups. Compared to the healthy diet group, the 50 g-oats group had a bigger reduction in PPG (mean difference (MD): −1.04 mmol/L; 95% CI: −2.03, −0.05) and TC (MD: −0.24 mmol/L; 95% CI: −0.47, −0.01); the 100 g-oats group had a bigger reduction in PPG (MD: −1.48 mmol/L; 95% CI: −2.57, −0.39), HOMA-IR (MD: −1.77 mU·mol/L2; 95% CI: −3.49, −0.05), TC (MD: −0.33 mmol/L; 95% CI: −0.56, −0.10) and LDL-c (MD: −0.22 mmol/L; 95% CI: −0.41, −0.03). In the 1-year follow-up, greater effects in reducing weight (MD: −0.89 kg; 95% CI

  17. Trends in prevalence, incidence and pharmacologic management of diabetes mellitus among seniors newly admitted to long-term care facilities in Saskatchewan between 2003 and 2011.

    Science.gov (United States)

    Alsabbagh, Mhd Wasem; Mansell, Kerry; Lix, Lisa M; Teare, Gary; Shevchuk, Yvonne; Lu, Xinya; Champagne, Anne; Blackburn, David F

    2015-04-01

    We aimed to describe trends in the prevalence and incidence of diabetes mellitus and also report the overall use of diabetes medications among patients newly admitted to a long-term care facility (LTCF). A retrospective cohort study was done using health administrative databases in Saskatchewan. Eligible patients were newly admitted to LTCF in Saskatchewan between 2003 and 2011 and maintained LTCF residency for at least 6 months. Prevalence of diabetes was defined with physician or hospital claims in the 2 years preceding admission. Antihyperglycemic medication use was estimated from prescription claims data during the first 6 months after LTCF admission. All data were descriptively analyzed. The validated case definition for diabetes (≥2 diagnostic claims) in the 2 years before or 6 months after admission was met by 16.9% of patients (2471 of 14,624). An additional 965 patients (6.6%) had a single diabetes diagnostic claim or antihyperglycemic prescriptions only. Among patients receiving antihyperglycemic therapies, 64.9% (1518 of 2338) were exclusively managed with oral medications, and metformin was the most commonly used medication. Glyburide was commonly withdrawn after LTCF admission. Insulin use was observed in 23.9% of diabetes patients, with a mean daily average consumption of 54.7 units per day. Use of diabetes medications appear to generally align with Canadian practice recommendations as evidenced by declining use of glyburide and frequent use of metformin. Future studies should examine clinical benefits and safety of hypoglycemic agent use in LTCFs. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

  18. Human Impacts to Coastal Ecosystems in Puerto Rico (HICE-PR): A Long-Term Remote Sensing, Hydrologic, Ecologic, and Socio-Economic Assessment with Management Implications

    Science.gov (United States)

    Torres-Perez, J. L.; Barreto-Orta, M.; Ortiz, J.; Santiago, L.; Setegn, S. G.; Guild, L. S.; Ramos-Scharron, C. E.; Armstrong, R.; Detres, Y.

    2014-12-01

    For several decades Puerto Rico's coastal and marine ecosystems (CMEs) have suffered the effects of anthropogenic stresses associated to population growth and varying land use. Coral reefs, for instance, have been impacted by sedimentation, increased eutrophication, and coastal water contamination. Here we present an overview of a new NASA project to study human impacts in two priority watersheds (Manatí and Guánica). The project uses an interdisciplinary approach that includes historic and recent remote sensing analysis and hydrological, ecological and socio-economic modeling to provide a multi-decadal assessment of change in coral reefs, seagrass beds, mangroves and sandy beaches. The project's main goal is to evaluate the impacts of land use/land cover changes on the quality and extent of CMEs in priority watersheds in the north and south coasts of Puerto Rico. Methods include assessments of coral reefs benthic communities cover, monitoring of short- and long-term beach geomorphological changes associated with riverine and sediment input, calculation of the economical value of selected CMEs, establish permanent monitoring transects in never before studied coral reef areas, provide recommendations to enhance current coastal policy management practices, and disseminate the results to local stakeholders. This project will include imagery from the Operational Land Imager of Landsat 8 to assess coastal ecosystems extent. Habitat and species distribution maps will be created by incorporating field and remotely-sensed data into an Ecological Niche Factor Analysis. The social component will allow us to study the valuation of specific CMEs attributes from the stakeholder's point of view. Our results and the generality of the methodology will provide for its application to other similar tropical locations.

  19. The geologic, geomorphic, and hydrologic context underlying options for long-term management of the Spirit Lake outlet near Mount St. Helens, Washington

    Science.gov (United States)

    Grant, Gordon E.; Major, Jon J.; Lewis, Sarah L.

    2017-01-01

    The 1980 eruption of Mount St. Helens produced a massive landslide and consequent pyroclastic currents, deposits of which blocked the outlet to Spirit Lake. Without an outlet, the lake began to rise, threatening a breaching of the blockage and release of a massive volume of water. To mitigate the hazard posed by the rising lake and provide an outlet, in 1984–1985 the U.S. Army Corps of Engineers bored a 2.6-km (8,500-ft) long tunnel through a bedrock ridge on the western edge of the lake. Locally, the tunnel crosses weak rock along faults, and external pressures in these weak zones have caused rock heave and support failures, which have necessitated periodic major repairs. During its more than 30-year lifetime, the tunnel has maintained the level of Spirit Lake at a safe elevation. The lake approaches its maximum safe operating level only when the tunnel closes for repair. The most recent major repair in early 2016 highlights the need for a reliable outlet that does not require repeated and expensive interventions and extended closures. The U.S. Forest Service, U.S. Army Corps of Engineers, and U.S. Geological Survey developed, reviewed, and analyzed an array of options for a long-term plan to remove the threat of catastrophic failure of the tunnel. In this report, we (1) provide background on natural hazards that can affect existing and alternative infrastructure; (2) evaluate the potential for tunnel failure and consequent breaching of the blockage posed by the current tunnel infrastructure; (3) evaluate potential consequences to downstream communities and infrastructure in the event of a catastrophic breaching of the blockage; (4) evaluate potential risks associated with alternative lake outlets; and (5) identify data and knowledge gaps that need to be addressed to fully evaluate options available to management.

  20. Long-term follow-up after laparoscopic management of endometrial cancer in the obese: a fifteen-year cohort study.

    Science.gov (United States)

    Rabischong, Benoit; Larraín, Demetrio; Canis, Michel; Le Bouëdec, Guillaume; Pomel, Christophe; Jardon, Kris; Kwiatkowski, Fabrice; Bourdel, Nicolas; Achard, Jean-Louis; Dauplat, Jacques; Mage, Gerard

    2011-01-01

    To assess the surgical outcomes and long-term results of laparoscopic treatment of endometrial cancer in obese patients, and compare these results with those of nonobese women. Retrospective cohort study (Canadian Task Force classification II-2). Two referral cancer centers. Fifty-two obese and 155 nonobese women with clinical stage I endometrial cancer managed by laparoscopy from 1990-2005 in two referral centers. Demographic, surgical, perioperative and pathological characteristics of obese women and nonobese women with endometrial cancer treated by laparoscopy were analyzed and then compared. Recurrence-free and overall survival was calculated by use of Kaplan-Meier method. Median BMI of the study population was 26.2 Kg/m(2). Median BMI among obese patients was 34.2 Kg/m(2). The conversion rate was independent from the BMI of the patient (3.8% vs 4.5%, p = .80). Neither mean operative time (187.5 vs 172 min, p = .11) neither hospital stay (5.2 vs 4.9 days, p = .44) were related with BMI. Lymphadenectomy was considered not feasible in 7 obese (17%) and 8 nonobese (7%) women (p = 0.09). Fewer lymph nodes were retrieved among obese women (8 versus 11, p obese and nonobese, respectively (p = .59). Overall and disease-free 5-year survival rates did not differ between obese and nonobese patients (90.3% and 87.5% versus 88.5% and 89.8%, respectively). Despite some limitations, the laparoscopic approach seems to be particularly useful for obese patients with endometrial cancer, with similar survival and recurrence rates and without any more complications compared to the nonobese population. Copyright © 2011 AAGL. Published by Elsevier Inc. All rights reserved.

  1. Long-term forest management effects on streamflow and evapotranspiration: modeling the interaction of vegetation and climate at the catchment scale

    Science.gov (United States)

    Ford, C. R.; Vose, J.

    2011-12-01

    Forested watersheds, an important provider of ecosystems services related to water supply, can have their structure, function, and resulting streamflow substantially altered by land use and land cover. Using a retrospective analysis and synthesis of long-term climate and streamflow data (75 years) from six watersheds differing in management histories we explored whether streamflow, and thus evapotranspiration, responded differently to variation in annual temperature and extreme precipitation than unmanaged watersheds. We used a hybrid modeling approach that incorporated terms for the classic paired watershed regression, the response of the vegetation regrowth, and the interaction of vegetation regrowth and precipitation. We show significant increases in temperature and the frequency of extreme wet and dry years since the 1980s. Response models explained almost all streamflow variability (R2adj > 0.99). In all cases, changing land use altered streamflow. Observed watershed responses differed significantly in wet and dry extreme years in all but a stand managed as a coppice forest. Converting deciduous stands to pine altered the streamflow response to extreme annual precipitation the most; the apparent frequency of observed extreme wet years decreased on average by 7-fold. This effect was attributable partially to increased interception, but also to increased transpiration in the pine stand compared to the unmanaged, deciduous hardwood stand as indicated by sap flow studies on individual species. This increased soil water storage may reduce flood risk in wet years, but create conditions that could exacerbate drought. Forest management can potentially mitigate extreme annual precipitation associated with climate change; however, offsetting effects suggest the need for spatially-explicit analyses of risk and vulnerability, as well as an increased understanding of the relative contributions of interception and transpiration across species and community types. To address

  2. Scientific monitoring plan in support of the selected alternative of the Glen Canyon Dam Long-Term Experimental and Management Plan

    Science.gov (United States)

    Vanderkooi, Scott P.; Kennedy, Theodore A.; Topping, David J.; Grams, Paul E.; Ward, David L.; Fairley, Helen C.; Bair, Lucas S.; Yackulic, Charles B.; Schmidt, John C.; Sankey, Joel B.

    2017-01-18

    IntroductionThe purpose of this document is to describe a strategy by which monitoring and research data in the natural and social sciences will be collected, analyzed, and provided to the U.S. Department of the Interior (DOI), its bureaus, and to the Glen Canyon Dam Adaptive Management Program (GCDAMP) in support of implementation of the Glen Canyon Dam Long-Term Experimental and Management Plan (LTEMP) (U.S. Department of the Interior, 2016a). The selected alternative identified in the LTEMP Record of Decision (ROD) (U.S. Department of the Interior, 2016b) describes various data collection, analysis, modeling, and interpretation efforts to be conducted by the U.S. Geological Survey’s (USGS) Grand Canyon Monitoring and Research Center (GCMRC), partner agencies, and cooperators that will inform decisions about operations of Glen Canyon Dam and management of downstream resources between 2017 and 2037, the performance period of the LTEMP. General data collection, analysis, modeling, and interpretation activities are described in this science plan, whereas specific monitoring and research activities and detailed study plans are to be described in the GCDAMP’s triennial work plans (TWPs) to be developed by the Bureau of Reclamation and GCMRC with input from partner agencies and cooperators during the LTEMP period, which are to be reviewed and recommended by the GCDAMP and approved by the Secretary of the Interior. The GCDAMP consists of several components, the primary committee being the Adaptive Management Work Group (AMWG). This Federal advisory committee is composed of 25 agencies and stakeholder groups and is chaired by the Secretary of the Interior’s designee. The AMWG makes recommendations to the Secretary of the Interior concerning operations of Glen Canyon Dam and other experimental management actions that are intended to fulfill some obligations of the Grand Canyon Protection Act of 1992. The Technical Work Group (TWG) is a subcommittee of the AMWG and

  3. Managing aging effects on dry cask storage systems for extended long-term storage and transportation of used fuel - rev. 0

    Energy Technology Data Exchange (ETDEWEB)

    Chopra, O.K.; Diercks, D.; Fabian, R.; Ma, D.; Shah, V.; Tam, S.W.; Liu, Y. (Decision and Information Sciences); ( EVS); ( NE)

    2012-07-06

    The cancellation of the Yucca Mountain repository program in the United States raises the prospect of extended long-term storage (i.e., >120 years) and deferred transportation of used fuel at operating and decommissioned nuclear power plant sites. Under U.S. federal regulations contained in Title 10 of the Code of Federal Regulations (CFR) 72.42, the initial license term for an Independent Spent Fuel Storage Installation (ISFSI) must not exceed 40 years from the date of issuance. Licenses may be renewed by the U.S. Nuclear Regulatory Commission (NRC) at the expiration of the license term upon application by the licensee for a period not to exceed 40 years. Application for ISFSI license renewals must include the following: (1) Time-limited aging analyses (TLAAs) that demonstrate that structures, systems, and components (SSCs) important to safety will continue to perform their intended function for the requested period of extended operation; and (2) a description of the aging management program (AMP) for management of issues associated with aging that could adversely affect SSCs important to safety. In addition, the application must also include design bases information as documented in the most recent updated final safety analysis report as required by 10 CFR 72.70. Information contained in previous applications, statements, or reports filed with the Commission under the license may be incorporated by reference provided that those references are clear and specific. The NRC has recently issued the Standard Review Plan (SRP) for renewal of used-fuel dry cask storage system (DCSS) licenses and Certificates of Compliance (CoCs), NUREG-1927, under which NRC may renew a specific license or a CoC for a term not to exceed 40 years. Both the license and the CoC renewal applications must contain revised technical requirements and operating conditions (fuel storage, surveillance and maintenance, and other requirements) for the ISFSI and DCSS that address aging effects that

  4. Long-term effectiveness and costs of a brief self-management intervention in women with pregnancy-related low back pain after delivery

    Directory of Open Access Journals (Sweden)

    Bastiaanssen Janneke M

    2008-05-01

    -line approach but further research is needed to draw inference on costs and to determine whether no care is a better option in the long term. Trial Registration [ISRCTN08477490

  5. A team-based approach to warfarin management in long term care: A feasibility study of the MEDeINR electronic decision support system

    Directory of Open Access Journals (Sweden)

    Wang Luqi

    2010-06-01

    Full Text Available Abstract Background Previous studies in long-term care (LTC have demonstrated that warfarin management is suboptimal with preventable adverse events often occurring as a result of poor International Normalized Ratio (INR control. To assist LTC teams with the challenge of maintaining residents on warfarin in the therapeutic range (INR of 2.0 to 3.0, we developed an electronic decision support system that was based on a validated algorithm for warfarin dosing. We evaluated the MEDeINR system in a pre-post implementation design by examining the impact on INR control, testing frequency, and experiences of staff in using the system. Methods For this feasibility study, we piloted the MEDeINR system in six LTC homes in Ontario, Canada. All128 residents (without a prosthetic valve who were taking warfarin were included. Three-months of INR data prior to MEDeINR was collected via a retrospective chart audit, and three-months of INR data after implementation of MEDeINR was captured in the central computer database. The primary outcomes compared in a pre-post design were time in therapeutic range (TTR and time in sub/supratherapeutic ranges based on all INR measures for every resident on warfarin. Secondary measures included the number of monthly INR tests/resident and survey/focus-group feedback from the LTC teams. Results LTC homes in our study had TTR's that were higher than past reports prior to the intervention. Overall, the TTR increased during the MEDeINR phase (65 to 69%, but was only significantly increased for one home (62% to 71%, p Conclusion Although LTC homes in our sample had TTR's that were relatively high prior to the intervention, the MEDeINR program represented a useful tool to promote optimal TTR, decrease INR venipunctures, streamline processes, and increase nurse and physician confidence around warfarin management. We have demonstrated that MEDeINR was a practical, usable clinical information system that can be incorporated into the

  6. The effects of lifestyle interventions on (long-term) weight management, cardiometabolic risk and depressive symptoms in people with psychotic disorders : a meta-analysis

    NARCIS (Netherlands)

    Bruins, Jojanneke; Jörg, Frederike; Bruggeman, Richard; Slooff, C. J.; Corpeleijn, Eva; Pijnenborg, Marieke

    2014-01-01

    AIMS: The aim of this study was to estimate the effects of lifestyle interventions on bodyweight and other cardiometabolic risk factors in people with psychotic disorders. Additionally, the long-term effects on body weight and the effects on depressive symptoms were examined. MATERIAL AND METHODS: W

  7. The effects of lifestyle interventions on (long-term) weight management, cardiometabolic risk and depressive symptoms in people with psychotic disorders : a meta-analysis

    NARCIS (Netherlands)

    Bruins, Jojanneke; Jörg, Frederike; Bruggeman, Richard; Slooff, C. J.; Corpeleijn, Eva; Pijnenborg, Marieke

    2014-01-01

    AIMS: The aim of this study was to estimate the effects of lifestyle interventions on bodyweight and other cardiometabolic risk factors in people with psychotic disorders. Additionally, the long-term effects on body weight and the effects on depressive symptoms were examined. MATERIAL AND METHODS:

  8. Long-term effects of a staff-development program on effective instruction and classroom management for teachers in multigrade classes

    NARCIS (Netherlands)

    Veenman, S.; Raemaekers, J.

    1995-01-01

    This study describes the long-term effects of a staff development programme based on selected findings from teaching effectiveness research in schools with multigrade or mixed-age classes. The short-term effects of this programme were examined in two studies directed at schools with multigrade class

  9. DOC export from a peat extraction site in transition to managed restoration - preliminary results of a long-term research project

    Science.gov (United States)

    Rüggen, Norman; Kutzbach, Lars; Kopelke, Susanne; Pfeiffer, Eva-Maria

    2013-04-01

    less than six hours and up to about 3 mg L-1 in 36 hours. The described recently established hydrological measurements are planned to be continued for the next ten years in combination with continuous eddy covariance measurements of land-atmosphere fluxes of Water, CO2 and CH4. This long-term monitoring of lateral and vertical exchange fluxes will serve as a basis for evaluating the success of the peatland restoration with respect to biogeochemical cycling and greenhouse gas budgets. Literature Armstrong, A., Holden, J., Kay, P., Francis, B., Foulger, M., Gledhill, S., McDonald, A., Walker, A., 2010. The impact of peatland drain-blocking on dissolved organic carbon loss and discolouration of water; results from a national survey. Journal of Hydrology 381, 112-120. Wilson, L., Wilson, J., Holden, J., Johnstone, I., Armstrong, A., Morris, M., 2011. Ditch blocking, water chemistry and organic carbon flux: Evidence that blanket bog restoration reduces erosion and fluvial carbon loss. Science of the Total Environment 409, 2010-2018.

  10. A new image for long-term care.

    Science.gov (United States)

    Wager, Richard; Creelman, William

    2004-04-01

    To counter widely held negative images of long-term care, managers in the industry should implement quality-improvement initiatives that include six key strategies: Manage the expectations of residents and their families. Address customers' concerns early. Build long-term customer satisfaction. Allocate resources to achieve exceptional outcomes in key areas. Respond to adverse events with compassion. Reinforce the facility's credibility.

  11. Current recommendations and importance of antifungal stewardship for the management of invasive candidiasis.

    Science.gov (United States)

    Miyazaki, Taiga; Kohno, Shigeru

    2015-01-01

    Invasive candidiasis can have a major effect on patient prognosis and medical economics. Quickly eliminating the focus of the infection and administering appropriate antifungal therapy are important. Clinical guidelines for invasive candidiasis have been issued in the USA, Europe and recently in Japan. The purpose of this review is to summarize the current recommendations on how to diagnose and treat invasive candidiasis based on the evidence gathered to date and by referencing guidelines from various countries. Echinocandin antifungals play a central role in the prevention and treatment of invasive candidiasis although a recent increase in echinocandin-resistant Candida glabrata is seen as problematic. In the future, promoting the appropriate use of antifungal agents by antifungal stewardship teams will be necessary to suppress adverse effects, appearance of resistant strains and unnecessary medical expenses, as well as improve positive clinical outcomes and prognoses.

  12. Five years of experience with the FiLaC™ laser for fistula-in-ano management: long-term follow-up from a single institution.

    Science.gov (United States)

    Wilhelm, A; Fiebig, A; Krawczak, M

    2017-04-01

    There are limited data available concerning endofistular therapies for fistula-in-ano, with our group reporting the first preliminary outcomes of the use of the radial fibre Fistula laser Closing (FiLaC ™) device. The aim of this study was to assess a cohort of anal fistulae managed with laser ablation plus definitive flap closure of the internal fistula opening over a long-term follow-up. Factors governing primary healing success and secondary healing success (i.e. success after one or two operations) were determined. The study analysed 117 patients over a median follow-up period of 25.4 months (range 6-60 months) with 13 patients (11.1%) having Crohn's-related fistulae. No incontinence to solid and liquid stool was reported. Minor incontinence to mucus and gas was observed in two cases (1.7%), and a late abscess treated in one case (0.8%). The primary healing rate was 75/117 (64.1%) overall, and 63.5% for cryptoglandular fistulae versus 69.2% for Crohn's fistulae, respectively. Of the 42 patients who failed FiLaC™ 31 underwent a second operation ("Re-FiLaC™", fistulectomy with sphincter reconstruction or fistulotomy). The secondary healing rate, defined as healing of the fistula at the end of the study period, was 103/117 (88.0%) overall and 85.5% for cryptoglandular fistulae versus 92.3% for Crohn's fistulae. A significantly higher primary success rate was observed for intersphincteric-type fistulae with primary and secondary outcome unaffected by age, gender, presence of Crohn's disease, number of prior surgeries and the type of flap designed to close the internal fistula opening. There is a moderate primary success rate using first-up FiLaC™ treatment. If FiLaC™ fails, secondary success with repeat FiLaC™ or other approaches was high. The minimally invasive FiLaC™ approach may therefore represent a sensible first-line treatment option for anal fistula repair.

  13. A generic open-source toolbox to help long term irrigation monitoring for integrated water management in semi-arid Mediterranean areas.

    Science.gov (United States)

    Le Page, Michel; Gosset, Cindy; Oueslati, Ines; Calvez, Roger; Zribi, Mehrez; Lili Chabaane, Zohra

    2016-04-01

    approach of (Evapotranspiration minus Efficient Rainfall) to estimate Irrigation at the monthly time step is not pertinent because only a subset of the irrigated commands is actually irrigated. Hence, a higher spatial resolution of remote sensing imagery is needed. Second, in this particular area, farmers have a different rationale about rainfall and irrigation water needs. Those two aspects need to be further investigated. The toolbox has proven to be an interesting tool to integrate different sources of data, efficiently process them and easily produce input data for the WEAP1 model on a long term range. Yet some new challenges have been raised.

  14. [Requirements for long-term follow-up on efficacy and safety of advanced therapy medicinal products. Risk management and traceability].

    Science.gov (United States)

    Klug, B; Reinhardt, J; Schröder, C

    2010-01-01

    Advanced therapy medicinal products (ATMPs) are an innovative treatment option. To promote timely access of the innovative medicinal product and to safeguard public health, new elements have been introduced into legislation. A key element of the ATMP regulation is the requirement for long-term follow-up on safety and efficacy of patients enrolled in clinical trials with ATMPs, which is beyond the routine requirements on pharmacovigilance. For gene therapy medicinal products, a guideline on long-term follow-up, which lays down the technical requirements, is available. A further key element of the ATMP regulation is the traceability of the starting materials used to manufacture the ATMP. A common European coding system is imperative to ensure the traceability of starting materials, especially across the borders of European Member States.

  15. Problems identified by dual sensory impaired older adults in long-term care when using a self-management program: A qualitative study

    Science.gov (United States)

    Zuidema, Sytse; Vernooij-Dassen, Myrra; Dees, Marianne; Hermsen, Pieter; Kempen, Gertrudis; Graff, Maud

    2017-01-01

    Objective To gain insights into the problems of dual sensory impaired older adults in long-term care. Insights into these problems are essential for developing adequate policies which address the needs of the increasing population of dual sensory impaired older adults in long-term care. Methods A qualitative study was conducted in parallel with a cluster randomized controlled trial. Dual sensory impaired older adults in the intervention group (n = 47, age range 82–98) were invited by a familiar nurse to identify the problems they wanted to address. Data were taken from the semi-structured intervention diaries in which nurses noted the older adults’ verbal responses during a five-month intervention period in 17 long-term care homes across the Netherlands. The data were analyzed using descriptive statistics and qualitative content analysis based on the Grounded Theory. Findings The 47 dual sensory impaired older adults identified a total of 122 problems. Qualitative content analysis showed that the older adults encountered participation problems and problems controlling what happens in their personal environment. Three categories of participation problems emerged: (1) existential concerns of not belonging or not being able to connect with other people, (2) lack of access to communication, information and mobility, and (3) the desire to be actively involved in care delivery. Two categories of control-in-personal-space problems emerged: (1) lack of control of their own physical belongings, and (2) lack of control regarding the behavior of nurses providing daily care in their personal environment. Conclusions The invasive problems identified indicate that dual sensory impaired older adults experience great existential pressures on their lives. Long-term care providers need to develop and implement policies that identify and address these problems, and be aware of adverse consequences of usual care, in order to improve dual sensory impaired residents’ autonomy and

  16. Risk Assessment and Management for Long-Term Storage of CO2 in Geologic Formations — United States Department of Energy R&D

    Directory of Open Access Journals (Sweden)

    Dawn Deel

    2007-02-01

    Full Text Available Concern about increasing atmospheric concentrations of carbon dioxide (CO2 and other greenhouse gases (GHG and their impact on the earth's climate has grown significantly over the last decade. Many countries, including the United States, wrestle with balancing economic development and meeting critical near-term environmental goals while minimizing long-term environmental risks. One promising solution to the buildup of GHGs in the atmosphere, being pursued by the U.S. Department of Energy's (DOE National Energy Technology Laboratory (NETL and its industrial and academic partners, is carbon sequestration—a process of permanent storage of CO2 emissions in underground geologic formations, thus avoiding CO2 release to the atmosphere. This option looks particularly attractive for point source emissions of GHGs, such as fossil fuel fired power plants. CO2 would be captured, transported to a sequestration site, and injected into an appropriate geologic formation. However, sequestration in geologic formations cannot achieve a significant role in reducing GHG emissions unless it is acceptable to stakeholders, regulators, and the general public, i.e., unless the risks involved are judged to be acceptable. One tool that can be used to achieve acceptance of geologic sequestration of CO2 is risk assessment, which is a proven method to objectively manage hazards in facilities such as oil and natural gas fields, pipelines, refineries, and chemical plants. Although probabilistic risk assessment (PRA has been applied in many areas, its application to geologic CO2 sequestration is still in its infancy. The most significant risk from geologic carbon sequestration is leakage of CO2. Two types of CO2 releases are possible—atmospheric and subsurface. High concentrations of CO2 caused by a release to the atmosphere would pose health risks to humans and animals, and any leakage of CO2 back into the atmosphere negates the effort expended to sequester the CO2

  17. Long-term water repellency in organic olive orchards in the Cànyoles River watershed. The impact of land management

    Science.gov (United States)

    Cerdà, Artemi; González Pelayo, Óscar; García Orenes, Fuensanta; Jordán, Antonio; Pereira, Paulo; Novara, Agata; Neris, Jonay

    2015-04-01

    recovery processes in Semi-Arid patchy rangelands of northern Patagonia, Argentina. Land Degradation & Development, 24: 393- 399. DOI 10.1002/ldr.1145 León, J. Bodí, M.B., Cerdà, A., Badía, D. 2013. The contrasted response of ash to wetting. The effects of ash type, thickness and rainfall events. Geoderma, 209-210, 143-152. http://dx.doi.org/10.1016/j.geoderma.2012.01.006 López-Garrido, R., Deurer, M., Madejón, E., Murillo, J. M., Moreno, F. 2012. Tillage influence on biophysical soil properties: The example of a long-term tillage experiment under Mediterranean rainfed conditions in South Spain. Soil and Tillage Research, 118, 52-60. Lozano, E., Jiménez-Pinilla, P., Mataix-Solera, J., Arcenegui, V., Bárcenas, G. M., González-Pérez, J. A., Mataix-Beneyto, J. 2013. Biological and chemical factors controlling the patchy distribution of soil water repellency among plant species in a Mediterranean semiarid forest. Geoderma, 207, 212-220. Madsen, M. D., Zvirzdin, D. L., Petersen, S. L., Hopkins, B. G., Roundy, B. A., Chandler, D. G. 2011. Soil water repellency within a burned piñon-juniper woodland: Spatial distribution, severity, and ecohydrologic implications. Soil Science Society of America Journal, 75(4), 1543-1553. Mataix-Solera, J., Arcenegui, V., Tessler, N., Zornoza, R., Wittenberg, L., Martínez, C., Jordán, M. M. 2013. Soil properties as key factors controlling water repellency in fire-affected areas: evidences from burned sites in Spain and Israel. Catena, 108, 6-13. Mekuria, W., Aynekulu, E. 2013. Exclosure land management for restoration of the soils in degrade communal grazing lands in Northern Ethiopia. Land Degradation & Development, 24: 528- 538. DOI 10.1002/ldr.1146 Nadal-Romero, E., Lasanta, T., García-Ruiz, J. M. 2013. Runoff and sediment yield from land under various uses in a Mediterranean mountain area: long-term results from an experimental station. Earth Surface Processes and Landforms, 38(4), 346-355. Neal, C., Reynolds, B., Norris, D

  18. Radiological management of patients with urinary obstruction following urinary diversion procedures: technical factors, complications, long-term management and outcome. Experience with 378 procedures.

    LENUS (Irish Health Repository)

    Maher, M M

    2012-02-03

    We aimed to assess management by interventional radiology techniques of patients with urinary diversion procedures (UD) complicated by urinary obstruction (UO). A 12-year electronic database of interventional cases was searched for urinary access in patients with UD. Patients\\' records were assessed for aetiology of obstruction, indication for procedure, types of interventional radiology, complications and outcome. Management issues included frequency of visits for catheter care, type of catheter placement and technical problems associated with catheter maintenance. Three hundred and seventy eight procedures were carried out in 25 patients (mean age 70 years; Male : Female ratio 13:12). Indications for UD were malignancy (n = 22) and neuropathic bladder (n = 3). UD included ileal conduits (n = 17), cutaneous ureterostomy (n = 3 (2 patients)) and sigmoid colon urinary conduit (n = 6). In most patients, catheters were placed antegradely through nephrostomy tract, but subsequent access was through the UD. Twenty of 25 patients had unilateral stents where as 5 had bilateral stents (8-10- Fr pigtail catheters (20-45 cm in length)). The mean number of procedures including catheter changes was 15 +\\/- 4 per patient and 331 of 378 procedures (87 %) were carried out as outpatients. Since catheter placement, 11 patients required hospital admission on 22 occasions for catheter-related complications. Ureteric strictures in patients with UD can be successfully managed by interventional radiology.

  19. Consider long-term care as service alternative.

    Science.gov (United States)

    Loria, L S

    1987-04-01

    The increasing demand for elderly care services, pressures on inpatient average length of stay and payment levels, and potential financial rewards from providing additional services, makes long-term care look attractive to hospitals. Long-term care, however, is not for every hospital. Before deciding to establish long-term care services, management should examine how the service fits within the hospital's strategic plan. The action plan below provides guidance in evaluating a decision to use hospital facilities for long-term care. Examine how long-term care services fit within the hospital's strategic plan. Study area demographics and competitors to assess the need and supply of long-term care services. Survey the medical staff, consumers and payers to determine attitudes, perceptions and interests regarding long-term care services. Develop a facility plan that identifies areas of excess capacity that can be most easily converted into long-term care with minimal effects on hospital operations. Prepare a financial feasibility analysis of the contribution margin and return on investment attributable to long-term care services. Include an impact analysis on hospital operations. Establish a management task force to develop a detailed implementation plan including assigned individual responsibilities and related timetable. Develop an effective marketing plan designed to generate increased patient market share.

  20. Analysing long term discursive processes

    DEFF Research Database (Denmark)

    Horsbøl, Anders

    What do timescales - the notion that processes take place or can be viewed within a shorter or longer temporal range (Lemke 2005) - mean for the analysis of discourse? What are the methodological consequences of analyzing discourse at different timescales? It may be argued that discourse analysis...... in general has favored either the analysis of short term processes such as interviews, discussions, and lessons, or the analysis of non-processual entities such as (multimodal) texts, arguments, discursive repertoires, and discourses (in a Foucaultian sense). In contrast, analysis of long term processes...... which extend beyond the single interaction, for instance negotiations or planning processes, seems to have played a less important role, with studies such as Iedema 2001 and Wodak 2000 as exceptions. These long term processes, however, are central to the constitution and workings of organizations...

  1. Incorporating genetic sampling in long-term monitoring and adaptive management in the San Diego County Management Strategic Plan Area, Southern California

    Science.gov (United States)

    Vandergast, Amy G.

    2017-06-02

    Habitat and species conservation plans usually rely on monitoring to assess progress towards conservation goals. Southern California, USA, is a hotspot of biodiversity and home to many federally endangered and threatened species. Here, several regional multi-species conservation plans have been implemented to balance development and conservation goals, including in San Diego County. In the San Diego County Management Strategic Plan Area (MSPA), a monitoring framework for the preserve system has been developed with a focus on species monitoring, vegetation monitoring, threats monitoring and abiotic monitoring. Genetic sampling over time (genetic monitoring) has proven useful in gathering species presence and abundance data and detecting population trends, particularly related to species and threats monitoring objectives. This report reviews genetic concepts and techniques of genetics that relate to monitoring goals and outlines components of a genetic monitoring scheme that could be applied in San Diego or in other monitoring frameworks throughout the Nation.

  2. Law for Country: the Structure of Warlpiri Ecological Knowledge and Its Application to Natural Resource Management and Ecosystem Stewardship

    Directory of Open Access Journals (Sweden)

    Miles C. C. Holmes

    2013-09-01

    Full Text Available Indigenous Ecological Knowledge (IEK is deeply encoded in social processes. Our research shows that from an Indigenous perspective, IEK is a way of living whose core aim is to sustain the healthy functioning of people and country through relationships of reciprocity. However, IEK is often portrayed more prosaically as a body of knowledge about the environment. We introduce a framework, called ngurra-kurlu, that enables appreciation of indigenous perspectives on IEK. The framework was identified from the collaborative work of the authors with Warlpiri aboriginal elders in the Tanami Desert region of central Australia. Ngurra-kurlu facilitates cross-cultural understanding by distilling, from a complex cultural system, the five distinct conceptual categories that comprise IEK: law, skin, ceremony, language, and country. The framework enables engagement with nuanced environmental knowledge because it synthesizes, for cross-cultural audiences, all the key areas of knowledge and practice in which IEK is located. In particular, the framework highlights how social systems mediate the transmission, deployment, and regulation of environmental knowledge in on-ground situations, including collaborative natural resource management. Although the framework was generated in relation to one indigenous group, the epistemological structure of Warlpiri IEK is relevant throughout Australia, and the framework can be applied internationally to the emerging interest in fostering ecosystem stewardship in which the cultural connections between people and place are an integral part of ecosystems management.

  3. Assessing the value of post-processed state-of-the-art long-term weather forecast ensembles for agricultural water management mediated by farmers' behaviours

    Science.gov (United States)

    Li, Yu; Giuliani, Matteo; Castelletti, Andrea

    2016-04-01

    Recent advances in modelling of coupled ocean-atmosphere dynamics significantly improved skills of long-term climate forecast from global circulation models (GCMs). These more accurate weather predictions are supposed to be a valuable support to farmers in optimizing farming operations (e.g. crop choice, cropping and watering time) and for more effectively coping with the adverse impacts of climate variability. Yet, assessing how actually valuable this information can be to a farmer is not straightforward and farmers' response must be taken into consideration. Indeed, in the context of agricultural systems potentially useful forecast information should alter stakeholders' expectation, modify their decisions, and ultimately produce an impact on their performance. Nevertheless, long-term forecast are mostly evaluated in terms of accuracy (i.e., forecast quality) by comparing hindcast and observed values and only few studies investigated the operational value of forecast looking at the gain of utility within the decision-making context, e.g. by considering the derivative of forecast information, such as simulated crop yields or simulated soil moisture, which are essential to farmers' decision-making process. In this study, we contribute a step further in the assessment of the operational value of long-term weather forecasts products by embedding these latter into farmers' behavioral models. This allows a more critical assessment of the forecast value mediated by the end-users' perspective, including farmers' risk attitudes and behavioral patterns. Specifically, we evaluate the operational value of thirteen state-of-the-art long-range forecast products against climatology forecast and empirical prediction (i.e. past year climate and historical average) within an integrated agronomic modeling framework embedding an implicit model of the farmers' decision-making process. Raw ensemble datasets are bias-corrected and downscaled using a stochastic weather generator, in

  4. Long-term screening for sleep apnoea in paced patients: preliminary assessment of a novel patient management flowchart by using automatic pacemaker indexes and sleep lab polygraphy.

    Science.gov (United States)

    Aimé, Ezio; Rovida, Marina; Contardi, Danilo; Ricci, Cristian; Gaeta, Maddalena; Innocenti, Ester; Cabral Tantchou-Tchoumi, Jacques

    2014-10-01

    The primary aim of this pilot study was to prospectively assess a flowchart to screen and diagnose paced patients (pts) affected by sleep apnoeas, by crosschecking indexes derived from pacemakers (minute ventilation sensor on-board) with Sleep-Lab Polygraphy (PG) outcomes. Secondarily, "smoothed" long-term pacemaker indexes (all the information between two consecutive follow-up visits) have been retrospectively compared vs. standard short-term pacemaker indexes (last 24h) at each follow-up (FU) visit, to test their correlation and diagnostic concordance. Data from long-term FU of 61 paced pts were collected. At each visit, the standard short-term apnoea+hypopnoea (PM_AHI) index was retrieved from the pacemaker memory. Patients showing PM_AHI ≥ 30 at least once during FU were proposed to undergo a PG for diagnostic confirmation. Smoothed pacemaker (PM_SAHI) indexes were calculated by averaging the overall number of apnoeas/hypopnoeas over the period between two FU visits, and retrospectively compared with standard PM_AHI. Data were available from 609 consecutive visits (overall 4.64 ± 1.78 years FU). PM_AHI indexes were positive during FU in 40/61 pts (65.6%); 26/40 pts (65%) accepted to undergo a PG recording; Sleep-Lab confirmed positivity in 22/26 pts (84.6% positive predictive value for PM_AHI). A strong correlation (r=0.73) and a high level of concordance were found between smoothed and standard indexes (multivariate analysis, Cohen's-k and Z-score tests). Pacemaker-derived indexes may help in screening paced pts potentially affected by sleep apnoeas. Long-term "smoothed" apnoea indexes could improve the accuracy of pacemaker screening capability, even though this hypothesis must be prospectively confirmed by larger studies. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  5. Effects of 42-year long-term fertilizer management on soil phosphorus availability, fractionation,adsorption–desorption isotherm and plant uptake in flooded tropical rice

    Institute of Scientific and Technical Information of China (English)

    Pratap; Bhattacharyya; Amaresh; Kumar; Nayak; Mohammad; Shahid; Rahul; Tripathi; Sangita; Mohanty; Anjani; Kumar; Rajagounder; Raja; Bipin; Bihari; Panda; Banwari; Lal; Priyanka; Gautam; Chinmaya; Kumar; Swain; Koushik; Singha; Roy; Pradeep; Kumar; Dash

    2015-01-01

    Soil phosphorus(P) fractionation, adsorption, and desorption isotherm, and rice yield and P uptake were investigated in flooded tropical rice(Oryza sativa L.) following 42-year fertilizer and manure application. The treatments included low-input [unfertilized control without N, P, or K(C0N0)], farmyard manure(FYM)(C1N0), NP(C0NP), NPK(C0NPK), FYM + NP(C1NP), and high-input treatment, FYM + NPK(C1NPK). Grain yield was increased significantly by 74%over the control under the combined application of FYM + NPK. However, under low- and high-input treatments, yield as well as P uptake was maintained at constant levels for 35 years.During the same period, high yield levels and P uptake were maintained under the C0 NP, C0 NPK,and C1 NPK treatments. These are unique characteristics of a tropical flooded ecosystem, which is a self-sustaining system for rice production. The Fe–P fraction was highest compared to the Ca–P and Al–P fractions after 42 years of fertilizer application and was significantly higher under FYM + NPK treatment. The P adsorption capacity of soil was highest under the low-input treatment and lowest under long-term balanced fertilization(FYM + NPK). In contrast, P desorption capacity was highest under NPK and lowest in the control treatment. Long-term balanced fertilization in the form of FYM + NPK for 42 years lowered the bonding energy and adsorption capacity for P in soil but increased its desorption potential, increasing P availability to the plant and leading to higher P uptake and yield maintenance.

  6. Long-term outcome in BRAFV600E melanoma patients treated with vemurafenib: Patterns of disease progression and clinical management of limited progression

    Science.gov (United States)

    Puzanov, Igor; Amaravadi, Ravi K.; McArthur, Grant A.; Flaherty, Keith T.; Chapman, Paul B.; Sosman, Jeffrey A.; Ribas, Antoni; Shackleton, Mark; Hwu, Patrick; Chmielowski, Bartosz; Nolop, Keith B.; Lin, Paul S.; Kim, Kevin B.

    2016-01-01

    Introduction Vemurafenib induces tumour regression in most patients with BRAFV600E-mutant melanoma; eventually, most experience progressive disease (PD). Long-term follow-up of patients with BRAFV600E melanoma treated in the phase 1 vemurafenib trial is reported. Methods Patients received vemurafenib 240–1120 mg (dose escalation cohort) or 960 mg (extension cohort) orally twice daily. Clinical response was evaluated every 8 weeks by RECIST. Patients with PD amenable to local therapy (surgery or radiotherapy) were allowed to continue vemurafenib after progression. Overall survival (OS) from time of treatment initiation and from PD was estimated. Sites of PD were recorded. Results Forty-eight patients (escalation cohort, n = 16; extension cohort, n = 32) received therapeutic doses of vemurafenib (≥240 mg twice daily). Forty-three patients had PD by the time of this analysis, and 5 remained progression free (follow-up time, 1.2–56.1 months). Median OS was 14 months (range, 1.2–56.1); 3- and 4-year melanoma-specific survival rate in the extension cohort was 26% and 19%, respectively. Median OS was 26.0 months (range, 7.7–56.1) among 20 patients who continued vemurafenib after local therapy. Median treatment duration beyond initial PD was 3.8 months (range, 1.1–26.6). In the extension cohort, 6 and 5 patients were alive after 3 and 4 years, respectively, on vemurafenib monotherapy. Conclusions Some patients with melanoma achieved long-term survival with vemurafenib monotherapy. Continuation of vemurafenib after PD might be beneficial in some patients because remaining disease might continue to respond to BRAF inhibition. PMID:25980594

  7. [Developing the core competencies of long-term care professionals].

    Science.gov (United States)

    Chen, Huey-Tzy; Lee, Kuang-Ting

    2012-12-01

    Longer average life expectancies and an ageing society have made long-term care an urgent and important issue in Taiwan. Although the implementation of Long-Term Care Ten-year Project four years ago has begun showing success in terms of assessing Taiwan's needs in terms of long-term care services and resources, there has been little forward progress in terms of training, recruiting and maintaining more competent professionals in the long-term care sector. This paper explores the current state of long-term care competency in Taiwan and educational strategies in place to improve the competency of long-term care professionals. Results indicate that the term geriatric competency embraces sub-competencies in direct care, communication, assessment, teamwork, cultural sensitivities and career care competencies. The term long-term care competency embraces the sub-competencies of supervision, management, information technology, resource management, and organizational skill. As a main contributor to effective long-term care, the nursing profession must employ effective strategies to develop competency-based education. Also, the profession must have an adequate supply of competent manpower to effectively respond to Taiwan's aging society.

  8. Long term stability of power systems

    Energy Technology Data Exchange (ETDEWEB)

    Kundur, P.; Gao, B. [Powertech Labs. Inc., Surrey, BC (Canada)

    1994-12-31

    Power system long term stability is still a developing subject. In this paper we provide our perspectives and experiences related to long term stability. The paper begins with the description of the nature of the long term stability problem, followed by the discussion of issues related to the modeling and solution techniques of tools for long term stability analysis. Cases studies are presented to illustrate the voltage stability aspect and plant dynamics aspect of long term stability. (author) 20 refs., 11 figs.

  9. Assessing Environmental Stewardship Motivation

    Science.gov (United States)

    Bramston, Paul; Pretty, Grace; Zammit, Charlie

    2011-01-01

    Environmental stewardship networks flourish across Australia. Although the environment benefits, this article looks to identify what volunteers draw from their stewardship. The authors adapted 16 questions that purportedly tap environmental stewardship motivation and administered them to a convenience sample of 318 university students and then to…

  10. A comparative study on the medium-long term results of endovascular repair and open surgical repair in the management of ruptured abdominal aortic aneurysms

    Institute of Scientific and Technical Information of China (English)

    HAN Yan-shuo; ZHANG Jian; XIA Qian; LIU Zhi-min; ZHANG Xiao-yu; WU Xiao-yu; LUN Yu

    2013-01-01

    Background Although it is generally acknowledged that patients with ruptured abdominal aortic aneurysm (rAAA)obtain the greatest benefit from endovascular repair (EVAR),convincing evidence on the medium-long term effect is lacking.The aim of this study was to compare and summarize published results of rAAA that underwent EVAR with open surgical repair (OSR).Methods A search of publicly published literature was performed.Based on an inclusion and exclusion criteria,a systematic meta-analysis was undertaken to compare patient characteristics,complications,short term mortality and medium-long term outcomes.A random-effects model was used to pool the data and calculate pooled odds ratios and weighted mean differences.A quantitative method was used to analyze the differences between these two methods.Results A search of the published literature showed that fourteen English language papers comprising totally 1213 patients with rAAA (435 EVAR and 778 OSR) would be suitable for this study.Furthermore,13 Chinese studies were included,including 267 patients with rAAA totally,among which 238 patients received operation.The endovascular method was associated with more respiratory diseases before treatment (OR=1.81,P=0.01),while there are more patients with hemodynamic instability before treatment in OSR group (OR=1.53,P=0.031).Mean blood transfusion was 1328 ml for EVAR and 2809 ml for OSR (weighted mean difference (WMD) 1500 ml,P=0.014).The endovascular method was associated with a shorter stay in intensive care (WMD 2.34 days,P <0.001) and a shorter total postoperative stay (WMD 6.27 days,P <0.001).The pooled post-operative complication rate of respiratory system and visceral ischemia seldom occurred in the EVAR group (OR=0.48,P <0.001 and OR=0.28,P=0.043,respectively).The pooled 30-day mortality was 25.7% for EVAR and 39.6% for OSR,and the odds ratio was 0.53 (95% confidence interval (CI) 0.41-0.70,P <0.001).There was not,however,any significant reduction in

  11. Long-term clinical benefit and cost-effectiveness of an 8-week multimodal knee osteoarthritis management program incorporating intra-articular sodium hyaluronate (Hyalgan® injections

    Directory of Open Access Journals (Sweden)

    Miller LE

    2017-05-01

    Full Text Available Larry E Miller,1 Michael J Sloniewsky,2 Thomas E Gibbons,3 Janice G Johnston,4 Kent D Vosler,4 Saad Nasir5 1Miller Scientific Consulting, Inc., Asheville, NC, 2RMG Holding, Inc., Florence, 3Doctors Care, PA, Columbia, SC, 4Arrowhead Health Centers, Glendale, AZ, 5Fidia Pharma USA Inc., Parsippany, NJ, USA Background: Given the poor long-term effectiveness of focused nonsurgical knee osteoarthritis (OA treatments, alternative therapies are needed for patients who have unsuccessfully exhausted nonsurgical options.Methods: A telephone interview was conducted in patients who participated in a single 8-week multimodal knee OA treatment program (mean follow-up: 3.7 years, range: 2.7–4.9 years. The program consisted of five intra-articular knee injections of sodium hyaluronate (Hyalgan®, with each injection given 1 week apart, structured physical therapy, knee bracing, and patient education. Clinical outcomes included knee pain severity, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC subscores, current medication use, and history of total knee arthroplasty. Base-case, subgroup, and sensitivity analyses were conducted to determine the incremental cost-effectiveness ratio (ICER of the treatment program with comparisons made to historical literature controls undergoing usual care. Results: A total of 218 patients (54% provided long-term follow-up data. Knee pain severity decreased 60% and WOMAC subscores decreased 33%–42% compared to baseline (all p<0.001. Total knee arthroplasty was performed in 22.8% (81/356 of knees during follow-up. The treatment program was highly cost-effective compared to usual care with a base-case ICER of $6,000 per quality-adjusted life year (QALY. Results of subgroup analyses, one-way deterministic sensitivity analyses, and second-order probabilistic sensitivity analyses resulted in ICERs ranging from $3,996 to $10,493 per QALY. The percentage of simulations with an ICER below willingness

  12. The connection between long-term and short-term risk management strategies for flood and landslide hazards: examples from land-use planning and emergency management in four European case studies

    Science.gov (United States)

    Prenger-Berninghoff, K.; Cortes, V. J.; Sprague, T.; Aye, Z. C.; Greiving, S.; Głowacki, W.; Sterlacchini, S.

    2014-12-01

    Adaptation to complex and unforeseen events requires enhancing the links between planning and preparedness phases to reduce future risks in the most efficient way. In this context, the legal-administrative and cultural context has to be taken into account. This is why four case study areas of the CHANGES1 project (Nehoiu Valley in Romania, Ubaye Valley in France, Val Canale in Italy, and Wieprzówka catchment in Poland) serve as examples to highlight currently implemented risk management strategies for land-use planning and emergency preparedness. The focus is particularly on flood and landslide hazards. The strategies described in this paper were identified by means of exploratory and informal interviews in each study site. Results reveal that a dearth or, in very few cases, a weak link exists between spatial planners and emergency managers. Management strategies could benefit from formally intensifying coordination and cooperation between emergency services and spatial planning authorities. Moreover, limited financial funds urge for a more efficient use of resources and better coordination towards long-term activities. The research indicates potential benefits to establishing or, in some cases, strengthening this link through contextual changes, e.g., in organizational or administrative structures, that facilitate proper interaction between risk management and spatial planning. It also provides suggestions for further development in the form of information and decision support systems as a key connection point. 1 Marie Curie ITN CHANGES - Changing Hydro-meteorological Risks as Analyzed by a New Generation of European Scientists

  13. Terminating a long-term clinical trial.

    Science.gov (United States)

    Klimt, C R

    1981-05-01

    Long-term clinical trials often include more than one active treatment group. These may be discontinued independently if found to be ineffective or possibly harmful. Certain subgroups of patients may be discovered, in the course of a clinical trial, who do not respond satisfactorily and are, therefore, excluded during the course of a trial. Yet another kind of termination comes when we have a therapeutic breakthrough or when hope has to be abandoned for demonstrating beneficial effects for one, several, or all treatments included in a trial. Examples from the authors' experience are presented, as are successful and unsuccessful techniques in managing terminations of various types.

  14. Chemical and biochemical properties of Stagnic Albeluvisols organic matter as result of long-term agricultural management and native forest ecosystem

    Science.gov (United States)

    Astover, Alar; Kõlli, Raimo; Wojciech Szajdak, Lech

    2010-05-01

    Soil organic matter (SOM) is considered to be as the most important factor in soil forming, development and continuous functioning. Sequestrated into SOM organic carbon concentrations, pools and residence time in soil, as well acting intensity of interconnected with SOM edaphon are soil type specific or characteristic to certain soil types. In depending on soil moisture regime, calcareousness and clay content for each soil type certain soil organic carbon (SOC) retaining capacity and its vertical distribution pattern are characteristic. However, land use change (crop rotation, continuous cropping, no-tillage, melioration, rewetting) has greatest influence mainly on fabric of epipedon and biological functions of soil cover. Stagnic Albeluvisols are largely distributed at Tartu County. They form here more than half from arable soils. The establishment of long-term field trial and forest research area in these regions for biochemical analysis of Stagnic Albeluvisols' organic matter is in all respects justified. In 1989, an international long-term experiment on the organic nitrogen or IOSDV (Internationale Organische Stickstoffdauerdiingungsversuche) with three-field crop rotation (potato - spring wheat - spring barley) was started at Eerika near Tartu (58° 22.5' N; 26° 39.8' E) on Stagnic Albeluvisol. The main aims of this study were to determine the long-term effects of cropping systems on physico-chemical properties of soils and their productivity. The design of this field experiment is similar to other European network of IOSDV experiments. Before the establishment of this experiment in 1989 it was in set-aside state (5-6 years) as field-grass fallow. It was used as arable land in condition of state farm during 1957-83. Average agrochemical characteristics of the plough horizon of soil in the year of establishment were the following: humus content 17.1 g kg-1, total nitrogen content 0.9 g kg-1, C:N ratio 11 and pHKCl 6.3. DL soluble phosphorus content was 44 mg

  15. Effects of Reduced Tillage on Crop Yield, Plant Available Nutrients and Soil Organic Matter in a 12-Year Long-Term Trial under Organic Management

    Directory of Open Access Journals (Sweden)

    Wilhelm Claupein

    2013-09-01

    Full Text Available A field experiment was performed in Southwest Germany to examine the effects of long-term reduced tillage (2000–2012. Tillage treatments were deep moldboard plow: DP, 25 cm; double-layer plow; DLP, 15 + 10 cm, shallow moldboard plow: SP, 15 cm and chisel plow: CP, 15 cm, each of them with or without preceding stubble tillage. The mean yields of a typical eight-year crop rotation were 22% lower with CP compared to DP, and 3% lower with SP and DLP. Stubble tillage increased yields by 11% across all treatments. Soil nutrients were high with all tillage strategies and amounted for 34–57 mg kg−1 P and 48–113 mg kg−1 K (0–60 cm soil depth. Humus budgets showed a high carbon input via crops but this was not reflected in the actual Corg content of the soil. Corg decreased as soil depth increased from 13.7 g kg−1 (0–20 cm to 4.3 g kg−1 (40–60 cm across all treatments. After 12 years of experiment, SP and CP resulted in significantly higher Corg content in 0–20 cm soil depth, compared to DP and DLP. Stubble tillage had no significant effect on Corg. Stubble tillage combined with reduced primary tillage can sustain yield levels without compromising beneficial effects from reduced tillage on Corg and available nutrient content.

  16. Management of Gastric Varices Unsuccessfully Treated by Balloon-Occluded Retrograde Transvenous Obliteration: Long-Term Follow-Up and Outcomes

    Directory of Open Access Journals (Sweden)

    Fumio Uchiyama

    2013-01-01

    Full Text Available Our aim was to evaluate the long-term efficacy and safety of percutaneous transhepatic obliteration (PTO alone and combined with balloon-occluded retrograde transvenous obliteration (BRTO for gastroesophageal varices refractory to BRTO alone. Between July 1999 and December 2010, 13 patients with gastroesophageal varices refractory to BRTO were treated with PTO (n = 6 or a combination of PTO and BRTO (n = 7. We retrospectively investigated the rates of survival, recurrence, or worsening of the varices; hepatic function before and after the procedure; and complications. The procedure achieved complete obliteration or significant reduction of the varices in all 13 patients without major complications. During follow-up, the varices had recurred in 2 patients, of which one had hepatocellular carcinoma, and the other died suddenly from variceal rebleeding 7 years after PTO. The remaining 11 patients did not experience worsening of the varices and showed significant improvements in the serum ammonia levels and prothrombin time. The mean follow-up period was 90 months, and the cumulative survival rate at 1, 3, and 5 years was 92.9%, 85.7%, and 85.7%, respectively. Both PTO and combined PTO and BRTO seem as safe and effective procedures for the treatment of gastroesophageal varices refractory to BRTO alone.

  17. Core Elements of Outpatient Antibiotic Stewardship.

    Science.gov (United States)

    Sanchez, Guillermo V; Fleming-Dutra, Katherine E; Roberts, Rebecca M; Hicks, Lauri A

    2016-11-11

    The Core Elements of Outpatient Antibiotic Stewardship provides a framework for antibiotic stewardship for outpatient clinicians and facilities that routinely provide antibiotic treatment. This report augments existing guidance for other clinical settings. In 2014 and 2015, respectively, CDC released the Core Elements of Hospital Antibiotic Stewardship Programs and the Core Elements of Antibiotic Stewardship for Nursing Homes. Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic prescribing involves implementing effective strategies to modify prescribing practices to align them with evidence-based recommendations for diagnosis and management. The four core elements of outpatient antibiotic stewardship are commitment, action for policy and practice, tracking and reporting, and education and expertise. Outpatient clinicians and facility leaders can commit to improving antibiotic prescribing and take action by implementing at least one policy or practice aimed at improving antibiotic prescribing practices. Clinicians and leaders of outpatient clinics and health care systems can track antibiotic prescribing practices and regularly report these data back to clinicians. Clinicians can provide educational resources to patients and families on appropriate antibiotic use. Finally, leaders of outpatient clinics and health systems can provide clinicians with education aimed at improving antibiotic prescribing and with access to persons with expertise in antibiotic stewardship. Establishing effective antibiotic stewardship interventions can protect patients and improve clinical outcomes in outpatient health care settings.

  18. Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Schuts, E.C.; Hulscher, M.E.J.L.; Mouton, J.W.; Verduin, C.M.; Stuart, J.W.; Overdiek, H.W.; Linden, P.D. van der; Natsch, S.S.; Hertogh, C.M.; Wolfs, T.F.; Schouten, J.A.; Kullberg, B.J.; Prins, J.M.

    2016-01-01

    BACKGROUND: Antimicrobial stewardship is advocated to improve the quality of antimicrobial use. We did a systematic review and meta-analysis to assess whether antimicrobial stewardship objectives had any effects in hospitals and long-term care facilities on four predefined patients' outcomes:

  19. Current evidence on hospital antimicrobial stewardship objectives : A systematic review and meta-analysis

    NARCIS (Netherlands)

    Schuts, Emelie C.; Hulscher, Marlies E J L; Mouton, Johan W.; Verduin, Cees M.; Stuart, James W T Cohen; Overdiek, Hans W P M; van der Linden, Paul D.; Natsch, Stephanie; Hertogh, Cees M P M; Wolfs, Tom F W; Schouten, Jeroen A.; Kullberg, Bart Jan; Prins, Jan M.

    2016-01-01

    BACKGROUND: Antimicrobial stewardship is advocated to improve the quality of antimicrobial use. We did a systematic review and meta-analysis to assess whether antimicrobial stewardship objectives had any effects in hospitals and long-term care facilities on four predefined patients' outcomes:

  20. Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients: A Guidance Report and Clinical Checklist by the Consensus on Managing Modifiable Risk in Transplantation (COMMIT) Group.

    Science.gov (United States)

    Neuberger, James M; Bechstein, Wolf O; Kuypers, Dirk R J; Burra, Patrizia; Citterio, Franco; De Geest, Sabina; Duvoux, Christophe; Jardine, Alan G; Kamar, Nassim; Krämer, Bernhard K; Metselaar, Herold J; Nevens, Frederik; Pirenne, Jacques; Rodríguez-Perálvarez, Manuel L; Samuel, Didier; Schneeberger, Stefan; Serón, Daniel; Trunečka, Pavel; Tisone, Giuseppe; van Gelder, Teun

    2017-04-01

    Short-term patient and graft outcomes continue to improve after kidney and liver transplantation, with 1-year survival rates over 80%; however, improving longer-term outcomes remains a challenge. Improving the function of grafts and health of recipients would not only enhance quality and length of life, but would also reduce the need for retransplantation, and thus increase the number of organs available for transplant. The clinical transplant community needs to identify and manage those patient modifiable factors, to decrease the risk of graft failure, and improve longer-term outcomes.COMMIT was formed in 2015 and is composed of 20 leading kidney and liver transplant specialists from 9 countries across Europe. The group's remit is to provide expert guidance for the long-term management of kidney and liver transplant patients, with the aim of improving outcomes by minimizing modifiable risks associated with poor graft and patient survival posttransplant.The objective of this supplement is to provide specific, practical recommendations, through the discussion of current evidence and best practice, for the management of modifiable risks in those kidney and liver transplant patients who have survived the first postoperative year. In addition, the provision of a checklist increases the clinical utility and accessibility of these recommendations, by offering a systematic and efficient way to implement screening and monitoring of modifiable risks in the clinical setting.

  1. Fractionated stereotactic radiation therapy in the management of benign cavernous sinus meningiomas. Long-term experience and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Milker-Zabel, S.; Zabel-du Bois, A.; Debus, J. [Heidelberg Univ. (Germany). Dept. of Radiation Oncology; Huber, P. [Heidelberg Univ. (Germany). Dept. of Radiotherapy; Schlegel, W. [German Cancer Research Center, Heidelberg (Germany). Dept. of Medical Physics

    2006-11-15

    Purpose: To analyze own long-term results with fractionated stereotactic radiotherapy (FSRT) in patients with benign meningiomas of the cavernous sinus and to review the literature on these rare lesions. Patients and Methods: 57 patients were treated with FSRT for benign meningiomas of the cavernous sinus between 01/1990 and 12/2003 at the authors' institution. Histology was WHO grade I in 28/57 lesions, and undetermined in 29/57 lesions. 29 patients received radiotherapy as primary treatment, ten following surgery, and 18 patients were irradiated for recurrent disease. Median target volume was 35.2 cm{sup 3}. Median total dose was 57.6 Gy with 1.8 Gy per fraction. 51/57 patients showed clinical symptoms before radiotherapy like reduced vision (n=19), diplopia (n=25), or trigeminal hyp-/dysesthesia (n=17). Results: Median follow-up period was 6.5 years. 50/57 patients were