WorldWideScience

Sample records for managing multiple skeletal

  1. Skeletal surveys in multiple myeloma

    International Nuclear Information System (INIS)

    Sebes, J.I.; Niell, H.B.; Palmieri, G.M.A.; Reidy, T.J.

    1986-01-01

    Thirty-three patients with multiple myeloma were studied with serial skeletal surveys, serum immunoglobulin levels, and postabsorptive urinary hydroxyproline (Spot-HYPRO) determinations. Twenty receiving chemotherapy were also followed with skeletal surveys in order to evaluate bone response to treatment. A close association was found between skeletal findings and changes in immunoglubulin levels with positive correlation in 71% of the patients. A similar association was found between skeletal disease and Spot-HYPRO level changes in 65%. Five of 12 patients (42%) with partial or complete clinical response to chemotherapy, demonstrated improvement in the appearance of skeletal lesions. Positive correlation between the roentgenographic changes and clinical markers of myeloma as well as therapeutic response, indicates that skeletal surveys are useful and effective in monitoring patients with multiple myeloma. (orig.)

  2. Complex orthopaedic management of patients with skeletal dysplasias

    Directory of Open Access Journals (Sweden)

    A. G. Baindurashvili

    2014-01-01

    Full Text Available Skeletal dysplasias are challenging for diagnostics and treatment. We present a series of fifteen patients with different forms of skeletal dysplasias with age ranged from 6 to 17 years with variable clinical presentations managed as a part of the project of scientific cooperation between Turner Paediatric Orthopaedic Institute and Orthopaedic Hospital Vienna-Speising. The spectrum of diagnoses included multiple epiphyseal dysplasia, spondyloepiphyseal dysplasia congenita, diastrophic dysplasia, metaphyseal dysplasia, spondylometaphyseal dysplasia, Stickler syndrome, Kniest dysplasia, and anauxetic dysplasia. Complex treatment, which included axial correction and juxta-articular realignment, was performed as a single-stage, or consecutive surgery. Surgical techniques included corrective osteotomies with internal fixation, guided growth technique and external fixation devices. Best results (full axial correction, normal alignment of the joint were achieved in 8 patients, including 2 patients with metaphyseal dysplasia, 2 patients with multiple epyphyseal dysplasia, 2 patients with spondyloepyphyseal dysplasia, patient with Stickler syndrome and patient with spondylometaphyseal dysplasia. Good results (partial correction at the present time were seen in 4 patients (2 patients with Kniest dysplasia, 1 - with multiple epyphyseal dysplasia and 1 - with anauxetic dysplasia. Satisfactory results (non-progressive condition in previous progression were obtained in 2 patients with diastrophic dysplasia, and poor results (progression of the deformity - in 1 patient with diastrophic dysplasia. Positive results in most of the cases of our series make promising future for usage of complex approach for orthopedic management of children with skeletal dysplasias; advanced international cooperation is productive and helpful for diagnostics and management of rare diseases.

  3. Multiple skeletal lesions and pleural effusion owing to Histoplasma ...

    African Journals Online (AJOL)

    We describe a rare case of multiple skeletal lesions and a pleural effusion owing to Histoplasma capsulatum infection in a 16-year-old immunocompetent girl residing in a non-endemic region. Of note is that she had a lesion within a thoracic vertebra. Following an extensive literature search, we found that vertebral ...

  4. Computed Tomography diagnosis of skeletal involvement in multiple myeloma

    International Nuclear Information System (INIS)

    Scutellari, Pier Nuccio; Galeotti, Roberto; Leprotti, Stefano; Piva, Nadia; Spanedda, Romedio

    1997-01-01

    The authors assess the role of Computed Topography in the diagnosis and management of multiple myeloma (MM) and investigate if Computed Tomography findings can influence the clinical approach, prognosis and treatment. 273 multiple myeloma patients submitted to Computed Tomography June 1994, to December, 1996. The patients were 143 men and 130 women (mean age: 65 years): 143 were stage I, 38 stage II and 92 stage III according to Durie and Salomon's clinical classification. All patients were submitted to blood tests, spinal radiography and Computed Tomography, the latter with serial 5-mm scans on several vertebral bodies. Computed Tomography despicted vertebral arch and process involvement in 3 cases with the vertebral pedicle sign. Moreover, Computed Tomography proved superior to radiography in showing the spread of myelomatous masses into the soft tissues in a case with solitary permeative lesion in the left public bone, which facilitated subsequent biopsy. As for extraosseous localizations, Computed Tomography demonstrated thoracic soft tissue (1 woman) and pelvic (1 man) involvement by myelomtous masses penetrating into surrounding tissues. In our series, only a case of osteosclerotic bone myeloma was observed in the pelvis, associated with lytic abnormalities. Computed Tomography findings do not seem to improve the clinical approach and therapeutic management of the disease. Nevertheless, the authors reccommend Computed Tomography for some myelomatous conditions, namely: a) in the patients with focal bone pain but normal skeletal radiographs; b) in the patients with M protein, bone marrow plasmocytosis and back pain, but with an incoclusive multiple myeloma diagnosis; c) to asses bone spread in the regions which are anatomically complex or difficult to study with radiography and to depict soft tissue involvement; d) for bone biopsy

  5. Low-dose biplanar skeletal survey versus digital skeletal survey in multiple myeloma

    International Nuclear Information System (INIS)

    Boutry, Nathalie; Dutouquet, Bastien; Cotten, Anne; Leleu, Xavier; Vieillard, Marie-Helene; Duhamel, Alain

    2013-01-01

    To evaluate the low-dose biplanar (LDB) skeletal survey (SS) for the assessment of focal bone involvement in patients with multiple myeloma (MM) as compared with digital SS and to compare the two techniques in terms of image quality, patient comfort and radiation exposure. Fifty-six consecutive patients with newly diagnosed or first relapsed MM underwent LDB and digital SS on the same day. These were assessed by two radiologists for the detection of focal bone lesions. In the case of discordance, whole-body MR imaging was performed. Image quality, patient comfort and radiation dose were also assessed. Fifty-six patients (M:30, F:26, mean age, 62 years) with newly diagnosed (n = 21) or first relapse MM (n = 35) were enrolled. A total of 473 bone lesions in 46 patients (82 %) were detected. Out of that total, digital SS detected significantly more lesions than LDB SS (451 [95.35 %] versus 467 [98.73 %]), especially in osteopenic and obese patients. Overall patient satisfaction was greater with LDB SS (48.6 %) compared with digital SS (2.7 %). The radiation dose was significantly reduced (by a factor of 7.8) with the LDB X-ray device. Low-dose biplanar skeletal surveys cannot replace digital SS in all patients suffering from multiple myeloma. (orig.)

  6. Low-dose biplanar skeletal survey versus digital skeletal survey in multiple myeloma

    Energy Technology Data Exchange (ETDEWEB)

    Boutry, Nathalie [University Hospital of Jeanne de Flandre and University of Lille 2, Departments of Pediatric and Musculoskeletal Imaging, Lille (France); University Hospital of Jeanne de Flandre and University of Lille 2, Department of Pediatric Imaging, Lille (France); Hopital Jeanne de Flandre, Service de Radiopediatrie, Lille (France); Dutouquet, Bastien; Cotten, Anne [University Hospital of Roger Salengro and University of Lille 2, Department of Musculoskeletal Imaging, Lille (France); Leleu, Xavier [University Hospital of Claude Huriez and University of Lille 2, Clinical Hematology Department, Lille (France); Vieillard, Marie-Helene [University Hospital of Roger Salengro and University of Lille 2, Rheumatology Department, Lille (France); Duhamel, Alain [University of Lille 2, Department of Medical Statistics, Lille (France)

    2013-08-15

    To evaluate the low-dose biplanar (LDB) skeletal survey (SS) for the assessment of focal bone involvement in patients with multiple myeloma (MM) as compared with digital SS and to compare the two techniques in terms of image quality, patient comfort and radiation exposure. Fifty-six consecutive patients with newly diagnosed or first relapsed MM underwent LDB and digital SS on the same day. These were assessed by two radiologists for the detection of focal bone lesions. In the case of discordance, whole-body MR imaging was performed. Image quality, patient comfort and radiation dose were also assessed. Fifty-six patients (M:30, F:26, mean age, 62 years) with newly diagnosed (n = 21) or first relapse MM (n = 35) were enrolled. A total of 473 bone lesions in 46 patients (82 %) were detected. Out of that total, digital SS detected significantly more lesions than LDB SS (451 [95.35 %] versus 467 [98.73 %]), especially in osteopenic and obese patients. Overall patient satisfaction was greater with LDB SS (48.6 %) compared with digital SS (2.7 %). The radiation dose was significantly reduced (by a factor of 7.8) with the LDB X-ray device. Low-dose biplanar skeletal surveys cannot replace digital SS in all patients suffering from multiple myeloma. (orig.)

  7. Multiple Epiphyseal Dysplasia (MED: A Rare Type of Skeletal Dysplasia

    Directory of Open Access Journals (Sweden)

    Mohammad Imnul Islam

    2012-06-01

    Full Text Available Multiple epiphyseal dysplasia (MED is a congenital disorder of skeletal development that primarily affects the ends of long bones, causing progressive joint and bone inflammation and short stature. Mutations in several genes are responsible for pathogenesis of this disease. We are reporting a case of MED who presented with the complaints of multiple swelling of the joints which was associated with pain during movement for last seven years. The patient had flexion deformity of all the affected joints along with restriction of movement. These were associated with kyphosis, pectus carnitum, knock-knee and short stature. Radiological findings were suggestive of MED. Counseling was done with the parents regarding the etiology, progression and outcome of the disease.DOI: http://dx.doi.org/10.3329/bsmmuj.v5i1.11025 BSMMU J 2012; 5(1:57-60 

  8. Two cases of multiple skeletal tuberculosis with spina ventosa

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Byung Hee; Choi, Sung Wook; Kim, Byung Soo [Busan National University College of Medicine, Busan (Korea, Republic of)

    1974-10-15

    Two cases of multiple skeletal tuberculosis with spina ventosa proved by radiological and pathological methods, were reported. One of the cases was 3 years old boy who had multiple abscess formations in both lower legs, intermittent high fever and soft tissue swelling in both hands, and the other was 19 years old boy who had soft tissue swelling in both hands and feet. Radiologically, the former showed active hilar tuberculosis of the chest, and destructive changes with cortical expansion in the left humerus, left tibra, left calcaneus and both hands; the latter showed almost fibroconsolidated lesions of the chest, and the bony lesions in both radii, left calcaneus, and both hands and feet. Biopsy specimen showed tubercles composed of epithelial cells, small round cells and fibroblasts with caseous necrosis in part.

  9. Multiple skeletal muscle metastases revealing a cardiac intimal sarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Crombe, Amandine [Institut Bergonie, Department of Radiology, Bordeaux (France); Lintingre, Pierre-Francois; Dallaudiere, Benjamin [Clinique du Sport de Bordeaux-Merignac, Department of Musculoskeletal Radiology, Merignac (France); Le Loarer, Francois [Institut Bergonie, Department of Pathology, Bordeaux (France); Lachatre, Denis [Dupuytren University Hospital, Department of Radiology, Limoges (France)

    2018-01-15

    We report the case of a 59-year-old female with progressive bilateral painful swelling of the thighs. MRI revealed multiple intramuscular necrotic masses with similar morphologic patterns. Whole-body CT and 18-FDG PET-CT scans demonstrated additional hypermetabolic muscular masses and a lobulated lesion within the left atrial cavity. As biopsy of a muscular mass was compatible with a poorly differentiated sarcoma with MDM2 oncogene amplification, two diagnoses were discussed: a dedifferentiated liposarcoma with muscle and heart metastases or a primary cardiac sarcoma, mainly a cardiac intimal sarcoma, with muscular metastases, which was finally confirmed by array-comparative genomic hybridization (aCGH) in a sarcoma reference center. This case emphasizes the potential for intimal sarcoma to disseminate in skeletal muscle prior to any other organ and the need for a genomic approach in addition to classical radiopathologic analyses to distinguish primary from secondary locations facing simultaneous tumors of the heart and skeletal muscles with MDM2 amplification. (orig.)

  10. Multiple congenital skeletal malformations in a lamb associated with ...

    African Journals Online (AJOL)

    Other malformations included patella absence, resulting in bowing of both fore and hind limbs with poorly developed muscles associated with these skeletal structure. Dystocia was believed to be a result of fetal monstrosity resulting in abnormal posture. The cause of the congenital malformations was not obvious ...

  11. The role of skeletal muscle in the pathophysiology and management of knee osteoarthritis.

    Science.gov (United States)

    Krishnasamy, Priathashini; Hall, Michelle; Robbins, Sarah R

    2018-05-01

    The role of skeletal muscle in the pathophysiology of knee OA is poorly understood. To date, the majority of literature has focused on the association of muscle strength with OA symptoms, disease onset and progression. However, deficits or improvements in skeletal muscle strength do not fully explain the mechanisms behind outcome measures in knee OA, such as pain, function and structural disease. This review aims to summarize components of skeletal muscle, providing a holistic view of skeletal muscle mechanisms that includes muscle function, quality and composition and their interactions. Similarly, the role of skeletal muscle in the management of knee OA will be discussed.

  12. Association between diffuse idiopathic skeletal hyperostosis and multiple myeloma

    International Nuclear Information System (INIS)

    Scutellari, P.N.; Orzincolo, C.D.; Castaldi, G.

    1995-01-01

    Radiologic studies were performed over a 26-month period in a series of 97 consecutive patients with multiple myeloma (56 male and 41 female, aged 42-91 years). Both myelomatous bone lesions and hyperostosis similar to DISH were found in these patients. The prevalence of DISH in association with multiple myeloma (21 male and 8 females patients) was higher (29.8%) than in our control group (973 patients, 449 male and 524 female) or in the general population (15-20%). The involved segments of the column were thoracic in 11 males and 7 females, cervical in 8 males and 2 females, and lumbar in 5 males and 4 females. Ossifying enthesopathy in the pelvis (''whiskering'') was observed in 7 males and 1 female. (orig./MG)

  13. Association between diffuse idiopathic skeletal hyperostosis and multiple myeloma

    Energy Technology Data Exchange (ETDEWEB)

    Scutellari, P.N. [Inst. of Radiology, Ferrara Univ. School of Medicine (Italy); Orzincolo, C.D. [Dept. of Radiology, St. Anna Hospital, Ferrara (Italy); Castaldi, G. [Dept. of Medicine, St. Maria delle Croci Hospital, Ravenna (Italy)

    1995-10-01

    Radiologic studies were performed over a 26-month period in a series of 97 consecutive patients with multiple myeloma (56 male and 41 female, aged 42-91 years). Both myelomatous bone lesions and hyperostosis similar to DISH were found in these patients. The prevalence of DISH in association with multiple myeloma (21 male and 8 females patients) was higher (29.8%) than in our control group (973 patients, 449 male and 524 female) or in the general population (15-20%). The involved segments of the column were thoracic in 11 males and 7 females, cervical in 8 males and 2 females, and lumbar in 5 males and 4 females. Ossifying enthesopathy in the pelvis (``whiskering``) was observed in 7 males and 1 female. (orig./MG)

  14. Multiple myeloma: Results of radiotherapy in skeletal lesions

    International Nuclear Information System (INIS)

    Budach, V.; Hueltenschmidt, B.; Stuschke, M.; Stueben, G.; Sack, H.; Bamberg, M.

    1991-01-01

    In this retrospective study the records of 157 patients with the diagnosis of multiple myeloma were evaluated with regard to subjective pain relief after a series of radiation therapy at 389 local sites. The most frequently treated region was the spine (50.2%), followed by the thoracic wall (17.9%) and the upper and lower extremities (17.8%). The median survival after diagnosis of all patients was 36 months. 88.4% of all treated sites showed good to moderate response in terms of pain remission after irradiation. It is shown that pain relief is significantly dependent on the total dose but independent of the dose per fraction. A total dose of 30 Gy in two weeks (5x3 Gy/week) is recommended as a well tolerated and reasonable treatment option to achieve maximum palliation and minimum hospitalization time for patients in whom multiple myeloma is diagnosed. (orig.) [de

  15. Sagittal and Vertical Craniofacial Growth Pattern and Timing of Circumpubertal Skeletal Maturation: A Multiple Regression Study

    Directory of Open Access Journals (Sweden)

    Giuseppe Perinetti

    2016-01-01

    Full Text Available The knowledge of the associations between the timing of skeletal maturation and craniofacial growth is of primary importance when planning a functional treatment for most of the skeletal malocclusions. This cross-sectional study was thus aimed at evaluating whether sagittal and vertical craniofacial growth has an association with the timing of circumpubertal skeletal maturation. A total of 320 subjects (160 females and 160 males were included in the study (mean age, 12.3±1.7 years; range, 7.6–16.7 years. These subjects were equally distributed in the circumpubertal cervical vertebral maturation (CVM stages 2 to 5. Each CVM stage group also had equal number of females and males. Multiple regression models were run for each CVM stage group to assess the significance of the association of cephalometric parameters (ANB, SN/MP, and NSBa angles with age of attainment of the corresponding CVM stage (in months. Significant associations were seen only for stage 3, where the SN/MP angle was negatively associated with age (β coefficient, −0.7. These results show that hyperdivergent and hypodivergent subjects may have an anticipated and delayed attainment of the pubertal CVM stage 3, respectively. However, such association remains of little entity and it would become clinically relevant only in extreme cases.

  16. Sagittal and Vertical Craniofacial Growth Pattern and Timing of Circumpubertal Skeletal Maturation: A Multiple Regression Study

    Science.gov (United States)

    Rosso, Luigi; Riatti, Riccardo

    2016-01-01

    The knowledge of the associations between the timing of skeletal maturation and craniofacial growth is of primary importance when planning a functional treatment for most of the skeletal malocclusions. This cross-sectional study was thus aimed at evaluating whether sagittal and vertical craniofacial growth has an association with the timing of circumpubertal skeletal maturation. A total of 320 subjects (160 females and 160 males) were included in the study (mean age, 12.3 ± 1.7 years; range, 7.6–16.7 years). These subjects were equally distributed in the circumpubertal cervical vertebral maturation (CVM) stages 2 to 5. Each CVM stage group also had equal number of females and males. Multiple regression models were run for each CVM stage group to assess the significance of the association of cephalometric parameters (ANB, SN/MP, and NSBa angles) with age of attainment of the corresponding CVM stage (in months). Significant associations were seen only for stage 3, where the SN/MP angle was negatively associated with age (β coefficient, −0.7). These results show that hyperdivergent and hypodivergent subjects may have an anticipated and delayed attainment of the pubertal CVM stage 3, respectively. However, such association remains of little entity and it would become clinically relevant only in extreme cases. PMID:27995136

  17. An uncommon disorder with multiple skeletal anomalies: Gorlin-Goltz syndrome.

    Science.gov (United States)

    Keçeli, Onur; Coskun-Benlidayı, İlke; Benlidayı, M Emre; Erdoğan, Özgür

    2014-01-01

    Gorlin-Goltz syndrome is an uncommon disorder transmitted through autosomal dominant inheritance. This syndrome is characterized by multiple odontogenic keratocysts, along with congenital skeletal anomalies and basal cell carcinomas. A 16-year-old girl was admitted with a complaint of swelling on the lower jaw. She had multiple basal cell nevi on both hands. Multiple lytic bone lesions on radiographs were defined as odontogenic keratocysts following the biopsy. The patient was referred to the Department of Physical Medicine and Rehabilitation for detailed musculoskeletal evaluation. Adam's forward bend test revealed a hump on the right side representing right thoracic scoliosis. Cervical kyphosis, thoracic lordosis and scoliosis, bifid rib and sacral and lumbar spina bifida on plain radiographs led to the diagnosis of Gorlin-Goltz syndrome. Since early diagnosis may provide optimum surveillance for related neoplasms, it is of paramount importance for pediatricians as well as physicians dealing with the musculoskeletal system to be aware of this rare condition.

  18. Symptomatic management in multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Pushkar Shah

    2015-01-01

    Full Text Available Multiple sclerosis (MS is the commonest cause of disability in young adults. While there is increasing choice and better treatments available for delaying disease progression, there are still, very few, effective symptomatic treatments. For many patients such as those with primary progressive MS (PPMS and those that inevitably become secondary progressive, symptom management is the only treatment available. MS related symptoms are complex, interrelated, and can be interdependent. It requires good understanding of the condition, a holistic multidisciplinary approach, and above all, patient education and empowerment.

  19. Managed care aspects of managing multiple sclerosis.

    Science.gov (United States)

    Owens, Gary M

    2013-11-01

    Multiple sclerosis (MS) is a chronic disease of the central nervous system usually diagnosed in the second or third decade of life; MS is more common among women than men by a ratio of 3 to 1. With its relatively early age of onset and symptoms that impair patients' quality of life, MS requires lifelong, dynamic treatment, and places a substantial economic burden on individuals, healthcare systems, and society. The costs associated with providing benefits for MS therapy are growing rapidly and the increasing complexity of the MS market is impacting disease management for payers. Employers are also increasingly aware of the costs associated with MS and are asking health plans to advise on the most appropriate and cost-effective ways to manage both pharmacologic and non-pharmacologic therapies for MS. Health plans, by necessity, must therefore balance appropriate access to treatments for MS with the need to manage rising treatment costs. To meet this goal, payers require population-based solutions, guidelines, and treatment algorithms for the management of MS that can be used in clinical and formulary management decision making in the context of an evolving therapeutic landscape. Further, comparative studies are necessary for payers to determine which agents may work best on a population basis. Due to the current lack of appropriate clinical guidance and insufficient head-to-head data on disease-modifying drugs, strategies for health plans and clinical management have been designed using the best available evidence. Undoubtedly, management of this class will continue to evolve with the launch of newer agents.

  20. Multiple Learning Tracks: For Training Multinational Managers

    Science.gov (United States)

    Harvey, Michael G.; Kerin, Roger A.

    1977-01-01

    The problem of identifying and training college students to be effective multinational marketing managers is investigated in three parts: (1) Identification of multinational manager attributes, (2) selection of multinational managers, and (3) multiple "track" training programs. (TA)

  1. Treatment of inherently unstable open or infected fractures by open wound management and external skeletal fixation.

    Science.gov (United States)

    Ness, M G

    2006-02-01

    To assess the use of external skeletal fixation with open wound management for the treatment of inherently unstable open or infected fractures in dogs. A retrospective review of 10 cases. Fracture stabilisation and wound management required only a single anaesthetic, and despite the challenging nature of these injuries, the final outcome was acceptable or good in every case. However, minor complications associated with the fixator pins were quite common, and two dogs developed complications which required additional surgery. Open management of wounds, even when bone was exposed, proved to be an effective technique, and external skeletal fixators were usually effective at maintaining stability throughout an inevitably extended fracture healing period.

  2. Management of severe skeletal Class III malocclusion with bimaxillary orthognathic surgery

    Directory of Open Access Journals (Sweden)

    Jitesh Haryani

    2016-01-01

    Full Text Available Orthognathic surgery in conjunction with fixed orthodontics is a common indication for interdisciplinary management of severe skeletal Class III malocclusion. A thorough analysis of pretreatment investigations and development of a surgical visual treatment objective is essential to plan the type of surgical technique required. Bimaxillary orthognathic surgery is the most common type of surgical procedure for severe skeletal discrepancies. The present case report is a combined ortho-surgical team management of a skeletally Class III patient. The severity of the case required bilateral upper first premolar extraction for dentoalveolar decompensation and simultaneous “Two-jaw surgery” with maxillary advancement of 4 mm and mandibular setback of 7 mm. Postsurgery, a pleasing good facial profile was achieved with Class II molar relation and positive overjet.

  3. MULTIPLE PROJECT MANAGEMENT IN THE CONSTRUCTION INDSUTRY

    Directory of Open Access Journals (Sweden)

    Luciana Hazin Alencar

    2010-06-01

    Full Text Available The field of project management has historically focused on the administration of one project at a time, a focus that is insufficient given the growing need for organizations to manage multiple projects simultaneously. The requirements of Multiple Project Management (MPM involves demands and practices that are different from those of single projects. MPM poses a special need for coordination of shared resources across multiple projects in a way that can maintain the firm’s strategic focus and facilitate effective decision making. The construction industry is noteworthy for its frequent need for the management of multiple projects. This paper offers a review of the last five years of indexed literature related to multiple project management in the construction industry, identifies gaps and suggests promising new avenues of inquiry.

  4. Use of iowa spaces for the orthodontic management of mandibular postsurgical skeletal relapse

    Directory of Open Access Journals (Sweden)

    Roberto Justus

    2016-01-01

    Full Text Available It has been documented that there is a tendency for skeletal relapse after orthognathic surgery. This relapse occurs more often following mandibular bilateral sagittal split osteotomy setbacks. The possible causes for lack of postsurgical stability as well as the clinical recommendations to manage the relapse are presented. Among these recommendations is the creation of Iowa Spaces.

  5. Management of skeletal Class III malocclusion with reverse pull headgear in a growing individual

    Directory of Open Access Journals (Sweden)

    Ambreen Afzal

    2016-01-01

    Full Text Available Skeletal Class III malocclusion is considered to be one of the most difficult orthodontic problems to treat. This malocclusion is associated with the retrognathic maxilla or prognathic mandible or sometimes a combination of both. The treatment of such cases requires an integrated approach and a comprehensive treatment plan including growth modification, dental camouflage, or orthognathic surgery. In a growing patient, orthopedic correction of skeletal Class III malocclusion with the help of a reverse pull headgear is crucial as it can reduce the chances of further surgical treatment to correct the skeletal discrepancy. This case report describes the management of skeletal Class III malocclusion in a 12-year-old female child with a retrognathic maxilla. The patient did not have any other genetic abnormality or significant known comorbidity. The treatment plan involved fixed orthodontic appliance therapy in combination with a reverse pull headgear for an orthopedic effect. This treatment was continued for 3 years, and well-aligned dental arches with a positive over jet were achieved at the conclusion of treatment. Using facemask therapy in conjunction with fixed orthodontic appliances has been a successful treatment option in growing children. Treatment should be carried out as early as possible to correct the skeletal discrepancy nonsurgically and achieve better results.

  6. Best practices in peri-operative management of patients with skeletal dysplasias.

    Science.gov (United States)

    White, Klane K; Bompadre, Viviana; Goldberg, Michael J; Bober, Michael B; Cho, Tae-Joon; Hoover-Fong, Julie E; Irving, Melita; Mackenzie, William G; Kamps, Shawn E; Raggio, Cathleen; Redding, Gregory J; Spencer, Samantha S; Savarirayan, Ravi; Theroux, Mary C

    2017-10-01

    Patients with skeletal dysplasia frequently require surgery. This patient population has an increased risk for peri-operative complications related to the anatomy of their upper airway, abnormalities of tracheal-bronchial morphology and function; deformity of their chest wall; abnormal mobility of their upper cervical spine; and associated issues with general health and body habitus. Utilizing evidence analysis and expert opinion, this study aims to describe best practices regarding the peri-operative management of patients with skeletal dysplasia. A panel of 13 multidisciplinary international experts participated in a Delphi process that included a thorough literature review; a list of 22 possible care recommendations; two rounds of anonymous voting; and a face to face meeting. Those recommendations with more than 80% agreement were considered as consensual. Consensus was reached to support 19 recommendations for best pre-operative management of patients with skeletal dysplasia. These recommendations include pre-operative pulmonary, polysomnography; cardiac, and neurological evaluations; imaging of the cervical spine; and anesthetic management of patients with a difficult airway for intubation and extubation. The goals of this consensus based best practice guideline are to provide a minimum of standardized care, reduce perioperative complications, and improve clinical outcomes for patients with skeletal dysplasia. © 2017 Wiley Periodicals, Inc.

  7. Management of Skeletal Class III Malocclusion with a Combined Approach of Facemask Therapy & Fixed Orthodontic Treatment - A Case Report

    Directory of Open Access Journals (Sweden)

    Shraddha Subhash Shetti

    2013-01-01

    Full Text Available A case report of an adolescent girl with a skeletal Class III malocclusion is presented. The associated clinical features of skeletal Class III are presented and management of such condition is discussed. The need for early identification and intervention of the skeletal Class III malocclusion is universally accepted by dentofacial orthopaedicians. Early intervention is associated with a better orthopedic response. Thus, treatment in the mixed or early permanent dentition can produce favorable results. Overcorrection of skeletal class III is recommended because treated patients grow similar to untreated Class III patients after treatment. Functional orthopaedic treatment rendered at an appropriate age ensures desired results in most cases. The intent of this article is to discuss the non-surgical treatment of a skeletal class III malocclusion along with a rationale of orthodontic management of such patients.

  8. MULTIPLE MYELOMA-LIKE SPINAL MRI FINDINGS IN SKELETAL FLUOROSIS: AN UNUSUAL PRESENTATION OF FLUORIDE TOXICITY IN HUMAN

    Directory of Open Access Journals (Sweden)

    Javed Ahsan Quadri

    2016-11-01

    Full Text Available Endemic fluorosis is a worldwide environmental problem due to excessive fluoride, commonly due to increased drinking water fluoride levels but sometimes due to other sources such food with high fluoride content. In India, 21 of the 35 states are known to have health problems associated with fluoride toxicity. The present report is a case of a 50-year-old female who was seen with progressive spinal complications and a MRI of the spine suggestive of multiple myeloma. The MRI of the lumbo-sacral spine showed a diffuse and heterogeneous marrow signal of the lower dorsal and lumbo-sacral vertebrae. The MRI was also suggestive of coarse trabeculation and appeared predominantly hypointanse on the T1W image and had mixed signal intensity on the T2W image. These findings were suggestive of neoplastic bone marrow infiltration and the presence of a proliferative disorder, with multiple myeloma being the most likely. During the patient workup, it was found that other family members were also having similar complications and, after investigation of these family members, it was found that they are suffering from systemic fluorosis. The patient was then evaluated for skeletal fluorosis and this condition was found to be present. Multiple myeloma was ruled out by the finding of a negative serum protein electrophoresis. The spinal complications appeared to be mainly due to the compression of the spinal cord and nerve roots by protruding osteophytes, thickening of the posterior longitudinal ligament, and thickening of the ligamentum flavum resulting in a compressive myeloradiculopathy and compressive myelopathy. The finding of multiple myeloma- like findings on the spinal MRI in association with skeletal fluorosis was considered to be a very rare event. This case report underlines the need to consider the presence of spinal skeletal fluorosis when evaluating spinal complications with unusual pseudo-multiple myeloma-like changes on the spinal MRI.

  9. The clandestine multiple graves in Malaysia: The first mass identification operation of human skeletal remains.

    Science.gov (United States)

    Mohd Noor, Mohd Suhani; Khoo, Lay See; Zamaliana Alias, Wan Zafirah; Hasmi, Ahmad Hafizam; Ibrahim, Mohamad Azaini; Mahmood, Mohd Shah

    2017-09-01

    The first ever mass identification operation of skeletal remains conducted for the clandestine graves in Malaysia consisted of 165 individuals unearthed from 28 human trafficking transit camps located in Wang Kelian, along the Thai-Malaysia border. A DVI response was triggered in which expert teams comprising of pathologists, anthropologists, odontologists, radiologists and DNA experts were gathered at the identified operation centre. The Department of Forensic Medicine, Hospital Sultanah Bahiyah, Alor Star, Kedah, located approximately 75km away from Wang Kelian, was temporarily converted into a victim identification centre (VIC) as it is the nearest available forensic facility to the mass grave site. The mortuary operation was conducted over a period of 3 months from June to September 2015, and was divided into two phases; phase 1 involving the postmortem examination of the remains of 116 suspected individuals and for phase 2 the remains of 49 suspected individuals. The fact that the graves were of unknown individuals afforded the mass identification operation a sufficient duration of 2 weeks as preparatory phase enabling procedurals and daily victim identification workflow to be established, and the setting up of a temporary body storage for the designated mortuary. The temporary body storage has proven to be a significant factor in enabling the successful conclusion of the VIC operation to the final phase of temporary controlled burials. Recognition from two international observers, Mr. Andréas Patiño Umaña, from the International Committee of Red Cross (ICRC) and Prof. Noel Woodford from Victoria Institute of Forensic Medicine (VIFM) had proven the mortuary operation was in compliance to the international quality and standards. The overall victim identification and mortuary operation identified a number of significant challenges, in particular the management of commingled human remains as well as the compilation of postmortem data in the absence of

  10. Comparison of multiple transcriptomes exposes unified and divergent features of quiescent and activated skeletal muscle stem cells

    DEFF Research Database (Denmark)

    Pietrosemoli, Natalia; Mella, Sébastien; Yennek, Siham

    2017-01-01

    of identifying quiescent markers. Here, we focused on the quiescent cell state and generated new transcriptome profiles that include subfractionations of adult satellite cell populations, and an artificially induced prenatal quiescent state, to identify core signatures for quiescent and proliferating. Methods......Background: Skeletal muscle satellite (stem) cells are quiescent in adult mice and can undergo multiple rounds of proliferation and self-renewal following muscle injury. Several labs have profiled transcripts of myogenic cells during the developmental and adult myogenesis with the aim...... with true in vivo quiescence from those that are first responding genes due to disruption of the stem cell niche....

  11. New management algorithms in multiple sclerosis

    DEFF Research Database (Denmark)

    Sorensen, Per Soelberg

    2014-01-01

    complex. The purpose of the review has been to work out new management algorithms for treatment of relapsing-remitting multiple sclerosis including new oral therapies and therapeutic monoclonal antibodies. RECENT FINDINGS: Recent large placebo-controlled trials in relapsing-remitting multiple sclerosis......PURPOSE OF REVIEW: Our current treatment algorithms include only IFN-β and glatiramer as available first-line disease-modifying drugs and natalizumab and fingolimod as second-line therapies. Today, 10 drugs have been approved in Europe and nine in the United States making the choice of therapy more...

  12. Management of the multiple limb amputee.

    Science.gov (United States)

    Davidson, J H; Jones, L E; Cornet, J; Cittarelli, T

    2002-09-10

    Multiple limb amputations involving at least one upper extremity are very uncommon. The amputation of both an upper and lower limb is even more uncommon. Due to the rarity of these amputations therapists are uncertain regarding the most appropriate treatment methods. While the majority of the protocols used for single limb amputations are appropriate for these multiple limb amputees, there are differences. Loss of multiple limbs creates a problem of overheating for the individual. Loss of an arm and leg results in difficulty donning the prostheses and difficulty using crutches and parallel bars during mobilization. A review is given of 16 multiple limb amputees seen in our rehabilitation centre in the last 15 years. Return to work was seen in one third and was not related to the number of the amputations. A higher proportion of these multiple limb amputations occur through alcoholism or attempted suicide behaviour than occurs with either single upper limb amputations or lower limb amputations. This existing behaviour can create a management problem for the rehabilitation team during rehabilitation. Guidelines as to appropriate prosthetic and preprosthetic care are provided to assist the practitioner who has the acute and long term care of these patients. All multiple limb amputees should be referred to a specialized rehabilitation centre to discuss prosthetic options and long term rehabilitation requirements. This paper does not discuss bilateral lower limb amputations when not combined with an upper limb amputation.

  13. Microcephaly, ectodermal dysplasia, multiple skeletal anomalies and distinctive facial appearance: delineation of cerebro-dermato-osseous-dysplasia.

    Science.gov (United States)

    Castori, Marco; Pascolini, Giulia; Parisi, Valentina; Sana, Maria Elena; Novelli, Antonio; Nürnberg, Peter; Iascone, Maria; Grammatico, Paola

    2015-04-01

    In 1980, a novel multiple malformation syndrome has been described in a 17-year-old woman with micro- and turricephaly, intellectual disability, distinctive facial appearance, congenital atrichia, and multiple skeletal anomalies mainly affecting the limbs. Four further sporadic patients and a couple of affected sibs are also reported with a broad clinical variability. Here, we describe a 4-year-old girl strikingly resembling the original report. Phenotype comparison identified a recurrent pattern of multisystem features involving the central nervous system, and skin and bones in five sporadic patients (including ours), while the two sibs and a further sporadic case show significant phenotypic divergence. Marked clinical variability within the same entity versus syndrome splitting is discussed and the term "cerebro-dermato-osseous dysplasia" is introduced to define this condition. © 2015 Wiley Periodicals, Inc.

  14. Fundamentals in the management of multiple myeloma.

    Science.gov (United States)

    Fadilah, S A W

    2010-09-01

    Progress in our understanding of multiple myeloma and its treatment has resulted in a more tailored approach to patient management, with different therapeutics regimens for different patient populations. The decision to initiate therapy depends primarily on the presence of symptoms which has to balance the chance of tumor clearance and against the risks of treatment related mortality. Selection of appropriate initial treatment should be based primarily on patient's characteristics (biologic age, co-morbidities), the disease characteristics (tumor burden and genetic risk profile) and the expected toxicity profile of the different regimens. When treatment begins, in younger transplant eligible patients the goal is to achieve high quality responses with intensive therapies as the quality of response appears to be important surrogates for long-term outcome. In the majority of myeloma patients in whom intensive treatment is not an option due to advanced age and co-morbidities, treatment should emphasize on optimal disease control to obtain symptomatic relief and to maintain a satisfactory quality of life. The introduction of novel agents has substantially changed the treatment paradigm of this otherwise incurable disease. The utilization of these drugs has moved from relapse setting to the front line setting and has benefited all patient groups. Because of these rapid developments and many treatment options we need good quality clinical studies to guide clinical practice in the management of patients with multiple myeloma. This review presents an update on current concepts of diagnosis and treatment of patients with multiple myeloma and provides recommendations on tailored therapies with particular reference to the local practice. The information presented herein may be used by the health care providers caring for myeloma patients as a guideline to counsel patients to understand their disease and the treatment better.

  15. Management Challenges of Launching Multiple Payloads for Multiple Customers

    OpenAIRE

    Callen, Dave

    1999-01-01

    Orbital has provided launch services for multiple satellites as a means to provide greater economy for access to space. These include satellites from NASA, 000, commercial companies, universities, and foreign governments. While satellite customers view shared launches as a means to achieve reduced launch costs, this approach adds many complexities that a traditional launch service provider does not have to address for a dedicated launch. This paper will discuss some of the challenges associat...

  16. Managing bay and estuarine ecosystems for multiple services

    Science.gov (United States)

    Needles, Lisa A.; Lester, Sarah E.; Ambrose, Richard; Andren, Anders; Beyeler, Marc; Connor, Michael S.; Eckman, James E.; Costa-Pierce, Barry A.; Gaines, Steven D.; Lafferty, Kevin D.; Lenihan, Junter S.; Parrish, Julia; Peterson, Mark S.; Scaroni, Amy E.; Weis, Judith S.; Wendt, Dean E.

    2013-01-01

    Managers are moving from a model of managing individual sectors, human activities, or ecosystem services to an ecosystem-based management (EBM) approach which attempts to balance the range of services provided by ecosystems. Applying EBM is often difficult due to inherent tradeoffs in managing for different services. This challenge particularly holds for estuarine systems, which have been heavily altered in most regions and are often subject to intense management interventions. Estuarine managers can often choose among a range of management tactics to enhance a particular service; although some management actions will result in strong tradeoffs, others may enhance multiple services simultaneously. Management of estuarine ecosystems could be improved by distinguishing between optimal management actions for enhancing multiple services and those that have severe tradeoffs. This requires a framework that evaluates tradeoff scenarios and identifies management actions likely to benefit multiple services. We created a management action-services matrix as a first step towards assessing tradeoffs and providing managers with a decision support tool. We found that management actions that restored or enhanced natural vegetation (e.g., salt marsh and mangroves) and some shellfish (particularly oysters and oyster reef habitat) benefited multiple services. In contrast, management actions such as desalination, salt pond creation, sand mining, and large container shipping had large net negative effects on several of the other services considered in the matrix. Our framework provides resource managers a simple way to inform EBM decisions and can also be used as a first step in more sophisticated approaches that model service delivery.

  17. Managers’ Use of Multiple Management Control Systems

    DEFF Research Database (Denmark)

    Willert, Jeanette

    This dissertation addresses the topic Management Control Systems (MCS) as a Package. Many research studies investigate management and control systems individually, whereas fewer research studies take a holistic view and include a larger part of all the MCS managers use to guide and direct...... subordinates behaviour in the best interest of their companies. In the MCS literature, it is stressed that knowledge is particularly lacking about how managers design and use MCS as a package, and the effectiveness of using the MCS. This dissertation responds to this call by carrying out a large survey among...... executive managers in large companies, a survey that investigates the subject: Effective Management and Control Systems. The focus in the survey is to explore how executive management in large companies design and use their management control systems package. Further, this study is supplemented...

  18. PET/CT Improves the Definition of Complete Response and Allows to Detect Otherwise Unidentifiable Skeletal Progression in Multiple Myeloma.

    Science.gov (United States)

    Zamagni, Elena; Nanni, Cristina; Mancuso, Katia; Tacchetti, Paola; Pezzi, Annalisa; Pantani, Lucia; Zannetti, Beatrice; Rambaldi, Ilaria; Brioli, Annamaria; Rocchi, Serena; Terragna, Carolina; Martello, Marina; Marzocchi, Giulia; Borsi, Enrica; Rizzello, Ilaria; Fanti, Stefano; Cavo, Michele

    2015-10-01

    To evaluate the role of 18F-FDG PET/CT in 282 symptomatic multiple myeloma patients treated up-front between 2002 and 2012. All patients were studied by PET/CT at baseline, during posttreatment follow-up, and at the time of relapse. Their median duration of follow-up was 67 months. Forty-two percent of the patients at diagnosis had >3 focal lesions, and in 50% SUVmax was >4.2; extramedullary disease was present in 5%. On multivariate analysis, ISS stage 3, SUVmax >4.2, and failure to achieve best complete response (CR) were the leading factors independently associated with shorter progression-free survival (PFS) and overall survival (OS). These 3 variables were used to construct a prognostic scoring system based on the number of risk factors. After treatment, PET/CT negativity (PET-neg) was observed in 70% of patients, whereas conventionally defined CR was achieved in 53%. Attainment of PET-neg favorably influenced PFS and OS. PET-neg was an independent predictor of prolonged PFS and OS for patients with conventionally defined CR. Sixty-three percent of patients experienced relapse or progression; in 12%, skeletal progression was exclusively detected by systematic PET/CT performed during follow-up. A multivariate analysis revealed that persistence of SUVmax >4.2 following first-line treatment was independently associated with exclusive PET/CT progression. PET/CT combined with ISS stage and achievement or not of CR on first-line therapy sorted patients into different prognostic groups. PET/CT led to a more careful evaluation of CR. Finally, in patients with persistent high glucose metabolism after first-line treatment, PET/CT can be recommended during follow-up, to screen for otherwise unidentifiable progression. ©2015 American Association for Cancer Research.

  19. Posterior-only surgery with preoperative skeletal traction for management of severe scoliosis.

    Science.gov (United States)

    Mehrpour, Saeedreza; Sorbi, Reza; Rezaei, Reza; Mazda, Keyvan

    2017-04-01

    The surgical treatment of severe adolescent spinal deformities is challenging and carries substantial risks of mortality and morbidity. To mitigate this risk, surgeons have employed various methods as this study designed to evaluate the safety and effectiveness of preoperative halo-femoral or halo gravity traction (HGT) followed by posterior-only surgery in the management of severe scoliosis. A total number of 23 patients with severe scoliosis treated by preoperative skeletal traction (halo gravity or halo femoral) followed by posterior fusion and instrumentation in one stage. All patients were followed for a minimum of 2 years after surgery. The average age of the patients was 12.7 years at the time of surgery. Mean of the Cobb angle improved from 99.9° ± 8.2° preoperatively to 75.3° ± 8° post-traction and 49.5° ± 7.7° postoperatively. Kyphosis angle corrected from 56.4° ± 9.5° to 38.6° ± 5.8°. The preop-FVC% was 41 ± 6.1% and after 1 year follow-up FVC% was 45.7 ± 7.7%. No patients required an anterior release due to amount of their deformity. Despite the benefits of modern instrumentation procedures, the treatment of severe scoliosis can be very competing. We think that by applying preoperative halo femoral traction and halo-gravity traction, managing severe scoliosis will be in safe and easy manner and can lead to better deformity correction and less neurological complications and facilitate to avoid anterior operation for severe scoliosis and its related complications.

  20. Management of skeletal Class III malocclusion with reverse pull headgear in a growing individual

    OpenAIRE

    Ambreen Afzal; Hasnain Sakrani; Norisha Ehsan Mahmood; Kamellia Mehershahi; Fatima Burney

    2016-01-01

    Skeletal Class III malocclusion is considered to be one of the most difficult orthodontic problems to treat. This malocclusion is associated with the retrognathic maxilla or prognathic mandible or sometimes a combination of both. The treatment of such cases requires an integrated approach and a comprehensive treatment plan including growth modification, dental camouflage, or orthognathic surgery. In a growing patient, orthopedic correction of skeletal Class III malocclusion with the help of a...

  1. Management of skeletal Class III malocclusion with face mask therapy and comprehensive orthodontic treatment.

    Science.gov (United States)

    Muthukumar, Kirthika; Vijaykumar, N M; Sainath, M C

    2016-01-01

    Orthopedic correction of skeletal Class III malocclusion in a growing patient is crucial as it can circumvent future surgical procedures. Further, as surgery is done only at a later stage, early treatment helps to avoid the detrimental effects produced by the facial disfigurement on the patient's social life. This case report describes the treatment of a child aged 9 years 6 months who had a skeletal Class III malocclusion. The treatment plan involved the use of a reverse pull headgear (facemask) and multibracket appliance therapy resulting in successful correction of the malocclusion. The treatment results were highly satisfactory resulting in improved facial esthetics, a skeletal Class I with a Dental Class I molar and canine relationship, an ideal overjet and overbite. Thus, dentoalveolar camouflage, if done in properly selected cases, alleviates the need for surgical intervention. The patient is being monitored until the end of growth to ensure the stability of treatment results.

  2. Management of skeletal Class III malocclusion with face mask therapy and comprehensive orthodontic treatment

    Directory of Open Access Journals (Sweden)

    Kirthika Muthukumar

    2016-01-01

    Full Text Available Orthopedic correction of skeletal Class III malocclusion in a growing patient is crucial as it can circumvent future surgical procedures. Further, as surgery is done only at a later stage, early treatment helps to avoid the detrimental effects produced by the facial disfigurement on the patient's social life. This case report describes the treatment of a child aged 9 years 6 months who had a skeletal Class III malocclusion. The treatment plan involved the use of a reverse pull headgear (facemask and multibracket appliance therapy resulting in successful correction of the malocclusion. The treatment results were highly satisfactory resulting in improved facial esthetics, a skeletal Class I with a Dental Class I molar and canine relationship, an ideal overjet and overbite. Thus, dentoalveolar camouflage, if done in properly selected cases, alleviates the need for surgical intervention. The patient is being monitored until the end of growth to ensure the stability of treatment results.

  3. Multiple system modelling of waste management

    International Nuclear Information System (INIS)

    Eriksson, Ola; Bisaillon, Mattias

    2011-01-01

    Highlights: → Linking of models will provide a more complete, correct and credible picture of the systems. → The linking procedure is easy to perform and also leads to activation of project partners. → The simulation procedure is a bit more complicated and calls for the ability to run both models. - Abstract: Due to increased environmental awareness, planning and performance of waste management has become more and more complex. Therefore waste management has early been subject to different types of modelling. Another field with long experience of modelling and systems perspective is energy systems. The two modelling traditions have developed side by side, but so far there are very few attempts to combine them. Waste management systems can be linked together with energy systems through incineration plants. The models for waste management can be modelled on a quite detailed level whereas surrounding systems are modelled in a more simplistic way. This is a problem, as previous studies have shown that assumptions on the surrounding system often tend to be important for the conclusions. In this paper it is shown how two models, one for the district heating system (MARTES) and another one for the waste management system (ORWARE), can be linked together. The strengths and weaknesses with model linking are discussed when compared to simplistic assumptions on effects in the energy and waste management systems. It is concluded that the linking of models will provide a more complete, correct and credible picture of the consequences of different simultaneous changes in the systems. The linking procedure is easy to perform and also leads to activation of project partners. However, the simulation procedure is a bit more complicated and calls for the ability to run both models.

  4. Demand Side Management for Multiple Devices

    NARCIS (Netherlands)

    Molderink, Albert; Bakker, Vincent; Smit, Gerardus Johannes Maria

    Steering a heterogeneous set of devices in a Smart Grid using cost functions: Demand Side Management (DSM) is an important element in smart grids. DSM is already in operation for large consumers, but thorough research is required into DSM on a building level within the distribution grid.

  5. Recognizing and Managing Multiple Organizational Approaches.

    Science.gov (United States)

    Giesecke, Joan

    1994-01-01

    Discusses a framework for identifying organizational processes or models within the context of the organization's decision-making processes. Five organizational models appropriate to academic libraries are presented: rational, political bargaining, garbage can, bureaucratic, and participatory. Guidelines for managers include how to distinguish…

  6. The management of multiple sclerosis in children: a European view

    DEFF Research Database (Denmark)

    Ghezzi, Angelo; Banwell, Brenda; Boyko, Alexey

    2010-01-01

    in the paediatric multiple sclerosis population has triggered the use of disease-modifying therapies that have been shown to reduce relapse rate, disease progression and cognitive decline in adult patients with multiple sclerosis. Hard evidence for the right treatment and its appropriate timing is scarce...... in the management of paediatric multiple sclerosis. One of the aims was to generate a common view on the management of paediatric multiple sclerosis patients. The result of this meeting is presented here to help standardize treatment and to support clinicians with less experience in this field.......About 3-5% of all patients with multiple sclerosis experience the onset of their disease under the age of 16. A significant proportion of paediatric multiple sclerosis patients develop significant cognitive disturbances and persistent physical disability. The high relapse rate and the morbidity...

  7. Bortezomib in the management of multiple myeloma

    Directory of Open Access Journals (Sweden)

    Jacob P Laubach

    2009-09-01

    Full Text Available Jacob P Laubach, Constantine S Mitsiades, Teru Hideshima, Robert Schlossman, Dharminder Chauhan, Nikhil Munshi, Irene Ghobrial, Nicole Carreau, Kenneth C Anderson, Paul G RichardsonDepartment of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USAAbstract: Multiple myeloma (MM is a B-cell malignancy characterized by clonal expansion of plasma cells within the bone marrow, the presence of a serum and/or urine monoclonal protein, lytic bone lesions, and anemia. On a cellular level, the disease is characterized by complex interactions between tumor cells and the surrounding bone marrow microenvironment. Understanding of the relationship between malignant plasma cells and the microenvironment has sparked ongoing efforts to develop targeted therapeutic agents for treatment of this disease. The successful development of the first-in-class small-molecule proteasome inhibitor bortezomib occurred as a result of these efforts. This review focuses on the rationale for bortezomib therapy in the treatment of patients with newly diagnosed and relapsed MM, important treatment-related side effects, and future directions for use of bortezomib and other, emerging proteasome inhibitors.Keywords: multiple myeloma, bortezomib, stem cell transplantation, peripheral neuropathy

  8. Pharmacological management of spasticity in multiple sclerosis

    DEFF Research Database (Denmark)

    Otero-Romero, Susana; Sastre-Garriga, Jaume; Comi, Giancarlo

    2016-01-01

    Background and objectives: Treatment of spasticity poses a major challenge given the complex clinical presentation and variable efficacy and safety profiles of available drugs. We present a systematic review of the pharmacological treatment of spasticity in multiple sclerosis (MS) patients. Methods...... improvement is seen with the previous drugs. Nabiximols has a positive effect when used as add-on therapy in patients with poor response and/or tolerance to first-line oral treatments. Despite limited evidence, intrathecal baclofen and intrathecal phenol show a positive effect in severe spasticity...... and suboptimal response to oral drugs. Conclusion: The available studies on spasticity treatment offer some insight to guide clinical practice but are of variable methodological quality. Large, well-designed trials are needed to confirm the effectiveness of antispasticity agents and to produce evidence...

  9. Combined Orthodontic-surgical Treatment for Skeletal Class III Malocclusion with Multiple Impacted Permanent and Supernumerary Teeth: Case Report.

    Science.gov (United States)

    Xue, Dai Juan And Feng

    2014-01-01

    In this report we describe a combined orthodontic and surgical treatment for a 14-year-old boy with severe skeletal class III deformity and dental problem. His upper posterior primary teeth in the left side were over-retained and 6 maxillary teeth (bilateral central incisors and canines, left first and second premolars) were impacted, together with 5 supernumerary teeth in both arches. The treatment protocol involved extraction of all the supernumerary and deciduous teeth, surgical exposure and orthodontic traction of the impacted teeth, a bimaxillary orthognathic approach including Lefort I osteotomy. Bilateral sagittal split ramus osteotomy (BSSRO) and genioplasty was performed to correct skeletal problem. After treatment, all of the impacted teeth were brought to proper alignment in the maxillary arch. A satisfied profile and good posterior occlusion was achieved. Treatment mechanics and consideration during different stages are discussed.

  10. How Managers Can Benefit from Multiple Perspectives on Design Management

    DEFF Research Database (Denmark)

    Gasparin, Marta; Christiansen, John K.

    Operations management should be more concerned with the relationship to design and how the interplay between design processes and operations can be managed. The design of products and services has huge implications on operations in different ways: Design can increase the value of products......; influence and lead to innovation of manufacturing processes; implications for the supply chain processes and has implications on the life cycle of products and sustainability issues. To fully exploit the opportunities, we claim that it's useful for managers to be aware of the different ways that design...... processes might be perceived and managed. Illustrated with examples....

  11. Managing large online classes across multiple locations.

    Science.gov (United States)

    Egea, Kathy; Zelmer, A C Lynn

    2004-01-01

    We now have many different ways of delivering educational offerings, hopefully tailored to the educational environments and student characteristics. Programs vary based on country of origin and delivery location, organisational structures, development and delivery technologies, and the business arrangements made between providers and agents/students. At Central Queensland University (CQU) we deliver the same courses domestically and internationally, often with more than 1000 students per offering, several times per year across 14 campuses located thousands of kilometers apart using face-to-face and/or virtual mode. The students are a mix of Australian distance and on campus plus international on campus. This chapter builds on the CQU experience managing these large classes, particularly within the Faculty of Informatics and Communication, using an evolving mix of technologies. The economic realities of tertiary education require providers to focus on servicing international markets, including an emphasis on student preferences for language of instruction, preferred location (campus or distance delivery) and mode of instruction. Educational delivery requires development and delivery teamwork, maintenance of consistency (quality) in terms of offerings and assessment, appropriate use of technology and cultural awareness.

  12. Detecting bony infiltrates in patients with multiple myeloma – Is there a role for computered tomography (CT) as an alternative to the radiographic skeletal survey?

    International Nuclear Information System (INIS)

    Field, L.J.; Clarke, R.

    2013-01-01

    Using 2 case studies, the aim of this article is to discuss if there is a role for the computed tomography (CT) skeletal survey in patients with multiple myeloma. CT has increased sensitivity and demonstrates an ability to characterise trabecular anatomy in difficult areas such as scapulae, ribs and sternum, compared with conventional radiography. It also allows differentiation between benign and pathological compression fractures, and is superior in estimating fracture risk. Other advantages of CT include demonstration of unsuspected associated pathology such as lung disease, soft tissue and visceral masses and identifying suitable biopsy sites, detection of small osteolytic lesions, multiplanar reconstructions, radiotherapy planning and surgical intervention, shorter examination time, no repositioning of the patient and therefore increased patient comfort. CT has previously been associated with increased radiation dose with careful selection of the exposure parameters the effective radiation dose can be comparable to that of conventional radiography. These case studies and examples of scanning techniques will demonstrate that whole body low dose multidetector CT is a viable alternative to the skeletal survey in patients with multiple myeloma and bone pain

  13. Multiple Challenges of Flexible Workforce Management: the contract managers experience

    Directory of Open Access Journals (Sweden)

    Yana Torres de Magalhães

    2010-07-01

    Full Text Available This article presents the results of a survey that had the purpose to evaluate the human resources (HR practices adopted by a Brazilian industrial corporation from the viewpoint of contracting out managers to deal with four flexible workforce management challenges: qualification; quality; commitment; standardization of outsourcing services. These HR practices are still little discussed by scholars. So, this is the main contribution of this article. It is also virtually nonexistent in the literature studies that encompass analysis about HR practices to deal with major challenges of outsourcing throughout the viewpoint of contracting out managers. We performed 15 semi-structured interviews with contracting out managers. It was also performed a documental analysis about the rules of outsourcing practices of the corporation. We found management practices to deal with each of the four challenges presented. The management of contracts and the provision of training programs were the most prominent of the related practices. The results show that Brazillian labor laws contribute to the segregation of temporary workers, because the companies avoid a more direct relationship fearing legal constraints. Although several efforts were put to improve the work conditions of the flexible workforce, these workers are still stigmatized, seen and treated as less important than direct employers; this causes negative impacts on commitment. The decision to use flexible workforce by companies is still mainly due to cost savings. Therefore, there is still a long way to improve HR practices related to temporary workers in order to avoid losses for all the social actors envolved.

  14. Non-surgical Management of Skeletal Class III Malocclusion with Bilateral Posterior Crossbite: A Case Report.

    Science.gov (United States)

    Kumari, Lalima; Nayan, Kamal

    2016-12-01

    A 16-year-old female patient with skeletal Class III malocclusion and bilateral posterior cross bite complaining of difficulty in chewing was treated orthodontically without surgery (camouflage treatment). The treatment comprised of fixed orthodontic treatment with MBT prescription (0.022˝×0.028˝ slot) using quad helix appliance for bilateral expansion of maxillary arch and Class III elastics for occlusal correction. Post-treatment records showed normal overbite and overjet with acceptable occlusion. So with this treatment strategy of expanding the maxillary arch using a quad helix appliance and use of Class III elastics, we achieved a good result with optimal occlusion.

  15. Anaesthetic management of a patient with multiple system atrophy ...

    African Journals Online (AJOL)

    Multiple system atrophy (MSA) is a rare adult-onset neurodegenerative disease. Symptoms vary from autonomic dysfunction to Parkinsonism and cerebellar ataxia, in any combination. MSA affects many organ systems with many possible complications and makes perioperative management of a patient with this condition ...

  16. Evaluation of dairy effluent management options using multiple criteria analysis.

    Science.gov (United States)

    Hajkowicz, Stefan A; Wheeler, Sarah A

    2008-04-01

    This article describes how options for managing dairy effluent on the Lower Murray River in South Australia were evaluated using multiple criteria analysis (MCA). Multiple criteria analysis is a framework for combining multiple environmental, social, and economic objectives in policy decisions. At the time of the study, dairy irrigation in the region was based on flood irrigation which involved returning effluent to the river. The returned water contained nutrients, salts, and microbial contaminants leading to environmental, human health, and tourism impacts. In this study MCA was used to evaluate 11 options against 6 criteria for managing dairy effluent problems. Of the 11 options, the MCA model selected partial rehabilitation of dairy paddocks with the conversion of remaining land to other agriculture. Soon after, the South Australian Government adopted this course of action and is now providing incentives for dairy farmers in the region to upgrade irrigation infrastructure and/or enter alternative industries.

  17. Optimization of landscape services under uncoordinated management by multiple landowners.

    Science.gov (United States)

    Porto, Miguel; Correia, Otília; Beja, Pedro

    2014-01-01

    Landscapes are often patchworks of private properties, where composition and configuration patterns result from cumulative effects of the actions of multiple landowners. Securing the delivery of services in such multi-ownership landscapes is challenging, because it is difficult to assure tight compliance to spatially explicit management rules at the level of individual properties, which may hinder the conservation of critical landscape features. To deal with these constraints, a multi-objective simulation-optimization procedure was developed to select non-spatial management regimes that best meet landscape-level objectives, while accounting for uncoordinated and uncertain response of individual landowners to management rules. Optimization approximates the non-dominated Pareto frontier, combining a multi-objective genetic algorithm and a simulator that forecasts trends in landscape pattern as a function of management rules implemented annually by individual landowners. The procedure was demonstrated with a case study for the optimum scheduling of fuel treatments in cork oak forest landscapes, involving six objectives related to reducing management costs (1), reducing fire risk (3), and protecting biodiversity associated with mid- and late-successional understories (2). There was a trade-off between cost, fire risk and biodiversity objectives, that could be minimized by selecting management regimes involving ca. 60% of landowners clearing the understory at short intervals (around 5 years), and the remaining managing at long intervals (ca. 75 years) or not managing. The optimal management regimes produces a mosaic landscape dominated by stands with herbaceous and low shrub understories, but also with a satisfactory representation of old understories, that was favorable in terms of both fire risk and biodiversity. The simulation-optimization procedure presented can be extended to incorporate a wide range of landscape dynamic processes, management rules and quantifiable

  18. Optimization of landscape services under uncoordinated management by multiple landowners.

    Directory of Open Access Journals (Sweden)

    Miguel Porto

    Full Text Available Landscapes are often patchworks of private properties, where composition and configuration patterns result from cumulative effects of the actions of multiple landowners. Securing the delivery of services in such multi-ownership landscapes is challenging, because it is difficult to assure tight compliance to spatially explicit management rules at the level of individual properties, which may hinder the conservation of critical landscape features. To deal with these constraints, a multi-objective simulation-optimization procedure was developed to select non-spatial management regimes that best meet landscape-level objectives, while accounting for uncoordinated and uncertain response of individual landowners to management rules. Optimization approximates the non-dominated Pareto frontier, combining a multi-objective genetic algorithm and a simulator that forecasts trends in landscape pattern as a function of management rules implemented annually by individual landowners. The procedure was demonstrated with a case study for the optimum scheduling of fuel treatments in cork oak forest landscapes, involving six objectives related to reducing management costs (1, reducing fire risk (3, and protecting biodiversity associated with mid- and late-successional understories (2. There was a trade-off between cost, fire risk and biodiversity objectives, that could be minimized by selecting management regimes involving ca. 60% of landowners clearing the understory at short intervals (around 5 years, and the remaining managing at long intervals (ca. 75 years or not managing. The optimal management regimes produces a mosaic landscape dominated by stands with herbaceous and low shrub understories, but also with a satisfactory representation of old understories, that was favorable in terms of both fire risk and biodiversity. The simulation-optimization procedure presented can be extended to incorporate a wide range of landscape dynamic processes, management rules

  19. Assessing and managing multiple risks in a changing world ...

    Science.gov (United States)

    Roskilde University (Denmark) hosted a November 2015 workshop, Environmental Risk—Assessing and Managing Multiple Risks in a Changing World. This Focus article presents the consensus recommendations of 30 attendees from 9 countries regarding implementation of a common currency (ecosystem services) for holistic environmental risk assessment and management; improvements to risk assessment and management in a complex, human-modified, and changing world; appropriate development of protection goals in a 2-stage process; dealing with societal issues; risk-management information needs; conducting risk assessment of risk management; and development of adaptive and flexible regulatory systems. The authors encourage both cross-disciplinary and interdisciplinary approaches to address their 10 recommendations: 1) adopt ecosystem services as a common currency for risk assessment and management; 2) consider cumulative stressors (chemical and nonchemical) and determine which dominate to best manage and restore ecosystem services; 3) fully integrate risk managers and communities of interest into the risk-assessment process; 4) fully integrate risk assessors and communities of interest into the risk-management process; 5) consider socioeconomics and increased transparency in both risk assessment and risk management; 6) recognize the ethical rights of humans and ecosystems to an adequate level of protection; 7) determine relevant reference conditions and the proper ecological c

  20. IBO Case Report: Management of Skeletal Class III Malocclusion with Combined Rapid Maxillary Expansion: Facemask Therapy and 5-Year Follow-up

    Directory of Open Access Journals (Sweden)

    Ashok Surana

    2012-01-01

    Full Text Available This case report describes the management of skeletal Class III malocclusion with maxillary deficiency in an adolescent girl, using combined rapid maxillary expansion-facemask approach, followed by comprehensive fixed appliance mechanotherapy. Excellent long-term stability is demonstrated up to 5 years post-treatment.

  1. Indian Board of Orthodontics case report: Orthodontic management of vertical excess using skeletal anchorage

    Directory of Open Access Journals (Sweden)

    Ajit J Kalia

    2016-01-01

    Full Text Available B.B., a 21-year-old girl, presented with the chief complaint of forwardly placed upper front teeth and gummy smile. Diagnosis revealed prognathic maxilla and average mandible, Class II skeletal base with vertical growth pattern, end-on molars and Class II canine relationship bilaterally, convex profile, potentially incompetent lips, gummy smile, and protrusive lower lip. The patient′s treatment plan was extraction of all first bicuspids and retraction using temporary anchorage devices. Anchorage was reinforced using microimplants in the maxillary arch and second molar banding in the mandibular arch. The implants were placed high up in the vestibule to have more of an intrusive component and to reduce gummy smile at the end of the treatment.

  2. Smart Energy Management of Multiple Full Cell Powered Applications

    Energy Technology Data Exchange (ETDEWEB)

    Mohammad S. Alam

    2007-04-23

    In this research project the University of South Alabama research team has been investigating smart energy management and control of multiple fuel cell power sources when subjected to varying demands of electrical and thermal loads together with demands of hydrogen production. This research has focused on finding the optimal schedule of the multiple fuel cell power plants in terms of electric, thermal and hydrogen energy. The optimal schedule is expected to yield the lowest operating cost. Our team is also investigating the possibility of generating hydrogen using photoelectrochemical (PEC) solar cells through finding materials for efficient light harvesting photoanodes. The goal is to develop an efficient and cost effective PEC solar cell system for direct electrolysis of water. In addition, models for hydrogen production, purification, and storage will be developed. The results obtained and the data collected will be then used to develop a smart energy management algorithm whose function is to maximize energy conservation within a managed set of appliances, thereby lowering O/M costs of the Fuel Cell power plant (FCPP), and allowing more hydrogen generation opportunities. The Smart Energy Management and Control (SEMaC) software, developed earlier, controls electrical loads in an individual home to achieve load management objectives such that the total power consumption of a typical residential home remains below the available power generated from a fuel cell. In this project, the research team will leverage the SEMaC algorithm developed earlier to create a neighborhood level control system.

  3. "Managed competition" for Ireland? The single versus multiple payer debate.

    LENUS (Irish Health Repository)

    Mikkers, Misja

    2014-09-01

    A persistent feature of international health policy debate is whether a single-payer or multiple-payer system can offer superior performance. In Ireland, a major reform proposal is the introduction of \\'managed competition\\' based on the recent reforms in the Netherlands, which would replace many functions of Ireland\\'s public payer with a system of competing health insurers from 2016. This article debates whether Ireland meets the preconditions for effective managed competition, and whether the government should implement the reform according to its stated timeline. We support our arguments by discussing the functioning of the Dutch and Irish systems.

  4. Managing Multiple Forms of Employment in the Construction Sector

    DEFF Research Database (Denmark)

    Raja, Jawwad; D. Green, Stuart; Leiringer, Roine

    2013-01-01

    different contracting arrangements impinge on attempts to reposition human resource management (HRM) as a strategic function along the business partnering model. Elevating the role of the HR function is found to be difficult to reconcile with the concurrent demands of managing multiple forms of employment......The construction industry is one of the largest and most complex industrial sectors in the UK. The industry's failure to adopt progressive human resource (HR) practices is routinely blamed on the challenges of operating in a fragmented, project-based environment reliant on subcontracting...

  5. Surgical Management of Multiple Valve Endocarditis Associated with Dialysis Catheter

    Directory of Open Access Journals (Sweden)

    R. Zea-Vera

    2016-01-01

    Full Text Available Endocarditis associated with dialysis catheter is a disease that must be suspected in every patient with hemodialysis who develops fever. Multiple valve disease is a severe complication of endocarditis that needs to be managed in a different way. There is very limited data for treatment and every case must be considered individually. We present a patient with this complication and describe the medical treatment and surgical management. We report the case of a 15-year-old patient with acute renal failure that develops trivalvular endocarditis after the hemodialysis catheter was placed, with multiple positive blood culture for Staphylococcus aureus. Transesophageal echocardiography was done and aortic and tricuspid valvular vegetations and mitral insufficiency were reported. Patient was successfully treated by surgery on the three valves, including aortic valve replacement. There is limited data about the appropriate treatment for multiple valvular endocarditis; it is important to consider this complication in the setting of hemodialysis patients that develop endocarditis and, despite the appropriate treatment, have a torpid evolution. In countries where endovenous drug abuse is uncommon, right sided endocarditis is commonly associated with vascular catheters. Aggressive surgical management should be the treatment of choice in these kinds of patients.

  6. Reconstruction of Multiple Facial Nerve Branches Using Skeletal Muscle-Derived Multipotent Stem Cell Sheet-Pellet Transplantation.

    Science.gov (United States)

    Saito, Kosuke; Tamaki, Tetsuro; Hirata, Maki; Hashimoto, Hiroyuki; Nakazato, Kenei; Nakajima, Nobuyuki; Kazuno, Akihito; Sakai, Akihiro; Iida, Masahiro; Okami, Kenji

    2015-01-01

    Head and neck cancer is often diagnosed at advanced stages, and surgical resection with wide margins is generally indicated, despite this treatment being associated with poor postoperative quality of life (QOL). We have previously reported on the therapeutic effects of skeletal muscle-derived multipotent stem cells (Sk-MSCs), which exert reconstitution capacity for muscle-nerve-blood vessel units. Recently, we further developed a 3D patch-transplantation system using Sk-MSC sheet-pellets. The aim of this study is the application of the 3D Sk-MSC transplantation system to the reconstitution of facial complex nerve-vascular networks after severe damage. Mouse experiments were performed for histological analysis and rats were used for functional examinations. The Sk-MSC sheet-pellets were prepared from GFP-Tg mice and SD rats, and were transplanted into the facial resection model (ST). Culture medium was transplanted as a control (NT). In the mouse experiment, facial-nerve-palsy (FNP) scoring was performed weekly during the recovery period, and immunohistochemistry was used for the evaluation of histological recovery after 8 weeks. In rats, contractility of facial muscles was measured via electrical stimulation of facial nerves root, as the marker of total functional recovery at 8 weeks after transplantation. The ST-group showed significantly higher FNP (about three fold) scores when compared to the NT-group after 2-8 weeks. Similarly, significant functional recovery of whisker movement muscles was confirmed in the ST-group at 8 weeks after transplantation. In addition, engrafted GFP+ cells formed complex branches of nerve-vascular networks, with differentiation into Schwann cells and perineurial/endoneurial cells, as well as vascular endothelial and smooth muscle cells. Thus, Sk-MSC sheet-pellet transplantation is potentially useful for functional reconstitution therapy of large defects in facial nerve-vascular networks.

  7. Reconstruction of Multiple Facial Nerve Branches Using Skeletal Muscle-Derived Multipotent Stem Cell Sheet-Pellet Transplantation.

    Directory of Open Access Journals (Sweden)

    Kosuke Saito

    Full Text Available Head and neck cancer is often diagnosed at advanced stages, and surgical resection with wide margins is generally indicated, despite this treatment being associated with poor postoperative quality of life (QOL. We have previously reported on the therapeutic effects of skeletal muscle-derived multipotent stem cells (Sk-MSCs, which exert reconstitution capacity for muscle-nerve-blood vessel units. Recently, we further developed a 3D patch-transplantation system using Sk-MSC sheet-pellets. The aim of this study is the application of the 3D Sk-MSC transplantation system to the reconstitution of facial complex nerve-vascular networks after severe damage. Mouse experiments were performed for histological analysis and rats were used for functional examinations. The Sk-MSC sheet-pellets were prepared from GFP-Tg mice and SD rats, and were transplanted into the facial resection model (ST. Culture medium was transplanted as a control (NT. In the mouse experiment, facial-nerve-palsy (FNP scoring was performed weekly during the recovery period, and immunohistochemistry was used for the evaluation of histological recovery after 8 weeks. In rats, contractility of facial muscles was measured via electrical stimulation of facial nerves root, as the marker of total functional recovery at 8 weeks after transplantation. The ST-group showed significantly higher FNP (about three fold scores when compared to the NT-group after 2-8 weeks. Similarly, significant functional recovery of whisker movement muscles was confirmed in the ST-group at 8 weeks after transplantation. In addition, engrafted GFP+ cells formed complex branches of nerve-vascular networks, with differentiation into Schwann cells and perineurial/endoneurial cells, as well as vascular endothelial and smooth muscle cells. Thus, Sk-MSC sheet-pellet transplantation is potentially useful for functional reconstitution therapy of large defects in facial nerve-vascular networks.

  8. The role of information system in multiple sclerosis management.

    Science.gov (United States)

    Ajami, Sima; Ahmadi, Golchehreh; Etemadifar, Masoud

    2014-12-01

    Multiple sclerosis (MS) is a chronic disease of central nervous system. The multiple sclerosis information system (MSIS), such as other information system (IS), depends on identification, collection and processing of data for producing useful information. Lack of the integrated IS for collecting standard data causes undesirable effects on exchanging, comparing, and managing. The aim of this study was to recognize the role of the IS in the MS management and determine the advantages and barriers in implementing of the MSIS. The present study was a nonsystematized review that was done in order to recognize the role of the IS in the MS management. In this study, electronic scientific resources such as scientific magazines and books and published topics at conferences were used. We used key words (IS, chronic disease management, and multiple sclerosis), their combination or their synonyms in title, key words, abstracts, and text of English articles and published reports from 1980 until 2013, and by using search engines such as Google, Google Scholar and scientific databases and electronic issues such as iPubMed, sufficiently important difference, Scopus, Medlib, and Magiran for gathering information. More than 200 articles and reports were collected and assessed and 139 of them. Findings showed that the MSIS can reduce of disease expenses through continuously collecting correct, accurate, sufficient, and timely patients and disease nature information; recoding; editing; processing; exchanging, and distributing among different health care centers. Although the MSIS has many advantages; but, we cannot ignore cultural, economic, technical, organizational, and managerial barriers. Therefore, it is necessary to do studies for preventing, reducing, and controlling them. One of the ways is to recognize the advantages of the MSIS and usage information technology in optimizing disease management.

  9. Androgen effects on skeletal muscle: implications for the development and management of frailty

    Directory of Open Access Journals (Sweden)

    Matthew DL O'Connell

    2014-04-01

    Full Text Available Androgens have potent anabolic effects on skeletal muscle and decline with age in parallel to losses in muscle mass and strength. This loss of muscle mass and function, known as sarcopenia, is the central event in development of frailty, the vulnerable health status that presages adverse outcomes and rapid functional decline in older adults. The potential role of falling androgen levels in the development of frailty and their utility as function promoting therapies in older men has therefore attracted considerable attention. This review summarizes current concepts and definitions in muscle ageing, sarcopenia and frailty, and evaluates recent developments in the study of androgens and frailty. Current evidence from observational and interventional studies strongly supports an effect of androgens on muscle mass in ageing men, but effects on muscle strength and particularly physical function have been less clear. Androgen treatment has been generally well-tolerated in studies of older men, but concerns remain over higher dose treatments and use in populations with high cardiovascular risk. The first trials of selective androgen receptor modulators (SARMs suggest similar effects on muscle mass and function to traditional androgen therapies in older adults. Important future directions include the use of these agents in combination with exercise training to promote functional ability across different populations of older adults, as well as more focus on the relationships between concurrent changes in hormone levels, body composition and physical function in observational studies.

  10. Biomarkers that Discriminate Multiple Myeloma Patients with or without Skeletal Involvement Detected Using SELDI-TOF Mass Spectrometry and Statistical and Machine Learning Tools

    Directory of Open Access Journals (Sweden)

    Sudeepa Bhattacharyya

    2006-01-01

    Full Text Available Multiple Myeloma (MM is a severely debilitating neoplastic disease of B cell origin, with the primary source of morbidity and mortality associated with unrestrained bone destruction. Surface enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS was used to screen for potential biomarkers indicative of skeletal involvement in patients with MM. Serum samples from 48 MM patients, 24 with more than three bone lesions and 24 with no evidence of bone lesions were fractionated and analyzed in duplicate using copper ion loaded immobilized metal affinity SELDI chip arrays. The spectra obtained were compiled, normalized, and mass peaks with mass-to-charge ratios (m/z between 2000 and 20,000 Da identified. Peak information from all fractions was combined together and analyzed using univariate statistics, as well as a linear, partial least squares discriminant analysis (PLS-DA, and a non-linear, random forest (RF, classification algorithm. The PLS-DA model resulted in prediction accuracy between 96–100%, while the RF model was able to achieve a specificity and sensitivity of 87.5% each. Both models as well as multiple comparison adjusted univariate analysis identified a set of four peaks that were the most discriminating between the two groups of patients and hold promise as potential biomarkers for future diagnostic and/or therapeutic purposes.

  11. A framework for assessing hydrogen management strategies involving multiple decisions

    International Nuclear Information System (INIS)

    Lee, S.D.; Suh, K.Y.; Park, G.C.; Jae, M.

    2000-01-01

    An accident management framework consisting of multiple and sequential decisions is developed and applied to a hydrogen control strategy for a reference plant. The compact influence diagrams including multiple decisions are constructed and evaluated with MAAP4 calculations. Each decision variable, represented by a node in the influence diagrams, has an uncertainty distribution. Using the values from the IPE (Individual Plant Examinations) report for the reference plant (UCN 3 and 4), the hydrogen control and accident management strategies are assessed. In this paper, a problem with two decisions is modeled for a simple illustration of the process involved. One decision is whether or not to actuate igniters at the time of core uncovery. Another decision is whether or not to turn on the containment sprays. We chose a small-break loss-of-coolant accident (LOCA) sequence, which was one of the dominant accident sequences in the reference plant. The framework involves the modeling of the decision problem by using decision-making tools, data analysis, and the MAAP4 calculations. It is shown that the proposed framework with a new measure for assessing hydrogen control is flexible enough to be applied to various accident management strategies. (author)

  12. Perioperative management of patient with alkaptonuria and associated multiple comorbidities

    Directory of Open Access Journals (Sweden)

    Ravindra Pandey

    2011-01-01

    Full Text Available Alkaptonuria is a rare inherited genetic disorder of tyrosine metabolism characterized by a triad of homogentisic aciduria, ochronosis, and arthritis. The most common clinical manifestations of ochronosis involve the musculoskeletal, respiratory, airway, cardiovascular, genitourinary, cutaneous, and ocular systems. We report the perioperative anesthetic management of a 56-year-old alkaptonuric patient, with multiple comorbidities scheduled, for revision total hip replacement. A review of her medical history revealed alkaptonuria, hypothyroidism, rheumatoid arthritis, hypertension, diabetes mellitus, and Pott′s spine with disc prolapse. We want to highlight the need of thorough preoperative evaluation in patients of alkaptonuria, as it is associated with multiple comorbidities. The systemic involvement should determine the anesthetic plan. Caution should be exercised during positioning to prevent injury to the joints and the spine.

  13. MACSIMS : multiple alignment of complete sequences information management system

    Directory of Open Access Journals (Sweden)

    Plewniak Frédéric

    2006-06-01

    Full Text Available Abstract Background In the post-genomic era, systems-level studies are being performed that seek to explain complex biological systems by integrating diverse resources from fields such as genomics, proteomics or transcriptomics. New information management systems are now needed for the collection, validation and analysis of the vast amount of heterogeneous data available. Multiple alignments of complete sequences provide an ideal environment for the integration of this information in the context of the protein family. Results MACSIMS is a multiple alignment-based information management program that combines the advantages of both knowledge-based and ab initio sequence analysis methods. Structural and functional information is retrieved automatically from the public databases. In the multiple alignment, homologous regions are identified and the retrieved data is evaluated and propagated from known to unknown sequences with these reliable regions. In a large-scale evaluation, the specificity of the propagated sequence features is estimated to be >99%, i.e. very few false positive predictions are made. MACSIMS is then used to characterise mutations in a test set of 100 proteins that are known to be involved in human genetic diseases. The number of sequence features associated with these proteins was increased by 60%, compared to the features available in the public databases. An XML format output file allows automatic parsing of the MACSIM results, while a graphical display using the JalView program allows manual analysis. Conclusion MACSIMS is a new information management system that incorporates detailed analyses of protein families at the structural, functional and evolutionary levels. MACSIMS thus provides a unique environment that facilitates knowledge extraction and the presentation of the most pertinent information to the biologist. A web server and the source code are available at http://bips.u-strasbg.fr/MACSIMS/.

  14. Tc-99m MIBI imaging for secondary skeletal involvement in breast and prostate cancers and multiple myeloma

    International Nuclear Information System (INIS)

    Zehra, F.; Haq, S.; Fatmi, S.; Safaqat, S.

    2004-01-01

    Objective:The Objective of the study was to evaluate the role of Tc-99m MIBI whole body imaging in assessing secondary osseous involvement in patients with malignancy of breast, prostate or multiple myeloma. In this study a total of 41 patients were included. Out of these 18 had breast carcinoma, 12 had prostate carcinoma and 11 were diagnosed cases of multiple myeloma. All patients had their whole body MIBI imaging done which was compared with MDP bone scan by employing some other diagnostic modality (plain radiographs, CT scan, MRI scan or histopathological evidence) to confirm the lesions detected by either of the scans. The results of all the studies were evaluated qualitatively by assessing the number of lesions visually by three experienced nuclear physicians. Quantitative analysis of the lesions was also done, by calculating the lesion to normal uptake ratio, to augment the findings of visual assessment and for statistical analysis. Results: Results obtained in this study by MIBI and MDP imaging varied significantly among different groups and subgroups of patients depending on the primary malignancy and stage of therapy. However results obtained by imaging of patients within a group and subgroup were consistent with each other. MIBI scan showed a sensitivity of 99% in cases of multiple myeloma, where MDP scan was only 16% sensitive. In case of pre-therapy patients of breast and prostate carcinoma, the sensitivity of MIBI scan came out to be 80% and 74% respectively. In patients who were on chemo/radiotherapy MIBI scan was 54% sensitive in patients with breast carcinoma and 38% sensitive in patients with prostate carcinoma. MDP scan showed a sensitivity of 100% in all the groups. The positive predictive value of MIBI scan came out to be 100% but that of MDP was 42-76% in different groups. It is therefore concluded that the most significant role of MIBI imaging is in detection of bone metastases secondary to breast and prostate carcinoma in pre

  15. Recovery of multiple impacted maxillary teeth in a hyperdivergent Class I patient using Temporary Skeletal Anchorage Devices and augmented corticotomy.

    Science.gov (United States)

    Kim, Kyung A; Hwang, Hyeon-Shik; Chung, Kyu-Rhim; Kim, Seong-Hun; Nelson, Gerald

    2018-01-01

    Treatment of multiple impacted teeth is challenging. Three-dimensional treatment planning can help in delivering a better outcome. This case report presents a patient with an incomplete dental transposition between the canine and lateral incisor of the maxillary right side associated with the impaction of a dilacerated right central incisor. Using a two-stage surgical exposure and augmented corticotomy, the patient's occlusion and smile esthetics were significantly improved, and Class I occlusal relationships with optimal overjet and overbite were achieved after 50 months of orthodontic treatment. Thirty-month posttreatment records revealed a stable result.

  16. Surgical management of complete penile duplication accompanied by multiple anomalies.

    Science.gov (United States)

    Karaca, Irfan; Turk, Erdal; Ucan, A Basak; Yayla, Derya; Itirli, Gulcin; Ercal, Derya

    2014-09-01

    Diphallus (penile duplication) is very rare and seen once every 5.5 million births. It can be isolated, but is usually accompanied by other congenital anomalies. Previous studies have reported many concurrent anomalies, such as bladder extrophy, cloacal extrophy, duplicated bladder, scrotal abnormalities, hypospadias, separated symphysis pubis, intestinal anomalies and imperforate anus; no penile duplication case accompanied by omphalocele has been reported. We present the surgical management of a patient with multiple anomalies, including complete penile duplication, hypo-gastric omphalocele and extrophic rectal duplication.

  17. Multiple Wins, Multiple Organizations—How to Manage Institutional Interaction in Financing Forest Landscape Restoration (FLR

    Directory of Open Access Journals (Sweden)

    Astrid Carrapatoso

    2018-03-01

    Full Text Available By restoring forest ecosystems and fostering resilient and sustainable land use practices, Forest Landscape Restoration (FLR contributes to climate change mitigation, adaptation and sustainable development as well as the protection of biological diversity and combating desertification. This integrative approach provides the opportunity for multiple wins, but it necessitates the management of complex institutional interactions arising from the involvement of multiple international organizations. Focusing on the pivotal aspect of financing, this article surveys the landscape of public international institutions supporting FLR and analyzes the effectiveness of existing mechanisms of inter-institutional coordination and harmonization. Methodologically, our research is based on a document analysis, complemented by participant observation of the two Bonn Climate Change Conferences in May and November 2017 as well as the Global Landscapes Forum in December 2017. We find that financial institutions have established fairly effective rules for the management of positive and negative externalities through the introduction of co-benefits and safeguards. The fact that each institution has their own safeguards provisions, however, leads to significant transaction costs for recipient countries. In the discussion, we thus recommend that institutions should refrain from an unnecessary duplication of standards and focus on best practice.

  18. Multiple Sclerosis Relapses: Epidemiology, Outcomes and Management. A Systematic Review.

    Science.gov (United States)

    Kalincik, Tomas

    2015-01-01

    Relapses (episodic exacerbations of neurological signs or symptoms) are a defining feature of relapsing-remitting multiple sclerosis (MS), the most prevalent MS phenotype. While their diagnostic value relates predominantly to the definition of clinically definite MS, their prognostic value is determined by their relatively high associated risk of incomplete remission resulting in residual disability. The mechanisms governing a relapse incidence are unknown, but numerous modifiers of relapse risk have been described, including demographic and clinical characteristics, many of which represent opportunities for improved disease management. Also relapse phenotypes have been associated with patient and disease characteristics and an individual predisposition to certain phenotypic presentations may imply individual neuroanatomical disease patterns. While immunomodulatory therapies and corticosteroids represent the mainstay of relapse prevention and acute management, respectively, their effect has only been partial and further search for more efficient relapse therapies is warranted. Other areas of research include pathophysiology and determinants of relapse incidence, recurrence and phenotypes, including the characteristics of the relapsing and non-relapsing multiple sclerosis variants and their responsiveness to therapies. © 2015 S. Karger AG, Basel.

  19. Meditation as an Adjunct to the Management of Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Adam B. Levin

    2014-01-01

    Full Text Available Background. Multiple sclerosis (MS disease course is known to be adversely affected by several factors including stress. A proposed mechanism for decreasing stress and therefore decreasing MS morbidity and improving quality of life is meditation. This review aims to critically analyse the current literature regarding meditation and MS. Methods. Four major databases were used to search for English language papers published before March 2014 with the terms MS, multiple sclerosis, meditation, and mindfulness. Results. 12 pieces of primary literature fitting the selection criteria were selected: two were randomised controlled studies, four were cohort studies, and six were surveys. The current literature varies in quality; however common positive effects of meditation include improved quality of life (QOL and improved coping skills. Conclusion. All studies suggest possible benefit to the use of meditation as an adjunct to the management of multiple sclerosis. Additional rigorous clinical trials are required to validate the existing findings and determine if meditation has an impact on disease course over time.

  20. [Multiple sclerosis management system 3D. Moving from documentation towards management of patients].

    Science.gov (United States)

    Schultheiss, T; Kempcke, R; Kratzsch, F; Eulitz, M; Pette, M; Reichmann, H; Ziemssen, T

    2012-04-01

    The increasing therapeutic options for relapsing-remitting multiple sclerosis require a specific treatment and risk management to recognize the individual response as well as potential side effects. To switch from pure MS documentation to MS management by implementing a new multiple sclerosis management and documentation tool may be of importance. This article presents the novel computer-based patient management system "multiple sclerosis management system 3D" (MSDS 3D). MSDS 3D allows documentation and visualization of visit schedules and mandatory examinations via defined study modules by integration of data input from patients, attending physicians and MS nurses. It provides forms for the documentation of patient visits as well as clinical and diagnostic findings. Information is collected via interactive touch screens. A specific module which is part of MSDS 3D's current version allows the monthly monitoring of patients under treatment with natalizumab. A checklist covering clinical signs of progressive multifocal leukoencephalopathy (PML) and a detailed questionnaire about the handling of natalizumab in practice have additionally been added. The MS patient management system MSDS 3D has successfully been implemented and is currently being evaluated in a multi-centre setting. Advanced assessment of patient data may allow improvements in clinical practice and research work. The addition of a checklist and a questionnaire into the natalizumab module may support the recognition of PML during its early, treatable course.

  1. LSN MS guidelines for the management of multiple sclerosis.

    Science.gov (United States)

    Shatila, A R; Koussa, S; Jabbour, R; Mourad, A; Aouad, A; Sabbagh, G; Kallab, K; Hilal, R; Khalifeh, R; Gebeily, S; Tourbah, A

    2013-12-01

    The prevalence of multiple sclerosis (MS) in Lebanon is unknown, as there are no available or reliable epidemiological studies to date. The circumstances of Middle East countries are different from those of Europe and North America in terms of differential diagnoses and disease management. The aim of the conference is to establish guidelines for diagnosis, treatment, follow-up and management of patients with MS in Lebanon. Another objective is to discuss and participate in research projects based on epidemiology, clinical trials and more fundamental aspects of the disease in the future. Under the authority of the Lebanese Society of Neurology (LSN), a group of neurologists took the initiative to participate in this LSN MS committee with the purpose of establishing a consensus for the management of patients with MS, and under the supervision of a Coordinator (A.T.) designed by the LSN board. Diagnostic and therapeutic, follow-up and research recommendations were proposed with special emphasis on the specific needs and circumstances of Lebanon. The experts highlighted the importance of considering particular needs, the identification of patients at high risk of developing MS in order to maximize therapeutic opportunities, and cost-effective control of treatment efficacy, as well as global assessment of disability. The experts established guidelines concerning diagnosis, treatment, and follow-up of patients with MS in Lebanon. Furthermore, they recommended some clinical and fundamental research projects. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  2. Advances in the management of multiple sclerosis symptoms: pathophysiology and assessment of spasticity in multiple sclerosis.

    Science.gov (United States)

    Tintoré, Mar

    2015-01-01

    Spasticity is a prevalent and troublesome symptom for people with multiple sclerosis (MS). Common instruments to measure MS spasticity include the clinician-rated (modified) Ashworth scale and the patient-rated 0-10 spasticity Numerical Rating Scale (NRS). Current opinion is that measurement of MS spasticity should incorporate the patient's perspective. Other instruments to assess spasticity-associated symptoms such as the Penn spasms frequency scale, sleep quality NRS and pain NRS can assist in tracking MS spasticity evolution and inform management choices. Worsening spasticity reduces patient autonomy, impacts negatively on quality of life and increases health resource utilization and costs. Despite the wide range of issues associated with MS spasticity, undertreatment is common and standard treatment options (physiotherapy and classical oral therapies) often fail to provide adequate symptomatic control.

  3. Safety concerns and risk management of multiple sclerosis therapies

    DEFF Research Database (Denmark)

    Soelberg Sorensen, P.

    2017-01-01

    Currently, more than ten drugs have been approved for treatment of relapsing-remitting multiple sclerosis (MS). Newer treatments may be more effective, but have less favorable safety record. Interferon-β preparations and glatiramer acetate treatment require frequent subcutaneous or intramuscular...... disease activity can choose between dimethyl fumarate and teriflunomide or the “old injectable.” Patients with very active MS may choose a more effective drug as the initial treatment. In case of side effects on one drug, switch to another drug can be tried. Suboptimal effect of the first drug indicates...... escalation to a highly efficacious drug. A favorable benefit-risk balance can be maintained by appropriate patient selection and appropriate risk management on therapy. New treatments will within the coming 1-2 years change our current treatment algorithm for relapsing-remitting MS....

  4. Software Configuration Management For Multiple Releases: Influence On Development Effort

    Directory of Open Access Journals (Sweden)

    Sławomir P. Maludziński

    2007-01-01

    Full Text Available Software Configuration Management (SCM evolves together with the discipline of softwareengineering. Teams working on software products become larger and are geographically distributedat multiple sites. Collaboration between such groups requires well evaluated SCMplans and strategies to easy cooperation and decrease software development cost by reducingtime spent on SCM activities – branching and merging, that is effort utilized on creation ofrevisions (’serial’ versions and variants (’parallel’ versions. This paper suggests that SCMpractices should be combined with modular design and code refactoring to reduce cost relatedto maintenance of the same code line. Teams which produce several variants of thesame code line at the same time should use approaches like components, modularization, orplug-ins over code alternations maintained on version branches. Findings described in thispaper were taken by teams in charge of development of radio communication systems inMotorola GEMS divisions. Each team collaborating on similar projects used different SCMstrategies to develop parts of this system.

  5. Sleep Management on Multiple Machines for Energy and Flow Time

    DEFF Research Database (Denmark)

    Chan, Sze-Hang; Lam, Tak-Wah; Lee, Lap Kei

    2011-01-01

    In large data centers, determining the right number of operating machines is often non-trivial, especially when the workload is unpredictable. Using too many machines would waste energy, while using too few would affect the performance. This paper extends the traditional study of online flow-time...... scheduling on multiple machines to take sleep management and energy into consideration. Specifically, we study online algorithms that can determine dynamically when and which subset of machines should wake up (or sleep), and how jobs are dispatched and scheduled. We consider schedules whose objective...... is to minimize the sum of flow time and energy, and obtain O(1)-competitive algorithms for two settings: one assumes machines running at a fixed speed, and the other allows dynamic speed scaling to further optimize energy usage. Like the previous work on the tradeoff between flow time and energy, the analysis...

  6. Economic and clinical impact of multiple myeloma to managed care.

    Science.gov (United States)

    Cook, Richard

    2008-09-01

    Because of the development of novel agents such as immunomodulators, proteasome inhibitors, and bisphosphonates, the standards of care for the multiple myeloma (MM) patient have changed. The costs associated with current and emerging therapies, as well as supportive care, are significant and pose a tremendous financial burden to both patients and managed care. To review the economic impact of MM and to weigh the advantages and disadvantages of current treatments in bringing value for prolonged life versus the cost of treatment. This chapter will also discuss the need for thorough data review and pharmacoeconomic analyses to determine the most cost-effective therapies. Although MM accounts for only a small percentage of all cancer types, the costs associated with treating and managing it are among the highest. Recent developments in diagnosing, treating, and managing myeloma have led to novel treatment strategies. Immunomodulators, proteasome inhibitors, and bisphosphonates are improving response rates and preserving quality of life. However, these agents are not replacing older treatment modalities, but being used in addition to them. Intensive chemotherapy, stem cell transplantation, and supportive care are all important components in achieving treatment goals. Costs associated with stem cell transplants and complications of the disease add to the economic burden of myeloma. Additional costs for routine diagnostics to measure the progression of the disease or response to treatment need to be considered. Complications (e.g., lytic bone disease, infection, anemia, and renal failure) also add to morbidity and mortality, thus increasing the burden to the patient and the health care system as a whole. Financial and time constraints of caregivers must also be considered, as well as the added administrative burdens to health care providers. New standards of care in the treatment and management of myeloma are likely to lead to significant increases in costs. Although

  7. Diagnostic radiology on multiple injured patients: interdisciplinary management

    International Nuclear Information System (INIS)

    Linsenmaier, U.; Pfeifer, K.J.; Kanz, K.G.; Mutschler, W.

    2001-01-01

    The presence of a radiologist within the admitting area of an emergency department and his capability as a member of the trauma team have a major impact on the role of diagnostic radiology in trauma care. The knowledge of clinical decision criteria, algorithms, and standards of patient care are essential for the acceptance within a trauma team. We present an interdisciplinary management concept of diagnostic radiology for trauma patients, which comprises basic diagnosis, organ diagnosis, radiological ABC, and algorithms of early clinical care. It is the result of a prospective study comprising over 2000 documented multiple injured patients. The radiologist on a trauma team should support trauma surgery and anesthesia in diagnostic and clinical work-up. The radiological ABC provides a structured approach for diagnostic imaging in all steps of the early clinical care of the multiple injured patient. Radiological ABC requires a reevaluation in cases of equivocal findings or difficulties in the clinical course. Direct communication of radiological findings with the trauma team enables quick clinical decisions. In addition, the radiologist can priority-oriented influence the therapy by using interventional procedures. The clinical radiologist is an active member of the interdisciplinary trauma team, not only providing diagnostic imaging but also participating in clinical decisions. (orig.) [de

  8. Cannabinoids in the management of spasticity associated with multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Anna Maria Malfitano

    2008-08-01

    Full Text Available Anna Maria Malfitano, Maria Chiara Proto, Maurizio BifulcoDipartimento di Scienze Farmaceutiche, Università degli Studi di SalernoAbstract: The endocannabinoid system and cannabinoid-based treatments have been involved in a wide number of diseases. In particular, several studies suggest that cannabinoids and endocannabinoids may have a key role in the pathogenesis and therapy of multiple sclerosis (MS. In this study we highlight the main findings reported in literature about the relevance of cannabinoid drugs in the management and treatment of MS. An increasing body of evidence suggests that cannabinoids have beneficial effects on the symptoms of MS, including spasticity and pain. In this report we focus on the effects of cannabinoids in the relief of spasticity describing the main findings in vivo, in the mouse experimental allergic encephalomyelitis model of MS. We report on the current treatments used to control MS symptoms and the most recent clinical studies based on cannabinoid treatments, although long-term studies are required to establish whether cannabinoids may have a role beyond symptom amelioration in MS.Keywords: cannabinoids, multiple sclerosis, spasticity

  9. Anesthetic management of a patient with multiple sclerosis - case report

    Directory of Open Access Journals (Sweden)

    Eduardo Barbin Zuccolotto

    Full Text Available Abstract Background and objectives: Multiple sclerosis is a demyelinating disease of the brain and spinal cord, characterized by muscle weakness, cognitive dysfunction, memory loss, and personality disorders. Factors that promote disease exacerbation are stress, physical trauma, infection, surgery, and hyperthermia. The objective is to describe the anesthetic management of a case referred to urological surgery. Case report: A female patient, 44 years of age, with multiple sclerosis, diagnosed with nephrolithiasis, referred for endoscopic ureterolythotripsy. Balanced general anesthesia was chosen, with midazolam, propofol and remifentanil target-controlled infusion; sevoflurane via laryngeal mask airway; and spontaneous ventilation. Because the patient had respiratory difficulty presenting with chest wall rigidity, it was decided to discontinue the infusion of remifentanil. There was no other complication or exacerbation of disease postoperatively. Conclusion: The use of neuromuscular blockers (depolarizing and non-depolarizing is a problem in these patients. As there was no need for muscle relaxation in this case, muscle relaxants were omitted. We conclude that the combination of propofol and sevoflurane was satisfactory, not resulting in hemodynamic instability or disease exacerbation.

  10. Predicting and preventing the future: actively managing multiple sclerosis.

    LENUS (Irish Health Repository)

    Hutchinson, Michael

    2012-02-01

    Relapsing-remitting multiple sclerosis (MS) has a highly variable clinical course but a number of demographic, clinical and MRI features can guide the clinician in the assessment of disease activity and likely disability outcome. It is also clear that the inflammatory activity in the first five years of relapsing-remitting MS results in the neurodegenerative changes seen in secondary progressive MS 10-15 years later. While conventional first-line disease modifying therapy has an effect on relapses, about one third of patients have a suboptimal response to treatment. With the advent of highly active second-line therapies with their evident marked suppression of inflammation, the clinician now has the tools to manage the course of relapsing-remitting MS more effectively. The development of treatment optimisation recommendations based on the clinical response to first-line therapies can guide the neurologist in more active management of the early course of relapsing-remitting MS, with the aim of preventing both acute inflammatory axonal injury and the neurodegenerative process which leads to secondary progressive MS.

  11. Distributed EMPC of multiple microgrids for coordinated stochastic energy management

    International Nuclear Information System (INIS)

    Kou, Peng; Liang, Deliang; Gao, Lin

    2017-01-01

    Highlights: • Reducing the system wide operating cost compared to the no-cooperation energy management strategy. • Maintaining the supply and demand balance within each microgrid. • Handling the uncertainties in both supply and demand. • Converting the stochastic optimization problems to standard quadratic and linear programming problems. • Achieving a good balance between control performance and computationally feasibility. - Abstract: The concept of multi-microgrids has the potential to improve the reliability and economic performance of a distribution system. To realize this potential, a coordination among multiple microgrids is needed. In this context, this paper presents a new distributed economic model predictive control scheme for the coordinated stochastic energy management of multi-microgrids. By optimally coordinating the operation of individual microgrids, this scheme maintains the system-wide supply and demand balance in an economical manner. Based on the probabilistic forecasts of renewable power generation and microgrid load, this scheme effectively handles the uncertainties in both supply and demand. Using the Chebyshev inequality and the Delta method, the corresponding stochastic optimization problems have been converted to quadratic and linear programs. The proposed scheme is evaluated on a large-scale case that includes ten interconnected microgrids. The results indicated that the proposed scheme successfully reduces the system wide operating cost, achieves the supply-demand balance in each microgrid, and brings the energy exchange between DNO and main grid to a predefined trajectory.

  12. Self-presentational persona: simultaneous management of multiple impressions.

    Science.gov (United States)

    Leary, Mark R; Allen, Ashley Batts

    2011-11-01

    Most research on self-presentation has examined how people convey images of themselves on only 1 or 2 dimensions at a time. In everyday interactions, however, people often manage their impressions on several image-relevant dimensions simultaneously. By examining people's self-presentations to several targets across multiple dimensions, these 2 studies offer new insights into the nature of self-presentation and provide a novel paradigm for studying impression management. Results showed that most people rely on a relatively small number of basic self-presentational personas in which they convey particular profiles of impressions as a set and that these personas reflect both normative influences to project images that are appropriate to a particular target and distinctive influences by which people put an idiosyncratic spin on these normative images. Furthermore, although people's self-presentational profiles correlate moderately with their self-views, they tailor their public images to specific targets. The degree to which participants' self-presentations were normative and distinctive, as well as the extent to which they reflected their own self-views, were moderated by individual differences in agreeableness, self-esteem, authenticity, and Machiavellianism.

  13. Airport Managers' Perspectives on Security and Safety Management Systems in Aviation Operations: A Multiple Case Study

    Science.gov (United States)

    Brown, Willie L., Jr.

    Global terrorism continues to persist despite the great efforts of various countries to protect and safely secure their citizens. As airports form the entry and exit ports of a country, they are one of the most vulnerable locations to terror attacks. Managers of international airports constantly face similar challenges in developing and implementing airport security protocols. Consequently, the technological advances of today have brought both positive and negative impacts on security and terrorism of airports, which are mostly managed by the airport managers. The roles of the managers have greatly increased over the years due to technological advances. The developments in technology have had different roles in security, both in countering terrorism and, at the same time, increasing the communication methods of the terrorists. The purpose of this qualitative multiple case study was to investigate the perspectives of airport managers with regard to societal security and social interactions in the socio-technical systems of the National Terrorism Advisory System (NTAS). Through the data gained regarding managers' perception and experiences, the researcher hoped to enable the development of security measures and policies that are appropriate for airports as socio-technical systems. The researcher conducted interviews with airport managers to gather relevant data to fulfill the rationale of the study. Ten to twelve airport managers based in three commercial aviation airports in Maryland, United States participated in the study. The researcher used a qualitative thematic analysis procedure to analyze the data responses of participants in the interview sessions.

  14. Skeletal sarcoidosis; Skelettsarkoidose

    Energy Technology Data Exchange (ETDEWEB)

    Freyschmidt, J. [Klinikum Bremen-Mitte, Beratungsstelle und Referenzzentrum fuer Osteoradiologie, Bremen (Germany); Freyschmidt, P. [Dermatologische Gemeinschaftspraxis, Schwalmstadt (Germany)

    2016-10-15

    Presentation of the etiology, pathology, clinical course, radiology and differential diagnostics of skeletal sarcoidosis. Noncaseating epithelioid cell granulomas can trigger solitary, multiple or disseminated osteolysis, reactive osteosclerosis and/or granulomatous synovitis. The incidence of sarcoidosis is 10-12 per 100,000 inhabitants per year. Skeletal involvement is approximately 14 %. Skeletal involvement occurs almost exclusively in the stage of lymph node and pulmonary manifestation. Most cases of skeletal involvement are clinically asymptomatic. In the case of synovial involvement, unspecific joint complaints (arthralgia) or less commonly arthritis can occur. Typical skin alterations can be diagnostically significant. Punch out lesions osteolysis, coarse destruction and osteosclerosis can occur, which are best visualized with projection radiography and/or computed tomography. Pure bone marrow foci without interaction with the bone can only be detected with magnetic resonance imaging (MRI) and more recently with positron emission tomography (PET), mostly as incidental findings. There is a predeliction for the hand and trunk skeleton. Skeletal tuberculosis, metastases, multiple myeloma, Langerhans cell histiocytosis and sarcoid-like reactions in solid tumors must be differentiated. The key factors for correct diagnosis are thorax radiography, thorax CT and dermatological manifestations. (orig.) [German] Darstellung von Aetiologie, Pathologie, Klinik, Radiologie und Differenzialdiagnose der Skelettsarkoidose. Nichtverkaesende Epitheloidzellgranulome koennen solitaere, multiple oder disseminierte Osteolysen, reaktive Osteosklerosen und/oder eine granulomatoese Synovialitis ausloesen. Inzidenz der Sarkoidose: 10-12/100.000 Einwohner/Jahr. Skelettbeteiligung ca. 14 %. Skelettbeteiligungen kommen fast ausschliesslich im Stadium einer Lymphknoten- und pulmonalen Manifestation vor. Die meisten Skelettbeteiligungen verlaufen klinisch stumm. Bei synovialer

  15. Skeletal metastasis as detected by 18F-FDG PET with negative CT of the PET/CT: Frequency and impact on cancer staging and or management

    Directory of Open Access Journals (Sweden)

    Fatma Ahmed

    2016-10-01

    Full Text Available Objectives: The aim of our study is to assess the frequency of detection of PET positive CT negative skeletal metastases (SM and determine the impact of such detection on staging and/or management in patients who had FDG PET/CT as part of the cancer work up.Methods: We retrospectively reviewed 2000 18F-FDG PET/CT scans of known cancer patients. A log was kept to record cases of suspected SM with or without bone changes from the low-dose non-contrast CT. The presence or absence of SM was evaluated based on available pathological and clinical data. The impact of detection of such lesions on cancer staging and/or management was evaluated by a board certified oncologist.Results: Of the 2000 cases, 18F-FDG PET/CT suggested SM in 146/2000 (7.3%. Of those 146 cases, 105 (72% were positive on both PET and CT. The remaining 41 (28% had PET positive CT negative bone lesions. SM was confirmed in 36/41 (88% PET positive/CT negative cases. This was based on biopsy, imaging or clinical follow-up. The detection of PET positive CT negative SM did not change staging or management in 7/36 (19.4%. However, staging and/or management was affected in 29/36 (80.6%. Conclusions: SM is not uncommon in 18F-FDG PET/CT, as it accounts for 146/2000 (7.3% of cases. PET demonstrated FDG-avid SM without a CT abnormality in at least 36/146 (25%. Patients staging and or management changed in 29/36 (80.5%. We concluded that 18F-FDG PET is sensitive in detection of SM with significant impact on staging & or management. Key words18F-FDG PET/CT, Skeletal metastasis, PET positive, CT negative

  16. Characterization of a managed aquifer recharge system using multiple tracers.

    Science.gov (United States)

    Moeck, Christian; Radny, Dirk; Popp, Andrea; Brennwald, Matthias; Stoll, Sebastian; Auckenthaler, Adrian; Berg, Michael; Schirmer, Mario

    2017-12-31

    Knowledge about the residence times of artificially infiltrated water into an aquifer and the resulting flow paths is essential to developing groundwater-management schemes. To obtain this knowledge, a variety of tracers can be used to study residence times and gain information about subsurface processes. Although a variety of tracers exists, their interpretation can differ considerably due to subsurface heterogeneity, underlying assumptions, and sampling and analysis limitations. The current study systematically assesses information gained from seven different tracers during a pumping experiment at a site where drinking water is extracted from an aquifer close to contaminated areas and where groundwater is artificially recharged by infiltrating surface water. We demonstrate that the groundwater residence times estimated using dye and heat tracers are comparable when the thermal retardation for the heat tracer is considered. Furthermore, major ions, acesulfame, and stable isotopes (δ 2 H and δ 18 O) show that mixing of infiltrated water and groundwater coming from the regional flow path occurred and a vertical stratification of the flow system exist. Based on the concentration patterns of dissolved gases (He, Ar, Kr, N 2 , and O 2 ) and chlorinated solvents (e.g., tetrachloroethene), three temporal phases are observed in the ratio between infiltrated water and regional groundwater during the pumping experiment. Variability in this ratio is significantly related to changes in the pumping and infiltration rates. During constant pumping rates, more infiltrated water was extracted, which led to a higher dilution of the regional groundwater. An infiltration interruption caused however, the ratio to change and more regional groundwater is extracted, which led to an increase in all concentrations. The obtained results are discussed for each tracer considered and its strengths and limitations are illustrated. Overall, it is demonstrated that aquifer heterogeneity and

  17. The management of multiple sclerosis in children: a European view

    DEFF Research Database (Denmark)

    Ghezzi, Angelo; Banwell, Brenda; Boyko, Alexey

    2010-01-01

    About 3-5% of all patients with multiple sclerosis experience the onset of their disease under the age of 16. A significant proportion of paediatric multiple sclerosis patients develop significant cognitive disturbances and persistent physical disability. The high relapse rate and the morbidity i...

  18. Forest management under uncertainty for multiple bird population objectives

    Science.gov (United States)

    Moore, C.T.; Plummer, W.T.; Conroy, M.J.; Ralph, C. John; Rich, Terrell D.

    2005-01-01

    We advocate adaptive programs of decision making and monitoring for the management of forest birds when responses by populations to management, and particularly management trade-offs among populations, are uncertain. Models are necessary components of adaptive management. Under this approach, uncertainty about the behavior of a managed system is explicitly captured in a set of alternative models. The models generate testable predictions about the response of populations to management, and monitoring data provide the basis for assessing these predictions and informing future management decisions. To illustrate these principles, we examine forest management at the Piedmont National Wildlife Refuge, where management attention is focused on the recovery of the Red-cockaded Woodpecker (Picoides borealis) population. However, managers are also sensitive to the habitat needs of many non-target organisms, including Wood Thrushes (Hylocichla mustelina) and other forest interior Neotropical migratory birds. By simulating several management policies on a set of-alternative forest and bird models, we found a decision policy that maximized a composite response by woodpeckers and Wood Thrushes despite our complete uncertainty regarding system behavior. Furthermore, we used monitoring data to update our measure of belief in each alternative model following one cycle of forest management. This reduction of uncertainty translates into a reallocation of model influence on the choice of optimal decision action at the next decision opportunity.

  19. Socio-ecological analysis of multiple-use forest management in the Bolivian Amazon

    NARCIS (Netherlands)

    Soriano Candia, Marlene

    2017-01-01

    Community families throughout tropical regions derive an important share of their income from multiple forest products, with generally positive outcomes on their livelihoods. The production of these products in a multiple-use forest management scheme (MFM, the production of multiple forest

  20. Multiple sclerosis care: an integrated disease-management model.

    Science.gov (United States)

    Burks, J

    1998-04-01

    A disease-management model must be integrated, comprehensive, individual patient focused and outcome driven. In addition to high quality care, the successful model must reduce variations in care and costs. MS specialists need to be intimately involved in the long-term care of MS patients, while not neglecting primary care issues. A nurse care manager is the "glue" between the managed care company, health care providers and the patient/family. Disease management focuses on education and prevention, and can be cost effective as well as patient specific. To implement a successful program, managed care companies and health care providers must work together.

  1. Anaesthetic management of a patient with multiple system atrophy

    African Journals Online (AJOL)

    Magnetic resonance imaging scan of the brain revealed multiple small ischaemic foci ... Induction was done by propofol 130 mg and atracurium 25 mg. The airway was secured ... distinguished clinically by the predominant motor symptom: the.

  2. Role of denosumab in the management of skeletal complications in patients with bone metastases from solid tumors

    Directory of Open Access Journals (Sweden)

    Stopeck AT

    2012-04-01

    Full Text Available Ursa Brown-Glaberman, Alison T StopeckUniversity of Arizona Cancer Center, Tucson, AZ, USAAbstract: Skeletal-related events (SREs including pain, fractures, and hypercalcemia are a major source of morbidity for cancer patients with bone metastases. The receptor activator of NF-κB ligand (RANKL is a key mediator of osteoclast formation and activity in normal bone physiology as well as cancer-induced bone resorption. The first commercially available drug that specifically targets and inhibits the RANKL pathway is denosumab, a fully human monoclonal antibody that binds and neutralizes RANKL, thereby inhibiting osteoclast function. In this review, we summarize the major studies leading to the US Food and Drug Administration-approval of denosumab for the prevention of SREs in patients with bone metastases from solid tumors. Further, we discuss the role of denosumab in the prevention and treatment of SREs and bone loss in cancer patients. As a monoclonal antibody, denosumab has several advantages over bisphosphonates, including improved efficacy, better tolerability, and the convenience of administration by subcutaneous injection. In addition, as denosumab has no known renal toxicity, it may be the preferred choice over bisphosphonates in patients with baseline renal insufficiency or receiving nephrotoxic therapies. However, other toxicities, including osteonecrosis of the jaw and hypocalcemia, appear to be class effects of agents that potently inhibit osteoclast activity and are associated with both denosumab and bisphosphonate use. The data presented highlight the differences associated with intravenous bisphosphonate and denosumab use as well as confirm the essential role bone-modifying agents play in maintaining the quality of life for patients with bone metastases.Keywords: denosumab, bone metastases, solid tumor, breast cancer, prostate cancer, skeletal related events, skeletal complications 

  3. Learning to manage quality in a multiple reservoir system ...

    African Journals Online (AJOL)

    The development of water policies based on integrated water management principles promotes the development of multistakeholder platforms to manage water resources at catchment level. This is the case of the Alto-Tietê watershed, the urban catchment encompassing the São Paulo metropolis in Brazil. The dynamic ...

  4. An architecture model for multiple disease management information systems.

    Science.gov (United States)

    Chen, Lichin; Yu, Hui-Chu; Li, Hao-Chun; Wang, Yi-Van; Chen, Huang-Jen; Wang, I-Ching; Wang, Chiou-Shiang; Peng, Hui-Yu; Hsu, Yu-Ling; Chen, Chi-Huang; Chuang, Lee-Ming; Lee, Hung-Chang; Chung, Yufang; Lai, Feipei

    2013-04-01

    Disease management is a program which attempts to overcome the fragmentation of healthcare system and improve the quality of care. Many studies have proven the effectiveness of disease management. However, the case managers were spending the majority of time in documentation, coordinating the members of the care team. They need a tool to support them with daily practice and optimizing the inefficient workflow. Several discussions have indicated that information technology plays an important role in the era of disease management. Whereas applications have been developed, it is inefficient to develop information system for each disease management program individually. The aim of this research is to support the work of disease management, reform the inefficient workflow, and propose an architecture model that enhance on the reusability and time saving of information system development. The proposed architecture model had been successfully implemented into two disease management information system, and the result was evaluated through reusability analysis, time consumed analysis, pre- and post-implement workflow analysis, and user questionnaire survey. The reusability of the proposed model was high, less than half of the time was consumed, and the workflow had been improved. The overall user aspect is positive. The supportiveness during daily workflow is high. The system empowers the case managers with better information and leads to better decision making.

  5. Guideline for the diagnosis and management of multiple sclerosis in ...

    African Journals Online (AJOL)

    Paediatric multiple sclerosis (MS) represents a particular MS subgroup with unique diagnostic challenges. Due to the narrow window of environmental exposures and clinical disease expression, children with MS may represent an important study population for gaining a better understanding of the pathogenesis of the ...

  6. Workflow Management for Multiple Sclerosis Patients: IT and Organization

    NARCIS (Netherlands)

    Michel-Verkerke, Margreet B.; Michel-Verkerke, M.B.; Schuring, R.W.; Spil, Antonius A.M.; Sprague, R.H.

    2004-01-01

    Patients with Multiple Sclerosis (MS) visit various healthcare providers during the course of their disease. It was suggested that IT might help to orchestrate their care provision. We have applied the USE IT-tool to get insight in the relevant problems, solutions and constraints of the MS-care and

  7. Managing for multiple resources under climate change: national forests.

    Science.gov (United States)

    Joyce, Linda A; Blate, Geoffrey M; McNulty, Steven G; Millar, Constance I; Moser, Susanne; Neilson, Ronald P; Peterson, David L

    2009-12-01

    This study explores potential adaptation approaches in planning and management that the United States Forest Service might adopt to help achieve its goals and objectives in the face of climate change. Availability of information, vulnerability of ecological and socio-economic systems, and uncertainties associated with climate change, as well as the interacting non-climatic changes, influence selection of the adaptation approach. Resource assessments are opportunities to develop strategic information that could be used to identify and link adaptation strategies across planning levels. Within a National Forest, planning must incorporate the opportunity to identify vulnerabilities to climate change as well as incorporate approaches that allow management adjustments as the effects of climate change become apparent. The nature of environmental variability, the inevitability of novelty and surprise, and the range of management objectives and situations across the National Forest System implies that no single approach will fit all situations. A toolbox of management options would include practices focused on forestalling climate change effects by building resistance and resilience into current ecosystems, and on managing for change by enabling plants, animals, and ecosystems to adapt to climate change. Better and more widespread implementation of already known practices that reduce the impact of existing stressors represents an important "no regrets" strategy. These management opportunities will require agency consideration of its adaptive capacity, and ways to overcome potential barriers to these adaptation options.

  8. Multiple challenges of risk management in EU credit institutions

    Directory of Open Access Journals (Sweden)

    Constantinescu, A.

    2011-01-01

    Full Text Available This paper is intended to be a significant insight into risk management issues by describing the main types of such risks and by providing management and evaluation procedures of significant risks into some active banking companies in Romania. In times of crisis, risk management in the banking system has a greater importance than in the normal economic times. The 2011 was a year in which Romania has been hit by the repercussions of the international economic crisis. Using strategies against risks, implementing procedures to monitor and control risks, risk assessment and quantification can substantially reduce the financial losses of a company or those of a financial institution. Risk management is an integral part of all decision making and business processes from credit institutions, its purpose being to protect their sustainable development. The innovations on the financial market, the internationalization of the specific operations, and the pressure of the competition are just a few arguments that impose a permanent supervision of the general and specific risks. This is the main reason why is compulsory to find new methods of managing risks, to keep in consideration the identification, evaluation of the management and the control of the banking system and of each bank.

  9. Permanent LMN denervation of human skeletal muscle and recovery by h-b FES: management and monitoring

    Directory of Open Access Journals (Sweden)

    Helmut Kern

    2010-09-01

    Full Text Available Denervation of a defined skeletal muscle is due to lower motor neuron (LMN or peripheral nerve lesions that have major consequences on the muscle tissue. After early atrophy, the mid- and late-phases presents two very contrasting myofibers populations: beside those severely atrophic with internalized groups of myonuclei, large fast-type muscle fibers continue to be present 4 to 6 years after Spinal Cord Injury (SCI. Recent results of rat experiments provides the rational basis for understanding the residual functional characteristics of the long-term denervated muscle and the molecular explanation of its ability to respond to home-base functional electrical stimulation (h-b FES using custom-designed electrodes and stimulators. Further outcomes of the Vienna-Padova ten-year collaboration are: 1. a world-unique Myo- Bank of muscle biopsies and 2. improved imaging procedures (Color Computer Tomography (CT scan and Functional Echomyography, all demonstrating that h-b FES induces improvements in muscle contractility, tissue composition and mass, despite permanent LMN denervation. The benefits of h-b FES could be extended from patents suffering with complete Conus-Cauda Syndrome to the numerous patients with incomplete LMN denervation of skeletal muscles to determine whether h-b FES reduces secondary complications related to disuse and impaired blood perfusion (reduction in bone density, risk of bone fracture, decubitus ulcers, and pulmonary thromboembolism. We are confident that translation of the results of a clinical experiment, the EU Project RISE, to the larger cohort of incomplete LMN denervated muscles will provide the wanted results.

  10. Optimal management of marine resources: spatial planning of multiple uses by multiple actors

    NARCIS (Netherlands)

    Punt, M.J.

    2011-01-01

    Ocean space supplies mankind with a multitude of goods and services and yet it is under severe pressure of pollution and over-extraction of resources. To extract goods and services sustainably and to protect vulnerable ecosystems, we need to manage human activities in the marine domain.

  11. A measurement model of multiple intelligence profiles of management graduates

    Science.gov (United States)

    Krishnan, Heamalatha; Awang, Siti Rahmah

    2017-05-01

    In this study, developing a fit measurement model and identifying the best fitting items to represent Howard Gardner's nine intelligences namely, musical intelligence, bodily-kinaesthetic intelligence, mathematical/logical intelligence, visual/spatial intelligence, verbal/linguistic intelligence, interpersonal intelligence, intrapersonal intelligence, naturalist intelligence and spiritual intelligence are the main interest in order to enhance the opportunities of the management graduates for employability. In order to develop a fit measurement model, Structural Equation Modeling (SEM) was applied. A psychometric test which is the Ability Test in Employment (ATIEm) was used as the instrument to measure the existence of nine types of intelligence of 137 University Teknikal Malaysia Melaka (UTeM) management graduates for job placement purposes. The initial measurement model contains nine unobserved variables and each unobserved variable is measured by ten observed variables. Finally, the modified measurement model deemed to improve the Normed chi-square (NC) = 1.331; Incremental Fit Index (IFI) = 0.940 and Root Mean Square of Approximation (RMSEA) = 0.049 was developed. The findings showed that the UTeM management graduates possessed all nine intelligences either high or low. Musical intelligence, mathematical/logical intelligence, naturalist intelligence and spiritual intelligence contributed highest loadings on certain items. However, most of the intelligences such as bodily kinaesthetic intelligence, visual/spatial intelligence, verbal/linguistic intelligence interpersonal intelligence and intrapersonal intelligence possessed by UTeM management graduates are just at the borderline.

  12. Cerebellar medulloblastoma presenting with skeletal metastasis

    Directory of Open Access Journals (Sweden)

    Barai Sukanta

    2004-04-01

    Full Text Available Medulloblastomas are highly malignant brain tumours, but only rarely produce skeletal metastases. No case of medulloblastoma has been documented to have produced skeletal metastases prior to craniotomy or shunt surgery. A 21-year-old male presented with pain in the hip and lower back with difficulty in walking of 3 months′ duration. Signs of cerebellar dysfunction were present hence a diagnosis of cerebellar neoplasm or skeletal tuberculosis with cerebellar abscess formation was considered. MRI of brain revealed a lesion in the cerebellum suggestive of medulloblastoma. Bone scan revealed multiple sites of skeletal metastases excluding the lumbar vertebrae. MRI of lumbar spine and hip revealed metastases to all lumbar vertebrae and both hips. Computed tomography-guided biopsy was obtained from the L3 vertebra, which revealed metastatic deposits from medulloblastoma. Cerebrospinal fluid cytology showed the presence of medulloblastoma cells. A final diagnosis of cerebellar medulloblastoma with skeletal metastases was made. He underwent craniotomy and histopathology confirmed medulloblastoma.

  13. Multiple Attempts for Online Assessments in an Operations Management Course: An Exploration

    Science.gov (United States)

    Orchard, Ryan K.

    2016-01-01

    In learning management systems, tools for online homework assessments include a number of alternatives for the assessment settings, including the ability to permit students to attempt an assessment multiple times, with options for how the multiple attempts are administered. A specific implementation of online assessments in an introductory…

  14. New approaches in the management of multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Laurie J Barten

    2010-11-01

    Full Text Available Laurie J Barten1, Douglas R Allington1, Kendra A Procacci2, Michael P Rivey11The University of Montana and Community Medical Center, Missoula, MT, USA; 2The University of Montana School of Pharmacy, Missoula, MT, USAAbstract: Multiple sclerosis (MS is a central nervous system chronic inflammatory disease that is characterized by an extensive and complex immune response. Scientific advances have occurred in immunology, pathophysiology, and diagnostic and clinical assessment tools, and recent discovery of unique therapeutic targets has spurred numerous Phase II and Phase III clinical trials. Reductions in MS relapse rates and improvements in T2 or gadolinium-enhancing lesion burdens have been reported from Phase III trials that include fingolimod, alemtuzumab, cladribine, and rituximab. Promising Phase II trial data exist for teriflunomide, daclizumab, laquinimod, and fumarate. The optimism created by these favorable findings must be tempered with evaluation of the adverse effect profile produced by these new agents. Given the discovery of progressive multifocal leukoencephalopathy with the use of natalizumab, ongoing vigilance for rare and life-threatening reactions due to new agents should be paramount. Patients with MS often experience difficulty with ambulation, spasticity, and cognition. Recent clinical trial data from two Phase III dalfampridine-SR trials indicate certain patients receive benefits in ambulation. This article provides an overview of data from clinical trials of newer agents of potential benefit in MS.Keywords: multiple sclerosis, Phase II trials, Phase III trials, progressive multifocal leukoencephalopathy, monoclonal antibody

  15. Risk management for sulfur dioxide abatement under multiple uncertainties

    Science.gov (United States)

    Dai, C.; Sun, W.; Tan, Q.; Liu, Y.; Lu, W. T.; Guo, H. C.

    2016-03-01

    In this study, interval-parameter programming, two-stage stochastic programming (TSP), and conditional value-at-risk (CVaR) were incorporated into a general optimization framework, leading to an interval-parameter CVaR-based two-stage programming (ICTP) method. The ICTP method had several advantages: (i) its objective function simultaneously took expected cost and risk cost into consideration, and also used discrete random variables and discrete intervals to reflect uncertain properties; (ii) it quantitatively evaluated the right tail of distributions of random variables which could better calculate the risk of violated environmental standards; (iii) it was useful for helping decision makers to analyze the trade-offs between cost and risk; and (iv) it was effective to penalize the second-stage costs, as well as to capture the notion of risk in stochastic programming. The developed model was applied to sulfur dioxide abatement in an air quality management system. The results indicated that the ICTP method could be used for generating a series of air quality management schemes under different risk-aversion levels, for identifying desired air quality management strategies for decision makers, and for considering a proper balance between system economy and environmental quality.

  16. Biological interactions and cooperative management of multiple species.

    Science.gov (United States)

    Jiang, Jinwei; Min, Yong; Chang, Jie; Ge, Ying

    2017-01-01

    Coordinated decision making and actions have become the primary solution for the overexploitation of interacting resources within ecosystems. However, the success of coordinated management is highly sensitive to biological, economic, and social conditions. Here, using a game theoretic framework and a 2-species model that considers various biological relationships (competition, predation, and mutualism), we compute cooperative (or joint) and non-cooperative (or separate) management equilibrium outcomes of the model and investigate the effects of the type and strength of the relationships. We find that cooperation does not always show superiority to non-cooperation in all biological interactions: (1) if and only if resources are involved in high-intensity predation relationships, cooperation can achieve a win-win scenario for ecosystem services and resource diversity; (2) for competitive resources, cooperation realizes higher ecosystem services by sacrificing resource diversity; and (3) for mutual resources, cooperation has no obvious advantage for either ecosystem services or resource evenness but can slightly improve resource abundance. Furthermore, by using a fishery model of the North California Current Marine Ecosystem with 63 species and seven fleets, we demonstrate that the theoretical results can be reproduced in real ecosystems. Therefore, effective ecosystem management should consider the interconnection between stakeholders' social relationship and resources' biological relationships.

  17. Relationship Between Spiritual Well-Being and Self-Management Among Iranian People With Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Zarei

    2015-10-01

    Full Text Available Background Self-management is the cornerstone for controlling multiple sclerosis. As one’s sense of meaning in life and his/her relationship with a higher power, spiritual well-being is an important coping resource in some chronic diseases. However, little is known about the role of spiritual well-being in self-management of people diagnosed with multiple sclerosis. Objectives This study was aimed to assess the relationship between spiritual well-being and self-management among Iranian people with multiple sclerosis. Patients and Methods Two hundred ninety-one people diagnosed with multiple sclerosis belonging to the Multiple Sclerosis Society of Mashhad, Iran, participated in this cross-sectional analytical study conducted in 2014. Demographic information was collected by using a demographic form. The multiple sclerosis self-management scale-revised (2011, developed by Bishop and Frain, was used to evaluate self-management of multiple sclerosis symptoms. Spiritual well-being of participants was assessed by using the spiritual well-being questionnaire developed by Paloutzian and Ellison in 1983. Descriptive statistic and inferential statistical methods including Pearson and Spearman’s coefficient, stepwise multiple regression, independent t-test, Mann-Whitney U test, one-way ANOVA, and Kruskal-Wallis test were employed by using SPSS, version 16.0. The significance level was set at P ≤ 0.05. Results Overall, the participants reported moderate levels of self-management and spiritual well-being as recorded on the multiple sclerosis self-management scale-revised and the spiritual well-being questionnaire. There was a significant correlation between the participants’ spiritual well-being and self-management scores (r = 0.59, P < 0.001. Furthermore, participants’ self-management was significantly correlated with existential health (r = 0.52, P < 0.001 and religious health (r = 0.57, P < 0.001. Finally, 40% of the variance of self-management

  18. Managing focal fields of vector beams with multiple polarization singularities.

    Science.gov (United States)

    Han, Lei; Liu, Sheng; Li, Peng; Zhang, Yi; Cheng, Huachao; Gan, Xuetao; Zhao, Jianlin

    2016-11-10

    We explore the tight focusing behavior of vector beams with multiple polarization singularities, and analyze the influences of the number, position, and topological charge of the singularities on the focal fields. It is found that the ellipticity of the local polarization states at the focal plane could be determined by the spatial distribution of the polarization singularities of the vector beam. When the spatial location and topological charge of singularities have even-fold rotation symmetry, the transverse fields at the focal plane are locally linearly polarized. Otherwise, the polarization state becomes a locally hybrid one. By appropriately arranging the distribution of the polarization singularities in the vector beam, the polarization distributions of the focal fields could be altered while the intensity maintains unchanged.

  19. Application of multiple objective models to water resources planning and management

    International Nuclear Information System (INIS)

    North, R.M.

    1993-01-01

    Over the past 30 years, we have seen the birth and growth of multiple objective analysis from an idea without tools to one with useful applications. Models have been developed and applications have been researched to address the multiple purposes and objectives inherent in the development and management of water resources. A practical approach to multiple objective modelling incorporates macroeconomic-based policies and expectations in order to optimize the results from both engineering (structural) and management (non-structural) alternatives, while taking into account the economic and environmental trade-offs. (author). 27 refs, 4 figs, 3 tabs

  20. Assessing risks to multiple resources affected by wildfire and forest management using an integrated probabilistic framework

    Science.gov (United States)

    Steven P. Norman; Danny C. Lee; Sandra Jacobson; Christine Damiani

    2010-01-01

    The tradeoffs that surround forest management are inherently complex, often involving multiple temporal and spatial scales. For example, conflicts may result when fuel treatments are designed to mediate long-term fuel hazards, but activities could impair sensitive aquatic habitat or degrade wildlife habitat in the short term. This complexity makes it hard for managers...

  1. Using State-Wide Multiple Measures for School Leadership and Management: Costs Incurred vs. Benefits Gained

    Science.gov (United States)

    Hentschke, Guilbert; Wohlstetter, Priscilla; Hirman, Jennifer; Zeehandelaar, Dara

    2011-01-01

    In this article, we examine the utility and value of multiple measures of school performance for school leaders and managers. The research was conducted within the context of the state of California through an investigation of how operators, managers and authorisers of autonomous "charter" (publicly financed but privately operated)…

  2. An Evaluation of Multiple Perceptions of Digital Rights Management

    Science.gov (United States)

    Stott, Allyn D.; Taneja, Aakash

    Digital Rights Management (DRM) solutions have generated much interest because of their influence on the expectations and responsibilities of customers and related organizations. It was created to restrict piracy and enhance digital media sales, however, it is found to be unable to fulfill its objectives. We find the protections by DRM lack an understanding of the end user and the evolving nature of copyright and fair use. The potential motives for pirating appear to increase as DRM becomes more intrusive causing a conflict in the objectives of DRM. Thus, adjustments must be made to the current DRM model in order for it to become beneficial for both the producer and the consumer. Our research identifies the needs, desires, and responsibilities of the various DRM stakeholders so that a successful use of DRM technologies can be modeled: a challenge faced by the media industry.

  3. Clinical experiences with cannabinoids in spasticity management in multiple sclerosis.

    Science.gov (United States)

    Lorente Fernández, L; Monte Boquet, E; Pérez-Miralles, F; Gil Gómez, I; Escutia Roig, M; Boscá Blasco, I; Poveda Andrés, J L; Casanova-Estruch, B

    2014-06-01

    Spasticity is a common symptom among patients with multiple sclerosis (MS). This study aims to assess the effectiveness and safety of the combination of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in clinical practice for the treatment of spasticity in MS. Retrospective observational study with patients treated with inhaled THC/CBD between April 2008 and March 2012. Descriptive patient and treatment variables were collected. Therapeutic response was evaluated based on the doctor's analysis and overall impression. Of the 56 patients who started treatment with THC/CBD, 6 were excluded because of missing data. We evaluated 50 patients (42% male) with a median age 47.8 years (25.6-76.8); 38% were diagnosed with primary progressive MS, 44% with secondary progressive MS, and 18% with relapsing-remitting MS. The reason for prescribing the drug was spasticity (44%), pain (10%), or both (46%). Treatment was discontinued in 16 patients because of ineffectiveness (7 patients), withdrawal (4), and adverse effects (5). The median exposure time in patients whose treatment was discontinued was 30 days vs 174 days in those whose treatment continued at the end of the study. THC/CBD was effective in 80% of patients at a median dose of 5 (2-10) inhalations/day. The adverse event profile consisted of dizziness (11 patients), somnolence (6), muscle weakness (7), oral discomfort (2), diarrhoea (3), dry mouth (2), blurred vision (2), agitation (1), nausea (1), and paranoid ideation (1). THC/CBD appears to be a good alternative to standard treatment as it improves refractory spasticity in MS and has an acceptable toxicity profile. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  4. Syntheses and evaluation of 68 Ga- and 153 Sm-labeled DOTA-conjugated bisphosphonate ligand for potential use in detection of skeletal metastases and management of pain arising from skeletal metastases.

    Science.gov (United States)

    Chakraborty, Sudipta; Goswami, Dibakar; Chakravarty, Rubel; Mohammed, Sahiralam Khan; Sarma, Haladhar Deb; Dash, Ashutosh

    2018-05-05

    This article reports the syntheses and evaluation of 68 Ga- and 153 Sm-complexes of a new DOTA (1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid)-conjugated geminal bisphosphonate, DOTA-Bn-SCN-BP, for their potential uses in the early detection of skeletal metastases by imaging and palliation of pain arising from skeletal metastases, respectively. The conjugate was synthesized in high purity following an easily adaptable three-step reaction scheme. Gallium-68- and 153 Sm-complexes were prepared in high yield (>98%) and showed excellent in vitro stability in phosphate-buffered saline (PBS) and human serum. Both the complexes showed high affinity for hydroxyapatite particles in in vitro binding study. In biodistribution studies carried out in normal Wistar rats, both the complexes exhibited rapid skeletal accumulation with almost no retention in any other major organ. The newly synthesized molecule DOTA-Bn-SCN-BP would therefore be a promising targeting ligand for the development of radiopharmaceuticals for both imaging skeletal metastases and palliation of pain arising out of it in patients with cancer when radiolabeled with 68 Ga and 153 Sm, respectively. A systematic comparative evaluation, however, showed that there was no significant improvement of skeletal accumulation of the 153 Sm-DOTA-Bn-SCN-BP complex over 153 Sm-DOTMP (1,4,7,10-tetraazacyclododecane-1,4,7,10-tetramethylenephosphonic acid) as the later itself demonstrated optimal properties required for an agent for bone pain palliation. © 2018 John Wiley & Sons A/S.

  5. Defining ecological and economical hydropoweroperations: a framework for managing dam releasesto meet multiple conflicting objectives

    Science.gov (United States)

    Irwin, Elise R.

    2014-01-01

    Hydroelectric dams are a flexible source of power, provide flood control, and contribute to the economic growth of local communities through real-estate and recreation. Yet the impoundment of rivers can alter and fragment miles of critical riverine habitat needed for other competing needs such as downstream consumptive water use, fish and wildlife population viability, or other forms of recreation. Multiple conflicting interests can compromise progressive management especially with recognized uncertainties related to whether management actions will fulfill the objectives of policy makers, resource managers and/or facility owners. Decision analytic tools were used in a stakeholder-driven process to develop and implement a template for evaluation and prediction of the effects of water resource management of multiple-use systems under the context provided by R.L. Harris Dam on the Tallapoosa River, Alabama, USA. The approach provided a transparent and structured framework for decision-making and incorporated both existing and new data to meet multiple management objectives. Success of the template has been evaluated by the stakeholder governing body in an adaptive resource management framework since 2005 and is ongoing. Consequences of management of discharge at the dam were evaluated annually relative to stakeholder satisfaction to allow for adjustment of both management scenarios and objectives. This template can be applied to attempt to resolve conflict inherent in many dam-regulated systems where management decisions impact diverse values of stakeholders.

  6. Diagnostic radiology on multiple injured patients: interdisciplinary management; Radiologische Diagnostik beim Polytrauma: interdisziplinaeres Management

    Energy Technology Data Exchange (ETDEWEB)

    Linsenmaier, U.; Pfeifer, K.J. [Inst. fuer Radiologische Diagnostik, Klinikum der Univ. Muenchen (Germany); Kanz, K.G.; Mutschler, W. [Chirurgische Klinik Innenstadt, Klinikum der Univ. Muenchen, (Germany)

    2001-06-01

    The presence of a radiologist within the admitting area of an emergency department and his capability as a member of the trauma team have a major impact on the role of diagnostic radiology in trauma care. The knowledge of clinical decision criteria, algorithms, and standards of patient care are essential for the acceptance within a trauma team. We present an interdisciplinary management concept of diagnostic radiology for trauma patients, which comprises basic diagnosis, organ diagnosis, radiological ABC, and algorithms of early clinical care. It is the result of a prospective study comprising over 2000 documented multiple injured patients. The radiologist on a trauma team should support trauma surgery and anesthesia in diagnostic and clinical work-up. The radiological ABC provides a structured approach for diagnostic imaging in all steps of the early clinical care of the multiple injured patient. Radiological ABC requires a reevaluation in cases of equivocal findings or difficulties in the clinical course. Direct communication of radiological findings with the trauma team enables quick clinical decisions. In addition, the radiologist can priority-oriented influence the therapy by using interventional procedures. The clinical radiologist is an active member of the interdisciplinary trauma team, not only providing diagnostic imaging but also participating in clinical decisions. (orig.) [German] Die Anwesenheit des Radiologen im Schockraum und dessen Teamfaehigkeit bestimmen den Status der diagnostischen Radiologie in der Traumaversorgung. Voraussetzung zur Mitarbeit im interdisziplinaeren Traumateam ist die detaillierte Kenntnis der wesentlichen Entscheidungskriterien, Algorithmen und Behandlungsablaeufe. Das hier vorgestellte interdisziplinaere Managementkonzept der radiologischen Diagnostik beim Polytrauma mit Basisdiagnostik, Organdiagnostik, radiologischer ABC-Regel und Algorithmen zur fruehklinischen Behandlung beruht auf einer prospektiven Polytraumastudie mit

  7. Modular multiple sensors information management for computer-integrated surgery.

    Science.gov (United States)

    Vaccarella, Alberto; Enquobahrie, Andinet; Ferrigno, Giancarlo; Momi, Elena De

    2012-09-01

    In the past 20 years, technological advancements have modified the concept of modern operating rooms (ORs) with the introduction of computer-integrated surgery (CIS) systems, which promise to enhance the outcomes, safety and standardization of surgical procedures. With CIS, different types of sensor (mainly position-sensing devices, force sensors and intra-operative imaging devices) are widely used. Recently, the need for a combined use of different sensors raised issues related to synchronization and spatial consistency of data from different sources of information. In this study, we propose a centralized, multi-sensor management software architecture for a distributed CIS system, which addresses sensor information consistency in both space and time. The software was developed as a data server module in a client-server architecture, using two open-source software libraries: Image-Guided Surgery Toolkit (IGSTK) and OpenCV. The ROBOCAST project (FP7 ICT 215190), which aims at integrating robotic and navigation devices and technologies in order to improve the outcome of the surgical intervention, was used as the benchmark. An experimental protocol was designed in order to prove the feasibility of a centralized module for data acquisition and to test the application latency when dealing with optical and electromagnetic tracking systems and ultrasound (US) imaging devices. Our results show that a centralized approach is suitable for minimizing synchronization errors; latency in the client-server communication was estimated to be 2 ms (median value) for tracking systems and 40 ms (median value) for US images. The proposed centralized approach proved to be adequate for neurosurgery requirements. Latency introduced by the proposed architecture does not affect tracking system performance in terms of frame rate and limits US images frame rate at 25 fps, which is acceptable for providing visual feedback to the surgeon in the OR. Copyright © 2012 John Wiley & Sons, Ltd.

  8. Experimental hyperthyroidism in rats increases the expression of the ubiquitin ligases atrogin-1 and MuRF1 and stimulates multiple proteolytic pathways in skeletal muscle.

    Science.gov (United States)

    O'Neal, Patrick; Alamdari, Nima; Smith, Ira; Poylin, Vitaliy; Menconi, Michael; Hasselgren, Per-Olof

    2009-11-01

    Muscle wasting is commonly seen in patients with hyperthyroidism and is mainly caused by stimulated muscle proteolysis. Loss of muscle mass in several catabolic conditions is associated with increased expression of the muscle-specific ubiquitin ligases atrogin-1 and MuRF1 but it is not known if atrogin-1 and MuRF1 are upregulated in hyperthyroidism. In addition, it is not known if thyroid hormone increases the activity of proteolytic mechanisms other than the ubiquitin-proteasome pathway. We tested the hypotheses that experimental hyperthyroidism in rats, induced by daily intraperitoneal injections of 100 microg/100 g body weight of triiodothyronine (T3), upregulates the expression of atrogin-1 and MuRF1 in skeletal muscle and stimulates lysosomal, including cathepsin L, calpain-, and caspase-3-dependent protein breakdown in addition to proteasome-dependent protein breakdown. Treatment of rats with T3 for 3 days resulted in an approximately twofold increase in atrogin-1 and MuRF1 mRNA levels. The same treatment increased proteasome-, cathepsin L-, and calpain-dependent proteolytic rates by approximately 40% but did not influence caspase-3-dependent proteolysis. The expression of atrogin-1 and MuRF1 remained elevated during a more prolonged period (7 days) of T3 treatment. The results provide support for a role of the ubiquitin-proteasome pathway in muscle wasting during hyperthyroidism and suggest that other proteolytic pathways as well may be activated in the hyperthyroid state. (c) 2009 Wiley-Liss, Inc.

  9. Dynamic information architecture system (DIAS) : multiple model simulation management

    International Nuclear Information System (INIS)

    Simunich, K. L.; Sydelko, P.; Dolph, J.; Christiansen, J.

    2002-01-01

    Dynamic Information Architecture System (DIAS) is a flexible, extensible, object-based framework for developing and maintaining complex multidisciplinary simulations of a wide variety of application contexts. The modeling domain of a specific DIAS-based simulation is determined by (1) software Entity (domain-specific) objects that represent the real-world entities that comprise the problem space (atmosphere, watershed, human), and (2) simulation models and other data processing applications that express the dynamic behaviors of the domain entities. In DIAS, models communicate only with Entity objects, never with each other. Each Entity object has a number of Parameter and Aspect (of behavior) objects associated with it. The Parameter objects contain the state properties of the Entity object. The Aspect objects represent the behaviors of the Entity object and how it interacts with other objects. DIAS extends the ''Object'' paradigm by abstraction of the object's dynamic behaviors, separating the ''WHAT'' from the ''HOW.'' DIAS object class definitions contain an abstract description of the various aspects of the object's behavior (the WHAT), but no implementation details (the HOW). Separate DIAS models/applications carry the implementation of object behaviors (the HOW). Any model deemed appropriate, including existing legacy-type models written in other languages, can drive entity object behavior. The DIAS design promotes plug-and-play of alternative models, with minimal recoding of existing applications. The DIAS Context Builder object builds a constructs or scenario for the simulation, based on developer specification and user inputs. Because DIAS is a discrete event simulation system, there is a Simulation Manager object with which all events are processed. Any class that registers to receive events must implement an event handler (method) to process the event during execution. Event handlers can schedule other events; create or remove Entities from the

  10. Dynamic information architecture system (DIAS) : multiple model simulation management.

    Energy Technology Data Exchange (ETDEWEB)

    Simunich, K. L.; Sydelko, P.; Dolph, J.; Christiansen, J.

    2002-05-13

    Dynamic Information Architecture System (DIAS) is a flexible, extensible, object-based framework for developing and maintaining complex multidisciplinary simulations of a wide variety of application contexts. The modeling domain of a specific DIAS-based simulation is determined by (1) software Entity (domain-specific) objects that represent the real-world entities that comprise the problem space (atmosphere, watershed, human), and (2) simulation models and other data processing applications that express the dynamic behaviors of the domain entities. In DIAS, models communicate only with Entity objects, never with each other. Each Entity object has a number of Parameter and Aspect (of behavior) objects associated with it. The Parameter objects contain the state properties of the Entity object. The Aspect objects represent the behaviors of the Entity object and how it interacts with other objects. DIAS extends the ''Object'' paradigm by abstraction of the object's dynamic behaviors, separating the ''WHAT'' from the ''HOW.'' DIAS object class definitions contain an abstract description of the various aspects of the object's behavior (the WHAT), but no implementation details (the HOW). Separate DIAS models/applications carry the implementation of object behaviors (the HOW). Any model deemed appropriate, including existing legacy-type models written in other languages, can drive entity object behavior. The DIAS design promotes plug-and-play of alternative models, with minimal recoding of existing applications. The DIAS Context Builder object builds a constructs or scenario for the simulation, based on developer specification and user inputs. Because DIAS is a discrete event simulation system, there is a Simulation Manager object with which all events are processed. Any class that registers to receive events must implement an event handler (method) to process the event during execution. Event handlers

  11. Induced skeletal mutations

    International Nuclear Information System (INIS)

    Selby, P.B.

    1979-01-01

    This paper describes a large-scale experiment that, by means of breeding tests, confirmed that many dominant skeletal mutations are induced by large-dose radiation exposure. The author also discusses: (1) the major advantages and disadvantages of the skeletal method in improving estimates of genetic hazard to man; (2) future uses of the skeletal method; (3) direct estimation of risk beyond the first generation using the skeletal method; and (4) the possibility of using the skeletal method as a quick and easy screen for chemical mutagens

  12. A Conceptual Schema Language for the Management of Multiple Representations of Geographic Entities

    DEFF Research Database (Denmark)

    Friis-Christensen, A.; Jensen, Christian Søndergaard; Nytun, J.P.

    2005-01-01

    Multiple representation of geographic information occurs when a real-world entity is represented more than once in the same or different databases. This occurs frequently in practice, and it invariably results in the occurrence of inconsistencies among the different representations of the same...... entity. In this paper, we propose an approach to the modeling of multiply represented entities, which is based on the relationships among the entities and their representations. Central to our approach is the Multiple Representation Schema Language that, by intuitive and declarative means, is used...... to specify rules that match objects representing the same entity, maintain consistency among these representations, and restore consistency if necessary. The rules configure a Multiple Representation Management System, the aim of which is to manage multiple representations over a number of autonomous...

  13. [First aid and management of multiple trauma: in-hospital trauma care].

    Science.gov (United States)

    Boschin, Matthias; Vordemvenne, Thomas

    2012-11-01

    Injuries remain the leading cause of death in children and young adults. Management of multiple trauma patients has improved in recent years by quality initiatives (trauma network, S3 guideline "Polytrauma"). On this basis, strong links with preclinical management, structured treatment algorithms, training standards (ATLS®), clear diagnostic rules and an established risk- and quality management are the important factors of a modern emergency room trauma care. We describe the organizational components that lead to successful management of trauma in hospital. © Georg Thieme Verlag Stuttgart · New York.

  14. Quantitative skeletal scintiscanning

    International Nuclear Information System (INIS)

    Haushofer, R.

    1982-01-01

    330 patients were examined by skeletal scintiscanning with sup(99m)Tc pyrophosphate and sup(99m)methylene diphosphonate in the years between 1977 and 1979. Course control examinations were carried out in 12 patients. The collective of patients presented with primary skeletal tumours, metastases, inflammatory and degenerative skeletal diseases. Bone scintiscanning combined with the ''region of interest'' technique was found to be an objective and reproducible technique for quantitative measurement of skeletal radioactivity concentrations. The validity of nuclear skeletal examinations can thus be enhanced as far as diagnosis, course control, and differential diagnosis are concerned. Quantitative skeletal scintiscanning by means of the ''region of interest'' technique has opened up a new era in skeletal diagnosis by nuclear methods. (orig./MG) [de

  15. Noninvasive pulsed focused ultrasound allows spatiotemporal control of targeted homing for multiple stem cell types in murine skeletal muscle and the magnitude of cell homing can be increased through repeated applications.

    Science.gov (United States)

    Burks, Scott R; Ziadloo, Ali; Kim, Saejeong J; Nguyen, Ben A; Frank, Joseph A

    2013-11-01

    Stem cells are promising therapeutics for cardiovascular diseases, and i.v. injection is the most desirable route of administration clinically. Subsequent homing of exogenous stem cells to pathological loci is frequently required for therapeutic efficacy and is mediated by chemoattractants (cell adhesion molecules, cytokines, and growth factors). Homing processes are inefficient and depend on short-lived pathological inflammation that limits the window of opportunity for cell injections. Noninvasive pulsed focused ultrasound (pFUS), which emphasizes mechanical ultrasound-tissue interactions, can be precisely targeted in the body and is a promising approach to target and maximize stem cell delivery by stimulating chemoattractant expression in pFUS-treated tissue prior to cell infusions. We demonstrate that pFUS is nondestructive to murine skeletal muscle tissue (no necrosis, hemorrhage, or muscle stem cell activation) and initiates a largely M2-type macrophage response. We also demonstrate that local upregulation of chemoattractants in pFUS-treated skeletal muscle leads to enhance homing, permeability, and retention of human mesenchymal stem cells (MSC) and human endothelial precursor cells (EPC). Furthermore, the magnitude of MSC or EPC homing was increased when pFUS treatments and cell infusions were repeated daily. This study demonstrates that pFUS defines transient "molecular zip codes" of elevated chemoattractants in targeted muscle tissue, which effectively provides spatiotemporal control and tunability of the homing process for multiple stem cell types. pFUS is a clinically translatable modality that may ultimately improve homing efficiency and flexibility of cell therapies for cardiovascular diseases. © AlphaMed Press.

  16. Orthodontic and surgical management of a patient with severe skeletal Class II deformity and facial asymmetry: A case report with a 5-year follow-up.

    Science.gov (United States)

    Gao, Xiang; Wang, Tao; Song, Jinlin

    2017-04-01

    In this case report, we present the orthodontic and surgical management of an 18-year-old girl who had a severe craniofacial deformity, including maxillary prognathism, vertical maxillary excess (gummy smile), mandibular retrognathism, receding chin, and facial asymmetry caused by unilateral temporomandibular joint ankylosis. For correction of the facial asymmetry, the patient's right mandibular ramus and body were lengthened via distraction osteogenesis after 5 months of preoperative orthodontic therapy. Subsequently, extraction of 4 first premolars, bimaxillary anterior segmental osteotomy, and genioplasty were simultaneously performed in the second-stage operation to correct the skeletal deformities in the sagittal and vertical planes. Postoperative orthodontic treatment completed the final occlusal adjustment. The total active treatment period lasted approximately 30 months. The clinical results show that the patient's facial esthetics were significantly improved with minimal surgical invasion and distress, and a desirable occlusion was achieved. These pleasing results were maintained during the 5-year follow-up. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  17. Primary sacrococcygeal chordoma with unusual skeletal muscle metastasis

    Directory of Open Access Journals (Sweden)

    Lisa Vu, MD

    2014-01-01

    Full Text Available Chordomas are rare neoplasms that do not often metastasize. Of the small percent that do metastasize, they very infrequently involve skeletal muscle. Only a few cases of skeletal muscle metastases have been reported in the literature. We report an unusual case of a patient with a primary sacrococcygeal chordoma who experienced a long period of remission but who subsequently developed recurrence and multiple metastatic lesions to skeletal muscles including the deltoid, triceps, and pectineus.

  18. The normalized administration of hybrid operating room: its practical application in managing multiple injuries

    International Nuclear Information System (INIS)

    Li Xue; Zhang Weiguo; Zhang Lianyang; Chen Tingjing; Chen Jinhua

    2011-01-01

    Objective: Through carrying out the normalized administration of hybrid operating room the application of the operating room is expanded to the performing of multiple injuries, and, in this way, the operative management become standardized and programmed, the cooperation and efficiency of hybrid operations for multiple injuries are improved and the surgeries can be ensured. Methods: According to the characteristics of hybrid interventional operation for multiple injuries, the basic construction of the hybrid operating room improved, the hybrid operation team was organized, and the administrative system as well as the working program were established. The green channel for rescuing patients with multiple injuries was set up. The cooperative behavior during interventional treatment for multiple injuries was specified. Results: The coordination and working efficiency of physicians, nurses, technicians and anesthetists were well improved. The qualified rate of lamina flow administration reached 100%. The success rate of the rescue of multiple injuries was increased. Conclusion: As one-stop complex interventional operation for multiple injuries is a new technique, there is no integrated administration system. Therefore, the establishment of standardized management of one-stop complex interventional operation is of great significance in guiding clinical practice. (authors)

  19. Pathogenesis of Insulin Resistance in Skeletal Muscle

    Directory of Open Access Journals (Sweden)

    Muhammad A. Abdul-Ghani

    2010-01-01

    Full Text Available Insulin resistance in skeletal muscle is manifested by decreased insulin-stimulated glucose uptake and results from impaired insulin signaling and multiple post-receptor intracellular defects including impaired glucose transport, glucose phosphorylation, and reduced glucose oxidation and glycogen synthesis. Insulin resistance is a core defect in type 2 diabetes, it is also associated with obesity and the metabolic syndrome. Dysregulation of fatty acid metabolism plays a pivotal role in the pathogenesis of insulin resistance in skeletal muscle. Recent studies have reported a mitochondrial defect in oxidative phosphorylation in skeletal muscle in variety of insulin resistant states. In this review, we summarize the cellular and molecular defects that contribute to the development of insulin resistance in skeletal muscle.

  20. Krogh’s principle or a multiple fish model approach to phosphate balance: is there a centrally regulated intestinal-skeletal-renal axis?

    Directory of Open Access Journals (Sweden)

    Pedro Miguel Guerreiro

    2015-10-01

    Full Text Available Inorganic phosphate (Pi is a crucial ion for vertebrate life. In addition to many physiological roles it is, together with calcium, the major element forming the internal skeleton and Pi balance has been considered a secondary consequence of calciotropic endocrine factors. However, contrary to calcium which can be readily obtained from even Ca-poor environments, Pi is not available in water, and fish can only obtain it via the food. Intestinal absorption drives Pi into the blood stream, but a central part of Pi balance is renal excretion and conservation. Recently, several Pi specific regulatory factors have been brought to light, and we use fish models to investigate their role and the hypothesis of a centrally controlled intestinal-skeletal-renal Pi axis. Using tissues mounted in Ussing chambers under symmetrical and asymmetrical short-circuited conditions we measure unidirectional 33Pi fluxes and test PTHrP, but also STC and FGF23 as regulatory factors, as well as specific drugs to unveil the functional transporting mechanisms. Pi absorption is modified in starved and fed sea bass, an effect dependent on Pi availability in diet, which modifies gene expression of uptake mechanisms. Phosphate secretion across flounder primary renal cell cultures is increased by PTHrP, which reduces the expression of reabsorption mechanisms such as NaPiII and evokes an increase in GFR in cannulated fish, thus resulting in net Pi excretion. A similar effect occurs in the toadfish urinary bladder, which displays moderate Pi transport that is abolished by the drug ouabain and modified by endocrines. Finally we used the shark choroid plexus (CP to show active CSF-to-blood transport with biochemical properties consistent with PiT Na+-dependent transporters. RT-PCR revealed the PiT1/2, but no NaPiII gene expression and we localized PiT2 in CP apical membranes while PiT1 occurred in vascular endothelial cells. Shark CP expresses both PTHrP and its receptor. Could

  1. A Case Study of Resources Management Planning with Multiple Objectives and Projects

    Science.gov (United States)

    David L. Peterson; David G. Silsbee; Daniel L. Schmoldt

    1995-01-01

    Each National Park Service unit in the United States produces a resources management plan (RMP) every four years or less. The plans commit budgets and personnel to specific projects for four years, but they are prepared with little quantitative and analytical rigor and without formal decisionmaking tools. We have previously described a multiple objective planning...

  2. Where and how to manage: optimal selection of conservation actions for multiple species

    NARCIS (Netherlands)

    Teeffelen, van A.J.A.; Moilanen, A.

    2008-01-01

    Multiple alternative options are frequently available for the protection, maintenance or restoration of conservation areas. The choice of a particular management action can have large effects on the species occurring in the area, because different actions have different effects on different species.

  3. The Use of Management and Marketing Textbook Multiple-Choice Questions: A Case Study.

    Science.gov (United States)

    Hampton, David R.; And Others

    1993-01-01

    Four management and four marketing professors classified multiple-choice questions in four widely adopted introductory textbooks according to the two levels of Bloom's taxonomy of educational objectives: knowledge and intellectual ability and skill. Inaccuracies may cause instructors to select questions that require less thinking than they intend.…

  4. Where and how to manage: Optimal selection of conservation actions for multiple species.

    Directory of Open Access Journals (Sweden)

    Astrid van Teeffelen

    2008-01-01

    Full Text Available Multiple alternative options are frequently available for the protection, maintenance or restoration of conservation areas. The choice of a particular management action can have large effects on the species occurring in the area, because different actions have different effects on different species. Together with the fact that conservation funds are limited and particular management actions are costly, it would be desirable to be able to identify where, and what kind of management should be applied to maximize conservation benefits. Currently available site-selection algorithms can identify the optimal set of sites for a reserve network. However, these algorithms have not been designed to answer what kind of action would be most beneficial at these sites when multiple alternative actions are available. We describe an algorithm capable of solving multi-species planning problems with multiple management options per site. The algorithm is based on benefit functions, which translate the effect of a management action on species representation levels into a value, in order to identify the most beneficial option. We test the performance of this algorithm with simulated data for different types of benefit functions and show that the algorithm’s solutions are optimal, or very near globally optimal, partially depending on the type of benefit function used. The good performance of the proposed algorithm suggests that it could be profitably used for large multi-action multi-species conservation planning problems.

  5. Lyophilized skeletal imaging composition

    International Nuclear Information System (INIS)

    Vanduzee, B.F.

    1983-01-01

    This invention encompasses a process for producing a dry-powder skeletal imaging kit. An aqueous solution of a diphosphonate, a stannous reductant, and, optionally, a stabilizer is prepared. The solution is adjusted to a pH within the range 4.2 to 4.8 and the pH-adjusted solution is then lyophilized. The adjustment of pH, within a particular range, during the process of manufacturing lyophilized diphosphonate containing skeletal imaging kits yields a kit which produces a technetium skeletal imaging agent with superior imaging properties. This improved performance is manifested through faster blood clearance and higher skeletal uptake of the technetium imaging agent

  6. Identification of optimal strategies for energy management systems planning under multiple uncertainties

    International Nuclear Information System (INIS)

    Cai, Y.P.; Huang, G.H.; Yang, Z.F.; Tan, Q.

    2009-01-01

    Management of energy resources is crucial for many regions throughout the world. Many economic, environmental and political factors are having significant effects on energy management practices, leading to a variety of uncertainties in relevant decision making. The objective of this research is to identify optimal strategies in the planning of energy management systems under multiple uncertainties through the development of a fuzzy-random interval programming (FRIP) model. The method is based on an integration of the existing interval linear programming (ILP), superiority-inferiority-based fuzzy-stochastic programming (SI-FSP) and mixed integer linear programming (MILP). Such a FRIP model allows multiple uncertainties presented as interval values, possibilistic and probabilistic distributions, as well as their combinations within a general optimization framework. It can also be used for facilitating capacity-expansion planning of energy-production facilities within a multi-period and multi-option context. Complexities in energy management systems can be systematically reflected, thus applicability of the modeling process can be highly enhanced. The developed method has then been applied to a case of long-term energy management planning for a region with three cities. Useful solutions for the planning of energy management systems were generated. Interval solutions associated with different risk levels of constraint violation were obtained. They could be used for generating decision alternatives and thus help decision makers identify desired policies under various economic and system-reliability constraints. The solutions can also provide desired energy resource/service allocation and capacity-expansion plans with a minimized system cost, a maximized system reliability and a maximized energy security. Tradeoffs between system costs and constraint-violation risks could be successfully tackled, i.e., higher costs will increase system stability, while a desire for lower

  7. Exploring Content Management Issues in Air Force On-Line Communities of Practice: A Multiple Case Study Approach

    National Research Council Canada - National Science Library

    Jaime

    2004-01-01

    .... Addressing existing or potential content management issues will help do so. This multiple-case study research observed and interviewed managers and members of eight active CoPs busted by AFMC/DRW...

  8. Multiple sclerosis documentation system (MSDS): moving from documentation to management of MS patients.

    Science.gov (United States)

    Ziemssen, Tjalf; Kempcke, Raimar; Eulitz, Marco; Großmann, Lars; Suhrbier, Alexander; Thomas, Katja; Schultheiss, Thorsten

    2013-09-01

    The long disease duration of multiple sclerosis and the increasing therapeutic options require a individualized therapeutic approach which should be carefully documented over years of observation. To switch from MS documentation to an innovative MS management, new computer- and internet-based tools could be implemented as we could demonstrate with the novel computer-based patient management system "multiple sclerosis management system 3D" (MSDS 3D). MSDS 3D allows documentation and management of visit schedules and mandatory examinations via defined study modules by integration of data input from various sources (patients, attending physicians and MS nurses). It provides forms for the documentation of patient visits as well as clinical and diagnostic findings. Information can be collected via interactive touch screens. Specific modules allow the management of highly efficacious treatments as natalizumab or fingolimod. MSDS can be used to transfer the documented data to databases as, e.g. the registry of the German MS society or REGIMS. MSDS has already been implemented successfully in clinical practice and is currently being evaluated in a multicenter setting. High-quality management and documentation are crucial for improvements in clinical practice and research work.

  9. Paleopathological Study of Dwarfism-Related Skeletal Dysplasia in a Late Joseon Dynasty (South Korean) Population

    OpenAIRE

    Woo, Eun Jin; Lee, Won-Joon; Hu, Kyung-Seok; Hwang, Jae Joon

    2015-01-01

    Skeletal dysplasias related to genetic etiologies have rarely been reported for past populations. This report presents the skeletal characteristics of an individual with dwarfism-related skeletal dysplasia from South Korea. To assess abnormal deformities, morphological features, metric data, and computed tomography scans are analyzed. Differential diagnoses include achondroplasia or hypochondroplasia, chondrodysplasia, multiple epiphyseal dysplasia, thalassemia-related hemolytic anemia, and l...

  10. Assessing and managing multiple risks in a changing world-The Roskilde recommendations.

    Science.gov (United States)

    Selck, Henriette; Adamsen, Peter B; Backhaus, Thomas; Banta, Gary T; Bruce, Peter K H; Burton, G Allen; Butts, Michael B; Boegh, Eva; Clague, John J; Dinh, Khuong V; Doorn, Neelke; Gunnarsson, Jonas S; Hauggaard-Nielsen, Henrik; Hazlerigg, Charles; Hunka, Agnieszka D; Jensen, John; Lin, Yan; Loureiro, Susana; Miraglia, Simona; Munns, Wayne R; Nadim, Farrokh; Palmqvist, Annemette; Rämö, Robert A; Seaby, Lauren P; Syberg, Kristian; Tangaa, Stine R; Thit, Amalie; Windfeld, Ronja; Zalewski, Maciej; Chapman, Peter M

    2017-01-01

    Roskilde University (Denmark) hosted a November 2015 workshop, Environmental Risk-Assessing and Managing Multiple Risks in a Changing World. This Focus article presents the consensus recommendations of 30 attendees from 9 countries regarding implementation of a common currency (ecosystem services) for holistic environmental risk assessment and management; improvements to risk assessment and management in a complex, human-modified, and changing world; appropriate development of protection goals in a 2-stage process; dealing with societal issues; risk-management information needs; conducting risk assessment of risk management; and development of adaptive and flexible regulatory systems. The authors encourage both cross-disciplinary and interdisciplinary approaches to address their 10 recommendations: 1) adopt ecosystem services as a common currency for risk assessment and management; 2) consider cumulative stressors (chemical and nonchemical) and determine which dominate to best manage and restore ecosystem services; 3) fully integrate risk managers and communities of interest into the risk-assessment process; 4) fully integrate risk assessors and communities of interest into the risk-management process; 5) consider socioeconomics and increased transparency in both risk assessment and risk management; 6) recognize the ethical rights of humans and ecosystems to an adequate level of protection; 7) determine relevant reference conditions and the proper ecological context for assessments in human-modified systems; 8) assess risks and benefits to humans and the ecosystem and consider unintended consequences of management actions; 9) avoid excessive conservatism or possible underprotection resulting from sole reliance on binary, numerical benchmarks; and 10) develop adaptive risk-management and regulatory goals based on ranges of uncertainty. Environ Toxicol Chem 2017;36:7-16. © 2016 SETAC. © 2016 SETAC.

  11. Proteomics of Skeletal Muscle

    DEFF Research Database (Denmark)

    Deshmukh, Atul

    2016-01-01

    , of altered protein expressions profiles and/or their posttranslational modifications (PTMs). Mass spectrometry (MS)-based proteomics offer enormous promise for investigating the molecular mechanisms underlying skeletal muscle insulin resistance and exercise-induced adaptation; however, skeletal muscle......Skeletal muscle is the largest tissue in the human body and plays an important role in locomotion and whole body metabolism. It accounts for ~80% of insulin stimulated glucose disposal. Skeletal muscle insulin resistance, a primary feature of Type 2 diabetes, is caused by a decreased ability...... of muscle to respond to circulating insulin. Physical exercise improves insulin sensitivity and whole body metabolism and remains one of the most promising interventions for the prevention of Type 2 diabetes. Insulin resistance and exercise adaptations in skeletal muscle might be a cause, or consequence...

  12. The Multiple Use of Tropical Forests by Indigenous Peoples in Mexico: a Case of Adaptive Management

    Directory of Open Access Journals (Sweden)

    Víctor M. Toledo

    2003-12-01

    Full Text Available The quest for an appropriate system of management for tropical ecosystems necessitates that ecologists consider the accumulated experiences of indigenous peoples in their long-term management of local resources, a subject of current ethnoecology. This paper provides data and empirical evidence of an indigenous multiple-use strategy (MUS of tropical forest management existing in Mexico, that can be considered a case of adaptive management. This conclusion is based on the observation that some indigenous communities avoid common modernization routes toward specialized, unsustainable, and ecologically disruptive systems of production, and yet probably achieve the most successful tropical forest utilization design, in terms of biodiversity conservation, resilience, and sustainability. This analysis relies on an exhaustive review of the literature and the authors' field research. Apparently, this MUS represents an endogenous reaction of indigenous communities to the intensification of natural resource use, responding to technological, demographic, cultural, and economic changes in the contemporary world. This transforms traditional shifting cultivators into multiple-use strategists. Based on a case study, three main features (biodiversity, resilience, and permanence considered relevant to achieving adaptive and sustainable management of tropical ecosystems are discussed.

  13. Traffic Management by Using Admission Control Methods in Multiple Node IMS Network

    Directory of Open Access Journals (Sweden)

    Filip Chamraz

    2016-01-01

    Full Text Available The paper deals with Admission Control methods (AC as a possible solution for traffic management in IMS networks (IP Multimedia Subsystem - from the point of view of an efficient redistribution of the available network resources and keeping the parameters of Quality of Service (QoS. The paper specifically aims at the selection of the most appropriate method for the specific type of traffic and traffic management concept using AC methods on multiple nodes. The potential benefit and disadvantage of the used solution is evaluated.

  14. Illustrating the multiple facets and levels of fidelity of implementation to a teacher classroom management intervention.

    Science.gov (United States)

    Reinke, Wendy M; Herman, Keith C; Stormont, Melissa; Newcomer, Lori; David, Kimberly

    2013-11-01

    Many school-based interventions to promote student mental health rely on teachers as implementers. Thus, understanding the interplay between the multiple domains of fidelity to the intervention and intervention support systems such as coaching and teacher implementation of new skills is an important aspect of implementation science. This study describes a systematic process for assessing multiple domains of fidelity. Data from a larger efficacy trial of the Incredible Years Teacher Classroom Management (IY TCM) program are utilized. Data on fidelity to the IY TCM workshop training sessions and onsite weekly coaching indicate that workshop leaders and the IY TCM coach implemented the training and coaching model with adequate adherence. Further, workshop leaders' ratings of engagement were associated with teacher implementation of specific praise, following training on this content. Lastly, the IY TCM coach differentiation of teacher exposure to coaching was evaluated and found to be associated with teacher implementation of classroom management practices and student disruptive behavior.

  15. Diffuse idiopathic skeletal hyperostosis in ancient clergymen.

    NARCIS (Netherlands)

    Verlaan, J.J.; Oner, F.C.; Maat, G.J.

    2007-01-01

    Diffuse idiopathic skeletal hyperostosis (DISH) is a common but often unrecognized systemic disorder observed mainly in the elderly. DISH is diagnosed when the anterior longitudinal ligament of the spine is ossified on at least four contiguous spinal levels or when multiple peripheral enthesopathies

  16. Diffuse idiopathic skeletal hyperostosis in ancient clergymen

    NARCIS (Netherlands)

    Verlaan, J.J.; Oner, F.C.; Maat, G.R.J.

    2007-01-01

    Diffuse idiopathic skeletal hyperostosis (DISH) is a common but often unrecognized systemic disorder observed mainly in the elderly. DISH is diagnosed when the anterior longitudinal ligament of the spine is ossified on at least four contiguous spinal levels or when multiple peripheral

  17. Designing an Electronic Patient Management System for Multiple Sclerosis: Building a Next Generation Multiple Sclerosis Documentation System.

    Science.gov (United States)

    Kern, Raimar; Haase, Rocco; Eisele, Judith Christina; Thomas, Katja; Ziemssen, Tjalf

    2016-01-08

    Technologies like electronic health records or telemedicine devices support the rapid mediation of health information and clinical data independent of time and location between patients and their physicians as well as among health care professionals. Today, every part of the treatment process from diagnosis, treatment selection, and application to patient education and long-term care may be enhanced by a quality-assured implementation of health information technology (HIT) that also takes data security standards and concerns into account. In order to increase the level of effectively realized benefits of eHealth services, a user-driven needs assessment should ensure the inclusion of health care professional perspectives into the process of technology development as we did in the development process of the Multiple Sclerosis Documentation System 3D. After analyzing the use of information technology by patients suffering from multiple sclerosis, we focused on the needs of neurological health care professionals and their handling of health information technology. Therefore, we researched the status quo of eHealth adoption in neurological practices and clinics as well as health care professional opinions about potential benefits and requirements of eHealth services in the field of multiple sclerosis. We conducted a paper-and-pencil-based mail survey in 2013 by sending our questionnaire to 600 randomly chosen neurological practices in Germany. The questionnaire consisted of 24 items covering characteristics of participating neurological practices (4 items), the current use of network technology and the Internet in such neurological practices (5 items), physicians' attitudes toward the general and MS-related usefulness of eHealth systems (8 items) and toward the clinical documentation via electronic health records (4 items), and physicians' knowledge about the Multiple Sclerosis Documentation System (3 items). From 600 mailed surveys, 74 completed surveys were returned

  18. Managing aquatic ecosystems and water resources under multiple stress--an introduction to the MARS project.

    Science.gov (United States)

    Hering, Daniel; Carvalho, Laurence; Argillier, Christine; Beklioglu, Meryem; Borja, Angel; Cardoso, Ana Cristina; Duel, Harm; Ferreira, Teresa; Globevnik, Lidija; Hanganu, Jenica; Hellsten, Seppo; Jeppesen, Erik; Kodeš, Vit; Solheim, Anne Lyche; Nõges, Tiina; Ormerod, Steve; Panagopoulos, Yiannis; Schmutz, Stefan; Venohr, Markus; Birk, Sebastian

    2015-01-15

    Water resources globally are affected by a complex mixture of stressors resulting from a range of drivers, including urban and agricultural land use, hydropower generation and climate change. Understanding how stressors interfere and impact upon ecological status and ecosystem services is essential for developing effective River Basin Management Plans and shaping future environmental policy. This paper details the nature of these problems for Europe's water resources and the need to find solutions at a range of spatial scales. In terms of the latter, we describe the aims and approaches of the EU-funded project MARS (Managing Aquatic ecosystems and water Resources under multiple Stress) and the conceptual and analytical framework that it is adopting to provide this knowledge, understanding and tools needed to address multiple stressors. MARS is operating at three scales: At the water body scale, the mechanistic understanding of stressor interactions and their impact upon water resources, ecological status and ecosystem services will be examined through multi-factorial experiments and the analysis of long time-series. At the river basin scale, modelling and empirical approaches will be adopted to characterise relationships between multiple stressors and ecological responses, functions, services and water resources. The effects of future land use and mitigation scenarios in 16 European river basins will be assessed. At the European scale, large-scale spatial analysis will be carried out to identify the relationships amongst stress intensity, ecological status and service provision, with a special focus on large transboundary rivers, lakes and fish. The project will support managers and policy makers in the practical implementation of the Water Framework Directive (WFD), of related legislation and of the Blueprint to Safeguard Europe's Water Resources by advising the 3rd River Basin Management Planning cycle, the revision of the WFD and by developing new tools for

  19. Management of Globally Distributed Software Development Projects in Multiple-Vendor Constellations

    Science.gov (United States)

    Schott, Katharina; Beck, Roman; Gregory, Robert Wayne

    Global information systems development outsourcing is an apparent trend that is expected to continue in the foreseeable future. Thereby, IS-related services are not only increasingly provided from different geographical sites simultaneously but beyond that from multiple service providers based in different countries. The purpose of this paper is to understand how the involvement of multiple service providers affects the management of the globally distributed information systems development projects. As research on this topic is scarce, we applied an exploratory in-depth single-case study design as research approach. The case we analyzed comprises a global software development outsourcing project initiated by a German bank together with several globally distributed vendors. For data collection and data analysis we have adopted techniques suggested by the grounded theory method. Whereas the extant literature points out the increased management overhead associated with multi-sourcing, the analysis of our case suggests that the required effort for managing global outsourcing projects with multiple vendors depends among other things on the maturation level of the cooperation within the vendor portfolio. Furthermore, our data indicate that this interplay maturity is positively impacted through knowledge about the client that has been derived based on already existing client-vendor relationships. The paper concludes by offering theoretical and practical implications.

  20. Case report 360: Multifocal Ewing tumor of the skeletal system

    Energy Technology Data Exchange (ETDEWEB)

    Coombs, R.J.; Zeiss, J.; McCann, K.; Phillips, E.

    1986-03-01

    In summary, a case of Ewing tumor, involving the left scapula with a grossly destructive pattern of multiple, lytic, permeating skeletal disease involving both femoral heads, multiple sites within the skull and the lumbar and thoracic spines at the time of the initial diagnosis, is presented. This extensive skeletal metastasis, consonant with the initial diagnosis, without obvious metastases to lungs or other parenchymal areas (before death and autopsy) has not been described previously in the literature available to the authors. (orig./SHA).

  1. Robust set-point regulation for ecological models with multiple management goals.

    Science.gov (United States)

    Guiver, Chris; Mueller, Markus; Hodgson, Dave; Townley, Stuart

    2016-05-01

    Population managers will often have to deal with problems of meeting multiple goals, for example, keeping at specific levels both the total population and population abundances in given stage-classes of a stratified population. In control engineering, such set-point regulation problems are commonly tackled using multi-input, multi-output proportional and integral (PI) feedback controllers. Building on our recent results for population management with single goals, we develop a PI control approach in a context of multi-objective population management. We show that robust set-point regulation is achieved by using a modified PI controller with saturation and anti-windup elements, both described in the paper, and illustrate the theory with examples. Our results apply more generally to linear control systems with positive state variables, including a class of infinite-dimensional systems, and thus have broader appeal.

  2. Skeletal imaging composition

    International Nuclear Information System (INIS)

    Vanduzee, B.F.; Degenhardt, C.R.

    1983-01-01

    This invention is based on the discovery that the adjustment of pH, within a particular range, during the process of manufacturing lyophilized diphosphonate-containing skeletal imaging kits yields a kit which produces a technetium skeletal imaging agent with superior imaging properties. This increased performance is manifested through faster blood clearance and higher skeletal uptake of the technetium imaging agent. The process for producing a dry-powder imaging kit comprises the steps of: preparing a solution of a diphosphonate carrier, stannous reductant, and a stabilizer in water; adjusting the pH to between 5.5 and 6.5; and lyophilizing the solution

  3. The Contribution of Multiple Use Forest Management to Small Farmers’ Annual Incomes in the Eastern Amazon

    Directory of Open Access Journals (Sweden)

    Plinio Sist

    2014-06-01

    Full Text Available Small-scale farmers in the Brazilian Amazon collectively hold tenure over more than 12 million ha of permanent forest reserves, as required by the Forest Code. The trade-off between forest conservation and other land uses entails opportunity costs for them and for the country, which have not been sufficiently studied. We assessed the potential income generated by multiple use forest management for farmers and compared it to the income potentially derived from six other agricultural land uses. Income from the forest was from (i logging, carried out by a logging company in partnership with farmers’ associations; and (ii harvesting the seeds of Carapa guianensis (local name andiroba for the production of oil. We then compared the income generated by multiple-use forest management with the income from different types of agrarian systems. According to our calculations in this study, the mean annual economic benefits from multiple forest use are the same as the least productive agrarian system, but only 25% of the annual income generated by the most productive system. Although the income generated by logging may be considered low when calculated on an annual basis and compared to incomes generated by agriculture, the one-time payment after logging is significant (US$5,800 to US$33,508 and could be used to implement more intensive and productive cropping systems such as planting black pepper. The income from forest management could also be used to establish permanent fields in deforested areas for highly productive annual crops using conservation agriculture techniques. These techniques are alternatives to the traditional land use based on periodic clearing of the forest. Nevertheless, the shift in current practices towards adoption of more sustainable conservation agriculture techniques will also require the technical and legal support of the State to help small farmers apply these alternatives, which aim to integrate forest management in

  4. 15 CFR 921.33 - Boundary changes, amendments to the management plan, and addition of multiple-site components.

    Science.gov (United States)

    2010-01-01

    ... management plan, and addition of multiple-site components. (a) Changes in the boundary of a Reserve and major changes to the final management plan, including state laws or regulations promulgated specifically for the... management plan change. Changes in the boundary of a Reserve involving the acquisition of properties not...

  5. Allocation and management issues in multiple-transaction open access transmission networks

    Science.gov (United States)

    Tao, Shu

    This thesis focuses on some key issues related to allocation and management by the independent grid operator (IGO) of unbundled services in multiple-transaction open access transmission networks. The three unbundled services addressed in the thesis are transmission real power losses, reactive power support requirements from generation sources, and transmission congestion management. We develop the general framework that explicitly represents multiple transactions undertaken simultaneously in the transmission grid. This framework serves as the basis for formulating various problems treated in the thesis. We use this comprehensive framework to develop a physical-flow-based mechanism to allocate the total transmission losses to each transaction using the system. An important property of the allocation scheme is its capability to effectively deal with counter flows that result in the presence of specific transactions. Using the loss allocation results as the basis, we construct the equivalent loss compensation concept and apply it to develop flexible and effective procedures for compensating losses in multiple-transaction networks. We present a new physical-flow-based mechanism for allocating the reactive power support requirements provided by generators in multiple-transaction networks. The allocatable reactive support requirements are formulated as the sum of two specific components---the voltage magnitude variation component and the voltage angle variation component. The formulation utilizes the multiple-transaction framework and makes use of certain simplifying approximations. The formulation leads to a natural allocation as a function of the amount of each transaction. The physical interpretation of each allocation as a sensitivity of the reactive output of a generator is discussed. We propose a congestion management allocation scheme for multiple-transaction networks. The proposed scheme determines the allocation of congestion among the transactions on a physical

  6. Generalized skeletal pathology: Results of radionuclide studies

    International Nuclear Information System (INIS)

    Fueger, G.F.; Aigner, R.

    1987-01-01

    Generalized pathological changes may involve the skeleton systematically (bone tissue, bone marrow) or at multiple sites involving destruction or infiltration. Appropriate radionuclide studies include total-body bone or bone marrow scintigraphy, absorptiometry (osteodensitometry) and the 24 h whole-body retention measurement. Established radioindicators are 99m-Tc-(hydroxy)methylendiphosphonate (HMDP or MDP) and 99m-Tc-human serumalbumin-nanocolloid. Absorptiometry of the forearm, extended by computer-assisted transaxial tomography, may be expected to prove as the most efficient method of bone density measurement. The 24 h whole-body retention measurement is useful for the diagnosis and follow-up of metabolic and endocrine osteopathies, if the very same osteotropic 99m-Tc-chelate is used. Whole-body bone scintigraphy today is one of the most important radionuclide studies for diagnosis and follow-up of skeletal metastases. Scintigraphy provides evidence of skeletal metastases several months earlier than radiological examinations. In about 40 percent of patients with cancer of the prostate, scintigraphy provided positive findings of skeletal metastases in the absence of both pain and increased levels of phosphatase. In patients with a history of malignancy, 60 percent of solitary findings on skeletal scintigraphy are metastases. The frequency of false negative findings obtained by whole-body skeletal scintigraphy are metastases. The frequency of false negative findings obtained by whole-body skeletal scintigraphy ranges from 2 to 4%. Compared to skeletal scintigraphy, bone marrow scintigraphy frequently yields significant additional findings in cases of plasmocytoma, histiocytoma, lymphoma and haemoblastoses. (orig.) [de

  7. Skeletal coccidioidomycosis: imaging findings in 19 patients

    International Nuclear Information System (INIS)

    Zeppa, M.A.; Greenspan, A.; McGahan, J.P.; Laorr, A.; Steinbach, L.S.

    1996-01-01

    The objective of this study was to describe the distribution and radiologic appearance of skeletal coccidioidomycosis in 19 documented cases. Medical records of 19 patients with clinically confirmed skeletal occidioidomycosis were retrospectively reviewed. The patients were studied with plain radiography, skeletal scintigraphy and MRI. Multiple lesions were seen in 11 of 19 patients (58%). Of a total of 46 lesions, 27 (59%) were described as punched-out lytic, 10 (22%) as permeative/destructive, and 9 (17%) as involving a joint and/or disk space. Lesions were identified in almost every bone (with the exception of the facial bones, ulna, carpus, and fibula) and were most commonly found in the axial skeleton (20 of 46; 43%). Plain radiographs are effective in the initial evaluation of bones and joints, scintigraphic studies can identify disseminated disease, and CT and MRI are effective in determining soft tissue involvement and spinal abnormalities. (orig./MG)

  8. Managing Multiple Sources of Competitive Advantage in a Complex Competitive Environment

    Directory of Open Access Journals (Sweden)

    Alexandre Howard Henry Lapersonne

    2013-12-01

    Full Text Available The aim of this article is to review the literature on the topic of sustained and temporary competitive advantage creation, specifically in dynamic markets, and to propose further research possibilities. After having analyzed the main trends and scholars’ works on the subject, it was concluded that a firm which has been experiencing erosion of its core sources of economic rent generation, should have diversified its strategy portfolio in a search for new sources of competitive advantage, ones that could compensate for the decline of profits provoked by intensive competitive environments. This review concludes with the hypothesis that firms, who have decided to enter and manage multiple competitive environments, should have developed a multiple strategies framework approach. The management of this source of competitive advantage portfolio should have allowed persistence of a firm’s superior economic performance through the management of diverse temporary advantages lifecycle and through a resilient effect, where a very successful source of competitive advantage compensates the ones that have been eroded. Additionally, the review indicates that economies of emerging countries, such as the ones from the BRIC block, should present a more complex competitive environment due to their historical nature of cultural diversity, social contrasts and frequent economic disruption, and also because of recent institutional normalization that has turned the market into hypercompetition. Consequently, the study of complex competition should be appropriate in such environments.

  9. A case study of resources management planning with multiple objectives and projects

    Science.gov (United States)

    Peterson, David L.; Silsbee, David G.; Schmoldt, Daniel L.

    1994-09-01

    Each National Park Service unit in the United States produces a resources management plan (RMP) every four years or less. The plans commit budgets and personnel to specific projects for four years, but they are prepared with little quantitative and analytical rigor and without formal decision-making tools. We have previously described a multiple objective planning process for inventory and monitoring programs (Schmoldt and others 1994). To test the applicability of that process for the more general needs of resources management planning, we conducted an exercise on the Olympic National Park (NP) in Washington State, USA. Eight projects were selected as typical of those considered in RMPs and five members of the Olympic NP staff used the analytic hierarchy process (AHP) to prioritize the eight projects with respect to their implicit management objectives. By altering management priorities for the park, three scenarios were generated. All three contained some similarities in rankings for the eight projects, as well as some differences. Mathematical allocations of money and people differed among these scenarios and differed substantially from what the actual 1990 Olympic NP RMP contains. Combining subjective priority measures with budget dollars and personnel time into an objective function creates a subjective economic metric for comparing different RMP’s. By applying this planning procedure, actual expenditures of budget and personnel in Olympic NP can agree more closely with the staff’s management objectives for the park.

  10. Multiple-use Management of Irrigation Systems: Technical Constraints and Challenges

    Science.gov (United States)

    Gowing, J.; Li, Q.; Mayilswami, C.; Gunawardhana, K.

    It is now widely recognised that many irrigation systems, originally planned only for irrigation supply, are de facto multiple-use systems. However, the importance of non- irrigation uses (such as bathing, laundry, livestock watering and fishing), to the liveli- hoods of the rural poor has generally been ignored. This has significant implications for irrigation engineers, water resources managers and other decision-makers. An im- proved understanding of competition and complementarity between these uses and irrigation demands is essential for effective multiple-use management of irrigation systems.This paper presents a study of multiple-use management, where the focus is on integrating aquaculture within irrigation systems with and without secondary storage. The Lower Bhavani scheme in South India and Mahaweli System H in Sri- Lanka were selected as representative smallholder irrigation schemes: - The Lower Bhavani scheme comprises a 200km contour canal serving a command area of 78,500ha. Apart from the main dam, there are no storage structures within the irriga- tion system. - Mahaweli System H comprises a command area of 43,000ha served by three main canals. The feature of particular interest in this scheme is the large number of secondary storage structures (known locally as tanks), which are in- tegrated within the canal network. It is apparent from these two sites and from studies elsewhere that non-irrigation uses are important to the livelihoods of the local peo- ple, but these uses are largely opportunistic. The failure to give explicit recognition to non-irrigation uses has important implications for assessments of economic per- formance and water productivity of irrigation systems. However, any attempt to give proper recognition to these alternative uses also has implication for irrigation project management. This paper describes a detailed study of water management in the two irrigation systems. The method of investigation involves in-depth studies in

  11. Radiological management of multiple hepatic artery pseudoaneurysms associated with cholangitic abscesses

    International Nuclear Information System (INIS)

    Goyal, Ankur; Madhusudhan, Kumble S; Gamanagatti, Shivanand; Baruah, Bhaskar; Shalimar; Sharma, Raju

    2016-01-01

    Hepatic artery pseudoaneurysms (HAP) are uncommon, occurring mostly as a complication of trauma (accidental or iatrogenic). Liver abscess rarely causes HAP and multiple HAP associated with cholangitic abscesses have not been reported in the literature. We present a patient of acute necrotizing pancreatitis with stent block cholangitis and multiple cholangitic abscesses who developed hemorrhagic output through drainage catheter in the liver abscess. A multiphasic CT angiography demonstrated three HAP, which were treated with a combination of endovascular coil embolization and percutaneous thrombin injection. The fact that cholangitic abscesses may be associated with pseudoaneurysms should not be neglected, considering the potentially catastrophic complication and relatively easy radiological management. CT angiography permits accurate diagnosis and lays down the roadmap for endovascular procedures

  12. Management of multiple intrusive luxative injuries: A case report with 7-year follow-up

    Directory of Open Access Journals (Sweden)

    Seema Thakur

    2014-01-01

    Full Text Available This report presents a case of severe intrusive luxation of multiple anterior teeth in an 11-year-old girl. The teeth were repositioned successfully by endodontic and orthodontic management. The case was monitored for 7 years. Depending on the severity of the injury, different clinical approaches for treatment of intrusive luxation may be used. Despite the variety of treatment modalities, rehabilitation of intruded teeth is always a challenge and a multidisciplinary approach is important to achieve a successful result. In this case, intruded teeth were endodontically treated with multiple calcium hydroxide dressings and repositioned orthodontically. The follow-up of such cases is very important as the repair process after intrusion is complex. After 7 years, no clinical or radiographic pathology was detected.

  13. Search and Classification Using Multiple Autonomous Vehicles Decision-Making and Sensor Management

    CERN Document Server

    Wang, Yue

    2012-01-01

    Search and Classification Using Multiple Autonomous Vehicles provides a comprehensive study of decision-making strategies for domain search and object classification using multiple autonomous vehicles (MAV) under both deterministic and probabilistic frameworks. It serves as a first discussion of the problem of effective resource allocation using MAV with sensing limitations, i.e., for search and classification missions over large-scale domains, or when there are far more objects to be found and classified than there are autonomous vehicles available. Under such scenarios, search and classification compete for limited sensing resources. This is because search requires vehicle mobility while classification restricts the vehicles to the vicinity of any objects found. The authors develop decision-making strategies to choose between these competing tasks and vehicle-motion-control laws to achieve the proposed management scheme. Deterministic Lyapunov-based, probabilistic Bayesian-based, and risk-based decision-mak...

  14. Radiological management of multiple hepatic artery pseudoaneurysms associated with cholangitic abscesses

    Directory of Open Access Journals (Sweden)

    Ankur Goyal

    2016-01-01

    Full Text Available Hepatic artery pseudoaneurysms (HAP are uncommon, occurring mostly as a complication of trauma (accidental or iatrogenic. Liver abscess rarely causes HAP and multiple HAP associated with cholangitic abscesses have not been reported in the literature. We present a patient of acute necrotizing pancreatitis with stent block cholangitis and multiple cholangitic abscesses who developed hemorrhagic output through drainage catheter in the liver abscess. A multiphasic CT angiography demonstrated three HAP, which were treated with a combination of endovascular coil embolization and percutaneous thrombin injection. The fact that cholangitic abscesses may be associated with pseudoaneurysms should not be neglected, considering the potentially catastrophic complication and relatively easy radiological management. CT angiography permits accurate diagnosis and lays down the roadmap for endovascular procedures.

  15. PORTFOLIO MANAGEMENT IN NEW PRODUCTS DEVELOPMENT IN THE TELECOMMUNICATION SECTOR IN BRAZIL: A MULTIPLE CASES STUDY

    Directory of Open Access Journals (Sweden)

    Roque Rabechini Jr.

    2017-06-01

    Full Text Available This study aimed to understand how the use of portfolio management practices influence the development of new products in the Brazilian telecommunications operators. The chosen alternative methodology was the multiple case study. The results showed that the processes of identification, selection and prioritization projects influence the development of new products. Specifically, we found that the optimization of resources and product launch projects in short periods of time, are indicators to reveal the possibilities of organizations to remain competitive in the market.

  16. Brittleness of diabetes due to achalasia cardia managed successfully by multiple innovative strategies

    Directory of Open Access Journals (Sweden)

    Vimal Upreti

    2013-01-01

    Full Text Available Achalasia cardia is an infrequent disorder of esophageal dysmotility that has failure of the lower end of the esophagus to relax with swallowing as hallmark abnormality. Diabetes mellitus, on the other hand, can afflict the motor activity of gastrointestinal tract by causing autonomic neuropathy. Combination of these diseases can be very distressing to a patient. We present a 45-year-old lady co-affected with both these disorders who presented with severe hypoglycemia and was managed successfully using the multiple strategies to treat achalasia and diabetes.

  17. Nuclear techniques in the development of management practices for multiple cropping systems

    International Nuclear Information System (INIS)

    1980-11-01

    The need for a new coordinated research programme was considered, aimed at the development of adequate fertilizer and water management practices for multiple cropping systems while taking into account soil properties and prevailing weather conditions. Ten papers were presented, followed by a summary of recommendations and a list of participants. Eight of the papers have been entered individually into the INIS data base. The remaining two papers, one on the role of legumes in intercropping systems (presented by Rajat De from New Delhi) and the other on the need for agroforestry and special considerations regarding field research (by P.A. Huxley from Nairobi) assess prevailing conditions but do not discuss isotope application

  18. Radiology of skeletal and soft tissue changes

    International Nuclear Information System (INIS)

    Walker, H.C. Jr.; Coleman, C.C.; Hunter, D.W.

    1986-01-01

    Skeletal complications are very common in renal transplant patients. Loss of bone mass in the posttransplant period places the skeletal system in jeopardy. Osteonecrosis, while not life threatening, often prevents rehabilitation. Spontaneous fractures are frequent but are usually not a major problem except in the diabetic transplant recipient. Septic arthritis and osteomyelitis are usually successfully managed by conservative measures, except when accompanied by severe occlusive vascular disease. Juvenile onset diabetic patients still may develop disabling neuropathic joint disease or occlusive vascular disease after renal transplantation. The authors hope that successful pancreas transplantation will avert these problems in the future

  19. Multiple myeloma: radiology or bone scanning

    International Nuclear Information System (INIS)

    Leonard, R.C.F.; Owen, J.P.; Proctor, S.J.; Hamilton, P.J.

    1981-01-01

    A comparative study of radionuclide bone scanning and skeletal radiology in patients with multiple myeloma revealed four principal findings: (i) There were no cases of negative bone scans with positive skeletal radiographs. (ii) Lytic bone lesions were seriously underestimated by bone scans. (iii) Bone scans tended to pick up lesions in ribs missed on the skeletal surveys. (iv) Patients with bone pain were more likely to have positive bone scans and skeletal radiographs than asymptomatic patients. (author)

  20. Management of osteonecrosis of the femoral head in children with sickle cell disease: results of conservative and operative treatments at skeletal maturity

    Science.gov (United States)

    Mallet, C.; Abitan, A.; Vidal, C.; Holvoet, L.; Mazda, K.; Simon, A.-L.; Ilharreborde, B.

    2018-01-01

    Abstract Purpose Sickle cell disease (SCD) is the most common cause of femoral head osteonecrosis (ONFH) during childhood with an overall prevalence of 10%. In children, spontaneous revascularization can occur, as in Legg-Calve-Perthes disease. Consequently, the aim of treatment is to restore proper hip containment to prevent joint arthritis. This is the first study reporting long-term results at skeletal maturity of non-operative and surgical treatments for ONFH in SCD children. Methods All children with ONFH due to SCD were retrospectively reviewed. At initial evaluation, extension of osteonecrosis was radiographically defined using Catterall, lateral pillar Herring and Ficat classifications. Subluxation of the femoral head with Reimers migration index > 30% required surgical treatment including femoral varus osteotomy and/or pelvic osteotomies. Conservative treatment including non-weight bearing and physiotherapy was performed in the remaining cases. Outcomes were assessed at skeletal maturity using the Harris Hip Score (HHS) and the Stulberg classification. Total hip arthroplasty and Stulberg 5 were defined as failures. Results A total of 25 hips in 17 patients were included (mean follow-up 7.5 years SD 3.4). Mean age at diagnosis was 11.4 years SD 2.9. In all, 15 hips (60%) were classified Catterall 3 and 4 and Herring B and C. A total of 13 patients (52%) underwent surgical treatment. At skeletal maturity, mean HHS was good (81 SD 17), 12 hips (48%) were classified Stulberg 1 and 2, seven hips (28%) were classified Stulberg 3 and 4. Conclusion Both treatments led to good functional results with 75% of congruent hips at skeletal maturity. Level of Evidence IV PMID:29456754

  1. Management of osteonecrosis of the femoral head in children with sickle cell disease: results of conservative and operative treatments at skeletal maturity.

    Science.gov (United States)

    Mallet, C; Abitan, A; Vidal, C; Holvoet, L; Mazda, K; Simon, A-L; Ilharreborde, B

    2018-02-01

    Sickle cell disease (SCD) is the most common cause of femoral head osteonecrosis (ONFH) during childhood with an overall prevalence of 10%. In children, spontaneous revascularization can occur, as in Legg-Calve-Perthes disease. Consequently, the aim of treatment is to restore proper hip containment to prevent joint arthritis. This is the first study reporting long-term results at skeletal maturity of non-operative and surgical treatments for ONFH in SCD children. All children with ONFH due to SCD were retrospectively reviewed. At initial evaluation, extension of osteonecrosis was radiographically defined using Catterall, lateral pillar Herring and Ficat classifications. Subluxation of the femoral head with Reimers migration index > 30% required surgical treatment including femoral varus osteotomy and/or pelvic osteotomies. Conservative treatment including non-weight bearing and physiotherapy was performed in the remaining cases. Outcomes were assessed at skeletal maturity using the Harris Hip Score (HHS) and the Stulberg classification. Total hip arthroplasty and Stulberg 5 were defined as failures. A total of 25 hips in 17 patients were included (mean follow-up 7.5 years SD 3.4). Mean age at diagnosis was 11.4 years SD 2.9. In all, 15 hips (60%) were classified Catterall 3 and 4 and Herring B and C. A total of 13 patients (52%) underwent surgical treatment. At skeletal maturity, mean HHS was good (81 SD 17), 12 hips (48%) were classified Stulberg 1 and 2, seven hips (28%) were classified Stulberg 3 and 4. Both treatments led to good functional results with 75% of congruent hips at skeletal maturity. IV.

  2. Management of osteonecrosis of the femoral head in children with sickle cell disease: results of conservative and operative treatments at skeletal maturity

    OpenAIRE

    Mallet, C.; Abitan, A.; Vidal, C.; Holvoet, L.; Mazda, K.; Simon, A.-L.; Ilharreborde, B.

    2018-01-01

    Abstract Purpose Sickle cell disease (SCD) is the most common cause of femoral head osteonecrosis (ONFH) during childhood with an overall prevalence of 10%. In children, spontaneous revascularization can occur, as in Legg-Calve-Perthes disease. Consequently, the aim of treatment is to restore proper hip containment to prevent joint arthritis. This is the first study reporting long-term results at skeletal maturity of non-operative and surgical treatments for ONFH in SCD children. Methods All ...

  3. Occupational Therapy and Management of Multiple Chronic Conditions in the Context of Health Care Reform

    Science.gov (United States)

    Fogelberg, Donald J.; Halle, Ashley D.; Mroz, Tracy M.

    2017-01-01

    One in four individuals living in the United States has multiple chronic conditions (MCCs), and the already high prevalence of MCCs continues to grow. This population has high rates of health care utilization yet poor outcomes, leading to elevated concerns about fragmented, low-quality care provided within the current health care system. Several national initiatives endeavor to improve care for the population with MCCs, and occupational therapy is uniquely positioned to contribute to these efforts for more efficient, effective, client-centered management of care. By integrating findings from the literature with current policy and practice, we aim to highlight the potential role for occupational therapy in managing MCCs within the evolving health care system. PMID:28027031

  4. Using Natural Language to Enable Mission Managers to Control Multiple Heterogeneous UAVs

    Science.gov (United States)

    Trujillo, Anna C.; Puig-Navarro, Javier; Mehdi, S. Bilal; Mcquarry, A. Kyle

    2016-01-01

    The availability of highly capable, yet relatively cheap, unmanned aerial vehicles (UAVs) is opening up new areas of use for hobbyists and for commercial activities. This research is developing methods beyond classical control-stick pilot inputs, to allow operators to manage complex missions without in-depth vehicle expertise. These missions may entail several heterogeneous UAVs flying coordinated patterns or flying multiple trajectories deconflicted in time or space to predefined locations. This paper describes the functionality and preliminary usability measures of an interface that allows an operator to define a mission using speech inputs. With a defined and simple vocabulary, operators can input the vast majority of mission parameters using simple, intuitive voice commands. Although the operator interface is simple, it is based upon autonomous algorithms that allow the mission to proceed with minimal input from the operator. This paper also describes these underlying algorithms that allow an operator to manage several UAVs.

  5. Anaesthetic Management of A Child with Multiple Congenital Anomalies Scheduled for Cataract Extraction

    Directory of Open Access Journals (Sweden)

    Kalpana Kulkarni

    2009-01-01

    Full Text Available In infants& children variety of conditions and syndromes are associated with difficult Airway. Anaesthetic management becomes a challenge if it remains unrecognized until induction and sometimes results in disaster, leading to oropharyngeal trauma, laryngeal oedema, cardiovascular& neurological complications. A 4-month-old child with multiple congenital anomalies was posted for cataract extraction for early and better development of vision. He had history of post birth respiratory distress, difficulty in feeding, breath holding with delayed mile stones. He was treated as for Juvenile asthma. This child was induced with inhalation anaesthesia. There was difficulty in laryngoscopic intubation and could pass much smaller size of the tube than predicted. He developed post operative stridor and desaturation. The problems which we faced during the anaesthetic management and during postoperative period are discussed with this case.

  6. Managing multiple projects: a literature review of setting priorities and a pilot survey of healthcare researchers in an academic setting.

    Science.gov (United States)

    Hopkins, Robert Borden; Campbell, Kaitryn; O'Reilly, Daria; Tarride, Jean-Eric; Bowen, Jim; Blackhouse, Gord; Goerre, Ron

    2007-05-16

    To summarize and then assess with a pilot study the use of published best practice recommendations for priority setting during management of multiple healthcare research projects, in a resource-constrained environment. Medical, economic, business, and operations literature was reviewed to summarize and develop a survey to assess best practices for managing multiple projects. Fifteen senior healthcare research project managers, directors, and faculty at an urban academic institution were surveyed to determine most commonly used priority rules, ranking of rules, characteristics of their projects, and availability of resources. Survey results were compared to literature recommendations to determine use of best practices. Seven priority-setting rules were identified for managing multiple projects. Recommendations on assigning priorities by project characteristics are presented. In the pilot study, a large majority of survey respondents follow best practice recommendations identified in the research literature. However, priority rules such as Most Total Successors (MTS) and Resource Scheduling Method (RSM) were used "very often" by half of the respondents when better performing priority rules were available. Through experience, project managers learn to manage multiple projects under resource constraints. Best practice literature can assist project managers in priority setting by recommending the most appropriate priority given resource constraints and project characteristics. There is room for improvement in managing multiple projects.

  7. Interdisciplinary management of an adult patient with class II div 1 Malocclusion, Anterior Open Bite and multiple missing molars

    Directory of Open Access Journals (Sweden)

    Rohit Mehrotra

    2014-01-01

    Full Text Available This case report describes the esthetic and functional rehabilitation of a female patient in her mid forties having Class II Div 1 malocclusion, anterior open bite and multiple missing molars, with orthodontics and implant prosthodontics. The patient had bilaterally missing upper first and third molars and lower first and second molars. Orthodontic treatment using skeletal anchorage was performed to retract and align the upper anteriors and correct the open bite. In the upper arch, first molar spaces were closed and no prosthesis was needed. In the lower arch, the anteriors and premolars were aligned and implants were placed bilaterally to replace the missing molars and provide proper occlusion with the upper posteriors. Significant improvement in the occlusion, smile and facial esthetics was achieved. This article highlights the importance of an interdisciplinary team approach for providing optimum treatment to many adult patients.

  8. Placenta Percreta in First Trimester after Multiple Rounds of Failed Medical Management for a Missed Abortion

    Directory of Open Access Journals (Sweden)

    Jaimin Shah

    2017-01-01

    Full Text Available Background. The detection of a morbidly adherent placenta (MAP in the first trimester is rare. Risk factors such as multiparity, advanced maternal age, prior cesarean delivery, prior myomectomy, placenta previa, or previous uterine evacuation place patients at a higher risk for having abnormal placental implantation. If these patients have a first trimester missed abortion and fail medical management, it is important that providers have a heightened suspicion for a MAP. Case. A 24-year-old G4P3003 with 3 prior cesarean deliveries underwent multiple rounds of failed medical management for a missed abortion. She had a dilation and curettage that was complicated by a significant hemorrhage and ultimately required an urgent hysterectomy. Conclusion. When patients fail medical management for a missed abortion, providers need to assess the patient’s risk factors for a MAP. If risk factors are present, a series of specific evaluations should be triggered to rule out a MAP and help further guide management. Early diagnosis of a MAP allows providers to coordinate a multidisciplinary treatment approach and thoroughly counsel patients. Ensuring adequate resources and personnel at a tertiary hospital is essential to provide the highest quality of care and improve outcomes.

  9. Management of relapsed multiple myeloma: recommendations of the International Myeloma Working Group.

    Science.gov (United States)

    Laubach, J; Garderet, L; Mahindra, A; Gahrton, G; Caers, J; Sezer, O; Voorhees, P; Leleu, X; Johnsen, H E; Streetly, M; Jurczyszyn, A; Ludwig, H; Mellqvist, U-H; Chng, W-J; Pilarski, L; Einsele, H; Hou, J; Turesson, I; Zamagni, E; Chim, C S; Mazumder, A; Westin, J; Lu, J; Reiman, T; Kristinsson, S; Joshua, D; Roussel, M; O'Gorman, P; Terpos, E; McCarthy, P; Dimopoulos, M; Moreau, P; Orlowski, R Z; Miguel, J S; Anderson, K C; Palumbo, A; Kumar, S; Rajkumar, V; Durie, B; Richardson, P G

    2016-05-01

    The prognosis for patients multiple myeloma (MM) has improved substantially over the past decade with the development of new, more effective chemotherapeutic agents and regimens that possess a high level of anti-tumor activity. In spite of this important progress, however, nearly all MM patients ultimately relapse, even those who experience a complete response to initial therapy. Management of relapsed MM thus represents a vital aspect of the overall care for patients with MM and a critical area of ongoing scientific and clinical research. This comprehensive manuscript from the International Myeloma Working Group provides detailed recommendations on management of relapsed disease, with sections dedicated to diagnostic evaluation, determinants of therapy, and general approach to patients with specific disease characteristics. In addition, the manuscript provides a summary of evidence from clinical trials that have significantly impacted the field, including those evaluating conventional dose therapies, as well as both autologous and allogeneic stem cell transplantation. Specific recommendations are offered for management of first and second relapse, relapsed and refractory disease, and both autologous and allogeneic transplant. Finally, perspective is provided regarding new agents and promising directions in management of relapsed MM.

  10. Multi-objective, multiple participant decision support for water management in the Andarax catchment, Almeria

    Science.gov (United States)

    van Cauwenbergh, N.; Pinte, D.; Tilmant, A.; Frances, I.; Pulido-Bosch, A.; Vanclooster, M.

    2008-04-01

    Water management in the Andarax river basin (Almeria, Spain) is a multi-objective, multi-participant, long-term decision-making problem that faces several challenges. Adequate water allocation needs informed decisions to meet increasing socio-economic demands while respecting the environmental integrity of this basin. Key players in the Andarax water sector include the municipality of Almeria, the irrigators involved in the intensive greenhouse agricultural sector, and booming second residences. A decision support system (DSS) is developed to rank different sustainable planning and management alternatives according to their socio-economic and environmental performance. The DSS is intimately linked to sustainability indicators and is designed through a public participation process. Indicators are linked to criteria reflecting stakeholders concerns in the 2005 field survey, such as fulfilling water demand, water price, technical and economical efficiency, social and environmental impacts. Indicators can be partly quantified after simulating the operation of the groundwater reservoir over a 20-year planning period and partly through a parallel expert evaluation process. To predict the impact of future water demand in the catchment, several development scenarios are designed to be evaluated in the DSS. The successive multi-criteria analysis of the performance indicators permits the ranking of the different management alternatives according to the multiple objectives formulated by the different sectors/participants. This allows more informed and transparent decision-making processes for the Andarax river basin, recognizing both the socio-economic and environmental dimensions of water resources management.

  11. Cost of managing an episode of relapse in multiple sclerosis in the United States

    Directory of Open Access Journals (Sweden)

    Ward Alexandra J

    2003-09-01

    Full Text Available Abstract Background The purpose of this study was to determine the direct medical US cost of managing multiple sclerosis relapses. Methods Direct data analysis and cost modeling were employed to derive typical resource use profiles and costs in 2002 US dollars, from the perspective of a third-party payer responsible for comprehensive health-care. The location and scope of health care services provided over a 90-day period were used to define three levels of relapse management. Hospitalization and resulting subsequent care was defined as high intensity management. A medium level of intervention was defined as either use of the emergency room, an observational unit, or administration of acute treatments, such as intravenous methylprednisolone in an outpatient or home setting. The lowest intensity of care comprised physician office visits and symptom-related medications. Data were obtained from many sources including all payer inpatient, ambulatory and emergency room databases from several states, fee schedules, government reports, and literature. All charges were adjusted using cost-to-charge ratios. Results Average cost per person for high management level was $12,870, based on analysis of 4,634 hospital cases (mean age 48 years, 73% female. Hospital care comprised 71% of that cost. At discharge, 36% required inpatient sub-acute care, rehabilitation or home care. The typical cost per moderate episode was $1,847 and mild episode $243. Conclusions Management strategies leading to a reduction in the frequency and severity of a relapse, less reliance on inpatient care, or increased access to steroid infusions in the home, would have a substantial impact on the economic consequences of managing relapses.

  12. A multiple criteria analysis for household solid waste management in the urban community of Dakar.

    Science.gov (United States)

    Kapepula, Ka-Mbayu; Colson, Gerard; Sabri, Karim; Thonart, Philippe

    2007-01-01

    Household solid waste management is a severe problem in big cities of developing countries. Mismanaged solid waste dumpsites produce bad sanitary, ecological and economic consequences for the whole population, especially for the poorest urban inhabitants. Dealing with this problem, this paper utilizes field data collected in the urban community of Dakar, in view of ranking nine areas of the city with respect to multiple criteria of nuisance. Nine criteria are built and organized in three families that represent three classical viewpoints: the production of wastes, their collection and their treatment. Thanks to the method PROMETHEE and the software ARGOS, we do a pair-wise comparison of the nine areas, which allows their multiple criteria rankings according to each viewpoint and then globally. Finding the worst and best areas in terms of nuisance for a better waste management in the city is our final purpose, fitting as well as possible the needs of the urban community. Based on field knowledge and on the literature, we suggest applying general and area-specific remedies to the household solid waste problems.

  13. Fully distributed monitoring architecture supporting multiple trackees and trackers in indoor mobile asset management application.

    Science.gov (United States)

    Jeong, Seol Young; Jo, Hyeong Gon; Kang, Soon Ju

    2014-03-21

    A tracking service like asset management is essential in a dynamic hospital environment consisting of numerous mobile assets (e.g., wheelchairs or infusion pumps) that are continuously relocated throughout a hospital. The tracking service is accomplished based on the key technologies of an indoor location-based service (LBS), such as locating and monitoring multiple mobile targets inside a building in real time. An indoor LBS such as a tracking service entails numerous resource lookups being requested concurrently and frequently from several locations, as well as a network infrastructure requiring support for high scalability in indoor environments. A traditional centralized architecture needs to maintain a geographic map of the entire building or complex in its central server, which can cause low scalability and traffic congestion. This paper presents a self-organizing and fully distributed indoor mobile asset management (MAM) platform, and proposes an architecture for multiple trackees (such as mobile assets) and trackers based on the proposed distributed platform in real time. In order to verify the suggested platform, scalability performance according to increases in the number of concurrent lookups was evaluated in a real test bed. Tracking latency and traffic load ratio in the proposed tracking architecture was also evaluated.

  14. Hybrid MCDA Methods to Integrate Multiple Ecosystem Services in Forest Management Planning: A Critical Review.

    Science.gov (United States)

    Uhde, Britta; Hahn, W Andreas; Griess, Verena C; Knoke, Thomas

    2015-08-01

    Multi-criteria decision analysis (MCDA) is a decision aid frequently used in the field of forest management planning. It includes the evaluation of multiple criteria such as the production of timber and non-timber forest products and tangible as well as intangible values of ecosystem services (ES). Hence, it is beneficial compared to those methods that take a purely financial perspective. Accordingly, MCDA methods are increasingly popular in the wide field of sustainability assessment. Hybrid approaches allow aggregating MCDA and, potentially, other decision-making techniques to make use of their individual benefits and leading to a more holistic view of the actual consequences that come with certain decisions. This review is providing a comprehensive overview of hybrid approaches that are used in forest management planning. Today, the scientific world is facing increasing challenges regarding the evaluation of ES and the trade-offs between them, for example between provisioning and regulating services. As the preferences of multiple stakeholders are essential to improve the decision process in multi-purpose forestry, participatory and hybrid approaches turn out to be of particular importance. Accordingly, hybrid methods show great potential for becoming most relevant in future decision making. Based on the review presented here, the development of models for the use in planning processes should focus on participatory modeling and the consideration of uncertainty regarding available information.

  15. Managing multiple roles: development of the Work-Family Conciliation Strategies Scale.

    Science.gov (United States)

    Matias, Marisa; Fontaine, Anne Marie

    2014-07-17

    Juggling the demands of work and family is becoming increasingly difficult in today's world. As dual-earners are now a majority and men and women's roles in both the workplace and at home have changed, questions have been raised regarding how individuals and couples can balance family and work. Nevertheless, research addressing work-family conciliation strategies is limited to a conflict-driven approach and context-specific instruments are scarce. This study develops an instrument for assessing how dual-earners manage their multiple roles detaching from a conflict point of view highlighting the work-family conciliation strategies put forward by these couples. Through qualitative and quantitative procedures the Work-Family Conciliation Strategies Scales was developed and is composed by 5 factors: Couple Coping; Positive Attitude Towards Multiple Roles, Planning and Management Skills, Professional Adjustments and Institutional Support; with good adjustment [χ2/df = 1.22; CFI = .90, RMSEA = .04, SRMR = .08.] and good reliability coefficients [from .67 to .87]. The developed scale contributes to research because of its specificity to the work-family framework and its focus on the proactive nature of balancing work and family roles. The results support further use of this instrument.

  16. Hybrid MCDA Methods to Integrate Multiple Ecosystem Services in Forest Management Planning: A Critical Review

    Science.gov (United States)

    Uhde, Britta; Andreas Hahn, W.; Griess, Verena C.; Knoke, Thomas

    2015-08-01

    Multi-criteria decision analysis (MCDA) is a decision aid frequently used in the field of forest management planning. It includes the evaluation of multiple criteria such as the production of timber and non-timber forest products and tangible as well as intangible values of ecosystem services (ES). Hence, it is beneficial compared to those methods that take a purely financial perspective. Accordingly, MCDA methods are increasingly popular in the wide field of sustainability assessment. Hybrid approaches allow aggregating MCDA and, potentially, other decision-making techniques to make use of their individual benefits and leading to a more holistic view of the actual consequences that come with certain decisions. This review is providing a comprehensive overview of hybrid approaches that are used in forest management planning. Today, the scientific world is facing increasing challenges regarding the evaluation of ES and the trade-offs between them, for example between provisioning and regulating services. As the preferences of multiple stakeholders are essential to improve the decision process in multi-purpose forestry, participatory and hybrid approaches turn out to be of particular importance. Accordingly, hybrid methods show great potential for becoming most relevant in future decision making. Based on the review presented here, the development of models for the use in planning processes should focus on participatory modeling and the consideration of uncertainty regarding available information.

  17. Conceptual study of SCRUM and CCPM combined application in multiple project flexible management

    Directory of Open Access Journals (Sweden)

    Ilton Marchi de Almeida

    2016-11-01

    Full Text Available Project Management (PM has gained a major role in the viability of organizational strategic objectives. The development of products and services has been under increasing market pressure, demanding frequent releases in ever-shorter time periods. To meet these new requirements, PM has to provide the information needed to make decisions in multiple complex projects that are exposed to uncertainty and volatility. Regarding the opportunities to improve PM practices in order to deal with this unstable and ambiguous environment, the aim of this paper is to propose, by means of a conceptual literature analysis, the combined application of two PM methodologies: Critical Chain Project Management (CCPM, and SCRUM. The results of this study indicate that integration of these methodologies can enhance the benefits and mitigate the weaknesses of each of them. This hybrid model could enable better articulation and coordination of project tasks, allowing more effective decisions to be made in multiple project environments affected by volatility, uncertainty, complexity and ambiguity (VUCA.

  18. A Multiple Period Problem in Distributed Energy Management Systems Considering CO2 Emissions

    Science.gov (United States)

    Muroda, Yuki; Miyamoto, Toshiyuki; Mori, Kazuyuki; Kitamura, Shoichi; Yamamoto, Takaya

    Consider a special district (group) which is composed of multiple companies (agents), and where each agent responds to an energy demand and has a CO2 emission allowance imposed. A distributed energy management system (DEMS) optimizes energy consumption of a group through energy trading in the group. In this paper, we extended the energy distribution decision and optimal planning problem in DEMSs from a single period problem to a multiple periods one. The extension enabled us to consider more realistic constraints such as demand patterns, the start-up cost, and minimum running/outage times of equipment. At first, we extended the market-oriented programming (MOP) method for deciding energy distribution to the multiple periods problem. The bidding strategy of each agent is formulated by a 0-1 mixed non-linear programming problem. Secondly, we proposed decomposing the problem into a set of single period problems in order to solve it faster. In order to decompose the problem, we proposed a CO2 emission allowance distribution method, called an EP method. We confirmed that the proposed method was able to produce solutions whose group costs were close to lower-bound group costs by computational experiments. In addition, we verified that reduction in computational time was achieved without losing the quality of solutions by using the EP method.

  19. Multiple exostotic hypochondroplasia: Syndrome of combined hypochondroplasia and multiple exostoses

    International Nuclear Information System (INIS)

    Dominguez, R.; Young, L.W.; Girdany, B.R.; Steele, M.W.

    1984-01-01

    This is a report of a family with major focus on the daughter who had short stature. The mother had hypochondroplasia and the father had multiple exostoses. The daughter's skeletal roentgenograms show features of both hypochondroplasia and multiple exostoses. The roentgenographic, clinical and genetic aspects of these skeletal dysplasias are reviewed and hypochrondroplasia is contrasted with achondroplasia. The genetic and counseling implications of the association of hypochondroplasia and multiple exostoses are discussed. (orig.)

  20. Multiple exostotic hypochondroplasia: Syndrome of combined hypochondroplasia and multiple exostoses

    Energy Technology Data Exchange (ETDEWEB)

    Dominguez, R.; Young, L.W.; Girdany, B.R.; Steele, M.W.

    1984-07-01

    This is a report of a family with major focus on the daughter who had short stature. The mother had hypochondroplasia and the father had multiple exostoses. The daughter's skeletal roentgenograms show features of both hypochondroplasia and multiple exostoses. The roentgenographic, clinical and genetic aspects of these skeletal dysplasias are reviewed and hypochrondroplasia is contrasted with achondroplasia. The genetic and counseling implications of the association of hypochondroplasia and multiple exostoses are discussed.

  1. The Effectiveness of Transdermal Opioid in the Management Multiple Rib Fractures: Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Okan Solak

    2013-09-01

    Full Text Available Background: The most commonly observed pathology in chest traumas is rib fracture, and the most important clinical symptom is severe pain. Aims: To investigate the effectiveness of intramuscular opioid (IMO, intravenous patient-controlled analgesia (IVPCA and the Fentanyl transdermal therapeutic system (TTS in the management of rib fracture pain. Study Design: Prospective randomized clinical trial. Methods: In our prospective and randomised study, we included 45 patients with a diagnosis of multiple rib fractures. There were three groups and intercostal nerve blockage (ICB in the first day and oral paracetamol for five days was administered to each group as standard. In Group IMO (n=15, 4x40 mg pethidine HCl was administered to the patients, while in Group IVPCA (n=15 this was 5 µg/mL continuous intravenous fentanyl and was 50 µg fentanyl TTS in Group TTS (n=15. The demographics, injury data and vital signs of the patients were recorded. Pain was scored using Visual Analogue Scale (VAS. The pain during lying down (VASl and mobilisation (VASm was detected. Results: There were no differences between the three groups regarding age, sex, the trauma pattern, the number and distribution of costal fracture localisations, the presence of additional pathology, complications, thoracal catheter and the duration of thoracal catheter. No significant difference between the groups regarding systolic and diastolic arterial tension, number of breaths and beats in a minute was observed (p>0.05. We observed an improvement in the mean VAS score after treatment in all three groups. The mean VASl score significantly decreased after treatment in each group (p0.05. Conclusion: In the analgesia of patients with multiple rib fractures, TTS administration with ICB showed similar effectiveness with IVPCA administration with ICB. In the management of pain due to multiple rib fractures, TTS administration is a safe, non-invasive and effective procedure.

  2. The effectiveness of transdermal opioid in the management multiple rib fractures: randomized clinical trial.

    Science.gov (United States)

    Solak, Okan; Oz, Gürhan; Kokulu, Serdar; Solak, Ozlem; Doğan, Gökçen; Esme, Hıdır; Ocalan, Kubilay; Baki, Elif Doğan

    2013-09-01

    The most commonly observed pathology in chest traumas is rib fracture, and the most important clinical symptom is severe pain. To investigate the effectiveness of intramuscular opioid (IMO), intravenous patient-controlled analgesia (IVPCA) and the Fentanyl transdermal therapeutic system (TTS) in the management of rib fracture pain. Prospective randomized clinical trial. In our prospective and randomised study, we included 45 patients with a diagnosis of multiple rib fractures. There were three groups and intercostal nerve blockage (ICB) in the first day and oral paracetamol for five days was administered to each group as standard. In Group IMO (n=15), 4×40 mg pethidine HCl was administered to the patients, while in Group IVPCA (n=15) this was 5 μg/mL continuous intravenous fentanyl and was 50 μg fentanyl TTS in Group TTS (n=15). The demographics, injury data and vital signs of the patients were recorded. Pain was scored using Visual Analogue Scale (VAS). The pain during lying down (VASl) and mobilisation (VASm) was detected. There were no differences between the three groups regarding age, sex, the trauma pattern, the number and distribution of costal fracture localisations, the presence of additional pathology, complications, thoracal catheter and the duration of thoracal catheter. No significant difference between the groups regarding systolic and diastolic arterial tension, number of breaths and beats in a minute was observed (p>0.05). We observed an improvement in the mean VAS score after treatment in all three groups. The mean VASl score significantly decreased after treatment in each group (p0.05). In the analgesia of patients with multiple rib fractures, TTS administration with ICB showed similar effectiveness with IVPCA administration with ICB. In the management of pain due to multiple rib fractures, TTS administration is a safe, non-invasive and effective procedure.

  3. Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome

    Directory of Open Access Journals (Sweden)

    Sthela Maria Murad-Regadas

    2012-06-01

    Full Text Available CONTEXT: Management of patients with obstructed defecation syndrome is still controversial. OBJECTIVE: To analyze the efficacy of clinical, clinical treatment followed by biofeedback, and surgical treatment in patients with obstructed defecation, rectocele and multiple dysfunctions evaluated with echodefecography. METHODS: The study included 103 females aged 26-84 years with obstructed defecation, grade-II/III rectocele and multiple dysfunctions on echodefecography. Patients were distributed into three treatment groups and constipation scores were assigned. Group I: 34 (33% patients with significant improvement of symptoms through clinical management only. Group II: 14 (14% with improvement through clinical treatment plus biofeedback. Group III: 55 (53% referred to surgery due to treatment failure. RESULTS: Group I: 20 (59% patients had grade-II rectocele, 14 (41% grade-III. Obstructed defecation syndrome was associated with intussusception (41%, mucosal prolapse (41%, anismus (29%, enterocele (9% or 2 dysfunctions (23%. The average constipation score decreased significantly from 11 to 5. Group II: 11 (79% grade-II rectocele, 3 (21% grade-III, associated with intussusception (7%, mucosal prolapse (43%, anismus (71% or 2 dysfunctions (29%. There was significant decrease in constipation score from 13 to 6. Group III: 8 (15% grade-II rectocele, 47 (85% grade-III, associated with intussusception (42%, mucosal prolapse (40% or 2 dysfunctions (32%. The constipation score remained unchanged despite clinical treatment and biofeedback. Twenty-three underwent surgery had a significantly decrease in constipation score from 12 to 4. The remaining 32 (31% patients which 22 refused surgery, 6 had low anal pressure and 4 had slow transit. CONCLUSIONS: Approximately 50% of patients with obstructed defecation, rectocele and multiple dysfunctions presented a satisfactory response to clinical treatment and/or biofeedback. Surgical repair was mainly required in

  4. Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome.

    Science.gov (United States)

    Murad-Regadas, Sthela Maria; Regadas, Francisco Sergio P; Rodrigues, Lusmar Veras; Fernandes, Graziela Olivia da Silva; Buchen, Guilherme; Kenmoti, Viviane T

    2012-01-01

    Management of patients with obstructed defecation syndrome is still controversial. To analyze the efficacy of clinical, clinical treatment followed by biofeedback, and surgical treatment in patients with obstructed defecation, rectocele and multiple dysfunctions evaluated with echodefecography. The study included 103 females aged 26-84 years with obstructed defecation, grade-II/III rectocele and multiple dysfunctions on echodefecography. Patients were distributed into three treatment groups and constipation scores were assigned. Group I: 34 (33%) patients with significant improvement of symptoms through clinical management only. Group II: 14 (14%) with improvement through clinical treatment plus biofeedback. Group III: 55 (53%) referred to surgery due to treatment failure. Group I: 20 (59%) patients had grade-II rectocele, 14 (41%) grade-III. Obstructed defecation syndrome was associated with intussusception (41%), mucosal prolapse (41%), anismus (29%), enterocele (9%) or 2 dysfunctions (23%). The average constipation score decreased significantly from 11 to 5. Group II: 11 (79%) grade-II rectocele, 3 (21%) grade-III, associated with intussusception (7%), mucosal prolapse (43%), anismus (71%) or 2 dysfunctions (29%). There was significant decrease in constipation score from 13 to 6. Group III: 8 (15%) grade-II rectocele, 47 (85%) grade-III, associated with intussusception (42%), mucosal prolapse (40%) or 2 dysfunctions (32%). The constipation score remained unchanged despite clinical treatment and biofeedback. Twenty-three underwent surgery had a significantly decrease in constipation score from 12 to 4. The remaining 32 (31%) patients which 22 refused surgery, 6 had low anal pressure and 4 had slow transit. Approximately 50% of patients with obstructed defecation, rectocele and multiple dysfunctions presented a satisfactory response to clinical treatment and/or biofeedback. Surgical repair was mainly required in patients with grade-III rectocele whose constipation

  5. Optimization of Financial Flow Management Based on Estimates of Regional Multiplicative Effects

    Directory of Open Access Journals (Sweden)

    Denis Aleksandrovich Tatarkin

    2015-12-01

    Full Text Available The article deals with questions of increasing the management efficiency of the regional financial resources. As the main hypothesis, the idea of the optimization of the management of the regional financial flows based on the multiplicative economic effect is proved. This measure will allow to evaluate more efficiently the impact of the regional socio-economic policy. The article presents a multifactor model of the management of the regional financial flows on the regional level — the matrix of financial flows, based on the principles of the general economic equilibrium theory, the balance method of «input-output» and the methodology of national accounts. The paper introduces a methodology for the integration of the regional consolidated budget balance in a matrix of financial flows. Matrix multipliers of the consolidated budget balance are calculated for some regions of the Russian Federation allowing to model the economic multiplicative effects resulting from impact of different types of exogenous factors on the economic development of the regions, such as to predict the impact of fiscal redistribution on the GRP and income, to assess the impact of foreign investment on economic growth, to explore the effectiveness of the federal tax policy at the regional level. The article shows that the multiplier effect depends on several factors, including the foreign trade relations of the region, its dependence on imports, the share of value added in gross output, as well as the household savings. Various levels of government can use the author’s approach during development of strategies for socio-economic development, in assessing the extent and direction of the influence of exogenous factors on the economy of the territory, as well as in analyzing the investment initiatives from the private sector applying for state financial support for projects. In the conclusion, the ways of improving the management of financial flows on the basis of

  6. Percutaneous Vertebroplasty for Pain Management in Patients with Multiple Myeloma: Is Radiofrequency Ablation Necessary?

    International Nuclear Information System (INIS)

    Orgera, Gianluigi; Krokidis, Miltiadis; Matteoli, Marco; Varano, Gianluca Maria; La Verde, Giacinto; David, Vincenzo; Rossi, Michele

    2014-01-01

    PurposeThis study was designed to investigate the added role of radiofrequency ablation (RFA) to vertebroplasty on the pain management of patients with multiple myeloma (MM).MethodsThirty-six patients (51–82 years) with vertebral localization of MM were randomly divided into two groups: 18 patients (group A) who underwent RFA and then vertebroplasty, and 18 patients (group B) who underwent only vertebroplasty. Primary endpoints were technical success and pain relief score rate measured by the visual analogue pain scores (VAS) and Roland–Morris Questionnaire (RMQ); secondary endpoint was the amount of administered analgesia. Survival and complications were compared.ResultsTechnical success was 100 % in both groups. The VAS score (at 24 h and 6 weeks postprocedure) decreased in equal manner for both groups from a mean of 9.1–3.4 and 2.0 for group A and from a mean of 9.3–3.0 and 2.3 for group B; RMQ mean score was 19.8 for group A and 19.9 for group B and decreased to a mean of 9.6 and 8.2 for group A and 9.5 and 8.7 for group B. The amount of medication was equally decreased in the two groups. No statistically significant difference was noted. No major complication occurred and two patients died from other causes.ConclusionsThe use of percutaneous vertebroplasty alone appears to be effective for the pain management of the patients with vertebral involvement of multiple myeloma. The use of RFA that includes cost and time does not offer any clear added benefit on the midterm pain management of such patients

  7. Percutaneous Vertebroplasty for Pain Management in Patients with Multiple Myeloma: Is Radiofrequency Ablation Necessary?

    Energy Technology Data Exchange (ETDEWEB)

    Orgera, Gianluigi [Sapienza Rome University, Department of Radiology, S. Andrea Hospital (Italy); Krokidis, Miltiadis, E-mail: mkrokidis@hotmail.com [Cambridge University Hospitals NHS Trust, Department of Radiology (United Kingdom); Matteoli, Marco; Varano, Gianluca Maria [Sapienza Rome University, Department of Radiology, S. Andrea Hospital (Italy); La Verde, Giacinto [Sapienza Rome University, Department of Medical Oncology, S. Andrea Hospital (Italy); David, Vincenzo; Rossi, Michele [Sapienza Rome University, Department of Radiology, S. Andrea Hospital (Italy)

    2013-05-08

    PurposeThis study was designed to investigate the added role of radiofrequency ablation (RFA) to vertebroplasty on the pain management of patients with multiple myeloma (MM).MethodsThirty-six patients (51–82 years) with vertebral localization of MM were randomly divided into two groups: 18 patients (group A) who underwent RFA and then vertebroplasty, and 18 patients (group B) who underwent only vertebroplasty. Primary endpoints were technical success and pain relief score rate measured by the visual analogue pain scores (VAS) and Roland–Morris Questionnaire (RMQ); secondary endpoint was the amount of administered analgesia. Survival and complications were compared.ResultsTechnical success was 100 % in both groups. The VAS score (at 24 h and 6 weeks postprocedure) decreased in equal manner for both groups from a mean of 9.1–3.4 and 2.0 for group A and from a mean of 9.3–3.0 and 2.3 for group B; RMQ mean score was 19.8 for group A and 19.9 for group B and decreased to a mean of 9.6 and 8.2 for group A and 9.5 and 8.7 for group B. The amount of medication was equally decreased in the two groups. No statistically significant difference was noted. No major complication occurred and two patients died from other causes.ConclusionsThe use of percutaneous vertebroplasty alone appears to be effective for the pain management of the patients with vertebral involvement of multiple myeloma. The use of RFA that includes cost and time does not offer any clear added benefit on the midterm pain management of such patients.

  8. Radiological diagnosis of skeletal metastases

    International Nuclear Information System (INIS)

    Soederlund, V.

    1996-01-01

    The clinical management of patients with skeletal metastases puts new demands on imaging. The radiological imaging in screening for skeletal metastases entails detection, metastatic site description and radiologically guided biopsy for morphological typing and diagnosis. Regarding sensitivity and the ease in performing surveys of the whole skeleton, radionuclide bone scintigraphy still is the first choice in routine follow-up of asymptomatic patients with metastatic disease of the skeleton. A negative scan has to be re-evaluated with other findings, with emphasis on the possibility of a false-negative result. Screening for metastases in patients with local symptoms or pain is best accomplished by a combination of radiography and MRI. Water-weighted sequences are superior in sensitivity and in detection of metastases. Standard spin-echo sequences on the other hand are superior in metastatic site description and in detection of intraspinal metastases. MRI is helpful in differentiating between malignant disease, infection, benign vertebral collapse, insufficiency fracture after radiation therapy, degenerative vertebral disease and benign skeletal lesions. About 30% of patients with known cancer have benign causes of radiographic abnormalities. Most of these are related to degenerative diseases and are often easily diagnosed. However, due to overlap in MRI characteristics, bone biopsy sometimes is essential for differentiating between malignant and nonmalignant lesions. Performing bone biopsy and aspiration cytology by radiologist and cytologist in co-operation has proven highly accurate in diagnosing bone lesions. The procedure involves low risk to the patient and provides a morphological diagnosis. Once a suspected metastatic lesion is detected, irrespective of modality, the morphological diagnosis determines the appropriate work-up imaging with respect to the therapy alternatives. (orig./VHE)

  9. in Skeletal Muscle

    Directory of Open Access Journals (Sweden)

    Espen E. Spangenburg

    2011-01-01

    Full Text Available Triglyceride storage is altered across various chronic health conditions necessitating various techniques to visualize and quantify lipid droplets (LDs. Here, we describe the utilization of the BODIPY (493/503 dye in skeletal muscle as a means to analyze LDs. We found that the dye was a convenient and simple approach to visualize LDs in both sectioned skeletal muscle and cultured adult single fibers. Furthermore, the dye was effective in both fixed and nonfixed cells, and the staining seemed unaffected by permeabilization. We believe that the use of the BODIPY (493/503 dye is an acceptable alternative and, under certain conditions, a simpler method for visualizing LDs stored within skeletal muscle.

  10. An Analysis of Student Affairs Professionals' Management of Role Conflict and Multiple Roles in Relation to Work/Life Balance

    Science.gov (United States)

    Mayo, Nicole Lepone

    2013-01-01

    The purpose of this inquiry is to study how student affairs professionals manage role conflict in relation to work/life balance based on the challenging culture of the field. The underlying goals are to identify the barriers or challenges of managing multiple roles as a student affairs administrator and identify strategies to assist employees in…

  11. Approach to evaluation and management of a patient with multiple food allergies.

    Science.gov (United States)

    Bird, J Andrew

    2016-01-01

    Diagnosing food allergy is often challenging, and validated testing modalities are mostly limited to immunoglobulin E (IgE)-mediated reactions to foods. Use of food-specific IgE tests and skin prick tests in individuals without a history that supports an IgE-mediated reaction to the specific food being tested diminishes the predictive capabilities of the test. To review the literature regarding evaluation of patients with a concern for multiple food allergies and to demonstrate an evidence-based approach to diagnosis and management. A literature search was performed and articles identified as relevant based on the search terms "food allergy," "food allergy diagnosis," "skin prick test," "serum IgE test," "oral food challenge", and "food allergy management." Patients at risk of food allergy are often misdiagnosed and appropriate evaluation of patients with concern for food allergy includes taking a thorough diet history and reaction history, performing specific tests intentionally and when indicated, and conducting an oral food challenge in a safe environment by an experienced provider when test results are inconclusive. An evidence-based approach to diagnosing and managing a patient at risk of having a life-threatening food allergy is reviewed.

  12. Management of multiple sclerosis: the role of coping self-efficacy and self-esteem.

    Science.gov (United States)

    Mikula, Pavol; Nagyova, Iveta; Vitkova, Marianna; Szilasiova, Jarmila

    2018-02-07

    Patients with multiple sclerosis (MS) engage in various coping behaviours in order to manage their disease. The aim of this study is to find out if the self-esteem of patients is associated with coping strategies - problem-focused (e.g. making a plan of action when confronted with a problem); emotion focused (e.g. get emotional support from community); and focused on stopping unpleasant emotions and thoughts (e.g. keeping oneself from feeling sad), and if it can enhance or hinder coping efforts in the disease management. We collected data from 155 consecutive MS patients who completed the Coping Self-Efficacy Scale (CSE) and the Rosenberg Self-esteem Scale (RSE). Explained variance for problem-focused coping, emotion-focused coping, and coping focused on stopping unpleasant emotions and thoughts was 33, 24, and 31%, respectively. Self-esteem seems to be associated with coping strategies indicating that feelings of self-worth are linked with the ability to handle difficult life situations and can be helpful in chronic disease management.

  13. Traumatic skeletal changes

    International Nuclear Information System (INIS)

    Troeger, J.; Schofer, O.

    1985-01-01

    Skeleton scintiscanning is indicated in the following cases: (1) Suspected bone injury after clinical examination, the radiograph of the skeletal region in question contributing findings that either do not confirm suspision, or make not clear whether the changes observed are traumatic. (2) Polytrauma. (3) When the accident scenario reported by the persons taking care of the child does not sufficiently explain the skeletal changes observed, or when these persons expressly deny the possibility of a trauma being the cause of findings observed. (4) Suspected or proven battered-child syndrome. (orig./MG) [de

  14. Optimising the application of multiple-capture traps for invasive species management using spatial simulation.

    Science.gov (United States)

    Warburton, Bruce; Gormley, Andrew M

    2015-01-01

    Internationally, invasive vertebrate species pose a significant threat to biodiversity, agricultural production and human health. To manage these species a wide range of tools, including traps, are used. In New Zealand, brushtail possums (Trichosurus vulpecula), stoats (Mustela ermine), and ship rats (Rattus rattus) are invasive and there is an ongoing demand for cost-effective non-toxic methods for controlling these pests. Recently, traps with multiple-capture capability have been developed which, because they do not require regular operator-checking, are purported to be more cost-effective than traditional single-capture traps. However, when pest populations are being maintained at low densities (as is typical of orchestrated pest management programmes) it remains uncertain if it is more cost-effective to use fewer multiple-capture traps or more single-capture traps. To address this uncertainty, we used an individual-based spatially explicit modelling approach to determine the likely maximum animal-captures per trap, given stated pest densities and defined times traps are left between checks. In the simulation, single- or multiple-capture traps were spaced according to best practice pest-control guidelines. For possums with maintenance densities set at the lowest level (i.e. 0.5/ha), 98% of all simulated possums were captured with only a single capacity trap set at each site. When possum density was increased to moderate levels of 3/ha, having a capacity of three captures per trap caught 97% of all simulated possums. Results were similar for stoats, although only two potential captures per site were sufficient to capture 99% of simulated stoats. For rats, which were simulated at their typically higher densities, even a six-capture capacity per trap site only resulted in 80% kill. Depending on target species, prevailing density and extent of immigration, the most cost-effective strategy for pest control in New Zealand might be to deploy several single

  15. Skeletal MR imaging: Correlation with skeletal scintigraphy

    International Nuclear Information System (INIS)

    Colletti, P.M.; Raval, J.K.; Ford, P.V.; Benson, R.C.; Kerr, R.M.; Boswell, W.D.; Siegel, M.E.; Ralls, P.W.

    1987-01-01

    Skeletal MR images bone marrow while skeletal scintigraphy uses bone metabolism to demonstrate abnormalities. The purpose of this paper is to correlate these MR and scintigraphic findings. T1 and T2 MR images at 0.5 T were correlated with planar bone scintigraphy (RN) using Tc-99m MDP in 56 patients. Of 23 cases with suspected spinal metastases, 19 were positive by MR imaging, 16 by RN. Individual lesions were shown better by MR imaging in five and by RN in two. These two cases had scoliosis, a potential difficulty with MR imaging. In 14 cases of suspected avascular necrosis (AVN), MR imaging was positive in 13 while RN was positive in ten. One negative case by RN had bilateral AVN by MR imaging. Four skull lesions shown easily by RN were seen only in retrospect on MR images. MR imaging is advantageous in evaluating bones with predominant marrow such as vertebrae or the femoral head, while RN is superior in areas primarily composed of cortical bone such as the skull

  16. Managing treatment fatigue in patients with multiple sclerosis on long-term therapy: the role of multiple sclerosis nurses

    Directory of Open Access Journals (Sweden)

    Crawford A

    2014-08-01

    Full Text Available Ann Crawford, Sally Jewell,* Holly Mara, Laura McCatty, Regina Pelfrey The Lash Group; Frisco, TX, USA *Sally Jewell is now retired Abstract: This article discusses the many ways that nurses can address the factors that lead to treatment fatigue in patients with multiple sclerosis (MS on long-term disease-modifying therapy, ultimately helping to preserve the patient’s health and quality of life. Patients with MS on long-term therapy may suffer from treatment fatigue and poor adherence due to a variety of different factors, including difficulties with injections, anxiety/depression, financial problems, and inaccurate beliefs about the MS disease process. Because MS nurses have regular interactions with patients, they are ideally situated to help patients cope with these and other factors that may limit adherence. Keywords: multiple sclerosis, disease-modifying therapy, injection, nurse

  17. One-Year Outcomes of an Integrated Multiple Sclerosis Disease Management Program.

    Science.gov (United States)

    Groeneweg, Marti; Forrester, Sara H; Arnold, Beth; Palazzo, Lorella; Zhu, Weiwei; Yoon, Paul; Scearce, Tim

    2018-05-01

    Multiple sclerosis (MS) is associated with high total health care cost, the majority of which is attributable to medications. Patients with MS are less likely to experience relapses, emergency department (ED) visits, and hospitalizations when they are adherent to disease-modifying treatments. Disease management programs are hypothesized to improve medication adherence thereby improving clinical and economic outcomes. To evaluate the clinical and economic effects of a specialty pharmacy and chronic disease management program for patients with MS from a health plan perspective. This study was a retrospective analysis using prescription drug claims, medical claims, and electronic medical record information (2013-2015) 1 year before and after enrollment in the disease management program for members with 24 months of continuous health plan coverage. Medication adherence was calculated using proportion of days covered (PDC). Relapse rate was defined as an MS outpatient visit associated with a corticosteroid dispense within 7 days of the visit or an MS hospitalization. Disease progression was assessed using the Modified Expanded Disability Status Scale (mEDSS). Resource use included outpatient visits, ED visits, and hospitalizations. Cost information was collected as health plan-paid amount and was reported in 2013 U.S. dollars. The analysis included 377 patients (mean age 55 years, 76.4% female). After enrollment in the program, 78.7% of the study group had a PDC of ≥ 0.80 compared with 70.0% before enrollment (P management for patients with MS can increase the proportion of patients adherent to medication. The increase in health plan spend on MS medications is not offset by savings in health care resource utilization. This study was funded by Kaiser Permanente Washington Health Research Institute and Kaiser Permanente Washington Pharmacy Administration. The authors have no disclosures to report.

  18. Managing the effects of multiple stressors on aquatic ecosystems under water scarcity. The GLOBAQUA project.

    Science.gov (United States)

    Navarro-Ortega, Alícia; Acuña, Vicenç; Bellin, Alberto; Burek, Peter; Cassiani, Giorgio; Choukr-Allah, Redouane; Dolédec, Sylvain; Elosegi, Arturo; Ferrari, Federico; Ginebreda, Antoni; Grathwohl, Peter; Jones, Colin; Rault, Philippe Ker; Kok, Kasper; Koundouri, Phoebe; Ludwig, Ralf Peter; Merz, Ralf; Milacic, Radmila; Muñoz, Isabel; Nikulin, Grigory; Paniconi, Claudio; Paunović, Momir; Petrovic, Mira; Sabater, Laia; Sabaterb, Sergi; Skoulikidis, Nikolaos Th; Slob, Adriaan; Teutsch, Georg; Voulvoulis, Nikolaos; Barceló, Damià

    2015-01-15

    Water scarcity is a serious environmental problem in many European regions, and will likely increase in the near future as a consequence of increased abstraction and climate change. Water scarcity exacerbates the effects of multiple stressors, and thus results in decreased water quality. It impacts river ecosystems, threatens the services they provide, and it will force managers and policy-makers to change their current practices. The EU-FP7 project GLOBAQUA aims at identifying the prevalence, interaction and linkages between stressors, and to assess their effects on the chemical and ecological status of freshwater ecosystems in order to improve water management practice and policies. GLOBAQUA assembles a multidisciplinary team of 21 European plus 2 non-European scientific institutions, as well as water authorities and river basin managers. The project includes experts in hydrology, chemistry, biology, geomorphology, modelling, socio-economics, governance science, knowledge brokerage, and policy advocacy. GLOBAQUA studies six river basins (Ebro, Adige, Sava, Evrotas, Anglian and Souss Massa) affected by water scarcity, and aims to answer the following questions: how does water scarcity interact with other existing stressors in the study river basins? How will these interactions change according to the different scenarios of future global change? Which will be the foreseeable consequences for river ecosystems? How will these in turn affect the services the ecosystems provide? How should management and policies be adapted to minimise the ecological, economic and societal consequences? These questions will be approached by combining data-mining, field- and laboratory-based research, and modelling. Here, we outline the general structure of the project and the activities to be conducted within the fourteen work-packages of GLOBAQUA. Copyright © 2014. Published by Elsevier B.V.

  19. Managing the effects of multiple stressors on aquatic ecosystems under water scarcity. The GLOBAQUA project

    Science.gov (United States)

    Navarro-Ortega, Alícia; Acuña, Vicenç; Bellin, Alberto; Burek, Peter; Cassiani, Giorgio; Choukr-Allah, Redouane; Dolédec, Sylvain; Elosegi, Arturo; Ferrari, Federico; Ginebreda, Antoni; Grathwohl, Peter; Jones, Colin; Rault, Philippe Ker; Kok, Kasper; Koundouri, Phoebe; Ludwig, Ralf Peter; Merz, Ralf; Milacic, Radmila; Muñoz, Isabel; Nikulin, Grigory; Paniconi, Claudio; Paunović, Momir; Petrovic, Mira; Sabater, Laia; Sabaterb, Sergi; Skoulikidis, Nikolaos Th.; Slob, Adriaan; Teutsch, Georg; Voulvoulis, Nikolaos; Barceló, Damià

    2015-01-01

    Water scarcity is a serious environmental problem in many European regions, and will likely increase in the near future as a consequence of increased abstraction and climate change. Water scarcity exacerbates the effects of multiple stressors, and thus results in decreased water quality. It impacts river ecosystems, threatens the services they provide, and it will force managers and policy-makers to change their current practices. The EU-FP7 project GLOBAQUA aims at identifying the prevalence, interaction and linkages between stressors, and to assess their effects on the chemical and ecological status of freshwater ecosystems in order to improve water management practice and policies. GLOBAQUA assembles a multidisciplinary team of 21 European plus 2 non-European scientific institutions, as well as water authorities and river basin managers. The project includes experts in hydrology, chemistry, biology, geomorphology, modelling, socio-economics, governance science, knowledge brokerage, and policy advocacy. GLOBAQUA studies six river basins (Ebro, Adige, Sava, Evrotas, Anglian and Souss Massa) affected by water scarcity, and aims to answer the following questions: how does water scarcity interact with other existing stressors in the study river basins? How will these interactions change according to the different scenarios of future global change? Which will be the foreseeable consequences for river ecosystems? How will these in turn affect the services the ecosystems provide? How should management and policies be adapted to minimise the ecological, economic and societal consequences? These questions will be approached by combining data-mining, field- and laboratory-based research, and modelling. Here, we outline the general structure of the project and the activities to be conducted within the fourteen work-packages of GLOBAQUA. PMID:25005236

  20. Management of sleep disorders in Parkinson's disease and multiple system atrophy.

    Science.gov (United States)

    Videnovic, Aleksandar

    2017-05-01

    Parkinson's disease (PD) and multiple system atrophy (MSA) are disorders associated with α synuclein-related neurodegeneration. Nonmotor symptoms are common hallmarks of these disorders, and disturbances of the sleep-wake cycle are among the most common nonmotor symptoms. It is only recently that sleep disturbances have received the attention of the medical and research community. Significant progress has been made in understanding the pathophysiology of sleep and wake disruption in alphasynucleinopathies during the past few decades. Despite these advancements, treatment options are limited and frequently associated with problematic side effects. Further studies that center on the development of novel treatment approaches are very much needed. In this article, the author discusses the current state of the management of disturbed sleep and alertness in PD and MSA. © 2017 International Parkinson and Movement Disorder Society. © 2017 International Parkinson and Movement Disorder Society.

  1. Development of a balance, safe mobility and falls management programme for people with multiple sclerosis.

    Science.gov (United States)

    Gunn, Hilary; Endacott, Ruth; Haas, Bernhard; Marsden, Jonathan; Freeman, Jennifer

    2017-08-07

    To utilise stakeholder input to inform the structure, format and approach of a multiple sclerosis (MS) balance, safe mobility and falls management programme. Using a three-round nominal group technique, participants individually rated their agreement with 20 trigger statements, followed by a facilitated group discussion and re-rating. Three mixed groups included service users (n = 15) and providers (n = 19). Quantitative analysis determined agreement, whilst qualitative responses were analysed thematically. Median scores for each of the 20 trigger statements did not change significantly over sequential rounds, however, deviations around the medians indicated more agreement amongst participants over time. Key recommendations were: Aims and approach: The programme should be tailored to the needs of people with MS. Falls and participation-based outcomes are equally important. Structure and format: The programme should balance expected burden and anticipated benefit, moving away from models requiring weekly attendance and promoting and supporting self-efficacy. Optimising engagement: Support to maintain engagement and intensity of practice over the long term is essential. Sustainability: Adequate funding is necessary. Staff should have MS specific knowledge and experience. Participants collaboratively identified critical components of a MS balance, safe mobility and falls management programme. They also highlighted the importance of a collaborative, user-centred, MS-specific approach. Implications for Rehabilitation People with multiple sclerosis need condition-specific interventions focussed on maximising balance and safe mobility and reducing falls. Programme design should support self-efficacy and flexible engagement. Adequate support and funding are seen as essential by both service users and providers.

  2. Flavocoxid (Limbrel  manages osteoarthritis through modification of multiple inflammatory pathways: a review

    Directory of Open Access Journals (Sweden)

    Bruce P. Burnett

    2012-11-01

    Full Text Available ABSTRACT:Limbrel (flavocoxid is marketed as an FDA-regulated medical food for the clinical dietary management of osteoarthritis (OA to be used under physician supervision. Flavocoxid is composed of a >90% mixture of baicalin and catechin and represents a non-targeted antiinflammatory which works differently than non-steroidal anti-inflammatory drugs (NSAIDs that bind to and only inhibit the cyclooxygenase moieties of COX-1 and COX-2. Flavocoxid binds to and weakly modulates the peroxidase activity of the COX enzymes permitting low level expression of prostaglandins (PGs, prostacyclin (PGI2 and thromboxane (TxA2. In addition, flavocoxid weakly inhibits phospholipase A2 (PLA2 and 5-lipoxygenase (5-LOX as well as increases IBα and prevents nuclear factor kappa B (NFB activation/induction of inflammatory genes such as tumor necrosis factor-alpha (TNFα, interleukin-1β (IL-1 β, IL-6, COX-2, inducible nitric oxide synthase (iNOS and 5-LOX. In clinical studies, flavocoxid shows equivalent efficacy to naproxen with statistically fewer renal (edema and upper gastrointestinal (GI side effects, does not affect platelet function and bleeding times, does not change international normalized ratio (INR in warfarinized patients, is well-tolerated in patients with previous NSAID-induced GI side effects, and decreases or eliminates the use of gastroprotective medications in patients who previously required them to tolerate NSAIDs. With its broad, non-targeted and multiple weak activities which result in fewer side effects compared to NSAIDs, flavocoxid represents a different way managing OA by working on the underlying and multiple causes of cartilage degradation as well as joint inflammation.

  3. Multiple sclerosis: patients’ information sources and needs on disease symptoms and management

    Directory of Open Access Journals (Sweden)

    Albert I Matti

    2010-06-01

    Full Text Available Albert I Matti1, Helen McCarl2, Pamela Klaer2, Miriam C Keane1, Celia S Chen11Department of Ophthalmology, Flinders Medical Centre and Flinders University, Bedford Park, SA, Australia; 2The Multiple Sclerosis Society of South Australia and Northern Territory, Klemzig, SA, AustraliaObjective: To investigate the current information sources of patients with multiple sclerosis (MS in the early stages of their disease and to identify patients’ preferred source of information. The relative amounts of information from the different sources were also compared.Methods: Participants at a newly diagnosed information session organized by the Multiple Sclerosis Society of South Australia were invited to complete a questionnaire. Participants were asked to rate on a visual analog scale how much information they had received about MS and optic neuritis from different information sources and how much information they would like to receive from each of the sources.Results: A close to ideal amount of information is being provided by the MS society and MS specialist nurses. There is a clear deficit between what information patients are currently receiving and the amount of information they actually want from various sources. Patients wish to receive significantly more information from treating general practitioners, eye specialists, neurologists, and education sessions. Patients have identified less than adequate information received on optic neuritis from all sources.Conclusion: This study noted a clear information deficit regarding MS from all sources. This information deficit is more pronounced in relation to optic neuritis and needs to be addressed in the future.Practice implications: More patient information and counselling needs to be provided to MS patients even at early stages of their disease, especially in relation to management of disease relapse.Keywords: information sources, information needs, MS patients, optic neuritis

  4. Methodology for Selecting Best Management Practices Integrating Multiple Stakeholders and Criteria. Part 1: Methodology

    Directory of Open Access Journals (Sweden)

    Mauricio Carvallo Aceves

    2016-02-01

    Full Text Available The implementation of stormwater Best Management Practices (BMPs could help re-establish the natural hydrological cycle of watersheds after urbanization, with each BMP presenting a different performance across a range of criteria (flood prevention, pollutant removal, etc.. Additionally, conflicting views from the relevant stakeholders may arise, resulting in a complex selection process. This paper proposes a methodology for BMP selection based on the application of multi-criteria decision aid (MCDA methods, integrating multiple stakeholder priorities and BMP combinations. First, in the problem definition, the MCDA methods, relevant criteria and design guidelines are selected. Next, information from the preliminary analysis of the watershed is used to obtain a list of relevant BMPs. The third step comprises the watershed modeling and analysis of the BMP alternatives to obtain performance values across purely objective criteria. Afterwards, a stakeholder analysis based on survey applications is carried out to obtain social performance values and criteria priorities. Then, the MCDA methods are applied to obtain the final BMP rankings. The last step considers the sensitivity analysis and rank comparisons in order to draw the final conclusions and recommendations. Future improvements to the methodology could explore inclusion of multiple objective analysis, and alternative means for obtaining social performance values.

  5. Applying voting theory in natural resource management: a case of multiple-criteria group decision support.

    Science.gov (United States)

    Laukkanen, Sanna; Kangas, Annika; Kangas, Jyrki

    2002-02-01

    Voting theory has a lot in common with utility theory, and especially with group decision-making. An expected-utility-maximising strategy exists in voting situations, as well as in decision-making situations. Therefore, it is natural to utilise the achievements of voting theory also in group decision-making. Most voting systems are based on a single criterion or holistic preference information on decision alternatives. However, a voting scheme called multicriteria approval is specially developed for decision-making situations with multiple criteria. This study considers the voting theory from the group decision support point of view and compares it with some other methods applied to similar purposes in natural resource management. A case study is presented, where the approval voting approach is introduced to natural resources planning and tested in a forestry group decision-making process. Applying multicriteria approval method was found to be a potential approach for handling some challenges typical for forestry group decision support. These challenges include (i) utilising ordinal information in the evaluation of decision alternatives, (ii) being readily understandable for and treating equally all the stakeholders in possession of different levels of knowledge on the subject considered, (iii) fast and cheap acquisition of preference information from several stakeholders, and (iv) dealing with multiple criteria.

  6. Development of Optimal Water-Resources Management Strategies for Kaidu-Kongque Watershed under Multiple Uncertainties

    Directory of Open Access Journals (Sweden)

    Y. Zhou

    2013-01-01

    Full Text Available In this study, an interval-stochastic fractile optimization (ISFO model is advanced for developing optimal water-resources management strategies under multiple uncertainties. The ISFO model can not only handle uncertainties presented in terms of probability distributions and intervals with possibility distribution boundary, but also quantify subjective information (i.e., expected system benefit preference and risk-averse attitude from different decision makers. The ISFO model is then applied to a real case of water-resources systems planning in Kaidu-kongque watershed, China, and a number of scenarios with different ecological water-allocation policies under varied p-necessity fractiles are analyzed. Results indicate that different policies for ecological water allocation can lead to varied water supplies, economic penalties, and system benefits. The solutions obtained can help decision makers identify optimized water-allocation alternatives, alleviate the water supply-demand conflict, and achieve socioeconomic and ecological sustainability, particularly when limited water resources are available for multiple competing users.

  7. The skeletal system

    NARCIS (Netherlands)

    Nikkels, PGJ

    2015-01-01

    Skeletal dysplasias are a group of disorders with a disturbance in development and/or growth of cartilage and/or bone. Epiphysis, metaphysis, and diaphysis of long bones are affected in a generalized manner with or without involvement of membranous bone of the skull. A dysostosis affects one or some

  8. Lipolysis in Skeletal Muscle

    DEFF Research Database (Denmark)

    Serup, Annette Karen Lundbeck

    chemical structure of DAG. We took advantage of the fact that insulin sensitivity is increased after exercise, and that mice knocked out (KO) of HSL accumulate DAG after exercise, and measured insulin stimulated glucose uptake after treadmill running in skeletal muscle from HSL KO mice and wildtype control...

  9. skeletal complications in gaucher's disease: a case report abstract

    African Journals Online (AJOL)

    2012-09-06

    Sep 6, 2012 ... abscess of the left thigh, multiple left knee swellings and multiple blood transfusions, the latest being ... left knee swellings, palpitations and severe anaemia. (Hb 3.99). At this admission, splenomegaly .... patients by such procedures like Total Hip Replacement in the face of severe skeletal damage. For our ...

  10. Treatment and disease management of multiple sclerosis patients: A review for nurse practitioners.

    Science.gov (United States)

    Roman, Cortnee; Menning, Kara

    2017-10-01

    This review discusses the role of the nurse practitioner (NP) in evaluating the clinical effects, potential side effects, and monitoring requirements for treatment options in multiple sclerosis (MS) and provides guidance on how to help patients understand these issues. A literature search was conducted on PubMed to identify publications on monitoring and disease management of MS patients. Additional resources included drug information web sites and package inserts. NPs play an active role in the management of MS patients via effective monitoring and communication throughout the patient's treatment regimen and disease course. In the shared decision-making model of MS treatment, NPs ensure that patients understand the implications of their disease-modifying therapies (DMTs). As patients move through treatments during the course of their disease, the importance of this role increases, and it is critical that NPs follow the guidelines in each medication's product label and take into account any potential lingering effects of prior medications. It is critical for NPs to promote patient adherence, to ensure that patients understand treatment side effects and monitoring requirements, and to take sequencing and reversibility implications of DMTs into account when making clinical decisions. ©2017 American Association of Nurse Practitioners.

  11. Management of pregnancy-related issues in multiple sclerosis patients: the need for an interdisciplinary approach.

    Science.gov (United States)

    Amato, Maria Pia; Bertolotto, Antonio; Brunelli, Roberto; Cavalla, Paola; Goretti, Benedetta; Marrosu, Maria Giovanna; Patti, Francesco; Pozzilli, Carlo; Provinciali, Leandro; Rizzo, Nicola; Strobelt, Nicola; Tedeschi, Gioacchino; Trojano, Maria; Comi, Giancarlo

    2017-10-01

    Multiple sclerosis (MS) is a demyelinating and neurodegenerative disease of the central nervous system (CNS), most probably autoimmune in origin, usually occurring in young adults with a female/male prevalence of approximately 3:1. Women with MS in the reproductive age may face challenging issues in reconciling the desire for parenthood with their condition, owing to the possible influence both on the ongoing or planned treatment with the possible consequences on the disease course and on the potential negative effects of treatments on foetal and pregnancy outcomes. At MS diagnosis, timely counselling should promote informed parenthood, while disease evolution should be assessed before making therapeutic decisions. Current guidelines advise the discontinuation of any treatment during pregnancy, with possible exceptions for some treatments in patients with very active disease. Relapses decline during pregnancy but are more frequent during puerperium, when MS therapy should be promptly resumed in most of the cases. First-line immunomodulatory agents, such as interferon-β (IFN-β) and glatiramer acetate (GA), significantly reduce the post-partum risk of relapse. Due to substantial evidence of safety with the use of GA during pregnancy, a recent change in European marketing authorization removed the pregnancy contraindication for GA. This paper reports a consensus of Italian experts involved in MS management, including neurologists, gynaecologists and psychologists. This consensus, based on a review of the available scientific evidence, promoted an interdisciplinary approach to the management of pregnancy in MS women.

  12. Optimal Reoperation of Multi-Reservoirs for Integrated Watershed Management with Multiple Benefits

    Directory of Open Access Journals (Sweden)

    Xinyi Xu

    2014-04-01

    Full Text Available Constructing reservoirs can make more efficient use of water resources for human society. However, the negative impacts of these projects on the environment are often ignored. Optimal reoperation of reservoirs, which considers not only in socio-economic values but also environmental benefits, is increasingly important. A model of optimal reoperation of multi-reservoirs for integrated watershed management with multiple benefits was proposed to alleviate the conflict between water use and environmental deterioration. The social, economic, water quality and ecological benefits were respectively taken into account as the scheduling objectives and quantified according to economic models. River minimum ecological flows and reservoir water levels based on flood control were taken as key constraint conditions. Feasible search discrete differential dynamic programming (FS-DDDP was used to run the model. The proposed model was used in the upstream of the Nanpan River, to quantitatively evaluate the difference between optimal reoperation and routine operation. The results indicated that the reoperation could significantly increase the water quality benefit and have a minor effect on the benefits of power generation and irrigation under different hydrological years. The model can be readily adapted to other multi-reservoir systems for water resources management.

  13. UK guidance on the management of personal dosimetry systems for healthcare staff working at multiple organizations.

    Science.gov (United States)

    Rogers, Andy; Chapple, Claire-Louise; Murray, Maria; Platton, David; Saunderson, John

    2017-11-01

    There has been concern expressed by the UK regulator, the Health & Safety Executive, regarding the management of occupation dose for healthcare radiation workers who work across multiple organizations. In response to this concern, the British Institute of Radiology led a working group of relevant professional bodies to develop guidance in this area. The guidance addresses issues of general system management that would apply to all personal dosimetry systems, regardless of whether or not the workers within that system work across organizational boundaries, along with exploring efficient strategies to comply with legislation where those workers do indeed work across organizational boundaries. For those specific instances, the guidance discusses both system requirements to enable organizations to co-operate (Ionising Radiation Regulations 1999 Regulation 15), as well as specific instances of staff exposure. This is broken down into three categories-low, medium and high risk. A suggested approach to each is given to guide employers and their radiation advisers in adopting sensible strategies for the monitoring of their staff and the subsequent sharing of dosimetry data to ensure overall compliance with both dose limits and optimization requirements.

  14. Membranous lipodystrophy: skeletal findings on CT and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Nwawka, O.K.; Schneider, Robert; Mintz, Douglas N. [Hospital for Special Surgery, Department of Radiology and Imaging, New York, NY (United States); Bansal, Manjula [Hospital for Special Surgery, Department of Pathology and Laboratory Medicine, New York, NY (United States); Lane, Joseph [Hospital for Special Surgery, Department of Orthopedic Surgery, New York, NY (United States)

    2014-10-15

    Membranous lipodystrophy, also known as Nasu-Hakola disease, is a rare hereditary condition with manifestations in the nervous and skeletal systems. The radiographic appearance of skeletal lesions has been well described in the literature. However, CT and MRI findings of lesions in the bone have not been documented to date. This report describes the radiographic, CT, MRI, and histopathologic skeletal findings in a case of membranous lipodystrophy. With corroborative pathologic findings, a diagnosis of membranous lipodystrophy on imaging allows for appropriate clinical management of disease manifestations. (orig.)

  15. Waste management under multiple complexities: Inexact piecewise-linearization-based fuzzy flexible programming

    International Nuclear Information System (INIS)

    Sun Wei; Huang, Guo H.; Lv Ying; Li Gongchen

    2012-01-01

    Highlights: ► Inexact piecewise-linearization-based fuzzy flexible programming is proposed. ► It’s the first application to waste management under multiple complexities. ► It tackles nonlinear economies-of-scale effects in interval-parameter constraints. ► It estimates costs more accurately than the linear-regression-based model. ► Uncertainties are decreased and more satisfactory interval solutions are obtained. - Abstract: To tackle nonlinear economies-of-scale (EOS) effects in interval-parameter constraints for a representative waste management problem, an inexact piecewise-linearization-based fuzzy flexible programming (IPFP) model is developed. In IPFP, interval parameters for waste amounts and transportation/operation costs can be quantified; aspiration levels for net system costs, as well as tolerance intervals for both capacities of waste treatment facilities and waste generation rates can be reflected; and the nonlinear EOS effects transformed from objective function to constraints can be approximated. An interactive algorithm is proposed for solving the IPFP model, which in nature is an interval-parameter mixed-integer quadratically constrained programming model. To demonstrate the IPFP’s advantages, two alternative models are developed to compare their performances. One is a conventional linear-regression-based inexact fuzzy programming model (IPFP2) and the other is an IPFP model with all right-hand-sides of fussy constraints being the corresponding interval numbers (IPFP3). The comparison results between IPFP and IPFP2 indicate that the optimized waste amounts would have the similar patterns in both models. However, when dealing with EOS effects in constraints, the IPFP2 may underestimate the net system costs while the IPFP can estimate the costs more accurately. The comparison results between IPFP and IPFP3 indicate that their solutions would be significantly different. The decreased system uncertainties in IPFP’s solutions demonstrate

  16. Multidisciplinary approaches to managing osteoarthritis in multiple joint sites: a systematic review.

    Science.gov (United States)

    Finney, Andrew; Healey, Emma; Jordan, Joanne L; Ryan, Sarah; Dziedzic, Krysia S

    2016-07-08

    The National Institute for Health and Care Excellence's Osteoarthritis (OA) guidelines recommended that future research should consider the benefits of combination therapies in people with OA across multiple joint sites. However, the clinical effectiveness of such approaches to OA management is unknown. This systematic review therefore aimed to identify the clinical and cost effectiveness of multidisciplinary approaches targeting multiple joint sites for OA in primary care. A systematic review of randomised controlled trials. Computerised bibliographic databases were searched (MEDLINE, EMBASE, CINAHL, PsychINFO, BNI, HBE, HMIC, AMED, Web of Science and Cochrane). Studies were included if they met the following criteria; a randomised controlled trial (RCT), a primary care population with OA across at least two different peripheral joint sites (multiple joint sites), and interventions undertaken by at least two different health disciplines (multidisciplinary). The Cochrane 'Risk of Bias' tool and PEDro were used for quality assessment of eligible studies. Clinical and cost effectiveness was determined by extracting and examining self-reported outcomes for pain, function, quality of life (QoL) and health care utilisation. The date range for the search was from database inception until August 2015. The search identified 1148 individual titles of which four were included in the review. A narrative review was conducted due to the heterogeneity of the included trials. Each of the four trials used either educational or exercise interventions facilitated by a range of different health disciplines. Moderate clinical benefits on pain, function and QoL were reported across the studies. The beneficial effects of exercise generally decreased over time within all studies. Two studies were able to show a reduction in healthcare utilisation due to a reduction in visits to a physiotherapist or a reduction in x-rays and orthopaedic referrals. The intervention that showed the most

  17. [Management of symptoms associated with spasticity in patients with multiple sclerosis].

    Science.gov (United States)

    Fernández-Pablos, María Asunción; Costa-Frossard, Lucienne; García-Hernández, Carlos; García-Montes, Inmaculada; Escutia-Roig, Matilde

    To describe the role of nurses in the management of symptoms related to spasticity in patients with multiple sclerosis (MS). A descriptive study was developed based on a questionnaire on spasticity in MS patients. The questionnarie was completed through an anonymous tele-voting system at a national meeting with nurses involved in the management of these patients. Apart from fatigue, according to the opinion of the participants, the spasticity symptom associated with MS most notified by patients was difficulty in walking, followed by spasms and pain. Participants thought that it is important that nursing takes: 1) a role in identifying these symptoms, 2) should focus on the detection of the triggering or aggravating factors, and 3) on providing support in the assessment of the level of spasticity. It is important to inform about the correct use of anti-spasticity drugs, how to adjust the dosage and side effects of treatments, including cannabinoids via an oromucosal spray, titrating its doses according to each patient, and monitoring its tolerability, efficacy and adherence. Although there are usually resources to follow up these patients, there are still important gaps, including the lack of a specific follow-up protocol. Although all the participants are experts in the management of patients with MS, there is still diversity in the functions they perform, and the available resources they have in their hospitals. Nurses act as a key element in the process of identification of symptoms, training and monitoring of these patients with spasticity in EM. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  18. Adaptations of a Yucatec Maya Multiple-Use Ecological Management Strategy to Ecotourism

    Directory of Open Access Journals (Sweden)

    Eduardo García-Frapolli

    2008-12-01

    Full Text Available Over the last 40 years, the Yucatan Peninsula has experienced the implementation and promotion of development programs that have economically and ecologically shaped this region of Mexico. Nowadays, tourist development has become the principal catalyst of social, economic, and ecological changes in the region. All these programs, which are based on a specialization rationale, have historically clashed with traditional Yucatec Maya management of natural resources. Using participant observation, informal and semi-structured interviews, and life-history interviews, we carried out an assessment of a Yucatec Maya natural resources management system implemented by three indigenous communities located within a natural protected area. The assessment, intended as an examination of the land-use practices and productive strategies currently implemented by households, was framed within an ecological-economic approach to ecosystems appropriation. To examine the influence of tourism on the multiple-use strategy, we contrasted productive activities among households engaged primarily in ecotourism with those more oriented toward traditional agriculture. Results show that households from these communities allocated an annual average of 586 work days to implement a total of 15 activities in five different land-use units, and that those figures vary significantly in accordance with households' productive strategy (agriculture oriented or service oriented. As the region is quickly becoming an important tourist destination and ecotourism is replacing many traditional activities, we discuss the need for a balance between traditional and alternative economic activities that will allow Yucatec Maya communities to diversify their economic options without compromising existing local management practices.

  19. Energy Management of an Off-Grid Hybrid Power Plant with Multiple Energy Storage Systems

    Directory of Open Access Journals (Sweden)

    Laura Tribioli

    2016-08-01

    Full Text Available In this paper, an off-grid hybrid power plant with multiple storage systems for an artificial island is designed and two possible strategies for the management of the stored energy are proposed. Renewable power sources (wind/solar technologies are used as primary power suppliers. A lead-acid battery pack (BAT and a reversible polymer electrolyte fuel cell are employed to fulfill the power demand and to absorb extra power. The reversible fuel cell allows reducing costs and occupied space and the fuel cell can be fed by the pure hydrogen produced by means of its reversible operation as an electrolyzer. A diesel engine is employed as backup system. While HOMER Pro® has been employed for a full-factorial-based optimization of the sizes of the renewable sources and the BAT, Matlab/Simulink® has been later used for simulating the plant operation and compare two possible power management control strategies. For the reversible fuel cell sizing, a sensitivity analysis has been carried out varying stack and hydrogen tank sizes. The final choice for plant configuration and power management control strategy has been made on the basis of a comparative analysis of the results, aimed at minimizing fossil fuel consumption and CO2 emissions, battery aging rate and at maximizing the power plant overall efficiency. The obtained results demonstrate the possibility of realizing a renewable power plant, able to match the needs of electrical power in a remote area, by achieving a good integration of different energy sources and facing the intermittent nature of renewable power sources, with very low use of fossil fuels.

  20. Once an Impression Manager, Always an Impression Manager? Antecedents of Honest and Deceptive Impression Management Use and Variability across Multiple Job Interviews.

    Science.gov (United States)

    Roulin, Nicolas; Bourdage, Joshua S

    2017-01-01

    Research has examined the antecedents of applicants' use of impression management (IM) tactics in employment interviews. All existing empirical studies have measured IM in one particular interview. Yet, applicants generally interview multiple times for different positions, and thus have multiple opportunities to engage in IM, before they can secure a job. Similarly, recent theoretical advances in personnel selection and IM research have suggested that applicant behaviors should be considered as dynamic and adaptive in nature. In line with this perspective, the present study is the first to examine the role of individual differences in both applicants' use of IM tactics and the variability in IM use across multiple interviews. It also highlights which honest and deceptive IM tactics remain stable vs. vary in consecutive interviews with different interviewers and organizations. Results suggest that applicants high in Extraversion or core self-evaluations tend to engage in more honest self-promotion but do not adapt their IM approach across interviews. In contrast, applicants who possess more undesirable personality traits (i.e., low on Honesty-Humility and Conscientiousness, but high on Machiavellianism, Narcissism, Psychopathy, or Competitive Worldviews) tend to use more deceptive IM (and especially image creation tactics) and are also more likely to adapt their IM strategy across interviews. Because deceptive IM users can obtain better evaluations from interviewers and the personality profile of those users is often associated with undesirable workplace outcomes, this study provides additional evidence for the claim that deceptive IM (or faking) is a potential threat for organizations.

  1. Management of skeletal Class III malocclusion with unilateral crossbite on a growing patient using facemask-bonded rapid palatal expander and fixed appliances

    Directory of Open Access Journals (Sweden)

    Tinnie Effendy

    2015-01-01

    Full Text Available Facemask (FM and bonded rapid palatal expander (RPE are part of growth modification treatments for correcting skeletal Class III pattern with retrognathic maxilla. This orthopaedic treatment is usually preceded by fixed appliances to achieve aesthetic dental alignment and improve interdigitation. This case report reviews treatment of Class III malocclusion with unilateral crossbite in a 12-year-old boy using FM and bonded RPE, followed by fixed appliances. Choice of FM and bonded RPE was in line with indication which was mild Class III malocclusion with retrognathic maxilla. Execution of treatment was made considering treatment biomechanics and patient cooperation. This orthopaedic treatment was followed by orthodontic treatment specifically aimed to correct unilateral crossbite, canine relationship yet to reach Class I, lower midline shift, as well as unintended dental consequences of using bonded RPE, namely posterior open bite and deepening curve of spee. Posttreatment facial profile and smile are more esthetic. Occlusion is significantly improved both functionally and aesthetically.

  2. Ossified skeletal muscle hemangioma: Radiologic and pathologic features

    Energy Technology Data Exchange (ETDEWEB)

    Engelstad, B L; Gilula, L A [Mallinckrodt Inst. of Radiology, St. Louis, MO (USA); Kynakos, M [Washington Univ., St. Louis, MO (USA). Dept. of Surgical Pathology

    1980-01-01

    Skeletal muscle hemangiomas are relatively uncommon tumors in children and young adults. Although the operative management of these lesions may be affected by their vascularity, the correct preoperative diagnosis is often not made. Ossification of these lesions is rare. Two patients are described whose skeletal muscle hemangiomas contained abundant osseous tissue. This was radiologically reflected by the 'swiss cheese' appearance of the tumors. Such an appearance in an ossified soft tissue mass may allow the correct preoperative diagnosis of this condition.

  3. Regulation of the skeletal muscle blood flow in humans

    DEFF Research Database (Denmark)

    Mortensen, Stefan; Saltin, Bengt

    2014-01-01

    In humans, skeletal muscle blood flow is regulated by an interaction between several locally formed vasodilators including nitric oxide (NO) and prostaglandins. In plasma, ATP is a potent vasodilator that stimulates the formation of NO and prostaglandins and very importantly can offset local...... concentration does not increase during exercise. In the skeletal muscle interstitium, there is a marked increase in the concentration of ATP and adenosine and this increase is tightly coupled to the increase in blood flow. The sources of interstitial ATP and adenosine are thought to be skeletal muscle cells...... hyperaemia whereas the role of ATP remains uncertain due to lack of specific purinergic receptor blockers for human use. The purpose of this review is to address the interaction between vasodilator systems and to discuss the multiple proposed roles of ATP in human skeletal muscle blood flow regulation...

  4. Skeletal and reticuloendothelial imaging in osteopetrosis: case report

    International Nuclear Information System (INIS)

    Park, H.M.; Lambertus, J.

    1977-01-01

    Skeletal and reticuloendothelial images, using Tc-99m HEDP and Tc-99m sulfur colloid, respectively, were obtained from two adult patients with osteopetrosis. Skeletal images demonstrated increased activity in multiple fracture sites, in mandibular osteomyelitis, in ends of splayed long bones adjacent to joints, and in the epiphyseal ends of short tubular bones. The remainder of the skeleton involved with osteopetrosis showed no generalized increased uptake of Tc-99m HEDP. These findings indicate that metabolic activity in this disease is abnormally increased in the usual areas of bone growth but appears normal elsewhere. Reticuloendothelial imaging showed an almost total lack of activity in the axial and peripheral skeletal marrow space. Anemia, however, was only moderate in these patients. Skeletal scintigraphy may be useful to evaluate the presence and extent of the frequent complications of osteopetrosis, namely fractures and osteomyelitis

  5. PGC-1α-mediated adaptations in skeletal muscle

    DEFF Research Database (Denmark)

    Olesen, Jesper; Kiilerich, Kristian; Pilegaard, Henriette

    2010-01-01

    multiple pathways and functions underline the potential importance of PGC-1alpha in skeletal muscle adaptations in humans. The absence of exercise-induced PGC-1alpha-mediated gene regulation during a physical inactive lifestyle is suggested to lead to reduced oxidative capacity of skeletal muscle...... involved in angiogenesis and the anti-oxidant defence as well as to affect expression of inflammatory markers. Exercise increases PGC-1alpha transcription and potentially PGC-1alpha activity through post-translational modifications, and concomitant PGC-1alpha-mediated gene regulation is suggested...... to be an underlying mechanism for adaptations in skeletal muscle, when exercise is repeated. The current review presents some of the key findings in PGC-1alpha-mediated regulation of metabolically related, anti-oxidant and inflammatory proteins in skeletal muscle in the basal state and in response to exercise...

  6. Insulin Increases Ceramide Synthesis in Skeletal Muscle

    Directory of Open Access Journals (Sweden)

    M. E. Hansen

    2014-01-01

    Full Text Available Aims. The purpose of this study was to determine the effect of insulin on ceramide metabolism in skeletal muscle. Methods. Skeletal muscle cells were treated with insulin with or without palmitate for various time periods. Lipids (ceramides and TAG were isolated and gene expression of multiple biosynthetic enzymes were quantified. Additionally, adult male mice received daily insulin injections for 14 days, followed by muscle ceramide analysis. Results. In muscle cells, insulin elicited an increase in ceramides comparable to palmitate alone. This is likely partly due to an insulin-induced increase in expression of multiple enzymes, particularly SPT2, which, when knocked down, prevented the increase in ceramides. In mice, 14 days of insulin injection resulted in increased soleus ceramides, but not TAG. However, insulin injections did significantly increase hepatic TAG compared with vehicle-injected animals. Conclusions. This study suggests that insulin elicits an anabolic effect on sphingolipid metabolism in skeletal muscle, resulting in increased ceramide accumulation. These findings reveal a potential mechanism of the deleterious consequences of the hyperinsulinemia that accompanies insulin resistance and suggest a possible novel therapeutic target to mitigate its effects.

  7. Skeletal (stromal) stem cells

    DEFF Research Database (Denmark)

    Abdallah, Basem M; Kermani, Abbas Jafari; Zaher, Walid

    2015-01-01

    Skeletal (marrow stromal) stem cells (BMSCs) are a group of multipotent cells that reside in the bone marrow stroma and can differentiate into osteoblasts, chondrocytes and adipocytes. Studying signaling pathways that regulate BMSC differentiation into osteoblastic cells is a strategy....../preadipocyte factor 1 (Dlk1/Pref-1), the Wnt co-receptor Lrp5 and intracellular kinases. This article is part of a Special Issue entitled: Stem Cells and Bone....

  8. Logistics management for storing multiple cask plug and remote handling systems in ITER

    International Nuclear Information System (INIS)

    Ventura, Rodrigo; Ferreira, João; Filip, Iulian; Vale, Alberto

    2013-01-01

    Highlights: ► We model the logistics management problem in ITER, taking into account casks of multiple typologies. ► We propose a method to determine the best position of the casks inside a given storage area. ► Our method obtains the sequence of operations required to retrieve or store an arbitrary cask, given its storage place. ► We illustrate our method with simulation results in an example scenario. -- Abstract: During operation, maintenance inside the reactor building at ITER (International Thermonuclear Experimental Reactor) has to be performed by remote handling, due to the presence of activated materials. Maintenance operations involve the transportation and storage of large, heavyweight casks from and to the tokamak building. The transportation is carried out by autonomous vehicles that lift and move beneath these casks. The storage of these casks face several challenges, since (1) the cask storage area is limited in space, and (2) all casks have to be accessible for transportation by the vehicles. In particular, casks in the storage area may block other casks, so that the former has to be moved to a temporary position to give way to the latter. This paper addresses the challenge of managing the logistics of cask storage, where casks may have different typologies. In particular, we propose an approach to (1) determine the best position of the casks inside the storage area, and to (2) obtain the sequence of operations required to retrieve and store an arbitrary cask from/to a given storage place. A combinatorial optimization approach is used to obtain solutions to both these problems. Simulation results illustrate the application of the proposed method to a simple scenario

  9. Logistics management for storing multiple cask plug and remote handling systems in ITER

    Energy Technology Data Exchange (ETDEWEB)

    Ventura, Rodrigo, E-mail: rodrigo.ventura@isr.ist.utl.pt [Laboratório de Robótica e Sistemas em Engenharia e Ciência – Laboratório Associado, Instituto Superior Técnico, Universidade Técnica de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa (Portugal); Ferreira, João, E-mail: jftferreira@ipfn.ist.utl.pt [Instituto de Plasmas e Fusão Nuclear – Laboratório Associado, Instituto Superior Técnico, Universidade Técnica de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa (Portugal); Filip, Iulian, E-mail: ifilip@gmail.com [Faculty of Mechanical Engineering – Technical University Gheorghe Asachi of Iasi, 61 Dimitrie Mangeron Bldv., Iasi 700050 (Romania); Vale, Alberto, E-mail: avale@ipfn.ist.utl.pt [Instituto de Plasmas e Fusão Nuclear – Laboratório Associado, Instituto Superior Técnico, Universidade Técnica de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa (Portugal)

    2013-10-15

    Highlights: ► We model the logistics management problem in ITER, taking into account casks of multiple typologies. ► We propose a method to determine the best position of the casks inside a given storage area. ► Our method obtains the sequence of operations required to retrieve or store an arbitrary cask, given its storage place. ► We illustrate our method with simulation results in an example scenario. -- Abstract: During operation, maintenance inside the reactor building at ITER (International Thermonuclear Experimental Reactor) has to be performed by remote handling, due to the presence of activated materials. Maintenance operations involve the transportation and storage of large, heavyweight casks from and to the tokamak building. The transportation is carried out by autonomous vehicles that lift and move beneath these casks. The storage of these casks face several challenges, since (1) the cask storage area is limited in space, and (2) all casks have to be accessible for transportation by the vehicles. In particular, casks in the storage area may block other casks, so that the former has to be moved to a temporary position to give way to the latter. This paper addresses the challenge of managing the logistics of cask storage, where casks may have different typologies. In particular, we propose an approach to (1) determine the best position of the casks inside the storage area, and to (2) obtain the sequence of operations required to retrieve and store an arbitrary cask from/to a given storage place. A combinatorial optimization approach is used to obtain solutions to both these problems. Simulation results illustrate the application of the proposed method to a simple scenario.

  10. Computed tomography guidance for skeletal biopsy

    International Nuclear Information System (INIS)

    Frager, D.H.; Goldman, M.J.; Elkin, C.M.; Cynamon, J.; Leeds, N.E.; Seimon, L.P.; Habermann, E.T.; Schreiber, K.; Freeman, L.M.

    1987-01-01

    Computed tomographic (CT) guided biopsy and abscess drainage of multiple organ systems have been well described. Reports of spinal and skeletal applications have been less common. This study describes the use of CT guidance in the biopsy of various skeletal lesions in 46 patients. Forty-one patients had skinny needle aspirations (18 or 22 gauge) and 23 patients had trephine core biopsies. Sites of the lesions included: thoracic spine - 15 patients, lumbosacral spine - 17 patients, bony pelvis - 6 patients, rib - 2 patients, and long bones - 6 patients. Fast scanners capable of rapid image reconstruction have overcome many constraints. With CT guidance, the physician who performs the procedure receives virtually no ionizing radiation. The exact location of the needle tip is accurately visualized in relation to the lesion being biopsied and to the vital organs. (orig.)

  11. Motivating factors in hospital environmental management programs: a multiple case study in four private Brazilian hospitals

    Directory of Open Access Journals (Sweden)

    Jan Krüger

    Full Text Available Abstract Environmental responsibility has been a widespread and relatively recent research theme in the healthcare sector. Considering that the greater life expectancy increases the need for healthcare services and that these services produce negative environmental externalities on human health, it is important to understand the relationship between environmental responsibility and the healthcare sector. This article aims to investigate what motivates hospital managers to adopt environmental responsibility programs and to identify the actions implemented by them. A multiple case study was conducted involving four Brazilian hospitals based in Rio de Janeiro and São Paulo. The results indicate that the main drivers are competitive, ethical and regulatory and that the competitive and regulatory motivators have the potential to establish a baseline for environmental performance that varies across ownership type (public or private. The results also indicate that the comprehensiveness of environmental actions is related to organizational resilience and to the motivators that drive hospitals to adopt those actions. Two conceptual models are proposed to illustrate these findings and offer bases for further research.

  12. Effectiveness of energy conservation management on fatigue and participation in multiple sclerosis: A randomized controlled trial.

    Science.gov (United States)

    Blikman, Lyan Jm; van Meeteren, Jetty; Twisk, Jos Wr; de Laat, Fred Aj; de Groot, Vincent; Beckerman, Heleen; Stam, Henk J; Bussmann, Johannes Bj

    2017-10-01

    Fatigue is a frequently reported and disabling symptom in multiple sclerosis (MS). To investigate the effectiveness of an individual energy conservation management (ECM) intervention on fatigue and participation in persons with primary MS-related fatigue. A total of 86 severely fatigued and ambulatory adults with a definite diagnosis of MS were randomized in a single-blind, two-parallel-arm randomized clinical trial to the ECM group or the information-only control group in outpatient rehabilitation departments. Blinded assessments were carried out at baseline and at 8, 16, 26 and 52 weeks after randomization. Primary outcomes were fatigue (fatigue subscale of Checklist Individual Strength - CIS20r) and participation (Impact on Participation and Autonomy scale - IPA). Modified intention-to-treat analysis was based on 76 randomized patients (ECM, n = 36; MS nurse, n=40). No significant ECM effects were found for fatigue (overall difference CIS20r between the groups = -0.81; 95% confidence interval (CI), -3.71 to 2.11) or for four out of five IPA domains. An overall unfavourable effect was found in the ECM group for the IPA domain social relations (difference between the groups = 0.19; 95% CI, 0.03 to 0.35). The individual ECM format used in this study did not reduce MS-related fatigue and restrictions in participation more than an information-only control condition.

  13. Managing the oral side-effects of medications used to treat multiple sclerosis.

    Science.gov (United States)

    Cockburn, N; Pateman, K; Taing, M W; Pradhan, A; Ford, P J

    2017-09-01

    Many medications used to manage multiple sclerosis (MS) affect oral health. This review aimed to identify the oral side-effects of the current drugs recommended in Australia to treat MS and make dental practitioners aware of the range of symptoms. The Australian Therapeutic Guidelines and the Australian Medicines Handbook were searched for medications used to treat MS. For each medication, the generic name, class, route of administration, dosage and drug company reported side-effects were extracted from the online Monthly Index of Medical Specialties (MIMs) database. Meyler's Side-effect of Drugs Encyclopaedia was used to identify any additional oral adverse reactions to medications used to treat MS. Fourteen drugs were identified for the treatment of MS progression and 13 drugs for the treatment of MS symptoms. For these medications, 18 oral side-effects were documented: xerostomia was the most common, followed by dysgeusia, dysphagia, mouth ulceration and sinusitis. Anticholinergic drugs caused xerostomia while immunosuppressants resulted in more infection-related side-effects. Dental practitioners should be aware of the range of symptoms likely to be reported by this population. Clinicians are encouraged to continue providing dental care for their patients who develop MS and refer complex cases to specialists. © 2017 Australian Dental Association.

  14. Overview of recent trends in diagnosis and management of leptomeningeal multiple myeloma.

    Science.gov (United States)

    Yellu, Mahender R; Engel, Jessica M; Ghose, Abhimanyu; Onitilo, Adedayo A

    2016-03-01

    Neurological complications related to multiple myeloma (MM) are not uncommon; however, direct involvement of the central nervous system (CNS) is extremely rare and represents a diagnostic and therapeutic challenge. Significant survival difference has been noted with the introduction of novel therapy in patients with MM, but their effect on the incidence and their use for management of leptomeningeal myeloma (LMM) is uncertain. Analysis of published data demonstrates its recent increased incidence, median time to CNS presentation, and slight improvement in median survival after diagnosis of LMM. Less common MM isotypes have been overrepresented in LMM. CNS relapse occurred mostly in patients with Durie-Salmon stage III MM. Despite treatments, standard or experimental, the survival rates of LMM remain dismal. Monitoring high risk patients closely, even after achieving complete remission, may be useful in early detection of LMM. As we gain better understanding of LMM, we recommend that future research and clinical care focus on earlier diagnosis and development of more efficient CNS-directed therapy to improve survival in this patient population. Copyright © 2014 John Wiley & Sons, Ltd.

  15. Management of Patients With Hepatitis C Virus, Monoclonal Gammopathy of Undetermined Significance, and Multiple Myeloma

    Directory of Open Access Journals (Sweden)

    Alisse Hannaford BS

    2017-04-01

    Full Text Available Background and Aim: The vast majority of the 2.7 million individuals in the United States who are currently infected with hepatitis C virus (HCV were born between 1945 and 1965. The median age of these patients in this particular generation at the time of this writing was 55 years. In the general population, older age is a risk factor for multiple myeloma (MM and other monogammopathies. As the baby boomer population ages, HCV providers are increasingly likely to encounter HCV-infected patients with a monoclonal gammopathy. Guidelines for managing these patients are needed. Methods: We conducted a detailed case series investigation of 4 HCV-positive patients with MM or a monoclonal gammopathy disorder. Patients were followed at the Mount Sinai Faculty Practice liver clinic. We also performed a detailed review of the literature exploring if there is any known association between HCV, MM, and monoclonal gammopathy. Results and Conclusions: There is no convincing evidence of a causal association between HCV and MM. HCV is linked to type II and type III cryoglobulinemia, specific kinds of monoclonal gammopathies of determinable significance. Whether a link exists between HCV and MM or monoclonal gammopathy of undetermined significance is unclear. Our case series provides the first evidence that modern HCV treatments with direct-acting antivirals can be safely and effectively co-administered with MM chemotherapy.

  16. Methodology for Selecting Best Management Practices Integrating Multiple Stakeholders and Criteria. Part 2: Case Study

    Directory of Open Access Journals (Sweden)

    Mauricio Carvallo Aceves

    2016-02-01

    Full Text Available The selection of stormwater Best Management Practices (BMPs for mitigating the effects of urbanization on the hydrological cycle could be a complex process due to conflicting stakeholder views, and varying levels of performance of BMPs across a range of criteria (runoff reduction, erosion control, etc.. Part 1 of this article proposed a methodology based on the application of multi-criteria decision aid (MCDA methods, which was tested here on a residential stormwater network in the Montreal area. The case study considered green roofs, rain gardens, rain barrels and pervious pavement over a range of economic, social, and water quality and quantity criteria by applying 4 MCDA methods under three different stakeholder views. The results indicated Elimination et Choix Traduisant la Réalité (ELECTRE III to be the most appropriate method for the methodology, presenting flexibility concerning threshold values, criteria weights, and showing shared top choices across stakeholders (rain gardens, and rain gardens in combination with pervious pavement. The methodology shows potential for more formal applications and research opportunities. Future work may lie in the inclusion of multiple objective optimization, better stakeholder engagement, estimation of economic benefits, water quality modeling, long-term hydrological simulations, and estimating real BMP pollutant removal rates.

  17. Comprehending the multiple 'values' of green infrastructure - Valuing nature-based solutions for urban water management from multiple perspectives.

    Science.gov (United States)

    Wild, T C; Henneberry, J; Gill, L

    2017-10-01

    The valuation of urban water management practices and associated nature-based solutions (NBS) is highly contested, and is becoming increasingly important to cities seeking to increase their resilience to climate change whilst at the same time facing budgetary pressures. Different conceptions of 'values' exist, each being accompanied by a set of potential measures ranging from calculative practices (closely linked to established market valuation techniques) - through to holistic assessments that seek to address wider concerns of sustainability. Each has the potential to offer important insights that often go well beyond questions of balancing the costs and benefits of the schemes concerned. However, the need to address - and go beyond - economic considerations presents policy-makers, practitioners and researchers with difficult methodological, ethical and practical challenges, especially when considered without the benefit of a broader theoretical framework or in the absence of well-established tools (as might apply within more traditional infrastructural planning contexts, such as the analysis of transport interventions). Drawing on empirical studies undertaken in Sheffield over a period of 10 years, and delivered in partnership with several other European cities and regions, we compare and examine different attempts to evaluate the benefits of urban greening options and future development scenarios. Comparing these different approaches to the valuation of nature-based solutions alongside other, more conventional forms of infrastructure - and indeed integrating both 'green and grey' interventions within a broader framework of infrastructures - throws up some surprising results and conclusions, as well as providing important sign-posts for future research in this rapidly emerging field. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Scripted collaboration in serious gaming for complex learning: Effects of multiple perspectives when acquiring water management skills

    NARCIS (Netherlands)

    Hummel, Hans; Van Houcke, Jasper; Nadolski, Rob; Van der Hiele, Tony; Kurvers, Hub; Löhr, Ansje

    2010-01-01

    Hummel, H. G. K., Van Houcke, J., Nadolski, R. J., Van der Hiele, T., Kurvers, H., & Löhr, A. (2011). Scripted collaboration in gaming for complex learning: Effects of multiple perspectives when acquiring water management skills. British Journal of Educational Technology, 42(6),

  19. The impact of conservation management on the community composition of multiple organism groups in eutrophic interconnected man-made ponds

    NARCIS (Netherlands)

    Lemmens, P.; Mergeay, J.; Van Wichelen, J.; De Meester, Luc; Declerck, S.A.J.

    2015-01-01

    Ponds throughout the world are subjected to a variety of management measures for purposes of biodiversity conservation. Current conservation efforts typically comprise a combination of multiple measures that directly and indirectly impact a wide range of organism groups. Knowledge of the relative

  20. Exercise, Diet, and Stress Management as Mediators between Functional Disability and Health-Related Quality of Life in Multiple Sclerosis

    Science.gov (United States)

    Sung, Connie; Chiu, Chung-Yi; Lee, Eun-Jeong; Bezyak, Jill; Chan, Fong; Muller, Veronica

    2013-01-01

    The main objective of this study was to examine the mediational and moderational effect of exercise, diet, and stress management on the relationship between functional disability and health-related quality of life. Quantitative descriptive research design using multiple regression and correlation techniques was used. Participants were 215…

  1. Confidentiality Protection of User Data and Adaptive Resource Allocation for Managing Multiple Workflow Performance in Service-Based Systems

    Science.gov (United States)

    An, Ho

    2012-01-01

    In this dissertation, two interrelated problems of service-based systems (SBS) are addressed: protecting users' data confidentiality from service providers, and managing performance of multiple workflows in SBS. Current SBSs pose serious limitations to protecting users' data confidentiality. Since users' sensitive data is sent in…

  2. Managing forest and marginal agricultural land for multiple tradeoffs : compromising on economic, carbon and structural biodiversity objectives

    NARCIS (Netherlands)

    Krcmar, E.; Kooten, van G.C.; Vertinsky, I.

    2005-01-01

    In this paper, we use compromise programming to solve a multiple-objective land use and forest management planning model. Long- and short- (`fast¿) term carbon uptake, maintenance of structural diversity, and economic (net returns to forestry and agriculture) objectives are simultaneously achieved

  3. Management of Multiple Nitrogen Sources during Wine Fermentation by Saccharomyces cerevisiae.

    Science.gov (United States)

    Crépin, Lucie; Truong, Nhat My; Bloem, Audrey; Sanchez, Isabelle; Dequin, Sylvie; Camarasa, Carole

    2017-03-01

    During fermentative growth in natural and industrial environments, Saccharomyces cerevisiae must redistribute the available nitrogen from multiple exogenous sources to amino acids in order to suitably fulfill anabolic requirements. To exhaustively explore the management of this complex resource, we developed an advanced strategy based on the reconciliation of data from a set of stable isotope tracer experiments with labeled nitrogen sources. Thus, quantifying the partitioning of the N compounds through the metabolism network during fermentation, we demonstrated that, contrary to the generally accepted view, only a limited fraction of most of the consumed amino acids is directly incorporated into proteins. Moreover, substantial catabolism of these molecules allows for efficient redistribution of nitrogen, supporting the operative de novo synthesis of proteinogenic amino acids. In contrast, catabolism of consumed amino acids plays a minor role in the formation of volatile compounds. Another important feature is that the α-keto acid precursors required for the de novo syntheses originate mainly from the catabolism of sugars, with a limited contribution from the anabolism of consumed amino acids. This work provides a comprehensive view of the intracellular fate of consumed nitrogen sources and the metabolic origin of proteinogenic amino acids, highlighting a strategy of distribution of metabolic fluxes implemented by yeast as a means of adapting to environments with changing and scarce nitrogen resources. IMPORTANCE A current challenge for the wine industry, in view of the extensive competition in the worldwide market, is to meet consumer expectations regarding the sensory profile of the product while ensuring an efficient fermentation process. Understanding the intracellular fate of the nitrogen sources available in grape juice is essential to the achievement of these objectives, since nitrogen utilization affects both the fermentative activity of yeasts and the

  4. Management of Multiple Nitrogen Sources during Wine Fermentation by Saccharomyces cerevisiae

    Science.gov (United States)

    Crépin, Lucie; Truong, Nhat My; Bloem, Audrey; Sanchez, Isabelle; Dequin, Sylvie

    2017-01-01

    ABSTRACT During fermentative growth in natural and industrial environments, Saccharomyces cerevisiae must redistribute the available nitrogen from multiple exogenous sources to amino acids in order to suitably fulfill anabolic requirements. To exhaustively explore the management of this complex resource, we developed an advanced strategy based on the reconciliation of data from a set of stable isotope tracer experiments with labeled nitrogen sources. Thus, quantifying the partitioning of the N compounds through the metabolism network during fermentation, we demonstrated that, contrary to the generally accepted view, only a limited fraction of most of the consumed amino acids is directly incorporated into proteins. Moreover, substantial catabolism of these molecules allows for efficient redistribution of nitrogen, supporting the operative de novo synthesis of proteinogenic amino acids. In contrast, catabolism of consumed amino acids plays a minor role in the formation of volatile compounds. Another important feature is that the α-keto acid precursors required for the de novo syntheses originate mainly from the catabolism of sugars, with a limited contribution from the anabolism of consumed amino acids. This work provides a comprehensive view of the intracellular fate of consumed nitrogen sources and the metabolic origin of proteinogenic amino acids, highlighting a strategy of distribution of metabolic fluxes implemented by yeast as a means of adapting to environments with changing and scarce nitrogen resources. IMPORTANCE A current challenge for the wine industry, in view of the extensive competition in the worldwide market, is to meet consumer expectations regarding the sensory profile of the product while ensuring an efficient fermentation process. Understanding the intracellular fate of the nitrogen sources available in grape juice is essential to the achievement of these objectives, since nitrogen utilization affects both the fermentative activity of yeasts and

  5. Data Management for Flexible Access - Implementation and Lessons Learned from work with Multiple User Communities

    Science.gov (United States)

    Benedict, K. K.; Scott, S.; Hudspeth, W. B.

    2012-12-01

    There is no shortage of community-specific and generic data discovery and download platforms and protocols (e.g. CUAHSI HIS, DataONE, GeoNetwork Open Source, GeoPortal, OGC CSW, OAI PMH), documentation standards (e.g. FGDC, ISO 19115, EML, Dublin Core), data access and visualization standards and models (e.g. OGC WxS, OpenDAP), and general-purpose web service models (i.e. REST & SOAP) upon which Geo-informatics cyberinfrastructure (CI) may be built. When attempting to develop a robust platform that may service a wide variety of users and use cases the challenge is one of identifying which existing platform (if any) may support those current needs while also allowing for future expansion for additional capabilities. In the case of the implementation of a data storage, discovery and delivery platform to support the multiple projects at the Earth Data Analysis Center at UNM, no single platform or protocol met the joint requirements of two initial applications (the New Mexico Resource Geographic Information System [http://rgis.unm.edu] and the New Mexico EPSCoR Data Portal [http://nmepscor.org/dataportal]) and furthermore none met anticipated additional requirements as new applications of the platform emerged. As a result of this assessment three years ago EDAC embarked on the development of the Geographic Storage, Transformation, and Retrieval Engine (GSToRE) platform as a general purpose platform upon which n-tiered geospatially enabled data intensive applications could be built. When initially released in 2010 the focus was on the publication of dynamically generated Open Geospatial Consortium services based upon a PostgreSQL/PostGIS backend database. The identification of additional service interface requirements (implementation of the DataONE API and CUAHSI WaterML services), use cases provided by the NM EPSCoR education working group, and expanded metadata publication needs have led to a significant update to the underlying data management tier for GSToRE - the

  6. Effects of correlations and fees in random multiplicative environments: Implications for portfolio management.

    Science.gov (United States)

    Alper, Ofer; Somekh-Baruch, Anelia; Pirvandy, Oz; Schaps, Malka; Yaari, Gur

    2017-08-01

    Geometric Brownian motion (GBM) is frequently used to model price dynamics of financial assets, and a weighted average of multiple GBMs is commonly used to model a financial portfolio. Diversified portfolios can lead to an increased exponential growth compared to a single asset by effectively reducing the effective noise. The sum of GBM processes is no longer a log-normal process and has a complex statistical properties. The nonergodicity of the weighted average process results in constant degradation of the exponential growth from the ensemble average toward the time average. One way to stay closer to the ensemble average is to maintain a balanced portfolio: keep the relative weights of the different assets constant over time. To keep these proportions constant, whenever assets values change, it is necessary to rebalance their relative weights, exposing this strategy to fees (transaction costs). Two strategies that were suggested in the past for cases that involve fees are rebalance the portfolio periodically and rebalance it in a partial way. In this paper, we study these two strategies in the presence of correlations and fees. We show that using periodic and partial rebalance strategies, it is possible to maintain a steady exponential growth while minimizing the losses due to fees. We also demonstrate how these redistribution strategies perform in a phenomenal way on real-world market data, despite the fact that not all assumptions of the model hold in these real-world systems. Our results have important implications for stochastic dynamics in general and to portfolio management in particular, as we show that there is a superior alternative to the common buy-and-hold strategy, even in the presence of correlations and fees.

  7. Effects of correlations and fees in random multiplicative environments: Implications for portfolio management

    Science.gov (United States)

    Alper, Ofer; Somekh-Baruch, Anelia; Pirvandy, Oz; Schaps, Malka; Yaari, Gur

    2017-08-01

    Geometric Brownian motion (GBM) is frequently used to model price dynamics of financial assets, and a weighted average of multiple GBMs is commonly used to model a financial portfolio. Diversified portfolios can lead to an increased exponential growth compared to a single asset by effectively reducing the effective noise. The sum of GBM processes is no longer a log-normal process and has a complex statistical properties. The nonergodicity of the weighted average process results in constant degradation of the exponential growth from the ensemble average toward the time average. One way to stay closer to the ensemble average is to maintain a balanced portfolio: keep the relative weights of the different assets constant over time. To keep these proportions constant, whenever assets values change, it is necessary to rebalance their relative weights, exposing this strategy to fees (transaction costs). Two strategies that were suggested in the past for cases that involve fees are rebalance the portfolio periodically and rebalance it in a partial way. In this paper, we study these two strategies in the presence of correlations and fees. We show that using periodic and partial rebalance strategies, it is possible to maintain a steady exponential growth while minimizing the losses due to fees. We also demonstrate how these redistribution strategies perform in a phenomenal way on real-world market data, despite the fact that not all assumptions of the model hold in these real-world systems. Our results have important implications for stochastic dynamics in general and to portfolio management in particular, as we show that there is a superior alternative to the common buy-and-hold strategy, even in the presence of correlations and fees.

  8. Management of Multiple Myeloma and Usage of Bortezomib: Perspective from India and Ukraine.

    Science.gov (United States)

    Garg, Amit; Morgunskyy, Mykhaylo; Belagali, Yogesh; Gupta, Namita; Akku, Shyam Prasad

    2016-01-01

    Novel treatment strategies have remarkably improved the multiple myeloma (MM) patients' survival, with associated increased costs. A joint panel meet of international experts from India and Ukraine was held in New Delhi on May 19, 2016 focusing on MM management, bortezomib role, unmet medical needs, and current challenges. The health-care system for oncology in India is majorly private vs. government-based in Ukraine. In India, electrophoresis, serum-free light chain assays, bone marrow tests, and X-rays are available modes of diagnosis. Despite of the numerous cancer centers and stem cell transplant centers, most patients do not prefer transplant owing to its high-cost and social stigma. Majority of the patients are treated with bortezomib or lenalidomide-based regimens. Most patients buy drug themselves. The expanding generic drugs market is a ray of hope for the affordable drugs. In Ukraine, immuno-fixation, bone marrow analysis, and magnetic resonance imaging are common diagnostic modalities. Due to high cost, only few patients undergo transplant. Bortezomib-based regimens are preferred in most of the patients; however, usage is limited due to high costs and lack of funds. Thalidomide-based regimens are used for maintenance therapy due to affordability. In case of relapsed MM, bortezomib is preferred in triple therapy; however, more affordable option is cyclophosphamide, thalidomide, and dexamethasone (CTD). Issues, such as cost containment, common treatment strategies, enhanced collaboration, and improved health-care access, need immediate attention. High-quality generics access will improve outcomes and support health-care cost containment. Pharmacoeconomic studies and head-to-head trials are warranted to determine the cost-effectiveness and benefit of novel therapies in MM.

  9. The Effects of Combined Treadmill Training and Pharmacological Treatment on Management of Multiple Sclerosis Female Patients

    Directory of Open Access Journals (Sweden)

    Ali Asghar Arastoo

    2013-04-01

    Full Text Available Objectives: To compare the effectiveness of two treatment methods of ‘combination pharmacological treatment and treadmill training’ and ‘pharmacological treatment’ on management of multiple sclerosis (MS female patients. Methods: In this quasi experimental and interventional study a sample of 20 MS patients (mean age: 36.75 years with Expanded Disability Status Scale scores (EDSS 1.0 to 4.0 were randomly assigned to a ‘pharmacologic treatment’ (Ph group and a combination group of ‘pharmacologic treatment& treadmill training’ (PhTT. All these individuals used the drugs of choice ‘Rebif’ and ‘Avonex’. The intervention consisted of 8-weeks (24 sessions of treadmill training (30 minutes each, at 40-75% of age-predicted maximum heart rate for the PhTT group. The Ph group followed their own routine treatment program. Balance, speed and endurance of walking, quality of life and fatigue were measured by Berg Balance Score, 10 meter timed walk test, 2 minute walk test, and Fatigue Severity Scale (FFS. Data were analyzed by paired t test and one way ANOVA. Results: Comparison of results indicated that pre and post intervention led to significant improvements in the balance score (P=0.001, 10m walk time (P=0.001, walking endurance (P=0.007, and FFS (P=0.04 in the PhTT group. In contrast, no significant changes were observed in the Ph group’s balance score, 10m timed walk and fatigue, while there was a significant decrease in the 2min walking distance (P=0.015 in this group. Discussion: These results suggest that treadmill training in combination with pharmacological treatment improve balance and walking capacity and level of fatigue in women with mild to moderate MS.

  10. Management of Multiple Myeloma and Usage of Bortezomib: Perspective from India and Ukraine

    Directory of Open Access Journals (Sweden)

    India and Ukraine Haemato-oncology Group

    2016-11-01

    Full Text Available Novel treatment strategies have remarkably improved the multiple myeloma (MM patients’ survival, with associated increased costs.A joint panel meet of international experts from India and Ukraine was held in New Delhi on 19th May 2016 focusing on: MM management, bortezomib role, unmet medical needs, and current challenges.The healthcare system for oncology in India is majorly private versus government-based in Ukraine. In India, electrophoresis, serum-free light chain assays, bone marrow tests, and X-rays are available modes of diagnosis. Despite of the numerous cancer centers and stem cell transplant centers, most patients do not prefer transplant owing to its high-cost and social stigma. Majority of the patients are treated with bortezomib or lenalidomide-based regimens. Most patients buy drug themselves. The expanding generic drugs market is a ray of hope for the affordable drugs.In Ukraine, immuno-fixation, bone-marrow analysis, and magnetic-resonance-imaging are common diagnostic modalities. Due to high-cost, only few patients undergo transplant. Bortezomib-based regimens are preferred in most of the patients, however usage is limited due to high costs and lack of funds. Thalidomide-based regimens are used for maintenance therapy due to affordability. In case of relapsed MM, bortezomib is preferred in triple therapy, however more affordable option is cyclophosphamide, thalidomide, and dexamethasone (CTD. Issues such as cost containment, common treatment strategies, enhanced collaboration, and improved healthcare access need immediate attention. High-quality generics access will improve outcomes and support healthcare cost containment. Pharmacoeconomic studies and head-to-head trials are warranted to determine the cost-effectiveness and benefit of novel therapies in MM.

  11. Spectrum of musculo-skeletal disorders in sickle cell disease in Lagos, Nigeria

    Directory of Open Access Journals (Sweden)

    Ogo Chidiebere N

    2010-01-01

    Full Text Available Abstract Background Sickle cell anemia (SCA is a common genetic disease in Nigeria. Past studies from West Africa focused on isolated aspects of its medical and surgical presentations. To the best of our knowledge, the musculo-skeletal presentations amongst Nigerians with SCA have not been documented in a single all encompassing study. This work aims to prospectively document the musculo-skeletal disease burden among SCA patients. Methods In a prospective study of 318 consecutive patients with genotype-confirmed SCA at the Lagos University Teaching Hospital (LUTH, the musculo-skeletal pathologies, anatomic sites, grade of disease, age at presentation and management outcome were recorded over a one-year period. Data obtained were analyzed using Epi-Info software version 6.0. Data are presented as frequencies (% and mean values (SD as appropriate. Results The HbSS genotype occurred in 296 (93.0%, while 22 (7.0% were HbSC. 100 (31.4% patients with average presenting haemoglobin concentration of 8.2 g/100 ml in the study group, presented with 131 musculo-skeletal pathologies in 118 anatomic sites. Osteomyelitis 31 (31% and septic arthritis 19 (19% were most commonly observed in children less than 10 years. Skin ulcers and avascular necrosis (AVN occurred predominantly in the older age groups, with frequencies of 13 (13.0% and 26 (26.0% respectively. 20 (71.5% of diagnosed cases of AVN presented with radiological grade 4 disease. The lower limbs were involved in 84 (71.1% of sites affected. Lesions involving the spine were rare 11 (0.9%. Multiple presentations occurred in 89 (28.0% of patients; 62 (69.7% of which were children below 10 years. Conclusions Musculo-skeletal complications are common features of sickle cell anaemia seen in 31.4%. Infectious aetiologies predominate with long bones and joints of lower limbs more commonly affected by osteomyelitis and septic arthritis. Healthcare providers managing SCA should be aware of the potential

  12. Skeletal adaptations to bipedalism

    Directory of Open Access Journals (Sweden)

    Vasiljević Perica

    2014-01-01

    Full Text Available Bipedalism is the main characteristic of humans. During evolutin bipedalism emerged probably as an adaptation to a changing environment. Major changes in skeletal system included femur, pelvis, skull and spine. The significance of bipedal locomotion: Bipedalism freed the forelimbs for carrying objects, creation and usage of tools. In the upright position animals have a broader view of the environment and the early detection of predators is crucial for survival. Bipedal locomotion makes larger distances easier to pass, which is very important in the migration of hominids.

  13. Comprehensive analysis of tropomyosin isoforms in skeletal muscles by top-down proteomics.

    Science.gov (United States)

    Jin, Yutong; Peng, Ying; Lin, Ziqing; Chen, Yi-Chen; Wei, Liming; Hacker, Timothy A; Larsson, Lars; Ge, Ying

    2016-04-01

    Mammalian skeletal muscles are heterogeneous in nature and are capable of performing various functions. Tropomyosin (Tpm) is a major component of the thin filament in skeletal muscles and plays an important role in controlling muscle contraction and relaxation. Tpm is known to consist of multiple isoforms resulting from different encoding genes and alternative splicing, along with post-translational modifications. However, a systematic characterization of Tpm isoforms in skeletal muscles is still lacking. Therefore, we employed top-down mass spectrometry (MS) to identify and characterize Tpm isoforms present in different skeletal muscles from multiple species, including swine, rat, and human. Our study revealed that Tpm1.1 and Tpm2.2 are the two major Tpm isoforms in swine and rat skeletal muscles, whereas Tpm1.1, Tpm2.2, and Tpm3.12 are present in human skeletal muscles. Tandem MS was utilized to identify the sequences of the major Tpm isoforms. Furthermore, quantitative analysis revealed muscle-type specific differences in the abundance of un-modified and modified Tpm isoforms in rat and human skeletal muscles. This study represents the first systematic investigation of Tpm isoforms in skeletal muscles, which not only demonstrates the capabilities of top-down MS for the comprehensive characterization of skeletal myofilament proteins but also provides the basis for further studies on these Tpm isoforms in muscle-related diseases.

  14. Clinical role of skeletal scanning

    Energy Technology Data Exchange (ETDEWEB)

    Ell, P J

    1975-12-01

    Malignant disease very often spreads to the skeleton. This is particularly true for carcinomas of the breast, the lungs, the prostate, and the thyroid. Knowledge of the state of the skeleton in these disorders is therefore desirable since patient management will largely depend on the early detection of bony deposits. Primary bone disease often spreads to soft tissue (lungs), and the early detection of this may alter significantly the therapeutic approach to the primary lesion. Traditionally, x-ray skeletal surveys and serum enzyme measurements provide indices which can be used in the staging of these disorders. Complementary techniques such as mammography, xeroradiography, thermography, and radionuclide imaging have been used to provide further relevant information. A number of benign bone diseases need early assessment in order to institute the best form of treatment. It is of importance to assess the circulation in localized areas of bone and to predict the appearance of avascular necrosis, to understand the healing mechanisms involved in fractures, and to predict the outcome of bone grafting. In this paper the clinical role of bone scanning is reviewed, particular attention being given to the recent advances brought about by the introduction of the /sup 99m/Tc compounds. It is important that the non-specialist should be aware of the great improvement in the results obtained and in the help they can give him in deciding on the best management of each patient as an individual.

  15. SET: Session Layer-Assisted Efficient TCP Management Architecture for 6LoWPAN with Multiple Gateways

    Directory of Open Access Journals (Sweden)

    Akbar AliHammad

    2010-01-01

    Full Text Available 6LoWPAN (IPv6 based Low-Power Personal Area Network is a protocol specification that facilitates communication of IPv6 packets on top of IEEE 802.15.4 so that Internet and wireless sensor networks can be inter-connected. This interconnection is especially required in commercial and enterprise applications of sensor networks where reliable and timely data transfers such as multiple code updates are needed from Internet nodes to sensor nodes. For this type of inbound traffic which is mostly bulk, TCP as transport layer protocol is essential, resulting in end-to-end TCP session through a default gateway. In this scenario, a single gateway tends to become the bottleneck because of non-uniform connectivity to all the sensor nodes besides being vulnerable to buffer overflow. We propose SET; a management architecture for multiple split-TCP sessions across a number of serving gateways. SET implements striping and multiple TCP session management through a shim at session layer. Through analytical modeling and ns2 simulations, we show that our proposed architecture optimizes communication for ingress bulk data transfer while providing associated load balancing services. We conclude that multiple split-TCP sessions managed in parallel across a number of gateways result in reduced latency for bulk data transfer and provide robustness against gateway failures.

  16. TAK1 regulates skeletal muscle mass and mitochondrial function

    Science.gov (United States)

    Hindi, Sajedah M.; Sato, Shuichi; Xiong, Guangyan; Bohnert, Kyle R.; Gibb, Andrew A.; Gallot, Yann S.; McMillan, Joseph D.; Hill, Bradford G.

    2018-01-01

    Skeletal muscle mass is regulated by a complex array of signaling pathways. TGF-β–activated kinase 1 (TAK1) is an important signaling protein, which regulates context-dependent activation of multiple intracellular pathways. However, the role of TAK1 in the regulation of skeletal muscle mass remains unknown. Here, we report that inducible inactivation of TAK1 causes severe muscle wasting, leading to kyphosis, in both young and adult mice.. Inactivation of TAK1 inhibits protein synthesis and induces proteolysis, potentially through upregulating the activity of the ubiquitin-proteasome system and autophagy. Phosphorylation and enzymatic activity of AMPK are increased, whereas levels of phosphorylated mTOR and p38 MAPK are diminished upon inducible inactivation of TAK1 in skeletal muscle. In addition, targeted inactivation of TAK1 leads to the accumulation of dysfunctional mitochondria and oxidative stress in skeletal muscle of adult mice. Inhibition of TAK1 does not attenuate denervation-induced muscle wasting in adult mice. Finally, TAK1 activity is highly upregulated during overload-induced skeletal muscle growth, and inactivation of TAK1 prevents myofiber hypertrophy in response to functional overload. Overall, our study demonstrates that TAK1 is a key regulator of skeletal muscle mass and oxidative metabolism. PMID:29415881

  17. Aberrant and alternative splicing in skeletal system disease.

    Science.gov (United States)

    Fan, Xin; Tang, Liling

    2013-10-01

    The main function of skeletal system is to support the body and help movement. A variety of factors can lead to skeletal system disease, including age, exercise, and of course genetic makeup and expression. Pre-mRNA splicing plays a crucial role in gene expression, by creating multiple protein variants with different biological functions. The recent studies show that several skeletal system diseases are related to pre-mRNA splicing. This review focuses on the relationship between pre-mRNA splicing and skeletal system disease. On the one hand, splice site mutation that leads to aberrant splicing often causes genetic skeletal system disease, like COL1A1, SEDL and LRP5. On the other hand, alternative splicing without genomic mutation may generate some marker protein isoforms, for example, FN, VEGF and CD44. Therefore, understanding the relationship between pre-mRNA splicing and skeletal system disease will aid in uncovering the mechanism of disease and contribute to the future development of gene therapy. © 2013 Elsevier B.V. All rights reserved.

  18. CT findings in skeletal cystic echinococcosis

    Energy Technology Data Exchange (ETDEWEB)

    Tuezuen, M.; Hekimoglu, B. [Social Security Hospital, Ankara (Turkey). Dept. of Radiology

    2002-09-01

    Purpose: To evaluate the CT findings of skeletal cystic echinococcosis. Material and Methods: CT findings of 7 patients with pathologically confirmed skeletal cystic echinococcosis were evaluated. Results: There were 4 men and 3 women, aged 36-75 years. Hydatid cysts were located in the spine (n=2), a rib (n=3), the pelvis and a vertebra (n=1), the pelvis and the left femur (n=1). The size of the lesions varied from 1 cm to 15 cm. CT showed well defined, single or multiple cystic lesions with no contrast enhancement, no calcification, no daughter cysts, and no germinal membrane detachment. The cystic lesion had a honeycomb appearance in 2 cases, there was pathologic fracture in 2 cases, bone expansion in 5 cases, cortical thinning in 6 cases, cortical destruction in 6 cases, bone sclerosis in 1 case, and soft tissue extension in 6 cases. Conclusion: Preoperative differential diagnosis of skeletal cystic lesions should include cystic echinococcosis, especially in endemic areas, since this diagnosis may easily be missed unless kept in mind.

  19. Similarly Torn, Differentially Shorn? The Experience and Management of Conflict between Multiple Roles, Relationships, and Social Categories

    Directory of Open Access Journals (Sweden)

    Janelle M. Jones

    2017-10-01

    Full Text Available In three studies we examined the experience and management of conflict between different types of multiple identities. Participants described a conflict between pairs of role, relational, or social identities before rating the experience (i.e., magnitude, stress, and growth and management of conflict on a newly developed scale assessing four strategies: reconciliation, where identities are integrated, realignment, where one identity is chosen over another, retreat, where both identities are avoided, and reflection, where fit (with others, situation determines identity selection. In general, the types of identities mattered for conflict management but not its experience: Magnitude and growth did not differ, however, stress was greater for role identity conflicts (Study 3 only and participants endorsed the use of more realignment for role conflicts (Study 2 and more retreat for relational conflicts (Study 3 relative to other types of identity conflicts. Furthermore, findings suggested that the perceived flexibility of identities, not their importance or valence, were associated with realignment and retreat for roles and with retreat for relationships. Experiencing conflicts between multiple identities leaves people similarly torn, but multiple roles and relationships may be differentially shorn to manage conflict.

  20. Similarly Torn, Differentially Shorn? The Experience and Management of Conflict between Multiple Roles, Relationships, and Social Categories

    Science.gov (United States)

    Jones, Janelle M.; Hynie, Michaela

    2017-01-01

    In three studies we examined the experience and management of conflict between different types of multiple identities. Participants described a conflict between pairs of role, relational, or social identities before rating the experience (i.e., magnitude, stress, and growth) and management of conflict on a newly developed scale assessing four strategies: reconciliation, where identities are integrated, realignment, where one identity is chosen over another, retreat, where both identities are avoided, and reflection, where fit (with others, situation) determines identity selection. In general, the types of identities mattered for conflict management but not its experience: Magnitude and growth did not differ, however, stress was greater for role identity conflicts (Study 3 only) and participants endorsed the use of more realignment for role conflicts (Study 2) and more retreat for relational conflicts (Study 3) relative to other types of identity conflicts. Furthermore, findings suggested that the perceived flexibility of identities, not their importance or valence, were associated with realignment and retreat for roles and with retreat for relationships. Experiencing conflicts between multiple identities leaves people similarly torn, but multiple roles and relationships may be differentially shorn to manage conflict. PMID:29051744

  1. Similarly Torn, Differentially Shorn? The Experience and Management of Conflict between Multiple Roles, Relationships, and Social Categories.

    Science.gov (United States)

    Jones, Janelle M; Hynie, Michaela

    2017-01-01

    In three studies we examined the experience and management of conflict between different types of multiple identities. Participants described a conflict between pairs of role, relational, or social identities before rating the experience (i.e., magnitude, stress, and growth) and management of conflict on a newly developed scale assessing four strategies: reconciliation , where identities are integrated, realignment , where one identity is chosen over another, retreat , where both identities are avoided, and reflection , where fit (with others, situation) determines identity selection. In general, the types of identities mattered for conflict management but not its experience: Magnitude and growth did not differ, however, stress was greater for role identity conflicts ( Study 3 only ) and participants endorsed the use of more realignment for role conflicts ( Study 2 ) and more retreat for relational conflicts ( Study 3 ) relative to other types of identity conflicts. Furthermore, findings suggested that the perceived flexibility of identities, not their importance or valence, were associated with realignment and retreat for roles and with retreat for relationships. Experiencing conflicts between multiple identities leaves people similarly torn, but multiple roles and relationships may be differentially shorn to manage conflict.

  2. An integrated modeling approach to support management decisions of coupled groundwater-agricultural systems under multiple uncertainties

    Science.gov (United States)

    Hagos Subagadis, Yohannes; Schütze, Niels; Grundmann, Jens

    2015-04-01

    The planning and implementation of effective water resources management strategies need an assessment of multiple (physical, environmental, and socio-economic) issues, and often requires new research in which knowledge of diverse disciplines are combined in a unified methodological and operational frameworks. Such integrative research to link different knowledge domains faces several practical challenges. Such complexities are further compounded by multiple actors frequently with conflicting interests and multiple uncertainties about the consequences of potential management decisions. A fuzzy-stochastic multiple criteria decision analysis tool was developed in this study to systematically quantify both probabilistic and fuzzy uncertainties associated with complex hydrosystems management. It integrated physical process-based models, fuzzy logic, expert involvement and stochastic simulation within a general framework. Subsequently, the proposed new approach is applied to a water-scarce coastal arid region water management problem in northern Oman, where saltwater intrusion into a coastal aquifer due to excessive groundwater extraction for irrigated agriculture has affected the aquifer sustainability, endangering associated socio-economic conditions as well as traditional social structure. Results from the developed method have provided key decision alternatives which can serve as a platform for negotiation and further exploration. In addition, this approach has enabled to systematically quantify both probabilistic and fuzzy uncertainties associated with the decision problem. Sensitivity analysis applied within the developed tool has shown that the decision makers' risk aversion and risk taking attitude may yield in different ranking of decision alternatives. The developed approach can be applied to address the complexities and uncertainties inherent in water resources systems to support management decisions, while serving as a platform for stakeholder participation.

  3. Multiple forms of stakeholder interaction in environmental management: business arguments regarding differences in stakeholder relationships

    OpenAIRE

    Onkila, Tiina

    2011-01-01

    This study describes and interprets differences in stakeholder interaction as rhetorically constructed in environmental reports and in interviews with environmental managers. It also interprets the role of the natural environment among stakeholders, and discusses how that role is justified or not justified. The study focuses in a business perspective on stakeholder interaction in environmental management. Characteristically, stakeholder studies of environmental management have concentrated on...

  4. Multiple Case Study of Event Management Curricula and Industry Professionals' Expectations of New Graduates

    Science.gov (United States)

    Whitney, Premila A.

    2016-01-01

    The event management segment of the hospitality industry has experienced tremendous growth in recent years. As a result, demand for qualified event management professionals continues to increase. To help prepare qualified professionals for the event management industry, higher education institutions in the United States are now offering…

  5. Possible uses of skeletal scintigraphy in traumatology

    International Nuclear Information System (INIS)

    Tittel, K.

    1986-01-01

    With customary X-ray examinations bone changes and traumatic lesions remain undetectable so long, because the contour changes are missing or the thickness and density differences are too small. Skeletal scintigraphy helps fill in these gaps in diagnosis, which can be especially important with patients with multiple injuries. The demands for an appropriate radiopharmaceutical are best filled by 99m Tc-methylene diphosphonate. The examination procedure after the injection of a bolus of 10-20 mCi 99m Tc-MDP is described and the indications are listed. (MG) [de

  6. Skeletal manifestations of primary malignant fibrous histiocytoma

    International Nuclear Information System (INIS)

    David, R.; Lindell, M.M.; Kumar, R.; Madewell, J.E.; Shirkhoda, A.

    1986-01-01

    Sixty-five patients, aged 18-84 years, with pathologically proved primary malignant fibrous histiocytoma of bone were studied. Tumors were distributed equally between men and women. The plain film, CT, bone scan, and angiographic findings in each patient were reviewed and correlated. The lesions were predominantly in the appendicular skeleton (66%), with about 33% being centrally located. Only one patient had multiple skeletal lesions. Fifty-two percent of the lesions were lytic, 28% were blastic, and 20% had a mixed pattern. This lesion should be recognized by the radiologist as an entity which has a poor prognosis

  7. Acylated and unacylated ghrelin impair skeletal muscle atrophy in mice

    Science.gov (United States)

    Cachexia is a wasting syndrome associated with cancer, AIDS, multiple sclerosis, and several other disease states. It is characterized by weight loss, fatigue, loss of appetite, and skeletal muscle atrophy and is associated with poor patient prognosis, making it an important treatment target. Ghreli...

  8. The clinical spectrum and pathophysiology of skeletal complications in lysosomal storage disorders

    NARCIS (Netherlands)

    Clarke, Lorne A.; Hollak, Carla E. M.

    2015-01-01

    Lysosomal storage disorders affect multiple organs including the skeleton. Disorders with prominent skeletal symptoms are type 1 and 3 Gaucher disease, the mucopolysaccharidoses, the glycoproteinoses and pycnodysostosis. Clinical manifestations range from asymptomatic radiographical evidence of bone

  9. An Interactive Platform to Visualize Data-Driven Clinical Pathways for the Management of Multiple Chronic Conditions.

    Science.gov (United States)

    Zhang, Yiye; Padman, Rema

    2017-01-01

    Patients with multiple chronic conditions (MCC) pose an increasingly complex health management challenge worldwide, particularly due to the significant gap in our understanding of how to provide coordinated care. Drawing on our prior research on learning data-driven clinical pathways from actual practice data, this paper describes a prototype, interactive platform for visualizing the pathways of MCC to support shared decision making. Created using Python web framework, JavaScript library and our clinical pathway learning algorithm, the visualization platform allows clinicians and patients to learn the dominant patterns of co-progression of multiple clinical events from their own data, and interactively explore and interpret the pathways. We demonstrate functionalities of the platform using a cluster of 36 patients, identified from a dataset of 1,084 patients, who are diagnosed with at least chronic kidney disease, hypertension, and diabetes. Future evaluation studies will explore the use of this platform to better understand and manage MCC.

  10. Non-syndromic multiple odontogenic keratocysts associated with dental anomalies: A report of unusual case and its management

    Directory of Open Access Journals (Sweden)

    Sulabha A Narsapur

    2015-01-01

    Full Text Available Odontogenic keratocyst (OKC, now known as keratocystic odontogenic tumor (KCOT, is the most common cystic lesion occurring in the maxillofacial region. Multiple occurrence of these cysts is less frequent and is usually associated with syndromes, the most common being the Gorlin Goltz syndrome or the nevoid basal cell carcinoma syndrome (NBCCS. We hereby report an unusual case of multiple OKCs in a healthy adult, associated with other dental anomalies. Management approach consisted of enucleation with curettage of the smaller lesions and decortication of buccal cortex in the large lesion. The condition in the present case may be because of the multifocal nature of OKC rather than its association with any syndrome. Concomitant occurrence of multiple OKCs with other dental anomalies may be coincidental. Impacted teeth or missing teeth must be radiographed to rule out the lesions associated with them.

  11. Approaches to the management of agents used for the treatment of multiple sclerosis: consensus statements from a panel of U.S. managed care pharmacists and physicians.

    Science.gov (United States)

    Miller, Ross M; Happe, Laura E; Meyer, Kellie L; Spear, Rachel J

    2012-01-01

    Multiple sclerosis (MS) is a chronic, disabling, and costly disease with several treatment options available; however, there is variability in evidence-based clinical guidelines. Therefore, payers are at a disadvantage when making management decisions without the benefit of definitive guidance from treatment guidelines. To outline approaches for the management of agents used to treat MS, as determined from a group of U.S. managed care pharmacists and physicians. A modified Delphi process was used to develop consensus statements regarding MS management approaches. The panel was composed of experts in managed care and included 8 pharmacy directors and 6 medical directors presently or previously involved in formulary decision making from 12 health plans, 1 specialty pharmacy, and 1 consulting company. These decision makers, who have experience designing health care benefits that include MS treatments, provided anonymous feedback through 2 rounds of web-based surveys and participated in 1 live panel meeting held in December 2010. Consensus was defined as a mean response of at least 3.3 or 100% of responses either "agree" or "strongly agree" (i.e., no panelist answered "disagree" or "strongly disagree") on a 4-item Likert scale (1=strongly disagree, 2=disagree, 3=agree, 4=strongly agree). After 3 phases, these managed care representatives reached consensus on 25 statements for management of patients with MS. Consistent with managed care principles, this group of managed care experts found that health plans should consider efficacy, effectiveness, and safety, as well as patient preference, when evaluating MS therapies for formulary placement. Cost and contracting should be considered if efficacy and safety are judged to be comparable between agents. The consensus statements developed by a panel of managed care representatives provide some insight into decision making in formulary and utilization management of MS therapies.

  12. Nonoperative Management of Multiple Penetrating Cardiac and Colon Wounds from a Shotgun: A Case Report and Literature Review

    OpenAIRE

    Jaramillo, Paula M.; Montoya, Jaime A.; Mejia, David A.; Pereira Warr, Salin

    2018-01-01

    Introduction. Surgery for cardiac trauma is considered fatal and for wounds of the colon by associated sepsis is normally considered; however, conservative management of many traumatic lesions of different injured organs has progressed over the years. Presentation of the Case. A 65-year-old male patient presented with multiple shotgun wounds on the left upper limb, thorax, and abdomen. On evaluation, he was hemodynamically stable with normal sinus rhythm and normal blood pressure, no dyspnea,...

  13. Multiple stakeholders in multi-criteria decision-making in the context of Municipal Solid Waste Management: A review

    International Nuclear Information System (INIS)

    Soltani, Atousa; Hewage, Kasun; Reza, Bahareh; Sadiq, Rehan

    2015-01-01

    Highlights: • We review Municipal Solid Waste Management studies with focus on multiple stakeholders. • We focus on studies with multi-criteria decision analysis methods and discover their trends. • Most studies do not offer solutions for situations where stakeholders compete for more benefits or have unequal voting powers. • Governments and experts are the most participated stakeholders and AHP is the most dominant method. - Abstract: Municipal Solid Waste Management (MSWM) is a complicated process that involves multiple environmental and socio-economic criteria. Decision-makers look for decision support frameworks that can guide in defining alternatives, relevant criteria and their weights, and finding a suitable solution. In addition, decision-making in MSWM problems such as finding proper waste treatment locations or strategies often requires multiple stakeholders such as government, municipalities, industries, experts, and/or general public to get involved. Multi-criteria Decision Analysis (MCDA) is the most popular framework employed in previous studies on MSWM; MCDA methods help multiple stakeholders evaluate the often conflicting criteria, communicate their different preferences, and rank or prioritize MSWM strategies to finally agree on some elements of these strategies and make an applicable decision. This paper reviews and brings together research on the application of MCDA for solving MSWM problems with more focus on the studies that have considered multiple stakeholders and offers solutions for such problems. Results of this study show that AHP is the most common approach in consideration of multiple stakeholders and experts and governments/municipalities are the most common participants in these studies

  14. Multiple stakeholders in multi-criteria decision-making in the context of Municipal Solid Waste Management: A review

    Energy Technology Data Exchange (ETDEWEB)

    Soltani, Atousa; Hewage, Kasun; Reza, Bahareh; Sadiq, Rehan, E-mail: Rehan.sadiq@ubc.ca

    2015-01-15

    Highlights: • We review Municipal Solid Waste Management studies with focus on multiple stakeholders. • We focus on studies with multi-criteria decision analysis methods and discover their trends. • Most studies do not offer solutions for situations where stakeholders compete for more benefits or have unequal voting powers. • Governments and experts are the most participated stakeholders and AHP is the most dominant method. - Abstract: Municipal Solid Waste Management (MSWM) is a complicated process that involves multiple environmental and socio-economic criteria. Decision-makers look for decision support frameworks that can guide in defining alternatives, relevant criteria and their weights, and finding a suitable solution. In addition, decision-making in MSWM problems such as finding proper waste treatment locations or strategies often requires multiple stakeholders such as government, municipalities, industries, experts, and/or general public to get involved. Multi-criteria Decision Analysis (MCDA) is the most popular framework employed in previous studies on MSWM; MCDA methods help multiple stakeholders evaluate the often conflicting criteria, communicate their different preferences, and rank or prioritize MSWM strategies to finally agree on some elements of these strategies and make an applicable decision. This paper reviews and brings together research on the application of MCDA for solving MSWM problems with more focus on the studies that have considered multiple stakeholders and offers solutions for such problems. Results of this study show that AHP is the most common approach in consideration of multiple stakeholders and experts and governments/municipalities are the most common participants in these studies.

  15. "Converting a bi-jaw surgery to a single-jaw surgery:" Posterior maxillary dentoalveolar intrusion with microimplants to avoid the need of a maxillary surgery in the surgical management of skeletal Class III vertical malocclusion

    Directory of Open Access Journals (Sweden)

    Abhisek Ghosh

    2016-01-01

    Full Text Available The management of a vertical skeletal Class III malocclusion with mandibular prognathism revolves around the protocol of bi-jaw surgery (maxillary LeFort I impaction and mandibular bilateral sagittal split osteotomy with setback. The maxillary surgery not only provides increased stability to the ultimate surgical outcome but also increases the amount by which the mandibular set back can be done, therefore aiding in greater profile improvement. With the need of maxillary surgery almost inevitable in treating such situations, the complexity and the increased discomfort associated with such surgery can never be ignored. Is it at all possible to convert a bi-jaw surgery into a single-jaw surgery with the aid of microimplants? With increasing number of patients being treated with microimplants for anterior openbite and gummy smiles, our idea was to incorporate this novel protocol in treating Class III vertical situations and therefore avoid the need of a maxillary surgery in treating such a situation, together with achieving optimum treatment outcome.

  16. Axial skeletal CT densitometry

    International Nuclear Information System (INIS)

    Lampmann, L.E.H.

    1982-01-01

    Since the discovery of the Roentgen ray a precise and accurate assessment of bone mineral content has been a challenge to many investigators. A number of methods have been developed but no one satisfied. Considering its technical possibilities computed tomography is very promising in determination of bone mineral content (BMC). The new modality enables BMC estimations in the axial skeletal trabecular bone. CT densitometry can be performed on a normal commercially available third generation whole body CT scanner. No dedicated device in a special clinical set-up is necessary. In this study 106 patients, most of them clinically suspected of osteoporosis, were examined. The new method CT densitometry has been evaluated. The results have been correlated to alternative BMC determination methods. (Auth.)

  17. Illness perception, treatment beliefs, self-esteem, and self-efficacy as correlates of self-management in multiple sclerosis.

    Science.gov (United States)

    Wilski, M; Tasiemski, T

    2016-05-01

    Self-management of a disease is considered one of the most important factors affecting the treatment outcome. The research on the correlates of self-management in multiple sclerosis (MS) is limited. The aim of this study was to determine if personal factors, such as illness perception, treatment beliefs, self-esteem and self-efficacy, are correlates of self-management in MS. This cross-sectional study included 210 patients with MS who completed Multiple Sclerosis Self-Management Scale - Revised, Brief Illness Perception Questionnaire, Treatment Beliefs Scale, Rosenberg Self-Esteem Scale, and Generalized Self-Efficacy Scale. The patients were recruited from a MS rehabilitation clinic. Demographic data and illness-related problems of the study participants were collected with a self-report survey. Correlation and regression analyses were performed to determine associations between variables. Four factors: age at the time of the study (β = 0.14, P = 0.032), timeline (β = 0.16, P = 0.018), treatment control (β = 0.17, P = 0.022), and general self-efficacy (β = 0.19, P = 0.014) turned out to be the significant correlates of self-management in MS. The model including these variables explained 25% of variance in self-management in MS. Personal factors, such as general self-efficacy, perception of treatment control and realistic MS timeline perspective, are more salient correlates of self-management in MS than the objective clinical variables, such as the severity, type, and duration of MS. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Surgical management of symptomatic spinal cord and intracerebral cavernomas in a multiple cavernomas case

    Directory of Open Access Journals (Sweden)

    Gorgan R.M.

    2016-03-01

    Full Text Available Multiple cavernous malformations are associated with familial cases and are present in 10-20% of all cavernoma cases. 5% of cavernomas are located intramedullary and of these only 10% present multiple cavernomas. With the availability of echo gradient MRI the cases of multiple cavernomas are diagnosed earlier and it is not rare that it uncovers multiple cavernomas in cases where only a single lesion can be identified on regular MRI sequences. We present the case of a 55 years old woman presented with a two years history of mild backache, followed by progressive lower legs motor deficit and urinary retention. The spine MRI showed an intramedullary T2/3 lesion and the cerebral MRI established the diagnosis of multiple cavernomas. One year after the intramedullary cavernoma was operated with success, she developed generalized seizures and a new cerebral MRI showed bleeding and volume growth of one right temporal pole cavernoma. The cerebral lesion was resected successfully and the patient was discharged free of seizures. This familial type multiple cavernomas cases should be screened and followed with repeated brain and spine MRI’s every year.

  19. A multi-fuel management model for a community-level district heating system under multiple uncertainties

    International Nuclear Information System (INIS)

    Fu, D.Z.; Zheng, Z.Y.; Shi, H.B.; Xiao, Rui; Huang, G.H.; Li, Y.P.

    2017-01-01

    In this study, an interval two-stage double-stochastic single-sided fuzzy chance-constrained programming model is developed for supporting fuel management of a community-level district heating system (DHS) fed with both traditional fossil fuels and renewable biofuels under multiple uncertainties. The proposed model is based on the integration of interval parameter programming and single-sided fuzzy chance-constrained programming within an improved stochastic programming framework to tackle the uncertainties expressed as crisp intervals, fuzzy relationship, and probability distributions. Through transforming and solving the model, the related fuzzy and stochastic information can be effectively reflected in the generated solutions. A real fuel management case of a DHS located in Junpu New District of Dalian is utilized to demonstrate the model applicability. The obtained solutions provides an effective linkage in terms of both ‘‘quality’’ and ‘‘quantity’’ aspects for fuel management under various scenarios associated with multiple factors, and thus can help the decision makers to identify desired fuel allotment patterns. Moreover, this study is also useful for decision makers to address the other challenges (e.g. the imbalance between fuel supply and demand, the contradiction between air-pollution emission and environmental protection, as well as the tradeoff between the total heating cost and system satisfaction degree) generated in the fuel management processes. - Highlights: • A feasible two-stage stochastic programming method is improved. • A multi-fuel management model is developed under multiple uncertainties. • The fuel supply pattern for a district heating system can be obtained. • The variation tendencies of the pollutant emissions are examined. • Tradeoff analyses between system satisfaction degree and cost are carried out.

  20. Assessment of stormwater management options in urban contexts using Multiple Attribute Decision-Making

    DEFF Research Database (Denmark)

    Gogate, Nivedita G.; Kalbar, Pradip; Raval, Pratap M.

    2017-01-01

    This paper addresses the problem of selecting the most sustainable stormwater management alternative in developing countries in a dense urban context. Firstly, suitable Low Impact Development (LID) stormwater management measures for dense urban areas in developing countries were identified based...... sustainable stormwater management options in densely populated areas of developing countries....... on critical review of literature. Alternatives have been formulated as varying percentages (degree of adoption) of these suitable measures to manage the stormwater sustainably. Further, a novel decision-making framework is developed which generates the hierarchy for selection of the most sustainable...

  1. Multiple stakeholders in multi-criteria decision-making in the context of Municipal Solid Waste Management: A review.

    Science.gov (United States)

    Soltani, Atousa; Hewage, Kasun; Reza, Bahareh; Sadiq, Rehan

    2015-01-01

    Municipal Solid Waste Management (MSWM) is a complicated process that involves multiple environmental and socio-economic criteria. Decision-makers look for decision support frameworks that can guide in defining alternatives, relevant criteria and their weights, and finding a suitable solution. In addition, decision-making in MSWM problems such as finding proper waste treatment locations or strategies often requires multiple stakeholders such as government, municipalities, industries, experts, and/or general public to get involved. Multi-criteria Decision Analysis (MCDA) is the most popular framework employed in previous studies on MSWM; MCDA methods help multiple stakeholders evaluate the often conflicting criteria, communicate their different preferences, and rank or prioritize MSWM strategies to finally agree on some elements of these strategies and make an applicable decision. This paper reviews and brings together research on the application of MCDA for solving MSWM problems with more focus on the studies that have considered multiple stakeholders and offers solutions for such problems. Results of this study show that AHP is the most common approach in consideration of multiple stakeholders and experts and governments/municipalities are the most common participants in these studies. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Skeletal Manifestations in Gaucher Disease: A Case Report

    Directory of Open Access Journals (Sweden)

    Altınay Göksel Karatepe

    2005-09-01

    Full Text Available Gauchers disease is the most frequent hereditary lysosomal deposit storage disorder. It is characterized by a deficiency of the enzyme glucocerebrosidase that leads to an accumulation of glucocerebroside in the macrophage lysosomes. It is classified in three types, according to the presence of central nervous system involvement (type 2 and 3 or not (type 1. In the majority of patients there are hepatosplenomegaly, anemia and thrombocytopenia. Skeletal involvement is also important and it is the most disabling manifestation. In this case report, there is presented a case of Gauchers disease with multiple skeletal involvement and the literature is reviewed.

  3. An atlas of normal skeletal scintigraphy

    International Nuclear Information System (INIS)

    Flanagan, J.J.; Maisey, M.N.

    1985-01-01

    This atlas was compiled to provide the neophyte as well as the experienced radiologist and the nuclear medicine physician with a reference on normal skeletal scintigraphy as an aid in distinguishing normal variations in skeletal uptake from abnormal findings. Each skeletal scintigraph is labeled, and utilizing an identical scale, a relevant skeletal photograph and radiograph are placed adjacent to the scintigraph

  4. Skeletal Muscle Na+ Channel Disorders

    Directory of Open Access Journals (Sweden)

    Dina eSimkin

    2011-10-01

    Full Text Available Five inherited human disorders affecting skeletal muscle contraction have been traced to mutations in the gene encoding the voltage-gated sodium channel Nav1.4. The main symptoms of these disorders are myotonia or periodic paralysis caused by changes in skeletal muscle fiber excitability. Symptoms of these disorders vary from mild or latent disease to incapacitating or even death in severe cases. As new human sodium channel mutations corresponding to disease states become discovered, the importance of understanding the role of the sodium channel in skeletal muscle function and disease state grows.

  5. Governance and management dynamics of landscape restoration at multiple scales: Learning from successful environmental managers in Sweden.

    Science.gov (United States)

    Dawson, Lucas; Elbakidze, Marine; Angelstam, Per; Gordon, Johanna

    2017-07-15

    Due to a long history of intensive land and water use, habitat networks for biodiversity conservation are generally degraded in Sweden. Landscape restoration (LR) is an important strategy for achieving representative and functional green infrastructures. However, outcomes of LR efforts are poorly studied, particularly the dynamics of LR governance and management. We apply systems thinking methods to a series of LR case studies to analyse the causal structures underlying LR governance and management in Sweden. We show that these structures appear to comprise of an interlinked system of at least three sets of drivers and four core processes. This system exhibits many characteristics of a transformative change towards an integrated, adaptive approach to governance and management. Key challenges for Swedish LR projects relate to institutional and regulatory flexibility, the timely availability of sufficient funds, and the management of learning and knowledge production processes. In response, successful project leaders develop several key strategies to manage complexity and risk, and enhance perceptions of the attractiveness of LR projects. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. The Experience of Persons With Multiple Sclerosis Using MS INFoRm: An Interactive Fatigue Management Resource.

    Science.gov (United States)

    Pétrin, Julie; Akbar, Nadine; Turpin, Karen; Smyth, Penelope; Finlayson, Marcia

    2018-04-01

    We aimed to understand participants' experiences with a self-guided fatigue management resource, Multiple Sclerosis: An Interactive Fatigue Management Resource ( MS INFoRm), and the extent to which they found its contents relevant and useful to their daily lives. We recruited 35 persons with MS experiencing mild to moderate fatigue, provided them with MS INFoRm, and then conducted semistructured interviews 3 weeks and 3 months after they received the resource. Interpretive description guided the analysis process. Findings indicate that participants' experience of using MS INFoRm could be understood as a process of change, influenced by their initial reactions to the resource. They reported experiencing a shift in knowledge, expectations, and behaviors with respect to fatigue self-management. These shifts led to multiple positive outcomes, including increased levels of self-confidence and improved quality of life. These findings suggest that MS INFoRm may have a place in the continuum of fatigue management interventions for people with MS.

  7. Decision Aids for Multiple-Decision Disease Management as Affected by Weather Input Errors

    Science.gov (United States)

    Many disease management decision support systems (DSS) rely, exclusively or in part, on weather inputs to calculate an indicator for disease hazard. Error in the weather inputs, typically due to forecasting, interpolation or estimation from off-site sources, may affect model calculations and manage...

  8. Assessing buyer-supplier relationship management : A multiple case-study in the Dutch construction industry

    NARCIS (Netherlands)

    Bemelmans, J.; Voordijk, H.; Vos, G.C.J.M.; Buter, J.

    2012-01-01

    The objective of this paper is to shed light on obstacles to, and opportunities for, increasing the effectiveness of construction firms in managing buyer-supplier relationships. More specifically, the focus is on assessing the maturity level of buyer-supplier relationship management by construction

  9. Values mapping with Latino forest users: Contributing to the dialogue on multiple land use conflict management

    Science.gov (United States)

    Kelly Biedenweg; Lee Cerveny; Rebecca J. McLain

    2014-01-01

    Participatory mapping of landscape values is gaining ground as a method for engaging communities and stakeholders in natural resource management. Socio-spatial mapping allows the public to identify places of economic, social, cultural, or personal importance. In addition to providing data for planning and land management, the mapping process can open dialogue about...

  10. Options for biodiversity conservation in managed forest landscapes of multiple ownerships in Oregon and Washington, USA.

    Science.gov (United States)

    N. Suzuki; D.H. Olson

    2007-01-01

    We review the policies and management approaches used in U.S. Pacific Northwest planted forest to address biodiversity protection. We provide a case-study watershed design from southern Oregon, integrating various stand-to-landscape biodiversity-management approaches.

  11. Assessing buyer-supplier relationship management: a multiple case-study in the Dutch construction industry

    NARCIS (Netherlands)

    Bemelmans, Jeroen; Voordijk, Johannes T.; Vos, B.; Buter, J.I.H.

    2012-01-01

    The objective of this paper is to shed light on obstacles to, and opportunities for, increasing the effectiveness of construction firms in managing buyer-supplier relationships. More specifically, the focus is on assessing the maturity level of buyer-supplier relationship management by construction

  12. Quality management implementation : a multiple case study in Indonesian manufacturing firms

    NARCIS (Netherlands)

    Irianto, Dradjad

    2005-01-01

    Quality management is viewed as concepts, principles, or practices, within which prescriptive views and empirical facts play roles in constructing its recent definition. Essentially, the concepts of quality management share three principles, i.e. customer focus, continuous improvement, and the

  13. Assessing and managing multiple risks in a changing world — The Roskilde recommendations

    DEFF Research Database (Denmark)

    Selck, Henriette; Adamsen, Peter B.; Backhaus, Thomas

    2017-01-01

    -management process; 5) consider socioeconomics and increased transparency in both risk assessment and risk management; 6) recognize the ethical rights of humans and ecosystems to an adequate level of protection; 7) determine relevant reference conditions and the proper ecological context for assessments in human...

  14. Organizational learning contributes to guidance for managing wildland fires for multiple objectives

    Science.gov (United States)

    Tom Zimmerman; Tim Sexton

    2010-01-01

    Since the inception of organized fire suppression in the early 1900s, wildland fire management has dramatically evolved in operational complexity; ecological significance; social, economic, and political magnitude; areas and timing of application; and recognition of potentially serious consequences. Throughout the past 100 years, fire management has matured from a...

  15. [Multiple non-responding ESWL lithiasis in ectopic pelvic kidney: laparotomic surgical management].

    Science.gov (United States)

    Abed El Rahman, D; Zanetti, G; Cozzi, G; Cozzi, L A; Abed El Rahman, S; Maggioni, A; Rocco, F

    2010-01-01

    A 34 year-old male with multiple lithiasis of ectopic pelvic left kidney, which for 5 years had been causing pain in the left iliac region irradiating to ipsilateral inguinal region and testis. 4 ESWL treatments were unsuccessful. The diagnostic imaging (Angio-CT + Uro-CT) showed ectopic pelvic left kidney with abnormal vascularisation, characterised by multiple lithiasis extending in total area of 4x2 cm with shorter ureter. Right kidney was in normal position. A left pyelocalicolithotomy after DJ stent positioning was performed.

  16. Simvastatin effects on skeletal muscle

    DEFF Research Database (Denmark)

    Larsen, Steen; Stride, Nis; Hey-Mogensen, Martin

    2013-01-01

    Glucose tolerance and skeletal muscle coenzyme Q(10) (Q(10)) content, mitochondrial density, and mitochondrial oxidative phosphorylation (OXPHOS) capacity were measured in simvastatin-treated patients (n = 10) and in well-matched control subjects (n = 9)....

  17. Skeletal recurrences and metastases of extraskeletal myxoid chondrosarcoma

    International Nuclear Information System (INIS)

    Ehara, Shigeru; Nishida, Jun; Shiraishi, Hideo; Yoshioka, Hiroshi; Okada, Kyoji; Sumiya, Hisashi; Takano, Hideyuki

    2007-01-01

    The objective was to elucidate clinical and imaging features of skeletal involvement, recurrences, and metastases of extraskeletal myxoid chondrosarcoma. Included in this series are 4 patients, aged 44 to 65 years, 3 of whom were men and 1 a woman. The primary lesions were in the thigh (n 3) and the upper arm (n = 1). Three patients with multiple metastases died of the disease, 2 were considered to have local recurrence in the adjacent bone. Skeletal metastases occurred after lung metastases in 2 cases, and before lung metastases in 1 case. Typical imaging findings are well-defined lesions with no sclerotic margin or matrix mineralization. A slow, but persistent growth is noted on the imaging features. Although skeletal metastases of chondrosarcoma of bone and soft tissue are rare, myxoid chondrosarcomas, currently classified tumors of uncertain differentiation, rarely metastasize and/or recur in the bones. The imaging features are typically of a localized lesion with cortical disruption or expansion. (orig.)

  18. Skeletal recurrences and metastases of extraskeletal myxoid chondrosarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Ehara, Shigeru [Iwate Medical University School of Medicine, Department of Radiology, Morioka (Japan); Nishida, Jun; Shiraishi, Hideo [Iwate Medical University School of Medicine, Department of Orthopedic Surgery, Iwate (Japan); Yoshioka, Hiroshi [University of Tsukuba School of Medicine, Department of Radiology, Tsukuba (Japan); Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Okada, Kyoji [Akita University School of Medicine, Department of Orthopedic Surgery, Akita (Japan); Sumiya, Hisashi [Kanazawa University School of Medicine, Department of Nuclear Medicine, Kanazawa (Japan); Yawata Medical Center, Komatsu (Japan); Takano, Hideyuki [Chiba Cancer Center, Division of Diagnostic Imaging, Chiba (Japan)

    2007-09-15

    The objective was to elucidate clinical and imaging features of skeletal involvement, recurrences, and metastases of extraskeletal myxoid chondrosarcoma. Included in this series are 4 patients, aged 44 to 65 years, 3 of whom were men and 1 a woman. The primary lesions were in the thigh (n = 3) and the upper arm (n = 1). Three patients with multiple metastases died of the disease, 2 were considered to have local recurrence in the adjacent bone. Skeletal metastases occurred after lung metastases in 2 cases, and before lung metastases in 1 case. Typical imaging findings are well-defined lesions with no sclerotic margin or matrix mineralization. A slow, but persistent growth is noted on the imaging features. Although skeletal metastases of chondrosarcoma of bone and soft tissue are rare, myxoid chondrosarcomas, currently classified tumors of uncertain differentiation, rarely metastasize and/or recur in the bones. The imaging features are typically of a localized lesion with cortical disruption or expansion. (orig.)

  19. Management of citation verification requests for multiple projects at Sandia National Laboratories

    International Nuclear Information System (INIS)

    Crawford, C.S.

    1995-01-01

    Sandia National Laboratories' (SNL) Technical Library is now responsible for providing citation verification management support for all references cited in technical reports issued by the Nuclear Waste Management (NWM) Program. This paper dancing how this process is managed for the Yucca Mountain Site Characterization (YWP), Waste Isolation Pilot Plant (WIPP), Idaho National Engineering Laboratory (INEL), and Greater Confinement Disposal (GCD) projects. Since technical reports are the main product of these projects, emphasis is placed on meeting the constantly evolving needs of these customers in a timely and cost-effective manner

  20. Skeletal muscle performance and ageing.

    Science.gov (United States)

    Tieland, Michael; Trouwborst, Inez; Clark, Brian C

    2018-02-01

    The world population is ageing rapidly. As society ages, the incidence of physical limitations is dramatically increasing, which reduces the quality of life and increases healthcare expenditures. In western society, ~30% of the population over 55 years is confronted with moderate or severe physical limitations. These physical limitations increase the risk of falls, institutionalization, co-morbidity, and premature death. An important cause of physical limitations is the age-related loss of skeletal muscle mass, also referred to as sarcopenia. Emerging evidence, however, clearly shows that the decline in skeletal muscle mass is not the sole contributor to the decline in physical performance. For instance, the loss of muscle strength is also a strong contributor to reduced physical performance in the elderly. In addition, there is ample data to suggest that motor coordination, excitation-contraction coupling, skeletal integrity, and other factors related to the nervous, muscular, and skeletal systems are critically important for physical performance in the elderly. To better understand the loss of skeletal muscle performance with ageing, we aim to provide a broad overview on the underlying mechanisms associated with elderly skeletal muscle performance. We start with a system level discussion and continue with a discussion on the influence of lifestyle, biological, and psychosocial factors on elderly skeletal muscle performance. Developing a broad understanding of the many factors affecting elderly skeletal muscle performance has major implications for scientists, clinicians, and health professionals who are developing therapeutic interventions aiming to enhance muscle function and/or prevent mobility and physical limitations and, as such, support healthy ageing. © 2017 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society on Sarcopenia, Cachexia and Wasting Disorders.

  1. Managing multimorbidity: profiles of integrated care approaches targeting people with multiple chronic conditions in Europe.

    NARCIS (Netherlands)

    Rijken, M.; Hujala, A.; Ginneken, E. van; Melchiorre, M.G.; Groenewegen, P.; Schellevis, F.

    2018-01-01

    In response to the growing populations of people with multiple chronic diseases, new models of care are currently being developed in European countries to better meet the needs of these people. This paper aims to describe the occurrence and characteristics of various types of integrated care

  2. Managing multiple roles - Personality, stress, and work-family interference in dual-earner couples

    NARCIS (Netherlands)

    Wierda-Boer, H.H.; Gerris, J.R.M.; Vermulst, A.A.

    2009-01-01

    Today many parents have multiple roles. This study examined how personality, domain-specific stress, and work-family interference are interrelated. Questionnaire data of 276 Dutch dual-earner couples with young children were analyzed using structural equation modeling. Findings demonstrated that job

  3. Accounting for multiple functions in environmental life cycle assessment of storm water management solutions

    DEFF Research Database (Denmark)

    Brudler, Sarah; Arnbjerg-Nielsen, Karsten; Rygaard, Martin

    The wide range of approaches to handle storm water runoff have varying effects on the environment. Local stormwater control measures for retention and treatment are increasingly used components in urban climate adaptation plans. Often, these solutions modify the multiple functions of urban...

  4. Orthodontic Management with Traction and Asymmetric Extraction for Multiple Impacted Permanent Maxillary Teeth - A Case Report.

    Science.gov (United States)

    Niu, Qiannan; Zhang, Liang; Dai, Juan; Li, Feifei; Feng, Xue

    2016-01-01

    Multiple impacted teeth are a rare eruption disturbance that increases the case complexity. In this article, we described a 13-year-old boy whose 5 permanent maxillary teeth were not erupted although their root formation was complete. The orthodontic treatment with traction and asymmetric extraction was performed to achieve a significantly improved functional and esthetic result.

  5. A Model of Distraction using new Architectural Mechanisms to Manage Multiple Goals

    NARCIS (Netherlands)

    Taatgen, Niels; Katidioti, Ioanna; Borst, Jelmer; van Vugt, Marieke; Taatgen, Niels; van Vugt, Marieke; Borst, Jelmer; Mehlhorn, Katja

    2015-01-01

    Cognitive models assume a one-to-one correspondence between task and goals. We argue that modeling a task by combining multiple goals has several advantages: a task can be constructed from components that are reused from other tasks, and it enables modeling thought processes that compete with or

  6. Two Persons with Multiple Disabilities Use Orientation Technology with Auditory Cues to Manage Simple Indoor Traveling

    Science.gov (United States)

    Lancioni, Giulio E.; Singh, Nirbhay N.; O'Reilly, Mark F.; Sigafoos, Jeff; Campodonico, Francesca; Oliva, Doretta

    2010-01-01

    This study was an effort to extend the evaluation of orientation technology for promoting independent indoor traveling in persons with multiple disabilities. Two participants (adults) were included, who were to travel to activity destinations within occupational settings. The orientation system involved (a) cueing sources only at the destinations…

  7. Key aspects in managing safety when working with multiple contractors: A case study

    NARCIS (Netherlands)

    Drupsteen, L.; Rasmussen, H.B.; Ustailieva, E.; Kampen, J. van

    2015-01-01

    Working with multiple contractors in a shared workplace can introduce and increase safety risks due to complexity. The aim of this study was to explore how safety issues are recognized in a specific case and to identify whether clients and contractors perceive problems similarly. The safety issues

  8. Quality management implementation: a multiple case study in Indonesian manufacturing firms

    OpenAIRE

    Irianto, Dradjad

    2005-01-01

    Quality management is viewed as concepts, principles, or practices, within which prescriptive views and empirical facts play roles in constructing its recent definition. Essentially, the concepts of quality management share three principles, i.e. customer focus, continuous improvement, and the central role of people. In this research, transforming the concepts and principles into a system, and then realising it through practices in order to improve organisational effectiveness are referred as...

  9. Multiple domains of social support are associated with diabetes self-management among Veterans.

    Science.gov (United States)

    Gray, Kristen E; Hoerster, Katherine D; Reiber, Gayle E; Bastian, Lori A; Nelson, Karin M

    2018-01-01

    Objectives To examine, among Veterans, relationships of general social support and diabetes-specific social support for physical activity and healthy eating with diabetes self-management behaviors. Methods Patients from VA Puget Sound, Seattle completed a cross-sectional survey in 2012-2013 ( N = 717). We measured (a) general social support and (b) diabetes-specific social support for healthy eating and physical activity with domains reflecting support person participation, encouragement, and sharing ideas. Among 189 self-reporting diabetes patients, we fit linear and modified Poisson regression models estimating associations of social support with diabetes self-management behaviors: adherence to general and diabetes-specific diets and blood glucose monitoring (days/week); physical activity (social support was not associated with diabetes self-management. For diabetes-specific social support, higher healthy eating support scores across all domains were associated with better adherence to general and diabetes-specific diets. Higher physical activity support scores were positively associated with ≥150 min/week of physical activity only for the participation domain. Discussion Diabetes-specific social support was a stronger and more consistent correlate of improved self-management than general social support, particularly for lifestyle behaviors. Incorporating family/friends into Veterans' diabetes self-management routines may lead to better self-management and improvements in disease control and outcomes.

  10. New developments in the management of relapsed/refractory multiple myeloma – the role of ixazomib

    Directory of Open Access Journals (Sweden)

    Richardson PG

    2017-08-01

    Full Text Available Paul G Richardson,1 Shaji Kumar,2 Jacob P Laubach,1 Claudia Paba-Prada,1 Neeraj Gupta,3 Deborah Berg,3 Helgi van de Velde,3 Philippe Moreau4 1Division of Hematologic Malignancy, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA; 2Division of Hematology, Mayo Clinic, Rochester, MN, USA; 3Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA; 4Hematology Department, University Hospital Hotel-Dieu, Nantes, France Abstract: Ixazomib is the first oral proteasome inhibitor to be approved, in combination with lenalidomide and dexamethasone, for the treatment of patients with multiple myeloma who have received at least one prior therapy. Approval was on the basis of results from the phase 3, double-blind, placebo-controlled TOURMALINE-MM1 study, which demonstrated a 35% improvement in progression-free survival with the all-oral combination of ixazomib plus lenalidomide–dexamethasone versus lenalidomide–dexamethasone alone (median: 20.6 vs 14.7 months; hazard ratio: 0.74, p=0.012; median follow-up 14.7 months. The addition of ixazomib to the lenalidomide–dexamethasone regimen was associated with limited additional toxicity and had no adverse impact on patient-reported quality of life. Common grade ≥3 adverse events with ixazomib include gastrointestinal adverse events, rash, and thrombocytopenia. Here, we review the efficacy, safety, pharmacokinetics, and patient-reported quality of life data seen with ixazomib, and discuss the role of this oral agent in the treatment of patients with relapsed/refractory multiple myeloma, including in patients with high-risk cytogenetic abnormalities and those with multiple prior therapies. Keywords: ixazomib, multiple myeloma, proteasome inhibitor, clinical, efficacy, tolerability, pharmacokinetics 

  11. Osteopoikilosis: A Sign Mimicking Skeletal Metastases in a Cancer Patient

    Directory of Open Access Journals (Sweden)

    Hamid Nasrolahi

    2011-01-01

    Full Text Available Osteopoikilosis is a rare benign osteosclerotic bone disorder that may be misdiagnosed as skeletal metastases. Here we describe a case of coincidental breast cancer and osteopoikilosis mimicking skeletal metastases. A 41-year-old woman underwent right modified radical mastectomy in April 2007. Twenty-eight months after initial treatment,the patient complained of bilateral knee and foot pain. Plain X-rays of the feet and knees showed multiple well-defined osteosclerotic lesions. According to the radiographic appearance, the most likely differential diagnoses included skeletal metastases from breast cancer and osteopoikilosis. A whole-body bone scintigraphy showed no increase in uptake by the sclerotic lesions, and serum lactic dehydrogenase, carcinoembryonic antigen, alkaline phosphatase and cancer antigen 15-3 were not elevated. We therefore diagnosed the patient’s skeletal lesions as osteopoikilosis. This case and ourliterature review suggest that the radiographic appearance of osteopoikilosis may mimic or mask skeletal metastases, potentially leading to misdiagnosis in patients with cancer.

  12. Tissue Engineered Strategies for Skeletal Muscle Injury

    Directory of Open Access Journals (Sweden)

    Umile Giuseppe Longo

    2012-01-01

    Full Text Available Skeletal muscle injuries are common in athletes, occurring with direct and indirect mechanisms and marked residual effects, such as severe long-term pain and physical disability. Current therapy consists of conservative management including RICE protocol (rest, ice, compression, and elevation, nonsteroidal anti-inflammatory drugs, and intramuscular corticosteroids. However, current management of muscle injuries often does not provide optimal restoration to preinjury status. New biological therapies, such as injection of platelet-rich plasma and stem-cell-based therapy, are appealing. Although some studies support PRP application in muscle-injury management, reasons for concern persist, and further research is required for a standardized and safe use of PRP in clinical practice. The role of stem cells needs to be confirmed, as studies are still limited and inconsistent. Further research is needed to identify mechanisms involved in muscle regeneration and in survival, proliferation, and differentiation of stem cells.

  13. Impact of a comprehensive supportive care team on management of hopelessly ill patients with multiple organ failure.

    Science.gov (United States)

    Field, B E; Devich, L E; Carlson, R W

    1989-08-01

    We developed a supportive care team for hopelessly ill patients in an urban emergency/trauma hospital. The team includes a clinical nurse specialist and a faculty physician as well as a chaplain and social worker. The supportive care team provides an alternative to intensive care or conventional ward management of hopelessly ill patients and concentrates on the physical and psychosocial comfort needs of patients and their families. We describe our experience with 20 hopelessly ill patients with multiple organ failure vs a similar group treated before the development of the supportive care team. Although there was no difference in mortality (100 percent), the length of stay in the medical ICU for patients with multiple organ failure decreased by 12 days to 6 days. Additionally, there were 50 percent fewer therapeutic interventions provided by the supportive care team vs intensive care or conventional ward treatment of multiple organ failure patients. We describe the methods that the supportive care team uses in an attempt to meet the physical and psychosocial comfort needs of hopelessly ill multiple organ failure patients and their families. This multidisciplinary approach to the care of the hopelessly ill may have applications in other institutions facing the ethical, medical, and administrative challenges raised by these patients.

  14. Nonoperative Management of Multiple Penetrating Cardiac and Colon Wounds from a Shotgun: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Paula M. Jaramillo

    2018-01-01

    Full Text Available Introduction. Surgery for cardiac trauma is considered fatal and for wounds of the colon by associated sepsis is normally considered; however, conservative management of many traumatic lesions of different injured organs has progressed over the years. Presentation of the Case. A 65-year-old male patient presented with multiple shotgun wounds on the left upper limb, thorax, and abdomen. On evaluation, he was hemodynamically stable with normal sinus rhythm and normal blood pressure, no dyspnea, or abdominal pain. Computed tomography (CT scan of the chest shows hematoma around the aorta without injury to the blood vessel wall with an intramyocardial projectile without pericardial effusion. CT scan of the abdomen showed pellets in the transverse colon and descending colon endoluminal without extravasation of contrast medium or intra-abdominal fluid. The patient remains hemodynamically stable, and nonsurgical procedure was established. Discussion. Patients with asymptomatic intramyocardial projectiles can be safely managed without surgery. Nonsurgical management is only possible in asymptomatic patients with trauma of the colon through close surveillance and with very selective patients since standard management is surgery. Conclusion. Nonsurgical management of cardiac trauma, as well as colon penetrating trauma, can be performed in carefully selected patients with proper clinical follow-up, imaging, and laboratory studies.

  15. Management of a rare case of idiopathic multiple unerupted impacted permanent teeth in an adult female patient

    Directory of Open Access Journals (Sweden)

    Karunakar Shetty

    2016-01-01

    Full Text Available This clinical case report describes the multi-disciplinary approach in the management of an unusual presentation of idiopathic multiple unerupted impacted permanent teeth in a 20-year-old female patient. The case was unique in that, not only were there multiple missing permanent teeth, but also over retained deciduous teeth and attrited existing permanent teeth with loss of vertical dimension of occlusion. Since the patient was young, it was decided to retain all the erupted permanent teeth and extract the infected deciduous teeth with the objective of fabricating overlay complete dentures. This is a simple, reversible and an economical treatment modality, which satisfies both the esthetic and functional demands where the extraction of teeth is not generally indicated and, in addition, provides a stable occlusion.

  16. Data Base Design with GIS in Ecosystem Based Multiple Use Forest Management in Artvin, Turkey: A Case Study in Balcı Forest Management Planning Unit.

    Science.gov (United States)

    Yolasığmaz, Hacı Ahmet; Keleş, Sedat

    2009-01-01

    In Turkey, the understanding of planning focused on timber production has given its place on Multiple Use Management (MUM). Because the whole infrastructure of forestry with inventory system leading the way depends on timber production, some cases of bottle neck are expected during the transition period. Database design, probably the most important stage during the transition to MUM, together with the digital basic maps making up the basis of this infrastructure constitute the main point of this article. Firstly, the forest management philosophy of Turkey in the past was shortly touched upon in the article. Ecosystem Based Multiple Use Forest Management (EBMUFM) approaches was briefly introduced. The second stage of the process of EBMUFM, database design was described by examining the classical planning infrastructure and the coverage to be produced and consumed were suggested in the form of lists. At the application stage, two different geographical databases were established with GIS in Balcı Planning Unit of the years 1984 and 2006. Following that the related basic maps are produced. Timely diversity of the planning unit of 20 years is put forward comparatively with regard to the stand parameters such as tree types, age class, development stage, canopy closure, mixture, volume and increment.

  17. Comparison of Monolateral External Fixation and Internal Fixation for Skeletal Stabilisation in the Management of Small Tibial Bone Defects following Successful Treatment of Chronic Osteomyelitis.

    Science.gov (United States)

    Wang, Yicun; Jiang, Hui; Deng, Zhantao; Jin, Jiewen; Meng, Jia; Wang, Jun; Zhao, Jianning; Sun, Guojing; Qian, Hongbo

    2017-01-01

    To compare the salvage rate and complication between internal fixation and external fixation in patients with small bone defects caused by chronic infectious osteomyelitis debridement. 125 patients with chronic infectious osteomyelitis of tibia fracture who underwent multiple irrigation, debridement procedure, and local/systemic antibiotics were enrolled. Bone defects, which were less than 4 cm, were treated with bone grafting using either internal fixation or monolateral external fixation. 12-month follow-up was conducted with an interval of 3 months to evaluate union of bone defect. Patients who underwent monolateral external fixation had higher body mass index and fasting blood glucose, longer time since injury, and larger bone defect compared with internal fixation. No significant difference was observed in incidence of complications (23.5% versus 19.3%), surgery time (156 ± 23 minutes versus 162 ± 21 minutes), and time to union (11.1 ± 3.0 months versus 10.9 ± 3.1 months) between external fixation and internal fixation. Internal fixation had no significant influence on the occurrence of postoperation complications after multivariate adjustment when compared with external fixation. Furthermore, patients who underwent internal fixation experienced higher level of daily living scales and lower level of anxiety. It was relatively safe to use internal fixation for stabilization in osteomyelitis patients whose bone defects were less than 4 cm and infection was well controlled.

  18. Flash memory management system and method utilizing multiple block list windows

    Science.gov (United States)

    Chow, James (Inventor); Gender, Thomas K. (Inventor)

    2005-01-01

    The present invention provides a flash memory management system and method with increased performance. The flash memory management system provides the ability to efficiently manage and allocate flash memory use in a way that improves reliability and longevity, while maintaining good performance levels. The flash memory management system includes a free block mechanism, a disk maintenance mechanism, and a bad block detection mechanism. The free block mechanism provides efficient sorting of free blocks to facilitate selecting low use blocks for writing. The disk maintenance mechanism provides for the ability to efficiently clean flash memory blocks during processor idle times. The bad block detection mechanism provides the ability to better detect when a block of flash memory is likely to go bad. The flash status mechanism stores information in fast access memory that describes the content and status of the data in the flash disk. The new bank detection mechanism provides the ability to automatically detect when new banks of flash memory are added to the system. Together, these mechanisms provide a flash memory management system that can improve the operational efficiency of systems that utilize flash memory.

  19. MANAGING MULTIPLE ACTIVITIES FOR SPECIFIC THEMES IN THE EFL CLASSROOM (PREK-GRADE 2

    Directory of Open Access Journals (Sweden)

    Hughes M. Terry

    2002-08-01

    Full Text Available The theory of Multiple Intelligences by Howard Gardner is enlightening and extremely useful in the EFL (English as a Foreign Language classroom. For starters it helps the teacher in understanding the individual differences found in the classroom and to comprehend how students go about learning. Multiple intelligences are not always taken into account even though they are very observable in children, since they are still so innocent and honest in their learning process. The purpose of this article is to discuss the importance of approaching the individuals encountered in our classroom, giving them the equal opportunity of learning another language and above all making our classes fun and resourceful so that these young learners are motivated for a lifetime.

  20. Multiple myeloma.

    LENUS (Irish Health Repository)

    Collins, Conor D

    2012-02-01

    Advances in the imaging and treatment of multiple myeloma have occurred over the past decade. This article summarises the current status and highlights how an understanding of both is necessary for optimum management.

  1. Skeletal Muscle Laminopathies: A Review of Clinical and Molecular Features

    Directory of Open Access Journals (Sweden)

    Lorenzo Maggi

    2016-08-01

    Full Text Available LMNA-related disorders are caused by mutations in the LMNA gene, which encodes for the nuclear envelope proteins, lamin A and C, via alternative splicing. Laminopathies are associated with a wide range of disease phenotypes, including neuromuscular, cardiac, metabolic disorders and premature aging syndromes. The most frequent diseases associated with mutations in the LMNA gene are characterized by skeletal and cardiac muscle involvement. This review will focus on genetics and clinical features of laminopathies affecting primarily skeletal muscle. Although only symptomatic treatment is available for these patients, many achievements have been made in clarifying the pathogenesis and improving the management of these diseases.

  2. Clinical efficacy and management of monoclonal antibodies targeting CD38 and SLAMF7 in multiple myeloma

    DEFF Research Database (Denmark)

    van de Donk, Niels W C J; Moreau, Philippe; Plesner, Torben

    2016-01-01

    Immunotherapeutic strategies are emerging as promising therapeutic approaches in multiple myeloma (MM), with several monoclonal antibodies in advanced stages of clinical development. Of these agents, CD38-targeting antibodies have marked single agent activity in extensively pretreated MM...... of therapeutic antibodies with immunofixation and serum protein electrophoresis assays may lead to underestimation of complete response. Strategies to mitigate interference, based on shifting the therapeutic antibody band, are in development. Furthermore, daratumumab, and probably also other CD38-targeting...

  3. Scintigraphy In skeletal trauma

    African Journals Online (AJOL)

    1989-08-05

    Aug 5, 1989 ... of unsuspected fractures in a patient with multiple injuries. S Atr MedJ 1989; 76: ... of left lumbosacral pain, bone scintigraphy was performed a. Department of ... Moreover, the scan demonstrated seven rib. • •. SAMJ VOL.

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

    Directory of Open Access Journals (Sweden)

    Pascal C. Sanginga

    2007-06-01

    Full Text Available Increasingly, social capital, defined as shared norms, trust, and the horizontal and vertical social networks that facilitate coordination and cooperation for mutually beneficial collective action, is seen as an important asset upon which people rely to manage natural resources and resolve conflicts. This paper uses empirical data from households and community surveys and case studies, to examine the role, strengths, and limits of social capital in managing conflicts over the use and management of natural resources. We inventoried over 700 cases ranging from conflicts between multiple resource users to supra-community conflicts between local communities concerns for better livelihoods and national/international concerns for environment conservation. Results show how different types of social capital are used in preventing and managing conflicts. Endowment in certain dimensions of social capital significantly decreased the occurrence of conflicts and played a significant role in managing them. However, social capital mechanisms have some limits, and are not always effective in resolving some types of conflicts. For such conflicts, people rely on formal mechanisms for arbitration and adjudication. In many cases, these have resulted in exclusion, coercion, and violence. Results show that policies or social capital alone do not possess the resources needed to promote broad-based and sustainable conflict resolution strategies. Rather, people use a range of conflict management strategies of different types and combinations of social capital and local polices. This synergy between social capital and local policy is based on complementarity and embededness: mutually supportive relations between local government and local communities, and the nature and extent of the ties connecting people and communities and public institutions. Better understanding of how this synergy between social capital and local policy can be strengthened is crucial to minimize

  5. A Multiple Agent Model of Human Performance in Automated Air Traffic Control and Flight Management Operations

    Science.gov (United States)

    Corker, Kevin; Pisanich, Gregory; Condon, Gregory W. (Technical Monitor)

    1995-01-01

    A predictive model of human operator performance (flight crew and air traffic control (ATC)) has been developed and applied in order to evaluate the impact of automation developments in flight management and air traffic control. The model is used to predict the performance of a two person flight crew and the ATC operators generating and responding to clearances aided by the Center TRACON Automation System (CTAS). The purpose of the modeling is to support evaluation and design of automated aids for flight management and airspace management and to predict required changes in procedure both air and ground in response to advancing automation in both domains. Additional information is contained in the original extended abstract.

  6. Paleopathological Study of Dwarfism-Related Skeletal Dysplasia in a Late Joseon Dynasty (South Korean Population.

    Directory of Open Access Journals (Sweden)

    Eun Jin Woo

    Full Text Available Skeletal dysplasias related to genetic etiologies have rarely been reported for past populations. This report presents the skeletal characteristics of an individual with dwarfism-related skeletal dysplasia from South Korea. To assess abnormal deformities, morphological features, metric data, and computed tomography scans are analyzed. Differential diagnoses include achondroplasia or hypochondroplasia, chondrodysplasia, multiple epiphyseal dysplasia, thalassemia-related hemolytic anemia, and lysosomal storage disease. The diffused deformities in the upper-limb bones and several coarsened features of the craniofacial bones indicate the most likely diagnosis to have been a certain type of lysosomal storage disease. The skeletal remains of EP-III-4-No.107 from the Eunpyeong site, although incomplete and fragmented, provide important clues to the paleopathological diagnosis of skeletal dysplasias.

  7. Paleopathological Study of Dwarfism-Related Skeletal Dysplasia in a Late Joseon Dynasty (South Korean) Population.

    Science.gov (United States)

    Woo, Eun Jin; Lee, Won-Joon; Hu, Kyung-Seok; Hwang, Jae Joon

    2015-01-01

    Skeletal dysplasias related to genetic etiologies have rarely been reported for past populations. This report presents the skeletal characteristics of an individual with dwarfism-related skeletal dysplasia from South Korea. To assess abnormal deformities, morphological features, metric data, and computed tomography scans are analyzed. Differential diagnoses include achondroplasia or hypochondroplasia, chondrodysplasia, multiple epiphyseal dysplasia, thalassemia-related hemolytic anemia, and lysosomal storage disease. The diffused deformities in the upper-limb bones and several coarsened features of the craniofacial bones indicate the most likely diagnosis to have been a certain type of lysosomal storage disease. The skeletal remains of EP-III-4-No.107 from the Eunpyeong site, although incomplete and fragmented, provide important clues to the paleopathological diagnosis of skeletal dysplasias.

  8. Decision aids for multiple-decision disease management as affected by weather input errors.

    Science.gov (United States)

    Pfender, W F; Gent, D H; Mahaffee, W F; Coop, L B; Fox, A D

    2011-06-01

    Many disease management decision support systems (DSSs) rely, exclusively or in part, on weather inputs to calculate an indicator for disease hazard. Error in the weather inputs, typically due to forecasting, interpolation, or estimation from off-site sources, may affect model calculations and management decision recommendations. The extent to which errors in weather inputs affect the quality of the final management outcome depends on a number of aspects of the disease management context, including whether management consists of a single dichotomous decision, or of a multi-decision process extending over the cropping season(s). Decision aids for multi-decision disease management typically are based on simple or complex algorithms of weather data which may be accumulated over several days or weeks. It is difficult to quantify accuracy of multi-decision DSSs due to temporally overlapping disease events, existence of more than one solution to optimizing the outcome, opportunities to take later recourse to modify earlier decisions, and the ongoing, complex decision process in which the DSS is only one component. One approach to assessing importance of weather input errors is to conduct an error analysis in which the DSS outcome from high-quality weather data is compared with that from weather data with various levels of bias and/or variance from the original data. We illustrate this analytical approach for two types of DSS, an infection risk index for hop powdery mildew and a simulation model for grass stem rust. Further exploration of analysis methods is needed to address problems associated with assessing uncertainty in multi-decision DSSs.

  9. Social demand for multiple benefits provided by Aleppo pine forest management in Catalonia, Spain

    DEFF Research Database (Denmark)

    Varela, Elsa; Jacobsen, Jette Bredahl; Mavsar, Robert

    2017-01-01

    This paper estimates the social demand for key benefits provided by Aleppo pine forests in Catalonia that can be enhanced by management. These so-called externalities are the side effects of forest management on citizens’ welfare and can be either positive or negative. The externalities addressed...... are: biodiversity (measured as the number of tree species), accessibility for practicing recreational activities, CO2 sequestration and annual burned area by wildfires. By the use of a choice experiment, an economic valuation method, we estimate in a joint manner people’s preferences...

  10. Analysing the effectiveness of vendor-managed inventory in a single-warehouse, multiple-retailer system

    Science.gov (United States)

    Rahim, Mohd Kamarul Irwan Abdul; Aghezzaf, El-Houssaine; Limère, Veronique; Raa, Birger

    2016-06-01

    This paper considers a two-stage supply chain, consisting of a single warehouse and multiple retailers facing deterministic demands, under a vendor-managed inventory (VMI) policy. It presents a two-phase optimisation approach for coordinating the shipments in this VMI system. The first phase uses direct shipping from the supplier to all retailers to minimise the overall inventory costs. Then, in the second phase, the retailers are clustered using a construction heuristic in order to optimise the transportation costs while satisfying some additional restrictions. The improvement of the system's performance through coordinated VMI replenishments against the system with direct shipping only is shown and discussed in the comparative analysis section.

  11. Energy Management Strategy Based on Multiple Operating States for a Photovoltaic/Fuel Cell/Energy Storage DC Microgrid

    Directory of Open Access Journals (Sweden)

    Ying Han

    2017-01-01

    Full Text Available It is a great challenge for DC microgrids with stochastic renewable sources and volatility loads to achieve better operation performance. This study proposes an energy management strategy based on multiple operating states for a DC microgrid, which is comprised of a photovoltaic (PV array, a proton exchange membrane fuel cell (PEMFC system, and a battery bank. This proposed strategy can share the power properly and keep the bus voltage steady under different operating states (the state of charge (SOC of the battery bank, loading conditions, and PV array output power. In addition, a microgrids test platform is established. In order to verify the effectiveness of the proposed energy management strategy, the strategy is implemented in a hardware system and experimentally tested under different operating states. The experimental results illustrate the good performance of the proposed control strategy for the DC microgrid under different scenarios of power generation and load demand.

  12. A multiple decision support metrics method for effective risk-informed asset management

    International Nuclear Information System (INIS)

    Liming, J.K.; Salter, J.E.

    2004-01-01

    The objective of this paper is to provide electric utilities with a concept for developing and applying effective decision support metrics via integrated risk-informed asset management (RIAM) programs for power stations and generating companies. RIAM is a process by which analysts review historical performance and develop predictive logic models and data analyses to predict critical decision support figures-of-merit (or metrics) for generating station managers and electric utility company executives. These metrics include, but are not limited to, the following: profitability, net benefit, benefit-to-cost ratio, projected return on investment, projected revenue, projected costs, asset value, safety (catastrophic facility damage frequency and consequences, etc.), power production availability (capacity factor, etc.), efficiency (heat rate), and others. RIAM applies probabilistic safety assessment (PSA) techniques and generates predictions in a probabilistic way so that metrics information can be supplied to managers in terms of probability distributions as well as point estimates. This enables the managers to apply the concept of 'confidence levels' in their critical decision-making processes. (authors)

  13. Juggling Multiple Accountability Systems: How Three Principals Manage These Tensions in Ontario, Canada

    Science.gov (United States)

    Pollock, Katina; Winton, Sue

    2016-01-01

    Accountability in education is not new. Schools have always been accountable in one way or another to the communities they serve, regardless of the policy environment of the time (Elmore, "The Educational Forum," 69:134-142, 2005). This article explores how three principals from Ontario, Canada manage the tensions of multiple…

  14. FME Senior Project Managers: A Juggling Act of Multiple Projects | Poster

    Science.gov (United States)

    By Peggy Pearl, Contributing Writer It was not until the 1950s that organizations in the United States began to apply project management tools and techniques to complex construction and engineering projects (http://en.m.wikipedia.org/wiki/Project_life_cycle).

  15. Management of a pregnant woman with multiple erythrocyte alloantibodies – Case report

    Directory of Open Access Journals (Sweden)

    Andreja Hrašovec Lampret

    2012-12-01

    Conclusion: HDFN is still considered an unpredictable disease. By the help of modern pro‑cedures for monitoring of immunised pregnant women also those pregnant women with mulip‑le, clinically significant erythrocyte alloantibod‑ies can be successfully managed in the course of pregnancy.

  16. ePortfolios in the Workplace for Human Capital Management: A Multiple Case Study

    Science.gov (United States)

    Lievens, Ronald

    2015-01-01

    This study researches whether the ePortfolio is a suitable instrument for human capital management in the business environment. The implementation of ePortfolio systems in five different organizations is analyzed. It considers whether ePortfolio implementations were successful, and relevant critical success factors were identified. For the latter…

  17. Conjoint analysis: a pragmatic approach for the accounting of multiple benefits in southern forest management

    Science.gov (United States)

    F. Christian Zinkhan; Thomas P. Holmes; D. Evan Mercer

    1994-01-01

    With conjoint analysis as its foundation, a practical approach for measuring the utility and dollar value of non-market outputs from southern forests is described and analyzed. The approach can be used in the process of evaluating alternative silvicultural and broader natural resource management plans when non-market as well as market outputs are recognized. When...

  18. Market Orientation in Managing Relationships with Multiple Constituencies of Croatian Higher Education

    Science.gov (United States)

    Pavicic, Jurica; Alfirevic, Niksa; Mihanovic, Zoran

    2009-01-01

    In this paper, market orientation in Croatian higher education (HE) is discussed within the context of stakeholder-oriented management. Drawing on existing studies, the "classical" empirical model, describing the market orientation of generic nonprofit organisations, has been adapted to the contingencies of the Croatian HE sector.…

  19. A scenario-based modeling approach for emergency evacuation management and risk analysis under multiple uncertainties

    Energy Technology Data Exchange (ETDEWEB)

    Lv, Y., E-mail: lvyying@hotmail.com [School of Traffic and Transportation, Beijing Jiaotong University, Beijing 100044 (China); Faculty of Engineering and Applied Science, University of Regina, Regina, Saskatchewan S4S 0A2 (Canada); Huang, G.H., E-mail: huang@iseis.org [Faculty of Engineering and Applied Science, University of Regina, Regina, Saskatchewan S4S 0A2 (Canada); Guo, L., E-mail: guoli8658@hotmail.com [Faculty of Engineering and Applied Science, University of Regina, Regina, Saskatchewan S4S 0A2 (Canada); Li, Y.P., E-mail: yongping.li@iseis.org [MOE Key Laboratory of Regional Energy and Environmental Systems Optimization, Resources and Environmental Research Academy, North China Electric Power University, Beijing 102206 (China); Dai, C., E-mail: daichao321@gmail.com [College of Environmental Sciences and Engineering, Peking University, Beijing 100871 (China); Wang, X.W., E-mail: wangxingwei0812@gamil.com [State Key Laboratory of Water Environment Simulation, School of Environment, Beijing Normal University, Beijing 100875 (China); Sun, W., E-mail: sunwei@iseis.org [Faculty of Engineering and Applied Science, University of Regina, Regina, Saskatchewan S4S 0A2 (Canada)

    2013-02-15

    Highlights: ► An interval-parameter joint-probabilistic integer programming method is developed. ► It is useful for nuclear emergency management practices under uncertainties. ► It can schedule optimal routes with maximizing evacuees during a finite time. ► Scenario-based analysis enhances robustness in controlling system risk. ► The method will help to improve the capability of disaster responses. -- Abstract: Nuclear emergency evacuation is important to prevent radioactive harms by hazardous materials and to limit the accidents’ consequences; however, uncertainties are involved in the components and processes of such a management system. In the study, an interval-parameter joint-probabilistic integer programming (IJIP) method is developed for emergency evacuation management under uncertainties. Optimization techniques of interval-parameter programming (IPP) and joint-probabilistic constrained (JPC) programming are incorporated into an integer linear programming framework, so that the approach can deal with uncertainties expressed as joint probability and interval values. The IJIP method can schedule the optimal routes to guarantee the maximum population evacuated away from the effected zone during a finite time. Furthermore, it can also facilitate post optimization analysis to enhance robustness in controlling system violation risk imposed on the joint-probabilistic constraints. The developed method has been applied to a case study of nuclear emergency management; meanwhile, a number of scenarios under different system conditions have been analyzed. It is indicated that the solutions are useful for evacuation management practices. The result of the IJIP method can not only help to raise the capability of disaster responses in a systematic manner, but also provide an insight into complex relationships among evacuation planning, resources utilizations, policy requirements and system risks.

  20. Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol.

    Science.gov (United States)

    Witt, Cordelie E; Bulger, Eileen M

    2017-01-01

    Rib fractures are common among patients sustaining blunt trauma, and are markers of severe bodily and solid organ injury. They are associated with high morbidity and mortality, including multiple pulmonary complications, and can lead to chronic pain and disability. Clinical and radiographic scoring systems have been developed at several institutions to predict risk of complications. Clinical strategies to reduce morbidity have been studied, including multimodal pain management, catheter-based analgesia, pulmonary hygiene, and operative stabilization. In this article, we review risk factors for morbidity and complications, intervention strategies, and discuss experience with bundled clinical pathways for rib fractures. In addition, we introduce the multidisciplinary rib fracture management protocol used at our level I trauma center.

  1. Management of open fractures of the tibial shaft in multiple trauma

    Directory of Open Access Journals (Sweden)

    Stanislaw Boltuc

    2008-01-01

    Full Text Available Background: The work presents the assessment of the results of treatment of open tibial shaft fractures in polytrauma patients. Materials and Methods: The study group comprised 28 patients who underwent surgical treatment of open fractures of the tibial shaft with locked intramedullary nailing. The mean age of the patients was 43 years (range from 19 to 64 years. The criterion for including the patients in the study was concomitant multiple trauma. For the assessment of open tibial fractures, Gustilo classification was used. The most common concomitant multiple trauma included craniocerebral injuries, which were diagnosed in 12 patients. In 14 patients, the surgery was performed within 24 h after the injury. In 14 patients, the surgery was delayed and was performed 8-10 days after the trauma. Results: The assessment of the results at 12 months after the surgery included the following features: time span between the trauma and the surgery and complications in the form of osteomyelitis and delayed union. The efficacy of gait, muscular atrophy, edema of the operated limb and possible disturbances of its axis were also taken under consideration. In patients operated emergently within 24 h after the injury, infected nonunion was observed in three (10.8% males. These patients had grade III open fractures of the tibial shaft according to Gustilo classification. No infectious complications were observed in patients who underwent a delayed operation. Conclusion: Evaluation of patients with open fractures of the tibial shaft in multiple trauma showed that delayed intramedullary nailing performed 8-10 days after the trauma, resulted in good outcome and avoided development of delayed union and infected nonunion. This approach gives time for stabilization of general condition of the patient and identification of pathogens from wound culture.

  2. Multiple brain metastases - current management and perspectives for treatment with electrochemotherapy

    DEFF Research Database (Denmark)

    Linnert, Mette; Iversen, Helle Klingenberg; Gehl, Julie

    2012-01-01

    BACKGROUND: Due to the advanced oncological treatments of cancer, an overall increase in cancer incidence, and better diagnostic tools, the incidence of brain metastases is on the rise. This review addresses the current treatment options for patients with multiple brain metastases, presenting...... of the chemotherapeutic drug bleomycin by 300 times. Preclinical data are promising and the first patient has been treated in an ongoing clinical trial for patients with brain metastases. Perspectives for ECT in the brain include treatment of primary and secondary brain tumors as well as soft tissue metastases elsewhere....

  3. [Coping with chronic illness and multiple medicines in older age: self-management support as an obligation in nursing].

    Science.gov (United States)

    Müller-Mundt, G; Schaeffer, D

    2011-02-01

    In later stages of chronic disease and especially in older age, chronically ill people are often dependent on multiple medicines. Coming to terms with complex medication regimes in everyday life is a challenging task. To provide the support actually needed, patient-centered interventions are essential, not only taking into account the patients' needs and preferences, but also promoting their ability to self manage their disease(s) and their medication regime. This paper outlines the results of a research project aimed at developing and evaluating an intervention to integrate self-management support into primary care, based on a qualitative exploration of the patients' and professionals' views. The findings stress that home care nurses should take an active part in self-management support but need to be prepared adequately. Therefore, a two-tier intervention was developed and evaluated in a prospective control study, consisting of a qualified training and guidelines for practice. The intervention serves to expand the nurses' professional competence to provide the needed individually tailored self-management support in home care.

  4. Multiple products management system with sensors array in automated storage and retrieval systems

    Science.gov (United States)

    Vongbunyong, Supachai; Roengritronnachai, Perawat; Kongsanit, Savanut; Chanok-owat, Chawisa; Polchankajorn, Pongsakorn

    2018-01-01

    Automated Storage and Retrieval Systems (AS/RS) have now been widely used in a number of industries due to its capability to automatically manage the storage of products in effective ways. One of the key features of AS/RS is that each rack is not assigned for a specific product resulting in the benefit of space utilization and logistics related issues. In this research, sensor arrays are equipped at each rack in order to enhance this feature. As a result, various products can be identified and mixed in each rack, so that the space utilization efficiency can be increased. To prove the concept, a prototype system consisting of a Cartesian robot that manages the storage and retrieval of products with 9 variations based on size and color. The concept of Cyber-Physical System and self-awareness of the system are also implemented in this concept prototype.

  5. Managing Multiple Catchment Demands for Sustainable Water Use and Ecosystem Service Provision

    Directory of Open Access Journals (Sweden)

    Kathleen C. Stosch

    2017-09-01

    Full Text Available Ensuring water, food and energy security for a growing world population represents a 21st century catchment management challenge. Failure to recognise the complexity of interactions across ecosystem service provision can risk the loss of other key environmental and socioeconomic benefits from the natural capital of catchment systems. In particular, the ability of soil and water to meet human needs is undermined by uncertainties around climate change effects, ecosystem service interactions and conflicting stakeholder interests across catchments. This critical review draws from an extensive literature to discuss the benefits and challenges of utilising an ecosystem service approach for integrated catchment management (ICM. State-of-the-art research on ecosystem service assessment, mapping and participatory approaches is evaluated and a roadmap of the key short- and longer-term research needs for maximising landscape-scale ecosystem service provision from catchments is proposed.

  6. Research reactor in-core fuel management optimization by application of multiple cyclic interchange algorithms

    Energy Technology Data Exchange (ETDEWEB)

    van Geemert, R.; Hoogenboom, J.E.; Gibcus, H.P.M. [Technische Univ. Delft (Netherlands). Interfacultair Reactor Inst.; Quist, A.J. [Delft University of Technology, Faculty of Applied Mathematics and Informatics Mekelweg 4, 2628 JB, Delft (Netherlands)

    1998-12-01

    Fuel shuffling optimization procedures are proposed for the Hoger Onderwijs Reactor (HOR) in Delft, The Netherlands, a 2MWth swimming-pool type research reactor. These procedures are based on the multiple cyclic interchange approach, according to which the search for the reload pattern associated with the highest objective function value can be thought of as divided in multiple stages. The transition from the initial to the final stage is characterized by an increase in the degree of locality of the search procedure. The general idea is that, during the first stages, the `elite` cluster containing the group of best patterns must be located, after which the solution space is sampled in a more and more local sense to find the local optimum in this cluster. The transition(s) from global search behaviour to local search behaviour can be either prompt, by defining strictly separate search regimes, or gradual by introducing stochastic acceptance tests. The possible objectives and the safety and operation constraints, as well as the optimization procedure, are discussed, followed by some optimization results for the HOR. (orig.) 4 refs.

  7. Management of monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM).

    Science.gov (United States)

    Kyle, Robert A; Rajkumar, S Vincent

    2011-06-01

    Monoclonal gammopathy of undetermined significance (MGUS) is defined as a serum M protein level of less than 3 g/dL, less than 10% clonal plasma cells in the bone marrow, and the absence of end-organ damage. The prevalence of MGUS is 3.2% in the white population but is approximately twice that high in the black population. MGUS may progress to multiple myeloma, AL amyloidosis, Waldenström macroglobulinemia, or lymphoma. The risk of progression is approximately 1% per year, but the risk continues even after more than 25 years of observation. Risk factors for progression include the size of the serum M protein, the type of serum M protein, the number of plasma cells in the bone marrow, and the serum free light chain ratio. Smoldering (asymptomatic) multiple myeloma (SMM) is characterized by the presence of an M protein level of 3 g/dL or higher and/or 10% or more monoclonal plasma cells in the bone marrow but no evidence of end-organ damage. The overall risk of progression to a malignant condition is 10% per year for the first 5 years, approximately 3% per year for the next 5 years, and 1% to 2% per year for the following 10 years. Patients with both MGUS and SMM must be followed up for their lifetime.

  8. Research reactor in-core fuel management optimization by application of multiple cyclic interchange algorithms

    International Nuclear Information System (INIS)

    Geemert, R. van; Hoogenboom, J.E.; Gibcus, H.P.M.

    1998-01-01

    Fuel shuffling optimization procedures are proposed for the Hoger Onderwijs Reactor (HOR) in Delft, The Netherlands, a 2MWth swimming-pool type research reactor. These procedures are based on the multiple cyclic interchange approach, according to which the search for the reload pattern associated with the highest objective function value can be thought of as divided in multiple stages. The transition from the initial to the final stage is characterized by an increase in the degree of locality of the search procedure. The general idea is that, during the first stages, the 'elite' cluster containing the group of best patterns must be located, after which the solution space is sampled in a more and more local sense to find the local optimum in this cluster. The transition(s) from global search behaviour to local search behaviour can be either prompt, by defining strictly separate search regimes, or gradual by introducing stochastic acceptance tests. The possible objectives and the safety and operation constraints, as well as the optimization procedure, are discussed, followed by some optimization results for the HOR. (orig.)

  9. Double hemibody irradiation (DHBI) in the management of relapsed and primary chemoresistant multiple myeloma

    Energy Technology Data Exchange (ETDEWEB)

    McSweeney, E.N.; Tobias, J.S.; Goldstone, A.H.; Richards, J.D.M. (University Coll. Hospital, London (United Kingdom)); Blackman, G. (Middlesex Hospital, London (United Kingdom))

    1993-01-01

    Fifty-five patients with multiple myeloma were treated with both upper and lower hemibody irradiation between January 1985 and January 1991; 42 had relapsed post-plateau and 13 were chemo-resistant to initial therapy. Fifteen patients received [alpha]IFN-2b maintenance therapy post-DHBI, at a dose of 3 Mu three times per week. Ninety-five per cent of patients experienced symptomatic improvement in bone pain post-DHBI, 21% of whom discontinued opiate analgesics altogether; 63% had a minor biochemical response and 38% had a partial biochemical response. The overall survival (OS) and progression free survivals (PFS) in all patients were 11 months and 8 months respectively. No significant difference was noted in either OS or PFS, according to whether patients were chemoresistant or had relapsed post-plateau. [alpha]IFN did not appear to prolong survival (OS or PFS) post-DHBI. We conclude that DHBI is an effective treatment in patients with relapsed multiple myeloma and in those who are chemoresistant to initial therapy. Cytopenia was a significant problem post-DHBI, such that the role of maintenance [alpha]IFN therapy could not be fully evaluated. (author).

  10. Double hemibody irradiation (DHBI) in the management of relapsed and primary chemoresistant multiple myeloma

    International Nuclear Information System (INIS)

    McSweeney, E.N.; Tobias, J.S.; Goldstone, A.H.; Richards, J.D.M.; Blackman, G.

    1993-01-01

    Fifty-five patients with multiple myeloma were treated with both upper and lower hemibody irradiation between January 1985 and January 1991; 42 had relapsed post-plateau and 13 were chemo-resistant to initial therapy. Fifteen patients received αIFN-2b maintenance therapy post-DHBI, at a dose of 3 Mu three times per week. Ninety-five per cent of patients experienced symptomatic improvement in bone pain post-DHBI, 21% of whom discontinued opiate analgesics altogether; 63% had a minor biochemical response and 38% had a partial biochemical response. The overall survival (OS) and progression free survivals (PFS) in all patients were 11 months and 8 months respectively. No significant difference was noted in either OS or PFS, according to whether patients were chemoresistant or had relapsed post-plateau. αIFN did not appear to prolong survival (OS or PFS) post-DHBI. We conclude that DHBI is an effective treatment in patients with relapsed multiple myeloma and in those who are chemoresistant to initial therapy. Cytopenia was a significant problem post-DHBI, such that the role of maintenance αIFN therapy could not be fully evaluated. (author)

  11. New approaches in the management of spasticity in multiple sclerosis patients: role of cannabinoids

    Directory of Open Access Journals (Sweden)

    Paul F Smith

    2010-02-01

    Full Text Available Paul F SmithDepartment of Pharmacology and Toxicology, School of Medical Sciences, University of Otago, Dunedin, New ZealandAbstract: Cannabinoids such as Cannabis-based medicinal extracts (CBMEs are increasingly being used in the treatment of spasticity associated with multiple sclerosis (MS. They have been shown to have a beneficial effect on spasticity; however, this evidence is largely based on subjective rating scales. Objective measurements using the Ashworth scale have tended to show no significant effect; however, the validity of this scale has been questioned. The available clinical trial data suggest that the adverse side effects associated with using CBMEs are generally mild, such as dry mouth, dizziness, somnolence, nausea and intoxication. However, most of these trials were run over a period of months and it is possible that other adverse side effects could develop with long-term use. There may be reason to be concerned about the use of therapeutic cannabinoids by adolescents, people predisposed to psychosis and pregnant women.Keywords: multiple sclerosis, spasticity, cannabinoids, Cannabis

  12. Skeletal maturation, fundamental motor skills and motor coordination in children 7-10 years.

    Science.gov (United States)

    Freitas, Duarte L; Lausen, Berthold; Maia, José António; Lefevre, Johan; Gouveia, Élvio Rúbio; Thomis, Martine; Antunes, António Manuel; Claessens, Albrecht L; Beunen, Gaston; Malina, Robert M

    2015-01-01

    Relationships between skeletal maturation and fundamental motor skills and gross motor coordination were evaluated in 429 children (213 boys and 216 girls) 7-10 years. Skeletal age was assessed (Tanner-Whitehouse 2 method), and stature, body mass, motor coordination (Körperkoordinations Test für Kinder, KTK) and fundamental motor skills (Test of Gross Motor Development, TGMD-2) were measured. Relationships among chronological age, skeletal age (expressed as the standardised residual of skeletal age on chronological age) and body size and fundamental motor skills and motor coordination were analysed with hierarchical multiple regression. Standardised residual of skeletal age on chronological age interacting with stature and body mass explained a maximum of 7.0% of the variance in fundamental motor skills and motor coordination over that attributed to body size per se. Standardised residual of skeletal age on chronological age alone accounted for a maximum of 9.0% of variance in fundamental motor skills, and motor coordination over that attributed to body size per se and interactions between standardised residual of skeletal age on chronological age and body size. In conclusion, skeletal age alone or interacting with body size has a negligible influence on fundamental motor skills and motor coordination in children 7-10 years.

  13. Architecture of security management unit for safe hosting of multiple agents

    Science.gov (United States)

    Gilmont, Tanguy; Legat, Jean-Didier; Quisquater, Jean-Jacques

    1999-04-01

    In such growing areas as remote applications in large public networks, electronic commerce, digital signature, intellectual property and copyright protection, and even operating system extensibility, the hardware security level offered by existing processors is insufficient. They lack protection mechanisms that prevent the user from tampering critical data owned by those applications. Some devices make exception, but have not enough processing power nor enough memory to stand up to such applications (e.g. smart cards). This paper proposes an architecture of secure processor, in which the classical memory management unit is extended into a new security management unit. It allows ciphered code execution and ciphered data processing. An internal permanent memory can store cipher keys and critical data for several client agents simultaneously. The ordinary supervisor privilege scheme is replaced by a privilege inheritance mechanism that is more suited to operating system extensibility. The result is a secure processor that has hardware support for extensible multitask operating systems, and can be used for both general applications and critical applications needing strong protection. The security management unit and the internal permanent memory can be added to an existing CPU core without loss of performance, and do not require it to be modified.

  14. Information Management System Supporting a Multiple Property Survey Program with Legacy Radioactive Contamination.

    Science.gov (United States)

    Stager, Ron; Chambers, Douglas; Wiatzka, Gerd; Dupre, Monica; Callough, Micah; Benson, John; Santiago, Erwin; van Veen, Walter

    2017-04-01

    The Port Hope Area Initiative is a project mandated and funded by the Government of Canada to remediate properties with legacy low-level radioactive waste contamination in the Town of Port Hope, Ontario. The management and use of large amounts of data from surveys of some 4800 properties is a significant task critical to the success of the project. A large amount of information is generated through the surveys, including scheduling individual field visits to the properties, capture of field data laboratory sample tracking, QA/QC, property report generation and project management reporting. Web-mapping tools were used to track and display temporal progress of various tasks and facilitated consideration of spatial associations of contamination levels. The IM system facilitated the management and integrity of the large amounts of information collected, evaluation of spatial associations, automated report reproduction and consistent application and traceable execution for this project.x. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  15. Stakeholder Theory As an Ethical Approach to Effective Management: applying the theory to multiple contexts

    Directory of Open Access Journals (Sweden)

    Jeffrey S. Harrison

    2015-09-01

    Full Text Available Objective – This article provides a brief overview of stakeholder theory, clears up some widely held misconceptions, explains the importance of examining stakeholder theory from a variety of international perspectives and how this type of research will advance management theory, and introduces the other articles in the special issue. Design/methodology/approach – Some of the foundational ideas of stakeholder theory are discussed, leading to arguments about the importance of the theory to management research, especially in an international context. Findings – Stakeholder theory is found to be a particularly useful perspective for addressing some of the important issues in business from an international perspective. It offers an opportunity to reinterpret a variety of concepts, models and phenomena across may different disciplines. Practical implications – The concepts explored in this article may be applied in many contexts, domestically and internationally, and across business disciplines as diverse as economics, public administration, finance, philosophy, marketing, law, and management. Originality/value – Research on stakeholder theory in an international context is both lacking and sorely needed. This article and the others in this special issue aim to help fill that void.

  16. Physical function and pain after surgical or conservative management of multiple rib fractures - a follow-up study.

    Science.gov (United States)

    Fagevik Olsén, Monika; Slobo, Margareta; Klarin, Lena; Caragounis, Eva-Corina; Pazooki, David; Granhed, Hans

    2016-10-28

    There is scarce knowledge of physical function and pain due to multiple rib fractures following trauma. The purpose of this follow-up was to assess respiratory and physical function, pain, range of movement and kinesiophobia in patients with multiple rib fractures who had undergone stabilizing surgery and compare with conservatively managed patients. A consecutive series of 31 patients with multiple rib fractures who had undergone stabilizing surgery were assessed >1 year after the trauma concerning respiratory and physical function, pain, range of movement in the shoulders and thorax, shoulder function and kinesiophobia. For comparison, 30 patients who were treated conservatively were evaluated with the same outcome measures. The results concerning pain, lung function, shoulder function and level of physical activity were similar in the two groups. The patients who had undergone surgery had a significantly larger range of motion in the thorax (p pain, better thoracic range of motion and physical function which would indicate that surgery is preferable. If operation technique could improve in the future with a less invasive approach, it would presumably decrease post-operative pain and the benefit of surgery would be greater than the morbidity of surgery. Patients undergoing surgery have a similar long-term recovery to those who are treated conservatively except for a better range of motion in the thorax and fewer limitations in physical function. Surgery seems to be beneficial for some patients, the question remains which patients. FoU i Sverige (R&D in Sweden), No 106121.

  17. EXTENDED CRITICAL SUCCESS FACTOR MODEL FOR MANAGEMENT OF MULTIPLE PROJECTS: AN EMPIRICAL VIEW FROM TRANSNET IN SOUTH AFRICA

    Directory of Open Access Journals (Sweden)

    J.M. Nethathe

    2012-01-01

    Full Text Available

    ENGLISH ABSTRACT: Transnet Freight Rail in South Africa has faced projects delays in its multi-project environment. This study takes South Africa as representative of developing countries, and develops the Critical Success Factors (CSFs model for multiple projects success, with the goal of expanding the conventional model by adding the demographic characteristics of the business units involved in the multiple projects. The empirical results showing the greatest number of success factors are people-related, with the focus on team selection and team commitment. Two demographic characteristics are of importance when managing multiple projects: the size of the business unit, and the employees’ project experience.

    AFRIKAANSE OPSOMMING: Transnet, ‘n spoorvragentiteit in Suid-Afrika, ondervind gereeld projekvertragings in hul multi-projekomgewing. Suid-Afrika, as ‘n voorbeeld van ontwikkelende lande, word in die studie gebruik en hierdie studie ontwikkel ‘n reeks suksesfaktore vir ‘n multi-projek-omgewing deur ‘n bestaande konvensionele model aan te pas om ook die demografiese eienskappe van die verskillende besigheidseenhede betrokke in die organisasie te inkorpo-reer. Die resultaat van die studie wys dat die grootste aantal suksesfaktore mens-geörienteerd is, met die fokus op die samestelling en toewyding van die betrokke projekspanne. Twee demografiese eienskape is belangrik by die bestuur van multi-projekte, naamlik die grootte van die besigheidseenheid asook projekondervinding van die werknemers.

  18. Regional management units for marine turtles: a novel framework for prioritizing conservation and research across multiple scales.

    Science.gov (United States)

    Wallace, Bryan P; DiMatteo, Andrew D; Hurley, Brendan J; Finkbeiner, Elena M; Bolten, Alan B; Chaloupka, Milani Y; Hutchinson, Brian J; Abreu-Grobois, F Alberto; Amorocho, Diego; Bjorndal, Karen A; Bourjea, Jerome; Bowen, Brian W; Dueñas, Raquel Briseño; Casale, Paolo; Choudhury, B C; Costa, Alice; Dutton, Peter H; Fallabrino, Alejandro; Girard, Alexandre; Girondot, Marc; Godfrey, Matthew H; Hamann, Mark; López-Mendilaharsu, Milagros; Marcovaldi, Maria Angela; Mortimer, Jeanne A; Musick, John A; Nel, Ronel; Pilcher, Nicolas J; Seminoff, Jeffrey A; Troëng, Sebastian; Witherington, Blair; Mast, Roderic B

    2010-12-17

    Resolving threats to widely distributed marine megafauna requires definition of the geographic distributions of both the threats as well as the population unit(s) of interest. In turn, because individual threats can operate on varying spatial scales, their impacts can affect different segments of a population of the same species. Therefore, integration of multiple tools and techniques--including site-based monitoring, genetic analyses, mark-recapture studies and telemetry--can facilitate robust definitions of population segments at multiple biological and spatial scales to address different management and research challenges. To address these issues for marine turtles, we collated all available studies on marine turtle biogeography, including nesting sites, population abundances and trends, population genetics, and satellite telemetry. We georeferenced this information to generate separate layers for nesting sites, genetic stocks, and core distributions of population segments of all marine turtle species. We then spatially integrated this information from fine- to coarse-spatial scales to develop nested envelope models, or Regional Management Units (RMUs), for marine turtles globally. The RMU framework is a solution to the challenge of how to organize marine turtles into units of protection above the level of nesting populations, but below the level of species, within regional entities that might be on independent evolutionary trajectories. Among many potential applications, RMUs provide a framework for identifying data gaps, assessing high diversity areas for multiple species and genetic stocks, and evaluating conservation status of marine turtles. Furthermore, RMUs allow for identification of geographic barriers to gene flow, and can provide valuable guidance to marine spatial planning initiatives that integrate spatial distributions of protected species and human activities. In addition, the RMU framework--including maps and supporting metadata--will be an

  19. Preliminary Study of Intravenous Amantadine Treatment for Ataxia Management in Patients with Probable Multiple System Atrophy with Predominant Cerebellar Ataxia

    Directory of Open Access Journals (Sweden)

    Jinyoung Youn

    2012-05-01

    Full Text Available Background and Purpose: Multiple system atrophy with predominant cerebellar ataxia is a disabling neurologic disease. However, effective management has not yet been established. We conducted a short-term, open-label preliminary study to assess the benefits of intravenous amantadine treatment in patients with probable multiple system atrophy with predominant cerebellar ataxia. Methods: Twenty patients (10 male, 10 female with probable multiple system atrophy with predominant cerebellar ataxia received 400 mg of amantadine by intravenous per day for 5 days. Ataxia severity was evaluated by the International Cooperative Ataxia Rating Scale before and after intravenous amantadine therapy and all subjects reported subjective improvement after intravenous amantadine treatment using a patient global impression scale. We analyzed the total and subscale scores by the ataxia scale and patient global impression scale. Results: The mean age was 57.4 years (range: 47–72 and the mean disease duration was 30.8 months (range: 11–79. The ataxia severity significantly decreased after intravenous amantadine therapy from 42.5 to 37.3 (p < 0.001. The mean patient global impression scale for improvement was 2.9 and there were no side effects of intravenous amantadine treatment observed. When we assessed responders, the duration of intravenous amantadine effect was more than 1 month in 4 subjects of 7 responders. Conclusions: Our findings suggest that intravenous amantadine treatment can be a safe management option in cerebellar ataxia, although the mechanism is unclear. Thus, further double-blind, long-term studies with a larger sample size are needed.

  20. Regional Management Units for Marine Turtles: A Novel Framework for Prioritizing Conservation and Research across Multiple Scales

    Science.gov (United States)

    Wallace, Bryan P.; DiMatteo, Andrew D.; Hurley, Brendan J.; Finkbeiner, Elena M.; Bolten, Alan B.; Chaloupka, Milani Y.; Hutchinson, Brian J.; Abreu-Grobois, F. Alberto; Amorocho, Diego; Bjorndal, Karen A.; Bourjea, Jerome; Bowen, Brian W.; Dueñas, Raquel Briseño; Casale, Paolo; Choudhury, B. C.; Costa, Alice; Dutton, Peter H.; Fallabrino, Alejandro; Girard, Alexandre; Girondot, Marc; Godfrey, Matthew H.; Hamann, Mark; López-Mendilaharsu, Milagros; Marcovaldi, Maria Angela; Mortimer, Jeanne A.; Musick, John A.; Nel, Ronel; Pilcher, Nicolas J.; Seminoff, Jeffrey A.; Troëng, Sebastian; Witherington, Blair; Mast, Roderic B.

    2010-01-01

    Background Resolving threats to widely distributed marine megafauna requires definition of the geographic distributions of both the threats as well as the population unit(s) of interest. In turn, because individual threats can operate on varying spatial scales, their impacts can affect different segments of a population of the same species. Therefore, integration of multiple tools and techniques — including site-based monitoring, genetic analyses, mark-recapture studies and telemetry — can facilitate robust definitions of population segments at multiple biological and spatial scales to address different management and research challenges. Methodology/Principal Findings To address these issues for marine turtles, we collated all available studies on marine turtle biogeography, including nesting sites, population abundances and trends, population genetics, and satellite telemetry. We georeferenced this information to generate separate layers for nesting sites, genetic stocks, and core distributions of population segments of all marine turtle species. We then spatially integrated this information from fine- to coarse-spatial scales to develop nested envelope models, or Regional Management Units (RMUs), for marine turtles globally. Conclusions/Significance The RMU framework is a solution to the challenge of how to organize marine turtles into units of protection above the level of nesting populations, but below the level of species, within regional entities that might be on independent evolutionary trajectories. Among many potential applications, RMUs provide a framework for identifying data gaps, assessing high diversity areas for multiple species and genetic stocks, and evaluating conservation status of marine turtles. Furthermore, RMUs allow for identification of geographic barriers to gene flow, and can provide valuable guidance to marine spatial planning initiatives that integrate spatial distributions of protected species and human activities. In addition

  1. Sequential hemi-body radiotherapy in advanced multiple myeloma

    International Nuclear Information System (INIS)

    Jaffe, J.P.; Bosch, A.; Raich, P.C.

    1979-01-01

    Eleven patients with advanced multiple myeloma refractory to standard chemotherapy were treated with a regimen of sequential hemi-body radiotherapy consisting of 800 rad midplane in a single dose to each half. 9/10 patients experienced significant relief of skeletal pain and there were 5/11 objective tumor responses with one complete remission. Treatment-related morbidity was significant and consisted primarily of nausea and emesis, bone marrow suppression, and pneumonitis. This therapy is helpful in the management of advanced myeloma, and should be studied earlier in the course of the disease

  2. Multidisciplinary management of multiple maxillary anterior supernumerary teeth: a case report.

    Science.gov (United States)

    Kulkarni, Vinaya Kumar; Reddy, Sampath; Duddu, Mahesh; Reddy, Deepti

    2010-03-01

    Supernumerary teeth are a relatively frequent disorder of odontogenesis. They may occur alone or in multiple; be unilateral or bilateral; and appear in the maxilla, mandible, or both. Mesiodens is a supernumerary tooth in the anterior maxilla between the two central incisors. This case report describes the treatment of maxillary central incisors displaced and impacted because of the presence of four mesiodens in a 12-year-old boy. After clinical and radiographic examination, surgical removal of the mesiodens and exposure of the maxillary right central incisor was performed. This resulted in a 14-mm space between the displaced central incisors. Successively, fixed orthodontic treatment was planned with cephalometric analysis. The central incisors were brought to the occlusal plane and aligned, and the space between the incisors was redistributed. Remaining minor spaces between the incisors were closed with composite resin buildup.

  3. [Management of hepatic injuries with multiple trauma in the emergency unit. Report of three cases].

    Science.gov (United States)

    Qamouss, Y; Belyamani, L; Azendour, H; Balkhi, H; Haimeur, C; Atmani, M

    2006-01-01

    The problems put by the blunt hepatic injuries at the multiple traumas are discussed after the exposition of three observations. 60% of the blunt hepatic injuries are due to the accidents of the public way. The strategy diagnosis and therapeutic facing a hepatic lesion remains guided by the patient's state haemodynamic. The exam essential to the arrival in the sieve of the emergencies is the abdominal scan that searches for one extrusion intra and possibly retroperitoneal and analyze the hepatic parenchyrma. However, it depends extensively on the experience of the echographist. The city scan stood to the first plan of the medical imagery: it permits a precise diagnosis of the parenchymateuses hepatic lesions, specify the abundance of the hemoperitoine, facilitate the therapeutic conduct in presence of associated lesions and the surveillance of the blunt hepatic injuries.

  4. Established role of bisphosphonate therapy for prevention of skeletal complications from myeloma bone disease.

    Science.gov (United States)

    Terpos, Evangelos; Dimopoulos, Meletios A; Berenson, James

    2011-02-01

    Patients with advanced multiple myeloma (MM) often have increased osteolytic activity of osteoclasts and impaired osteogenesis by osteoblasts, resulting in osteolytic bone lesions that increase the risk of skeletal-related events (SREs) including pathologic fracture, the need for radiotherapy or surgery to bone, and spinal cord compression. Such SREs are potentially life-limiting, and can reduce patients' functional independence and quality of life. Bisphosphonates (e.g., oral clodronate and intravenous pamidronate and zoledronic acid) can inhibit osteoclast-mediated osteolysis, thereby reducing the risk of SREs, ameliorating bone pain, and potentially prolonging survival in patients with MM. Extensive clinical experience demonstrates that bisphosphonates are generally well tolerated, and common adverse events are typically mild and manageable. Studies are ongoing to optimize the timing and duration of bisphosphonate therapy in patients with bone lesions from MM. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  5. Seniors managing multiple medications: using mixed methods to view the home care safety lens.

    Science.gov (United States)

    Lang, Ariella; Macdonald, Marilyn; Marck, Patricia; Toon, Lynn; Griffin, Melissa; Easty, Tony; Fraser, Kimberly; MacKinnon, Neil; Mitchell, Jonathan; Lang, Eddy; Goodwin, Sharon

    2015-12-12

    Patient safety is a national and international priority with medication safety earmarked as both a prevalent and high-risk area of concern. To date, medication safety research has focused overwhelmingly on institutional based care provided by paid healthcare professionals, which often has little applicability to the home care setting. This critical gap in our current understanding of medication safety in the home care sector is particularly evident with the elderly who often manage more than one chronic illness and a complex palette of medications, along with other care needs. This study addresses the medication management issues faced by seniors with chronic illnesses, their family, caregivers, and paid providers within Canadian publicly funded home care programs in Alberta (AB), Ontario (ON), Quebec (QC) and Nova Scotia (NS). Informed by a socio-ecological perspective, this study utilized Interpretive Description (ID) methodology and participatory photographic methods to capture and analyze a range of visual and textual data. Three successive phases of data collection and analysis were conducted in a concurrent, iterative fashion in eight urban and/or rural households in each province. A total of 94 participants (i.e., seniors receiving home care services, their family/caregivers, and paid providers) were interviewed individually. In addition, 69 providers took part in focus groups. Analysis was iterative and concurrent with data collection in that each interview was compared with subsequent interviews for converging as well as diverging patterns. Six patterns were identified that provide a rich portrayal of the complexity of medication management safety in home care: vulnerabilities that impact the safe management and storage of medication, sustaining adequate supports, degrees of shared accountability for care, systems of variable effectiveness, poly-literacy required to navigate the system, and systemic challenges to maintaining medication safety in the home

  6. The expected and actual communication of health care workers during the management of intrapartum: An interpretive multiple case study

    Directory of Open Access Journals (Sweden)

    Doreen K.M. M'Rithaa

    2015-12-01

    Full Text Available Background: Daily activities within a health care organisation are mediated by information communication processes (ICP involving multiple health care professionals at different levels of care. Effective perinatal management requires critical information to be accurately communicated. If there is a breakdown in this communication patient safety is at risk for various reasons such as: inadequate critical information, misconception of information and uninformed decisions being made. The purpose of this study was to interpret the complexities around ICP in order to contribute to the effective management of the intrapartum period. Methods: Multi method, multiple case study approach was used to understand the ICP during the management of the intrapartum period. During the study, the expected ICP, the actual ICP, the challenges involved and the desired ICP were analysed. Twenty-four in-depth interviews with skilled birth attendants (SBAs employing observer-as-participant roles, field notes, and document review methods were utilised to gather the data. Thematic analysis was utilised to analyse the data using Atlas TI software. Results: The study revealed three subthemes which emerged from the expected ICP, whilst three others that emerged formed the theme actual ICP. The subthemes from the expected ICP included: accessibility of obstetric services, expected referral, recommended tools, expected communication and expected documentation. The theme actual ICP held threee merging subthemes: the handover processes, collaborative information seeking, information communicated and referral processes. Conclusion: This study showed that what was expected was not what was actually happening. The requirements of the policies and protocols need to be effectively implemented to improve practice building these into current biomedical guidelines.

  7. Managing Bioenergy Production on Arable Field Margins for Multiple Ecosystem Services: Challenges and Opportunities

    Science.gov (United States)

    Ferrarini, Andrea; Serra, Paolo; Amaducci, Stefano; Trevisan, Marco; Puglisi, Edoardo

    2013-04-01

    Growing crops for bioenergy is increasingly viewed as conflicting with food production. However, energy use continues to rise and food production requires fuel inputs, which have increased with intensification. The debate should shift from "food or fuel" to the more challenging target: how the increasing demand for food and energy can be met in the future, particularly when water and land availability will be limited. As for food crops, also for bioenergy crops it is questioned whether it is preferable to manage cultivation to enhance ecosystem services ("land sharing" strategy) or to grow crops with lower ecosystem services but higher yield, thereby requiring less land to meet bioenergy demand ("land sparing" strategy). Energy crop production systems differ greatly in the supply of ecosystem services. The use of perennial biomass (e.g. Switchgrass, Mischantus, Giant reed) for energy production is considered a promising way to reduce net carbon emissions and mitigate climate change. In addition, regulating and supporting ecosystem services could be provided when specific management of bioenergy crops is implemented. The idea of HEDGE-BIOMASS* project is to convert the arable field margins to bioenergy crop production fostering a win-win strategy at landscape level. Main objective of the project is to improve land management to generate environmental benefits and increase farmer income. The various options available in literature for an improved field boundary management are presented. The positive/unknown/negative effects of growing perennial bioenergy crops on field margins will be discussed relatively to the following soil-related ecosystem services: (I) biodiversity conservation and enhancement, (II) soil nutrient cycling, (III) climate regulation (reduction of GHG emissions and soil carbon sequestration/stabilization, (IV) water regulation (filtering and buffering), (V) erosion regulation, (VI) pollination and pest regulation. From the analysis of available

  8. Management Control in Major Brazilian Multiple Banks: the Impact of Internationalization and Convergence of Accounting Standards on the Control Systems

    Directory of Open Access Journals (Sweden)

    João Carlos Damasceno Reis

    2014-08-01

    Full Text Available This study verifies the impact caused by the processes of globalization and convergence to international accounting standards on the managerial control systems of the largest multiple banks that operate in Brazil. The study was exploratory in nature, with the use of the case study method and the application of questionnaires containing mostly open questions to upper tier executives of four major Brazilian banks. The analysis showed that globalization has resulted in improved control systems and widespread use of information technology. It was also found that the convergence to international accounting standards occurred properly, thanks to the steps taken by the Central Bank that aimed at an agile updating of the Brazilian accounting standards laid down for banks operating in Brazil, in line with international standards. In general, the researched banks did not report a significant impact of convergence to the IFRS on their management control systems; adherence to the international accounting standards has had more significant impacts on information systems, especially regarding the new reporting and transparency standards, rather than on management controls. This result signals that the management control systems of the four banks in the sample are in line with Anthony (1965’s vision, that is, that flexibility to adapt to every change in the external environment might actually increase risks of failure.

  9. Flow forecasting scenarios to support multiple-objective management of publicly-owned dams in Quebec

    Energy Technology Data Exchange (ETDEWEB)

    Turcotte, R [Institut National de la Recherche Scientifique, Ste-Foy, PQ (Canada). Centre de l' Energie

    2004-07-01

    This presentation described the application of flow forecasting at the Centre d'Expertise Hydrique du Quebec (CEHQ), an agency that provides expertise in hydrology and hydraulics. CEHQ ensures land management of public water and enforces the Dam Safety Act. It also provides support to municipalities in defining flood-risk areas and effective control of floods. Other responsibilities include the operation of hydrometric stations and 36 publicly-owned dams used for flood control, water supply, recreational activities and hydroelectricity. The role of stream flow forecasting within the decision making process was discussed and operational examples were presented to demonstrate the possibilities of forecast scenarios such as the one in place at the Kenogami River Basin in Quebec. Future challenges lie in improving the way information is communicated and evaluating the probability of occurrences associated with short-term precipitation scenarios to current weather conditions. tabs., figs.

  10. Complexity Management - A multiple case study analysis on control and reduction of complexity costs

    DEFF Research Database (Denmark)

    Myrodia, Anna

    of products, with features more custom-made to cover individual needs, both regarding characteristics of products and support services. This necessity leads to a considerable increase of the complexity in the company, which affects the product portfolio, production and supply chain, market segments......, IT systems, and business processes. In order to identify and eliminate complexity, several approaches are used, both by researchers and practitioners. The purpose of this thesis is to contribute to the existing knowledge of complexity management theory. This research focuses on the relationship between......Complexity tends to be arguably the biggest challenge of manufacturing companies. The motivation of further studying complexity is a combination between the existing literature and the practical experiences from the industry. Based on the latest trend companies are trying to supply a growing mix...

  11. Managing the side effects of multiple sclerosis therapy: pharmacotherapy options for patients.

    Science.gov (United States)

    Rommer, Paulus S; Zettl, Uwe K

    2018-04-01

    Multiple sclerosis (MS) is an immune-mediated and neurodegenerative disease with an unpredictable outcome. Immune-modulatory treatment aims at decreasing long-term disability. With the increasing number of treatment options, it is essential to fully digest the possible side effects of the available therapeutics and to monitor patients is essential. Areas covered: All approved disease-modifying drugs (DMD) for MS are discussed in this review. Mode of action, adverse effects, reported risks for infections and malignancies, and pregnancy related issues are discussed in the review. The authors also provide suggestions for monitoring therapy. For all approved DMDs the pivotal studies have been included for possible side effects, as well as reports by health authorities. For this manuscript, PubMed was checked for reports on side effects for various drugs. Expert opinion: Treatment options in MS are manifold, each carrying different risks. The safety-risk profile for approved agents is favorable. Knowing and monitoring these possible side effects is essential to minimize risks associated with treatment. Presently, the long-term experience for some of these therapies is missing and this must be addressed.

  12. Evaluating Sativex® in Neuropathic Pain Management: A Clinical and Neurophysiological Assessment in Multiple Sclerosis.

    Science.gov (United States)

    Russo, Margherita; Naro, Antonino; Leo, Antonino; Sessa, Edoardo; D'Aleo, Giangaetano; Bramanti, Placido; Calabrò, Rocco Salvatore

    2016-06-01

    The aim of our study was to better investigate the role of Sativex(®) in improving pain in multiple sclerosis (MS) patients by means of either clinical or neurophysiological assessment. Pain is a common symptom of MS, affecting up to 70% of patients. Pain treatment is often unsatisfactory, although emerging drugs (including cannabinoids) are giving encouraging results. Clinical pain assessment in MS is very difficult, and more objective tools are necessary to better quantify this symptom and its potential response to the treatments. We enrolled 20 MS patients (10 with and 10 without neuropathic pain), who underwent a specific clinical (such as visual analog scale) and neurophysiological assessment (by means of laser-evoked potentials and transcranial magnetic stimulation), before and after 4 weeks of Sativex administration. One month of drug administration in MS patients with neuropathic pain successfully reduced pain rating and improved quality of life. Interestingly, such effects were paralleled by an increase of fronto-central γ-band oscillation and of pain-motor integration strength. Our data suggest that Sativex may be effective in improving MS-related neuropathic pain, maybe through its action on specific cortical pathways. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  13. Prenatal diagnosis of fetal skeletal dysplasia with 3D CT

    International Nuclear Information System (INIS)

    Miyazaki, Osamu; Horiuchi, Tetsuya; Nishimura, Gen; Sago, Haruhiko; Hayashi, Satoshi; Kosaki, Rika

    2012-01-01

    Clinical use of 3D CT for fetal skeletal malformations is controversial. The purpose of this study was to evaluate the efficacy of fetal 3D CT using three protocols with different radiation doses and through comparing findings between fetal CT and conventional postnatal radiographic skeletal survey. Seventeen fetuses underwent CT for suspected skeletal dysplasia. A relay of three CT protocols with stepwise dose-reduction were used over the study period. The concordance between the CT diagnosis and the final diagnosis was assessed. Ninety-three radiological findings identifiable on radiographs were compared with CT. Fetal CT provided the correct diagnosis in all 17 fetuses, the detectability rate of cardinal findings was 93.5 %. In 59 % of the fetuses an US-based diagnosis was changed prenatally due to CT findings. The estimated fetal radiation dose in the final protocol was 3.4 mSv (50 %) of the initial protocol, and this dose reduction did not result in degraded image quality. The capability of fetal CT to delineate the skeleton was almost the same as that of postnatal skeletal survey. The perinatal management was altered due to these more specific CT findings, which aided in counseling and in the management of the pregnancy. (orig.)

  14. Prenatal diagnosis of fetal skeletal dysplasia with 3D CT

    Energy Technology Data Exchange (ETDEWEB)

    Miyazaki, Osamu; Horiuchi, Tetsuya [National Center for Child Health and Development, Department of Radiology, Seatagaya-ku, Tokyo (Japan); Nishimura, Gen [Tokyo Metropolitan Children' s Medical Center, Department of Pediatric Imaging, Fuchu-shi, Tokyo (Japan); Sago, Haruhiko; Hayashi, Satoshi [National Center for Child Health and Development, Department of Perinatal Medicine and Maternal Care, Seatagaya-ku, Tokyo (Japan); Kosaki, Rika [National Center for Child Health and Development, Department of Strategic Medicine, Division of Clinical Genetics and Molecular Medicine, Seatagaya-ku, Tokyo (Japan)

    2012-07-15

    Clinical use of 3D CT for fetal skeletal malformations is controversial. The purpose of this study was to evaluate the efficacy of fetal 3D CT using three protocols with different radiation doses and through comparing findings between fetal CT and conventional postnatal radiographic skeletal survey. Seventeen fetuses underwent CT for suspected skeletal dysplasia. A relay of three CT protocols with stepwise dose-reduction were used over the study period. The concordance between the CT diagnosis and the final diagnosis was assessed. Ninety-three radiological findings identifiable on radiographs were compared with CT. Fetal CT provided the correct diagnosis in all 17 fetuses, the detectability rate of cardinal findings was 93.5 %. In 59 % of the fetuses an US-based diagnosis was changed prenatally due to CT findings. The estimated fetal radiation dose in the final protocol was 3.4 mSv (50 %) of the initial protocol, and this dose reduction did not result in degraded image quality. The capability of fetal CT to delineate the skeleton was almost the same as that of postnatal skeletal survey. The perinatal management was altered due to these more specific CT findings, which aided in counseling and in the management of the pregnancy. (orig.)

  15. Skeletal muscle regeneration is modulated by inflammation

    Directory of Open Access Journals (Sweden)

    Wenjun Yang

    2018-04-01

    Full Text Available Skeletal muscle regeneration is a complex process orchestrated by multiple steps. Recent findings indicate that inflammatory responses could play central roles in bridging initial muscle injury responses and timely muscle injury reparation. The various types of immune cells and cytokines have crucial roles in muscle regeneration process. In this review, we briefly summarise the functions of acute inflammation in muscle regeneration. The translational potential of this article: Immune system is closely relevant to the muscle regeneration. Understanding the mechanisms of inflammation in muscle regeneration is therefore critical for the development of effective regenerative, and therapeutic strategies in muscular disorders. This review provides information for muscle regeneration research regarding the effects of inflammation on muscle regeneration. Keywords: Chronic muscle disorders, Cytokines, Immune cells, Inflammation, Muscle regeneration, Muscle stem cells

  16. Skeletal muscle lymphoma: observations at MR imaging

    International Nuclear Information System (INIS)

    Eustace, S.; Winalski, C.S.; McGowen, A.; Lan, H.; Dorfman, D.

    1996-01-01

    We present the MR appearances of three patients with biopsy-proven primary lymphoma of skeletal muscle. In each case lymphoma resulted in bulky expansion of the involved muscle, homogeneously isointense to skeletal muscle on T1-weighted images, homogeneously hyperintense to skeletal muscle on T2-weighted images and diffusely enhancing following intravenous administration of gadopentate dimeglumine. (orig.)

  17. The construction of feelings of justice in environmental management: An empirical study of multiple biodiversity conflicts in Calakmul, Mexico.

    Science.gov (United States)

    Lecuyer, Lou; White, Rehema M; Schmook, Birgit; Lemay, Violaine; Calmé, Sophie

    2018-05-01

    A failure to address social concerns in biodiversity conservation can lead to feelings of injustice among some actors, and hence jeopardize conservation goals. The complex socio-cultural and political context of the Calakmul Biosphere Reserve, Mexico, has historically led to multiple biodiversity conflicts. Our goal, in this case study, was to explore perceptions of justice held by local actors in relation to biodiversity conflicts. We then aimed to determine the following: 1) people's definitions of their feelings of justice; 2) the criteria used in this assessment; 3) variability in the criteria influencing them; and 4) implications for environmental management in the region and beyond. We worked with five focus groups, exploring three examples of biodiversity conflict around forest, water and jaguar management with a total of 41 ranchers, farmers and representatives of local producers. Our results demonstrated that people constructed their feelings of justice around four dimensions of justice: recognition (acknowledging individuals' rights, values, cultures and knowledge systems); ecological (fair and respectful treatment of the natural environment), procedural (fairness in processes of environmental management), distributive (fairness in the distribution of costs and benefits). We identified a list of criteria the participants used in their appraisal of justice and sources of variation such as the social scale of focus and participant role, and whom they perceived to be responsible for resource management. We propose a new framework that conceptualizes justice-as-recognition and ecological justice as forms of conditional justices, and procedural and distributive justices as forms of practical justice. Conditional justice allows us to define who is a legitimate source of justice norms and if nature should be integrated in the scope of justice; hence, conditional justice underpins other dimensions of justice. On the other hand, procedural and distributive address

  18. Magnetic resonance findings in skeletal muscle tears

    International Nuclear Information System (INIS)

    De Smet, A.A.

    1993-01-01

    Magnetic resonance (MR) images of skeletal muscle tears can clearly delineate the severity of muscle injury. Although MR imaging is seldom necessary in patients with acute musle trauma, it can be helpful in deciding on clinical management. The two major MR findings in acute muscle tears are deformity of the muscle and the presence of abnormal signal reflecting hemorrhage and edema. In acute tears, methemoglobin within the extravascular blood causes high-signal areas on both T1- and T2-weighted images. With partial tears, the blood may dissect in a distinctive linear pattern along the muscle bundles and fibers. As healing begins, the muscle signal diminishes, first on the T1-weighted images and then on the T2-weighted images. When there is residual abnormal signal on images obtained more than several months after the injury, it is presumed to represent hemorrhage from recurrent tears. In patients with a questionable history of a remote injury, the clinical presentation may be that of persistent pain or a soft tissue mass. In these cases MR imaging may identify the cause of the pain and can exclude a neoplasm by proving that the mass is a hypertrophied or retracted musle. Thus, MR imaging has a limited, but occasionally important role in selected patients with skeletal muscle tears. (orig.)

  19. Simulating mesoscale coastal evolution for decadal coastal management: A new framework integrating multiple, complementary modelling approaches

    Science.gov (United States)

    van Maanen, Barend; Nicholls, Robert J.; French, Jon R.; Barkwith, Andrew; Bonaldo, Davide; Burningham, Helene; Brad Murray, A.; Payo, Andres; Sutherland, James; Thornhill, Gillian; Townend, Ian H.; van der Wegen, Mick; Walkden, Mike J. A.

    2016-03-01

    Coastal and shoreline management increasingly needs to consider morphological change occurring at decadal to centennial timescales, especially that related to climate change and sea-level rise. This requires the development of morphological models operating at a mesoscale, defined by time and length scales of the order 101 to 102 years and 101 to 102 km. So-called 'reduced complexity' models that represent critical processes at scales not much smaller than the primary scale of interest, and are regulated by capturing the critical feedbacks that govern landform behaviour, are proving effective as a means of exploring emergent coastal behaviour at a landscape scale. Such models tend to be computationally efficient and are thus easily applied within a probabilistic framework. At the same time, reductionist models, built upon a more detailed description of hydrodynamic and sediment transport processes, are capable of application at increasingly broad spatial and temporal scales. More qualitative modelling approaches are also emerging that can guide the development and deployment of quantitative models, and these can be supplemented by varied data-driven modelling approaches that can achieve new explanatory insights from observational datasets. Such disparate approaches have hitherto been pursued largely in isolation by mutually exclusive modelling communities. Brought together, they have the potential to facilitate a step change in our ability to simulate the evolution of coastal morphology at scales that are most relevant to managing erosion and flood risk. Here, we advocate and outline a new integrated modelling framework that deploys coupled mesoscale reduced complexity models, reductionist coastal area models, data-driven approaches, and qualitative conceptual models. Integration of these heterogeneous approaches gives rise to model compositions that can potentially resolve decadal- to centennial-scale behaviour of diverse coupled open coast, estuary and inner

  20. The Use of Digital and Remote Communication Technologies as a Tool for Multiple Sclerosis Management: Narrative Review

    Science.gov (United States)

    Marziniak, Martin; Brichetto, Giampaolo; Feys, Peter; Meyding-Lamadé, Uta; Vernon, Karen

    2018-01-01

    Despite recent advances in multiple sclerosis (MS) care, many patients only infrequently access health care services, or are unable to access them easily, for reasons such as mobility restrictions, travel costs, consultation and treatment time constraints, and a lack of locally available MS expert services. Advances in mobile communications have led to the introduction of electronic health (eHealth) technologies, which are helping to improve both access to and the quality of health care services. As the Internet is now readily accessible through smart mobile devices, most people can take advantage of eHealth apps. The development of digital applications and remote communication technologies for patients with MS has increased rapidly in recent years. These apps are intended to complement traditional in-clinic approaches and can bring significant benefits to both patients with MS and health care providers (HCPs). For patients, such eHealth apps have been shown to improve outcomes and increase access to care, disease information, and support. These apps also help patients to participate actively in self-management, for example, by tracking adherence to treatment, changes in bladder and bowel habits, and activity and mood. For HCPs, MS eHealth solutions can simplify the multidisciplinary approaches needed to tailor MS management strategies to individual patients; facilitate remote monitoring of patient symptoms, adverse events, and outcomes; enable the efficient use of limited resources and clinic time; and potentially allow more timely intervention than is possible with scheduled face-to-face visits. These benefits are important because MS is a long-term, multifaceted chronic condition that requires ongoing monitoring, assessment, and management. We identified in the literature 28 eHealth solutions for patients with MS that fall within the four categories of screening and assessment, disease monitoring and self-management, treatment and rehabilitation, and advice and

  1. The Use of Digital and Remote Communication Technologies as a Tool for Multiple Sclerosis Management: Narrative Review.

    Science.gov (United States)

    Marziniak, Martin; Brichetto, Giampaolo; Feys, Peter; Meyding-Lamadé, Uta; Vernon, Karen; Meuth, Sven G

    2018-04-24

    Despite recent advances in multiple sclerosis (MS) care, many patients only infrequently access health care services, or are unable to access them easily, for reasons such as mobility restrictions, travel costs, consultation and treatment time constraints, and a lack of locally available MS expert services. Advances in mobile communications have led to the introduction of electronic health (eHealth) technologies, which are helping to improve both access to and the quality of health care services. As the Internet is now readily accessible through smart mobile devices, most people can take advantage of eHealth apps. The development of digital applications and remote communication technologies for patients with MS has increased rapidly in recent years. These apps are intended to complement traditional in-clinic approaches and can bring significant benefits to both patients with MS and health care providers (HCPs). For patients, such eHealth apps have been shown to improve outcomes and increase access to care, disease information, and support. These apps also help patients to participate actively in self-management, for example, by tracking adherence to treatment, changes in bladder and bowel habits, and activity and mood. For HCPs, MS eHealth solutions can simplify the multidisciplinary approaches needed to tailor MS management strategies to individual patients; facilitate remote monitoring of patient symptoms, adverse events, and outcomes; enable the efficient use of limited resources and clinic time; and potentially allow more timely intervention than is possible with scheduled face-to-face visits. These benefits are important because MS is a long-term, multifaceted chronic condition that requires ongoing monitoring, assessment, and management. We identified in the literature 28 eHealth solutions for patients with MS that fall within the four categories of screening and assessment, disease monitoring and self-management, treatment and rehabilitation, and advice and

  2. Multiple Carrying Capacities from a management-oriented perspective to operationalize sustainable tourism in protected areas.

    Science.gov (United States)

    Salerno, Franco; Viviano, Gaetano; Manfredi, Emanuela C; Caroli, Paolo; Thakuri, Sudeep; Tartari, Gianni

    2013-10-15

    This article describes how the concept of Tourism Carrying Capacity (TCC) has shifted from a uni-dimensional approach to incorporating environmental, social and political aspects. This shift is demonstrated by a study of a large, internationally popular protected area used by trekkers, the Mt. Everest Region, where qualitative data collected from visitors was combined with environmental modeling using a participatory framework. Tourist satisfaction showed positive margins for further tourist industry expansion, but current environmental conditions limit growth and further development. Space and time dimensions were also considered. We observed that the limits on growth and further development can be manipulated, with a certain degree of flexibility, through investments and regulatory measures. We hypothesized that TCC can play an important role in the management of protected areas only if it is viewed as a systematic, strategic policy tool within a planning process rather than as a unique, intrinsic number that is not modifiable. We conclude that to translate the strategy into action using standard measures, further investigation is needed to balance the various TCC components as a part of a decision-making framework that includes the integration of different cultural approaches and policy needs. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. Acceptance of spent nuclear fuel in multiple element sealed canisters by the Federal Waste Management System

    International Nuclear Information System (INIS)

    1990-03-01

    This report is one of a series of eight prepared by E.R. Johnson Associates, Inc. (JAI) under ORNL's contract with DOE's OCRWM Systems Integration Program and in support of the Annual Capacity Report (ACR) Issue Resolution Process. The report topics relate specifically to the list of high priority technical waste acceptance issues developed jointly by DOE and a utility-working group. JAI performed various analyses and studies on each topic to serve as starting points for further discussion and analysis leading eventually to finalizing the process by which DOE will accept spent fuel and waste into its waste management system. The eight reports are concerned with the conditions under which spent fuel and high level waste will be accepted in the following categories: (1) failed fuel; (2) consolidated fuel and associated structural parts; (3) non-fuel-assembly hardware; (4) fuel in metal storage casks; (5) fuel in multi-element sealed canisters; (6) inspection and testing requirements for wastes; (7) canister criteria; (8) spent fuel selection for delivery; and (9) defense and commercial high-level waste packages. 14 refs., 27 figs

  4. Story of skeletally substituted benzenes

    Indian Academy of Sciences (India)

    Unknown

    values are extensively used to define aromaticity quantitatively.3 In a recent study on ... studies were directed to unravel the subtle ways in which the stability, reactivity, and ..... The singlet–triplet gaps of all the skeletally substituted benzenes ...

  5. Computational modeling as a tool for water resources management: an alternative approach to problems of multiple uses

    Directory of Open Access Journals (Sweden)

    Haydda Manolla Chaves da Hora

    2012-04-01

    Full Text Available Today in Brazil there are many cases of incompatibility regarding use of water and its availability. Due to the increase in required variety and volume, the concept of multiple uses was created, as stated by Pinheiro et al. (2007. The use of the same resource to satisfy different needs with several restrictions (qualitative and quantitative creates conflicts. Aiming to minimize these conflicts, this work was applied to the particular cases of Hydrographic Regions VI and VIII of Rio de Janeiro State, using computational modeling techniques (based on MOHID software – Water Modeling System as a tool for water resources management.

  6. Guidelines for supportive care in multiple myeloma 2011.

    Science.gov (United States)

    Snowden, John A; Ahmedzai, Sam H; Ashcroft, John; D'Sa, Shirley; Littlewood, Timothy; Low, Eric; Lucraft, Helen; Maclean, Rhona; Feyler, Sylvia; Pratt, Guy; Bird, Jennifer M

    2011-07-01

    Supportive care plays an increasingly important role in the modern management of multiple myeloma. While modern treatments have significantly prolonged overall and progression free survival through improved disease control, the vast majority of patients remain incurable, and live with the burden of the disease itself and the cumulative side effects of treatments. Maintenance of quality of life presents challenges at all stages of the disease from diagnosis through the multiple phases of active treatment to the end of life. Written on behalf of the British Committee for Standards in Haematology (BCSH) and the UK Myeloma Forum (UKMF), these evidence based guidelines summarize the current national consensus for supportive and symptomatic care in multiple myeloma in the following areas; pain management, peripheral neuropathy, skeletal complications, infection, anaemia, haemostasis and thrombosis, sedation, fatigue, nausea, vomiting, anorexia, constipation, diarrhoea, mucositis, bisphosphonate-induced osteonecrosis of the jaw, complementary therapies, holistic needs assessment and end of life care. Although most aspects of supportive care can be supervised by haematology teams primarily responsible for patients with multiple myeloma, multidisciplinary collaboration involving specialists in palliative medicine, pain management, radiotherapy and surgical specialities is essential, and guidance is provided for appropriate interdisciplinary referral. These guidelines should be read in conjunction with the BCSH/UKMF Guidelines for the Diagnosis and Management of Multiple Myeloma 2011. © 2011 Blackwell Publishing Ltd.

  7. Application of risk-based multiple criteria decision analysis for selection of the best agricultural scenario for effective watershed management.

    Science.gov (United States)

    Javidi Sabbaghian, Reza; Zarghami, Mahdi; Nejadhashemi, A Pouyan; Sharifi, Mohammad Bagher; Herman, Matthew R; Daneshvar, Fariborz

    2016-03-01

    Effective watershed management requires the evaluation of agricultural best management practice (BMP) scenarios which carefully consider the relevant environmental, economic, and social criteria involved. In the Multiple Criteria Decision-Making (MCDM) process, scenarios are first evaluated and then ranked to determine the most desirable outcome for the particular watershed. The main challenge of this process is the accurate identification of the best solution for the watershed in question, despite the various risk attitudes presented by the associated decision-makers (DMs). This paper introduces a novel approach for implementation of the MCDM process based on a comparative neutral risk/risk-based decision analysis, which results in the selection of the most desirable scenario for use in the entire watershed. At the sub-basin level, each scenario includes multiple BMPs with scores that have been calculated using the criteria derived from two cases of neutral risk and risk-based decision-making. The simple additive weighting (SAW) operator is applied for use in neutral risk decision-making, while the ordered weighted averaging (OWA) and induced OWA (IOWA) operators are effective for risk-based decision-making. At the watershed level, the BMP scores of the sub-basins are aggregated to calculate each scenarios' combined goodness measurements; the most desirable scenario for the entire watershed is then selected based on the combined goodness measurements. Our final results illustrate the type of operator and risk attitudes needed to satisfy the relevant criteria within the number of sub-basins, and how they ultimately affect the final ranking of the given scenarios. The methodology proposed here has been successfully applied to the Honeyoey Creek-Pine Creek watershed in Michigan, USA to evaluate various BMP scenarios and determine the best solution for both the stakeholders and the overall stream health. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Changes in skeletal muscle gene expression following clenbuterol administration

    Directory of Open Access Journals (Sweden)

    McIntyre Lauren M

    2006-12-01

    Full Text Available Abstract Background Beta-adrenergic receptor agonists (BA induce skeletal muscle hypertrophy, yet specific mechanisms that lead to this effect are not well understood. The objective of this research was to identify novel genes and physiological pathways that potentially facilitate BA induced skeletal muscle growth. The Affymetrix platform was utilized to identify gene expression changes in mouse skeletal muscle 24 hours and 10 days after administration of the BA clenbuterol. Results Administration of clenbuterol stimulated anabolic activity, as indicated by decreased blood urea nitrogen (BUN; P P Conclusion Global evaluation of gene expression after administration of clenbuterol identified changes in gene expression and overrepresented functional categories of genes that may regulate BA-induced muscle hypertrophy. Changes in mRNA abundance of multiple genes associated with myogenic differentiation may indicate an important effect of BA on proliferation, differentiation, and/or recruitment of satellite cells into muscle fibers to promote muscle hypertrophy. Increased mRNA abundance of genes involved in the initiation of translation suggests that increased levels of protein synthesis often associated with BA administration may result from a general up-regulation of translational initiators. Additionally, numerous other genes and physiological pathways were identified that will be important targets for further investigations of the hypertrophic effect of BA on skeletal muscle.

  9. Capturing the multiple benefits associated with nature-based solutions: lessons from natural flood management project in the Cotswolds, UK

    Science.gov (United States)

    Short, Chrisopher; Clarke, Lucy; Uttley, Chris; Smith, Brian

    2017-04-01

    co-management and suggest how this type of framework is suitable for a range of nature-based solutions across Europe. However, the challenge remains of capturing the multiple-benefits that such projects offer as these are often missed through conventional approaches such as cost-benefit analysis and some reflections on this will also be presented along with a potential way forward.

  10. Lepidopteran larva consumption of soybean foliage: basis for developing multiple-species economic thresholds for pest management decisions.

    Science.gov (United States)

    Bueno, Regiane Cristina Oliveira de Freitas; Bueno, Adeney de Freitas; Moscardi, Flávio; Parra, José Roberto Postali; Hoffmann-Campo, Clara Beatriz

    2011-02-01

    Defoliation by Anticarsia gemmatalis (Hübner), Pseudoplusia includens (Walker), Spodoptera eridania (Cramer), S. cosmioides (Walker) and S. frugiperda (JE Smith) (Lepidoptera: Noctuidae) was evaluated in four soybean genotypes. A multiple-species economic threshold (ET), based upon the species' feeding capacity, is proposed with the aim of improving growers' management decisions on when to initiate control measures for the species complex. Consumption by A. gemmatalis, S. cosmioides or S. eridania on different genotypes was similar. The highest consumption of P. includens was 92.7 cm(2) on Codetec 219RR; that of S. frugiperda was 118 cm(2) on Codetec 219RR and 115.1 cm(2) on MSoy 8787RR. The insect injury equivalent for S. cosmoides, calculated on the basis of insect consumption, was double the standard consumption by A. gemmatalis, and statistically different from the other species tested, which were similar to each other. As S. cosmioides always defoliated nearly twice the leaf area of the other species, the injury equivalent would be 2 for this lepidopteran species and 1 for the other species. The recommended multiple-species ET to trigger the beginning of insect control would then be 20 insect equivalents per linear metre. Copyright © 2010 Society of Chemical Industry.

  11. Colon Carcinoma with Unusual Metastasis to the Esophagus Manifesting as Multiple Nodules and Dysphagia: Management with Systemic Chemotherapy

    Directory of Open Access Journals (Sweden)

    Pankaj G. Vashi

    2012-07-01

    Full Text Available We present here the rare clinical case of a 44-year-old gentleman with metastasis from colon carcinoma to the esophagus presenting with multiple nodules and dysphagia, which was successfully managed with systemic chemotherapy. The patient presented at our institution with 3-month history of dysphagia almost 4 years after being operated for stage III carcinoma in the sigmoid colon. Endoscopic findings showed multiple nodules at the gastroesophageal junction and mid esophagus. Histological features and immunostains confirmed the diagnosis of metastatic colon carcinoma. Because of evidence of extensive metastatic disease in the spine and liver requiring systemic therapy, the patient was treated with chemotherapy with irinotecan and cetuximab, with subsequent improvement in tumor markers, liver metastasis and symptoms of dysphagia. Even though repeat endoscopy showed no improvement in esophageal nodules, the overall response to chemotherapy was positive. In conclusion, we present a very rare, previously unreported case of metastases from colon cancer to the esophagus presenting as non-obstructive nodules and dysphagia that responded to systemic chemotherapy.

  12. Ensuring comparability of data generated by multiple analytical laboratories for environmental decision making at the Fernald Environmental Management Project

    International Nuclear Information System (INIS)

    Sutton, C.; Campbell, B.A.; Danahy, R.J.; Dugan, T.A.; Tomlinson, F.K.

    1994-01-01

    The Fernald Environmental Management Project is a US Department of Energy (DOE)-owned facility located 17 miles northwest of Cincinnati, Ohio. From 1952 until 1989, the Fernald site provided high-purity uranium metal products to support US defense programs. In 1989 the mission of Fernald changed from one of uranium production to one of environmental restoration. At Fernald, multiple functional programs require analytical data. Inorganic and organic data for these programs are currently generated by seven laboratories, while radiochemical data are being obtained from six laboratories. Quality Assurance (QA) and Quality Control (QC) programs have been established to help ensure comparability of data generated by multiple laboratories at different times. The quality assurance program for organic and inorganic measurements specifies which analytical methodologies and sample preparation procedures are to be used based on analyte class, sample matrix, and data quality requirements. In contrast, performance specifications have been established for radiochemical analyses. A blind performance evaluation program for all laboratories, both on-site and subcontracted commercial laboratories, provides continuous feedback on data quality. The necessity for subcontractor laboratories to participate in the performance evaluation program is a contractual requirement. Similarly, subcontract laboratories are contractually required to generate data which meet radiochemical performance specifications. The Fernald on-site laboratory must also fulfill these requirements

  13. MULTIPLE OBJECTS

    Directory of Open Access Journals (Sweden)

    A. A. Bosov

    2015-04-01

    Full Text Available Purpose. The development of complicated techniques of production and management processes, information systems, computer science, applied objects of systems theory and others requires improvement of mathematical methods, new approaches for researches of application systems. And the variety and diversity of subject systems makes necessary the development of a model that generalizes the classical sets and their development – sets of sets. Multiple objects unlike sets are constructed by multiple structures and represented by the structure and content. The aim of the work is the analysis of multiple structures, generating multiple objects, the further development of operations on these objects in application systems. Methodology. To achieve the objectives of the researches, the structure of multiple objects represents as constructive trio, consisting of media, signatures and axiomatic. Multiple object is determined by the structure and content, as well as represented by hybrid superposition, composed of sets, multi-sets, ordered sets (lists and heterogeneous sets (sequences, corteges. Findings. In this paper we study the properties and characteristics of the components of hybrid multiple objects of complex systems, proposed assessments of their complexity, shown the rules of internal and external operations on objects of implementation. We introduce the relation of arbitrary order over multiple objects, we define the description of functions and display on objects of multiple structures. Originality.In this paper we consider the development of multiple structures, generating multiple objects.Practical value. The transition from the abstract to the subject of multiple structures requires the transformation of the system and multiple objects. Transformation involves three successive stages: specification (binding to the domain, interpretation (multiple sites and particularization (goals. The proposed describe systems approach based on hybrid sets

  14. Standard values of quality and ore mining costs in management of multi-plant mining company

    Energy Technology Data Exchange (ETDEWEB)

    Kudelko, Jan [KGHM CUPRUM Research and Development Center, Wroclaw (Poland); Wirth, Herbert [KGHM Polska Miedz S.A., Lubin (Poland)

    2010-03-15

    Profitability of copper deposit mining depends on three basic variables, electrolytic copper price, manufacturing and selling costs of copper and company property involved in production process. If the company property is adjusted to its tasks then the mining profiability depends on costs of copper mining and selling, because the price is the external variable defined by the market. We can shape the costs in two (complementary) ways, traditionally, reducing the labor, material and power consumption, and by adjusting the quality of mined ore (copper content) to the level required by the current copper prices. Required quality of copper ore in the whole company we determine according to the accepted profitability criteria and then we determine quality standard for individual mines. Algorithms determining the ore quality standard resulting from current market price of copper are presented in the paper. Calculation models for the mined ore quality standards, unit mining costs per one ton of copper, electrolytic copper production and ore output are given. Standards were established for one variable assuming that the other variables are determined in this calculation. Innovative solution, presented in the paper, is the method of decomposition of the company controllable variables into the tasks for individual mines providing reaching the targets to the whole technological circuit. Using the models, having relatively few data, it will be possible to calculate quickly the values which are interesting for managers such as for example the prognosis of rate of return (economic or operational), required copper content in the mined ore for the whole company and individual mines at given rate of return or boundary level of copper content in comparison with cost and production level. Examples of calculation are provided. (orig.)

  15. Human skeletal muscle releases leptin in vivo

    DEFF Research Database (Denmark)

    Wolsk, Emil; Grøndahl, Thomas Sahl; Pedersen, Bente Klarlund

    2012-01-01

    Leptin is considered an adipokine, however, cultured myocytes have also been found to release leptin. Therefore, as proof-of-concept we investigated if human skeletal muscle synthesized leptin by measuring leptin in skeletal muscle biopsies. Following this, we quantified human skeletal muscle...... was unaltered. During saline infusion the adipose tissue release averaged 0.8 ± 0.3 ng min(-1) 100g tissue(-1) whereas skeletal muscle release was 0.5 ± 0.1 ng min(-1) 100g tissue(-1). In young healthy humans, skeletal muscle contribution to whole body leptin production could be substantial given the greater...

  16. State-of-the-Art Management of Complications of Myeloma and Its Treatment

    Directory of Open Access Journals (Sweden)

    Monique A. Hartley-Brown

    2010-01-01

    Full Text Available Multiple myeloma is an incurable disease, although patient survival has increased with the availability of novel agents. Both multiple myeloma and its therapies often affect the renal, immune, skeletal, hematologic, and nervous systems. The resulting organ dysfunctions often impair the quality of life of affected patients, complicate and limit subsequent therapies, and may result in significant mortality. Research on the treatment of complications of multiple myeloma has been limited; hence, preventative and management strategies for patients with these complications are heterogeneous and often based on anecdotal experience. In this paper, we review the effects of myeloma and the novel therapies on organ systems and suggest management strategies.

  17. Future of Management of Multiple Sclerosis in the Middle East: A Consensus View from Specialists in Ten Countries

    Directory of Open Access Journals (Sweden)

    Mohammed Aljumah

    2013-01-01

    Full Text Available The prevalence of multiple sclerosis (MS is now considered to be medium-to-high in the Middle East and is rising, particularly among women. While the characteristics of the disease and the response of patients to disease-modifying therapies are generally comparable between the Middle East and other areas, significant barriers to achieving optimal care for MS exist in these developing nations. A group of physicians involved in the management of MS in ten Middle Eastern countries met to consider the future of MS care in the region, using a structured process to reach a consensus. Six key priorities were identified: early diagnosis and management of MS, the provision of multidisciplinary MS centres, patient engagement and better communication with stakeholders, regulatory body education and reimbursement, a commitment to research, and more therapy options with better benefit-to-risk ratios. The experts distilled these priorities into a single vision statement: “Optimization of patient-centred multidisciplinary strategies to improve the quality of life of people with MS.” These core principles will contribute to the development of a broader consensus on the future of care for MS in the Middle East.

  18. Psychotherapeutic and psychosocial interventions for managing stress in multiple sclerosis: the contribution of mindfulness-based interventions.

    Science.gov (United States)

    Muñoz San José, A; Oreja-Guevara, C; Cebolla Lorenzo, S; Carrillo Notario, L; Rodríguez Vega, B; Bayón Pérez, C

    2016-03-01

    Depression or anxiety in multiple sclerosis (MS) has been linked to a more severe course of the disease and higher numbers of relapses, in addition to poorer treatment adherence and exacerbated immune system dysregulation. Recent investigations indicate that psychotherapeutic interventions for stress management, such as mindfulness-based interventions (MBIs), could improve quality of life, depression, anxiety, and fatigue in MS patients. Mindfulness fosters the ability to slow down and observe experiences as they truly are, which improves affect regulation. Mindfulness is acquired through training; its advantage over other psychotherapeutic interventions is that effects may remain over time, since cultivating mindfulness depends on regular practising of abilities learned during training. The objective of this article is to review the current evidence of psychotherapeutic and psychosocial interventions, including MBIs for stress management, and their beneficial effects on MS patients. Copyright © 2015 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  19. Improving multiple sclerosis management and collecting safety information in the real world: the MSDS3D software approach.

    Science.gov (United States)

    Haase, Rocco; Wunderlich, Maria; Dillenseger, Anja; Kern, Raimar; Akgün, Katja; Ziemssen, Tjalf

    2018-04-01

    For safety evaluation, randomized controlled trials (RCTs) are not fully able to identify rare adverse events. The richest source of safety data lies in the post-marketing phase. Real-world evidence (RWE) and observational studies are becoming increasingly popular because they reflect usefulness of drugs in real life and have the ability to discover uncommon or rare adverse drug reactions. Areas covered: Adding the documentation of psychological symptoms and other medical disciplines, the necessity for a complex documentation becomes apparent. The collection of high-quality data sets in clinical practice requires the use of special documentation software as the quality of data in RWE studies can be an issue in contrast to the data obtained from RCTs. The MSDS3D software combines documentation of patient data with patient management of patients with multiple sclerosis. Following a continuous development over several treatment-specific modules, we improved and expanded the realization of safety management in MSDS3D with regard to the characteristics of different treatments and populations. Expert opinion: eHealth-enhanced post-authorisation safety study may complete the fundamental quest of RWE for individually improved treatment decisions and balanced therapeutic risk assessment. MSDS3D is carefully designed to contribute to every single objective in this process.

  20. Skeletal anteroposterior discrepancy and vertical type effects on lower incisor preoperative decompensation and postoperative compensation in skeletal Class III patients.

    Science.gov (United States)

    Ahn, Hyo-Won; Baek, Seung-Hak

    2011-01-01

    To determine the initial compensation, preoperative decompensation, and postoperative compensation of the lower incisors according to the skeletal anteroposterior discrepancy and vertical type in skeletal Class III patients. The samples consisted of 68 skeletal Class III patients treated with two-jaw surgery and orthodontic treatment. Lateral cephalograms were taken before preoperative orthodontic treatment (T0) and before surgery (T1) and after debonding (T2). According to skeletal anteroposterior discrepancy/vertical type (ANB, criteria  =  -4°; SN-GoMe, criteria  =  35°) at the T0 stage, the samples were allocated into group 1 (severe anteroposterior discrepancy/hypodivergent vertical type, N  =  17), group 2 (moderate anteroposterior discrepancy/hypodivergent vertical type, N  =  17), group 3 (severe anteroposterior discrepancy/hyperdivergent vertical type, N  =  17), or group 4 (moderate anteroposterior discrepancy/hyperdivergent vertical type, N  =  17). After measurement of variables, one-way analysis of variance with Duncan's multiple comparison test, crosstab analysis, and Pearson correlation analysis were performed. At T0, groups 3 and 2 exhibited the most and least compensated lower incisors. In group 2, good preoperative decompensation and considerable postoperative compensation resulted in different values for T0, T1, and T2 (IMPA, T0 lower incisors in Class III patients.

  1. Solitary extra-skeletal sinonasal metastasis from a primary skeletal Ewing's sarcoma.

    Science.gov (United States)

    Hayes, S M; Jani, T N; Rahman, S M; Jogai, S; Harries, P G; Salib, R J

    2011-08-01

    Ewing's sarcoma is a rare, malignant tumour predominantly affecting young adolescent males. We describe a unique case of an isolated extra-skeletal metastasis from a skeletal Ewing's sarcoma primary, arising in the right sinonasal cavity of a young man who presented with severe epistaxis and periorbital cellulitis. Histologically, the lesion comprised closely packed, slightly diffuse, atypical cells with round, hyperchromatic nuclei, scant cytoplasm and occasional mitotic figures, arranged in a sheet-like pattern. Immunohistochemical analysis showed positive staining only for cluster of differentiation 99 glycoprotein. Fluorescent in situ hybridisation identified the Ewing's sarcoma gene, confirming the diagnosis. Complete surgical resection was achieved via a minimally invasive endoscopic transnasal approach; post-operative radiotherapy. Ten months post-operatively, there were no endoscopic or radiological signs of disease. Metastatic Ewing's sarcoma within the head and neck is incredibly rare and can pose significant diagnostic and therapeutic challenges. An awareness of different clinical presentations and distinct histopathological features is important to enable early diagnosis. This case illustrates one potential management strategy, and reinforces the evolving role of endoscopic transnasal approaches in managing sinonasal cavity and anterior skull base tumours.

  2. The diagnosis of skeletal dysplasias: a multidisciplinary approach

    International Nuclear Information System (INIS)

    Mortier, Geert R.

    2001-01-01

    Skeletal dysplasias are heritable connective tissue disorders affecting skeletal morphogenesis and development. They represent a heterogeneous group of genetic disorders with more than 200 different entities being delineated to date. Because of this diversity, the diagnosis of a skeletal dysplasia is usually based on a combination of clinical, radiographic, morphologic, and, in some instances, biochemical and molecular studies. Tremendous advances have been made in the elucidation of the genetic defect of several of these conditions over the past 10 years. This progress has provided us with more insights into the genes controlling normal skeletal development. It also has opened new diagnostic perspectives. For several disorders, identification of the causal gene allows us now to confirm with a molecular test the diagnosis postulated on the basis of clinical, radiographic and/or morphologic studies. It also enables us to establish the diagnosis early in pregnancy. An accurate diagnosis is not only important for proper management of the affected individual but also the cornerstone for adequate genetic counseling

  3. The diagnosis of skeletal dysplasias: a multidisciplinary approach

    Energy Technology Data Exchange (ETDEWEB)

    Mortier, Geert R. E-mail: geert.mortier@rug.ac.be

    2001-12-01

    Skeletal dysplasias are heritable connective tissue disorders affecting skeletal morphogenesis and development. They represent a heterogeneous group of genetic disorders with more than 200 different entities being delineated to date. Because of this diversity, the diagnosis of a skeletal dysplasia is usually based on a combination of clinical, radiographic, morphologic, and, in some instances, biochemical and molecular studies. Tremendous advances have been made in the elucidation of the genetic defect of several of these conditions over the past 10 years. This progress has provided us with more insights into the genes controlling normal skeletal development. It also has opened new diagnostic perspectives. For several disorders, identification of the causal gene allows us now to confirm with a molecular test the diagnosis postulated on the basis of clinical, radiographic and/or morphologic studies. It also enables us to establish the diagnosis early in pregnancy. An accurate diagnosis is not only important for proper management of the affected individual but also the cornerstone for adequate genetic counseling.

  4. Multiple plastic biliary stent placement in the management of large and multiple choledochal stones: single center experience and review of the literature.

    Science.gov (United States)

    Bektaş, Hasan; Gürbulak, Bünyamin; Şahin, Zeynep Deniz; Düzköylü, Yiğit; Çolak, Şükrü; Gürbulak, Esin Kabul; Güneş, Mehmet Emin; Çakar, Ekrem

    2017-09-01

    Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is the first step treatment modality of choledocholithiasis. In spite of an extended sphincterotomy, 10-15% of complex choledochal stones (larger than 15 mm and/or more than 3 stones) cannot be removed and recurrent ERCP procedures may be needed. To evaluate the role and efficiency of multiple biliary stent application in the treatment of large and multiple choledochal stones. Patients with complex choledochal stones and patients with inadequate choledochal clearance during ERCP were included in the study. The study group was divided into 2 groups as the placement of single (n = 27 patients) or multiple stents (n = 58 patients). After a mean time interval of 21 days (10-28), the ERCP procedure was tried for the second time and a stent was placed in case of recurrence. Successful biliary drainage was provided in both groups. The decrease in the longitudinal or transverse size of the stones after stent placement was found to be statistically significant in both groups (p = 0.001). Cholestatic enzymes (alkaline phosphatase (ALP), γ-glutamyltransferase (GGT)) and bilirubin levels decreased significantly in both groups following stenting (p = 0.001). Additionally, multiple stents functioned as a bridge starting from the first ERCP to full clearance in patients with large and multiple stones which could not be removed at once and saved them from the possible morbidities of an invasive operation. Endoscopic multiple biliary stent placement should be preferred in the treatment of patients with complex choledochal stones and high rates of co-morbidity, as a safe alternative to surgery.

  5. The skeletal consequences of thyrotoxicosis.

    Science.gov (United States)

    Nicholls, Jonathan J; Brassill, Mary Jane; Williams, Graham R; Bassett, J H Duncan

    2012-06-01

    Euthyroid status is essential for normal skeletal development and the maintenance of adult bone structure and strength. Established thyrotoxicosis has long been recognised as a cause of high bone turnover osteoporosis and fracture but more recent studies have suggested that subclinical hyperthyroidism and long-term suppressive doses of thyroxine (T4) may also result in decreased bone mineral density (BMD) and an increased risk of fragility fracture, particularly in postmenopausal women. Furthermore, large population studies of euthyroid individuals have demonstrated that a hypothalamic-pituitary-thyroid axis set point at the upper end of the normal reference range is associated with reduced BMD and increased fracture susceptibility. Despite these findings, the cellular and molecular mechanisms of thyroid hormone action in bone remain controversial and incompletely understood. In this review, we discuss the role of thyroid hormones in bone and the skeletal consequences of hyperthyroidism.

  6. Decision making under uncertainty, therapeutic inertia, and physicians' risk preferences in the management of multiple sclerosis (DIScUTIR MS).

    Science.gov (United States)

    Saposnik, Gustavo; Sempere, Angel Perez; Raptis, Roula; Prefasi, Daniel; Selchen, Daniel; Maurino, Jorge

    2016-05-04

    The management of multiple sclerosis (MS) is rapidly changing by the introduction of new and more effective disease-modifying agents. The importance of risk stratification was confirmed by results on disease progression predicted by different risk score systems. Despite these advances, we know very little about medical decisions under uncertainty in the management of MS. The goal of this study is to i) identify whether overconfidence, tolerance to risk/uncertainty, herding influence medical decisions, and ii) to evaluate the frequency of therapeutic inertia (defined as lack of treatment initiation or intensification in patients not at goals of care) and its predisposing factors in the management of MS. This is a prospective study comprising a combination of case-vignettes and surveys and experiments from Neuroeconomics/behavioral economics to identify cognitive distortions associated with medical decisions and therapeutic inertia. Participants include MS fellows and MS experts from across Spain. Each participant will receive an individual link using Qualtrics platform(©) that includes 20 case-vignettes, 3 surveys, and 4 behavioral experiments. The total time for completing the study is approximately 30-35 min. Case vignettes were selected to be representative of common clinical encounters in MS practice. Surveys and experiments include standardized test to measure overconfidence, aversion to risk and ambiguity, herding (following colleague's suggestions even when not supported by the evidence), physicians' reactions to uncertainty, and questions from the Socio-Economic Panel Study (SOEP) related to risk preferences in different domains. By applying three different MS score criteria (modified Rio, EMA, Prosperini's scheme) we take into account physicians' differences in escalating therapy when evaluating medical decisions across case-vignettes. The present study applies an innovative approach by combining tools to assess medical decisions with experiments from

  7. Bone-seeking radiopharmaceuticals in skeletal malignancy: evolution, not revolution

    International Nuclear Information System (INIS)

    MacFarlane, D.

    2003-01-01

    Many advanced malignancies are complicated by skeletal metastases, with attendant pain and disability. External beam radiotherapy is still the most effective treatment for isolated lesions. Bone-seeking radiopharmaceuticals were perceived as a means of delivering radiation to multiple lesions simultaneously. A wide variety of radioisotopes have been used in this endeavor, with myelosuppression being the most significant potential adverse effect. Benefits of treatment are modest, including a transient improvement in pain control and perhaps prolongation of the treatment-free period. This is best demonstrated in prostate cancer with lower responses by skeletal metastases from breast and lung cancers. However, the treatment is yet to produce any improvement in patient survival. Experimental approaches to improve treatment efficacy include combination with cytotoxic therapy, and administration earlier in the course of the disease. Bone seeking radiopharmaceuticals have been used in treatment of advanced osteosarcoma in humans and canines and achieved effective palliation. The myelosuppressive effects of these agents have been exploited in patients with multiple myeloma to assist in attaining myeloablation prior to stem cell transplantation. Development of more potent non-radiolabelled bisphosphonates and recognition of their antitumour effect against several tumours has sparked a recrudescence of interest in their use for bone metastases. Set against these developments, the role of bone-seeking radiopharmaceuticals in skeletal metastases may need to be redefined

  8. Discourse segmentation and the management of multiple tasks in single episodes of air traffic controller-pilot spoken radio communication

    Directory of Open Access Journals (Sweden)

    Paul A. Falzon

    2009-06-01

    Full Text Available Episodes of VHF radio-mediated pilot-controller spoken communication in which multiple tasks are conducted are engendered in and through the skilful deployment and combination, by the parties to the talk, of multiple orders of discourse segmentation. These orders of segmentation are manifest at the levels of transmission design and sequential organisation. Both of these features are analysed from a Conversation Analytic standpoint in order to track their segment by segment genesis, development and completion. From the analysis it emerges that in addition to the serial type of sequential organisations described by Schegloff (1986, there exists an alternative form of organisation that enables tasks to be managed in a quasi-parallel manner, and which affords controllers and pilots a number of practical advantages in the conduct of their radio-mediated service encounters.Cet article présente des extraits d’échanges oraux entre pilots et contrôleurs du ciel via la radio VHF. On peut y voir comment le déploiement et la combinaison habile de plusieurs ordres de segmentation discursive, engageant les deux coénonciateurs de la conversation, leur permet d’accomplir des tâches multiples. Ces ordres de segmentation se manifestent aux niveaux du plan de la transmission et de l’organisation séquentielle. Ces deux niveaux sont envisagées du point de vue de l’analyse conversationnelle dans le but d’examiner, segment après segment, comment ils se mettent en place, se développent puis prennent fin. Notre étude montre que, outre le type sériel d’organisations séquentielles décrit par Schegloff (1986, il existe une forme alternative d’organisation qui permet de gérer les tâches de manière quasi parallèle, et qui fournit aux contrôleurs aériens ainsi qu’aux pilotes de nombreux avantages pratiques dans la conduite de leurs radio.

  9. Vasodilator interactions in skeletal muscle blood flow regulation

    DEFF Research Database (Denmark)

    Hellsten, Ylva; Nyberg, Michael Permin; Jensen, Lasse Gliemann

    2012-01-01

    During exercise, oxygen delivery to skeletal muscle is elevated to meet the increased oxygen demand. The increase in blood flow to skeletal muscle is achieved by vasodilators formed locally in the muscle tissue, either on the intraluminal or the extraluminal side of the blood vessels. A number...... vasodilators are both stimulated by several compounds, eg. adenosine, ATP, acetylcholine, bradykinin, and are affected by mechanically induced signals, such as shear stress. NO and prostacyclin have also been shown to interact in a redundant manner where one system can take over when formation of the other...... is compromised. Although numerous studies have examined the role of single and multiple pharmacological inhibition of different vasodilator systems, and important vasodilators and interactions have been identified, a large part of the exercise hyperemic response remains unexplained. It is plausible...

  10. Insights into skeletal muscle development and applications in regenerative medicine.

    Science.gov (United States)

    Tran, T; Andersen, R; Sherman, S P; Pyle, A D

    2013-01-01

    Embryonic and postnatal development of skeletal muscle entails highly regulated processes whose complexity continues to be deconstructed. One key stage of development is the satellite cell, whose niche is composed of multiple cell types that eventually contribute to terminally differentiated myotubes. Understanding these developmental processes will ultimately facilitate treatments of myopathies such as Duchenne muscular dystrophy (DMD), a disease characterized by compromised cell membrane structure, resulting in severe muscle wasting. One theoretical approach is to use pluripotent stem cells in a therapeutic setting to help replace degenerated muscle tissue. This chapter discusses key myogenic developmental stages and their regulatory pathways; artificial myogenic induction in pluripotent stem cells; advantages and disadvantages of DMD animal models; and therapeutic approaches targeting DMD. Furthermore, skeletal muscle serves as an excellent paradigm for understanding general cell fate decisions throughout development. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. Managing Multiple Risk Factors

    National Research Council Canada - National Science Library

    Lollis, Charlie

    1998-01-01

    ...) contribute to the racial differences in cardiovascular risk and events among women. High levels of socioeconomic stress, higher dietary fat intake and sedentary lifestyle are more prevalent among black than white women...

  12. Congenital anomalies and normal skeletal variants

    International Nuclear Information System (INIS)

    Guebert, G.M.; Yochum, T.R.; Rowe, L.J.

    1987-01-01

    Congenital anomalies and normal skeletal variants are a common occurrence in clinical practice. In this chapter a large number of skeletal anomalies of the spine and pelvis are reviewed. Some of the more common skeletal anomalies of the extremities are also presented. The second section of this chapter deals with normal skeletal variants. Some of these variants may simulate certain disease processes. In some instances there are no clear-cut distinctions between skeletal variants and anomalies; therefore, there may be some overlap of material. The congenital anomalies are presented initially with accompanying text, photos, and references, beginning with the skull and proceeding caudally through the spine to then include the pelvis and extremities. The normal skeletal variants section is presented in an anatomical atlas format without text or references

  13. AMPK in skeletal muscle function and metabolism

    DEFF Research Database (Denmark)

    Kjøbsted, Rasmus; Hingst, Janne Rasmuss; Fentz, Joachim

    2018-01-01

    Skeletal muscle possesses a remarkable ability to adapt to various physiologic conditions. AMPK is a sensor of intracellular energy status that maintains energy stores by fine-tuning anabolic and catabolic pathways. AMPK's role as an energy sensor is particularly critical in tissues displaying...... highly changeable energy turnover. Due to the drastic changes in energy demand that occur between the resting and exercising state, skeletal muscle is one such tissue. Here, we review the complex regulation of AMPK in skeletal muscle and its consequences on metabolism (e.g., substrate uptake, oxidation......, and storage as well as mitochondrial function of skeletal muscle fibers). We focus on the role of AMPK in skeletal muscle during exercise and in exercise recovery. We also address adaptations to exercise training, including skeletal muscle plasticity, highlighting novel concepts and future perspectives...

  14. The exercised skeletal muscle: a review

    Directory of Open Access Journals (Sweden)

    Marina Marini

    2010-09-01

    Full Text Available The skeletal muscle is the second more plastic tissue of the body - second to the nervous tissue only. In fact, both physical activity and inactivity contribute to modify the skeletal muscle, by continuous signaling through nerve impulses, mechanical stimuli and humoral clues. In turn, the skeletal muscle sends signals to the body, thus contributing to its homeostasis. We'll review here the contribute of physical exercise to the shaping of skeletal muscle, to the adaptation of its mass and function to the different needs imposed by different physical activities and to the attainment of the health benefits associated with active skeletal muscles. Focus will primarily be on the molecular pathways and on gene regulation that result in skeletal muscle adaptation to exercise.

  15. Development and external validation of nomograms to predict the risk of skeletal metastasis at the time of diagnosis and skeletal metastasis-free survival in nasopharyngeal carcinoma.

    Science.gov (United States)

    Yang, Lin; Xia, Liangping; Wang, Yan; He, Shasha; Chen, Haiyang; Liang, Shaobo; Peng, Peijian; Hong, Shaodong; Chen, Yong

    2017-09-06

    The skeletal system is the most common site of distant metastasis in nasopharyngeal carcinoma (NPC); various prognostic factors have been reported for skeletal metastasis, though most studies have focused on a single factor. We aimed to establish nomograms to effectively predict skeletal metastasis at initial diagnosis (SMAD) and skeletal metastasis-free survival (SMFS) in NPC. A total of 2685 patients with NPC who received bone scintigraphy (BS) and/or 18F-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and 2496 patients without skeletal metastasis were retrospectively assessed to develop individual nomograms for SMAD and SMFS. The models were validated externally using separate cohorts of 1329 and 1231 patients treated at two other institutions. Five independent prognostic factors were included in each nomogram. The SMAD nomogram had a significantly higher c-index than the TNM staging system (training cohort, P = 0.005; validation cohort, P system (P skeletal metastasis, which may improve counseling and facilitate individualized management of patients with NPC.

  16. E-SCM AND INVENTORY MANAGEMENT: A STUDY OF MULTIPLE CASES IN A SEGMENT OF THE DEPARTMENT STORE CHAIN

    Directory of Open Access Journals (Sweden)

    Juliana Chiaretti Novi

    2011-08-01

    Full Text Available Inventory management through the supply chains is a theme that has always enticed managers throughout the world. Due to the increase in market competitiveness and complexity, the traditional statistical models of forecasting demand, based on time series, no longer met the needs imposed on businesses to maintain adequate levels of their inventory and supply interruptions. With the intent to meet these market demands, ERP systems appeared in the 1990’s. Nevertheless, even if allowing for a more adequate level of inventory and supply interruptions achieved mainly by the optimization of internal processes and the reduction in lead time, ERP systems did not contribute to reach the SCM’s desired levels of inventory that were aimed at by the more competitive businesses. This is because ERP limits itself to an internal analysis of the business. By contrast, inventory management depends on the consumption information (which is external to the business. Aiming to improve even further the level of services delivered to the end consumer, new solutions have been developed, among them the e- SCM, which, since it makes consumption information available in real time, ends up being more dynamic and efficient than the traditional demand forecasting models, Therefore, the present study aims to analyze how the e-SCM can collaborate in maintaining adequate levels of inventory and interruptions in the supply chains. The hypothesis made is that the traditional statistical forecasting models, based on time series and isolatedly, are no longer adequate to adjust the demand, as the tools based on these models do not update the demand in real time and this is fundamental in the current business dynamics. The research method used was the study of multiple cases in a segment of a chain involving a large retailer, its Distribution Center and a supplier of home appliances. For the analysis of the data, the content analysis technique was used. As main results, it was

  17. Managing multiple diffuse pressures on water quality and ecological habitat: Spatially targeting effective mitigation actions at the landscape scale.

    Science.gov (United States)

    Joyce, Hannah; Reaney, Sim

    2015-04-01

    than absolute sense at the landscape scale. Riparian woodland planting is proposed as one mitigation action to address these pressures. This planting disconnects the transfer of material from the landscape to the river channel by promoting increased infiltration and also provides river shading and hence decreases the rate of water heating. To identify the optimal locations for riparian woodland planting, a Monte Carlo based approach was used to identify multiple mitigation options and their influence on the pressures identified. These results were integrated into a decision support tool, which allows the user to explore the implications of individual and a set of pressures. This is achieved by allowing the user to change the importance of different pressures to identify the optimal locations for a custom combination of pressures. For example, reductions in flood risk can be prioritized over reductions in fine sediment. This approach provides an innovative way of identifying and targeting multiple diffuse pressures at the catchment scale simultaneously, which has presented a challenge in previous management efforts. The approach has been tested in the River Ribble Catchment, North West England.

  18. The Part-Time Student Role: Implications for the Emotional Experience of Managing Multiple Roles amongst Hong Kong Public Health Nurses.

    Science.gov (United States)

    Shiu, Ann Tak-Ying

    1999-01-01

    Nine public-health nurses studying part time and 11 other nurses sampled their mood states randomly over seven days. The part-time student role created additional strain for nurses with children. The stress of managing multiple roles was greatest when both work and nonwork role responsibilities were heavy. (SK)

  19. The Health Action Process Approach as a Motivational Model of Dietary Self-Management for People with Multiple Sclerosis: A Path Analysis

    Science.gov (United States)

    Chiu, Chung-Yi; Lynch, Ruth Torkelson; Chan, Fong; Rose, Lindsey

    2012-01-01

    The main objective of this study was to evaluate the health action process approach (HAPA) as a motivational model for dietary self-management for people with multiple sclerosis (MS). Quantitative descriptive research design using path analysis was used. Participants were 209 individuals with MS recruited from the National MS Society and a…

  20. The influence of multiple ownership interests and decision-making networks on the management of family forest lands: evidence from the United States

    Science.gov (United States)

    Stephanie A. Snyder; Michael A. Kilgore

    2018-01-01

    A national assessment of how the number of parcel owners influence family forest land management and use decisions in the US was conducted using a subset of the US Forest Service's National Woodland Owner Survey Dataset. Seventy-two percent of single parcel family forest land ownership respondents of at least 4.05 ha had multiple owners. The extent to which past...

  1. Pelvic radiograph in skeletal dysplasias: An approach

    Directory of Open Access Journals (Sweden)

    Manisha Jana

    2017-01-01

    Full Text Available The bony pelvis is constituted by the ilium, ischium, pubis, and sacrum. The pelvic radiograph is an important component of the skeletal survey performed in suspected skeletal dysplasia. Most of the common skeletal dysplasias have either minor or major radiological abnormalities; hence, knowledge of the normal radiological appearance of bony pelvis is vital for recognizing the early signs of various skeletal dysplasias. This article discusses many common and some uncommon radiological findings on pelvic radiographs along with the specific dysplasia in which they are seen; common differential diagnostic considerations are also discussed.

  2. Skeletal muscle and fetal alcohol spectrum disorder.

    Science.gov (United States)

    Myrie, Semone B; Pinder, Mark A

    2018-04-01

    Skeletal muscle is critical for mobility and many metabolic functions integral to survival and long-term health. Alcohol can affect skeletal muscle physiology and metabolism, which will have immediate and long-term consequences on health. While skeletal muscle abnormalities, including morphological, biochemical, and functional impairments, are well-documented in adults that excessively consume alcohol, there is a scarcity of information about the skeletal muscle in the offspring prenatally exposed to alcohol ("prenatal alcohol exposure"; PAE). This minireview examines the available studies addressing skeletal muscle abnormalities due to PAE. Growth restriction, fetal alcohol myopathy, and abnormalities in the neuromuscular system, which contribute to deficits in locomotion, are some direct, immediate consequences of PAE on skeletal muscle morphology and function. Long-term health consequences of PAE-related skeletal abnormalities include impaired glucose metabolism in the skeletal muscle, resulting in glucose intolerance and insulin resistance, leading to an increased risk of type 2 diabetes. In general, there is limited information on the morphological, biochemical, and functional features of skeletal abnormalities in PAE offspring. There is a need to understand how PAE affects muscle growth and function at the cellular level during early development to improve the immediate and long-term health of offspring suffering from PAE.

  3. Skeletal stem cells and their contribution to skeletal fragility

    DEFF Research Database (Denmark)

    Aldahmash, A.

    2016-01-01

    Age-related osteoporotic fractures are major health care problem worldwide and are the result of impaired bone formation, decreased bone mass and bone fragility. Bone formation is accomplished by skeletal stem cells (SSC) that are recruited to bone surfaces from bone marrow microenvironment....... This review discusses targeting SSC to enhance bone formation and to abolish age-related bone fragility in the context of using stem cells for treatment of age-related disorders. Recent studies are presented that have demonstrated that SSC exhibit impaired functions during aging due to intrinsic senescence...

  4. Skeletal Dysplasias Associated with Mild Myopathy—A Clinical and Molecular Review

    Directory of Open Access Journals (Sweden)

    Katarzyna A. Piróg

    2010-01-01

    Full Text Available Musculoskeletal system is a complex assembly of tissues which acts as scaffold for the body and enables locomotion. It is often overlooked that different components of this system may biomechanically interact and affect each other. Skeletal dysplasias are diseases predominantly affecting the development of the osseous skeleton. However, in some cases skeletal dysplasia patients are referred to neuromuscular clinics prior to the correct skeletal diagnosis. The muscular complications seen in these cases are usually mild and may stem directly from the muscle defect and/or from the altered interactions between the individual components of the musculoskeletal system. A correct early diagnosis may enable better management of the patients and a better quality of life. This paper attempts to summarise the different components of the musculoskeletal system which are affected in skeletal dysplasias and lists several interesting examples of such diseases in order to enable better understanding of the complexity of human musculoskeletal system.

  5. Unusual skeletal metastases from myxoid liposarcoma only detectable by MR imaging

    International Nuclear Information System (INIS)

    Ishii, T.; Ueda, T.; Myoui, A.; Tamai, N.; Hosono, N.; Yoshikawa, H.

    2003-01-01

    We present two cases of skeletal metastases from myxoid liposarcoma, occurring several years after treatment of the primary tumors in the lower limb. The present two case reports have unusual radiological features only detectable by MR imaging and not by plain radiographs or bone scans. From the present two cases, we found that a negative plain radiograph of the spine or a negative bone scan could not exclude skeletal metastases from myxoid liposarcoma, and MRI was a more sensitive screening procedure for their detection, especially in T1-weighted images. Unusual radiological features of skeletal metastases from myxoid liposarcoma are not well documented and only a few cases have been previously reported. Our aim is to document two more patients exhibiting the unusual radiological features of skeletal metastases from myxoid liposarcoma to improve their early detection and management. (orig.)

  6. Radiation injury to skeletal muscle

    International Nuclear Information System (INIS)

    Persons, C.C.M.; Wondergem, J.; Leer, J.W.H.

    1997-01-01

    Radiotherapy of neoplasia has increased the mean life expectancy of cancer patients. On the other hand, more reports are published on morbidity of the treatment with regard to normal tissue. Studies on skeletal muscle injury specifically are scarce, but many clinical long term follow-up studies make note of side effects as muscle atrophy, fibrosis and limited function. Furthermore it is suggested that skeletal muscles of children are more prone to radiation injury than those of adult subjects. Effects of radiation on skeletal muscle were studied in rats. On hind limb of young (100 g) and adult (350 g) rats was irradiated with single doses (15-30 Gy), while the other served as control. Follow-up was up to 12 months post treatment. Muscular function in young rats was decreased significantly at 6 months post irradiation, but did not further decrease in the following 6 months. The amount of collagen, on the other hand, was not increased at 6 months, but became highly elevated at 12 months past treatment. This suggests that at 6 months, impaired muscular function may not be explained by increased fibrotic tissues. This is an agreement with results obtained in adult rats, where function was also impaired, without concomitant increase in collagen. In an earlier study, mitochondrial oxygen consumption was dose dependently decreased after irradiation, at 12 months, but not at 6 months post treatment. Furthermore, myosin-actin interaction was measured in skinned fibers. The first results of this study indicate changes in the interaction of contraction proteins, as early as 6 months post treatment. (authors)

  7. Comparative Study of Skeletal Stability between Postoperative Skeletal Intermaxillary Fixation and No Skeletal Fixation after Bilateral Sagittal Split Ramus Osteotomy

    DEFF Research Database (Denmark)

    Hartlev, Jens; Godtfredsen, Erik; Andersen, Niels Trolle

    2014-01-01

    OBJECTIVES: The purpose of the present study was to evaluate skeletal stability after mandibular advancement with bilateral sagittal split osteotomy. MATERIAL AND METHODS: Twenty-six patients underwent single-jaw bilateral sagittal split osteotomy (BSSO) to correct skeletal Class II malocclusion....

  8. Diagnostic imaging of skeletal metastases

    International Nuclear Information System (INIS)

    Scutellari, P. N.; Addonisio, G.; Righi, R.; Giganti, M.

    2000-01-01

    Purpose of this article is to present an algorithm for detection and diagnosis of skeletal metastases, which may be applied differently in symptomatic and asymptomatic cancer patients. February to March 1999 it was randomly selected and retrospectively reviewed the clinical charts of 100 cancer patients (70 women and 30 men; mean age: 63 years, range: 55-87). All the patients had been staged according to TNM criteria and had undergone conventional radiography and bone scan; when findings were equivocal, CT and MRI had been performed too. The primary lesions responsible for bone metastases were sited in the: breast (51 cases), colon (30 cases: 17 men and 13 women), lung (7 cases: 6 men and 1 woman), stomach (4 cases: 2 men and 2 women), skin (4 cases: 3 men and 1 woman), kidney (2 men), pleura (1 woman), and finally liver (1 man). The most frequent radiographic pattern was the lytic type (52%), followed by osteosclerotic, mixed, lytic vs mixed and osteosclerotic vs lytic patterns. The patients were divided into two groups: group A patients were asymptomatic and group B patients had local symptoms and/or pain. Skeletal metastases are the most common malignant bone tumors: the spine and the pelvis are the most frequent sites of metastasis, because of the presence of high amounts of red (hematopoietic active) bone marrow. Pain is the main symptom, even though many bone metastases are asymptomatic. Pathological fractures are the most severe consequences. With the algorithm for detection and diagnosis of skeletal metastases two different diagnostic courses are available for asymptomatic and symptomatic patients. Bone scintigraphy remains the technique of choice in asymptomatic patients in whom skeletal metastases are suspected. However this technique, though very sensitive, is poorly specific, and thus a negative bone scan finding is double-checked with another physical examination: if the findings remain negative, the diagnostic workup is over. On the contrary, in

  9. Computational radiology in skeletal radiography

    International Nuclear Information System (INIS)

    Peloschek, Ph.; Nemec, S.; Widhalm, P.; Donner, R.; Birngruber, E.; Thodberg, H.H.; Kainberger, F.; Langs, G.

    2009-01-01

    Recent years have brought rapid developments in computational image analysis in musculo-skeletal radiology. Meanwhile the algorithms have reached a maturity that makes initial clinical use feasible. Applications range from joint space measurement to erosion quantification, and from fracture detection to the assessment of alignment angles. Current results of computational image analysis in radiography are very promising, but some fundamental issues remain to be clarified, among which the definition of the optimal trade off between automatization and operator-dependency, the integration of these tools into clinical work flow and last not least the proof of incremental clinical benefit of these methods.

  10. The Efficacy of Psychological Interventions for Managing Fatigue in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Aung Zaw Zaw Phyo

    2018-04-01

    Full Text Available BackgroundMultiple sclerosis (MS is a complex, demyelinating disease of the central nervous system. Fatigue is commonly reported by people with MS (PwMS. MS-related fatigue severely affects daily activities, employment, socioeconomic status, and quality of life.ObjectiveWe conducted this systematic review and meta-analysis to determine whether psychological interventions are effective in managing fatigue in PwMS.Data sourcesWe performed systematic searches of Medline, EMBASE, PsycINFO, and CINAHL to identify relevant articles published from database inception to April 5, 2017. Reference lists from relevant reviews were also searched.Study selection and designTwo independent reviewers screened the papers, extracted data, and appraised the included studies. A clinical psychologist verified whether interventions were psychological approaches. A narrative synthesis was conducted for all included studies. For relevant randomized controlled trials that reported sufficient information to determine standardized mean differences (SMDs and 95% confidence intervals (CIs, meta-analyses were conducted using a random-effects model.ResultsOf the 353 identified articles, 20 studies with 1,249 PwMS were included in this systematic review. Narrative synthesis revealed that psychological interventions reduced fatigue in PwMS. Meta-analyses revealed that cognitive behavioral therapy decreased levels of fatigue compared with non-active controls (SMD = −0.32; 95% CI: −0.63 to −0.01 and compared with active controls (relaxation or psychotherapy (SMD = −0.71; 95% CI: −1.05 to −0.37. Meta-analyses further showed that both relaxation (SMD = −0.90; 95% CI: −1.30 to −0.51, and mindfulness interventions (SMD = −0.62; 95% CI: −1.12 to −0.12, compared with non-active control, decreased fatigue levels. The estimates of heterogeneity for the four meta-analyses varied between none and moderate.ConclusionThis study found that the use of

  11. Expression of Gla proteins during fish skeletal development

    OpenAIRE

    Gavaia, Paulo J.

    2006-01-01

    Senegal sole skeletal development; Skeletal malformations; Skeletal malformation in mediterranean species; Senegal sole skeletal deformities; Zebra fish as model system: skeletal development; Identification of bone cells / skeletal development; Spatial - temporal pattern of bgp expression; Single cell resolution: localization of bgp mRNA; Single cell resolution: Immunolocalization of Bgp; Single cell resolution: localization of mgp mRNA; Single cell resolution: Immunolocalization of Mgp; An i...

  12. Thermal management of a multiple mini-channel heat sink by the integration of a thermal responsive shape memory material

    International Nuclear Information System (INIS)

    Di Maio, E.; Mastrullo, R.; Mauro, A.W.; Toto, D.

    2014-01-01

    In this paper, a novel application of a thermo-responsive shape memory polymer (SMP) is proposed to smart-control the forced flow of water in a multi mini-channel heat sink. In particular, it is reported that millimeter-sized cylinders made of SMP could be used to smartly obstruct the fluid flow by adapting the flow cross section to the heat load to be removed. By integrating the sensing, the control and the actuation functions within a unique, millimeter-sized device, these micro-valves, unlike the traditional actuators normally used for flow control, could be easily embedded into small heat sinks, with significant space and energy saving, useful, in particular, in systems where several miniaturized components have to be cooled concurrently, such as the modern mainframes or the concentrated photovoltaic solar cells. Two possible configurations for the SMP were considered in this study: an “open” configuration, without any obstruction of the water flow free and an “obstructed” configuration, with the millimeter-sized cylinder partially occupying the mini-channel. A numerical, steady state analysis was carried out with water in single-phase forced convection, to determine the effect of these two states on the internal fluid flow characteristics under different conditions of heat flux and pressure drop and to evaluate the overall thermal behavior of the smart-controlled multiple mini-channel heat sink in terms of ability to control the temperature of the system and to reduce the energy consumption. -- Highlights: • A novel application of a SMP material is investigated for the thermal management of a heat sink. • Numerical simulations to find the matching of the heat sink and material system after regulation were carried out. • The investigated system is able to control the heat sink temperature. • Further analysis for system stability are required

  13. Adipocyte-myocyte crosstalk in skeletal muscle insulin resistance; is there a role for thyroid hormone?

    Science.gov (United States)

    Havekes, Bas; Sauerwein, Hans P

    2010-11-01

    To review original research studies and reviews that present data on adipocyte-myocyte crosstalk in the development of skeletal muscle insulin resistance with a specific focus on thyroid hormone. Adipose tissue communicates with skeletal muscle not only through free fatty acids but also through secretion of various products called adipokines. Adipokines came out as governors of insulin sensitivity and are deregulated in obesity. In addition to well known leptin, adiponectin, interleukin-6 and tumor necrosis factor-alpha, newer adipokines like retinol-binding protein 4 have been associated with insulin resistance. There is mounting evidence that not only adipose tissue but also skeletal muscle produces and secretes biologically active proteins or 'myokines' that facilitate metabolic crosstalk between organ systems. In recent years, increased expression of myostatin, a secreted anabolic inhibitor of muscle growth and development, has been associated with obesity and insulin resistance. Both hypothyroidism and hyperthyroidism affect insulin sensitivity in multiple ways that might overlap adipocyte-myocyte crosstalk. Recent studies have provided new insights in effects of processing of the parent hormone T4 to the active T3 at the level of the skeletal muscle. Adipocyte-myocyte crosstalk is an important modulator in the development of skeletal muscle insulin resistance. Thyroid disorders are very common and may have detrimental effects on skeletal muscle insulin resistance, potentially by interacting with adipocyte-myocyte crosstalk.

  14. Mechanical modeling of skeletal muscle functioning

    NARCIS (Netherlands)

    van der Linden, B.J.J.J.

    1998-01-01

    For movement of body or body segments is combined effort needed of the central nervous system and the muscular-skeletal system. This thesis deals with the mechanical functioning of skeletal muscle. That muscles come in a large variety of geometries, suggest the existence of a relation between muscle

  15. Skeletal stem cells in space and time

    DEFF Research Database (Denmark)

    Kassem, Moustapha; Bianco, Paolo

    2015-01-01

    The nature, biological characteristics, and contribution to organ physiology of skeletal stem cells are not completely determined. Chan et al. and Worthley et al. demonstrate that a stem cell for skeletal tissues, and a system of more restricted, downstream progenitors, can be identified in mice...

  16. Patient-provider relationship as mediator between adult attachment and self-management in primary care patients with multiple chronic conditions.

    Science.gov (United States)

    Brenk-Franz, Katja; Strauß, Bernhard; Tiesler, Fabian; Fleischhauer, Christian; Schneider, Nico; Gensichen, Jochen

    2017-06-01

    The conceptual model of attachment theory has been applied to understand the predispositions of patients in medical care and the patient-provider relationship. In patients with chronic conditions insecure attachment was connected to poorer self-management. The patient-provider relationship is associated with a range of health related outcomes and self-management skills. We determined whether the quality of the patient-provider relationship mediates the link between adult attachment and self-management among primary care patients with multiple chronic diseases. 209 patients with a minimum of three chronic diseases (including type II diabetes, hypertension and at least one other chronic condition) between the ages of 50 and 85 from eight general practices were included in the APRICARE cohort study. Adult attachment was measured via self-report (ECR-RD), self-management skills by the FERUS and the patient-provider relationship by the PRA-D. The health status and chronicity were assessed by the GP. Multiple mediation analyses were used to examine whether aspects of the patient-provider relationship (communication, information, affectivity) are a mediators of associations between adult attachment and self-management. The analysis revealed that the quality of the patient-provider relationship mediated the effect of attachment on self-management in patients with multiple chronic conditions. Particularly the quality of communication and information over the course of treatment has a significant mediating influence. A personalized, attachment-related approach that promotes active patient-provider communication and gives information about the treatment to the patient may improve self-management skills in patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Immunology Guides Skeletal Muscle Regeneration

    Directory of Open Access Journals (Sweden)

    F. Andrea Sass

    2018-03-01

    Full Text Available Soft tissue trauma of skeletal muscle is one of the most common side effects in surgery. Muscle injuries are not only caused by accident-related injuries but can also be of an iatrogenic nature as they occur during surgical interventions when the anatomical region of interest is exposed. If the extent of trauma surpasses the intrinsic regenerative capacities, signs of fatty degeneration and formation of fibrotic scar tissue can occur, and, consequentially, muscle function deteriorates or is diminished. Despite research efforts to investigate the physiological healing cascade following trauma, our understanding of the early onset of healing and how it potentially determines success or failure is still only fragmentary. This review focuses on the initial physiological pathways following skeletal muscle trauma in comparison to bone and tendon trauma and what conclusions can be drawn from new scientific insights for the development of novel therapeutic strategies. Strategies to support regeneration of muscle tissue after injury are scarce, even though muscle trauma has a high incidence. Based on tissue specific differences, possible clinical treatment options such as local immune-modulatory and cell therapeutic approaches are suggested that aim to support the endogenous regenerative potential of injured muscle tissues.

  18. The Skeletal Muscle Satellite Cell

    Science.gov (United States)

    2011-01-01

    The skeletal muscle satellite cell was first described and named based on its anatomic location between the myofiber plasma and basement membranes. In 1961, two independent studies by Alexander Mauro and Bernard Katz provided the first electron microscopic descriptions of satellite cells in frog and rat muscles. These cells were soon detected in other vertebrates and acquired candidacy as the source of myogenic cells needed for myofiber growth and repair throughout life. Cultures of isolated myofibers and, subsequently, transplantation of single myofibers demonstrated that satellite cells were myogenic progenitors. More recently, satellite cells were redefined as myogenic stem cells given their ability to self-renew in addition to producing differentiated progeny. Identification of distinctively expressed molecular markers, in particular Pax7, has facilitated detection of satellite cells using light microscopy. Notwithstanding the remarkable progress made since the discovery of satellite cells, researchers have looked for alternative cells with myogenic capacity that can potentially be used for whole body cell-based therapy of skeletal muscle. Yet, new studies show that inducible ablation of satellite cells in adult muscle impairs myofiber regeneration. Thus, on the 50th anniversary since its discovery, the satellite cell’s indispensable role in muscle repair has been reaffirmed. PMID:22147605

  19. A comprehensive grid to evaluate case management's expected effectiveness for community-dwelling frail older people: results from a multiple, embedded case study.

    Science.gov (United States)

    Van Durme, Thérèse; Schmitz, Olivier; Cès, Sophie; Anthierens, Sibyl; Maggi, Patrick; Delye, Sam; De Almeida Mello, Johanna; Declercq, Anja; Macq, Jean; Remmen, Roy; Aujoulat, Isabelle

    2015-06-18

    Case management is a type of intervention expected to improve the quality of care and therefore the quality of life of frail, community-dwelling older people while delaying institutionalisation in nursing homes. However, the heterogeneity, multidimensionality and complexity of these interventions make their evaluation by the means of classical approaches inadequate. Our objective was twofold: (i) to propose a tool allowing for the identification of the key components that explain the success of case management for this population and (ii) to propose a typology based on the results of this tool. The process started with a multiple embedded case study design in order to identify the key components of case management. Based on the results of this first step, data were collected among 22 case management interventions, in order to evaluate their expected effectiveness. Finally, multiple correspondence analyses was conducted to propose a typology of case management. The overall approach was informed by Wagner's Chronic Care Model and the theory of complexity. The study identified a total of 23 interacting key components. Based on the clustering of response patterns of the 22 case management projects included in our study, three types of case management programmes were evidenced, situated on a continuum from a more "socially-oriented" type towards a more "clinically-oriented" type of case management. The type of feedback provided to the general practitioner about both the global geriatric assessment and the result of the intervention turned out to be the most discriminant component between the types. The study design allowed to produce a tool that can be used to distinguish between different types of case management interventions and further evaluate their effect on frail older people in terms of the delaying institutionalisation, functional and cognitive status, quality of life and societal costs.

  20. Assessment of mandibular growth by skeletal scintigraphy

    International Nuclear Information System (INIS)

    Kaban, L.B.; Cisneros, G.J.; Heyman, S.; Treves, S.

    1982-01-01

    Accurate assessment of facial skeletal growth remains a major problem in craniomaxillofacial surgery. Current methods include: (1) comparisons of chronologic age with growth histories of the patient and the family, (2) hand-wrist radiographs compared with a standard, and (3) serial cephalometric radiographs. Uptake of technetium-99m methylene diphosphonate into bone is a reflection of current metabolic activity and blood flow. Therefore, scintigraphy with this radiopharmaceutical might serve as a good method of assessing skeletal growth. Thirty-four patients, ranging in age from 15 months to 22 years, who were undergoing skeletal scintigrams for acute pathologic conditions of the extremities, were used to develop standards of uptake based on age and skeletal maturation. The results indicate that skeletal scintigraphy may be useful in evaluation of mandibular growth

  1. Development of severe skeletal defects in induced SHP-2-deficient adult mice: a model of skeletal malformation in humans with SHP-2 mutations

    Directory of Open Access Journals (Sweden)

    Timothy J. Bauler

    2011-03-01

    SHP-2 (encoded by PTPN11 is a ubiquitously expressed protein tyrosine phosphatase required for signal transduction by multiple different cell surface receptors. Humans with germline SHP-2 mutations develop Noonan syndrome or LEOPARD syndrome, which are characterized by cardiovascular, neurological and skeletal abnormalities. To study how SHP-2 regulates tissue homeostasis in normal adults, we used a conditional SHP-2 mouse mutant in which loss of expression of SHP-2 was induced in multiple tissues in response to drug administration. Induced deletion of SHP-2 resulted in impaired hematopoiesis, weight loss and lethality. Most strikingly, induced SHP-2-deficient mice developed severe skeletal abnormalities, including kyphoses and scolioses of the spine. Skeletal malformations were associated with alterations in cartilage and a marked increase in trabecular bone mass. Osteoclasts were essentially absent from the bones of SHP-2-deficient mice, thus accounting for the osteopetrotic phenotype. Studies in vitro revealed that osteoclastogenesis that was stimulated by macrophage colony-stimulating factor (M-CSF and receptor activator of nuclear factor kappa B ligand (RANKL was defective in SHP-2-deficient mice. At least in part, this was explained by a requirement for SHP-2 in M-CSF-induced activation of the pro-survival protein kinase AKT in hematopoietic precursor cells. These findings illustrate an essential role for SHP-2 in skeletal growth and remodeling in adults, and reveal some of the cellular and molecular mechanisms involved. The model is predicted to be of further use in understanding how SHP-2 regulates skeletal morphogenesis, which could lead to the development of novel therapies for the treatment of skeletal malformations in human patients with SHP-2 mutations.

  2. Skeletal muscle expresses the extracellular cyclic AMP–adenosine pathway

    Science.gov (United States)

    Chiavegatti, T; Costa, V L; Araújo, M S; Godinho, R O

    2007-01-01

    Background and purpose: cAMP is a key intracellular signalling molecule that regulates multiple processes of the vertebrate skeletal muscle. We have shown that cAMP can be actively pumped out from the skeletal muscle cell. Since in other tissues, cAMP efflux had been associated with extracellular generation of adenosine, in the present study we have assessed the fate of interstitial cAMP and the existence of an extracellular cAMP-adenosine signalling pathway in skeletal muscle. Experimental approach: cAMP efflux and/or its extracellular degradation were analysed by incubating rat cultured skeletal muscle with exogenous cAMP, forskolin or isoprenaline. cAMP and its metabolites were quantified by radioassay or HPLC, respectively. Key results: Incubation of cells with exogenous cAMP was followed by interstitial accumulation of 5′-AMP and adenosine, a phenomenon inhibited by selective inhibitors of ecto-phosphodiesterase (DPSPX) and ecto-nucleotidase (AMPCP). Activation of adenylyl cyclase (AC) in cultured cells with forskolin or isoprenaline increased cAMP efflux and extracellular generation of 5′-AMP and adenosine. Extracellular cAMP-adenosine pathway was also observed after direct and receptor-dependent stimulation of AC in rat extensor muscle ex vivo. These events were attenuated by probenecid, an inhibitor of ATP binding cassette family transporters. Conclusions and implications: Our results show the existence of an extracellular biochemical cascade that converts cAMP into adenosine. The functional relevance of this extracellular signalling system may involve a feedback modulation of cellular response initiated by several G protein-coupled receptor ligands, amplifying cAMP influence to a paracrine mode, through its metabolite, adenosine. PMID:18157164

  3. Introduction to skeletal radiology and bone growth

    International Nuclear Information System (INIS)

    Rogers, L.F.

    1987-01-01

    Radiographic examination is the key to the diagnosis of many skeletal abnormalities. It is essential that each bone be examined in its entirety, including the cortex, medullary canal (cancellous bone or spongiosa), and articular ends. The position and alignment of joints are determined. In children, the epiphysis and epiphyseal line or physis must be observed. The adjacent soft tissues are examined. Obliteration of normal soft-tissue lines and the presence of a joint effusion are of particular importance. When disease is present, it is important to determine whether the process is limited to a single bone or joint or whether multiple bones or joints are involved. The distribution of disease is also a consideration. The presence and type of bone destruction and bone production, the appearance of the edges or borders of the lesion, and the presence or absence of cortical expansion and periosteal reaction are also noted. The radiographic findings are then correlated with the clinical history and the age and sex of the patient to arrive at a logical diagnosis. The diagnosis may be firm in some instances; in other cases, a differential diagnosis is offered since the exact diagnosis cannot be determined

  4. Computed tomography of the skeletal system

    International Nuclear Information System (INIS)

    Maas, R.; Heller, M.

    1990-01-01

    Patients showing severe multiple injuries, require special care and attention in the hospital. In these cases, the range of the diagnostic measures taken subsequent to computed tomography of the cranium must be broadened to include examinations of the vertebral column and pelvic ring for traumatic lesions. Radiological routine procedures are discussed wit hthe view of throwing some light on the problems involved incomputed tomography of the vertebral disks. In degenerative processes associated with spinal stenosis and hypertrophic facets it has been found that angular-sagittal-reconstruction may be quite useful. Computed tomography provides valuable information on morphological factors and has great discriminating power in the diagnosis of skeletal tumours of the extremities. Quantitative computed tomography offers unprecedented possibilities in the diagnosis and treatment of osteoporosis. Here, particular care must be taken to avoid inaccuracies of measurement as a result of incorrectly performed examinations. In malignant bone tumours the method of dynamic scanning permits the success or failure of any radiotherapeutic or chemical measures taken to be evaluated at an early stage. The success or failure of any radiotherapeutic or chemical measures taken to to treat malignant bone tumours can be evaluated at an early stage using the method on dynamic scanning. (orig.) [de

  5. Skeletal changes during and after spaceflight.

    Science.gov (United States)

    Vico, Laurence; Hargens, Alan

    2018-03-21

    Space sojourns are challenging for life. The ability of the human body to adapt to these extreme conditions has been noted since the beginning of human space travel. Skeletal alterations that occur during spaceflight are now better understood owing to tools such as dual-energy X-ray densitometry and high-resolution peripheral quantitative CT, and murine models help researchers to understand cellular and matrix changes that occur in bone and that are difficult to measure in humans. However, questions remain with regard to bone adaptation and osteocyte fate, as well as to interactions of the skeleton with fluid shifts towards the head and with the vascular system. Further investigations into the relationships between the musculoskeletal system, energy metabolism and sensory motor acclimatisation are needed. In this regard, an integrated intervention is required that will address multiple systems simultaneously. Importantly, radiation and isolation-related stresses are gaining increased attention as the prospect of human exploration into deep space draws nearer. Although space is a unique environment, clear parallels exist between the effects of spaceflight, periods of immobilization and ageing, with possibly irreversible features. Space travel offers an opportunity to establish integrated deconditioning and ageing interventions that combine nutritional, physical and pharmaceutical strategies.

  6. Tribbles 3 Mediates Endoplasmic Reticulum Stress-Induced Insulin Resistance in Skeletal Muscle

    Science.gov (United States)

    Koh, Ho-Jin; Toyoda, Taro; Didesch, Michelle M.; Lee, Min-Young; Sleeman, Mark W.; Kulkarni, Rohit N.; Musi, Nicolas; Hirshman, Michael F.; Goodyear, Laurie J.

    2013-01-01

    Endoplasmic Reticulum (ER) stress has been linked to insulin resistance in multiple tissues but the role of ER stress in skeletal muscle has not been explored. ER stress has also been reported to increase tribbles 3 (TRB3) expression in multiple cell lines. Here, we report that high fat feeding in mice, and obesity and type 2 diabetes in humans significantly increases TRB3 and ER stress markers in skeletal muscle. Overexpression of TRB3 in C2C12 myotubes and mouse tibialis anterior muscles significantly impairs insulin signaling. Incubation of C2C12 cells and mouse skeletal muscle with ER stressors thapsigargin and tunicamycin increases TRB3 and impairs insulin signaling and glucose uptake, effects reversed in cells overexpressing RNAi for TRB3 and in muscles from TRB3 knockout mice. Furthermore, TRB3 knockout mice are protected from high fat diet-induced insulin resistance in skeletal muscle. These data demonstrate that TRB3 mediates ER stress-induced insulin resistance in skeletal muscle. PMID:23695665

  7. Tomographic elastography of contracting skeletal muscles from their natural vibrations

    Science.gov (United States)

    Sabra, Karim G.; Archer, Akibi

    2009-11-01

    Conventional elastography techniques require an external mechanical or radiation excitation to measure noninvasively the viscoelastic properties of skeletal muscles and thus monitor human motor functions. We developed instead a passive elastography technique using only an array of skin-mounted accelerometers to record the low-frequency vibrations of the biceps brachii muscle naturally generated during voluntary contractions and to determine their two-dimensional directionality. Cross-correlating these recordings provided travel-times measurements of these muscle vibrations between multiple sensor pairs. Travel-time tomographic inversions yielded spatial variations of their propagation velocity during isometric elbow flexions which indicated a nonuniform longitudinal stiffening of the biceps.

  8. Subcutaneous interferon β-1a in pediatric patients with multiple sclerosis: Regional differences in clinical features, disease management, and treatment outcomes in an international retrospective study.

    Science.gov (United States)

    Krupp, Lauren B; Pohl, Daniela; Ghezzi, Angelo; Boyko, Alexey; Tenembaum, Silvia; Chen, Liang; Aycardi, Ernesto; Banwell, Brenda

    2016-04-15

    To further understand management of pediatric patients with multiple sclerosis (MS), we examined disease features, clinical practice patterns, and response to treatment in the United States (US) and seven other countries ('rest of World'; ROW). Anonymized data, recorded as part of routine clinical practice, were obtained from medical records (1997-2009) of study participants (who received subcutaneous interferon β-1a before age 18 years) from the US and ROW. Samples were stratified by age (preadolescents [managed differently, compared with ROW patients. Future prospective studies are needed to confirm these observations and ascertain their clinical significance. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

  9. The invisible work of personal health information management among people with multiple chronic conditions: qualitative interview study among patients and providers.

    Science.gov (United States)

    Ancker, Jessica S; Witteman, Holly O; Hafeez, Baria; Provencher, Thierry; Van de Graaf, Mary; Wei, Esther

    2015-06-04

    A critical problem for patients with chronic conditions who see multiple health care providers is incomplete or inaccurate information, which can contribute to lack of care coordination, low quality of care, and medical errors. As part of a larger project on applications of consumer health information technology (HIT) and barriers to its use, we conducted a semistructured interview study with patients with multiple chronic conditions (MCC) with the objective of exploring their role in managing their personal health information. Semistructured interviews were conducted with patients and providers. Patients were eligible if they had multiple chronic conditions and were in regular care with one of two medical organizations in New York City; health care providers were eligible if they had experience caring for patients with multiple chronic conditions. Analysis was conducted from a grounded theory perspective, and recruitment was concluded when saturation was achieved. A total of 22 patients and 7 providers were interviewed; patients had an average of 3.5 (SD 1.5) chronic conditions and reported having regular relationships with an average of 5 providers. Four major themes arose: (1) Responsibility for managing medical information: some patients perceived information management and sharing as the responsibility of health care providers; others—particularly those who had had bad experiences in the past—took primary responsibility for information sharing; (2) What information should be shared: although privacy concerns did influence some patients' perceptions of sharing of medical data, decisions about what to share were also heavily influenced by their understanding of health and disease and by the degree to which they understood the health care system; (3) Methods and tools varied: those patients who did take an active role in managing their records used a variety of electronic tools, paper tools, and memory; and (4) Information management as invisible work

  10. Approach to Investigating Congenital Skeletal Abnormalities in Livestock.

    Science.gov (United States)

    Dittmer, K E; Thompson, K G

    2015-09-01

    Congenital skeletal abnormalities may be genetic, teratogenic, or nutritional in origin; distinguishing among these different causes is essential in the management of the disease but may be challenging. In some cases, teratogenic or nutritional causes of skeletal abnormalities may appear very similar to genetic causes. For example, chondrodysplasia associated with intrauterine zinc or manganese deficiency and mild forms of hereditary chondrodysplasia have very similar clinical features and histologic lesions. Therefore, historical data are essential in any attempt to distinguish genetic and acquired causes of skeletal lesions; as many animals as possible should be examined; and samples should be collected for future analysis, such as genetic testing. Acquired causes of defects often show substantial variation in presentation and may improve with time, while genetic causes frequently have a consistent presentation. If a disease is determined to be of genetic origin, a number of approaches may be used to detect mutations, each with advantages and disadvantages. These approaches include sequencing candidate genes, single-nucleotide polymorphism array with genomewide association studies, and exome or whole genome sequencing. Despite advances in technology and increased cost-effectiveness of these techniques, a good clinical history and description of the pathology and a reliable diagnosis are still key components of any investigation. © The Author(s) 2015.

  11. Musculo-Skeletal Abnormalities in Patients with Marfan Syndrome

    Directory of Open Access Journals (Sweden)

    Ali Al Kaissi

    2013-01-01

    Full Text Available Background A leptosomic body type is tall and thin with long hands. Marfanoid features may be familial in nature or pathological, as occurs in congenital contractual arachnodactyly (Beal's syndrome and Shprintzen-Goldberg syndrome mimicking some of the changes of Marfan syndrome, although not accompanied by luxation of lens and dissecting aneurysm of aorta. Methods In this article we collected eight patients who were consistent with the diagnosis of Marfan syndrome via phenotypic and genotypic characterization. Results Our patients manifested a constellation of variable presentations of musculo-skeletal abnormalities ranging from developmental dysplasia of the hip, protrusio acetabuli, leg length inequality, patellar instability, scoliosis, to early onset osteoarthritis. Each abnormality has been treated accordingly. Conclusion This is the first paper which includes the diagnosis and the management of the associated musculo-skeletal abnormalities in patients with Marfan syndrome, stressing that patients with Marfan syndrome are exhibiting great variability in the natural history and the severity of musculo-skeletal abnormalities.

  12. A prospective study comparing whole-body skeletal X-ray survey with 18F-FDG-PET/CT, 18F-NaF-PET/CT and whole-body MRI in the detection of bone lesions in multiple myeloma patients

    DEFF Research Database (Denmark)

    Dyrberg, Eva; Hendel, Helle W; Al-Farra, Gina

    2017-01-01

    Background: For decades, the most widely used imaging technique for myeloma bone lesions has been a whole-body skeletal X-ray survey (WBXR), but newer promising imaging techniques are evolving. Purpose: To compare WBXR with the advanced imaging techniques 18F-fluorodeoxyglucose (FDG) positron emi...

  13. [Continuous insulin therapy versus multiple insulin injections in the management of type 1 diabetes: a longitutinal study].

    Science.gov (United States)

    Ribeiro, Maria Estela Bellini; Del Roio Liberatore Junior, Raphael; Custodio, Rodrigo; Martinelli Junior, Carlos Eduardo

    2016-01-01

    To compare multiple doses of insulin and continuous insulin infusion therapy as treatment for type 1 diabetes melito. 40 patients with type 1 diabetes melito (21 female) with ages between 10 and 20 years (mean=14.2) and mean duration of diabetes of 7 years used multiple doses of insulin for at least 6 months and after that, continuous insulin infusion therapy for at least 6 months. Each one of the patients has used multiple doses of insulin and continuous insulin infusion therapy. For analysis of HbA1c, mean glycated hemoglobin levels (mHbA1c) were obtained during each treatment period (multiple doses of insulin and continuous insulin infusion therapy period). Although mHbA1c levels were lower during continuous insulin infusion therapy the difference was not statistically significant. During multiple doses of insulin, 14.2% had mHbA1c values below 7.5% vs. 35.71% while on continuous insulin infusion therapy; demonstrating better glycemic control with the use of continuous insulin infusion therapy. During multiple doses of insulin, 15-40 patients have severe hypoglycemic events versus 5-40 continuous insulin infusion therapy. No episodes of ketoacidosis events were recorded. This is the first study with this design comparing multiple doses of insulin and continuous insulin infusion therapy in Brazil showing no significant difference in HbA1c; hypoglycemic events were less frequent during continuous insulin infusion therapy than during multiple doses of insulin and the percentage of patients who achieved a HbA1c less than 7.5% was greater during continuous insulin infusion therapy than multiple doses of insulin therapy. Copyright © 2015 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

  14. Management Certainly Matters, and There Are Multiple Ways to Conceptualize the Process; Comment on “Management Matters: A Leverage Point for Health Systems Strengthening in Global Health”

    Directory of Open Access Journals (Sweden)

    Beaufort B. Longest

    2015-11-01

    Full Text Available The authors of “Management matters: a leverage point for health systems strengthening in global health,” raise a crucial issue. Because more effective management can contribute to better performing health systems, attempts to strengthen health systems require attention to management. As a guide toward management capacity building, the authors outline a comprehensive set of core management competencies needed for managing global health efforts. Although, I agree with the authors’ central premise about the important role of management in improving global health and concur that focusing on competencies can guide management capacity building, I think it is important to recognize that a set of relevant competencies is not the only way to conceptualize and organize efforts to teach, learn, practice, or conduct research on management. I argue the added utility of also viewing management as a set of functions or activities as an alternative paradigm and suggest that the greatest utility could lie in some hybrid that combines various ways of conceptualizing management for study, practice, and research.

  15. Synergy between the Multiple Supply Chain and Green Supply Chain Management (GSCM) approaches: an initial analysis aimed at fostering supply chain sustainability

    OpenAIRE

    Ana Lima de Carvalho; Livia Rodrigues Ignácio; Kleber Francisco Esposto; Aldo Roberto Ometto

    2016-01-01

    The concept of Green Supply Chain Management (GSCM) was created in the 90s to reduce the environmental impacts of productive systems. This approach seeks to improve the environmental performance of all the participants in a supply chain, from the extraction of raw materials to the use and final disposal of the product, through relationships of collaboration or conformity between the parties. The multiple supply chains approach established by Gattorna (2009) brought to light different supply c...

  16. Radiopharmaceutical agents for skeletal scanning

    International Nuclear Information System (INIS)

    Jansen, S.E.; Van Aswegen, A.; Loetter, M.G.; Minnaar, P.C.; Otto, A.C.; Goedhals, L.; Dedekind, P.S.

    1987-01-01

    The quality of bone scan images obtained with a locally produced and with an imported radiopharmaceutical bone agent, methylene diphosphonate (MDP), was compared visually. Standard skeletal imaging was carried out on 10 patients using both agents, with a period of 2 to 7 days between studies with alternate agents. Equal amounts of activity were administered for both agents. All images were acquired on Polaroid film for subsequent evaluation. The acquisition time for standard amount of counts per study was recorded. Three physicians with applicable experience evaluated image quality (on a 4 point scale) and detectability of metastasis (on a 3 point scale). There was no statistically significant difference (p 0,05) between the two agents by paired t-test of Hotelling's T 2 analysis. It is concluded that the imaging properties of the locally produced and the imported MDP are similar

  17. Redox Control of Skeletal Muscle Regeneration.

    Science.gov (United States)

    Le Moal, Emmeran; Pialoux, Vincent; Juban, Gaëtan; Groussard, Carole; Zouhal, Hassane; Chazaud, Bénédicte; Mounier, Rémi

    2017-08-10

    Skeletal muscle shows high plasticity in response to external demand. Moreover, adult skeletal muscle is capable of complete regeneration after injury, due to the properties of muscle stem cells (MuSCs), the satellite cells, which follow a tightly regulated myogenic program to generate both new myofibers and new MuSCs for further needs. Although reactive oxygen species (ROS) and reactive nitrogen species (RNS) have long been associated with skeletal muscle physiology, their implication in the cell and molecular processes at work during muscle regeneration is more recent. This review focuses on redox regulation during skeletal muscle regeneration. An overview of the basics of ROS/RNS and antioxidant chemistry and biology occurring in skeletal muscle is first provided. Then, the comprehensive knowledge on redox regulation of MuSCs and their surrounding cell partners (macrophages, endothelial cells) during skeletal muscle regeneration is presented in normal muscle and in specific physiological (exercise-induced muscle damage, aging) and pathological (muscular dystrophies) contexts. Recent advances in the comprehension of these processes has led to the development of therapeutic assays using antioxidant supplementation, which result in inconsistent efficiency, underlying the need for new tools that are aimed at precisely deciphering and targeting ROS networks. This review should provide an overall insight of the redox regulation of skeletal muscle regeneration while highlighting the limits of the use of nonspecific antioxidants to improve muscle function. Antioxid. Redox Signal. 27, 276-310.

  18. Multiple muscle tear after fall on buttock-role of conservative management and exercise for early recovery and return to play.

    Science.gov (United States)

    Adhau, Rajesh; Angrish, Piyush; Ahuja, Ashok; Sandhu, Avtar Singh

    2014-04-01

    to describe role of alternative management as an approach to management and rehabilitation of multiple hip muscles tears by the use of 1 RM (Repetition Maximum) testing and hip muscle strengthening program along with the use of sports specific drills for rehabilitation and recovery. There is very limited literature describing multiple hip muscle tears and the conservative management of the same. 1RM testing and strengthening of hip muscles is an approach that is able to help in the return to sports of an athlete without surgical intervention. the patient, is a 21-year-old male hockey player who presented with pain right buttock, right lower leg and a limp on the right side while walking. Physical examination revealed a positive Trendelenburg sign both in stance and gait phase. Hip rotational movements showed a normal range of motion, there was a severe pain in the right buttock on movements which he described at 8/10 on VAS (Visual Analogue Scale). Strength assessment revealed weakness of the right hip flexors and extensors and also of the abductor and external hip rotator muscles. Treatment protocol followed was based on 1 RM testing of muscles and hip strengthening exercises and sports specific drills. following the intervention, the patient reported pain at 0/10 VAS while doing all activities and also showed good muscle control with no limp. this highlights an alternative protocol for treating multiple hip muscle tears and illustrates the importance of 1 RM testing as a part of examination and sports medicine intervention.

  19. Cardiac, Skeletal, and smooth muscle mitochondrial respiration

    DEFF Research Database (Denmark)

    Park, Song-Young; Gifford, Jayson R; Andtbacka, Robert H I

    2014-01-01

    , skeletal, and smooth muscle was harvested from a total of 22 subjects (53±6 yrs) and mitochondrial respiration assessed in permeabilized fibers. Complex I+II, state 3 respiration, an index of oxidative phosphorylation capacity, fell progressively from cardiac, skeletal, to smooth muscle (54±1; 39±4; 15......±1 pmol•s(-1)•mg (-1), prespiration rates were normalized by CS (respiration...... per mitochondrial content), oxidative phosphorylation capacity was no longer different between the three muscle types. Interestingly, Complex I state 2 normalized for CS activity, an index of non-phosphorylating respiration per mitochondrial content, increased progressively from cardiac, skeletal...

  20. Skeletal muscle tissue engineering: methods to form skeletal myotubes and their applications.

    Science.gov (United States)

    Ostrovidov, Serge; Hosseini, Vahid; Ahadian, Samad; Fujie, Toshinori; Parthiban, Selvakumar Prakash; Ramalingam, Murugan; Bae, Hojae; Kaji, Hirokazu; Khademhosseini, Ali

    2014-10-01

    Skeletal muscle tissue engineering (SMTE) aims to repair or regenerate defective skeletal muscle tissue lost by traumatic injury, tumor ablation, or muscular disease. However, two decades after the introduction of SMTE, the engineering of functional skeletal muscle in the laboratory still remains a great challenge, and numerous techniques for growing functional muscle tissues are constantly being developed. This article reviews the recent findings regarding the methodology and various technical aspects of SMTE, including cell alignment and differentiation. We describe the structure and organization of muscle and discuss the methods for myoblast alignment cultured in vitro. To better understand muscle formation and to enhance the engineering of skeletal muscle, we also address the molecular basics of myogenesis and discuss different methods to induce myoblast differentiation into myotubes. We then provide an overview of different coculture systems involving skeletal muscle cells, and highlight major applications of engineered skeletal muscle tissues. Finally, potential challenges and future research directions for SMTE are outlined.

  1. Comparative study of skeletal dosimetry methods in therapeutic schemes with Re186 HEDP and Sm153 EDTMP

    International Nuclear Information System (INIS)

    Papanikolos, G.; Lyra, M.; Kontogeorgakos, D.; Jordanou, J.; Vlahos, L.; Limouris, G.

    2005-01-01

    Full text: Optimum therapeutic management of patients suffering from metastatic bone pain, requires accurate calculations concerning absorbed dose by metastatic lesions and other critical organs, such as red marrow. Mean absorbed dose, which is the current parameter used to predict the efficacy of the treatment, can either overestimate or underestimate, actual doses delivered in these organs/tissues of interest (TOIs). This study presents differences in dosimetric calculations derived utilizing parameters from different sources (MIRDOSE3, MIRD Pamphlet No 11 and S values published by Bouchet et al.), in therapeutic schemes with Re186HEDP and Sm153EDTMP. A set of planar scintigraphic images for 2 groups of patients (1 for Re 186 patients and the other for Sm153 patients) were obtained in the following sequence: 2 during the first 24h post injection (the last of which at 24h post injection) and 2 more from 24h 7d post injection. Processing of the obtained images utilizing ROI quantitative methods, previously calibrated with waterphantom measurements, determine residence times and radionuclide uptakes not only by TOIs but by specific skeletal sites as well. Dosimetric calculations were performed using MIRDOSE3 computer code, S values from MIRD Pamphlet No 11 and site specific Re 186 and Sm 153 S values for several source target combinations within trabecular and cortical bone, reported by Bouchet et al. (J Nucl Med 2000; 41:189 212), along with cumulative site specific activities derived from values obtained by image processing. Skeletal averaged Re 186 and Sm 153 S values were also used from the aforementioned study by Bouchet et al. Time activity curves for various skeletal sites were generated for both groups of patients. Absorbed dose distributions along with time dose rate curves were derived for both red marrow and different regions of the skeleton. Comparisons are made between these parameters and mean absorbed doses calculated using skeletal averaged S values

  2. Voltage clamp methods for the study of membrane currents and SR Ca2+ release in adult skeletal muscle fibres

    Science.gov (United States)

    Hernández-Ochoa, Erick O.; Schneider, Martin F.

    2012-01-01

    Skeletal muscle excitation-contraction (E-C)1 coupling is a process composed of multiple sequential stages, by which an action potential triggers sarcoplasmic reticulum (SR)2 Ca2+ release and subsequent contractile activation. The various steps in the E-C coupling process in skeletal muscle can be studied using different techniques. The simultaneous recordings of sarcolemmal electrical signals and the accompanying elevation in myoplasmic Ca2+, due to depolarization-initiated SR Ca2+ release in skeletal muscle fibres, have been useful to obtain a better understanding of muscle function. In studying the origin and mechanism of voltage dependency of E-C coupling a variety of different techniques have been used to control the voltage in adult skeletal fibres. Pioneering work in muscles isolated from amphibians or crustaceans used microelectrodes or ‘high resistance gap’ techniques to manipulate the voltage in the muscle fibres. The development of the patch clamp technique and its variant, the whole-cell clamp configuration that facilitates the manipulation of the intracellular environment, allowed the use of the voltage clamp techniques in different cell types, including skeletal muscle fibres. The aim of this article is to present an historical perspective of the voltage clamp methods used to study skeletal muscle E-C coupling as well as to describe the current status of using the whole-cell patch clamp technique in studies in which the electrical and Ca2+ signalling properties of mouse skeletal muscle membranes are being investigated. PMID:22306655

  3. Sexual Dysfunction Management and Expectations Assessment in Multiple Sclerosis-Female (SEA-MS-F): creation and validation of a specific questionnaire.

    Science.gov (United States)

    Bisseriex, Hélène; Guinet-Lacoste, Amandine; Chevret-Méasson, Marie; Costa, Pierre; Sheikh Ismael, Samer; Rousseau, Alexandra; Amarenco, Gerard

    2014-12-01

    Until now, no questionnaire has been developed to study specific expectations concerning sexual dysfunction management and the availability of information on sexuality in the female population affected by multiple sclerosis (MS). Understanding and meeting the patient's expectations is an issue of considerable importance in the evaluation of medical care. We present the development and validation of a specific questionnaire designed for women with MS in order to assess their expectations in terms of sexual dysfunction management: the SEA-MS-F (Sexual Dysfunction Management and Expectations Assessment in Multiple Sclerosis-Female). This questionnaire was created and validated by an expert panel, using the Delphi method. The psychometric evaluation was obtained with a sample of 40 female MS patients. Cronbach's alpha index and principal component analysis were used to measure the questionnaire's internal consistency. A consensus on the questionnaire was reached with the Delphi method. The SEA-MS-F is fully compliant with the criteria for psychometric validation among female MS patients, and its internal consistency is excellent (Cronbach's alpha 0.948). The SEA-MS-F appears to be a useful tool that could be used either in routine medical situations or in prospective studies of MS in order to ascertain women's expectations concerning the management of their sexual dysfunction. © 2014 International Society for Sexual Medicine.

  4. Skeletal Class III and anterior open bite treatment with different retention protocols: a report of three cases.

    Science.gov (United States)

    Farret, Milton Meri Benitez; Farret, Marcel Marchiori; Farret, Alessandro Marchiori

    2012-09-01

    The treatment of skeletal class III and anterior open bite can be unstable and orthodontists frequently observe relapse. Here, we report on the management of three patients with skeletal class III profiles and open bites treated by orthodontic camouflage. Each received a retention protocol involving the use of two separate appliances during the night and day accompanied by myofunctional therapy. Long-term follow-up revealed a stable outcome.

  5. Use of Multiple Methodologies for Developing a Customer-Oriented Model of Total Quality Management in Higher Education

    Science.gov (United States)

    Sahney, Sangeeta

    2016-01-01

    Purpose: Educational institutes must embrace the principles of total quality management (TQM) if they seek to remain competitive, and survive and succeed in the long run. An educational institution must embrace the principles of quality management and incorporate them into all of their activities. Starting with a theoretical background, the paper…

  6. [Molecular mechanisms of skeletal muscle hypertrophy].

    Science.gov (United States)

    Astratenkova, I V; Rogozkin, V A

    2014-06-01

    Enzymes Akt, AMPK, mTOR, S6K and PGC-1a coactivator take part in skeletal muscles in the regulation of synthesis of proteins. The expression of these proteins is regulated by growth factors, hormones, nutrients, mechanical loading and leads to an increase in muscle mass and skeletal muscle hypertrophy. The review presents the results of studies published in the past four years, which expand knowledge on the effects of various factors on protein synthesis in skeletal muscle. The attention is focused on the achievements that reveal and clarify the signaling pathways involved in the regulation of protein synthesis in skeletal muscle. The central place is taken by mTOR enzyme which controls and regulates the main stages of the cascade of reactions of muscle proteins providing synthesis in the conditions of human life. coactivator PGC-1a.

  7. Skeletal muscle glucose uptake during exercise

    DEFF Research Database (Denmark)

    Rose, Adam John; Richter, Erik

    2005-01-01

    The increase in skeletal muscle glucose uptake during exercise results from a coordinated increase in rates of glucose delivery (higher capillary perfusion), surface membrane glucose transport, and intracellular substrate flux through glycolysis. The mechanism behind the movement of GLUT4...

  8. Skeletal Aging and Osteoporosis Biomechanics and Mechanobiology

    CERN Document Server

    2013-01-01

    The focus of this book is on mechanical aspects of skeletal fragility related to aging and osteoporosis. Topics include: Age-related changes in trabecular structure and strength; age-related changes in cortical material properties; age-related changes in whole-bone structure; predicting bone strength and fracture risk using image-based methods and finite element analysis; animal models of osteoporosis and aging; age-related changes in skeletal mechano responsiveness; exercise and physical interventions for osteoporosis.

  9. Exercise Promotes Healthy Aging of Skeletal Muscle

    DEFF Research Database (Denmark)

    Cartee, Gregory D; Hepple, Russell T; Bamman, Marcas M

    2016-01-01

    caused by diseases and lifestyle factors. Secondary aging can exacerbate deficits in mitochondrial function and muscle mass, concomitant with the development of skeletal muscle insulin resistance. Exercise opposes deleterious effects of secondary aging by preventing the decline in mitochondrial...... respiration, mitigating aging-related loss of muscle mass and enhancing insulin sensitivity. This review focuses on mechanisms by which exercise promotes "healthy aging" by inducing modifications in skeletal muscle....

  10. Role of Akirin in Skeletal Myogenesis

    Directory of Open Access Journals (Sweden)

    Dingbiao Long

    2013-02-01

    Full Text Available Akirin is a recently discovered nuclear factor that plays an important role in innate immune responses. Beyond its role in innate immune responses, Akirin has recently been shown to play an important role in skeletal myogenesis. In this article, we will briefly review the structure and tissue distribution of Akirin and discuss recent advances in our understanding of its role and signal pathway in skeletal myogenesis.

  11. Skeletal shape correspondence via entropy minimization

    Science.gov (United States)

    Tu, Liyun; Styner, Martin; Vicory, Jared; Paniagua, Beatriz; Prieto, Juan Carlos; Yang, Dan; Pizer, Stephen M.

    2015-03-01

    Purpose: Improving the shape statistics of medical image objects by generating correspondence of interior skeletal points. Data: Synthetic objects and real world lateral ventricles segmented from MR images. Method(s): Each object's interior is modeled by a skeletal representation called the s-rep, which is a quadrilaterally sampled, folded 2-sided skeletal sheet with spoke vectors proceeding from the sheet to the boundary. The skeleton is divided into three parts: up-side, down-side and fold-curve. The spokes on each part are treated separately and, using spoke interpolation, are shifted along their skeletal parts in each training sample so as to tighten the probability distribution on those spokes' geometric properties while sampling the object interior regularly. As with the surface-based correspondence method of Cates et al., entropy is used to measure both the probability distribution tightness and sampling regularity. The spokes' geometric properties are skeletal position, spoke length and spoke direction. The properties used to measure the regularity are the volumetric subregions bounded by the spokes, their quadrilateral sub-area and edge lengths on the skeletal surface and on the boundary. Results: Evaluation on synthetic and real world lateral ventricles demonstrated improvement in the performance of statistics using the resulting probability distributions, as compared to methods based on boundary models. The evaluation measures used were generalization, specificity, and compactness. Conclusions: S-rep models with the proposed improved correspondence provide significantly enhanced statistics as compared to standard boundary models.

  12. GaN-Based Multiple-Quantum-Well Light-Emitting Diodes Employing Nanotechnology for Photon Management

    KAUST Repository

    Hsiao, Yu Hsuan; Tsai, Meng Lin; He, Jr-Hau

    2015-01-01

    Nanostructures have been proved to be an efficient way of modifying/improving the performance of GaN-based light-emitting diodes (LEDs). The achievements in photon management include strain relaxation, light extraction enhancement, radiation pattern

  13. Using modified multiple phosphorus sensitivity indices for mitigation and management of phosphorus loads on a catchment level

    CSIR Research Space (South Africa)

    Oberholster, Paul J

    2013-01-01

    Full Text Available The relationships between river and lake phosphorus sensitivity, environmental drivers and catchment characteristics within the upper Olifants River and Lake Loskop were studied over a period of four years to come up with mitigation and management...

  14. Opportunity, risk, and success recognizing, addressing, and balancing multiple factors crucial to the success of a project management system deployed to support multi-lateral decommissioning programs

    International Nuclear Information System (INIS)

    Funk, Greg; Longsworth, Paul

    2007-01-01

    This paper addresses the factors involved in effectively implementing a world-class program/project management information system funded by multiple nations. Along with many other benefits, investing in and utilizing such systems improves delivery and drive accountability for major expenditures. However, there are an equally large number of impediments to developing and using such systems. To be successful, the process requires a dynamic combining of elements and strategic sequencing of initiatives. While program/project-management systems involve information technologies, software and hardware, they represent only one element of the overall system.. Technology, process, people and knowledge must all be integrated and working in concert with one another to assure a fully capable system. Major system implementations occur infrequently, and frequently miss established targets in relatively small organizations (with the risk increasing with greater complexity). The European Bank of Reconstruction (EBRD) is midway through just such an implementation. The EBRD is using funds from numerous donor countries to sponsor development of an overarching program management system. The system will provide the Russian Federation with the tools to effectively manage prioritizing, planning, and physically decommissioning assets i n northwest Russia to mitigate risks associated the Soviet era nuclear submarine program. Project-management delivery using world-class techniques supported by aligned systems has been proven to increase the probability of delivering on-time and on-budget, assuring those funding such programs optimum value for money. However, systems deployed to manage multi-laterally funded projects must be developed with appropriate levels of consideration given to unique aspects such as: accommodation of existing project management methods, consideration for differences is management structures and organizational behaviors, incorporation of unique strengths, and subtle

  15. Multiple Drivers of Local (Non- Compliance in Community-Based Marine Resource Management: Case Studies from the South Pacific

    Directory of Open Access Journals (Sweden)

    Janne R. Rohe

    2017-05-01

    Full Text Available The outcomes of marine conservation and related management interventions depend to a large extent on people's compliance with these rule systems. In the South Pacific, community-based marine resource management (CBMRM has gained wide recognition as a strategy for the sustainable management of marine resources. In current practice, CBMRM initiatives often build upon customary forms of marine governance, integrating scientific advice and management principles in collaboration with external partners. However, diverse socio-economic developments as well as limited legal mandates can challenge these approaches. Compliance with and effective (legally-backed enforcement of local management strategies constitute a growing challenge for communities—often resulting in considerable impact on the success or failure of CBMRM. Marine management arrangements are highly dynamic over time, and similarly compliance with rule systems tends to change depending on context. Understanding the factors contributing to (non- compliance in a given setting is key to the design and function of adaptive management approaches. Yet, few empirical studies have looked in depth into the dynamics around local (non- compliance with local marine tenure rules under the transforming management arrangements. Using two case studies from Solomon Islands and Fiji, we investigate what drives local (non- compliance with CBMRM and what hinders or supports its effective enforcement. The case studies reveal that non-compliance is mainly driven by: (1 diminishing perceived legitimacy of local rules and rule-makers; (2 increased incentives to break rules due to market access and/ or lack of alternative income; and (3 relatively weak enforcement of local rules (i.e., low perceptions of risk from sanctions for rule-breaking. These drivers do not stand alone but can act together and add up to impair effective management. We further analyze how enforcement of CBMRM is challenged through a range of

  16. Beyond bureaucracy and entrepreneurialism:examining the multiple discursive codes informing the work, careers and subjectivities of management graduates

    OpenAIRE

    Loacker, Bernadette Isabel; Sliwa, Martyna

    2016-01-01

    This paper examines how discursive codes and demands associated with ‘bureaucratic and entrepreneurial regimes’ of work and career organization shape the work, careers and subjectivities of management graduates. The study is based on an analysis of 30 narratives of management professionals who graduated from an Austrian business school in the early 1970s or 2000s. Its insights suggest that variegated discursive codes manifest in the graduates’ articulated professional practices and subjectivi...

  17. The human resource management contribute six sigma program: multiple-case study in companies situated in Rio Grande do Sul

    Directory of Open Access Journals (Sweden)

    Jaqueline T. M. Corrêa Rodrigues

    2011-09-01

    Full Text Available The world is going through rapid changes and the companies seek alternatives to improve its products and processes and maintain their competitiveness. One alternative is the implementation of programs of quality management that combine human’s and technical’s factors. Six Sigma has gained evidence on the last years because aggregate tools and methodology. However, all quality program factors need management. The main goal of this paper is classify what assignments of Human Resource Management can contribute to reduction of the difficulties that can be encountered on implementation and maintenance of Six Sigma program in companies that was situated in the Rio Grande do Sul. For carry this work was necessary contact companies of the Rio Grande do Sul that use this program and was applied one questionnaire to classify the contribution of the Human Resource Management for the success of Six Sigma. The statistical tools, contents analyze, tables of relationship and qualitative analysis were applied for analysis. It’s evidence in this research the existence of potentials difficulties of Six Sigma listed in the literature and the influence that some assignments of Human Resource Management can be for solve this difficulties. The result of the research indicate that the participative and compromised leadership and the clear and objective communication of program are the assignments of Human Resource Management among the studied that more contribute for reduction of the difficulties of Six Sigma in the companies of this research.

  18. Bone and bone marrow scintigraphy in the diagnosis of neoplastic involvement of the skeletal system

    International Nuclear Information System (INIS)

    Sacchi, S.; Marietta, M.; Rinaldi, G.; Torelli, U.; Pantusa, M.; Romani, F.; Zaniol, P.

    1987-01-01

    Bone and bone marrow scintigraphy has been performed in 16 patients with epithelial tumor or lymphoproliferative diseases and in 22 patients affected by multiple myeloma. The first technique revealed skeletal alterations in 60.5% of all the patients; the second in 42.1%. In 21 cases, however, there was agreement between bone and bone marrow radionuclide imaging, making possible a more accurate etiological diagnosis of the hot areas found in skeletal scintigraphy. In patients with multiple myeloma we found a high correlation between the marrow distribution pattern and the plasmocytoma staging accoding to Durie and Salmon. It is thoght therefore that bone marrow scintigraphy may be useful sice it provides a further diagnostic tool for a better clinical staging of patients with multiple myeloma

  19. A Forecast of Competencies Required for Management of Multiple Site Healthcare Services: A Delphi Study of Managers in a Veterans Health Administration Integrated System

    National Research Council Canada - National Science Library

    Welch, Andrew

    2001-01-01

    .... These managers responded, to two separate rounds of questionnaires using the Delphi method. The first round resulted in 45 respondents who supplied a total of 216 competency phrases and 528 SKA phrases...

  20. Report writing in skeletal radiology

    International Nuclear Information System (INIS)

    Rowe, L.J.; Yochum, T.R.

    1987-01-01

    The formulation of reports in clinical practice is a standard method of documentation of a patient's history, examination findings, therapeutic regime, and prognosis, as well as other important features. In the practice of producing and interpreting diagnostic radiographs, report writing also serves a number of important roles, which include providing an accurate means of recording findings in instances of 1) medicolegal circumstances; 2) a standard for comparison with previous or later examinations; 3) a permanent record if the radiographs are lost or not immediately available for perusal; 4) communication with other practitioners and health professionals; and 5) expediating the treatment regime by providing a resume of important indications and contraindictions for therapy. In the radiological literature there is a distinct lack of material on report writing and very little as to what would be considered a standard style. Consequently, radiological reporting has increasingly become a subjective, personalized procedure, with each individual modifying the report according to previous training, experience, and needs. It is the purpose of this chapter to provide basic guidelines on the mechanisms of formulating adequate standardized reports in radiological examinations of the skeletal system