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Sample records for sustained symptomatic improvement

  1. SIDRE: Symptomatic Improvement of Dry Eye Study

    Directory of Open Access Journals (Sweden)

    De Paz CJ

    2017-03-01

    Full Text Available Clarissa J De Paz, Agustin L Gonzalez, Chi Ngo Eye & Vision, Richardson, TX, USA Purpose: The aim of this study was to evaluate the effectiveness of lifitegrast 5% ophthalmic solution in reducing the symptoms of eye dryness using Ocular Surface Disease Index (OSDI questionnaire. Methods: A single-center study was undertaken to evaluate the clinical outcomes. Fourteen subjects (12 female and 2 male with symptoms of dry eye and a positive history of recent use of artificial tears were included in the study. OSDI questionnaire scores on the severity of symptoms, visual functionality, and quality of life related to the condition were recorded pre- and post-therapy. Subsequently, score data were analyzed for statistical significance. Results: The mean age of the 14 subjects was 44.86 (standard deviation [SD] ±3.08 years, with a range of 23–62 years. Mean duration of the evaluation was 28.79 days with a range of 25–34 days. Baseline OSDI mean score was 49.40 (SD ±1.28, and post-therapy mean score was 42.26 (SD ±0.99. Data analysis revealed that the scores were statistically significantly improved post-lifitegrast therapy in comparison to baseline (p=0.00041. Conclusion: Lifitegrast 5% ophthalmic solution may be a beneficial therapeutic option in the management of symptoms associated with dry eye disease. Keywords: dry eye disease, ocular surface disease, dry eye treatment, lifitegrast

  2. Interpersonal problems as predictors of alliance, symptomatic improvement and premature termination in treatment of depression.

    Science.gov (United States)

    Dinger, Ulrike; Zilcha-Mano, Sigal; McCarthy, Kevin S; Barrett, Marna S; Barber, Jacques P

    2013-11-01

    Previous studies reported inconsistent findings regarding the association of interpersonal problems with therapy outcome. The current study investigates if interpersonal problems predict process and outcome of three different treatments for depression. The data originate from a randomized clinical trial comparing supportive-expressive psychotherapy, antidepressant medication and pill-placebo for treatment of depression. Interpersonal problems were used as predictors of alliance, symptomatic improvement and premature termination of treatment. Interpersonal problems related to communion predicted better alliances, but slower symptomatic improvement. Low agency predicted slower symptomatic improvement in supportive-expressive psychotherapy, but not in the medication or placebo condition. Lower interpersonal distress was associated with an increased likelihood to terminate treatment prematurely. The sample size did not allow the detection of small effects within the treatment groups. Interpersonal problems are influential for the treatment of depression, but parts of their effects depend on the type of treatment. © 2013 Elsevier B.V. All rights reserved.

  3. Repair of symptomatic paraesophageal hernias in elderly (>70 years) patients results in sustained quality of life at 5 years and beyond.

    Science.gov (United States)

    Merzlikin, Oleg V; Louie, Brian E; Farivar, Alexander S; Shultz, Dale; Aye, Ralph W

    2017-10-01

    Paraesophageal hernias (PEHs) involve herniation of stomach and/or other viscera into the mediastinum. These commonly occur in the elderly and can severely limit quality of life. Short term outcomes of repaired PEH demonstrated low morbidity and significant improvement in quality of life, but long-term data for all patients, especially the elderly, are lacking. Retrospective chart review of a prospectively collected database of patients aged 70 or greater with a symptomatic PEH repaired 5+ years ago. Quality of life data were assessed preoperatively, at 12-24 months, and at 5+ years using QOLRAD, GERD-HRQL, and DSS. We identified 137 patients who met the age criteria, with 69 patients undergoing surgery 5+ years ago. With ten patients were lost to follow-up, 59 patients were analyzed, including 24 males and 35 females. Median age at repair was 77 years. There were two 90-day mortalities, with one occurring within 30 days of surgery. Patients alive at evaluation had a median age of 74 years and were followed a median 7.4 years. From baseline, QOLRAD improved from 4 to 6.5, GERD-HRQL improved from 11 to 5, and swallowing improved from 11 to 38. During follow-up, 21 patients died. Deceased patients lived a median of 4 years after repair, with a median age at repair of 80 years. At a median time follow-up of 2 years, this group's QOLRAD improved from 5.1 to 7, GERD-HRQL improved from 16 to 4, and swallowing improved from 14.5 to 35. In elderly patients with symptomatic PEH undergoing surgical repair more than 5 years ago, there was sustained improvement in quality of life. This justifies surgical repair of symptomatic PEH in elderly patients.

  4. Efficacy of syndromic management measured as symptomatic improvement in females with vaginal discharge syndrome.

    Science.gov (United States)

    Chauhan, Vidyalaxmi; Shah, Maitri C; Patel, Sangita V; Marfatia, Yogesh S; Zalavadiya, Dhara

    2016-01-01

    In spite of a few shortcomings such as over diagnosis and over treatment, syndromic management is a recommended practice in India for sexually transmitted infections (STIs). This study tries to find out the efficacy of syndromic management measured as symptomatic improvement in females with vaginal discharge syndrome. The objective of the study is to find out the effectiveness of syndromic management in terms of symptomatic improvement among females with vaginal discharge syndrome. A longitudinal study was conducted in Gynecology Department of Tertiary Care Hospital including 180 symptomatic females having vaginal discharge syndrome. Demographic profile, presenting complaints, menstrual history, obstetric history, partner history, and contraceptive history were noted. This was followed by clinical examination and specimen collection for laboratory tests and blood tests to find out type of STI including viral STI such as human immunodeficiency virus (HIV), herpes simplex virus (HSV), and hepatitis B surface antigen (HBsAg). Treatment was given according to syndromic management on the same day. All the participants were asked to come for follow-up after 15 days and their improvement in symptoms was noted as complete improvement, some improvement or no improvement on a five point scale. 63.9% cases showed complete improvement, while 36.1% showed some improvement. None of the patients was without any improvement. Vaginal discharge syndrome was most common between 20 and 30 years (43.4%), and 67.8% of symptomatic females with vaginal discharge syndrome belonged to the lower socioeconomic group. HSV infection was the most common (15%) associated viral infection with vaginal discharge syndrome, while hepatitis B infection was the least common (0.5%). HIV was reactive in 2.8% cases only. Syndromic management was found to be effective in relieving symptoms in most of the cases of vaginal discharge syndrome.

  5. Symptomatic improvement in uterine myomas after MRgFUS: 4 year follow up

    Science.gov (United States)

    Funaki, Kaoru; Fukunishi, Hidenobu

    2011-09-01

    Objective: To assess the long-term improvement in symptoms after magnetic resonance-guided focused ultrasound surgery (MRgFUS) for uterine myomas. Methods: Japanese women with symptomatic myomas underwent MRgFUS using the ExAblate 2000 system. The symptom severity score (SSS) was examined before and after the treatment at 3, 6, 12, 24, and 48 months. Simultaneously, we asked the patients' satisfaction level regarding the overall change of subjective symptoms: symptom free, improved a great deal, improved to some extent, no change, or worsened. The myoma volumes were measured at 6, 12, 24, 36 and 48 months after MRgFUS. Results: No severe adverse event occurred with any of the patients. The mean SSS value before treatment was 38.3±21.5 (n = 106), which diminished significantly during follow-up for 3-48 months after treatment. Patients' satisfaction level was favorable, although the response rate was low. Over 80% of the patients replied that their symptoms were improved to at least some extent, and over 50% of the patients replied that their symptoms were improved a great deal. This trend continued throughout this follow up period. The mean myoma volume was also decreased from the pretreatment volume in this follow up period. Conclusion: MRgFUS is an effective and safe method for treating symptomatic uterine myomas. Long-term symptomatic improvement is promising.

  6. Lake Naivasha Sustainability : Ecosystem Improvement for Health ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Lake Naivasha Sustainability : Ecosystem Improvement for Health and ... The overall goal is to make recommendations for the sustainable management of natural ... to improve livestock vaccine development and production to benefit farmers ...

  7. Respiratory sinus arrhythmia reactivity to a sad film predicts depression symptom improvement and symptomatic trajectory.

    Science.gov (United States)

    Panaite, Vanessa; Hindash, Alexandra Cowden; Bylsma, Lauren M; Small, Brent J; Salomon, Kristen; Rottenberg, Jonathan

    2016-01-01

    Respiratory sinus arrhythmia (RSA) reactivity, an index of cardiac vagal tone, has been linked to self-regulation and the severity and course of depression (Rottenberg, 2007). Although initial data supports the proposition that RSA withdrawal during a sad film is a specific predictor of depression course (Fraguas, 2007; Rottenberg, 2005), the robustness and specificity of this finding are unclear. To provide a stronger test, RSA reactivity to three emotion films (happy, sad, fear) and to a more robust stressor, a speech task, were examined in currently depressed individuals (n=37), who were assessed for their degree of symptomatic improvement over 30weeks. Robust RSA reactivity to the sad film uniquely predicted overall symptom improvement over 30weeks. RSA reactivity to both sad and stressful stimuli predicted the speed and maintenance of symptomatic improvement. The current analyses provide the most robust support to date that RSA withdrawal to sad stimuli (but not stressful) has specificity in predicting the overall symptomatic improvement. In contrast, RSA reactivity to negative stimuli (both sad and stressful) predicted the trajectory of depression course. Patients' engagement with sad stimuli may be an important sign to attend to in therapeutic settings. Copyright © 2015 Elsevier B.V. All rights reserved.

  8. Symptomatic improvement reported after receiving Reiki at a cancer infusion center.

    Science.gov (United States)

    Marcus, Dawn A; Blazek-O'Neill, Betsy; Kopar, Jennifer L

    2013-03-01

    To evaluate patient-perceived benefits from receiving Reiki at a cancer infusion center. During a 6-month period, adults at a university hospital receiving Reiki through volunteer services were invited to complete a survey asking about perceived changes after Reiki. Changes in pain, mood, distress, sleep, and appetite were rated on a 5-point scale from no benefit to great benefit. Surveys were distributed after completing treatment and were returned in postage-paid envelops. A total of 145 surveys were completed (34.5% response rate), with 47 participants seen in the cancer infusion center and 98 in other areas of the hospital. Reiki was rated as a positive experience by 94% at the cancer center and 93% of others, with 92% at the cancer center and 86% of others interested in receiving additional Reiki sessions. Symptomatic improvement was similar for people at the cancer center and others, respectively, with much to great improvement for 89% and 86% for relaxation, 75% and 75% for anxiety/worry, 81% and 78% for improved mood, 43% and 35% for improved sleep, 45% and 49% for reduced pain, 38% and 43% for reduced isolation/loneliness, 75% and 63% for improved attitude, and 30% and 30% for improved appetite. Response was unaffected by previous exposure to Reiki, massage, or other touch therapy. Reiki results in a broad range of symptomatic benefits, including improvements in common cancer-related symptoms.

  9. Contrast-enhanced spectral mammography improves diagnostic accuracy in the symptomatic setting.

    Science.gov (United States)

    Tennant, S L; James, J J; Cornford, E J; Chen, Y; Burrell, H C; Hamilton, L J; Girio-Fragkoulakis, C

    2016-11-01

    To assess the diagnostic accuracy of contrast-enhanced spectral mammography (CESM), and gauge its "added value" in the symptomatic setting. A retrospective multi-reader review of 100 consecutive CESM examinations was performed. Anonymised low-energy (LE) images were reviewed and given a score for malignancy. At least 3 weeks later, the entire examination (LE and recombined images) was reviewed. Histopathology data were obtained for all cases. Differences in performance were assessed using receiver operator characteristic (ROC) analysis. Sensitivity, specificity, and lesion size (versus MRI or histopathology) differences were calculated. Seventy-three percent of cases were malignant at final histology, 27% were benign following standard triple assessment. ROC analysis showed improved overall performance of CESM over LE alone, with area under the curve of 0.93 versus 0.83 (p<0.025). CESM showed increased sensitivity (95% versus 84%, p<0.025) and specificity (81% versus 63%, p<0.025) compared to LE alone, with all five readers showing improved accuracy. Tumour size estimation at CESM was significantly more accurate than LE alone, the latter tending to undersize lesions. In 75% of cases, CESM was deemed a useful or significant aid to diagnosis. CESM provides immediately available, clinically useful information in the symptomatic clinic in patients with suspicious palpable abnormalities. Radiologist sensitivity, specificity, and size accuracy for breast cancer detection and staging are all improved using CESM as the primary mammographic investigation. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  10. The Course of Neurocognitive Changes in Acute Psychosis: Relation to Symptomatic Improvement.

    Directory of Open Access Journals (Sweden)

    Liss Anda

    Full Text Available Cognitive impairment is a core aspect of psychosis, but the course of cognitive functioning during acute psychosis remains poorly understood, as does the association between symptom change and neurocognitive change. Some studies have found cognitive improvement to be related to improvement in negative symptoms, but few have examined cognitive changes in the early acute phase, when clinical improvement mainly happens. This study's aim was to investigate the relation between cognitive and symptomatic change in clinically heterogeneous patients during the early acute phase of psychosis.Participants (n = 84, including both first-episode and previously ill patients, were recruited from consecutive admissions to the acute psychiatric emergency ward of Haukeland University Hospital, Bergen, Norway, as part of the Bergen Psychosis Project (BPP. The RBANS neurocognitive test battery was administered on admission and again at discharge from the acute ward (mean time 4.1 weeks, SD 1.86 weeks. Symptomatic change was measured by PANSS.The proportion of subjects with cognitive impairment (t < 35 was 28.6% in the acute phase and 13.1% at follow-up. A sequential multiple linear regression model with RBANS change as the dependent variable found PANSS negative symptoms change to significantly predict total RBANS performance improvement (beta = -.307, p = .016. There was no significant difference between subjects with schizophrenia and those with other psychotic disorders in terms of cognitive change.The proportion of subjects with mild to moderate impairment in cognitive test performance is reduced across the acute phase of psychosis, with improvement related to amelioration of negative symptoms.

  11. Improvement of research reactor sustainability

    International Nuclear Information System (INIS)

    Ciocanescu, M.; Paunoiu, C.; Toma, C.; Preda, M.; Ionila, M.

    2010-01-01

    The Research Reactors as is well known have numerous applications in a wide range of science technology, nuclear power development, medicine, to enumerate only the most important. The requirements of clients and stack-holders are fluctuating for the reasons out of control of Research Reactor Operating Organization, which may ensure with priority the safety of facility and nuclear installation. Sustainability of Research Reactor encompasses several aspects which finally are concentrated on safety of Research Reactor and economical aspects concerning operational expenses and income from external resources. Ensuring sustainability is a continuous, permanent activity and also it requests a strategic approach. The TRIGA - 14 MW Research Reactor detains a 30 years experience of safe utilization with good performance indicators. In the last 4 years the reactor benefited of a large investment project for modernization, thus ensuring the previous performances and opening new perspectives for power increase and for new applications. The previous core conversion from LEU to HEU fuel accomplished in 2006 ensures the utilization of reactor based on new qualified European supplier of TRIGA LEU fuel. Due to reduction of number of performed research reactors, the 14 MW TRIGA modernized reactor will play a significant role for the following two decades. (author)

  12. Sustaining motivation for continuous improvement

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Kofoed, Lise Busk

    2007-01-01

    The objective of this article is to explore possibilities for improving motivation for participation in Continuous Improvement (CI). Due to a number of issues, for example, challenges with measuring outcomes of CI activities on performance, the inherent slower, incremental rather than big bang...... activities is an important issue for managers. The paper begins with a short description of CI, with an emphasis on barriers to successful implementation cited in the literature. Thereafter, a number of widely-acknowledged-albeit perhaps somewhat dated-theories of motivation are explored in relation...... to the elements of CI in practice. Based on their own experiences with CI implementation in numerous action-research based studies, the authors propose a scenario for motivating CI participation through emphasis on factors common to the presented motivational theories. The paper ends with insights into future...

  13. Symptomatic relief precedes improvement of myocardial blood flow in patients under spinal cord stimulation

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    Koulousakis Athanassios

    2005-05-01

    Full Text Available Abstract Background Spinal cord electrical stimulation (SCS has shown to be a treatment option for patients suffering from angina pectoris CCS III-IV although being on optimal medication and not suitable for conventional treatment strategies, e.g. CABG or PTCA. Although many studies demonstrated a clear symptomatic relief under SCS therapy, there are only a few short-term studies that investigated alterations in cardiac ischemia. Therefore doubts remain whether SCS has a direct effect on myocardial perfusion. Methods A prospective study to investigate the short- and long-term effect of spinal cord stimulation (SCS on myocardial ischemia in patients with refractory angina pectoris and coronary multivessel disease was designed. Myocardial ischemia was measured by MIBI-SPECT scintigraphy 3 months and 12 months after the beginning of neurostimulation. To further examine the relation between cardiac perfusion and functional status of the patients we measured exercise capacity (bicycle ergometry and 6-minute walk test, symptoms and quality of life (Seattle Angina Questionnaire [SAQ], as well. Results 31 patients (65 ± 11 SEM years; 25 male, 6 female were included into the study. The average consumption of short acting nitrates (SAN decreased rapidly from 12 ± 1.6 times to 3 ± 1 times per week. The walking distance and the maximum workload increased from 143 ± 22 to 225 ± 24 meters and 68 ± 7 to 96 ± 12 watt after 3 months. Quality of life increased (SAQ significantly after 3 month compared to baseline, as well. No further improvement was observed after one year of treament. Despite the symptomatic relief and the improvement in maximal workload computer based analysis (Emory Cardiac Toolbox of the MIBI-SPECT studies after 3 months of treatment did not show significant alterations of myocardial ischemia compared to baseline (16 patients idem, 7 with increase and 6 with decrease of ischemia, 2 patients dropped out during initial test phase

  14. Improving science education for sustainable development

    NARCIS (Netherlands)

    Eijck, van M.W.; Roth, W.-M.

    2007-01-01

    In recent issues of noteworthy journals, natural scientists have argued for the improvement of science education [1–4]. Such pleas reflect the growing awareness that high-quality science education is required not only for sustaining a lively scientific community that is able to address global

  15. Enabling Sustainable Improvement in IT Entrepreneurship

    Directory of Open Access Journals (Sweden)

    Paul E. Renaud

    2013-06-01

    Full Text Available Firms must embrace processes that enable the information technology (IT function to become a strategic partner to the business functions it serves. Process ambidexterity is a way for processes to be augmented to improve alignment and adaptability to new markets and technologies. By applying the principles of process ambidexterity, the key elements required for sustainable change within the capabilities that comprise the IT function of the firm are identified. Furthermore, the scope and depth of the dysfunction that is widespread across large firms that depend upon IT are outlined to provide a contextual basis for presenting a solution framework to address sustainable change. This framework for sustainable change is of primary benefit to IT executives seeking to systematically transform the IT function and enable IT entrepreneurship.

  16. Visual Aids for Improving Patient Decision Making in Severe Symptomatic Carotid Stenosis.

    Science.gov (United States)

    Fridman, Sebastian; Saposnik, Gustavo; Sposato, Luciano A

    2017-12-01

    Because of the large amount of information to process and the limited time of a clinical consult, choosing between carotid endarterectomy (CEA) and carotid angioplasty with stenting (CAS) can be confusing for patients with severe symptomatic internal carotid stenosis (ICA). We aim to develop a visual aid tool to help clinicians and patients in the decision-making process of selecting between CEA and CAS. Based on pooled analysis from randomized controlled trials including patients with symptomatic and severe ICA (SSICA), we generated visual plots comparing CEA with CAS for 3 prespecified postprocedural time points: (1) any stroke or death at 4 months, and (2) any stroke or death in the first 30 days and ipsilateral stroke thereafter at 5 years and (3) at 10 years. A total of 4574 participants (2393 assigned to CAS, and 2361 to CEA) were included in the analyses. For every 100 patients with SSICA, 6 would develop any stroke or death in the CEA group compared with 9 undergoing CAS at 4 months (hazard ratio [HR] 1.53; 95%CI 1.20-1.95). At 5 years, 7 patients in the CEA group would develop any periprocedural stroke or death and ipsilateral stroke thereafter versus 12 undergoing CAS (HR 1.72; 95%CI 1.24-2.39), compared with 10 patients in the CEA and 13 in the CAS groups at 10 years (HR 1.17; 95%CI 0.82-1.66). Visual aids presented in this study could potentially help patients with severe symptomatic internal carotid stenosis to better weigh the risks and benefits of CEA versus CAS as a function of time, allowing for the prioritization of personal preferences, and should be prospectively assessed. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  17. Sustainable Improvement of Animal Production and Health

    International Nuclear Information System (INIS)

    Odongo, N.E.; Garcia, M.; Viljoen, G.J.

    2010-01-01

    The world's poorest people, some one billion living mostly in Africa and Asia, depend on livestock for their day-to-day livelihood. To reduce poverty, fight hunger and ensure global food security, there is an urgent need to increase livestock production in sustainable ways. However, livestock production in developing countries is constrained by low genetic potential of the animals, poor nutrition and husbandry practices and infectious diseases. Nuclear techniques, when applied in conjunction with conventional methods, can identify constraints to livestock productivity as well as interventions that lead to their reduction or elimination in ways that are economically and socially acceptable. The challenge is how best to exploit these techniques for solving problems faced by livestock keepers within the many agricultural production systems that exist in developing countries and demonstrating their advantages to owners, local communities and government authorities. This publication is a compilation of the contributions emanating from an international Symposium on Sustainable Improvement of Animal Production and Health organised by the Joint FAO/IAEA Division of Nuclear Techniques in Food and Agriculture in cooperation with the Animal Production and Health Division of FAO. It provides invaluable information not only on how nuclear and related techniques can be used to support sustainable livestock production systems, but also about the constraints and opportunities for using these techniques in developing countries; it also attempts to identify specific research needs and gaps and new options for using these techniques for solving established and emerging problems. As such, it is hoped that the information presented and suggestions made will provide valuable guidance to scientists in both the public and private sectors as well as to government and institutional policy and decision makers. The Symposium comprised a plenary session and four thematic sessions, covering (i

  18. Sustainable Improvement of Animal Production and Health

    Energy Technology Data Exchange (ETDEWEB)

    Odongo, N E; Garcia, M; Viljoen, G J [Animal Production and Health Subprogramme, Joint FAO/IAEA Division of Nuclear Techniques in Food and Agriculture, Department of Nuclear Sciences and Applications, International Atomic Agency, Vienna (Austria)

    2010-07-01

    The world's poorest people, some one billion living mostly in Africa and Asia, depend on livestock for their day-to-day livelihood. To reduce poverty, fight hunger and ensure global food security, there is an urgent need to increase livestock production in sustainable ways. However, livestock production in developing countries is constrained by low genetic potential of the animals, poor nutrition and husbandry practices and infectious diseases. Nuclear techniques, when applied in conjunction with conventional methods, can identify constraints to livestock productivity as well as interventions that lead to their reduction or elimination in ways that are economically and socially acceptable. The challenge is how best to exploit these techniques for solving problems faced by livestock keepers within the many agricultural production systems that exist in developing countries and demonstrating their advantages to owners, local communities and government authorities. This publication is a compilation of the contributions emanating from an international Symposium on Sustainable Improvement of Animal Production and Health organised by the Joint FAO/IAEA Division of Nuclear Techniques in Food and Agriculture in cooperation with the Animal Production and Health Division of FAO. It provides invaluable information not only on how nuclear and related techniques can be used to support sustainable livestock production systems, but also about the constraints and opportunities for using these techniques in developing countries; it also attempts to identify specific research needs and gaps and new options for using these techniques for solving established and emerging problems. As such, it is hoped that the information presented and suggestions made will provide valuable guidance to scientists in both the public and private sectors as well as to government and institutional policy and decision makers. The Symposium comprised a plenary session and four thematic sessions, covering (i

  19. A Longitudinal Study of School Districts' Sustained Improvement

    Science.gov (United States)

    Sampson, Pauline M.

    2011-01-01

    In this longitudinal study of one region in the state of Texas, there was an examination of district leadership and the sustaining of high student achievement for their districts. The results of this study suggest that sustained improvement of student achievement is very difficult. The districts that had sustained improvement had stable district…

  20. Leadership Capacity--A Key to Sustaining Lasting Improvement

    Science.gov (United States)

    Williams, Henry S.

    2009-01-01

    Studies on school change indicate that schools successful in sustaining school improvement build capacity for leadership within the organization (Harris & Lambert, 2003). Reliance on the leadership of the principal alone is no longer viable if schools are to improve and sustain improvement. Leadership capacity is about creating conditions…

  1. Implementing and Sustaining School Improvement. The Informed Educator Series

    Science.gov (United States)

    Protheroe, Nancy

    2011-01-01

    This "Informed Educator" examines research-proven strategies for implementing and sustaining school improvement by looking at the key elements of the process, enabling conditions for improvement, issues of school culture, and implementation. It also looks at school turnarounds and how to sustain school improvement once reforms are implemented.

  2. A case of recurrent breast cancer with intramedullary spinal cord metastasis and symptomatic improvement by Radiation Therapy

    International Nuclear Information System (INIS)

    Wakahara, Makoto; Hosoya, Keiko; Hirooka, Yumi

    2017-01-01

    A 65-year-old woman underwent surgery for right breast cancer (TIN1aM0) in December 2005. In March 2011, the breast cancer recurred with multiple lung and lymph node metastases. In February 2013, because of multiple brain metastases whole-brain radiation therapy was performed. In January 2014, she developed paralysis of the left leg. Spinal cord magnetic resonance imaging revealed a mass lesion (Th12 to L1 level) in the spinal cord, and she was diagnosed with intramedullary spinal cord metastasis (ISCM) from the breast cancer. Spinal cord irradiation reduced the metastasis and improved her paralysis. Although pharmacotherapy was continued, her metastases, with the exception of ISCM, progressed and she died of the disease in November 2014. It is necessary to diagnose ISCM at the time of its onset. Additionally immediate therapeutic intervention can significantly reduce the volume of ISCM, resulting in symptomatic relief from neurological deficit; in this case, radiation therapy was effective. (author)

  3. Sustained School Improvement: A Case of How School Leaders ...

    African Journals Online (AJOL)

    Sustained School Improvement: A Case of How School Leaders Strategise for School Improvement in Zimbabwean Primary Schools. ... Zimbabwe Journal of Educational Research. Journal Home · ABOUT THIS JOURNAL · Advanced Search ...

  4. The executive control network and symptomatic improvement in attention-deficit/hyperactivity disorder

    NARCIS (Netherlands)

    Francx, Winke; Oldehinkel, Marianne; Oosterlaan, Jaap; Heslenfeld, Dirk; Hartman, Catharina A.; Hoekstra, Pieter J.; Franke, Barbara; Beckmann, Christian F.; Buitelaar, Jan K.; Mennes, Maarten

    2015-01-01

    Background: One neurodevelopmental theory hypothesizes remission of attention-deficit/hyperactivity disorder (ADHD) to result from improved prefrontal top-down control, while ADHD, independent of the current diagnosis, is characterized by stable non-cortical deficits (Halperin & Schulz, 2006). We

  5. Improving Sustainability Performance for Public-Private-Partnership (PPP Projects

    Directory of Open Access Journals (Sweden)

    Liyin Shen

    2016-03-01

    Full Text Available Improving sustainability performance in developing infrastructure projects is an important strategy for pursuing the mission of sustainable development. In recent years, the business model of public-private-partnership (PPP is promoted as an effective approach in developing infrastructure projects. It is considered that the distribution of the contribution on project investment between private and public sectors is one of the key variables affecting sustainability performance of PPP-type projects. This paper examines the impacts of the contribution distribution between public and private sectors on project sustainability performance. A model named the sustainability performance-based evaluation model (SPbEM is developed for assisting the assessment of the level of sustainability performance of PPP projects. The study examines the possibility of achieving better sustainability through proper arrangement of the investment distribution between the two primary sectors in developing PPP-type infrastructure projects.

  6. Improving the livelihoods of wool producers in a sustainable manner ...

    African Journals Online (AJOL)

    Improving the livelihoods of wool producers in a sustainable manner by optimizing the woolled sheep production systems within the communal farming area of the Eastern Cape. “A vision that is future directed”

  7. School effectiveness and school improvement : Sustaining links

    NARCIS (Netherlands)

    Creemers, B.P.M.; Reezigt, G.J.

    1997-01-01

    Ideally, school effectiveness research and school improvement might have a relationship with a surplus value for both. In reality, this relationship is often troublesome. Some problems can be attributed to the intrinsic differences between effectiveness and improvement, such as different missions.

  8. How to Sustain Change and Support Continuous Quality Improvement.

    Science.gov (United States)

    Silver, Samuel A; McQuillan, Rory; Harel, Ziv; Weizman, Adam V; Thomas, Alison; Nesrallah, Gihad; Bell, Chaim M; Chan, Christopher T; Chertow, Glenn M

    2016-05-06

    To achieve sustainable change, quality improvement initiatives must become the new way of working rather than something added on to routine clinical care. However, most organizational change is not maintained. In this next article in this Moving Points in Nephrology feature on quality improvement, we provide health care professionals with strategies to sustain and support quality improvement. Threats to sustainability may be identified both at the beginning of a project and when it is ready for implementation. The National Health Service Sustainability Model is reviewed as one example to help identify issues that affect long-term success of quality improvement projects. Tools to help sustain improvement include process control boards, performance boards, standard work, and improvement huddles. Process control and performance boards are methods to communicate improvement results to staff and leadership. Standard work is a written or visual outline of current best practices for a task and provides a framework to ensure that changes that have improved patient care are consistently and reliably applied to every patient encounter. Improvement huddles are short, regular meetings among staff to anticipate problems, review performance, and support a culture of improvement. Many of these tools rely on principles of visual management, which are systems transparent and simple so that every staff member can rapidly distinguish normal from abnormal working conditions. Even when quality improvement methods are properly applied, the success of a project still depends on contextual factors. Context refers to aspects of the local setting in which the project operates. Context affects resources, leadership support, data infrastructure, team motivation, and team performance. For these reasons, the same project may thrive in a supportive context and fail in a different context. To demonstrate the practical applications of these quality improvement principles, these principles are

  9. Improving Sustainability through a Dual Audit System

    Directory of Open Access Journals (Sweden)

    Shun-Ji Jin

    2018-01-01

    Full Text Available As a consequence of a large-scale accounting fraud, China implemented a dual audit system for listed companies issuing foreign stocks (B shares and H shares from 2001 to 2006, before adopting Chinese-IFRS in 2007. At the end of 2010, the EU proposed that listed corporations over a certain size should be required to implement a joint audit system. However, only a few countries have implemented this system, and thus, data and references are extremely limited. The dual audit system is called the “twin” of the joint audit system. We analyze whether the dual system improves a company’s earnings quality. Earnings quality is studied by means of real earnings management, and the variable of loss aversion. We find that real earnings management of dual audited enterprises is lower than that of single audited (A-share enterprises, and the inclination toward loss aversion of enterprises in the foreign share market has not increased significantly relative to the A-share enterprises after the abolition of the dual audit system. The results indicate that a dual audit system improves earnings quality. We expect that the conclusions of this research will resolve the issues and concerns about the joint audit system.

  10. Green innovation and sustainable industrial systems within sustainability and company improvement perspective

    Science.gov (United States)

    Edi Nugroho Soebandrija, Khristian

    2017-12-01

    This paper comprises discussion of Green Innovation and Sustainable Industrial Systems within Sustainability and Company Improvement Perspective of beverage manufacturing company (BMC). The stakeholder theory is the grand theory for the company improvement perspective in this paper. The data processing in this paper is conducted through software which are SEM-PLS with SmartPLS 2.0 and SPSS 19. The specified objective of this paper has focus on sustainability as one of 6 variables, in lieu of those 6 variables as the big picture. The reason behind this focus on sustainability is the fact that there are assorted challenges in sustainability that is ranging from economic, environment and company perspectives. Those challenges in sustainability include the sustainable service supply chain management and its involvement of society. The overall objective is to analyze relationship hypothesis of 6 variables, 4 of them (leadership, organizational learning, innovation, and performance) are based on Malcolm Baldrige’s performance excellence concept to achieve sustainability and competitive advantage through company-competitor and customer questionnaire, and its relation to Total Quality Management (TQM) and Quality Management System (QMS). In conclusion, the spearheaded of company improvement in this paper is in term of consumer satisfaction through 99.997% quality standards. These can be achieved by ambidexterity through exploitation and exploration innovation. Furthermore, in this paper, TQM enables to obtain popularity brand index achievement that is greater than 45.9%. Subsequently, ISO22000 of food security standard encompasses quality standard of ISO9000 and HACCP. Through the ambidexterity of exploitation and exploration (Non Standard Product Inspection) NOSPI machine, the company improvement generates the achievement of 75% automation, 99.997% quality control standard and 80% of waste reduction.

  11. Improving Sustainability of Ion Implant Modules

    Science.gov (United States)

    Mayer, Jim

    2011-01-01

    Semiconductor fabs have long been pressured to manage capital costs, reduce energy consumption and increasingly improve efforts to recycle and recover resources. Ion implant tools have been high-profile offenders on all three fronts. They draw such large volumes of air for heat dissipation and risk reduction that historically, they are the largest consumer of cleanroom air of any process tool—and develop energy usage and resource profiles to match. This paper presents a documented approach to reduce their energy consumption and dramatically downsize on-site facilities support for cleanroom air manufacture and abatement. The combination produces significant capital expenditure savings. The case entails applying SAGS Type 1 (sub-atmospheric gas systems) toxic gas packaging to enable engineering adaptations that deliver the energy savings and cost benefits without any reduction in environmental health and safety. The paper also summarizes benefits as they relate to reducing a fabs carbon emission footprint (and longer range advantages relative to potential cap and trade programs) with existing technology.

  12. Sustainability in the AAP Bronchiolitis Quality Improvement Project.

    Science.gov (United States)

    Shadman, Kristin A; Ralston, Shawn L; Garber, Matthew D; Eickhoff, Jens; Mussman, Grant M; Walley, Susan C; Rice-Conboy, Elizabeth; Coller, Ryan J

    2017-11-01

    Adherence to American Academy of Pediatrics (AAP) bronchiolitis clinical practice guideline recommendations improved significantly through the AAP's multiinstitutional collaborative, the Bronchiolitis Quality Improvement Project (BQIP). We assessed sustainability of improvements at participating institutions for 1 year following completion of the collaborative. Twenty-one multidisciplinary hospital-based teams provided monthly data for key inpatient bronchiolitis measures during baseline and intervention bronchiolitis seasons. Nine sites provided data in the season following completion of the collaborative. Encounters included children younger than 24 months who were hospitalized for bronchiolitis without comorbid chronic illness, prematurity, or intensive care. Changes between baseline-, intervention-, and sustainability-season data were assessed using generalized linear mixed-effects models with site-specific random effects. Differences between hospital characteristics, baseline performance, and initial improvement between sites that did and did not participate in the sustainability season were compared. A total of 2275 discharges were reviewed, comprising 995 baseline, 877 intervention, and 403 sustainability- season encounters. Improvements in all key bronchiolitis quality measures achieved during the intervention season were maintained during the sustainability season, and orders for intermittent pulse oximetry increased from 40.6% (95% confidence interval [CI], 22.8-61.1) to 79.2% (95% CI, 58.0- 91.3). Sites that did and did not participate in the sustainability season had similar characteristics. BQIP participating sites maintained improvements in key bronchiolitis quality measures for 1 year following the project's completion. This approach, which provided an evidence-based best-practice toolkit while building the quality-improvement capacity of local interdisciplinary teams, may support performance gains that persist beyond the active phase of the

  13. Sustainable Monitoring and Surveillance Systems to Improve HIV Programs: Review.

    Science.gov (United States)

    Low-Beer, Daniel; Mahy, Mary; Renaud, Francoise; Calleja, Txema

    2018-04-24

    HIV programs have provided a major impetus for investments in surveillance data, with 5-10% of HIV program budgets recommended to support data. However there are questions concerning the sustainability of these investments. The Sustainable Development Goals have consolidated health into one goal and communicable diseases into one target (Target 3.3). Sustainable Development Goals now introduce targets focused specifically on data (Targets 17.18 and 17.19). Data are seen as one of the three systemic issues (in Goal 17) for implementing Sustainable Development Goals, alongside policies and partnerships. This paper reviews the surveillance priorities in the context of the Sustainable Development Goals and highlights the shift from periodic measurement towards sustainable disaggregated, real-time, case, and patient data, which are used routinely to improve programs. Finally, the key directions in developing person-centered monitoring systems are assessed with country examples. The directions contribute to the Sustainable Development Goal focus on people-centered development applied to data. ©Daniel Low-Beer, Mary Mahy, Francoise Renaud, Txema Calleja. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 24.04.2018.

  14. Improving the environmental sustainability of a waste processing plant

    Energy Technology Data Exchange (ETDEWEB)

    Turner, Tom [AREVA RMC, Abingdon, Oxfordshire (United Kingdom); Watson, Stuart [RSRL, Harwell, Oxfordshire (United Kingdom)

    2013-07-01

    This paper describes how the level of environmental sustainability at the Solid Waste Processing plant at Research Sites Restoration Ltd (RSRL) Harwell was measured and improved. It provides reasons to improve environmental performance in an organisation, states best practice on how improvement should be conducted, and gives first-hand experience on how changes were implemented. In this paper sustainability is defined as 'meeting the needs of the present without compromising the ability of future generations to meet their own needs'. A baseline for environmental sustainability was created, by looking at multiple attributes. From this, a matrix was created to show how the baseline environmental performance compared to best practice, and a gap analysis was performed. Results from this analysis showed areas for potential systematic improvement, and actions were created. Nearly all actions were implemented within one year, and environmental sustainability improved significantly. Most improvements cost no money to implement, and the few that did had to pass criteria in a business case. Results from a company-wide survey showed that the vast majority of employees felt that environmental issues were important, and that they were willing to help improve performance. Environmental awareness training was given to everyone in the department, and individuals were given measurable improvement targets. A focus group was set up and met regularly to agree improvements and monitor results. Environmental performance was publicised regularly to highlight successes and seek further engagement and improvement. Improvement ideas were encouraged and managed in a transparent way which showed clear prioritisation and accountability. The culture of environmental improvement changed visibly and results at the end of the first year showed that electricity consumption had reduced by 12.5%, and gas consumption had reduced by 7.3%. In less than two years over UK Pound 60,000 was saved

  15. Improving the environmental sustainability of a waste processing plant

    International Nuclear Information System (INIS)

    Turner, Tom; Watson, Stuart

    2013-01-01

    This paper describes how the level of environmental sustainability at the Solid Waste Processing plant at Research Sites Restoration Ltd (RSRL) Harwell was measured and improved. It provides reasons to improve environmental performance in an organisation, states best practice on how improvement should be conducted, and gives first-hand experience on how changes were implemented. In this paper sustainability is defined as 'meeting the needs of the present without compromising the ability of future generations to meet their own needs'. A baseline for environmental sustainability was created, by looking at multiple attributes. From this, a matrix was created to show how the baseline environmental performance compared to best practice, and a gap analysis was performed. Results from this analysis showed areas for potential systematic improvement, and actions were created. Nearly all actions were implemented within one year, and environmental sustainability improved significantly. Most improvements cost no money to implement, and the few that did had to pass criteria in a business case. Results from a company-wide survey showed that the vast majority of employees felt that environmental issues were important, and that they were willing to help improve performance. Environmental awareness training was given to everyone in the department, and individuals were given measurable improvement targets. A focus group was set up and met regularly to agree improvements and monitor results. Environmental performance was publicised regularly to highlight successes and seek further engagement and improvement. Improvement ideas were encouraged and managed in a transparent way which showed clear prioritisation and accountability. The culture of environmental improvement changed visibly and results at the end of the first year showed that electricity consumption had reduced by 12.5%, and gas consumption had reduced by 7.3%. In less than two years over UK Pound 60,000 was saved

  16. Sustaining Operational Resiliency: A Process Improvement Approach to Security Management

    National Research Council Canada - National Science Library

    Caralli, Richard A

    2006-01-01

    .... Coordinating these efforts to sustain operational resiliency requires a process-oriented approach that can be defined, measured, and actively managed. This report describes the fundamental elements and benefits of a process approach to security and operational resiliency and provides a notional view of a framework for process improvement.

  17. Facilities improvement for sustainability of existing public office ...

    African Journals Online (AJOL)

    The study examined the building design features of a cosmopolitan public office building in Abuja. The features were classified into Spatial Plan, Structure and Facilities, to determine which of the 3 variables requires urgent sustainable improvement from end-users' perspective in existing public office buildings in developing ...

  18. Improvement in 24-hour bronchodilation and symptom control with aclidinium bromide versus tiotropium and placebo in symptomatic patients with COPD: post hoc analysis of a Phase IIIb study

    Directory of Open Access Journals (Sweden)

    Beier J

    2017-06-01

    Full Text Available Jutta Beier,1 Robert Mroz,2,3 Anne-Marie Kirsten,4 Ferran Chuecos,5 Esther Garcia Gil5 1insaf Respiratory Research Institute, Wiesbaden, Germany; 2Centrum Medycyny Oddechowej, 3Medical University of Białystok, Białystok, Poland; 4Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany; 5AstraZeneca PLC, Barcelona, Spain Background: A previous Phase IIIb study (NCT01462929 in patients with moderate to severe COPD demonstrated that 6 weeks of treatment with aclidinium led to improvements in 24-hour bronchodilation comparable to those with tiotropium, and improvement of symptoms versus placebo. This post hoc analysis was performed to assess the effect of treatment in the symptomatic patient group participating in the study. Methods: Symptomatic patients (defined as those with Evaluating Respiratory Symptoms [E-RS™] in COPD baseline score ≥10 units received aclidinium bromide 400 µg twice daily (BID, tiotropium 18 µg once daily (QD, or placebo, for 6 weeks. Lung function, COPD respiratory symptoms, and incidence of adverse events (AEs were assessed. Results: In all, 277 symptomatic patients were included in this post hoc analysis. Aclidinium and tiotropium treatment improved forced expiratory volume in 1 second (FEV1 from baseline to week 6 at all time points over 24 hours versus placebo. In addition, improvements in FEV1 from baseline during the nighttime period were observed for aclidinium versus tiotropium on day 1 (aclidinium 157 mL, tiotropium 67 mL; P<0.001 and week 6 (aclidinium 153 mL, tiotropium 90 mL; P<0.05. Aclidinium improved trough FEV1 from baseline versus placebo and tiotropium at day 1 (aclidinium 136 mL, tiotropium 68 mL; P<0.05 and week 6 (aclidinium 137 mL, tiotropium 71 mL; P<0.05. Aclidinium also improved early-morning and nighttime symptom severity, limitation of early-morning activities, and E-RS Total and domain scores versus

  19. Postoperative Reverse Remodeling and Symptomatic Improvement in Normal-Flow Low-Gradient Aortic Stenosis After Aortic Valve Replacement

    DEFF Research Database (Denmark)

    Carter-Storch, Rasmus; Møller, Jacob E; Christensen, Nicolaj L

    2017-01-01

    BACKGROUND: Severe aortic stenosis (AS) most often presents with reduced aortic valve area (benefit of aortic valve...... replacement (AVR) among NFLG patients is controversial. We compared the impact of NFLG condition on preoperative left ventricular (LV) remodeling and myocardial fibrosis and postoperative remodeling and symptomatic benefit. METHODS AND RESULTS: Eighty-seven consecutive patients with reduced aortic valve area...... and normal stroke volume index undergoing AVR underwent echocardiography, magnetic resonance imaging, a 6-minute walk test, and measurement of natriuretic peptides before and 1 year after AVR. Myocardial fibrosis was assessed from magnetic resonance imaging. Patients were stratified as NFLG or normal...

  20. Postoperative Reverse Remodeling and Symptomatic Improvement in Normal-Flow Low-Gradient Aortic Stenosis After Aortic Valve Replacement.

    Science.gov (United States)

    Carter-Storch, Rasmus; Møller, Jacob E; Christensen, Nicolaj L; Irmukhadenov, Akhmadjon; Rasmussen, Lars M; Pecini, Redi; Øvrehus, Kristian A; Søndergård, Eva V; Marcussen, Niels; Dahl, Jordi S

    2017-12-01

    Severe aortic stenosis (AS) most often presents with reduced aortic valve area (gradient (≥40 mm Hg; normal-flow high-gradient AS) or low mean gradient (normal-flow low-gradient [NFLG] AS). The benefit of aortic valve replacement (AVR) among NFLG patients is controversial. We compared the impact of NFLG condition on preoperative left ventricular (LV) remodeling and myocardial fibrosis and postoperative remodeling and symptomatic benefit. Eighty-seven consecutive patients with reduced aortic valve area and normal stroke volume index undergoing AVR underwent echocardiography, magnetic resonance imaging, a 6-minute walk test, and measurement of natriuretic peptides before and 1 year after AVR. Myocardial fibrosis was assessed from magnetic resonance imaging. Patients were stratified as NFLG or normal-flow high-gradient. In total, 33 patients (38%) had NFLG. Before AVR, they were characterized by similar symptom burden but less severe AS measured by aortic valve area index (0.50±0.09 versus 0.40±0.08 cm 2 /m 2 ; P gradient condition independently predicted change in LV mass index. Patients with NFLG had less severe AS and LV remodeling than patients with normal-flow high-gradient. Furthermore, NFLG patients experienced less reverse remodeling but the same symptomatic benefit. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02316587. © 2017 American Heart Association, Inc.

  1. Sustainability of compressive residual stress by stress improvement processes

    International Nuclear Information System (INIS)

    Nishikawa, Satoru; Okita, Shigeru; Yamaguchi, Atsunori

    2013-01-01

    Stress improvement processes are countermeasures against stress corrosion cracking in nuclear power plant components. It is necessary to confirm whether compressive residual stress induced by stress improvement processes can be sustained under operation environment. In order to evaluate stability of the compressive residual stress in 60-year operating conditions, the 0.07% cyclic strains of 200 times at 593 K were applied to the welded specimens, then a thermal aging treatment for 1.66x10 6 s at 673 K was carried out. As the result, it was confirmed that the compressive residual stresses were sustained on both surfaces of the dissimilar welds of austenitic stainless steel (SUS316L) and nickel base alloy (NCF600 and alloy 182) processed by laser peening (LP), water jet peening (WJP), ultrasonic shot peening (USP), shot peening (SP) and polishing under 60-year operating conditions. (author)

  2. Improving animal health for poverty alleviation and sustainable livelihoods.

    Science.gov (United States)

    Stringer, Andy

    2014-11-29

    Animals are vital to ensuring food security for individuals, families and communities in countries around the world. In this, the latest article in Veterinary Record's series promoting One Health, Andy Stringer, director of veterinary programmes at the Society for the Protection of Animals Abroad, discusses how improving animal health, particularly of poultry and working equids, has the potential to reduce poverty and promote food security and sustainable livelihoods in low-income countries. British Veterinary Association.

  3. Sustainable Livestock Farming for Improving Socio-Economic Condition

    Directory of Open Access Journals (Sweden)

    Mohammad Shamsuddoha

    2013-01-01

    Full Text Available Sustainability is the most effective concept to improve socio-economic condition, including environment. Constructive socio-economic changes are getting priority in recent years among academia and business sector in Bangladesh. Bangladesh poultry sub-sector has long supply chains having associated with various stakeholders. In this paper, a case poultry farm was taken to examine a production process that links with socio-economic benefits. Design science method under the quantitative paradigm was chosen to develop a model for the case industry. A Simulation model was developed using simul8 software to construct the real poultry operation. The objectives of this paper are to construct a sustainable model for a case poultry industry along with socio-economic issues. Later, simulated model output will examine it through various performance indicators (KPIs to find out the impacts on socio-economic benefits. Numbers of KPIs have been briefly discussed in light of the research problem to illustrate positive effects of sustainable production.

  4. Sustainability.

    Science.gov (United States)

    Chang, Chein-Chi; DiGiovanni, Kimberly; Mei, Ying; Wei, Li

    2016-10-01

    This review on Sustainability covers selected 2015 publications on the focus of Sustainability. It is divided into the following sections : • Sustainable water and wastewater utilities • Sustainable water resources management • Stormwater and green infrastructure • Sustainability in wastewater treatment • Life cycle assessment (LCA) applications • Sustainability and energy in wastewater industry, • Sustainability and asset management.

  5. Improved stoves in India: A study of sustainable business models

    International Nuclear Information System (INIS)

    Shrimali, Gireesh; Slaski, Xander; Thurber, Mark C.; Zerriffi, Hisham

    2011-01-01

    Burning of biomass for cooking is associated with health problems and climate change impacts. Many previous efforts to disseminate improved stoves – primarily by governments and NGOs – have not been successful. Based on interviews with 12 organizations selling improved biomass stoves, we assess the results to date and future prospects of commercial stove operations in India. Specifically, we consider how the ability of these businesses to achieve scale and become self-sustaining has been influenced by six elements of their respective business models: design, customers targeted, financing, marketing, channel strategy, and organizational characteristics. The two companies with the most stoves in the field shared in common generous enterprise financing, a sophisticated approach to developing a sales channel, and many person-years of management experience in marketing and operations. And yet the financial sustainability of improved stove sales to households remains far from assured. The only company in our sample with demonstrated profitability is a family-owned business selling to commercial rather than household customers. The stove sales leader is itself now turning to the commercial segment to maintain flagging cash flow, casting doubt on the likelihood of large positive impacts on health from sales to households in the near term. - Highlights: ► Business models to sell improved stoves can be viable in India. ► Commercial stove efforts may not be able to deliver all the benefits hoped for. ► The government could play a useful role if policies are targeted and well thought-out. ► Develops models for that hard-to-define entity mixing business and charity.

  6. Implementing electronic handover: interventions to improve efficiency, safety and sustainability.

    Science.gov (United States)

    Alhamid, Sharifah Munirah; Lee, Desmond Xue-Yuan; Wong, Hei Man; Chuah, Matthew Bingfeng; Wong, Yu Jun; Narasimhalu, Kaavya; Tan, Thuan Tong; Low, Su Ying

    2016-10-01

    Effective handovers are critical for patient care and safety. Electronic handover tools are increasingly used today to provide an effective and standardized platform for information exchange. The implementation of an electronic handover system in tertiary hospitals can be a major challenge. Previous efforts in implementing an electronic handover tool failed due to poor compliance and buy-in from end-users. A new electronic handover tool was developed and incorporated into the existing electronic medical records (EMRs) for medical patients in Singapore General Hospital (SGH). There was poor compliance by on-call doctors in acknowledging electronic handovers, and lack of adherence to safety rules, raising concerns about the safety and efficiency of the electronic handover tool. Urgent measures were needed to ensure its safe and sustained use. A quality improvement group comprising stakeholders, including end-users, developed multi-faceted interventions using rapid PDSA (P-Plan, D-Do, S-Study, A-Act ) cycles to address these issues. Innovative solutions using media and online software provided cost-efficient measures to improve compliance. The percentage of unacknowledged handovers per day was used as the main outcome measure throughout all PDSA cycles. Doctors were also assessed for improvement in their knowledge of safety rules and their perception of the electronic handover tool. An electronic handover tool complementing daily clinical practice can be successfully implemented using solutions devised through close collaboration with end-users supported by the senior leadership. A combined 'bottom-up' and 'top-down' approach with regular process evaluations is crucial for its long-term sustainability. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Clozapine for severe ("kraepelinian" schizophrenia: Sustained improvement over 5 years

    Directory of Open Access Journals (Sweden)

    Ricardo de Oliveira-Souza

    Full Text Available Abstract Clozapine has become a keystone in the treatment of schizophrenia because of its efficacy as an antipsychotic with negligible neuroleptic effects. The long-term stability of its effects, however, is poorly understood, because most studies have probed the usefulness of clozapine over a period of weeks to several months at the most. Knowing whether clozapine's benefits are sustained over the very long-term, i.e., more than 5 years, may be critical for cost-benefit analyses. Objective: To report the results of an open study on the efficacy of clozapine over the very long-term. Methods: Thirty-three adults (26 men with severe (kraepelinian schizophrenia were assessed at regular intervals using a brief neuropsychiatric battery over a 5-year period. Results: A significant improvement was observed between the pre-clozapine and the first "on-clozapine" evaluation. This improvement was paralleled by a remarkable conversion of schizophrenia from "active" (mostly paranoid into "residual" in 70% of all patients. Eight patients became functionally productive to the point of being capable of living an independent life. Roughly one-third of our cases showed no improvement. Conclusions: Clozapine is a safe and effective drug for patients with severe schizophrenia who have failed to improve on other antipsychotic drugs. Clozapine's maximal benefit is established by the end of the first year of treatment and continues unabated for many years thereafter. Clozapine-resistant patients remain a major challenge calling for the discovery of new treatments for schizophrenia.

  8. Perceived Factors Associated with Sustained Improvement Following Participation in a Multicenter Quality Improvement Collaborative.

    Science.gov (United States)

    Stone, Sohini; Lee, Henry C; Sharek, Paul J

    2016-07-01

    The California Perinatal Quality Care Collaborative led the Breastmilk Nutrition Quality Improvement Collaborative from October 2009 to September 2010 to increase the percentage of very low birth weight infants receiving breast milk at discharge in 11 collaborative neonatal ICUs (NICUs). Observed increases in breast milk feeding and decreases in necrotizing enterocolitis persisted for 6 months after the collaborative ended. Eighteen to 24 months after the end of the collaborative, some sites maintained or further increased their gains, while others trended back toward baseline. A study was conducted to assess the qualitative factors that affect sustained improvement following participation. Collaborative leaders at each of the 11 NICUs that participated in the Breastmilk Nutrition Quality Improvement Collaborative were invited to participate in a site-specific one-hour phone interview. Interviews were recorded and transcribed and then analyzed using qualitative research analysis software to identify themes associated with sustained improvement. Eight of 11 invited centers agreed to participate in the interviews. Thematic saturation was achieved by the sixth interview, so further interviews were not pursued. Factors contributing to sustainability included physician involvement within the multidisciplinary teams, continuous education, incorporation of interventions into the daily work flow, and integration of a data-driven feedback system. Early consideration by site leaders of how to integrate best-practice interventions into the daily work flow, and ensuring physician commitment and ongoing education based in continuous data review, should enhance the likelihood of sustaining improvements. To maximize sustained success, future collaborative design should consider proactively identifying and supporting these factors at participating sites.

  9. Sustainable Development Goals for Monitoring Action to Improve Global Health.

    Science.gov (United States)

    Cesario, Sandra K

    2016-01-01

    Women and children compose the largest segment of the more than 1 billion people worldwide who are unable to access needed health care services. To address this and other global health issues, the United Nations brought together world leaders to address growing health inequities, first by establishing the Millennium Development Goals in 2000 and more recently establishing Sustainable Development Goals, which are an intergovernmental set of 17 goals consisting of 169 targets with 304 indicators to measure compliance; they were designed to be applicable to all countries. Goal number 3, "Good Health and Well-Being: Ensure Heathy Lives and Promote Well-Being for All at All Ages," includes targets to improve the health of women and newborns. © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.

  10. Plants for Sustainable Improvement of Indoor Air Quality.

    Science.gov (United States)

    Brilli, Federico; Fares, Silvano; Ghirardo, Andrea; de Visser, Pieter; Calatayud, Vicent; Muñoz, Amalia; Annesi-Maesano, Isabella; Sebastiani, Federico; Alivernini, Alessandro; Varriale, Vincenzo; Menghini, Flavio

    2018-04-10

    Indoor pollution poses a serious threat to human health. Plants represent a sustainable but underexploited solution to enhance indoor air quality. However, the current selection of plants suitable for indoors fails to consider the physiological processes and mechanisms involved in phytoremediation. Therefore, the capacity of plants to remove indoor air pollutants through stomatal uptake (absorption) and non-stomatal deposition (adsorption) remains largely unknown. Moreover, the effects of the indoor plant-associated microbiome still need to be fully analyzed. Here, we discuss how a combination of the enhanced phytoremediation capacity of plants together with cutting-edge air-cleaning and smart sensor technologies can improve indoor life while reducing energy consumption. Copyright © 2018 Elsevier Ltd. All rights reserved.

  11. Sustainable Acquisition Process Improvement for Naval Facilities Engineering Command

    National Research Council Canada - National Science Library

    Sanders, Erin

    2003-01-01

    .... To meet the new requirements, laws must be implemented through effective policy. For over 6 years, the Navy has been acquiring sustainably designed facilities and has recently set sustainable development policy guidelines...

  12. The use of biological systems to improve the energy sustainability

    Energy Technology Data Exchange (ETDEWEB)

    Giovannozzi-Sermmanik, G. [Tuscia Univ., Viterbo (Italy)

    2005-06-01

    Few considerations on the possible role of biochemical reactions to improve energy availability for the mankind activities are presented. An improvement of the sustainability, among many biological cycles, can be obtained by amplified organic matter biosynthesis and its efficient utilisation. In the plants the increase of biosynthesis of cellulose, lignins, starch and hemicelluloses, main renewable reserves of chemical bonds in the biosphere, can be meliorated by more active photosynthetic cycle due to phophoenolpyruvic carboxylase. A second aspect is related to the efficient biodegradations of the plant organic matter by cellulases, hemicellulases and polyphenol oxidases allowing the mobilisation and utilisation of huge amounts of chemical bonds.The capability of this biodegradation can be improved by an emerging technology, the solid state fermentation (SSF), with which the biodegradation is controlled and driven. An example of such integrated approach is constituted by paper pulps from agricultural and forestry materials obtainable with less chemicals use, lower specific energy, better yield of paper pulps and better properties of the papers. (au)

  13. Efficiency improvement for a sustainable agriculture : the integration of agronomic and farm economics approaches

    OpenAIRE

    Koeijer, de, T.J.

    2002-01-01

    Keywords: Sustainable farming systems, Agronomic efficiency, Economic efficiency, Environmental efficiency, Sustainability index, Interdisciplinary analysis.

    The objective of the research described in this thesis was to determine what role improved agronomic efficiency can play in the transition towards more sustainable production systems. Agronomic efficiency measures the technical performance. If it could be improved, environmental damage could be reduced while, at the sam...

  14. How can we improve the environmental sustainability of poultry production?

    Science.gov (United States)

    Leinonen, Ilkka; Kyriazakis, Ilias

    2016-08-01

    The review presents results of recent life cycle assessment studies aiming to quantify and improve the environmental performance of UK poultry production systems, including broiler meat, egg and turkey meat production. Although poultry production has been found to be relatively environmentally friendly compared with the production of other livestock commodities, it still contributes to environmental impacts, such as global warming, eutrophication and acidification. Amongst different sub-processes, feed production and transport contributes about 70 % to the global warming potential of poultry systems, whereas manure management contributes about 40-60 % to their eutrophication potential and acidification potential, respectively. All these impacts can be reduced by improving the feed efficiency, either by changing the birds through genetic selection or by making the feed more digestible (e.g. by using additives such as enzymes). However, although genetic selection has the potential to reduce the resources needed for broiler production (including feed consumption), the changing need of certain feed ingredients, most notably protein sources as a result of changes in bird requirements may limit the benefits of this strategy. The use of alternative feed ingredients, such as locally grown protein crops and agricultural by-products, as a replacement of South American grown soya, can potentially also lead to improvements in several environmental impact categories, as long as such feeding strategies have no negative effect on bird performance. Other management options, such as improving poultry housing and new strategies for manure management have also the potential to further improve the environmental sustainability of the poultry industries in Europe.

  15. Efficiency improvement for a sustainable agriculture : the integration of agronomic and farm economics approaches

    NARCIS (Netherlands)

    Koeijer, de T.J.

    2002-01-01

    Keywords: Sustainable farming systems, Agronomic efficiency, Economic efficiency, Environmental efficiency, Sustainability index, Interdisciplinary analysis.

    The objective of the research described in this thesis was to determine what role improved agronomic efficiency can play in

  16. Focus is key: Panic-focused interpretations are associated with symptomatic improvement in panic-focused psychodynamic psychotherapy.

    Science.gov (United States)

    Keefe, John R; Solomonov, Nili; Derubeis, Robert J; Phillips, Alexander C; Busch, Fredric N; Barber, Jacques P; Chambless, Dianne L; Milrod, Barbara L

    2018-04-18

    This study examines whether, in panic-focused psychodynamic psychotherapy (PFPP), interpretations of conflicts that underlie anxiety (panic-focused or PF-interpretations) are specifically associated with subsequent panic disorder (PD) symptom improvement, over and above the provision of non-symptom-focused interpretations. Technique use in Sessions 2 and 10 of a 24-session PFPP protocol was assessed for the 65 patients with complete outcome data randomized to PFPP in a two-site trial of psychotherapies for PD. Sessions were rated in 15-min segments for therapists' use of PF-interpretations, non-PF-interpretations, and PF-clarifications. Robust regressions were conducted to examine the relationship between these interventions and symptom change subsequent to the sampled session. Interpersonal problems were examined as a moderator of the relationship of PF-interpretations to symptom change. At Session 10, but not at Session 2, patients who received a higher degree of PF-interpretations experienced greater subsequent improvement in panic symptoms. Non-PF-interpretations were not predictive. Patients with more interpersonal distress benefitted particularly from the use of PF-interpretations at Session 10. By the middle phase of PFPP, panic-focused interpretations may drive subsequent improvements in panic symptoms, especially among patients with higher interpersonal distress. Interpretations of conflict absent a panic focus may not be especially helpful.

  17. Improving Software Sustainability: Lessons Learned from Profiles in Science.

    Science.gov (United States)

    Gallagher, Marie E

    2013-01-01

    The Profiles in Science® digital library features digitized surrogates of historical items selected from the archival collections of the U.S. National Library of Medicine as well as collaborating institutions. In addition, it contains a database of descriptive, technical and administrative metadata. It also contains various software components that allow creation of the metadata, management of the digital items, and access to the items and metadata through the Profiles in Science Web site [1]. The choices made building the digital library were designed to maximize the sustainability and long-term survival of all of the components of the digital library [2]. For example, selecting standard and open digital file formats rather than proprietary formats increases the sustainability of the digital files [3]. Correspondingly, using non-proprietary software may improve the sustainability of the software--either through in-house expertise or through the open source community. Limiting our digital library software exclusively to open source software or to software developed in-house has not been feasible. For example, we have used proprietary operating systems, scanning software, a search engine, and office productivity software. We did this when either lack of essential capabilities or the cost-benefit trade-off favored using proprietary software. We also did so knowing that in the future we would need to replace or upgrade some of our proprietary software, analogous to migrating from an obsolete digital file format to a new format as the technological landscape changes. Since our digital library's start in 1998, all of its software has been upgraded or replaced, but the digitized items have not yet required migration to other formats. Technological changes that compelled us to replace proprietary software included the cost of product licensing, product support, incompatibility with other software, prohibited use due to evolving security policies, and product abandonment

  18. Comprehensive Sediment Management to Improve Wetland Sustainability in Coastal Louisiana

    Science.gov (United States)

    Khalil, S.; Freeman, A. M.; Raynie, R.

    2016-02-01

    Human intervention has impaired the Mississippi River's ability to deliver sediment to its deltaic wetlands, and as a consequence acute land loss in coastal Louisiana has resulted in an unprecedented ecocatastrophe. Since the 1930s, Louisiana has lost approximately 5,000 square kilometers of coastal land, and is continuing to lose land at the rate of approximately 43 square kilometers/year. This extreme rate of land loss threatens a range of key national assets and important communities. Coastal communities across the world as well as in Louisiana have realized the importance of sediment for the continuation of their very existence in these productive but vulnerable regions. Ecological restoration can only be undertaken on a stable coastline, for which sedimentological restoration is needed. A large-scale effort to restore coastal Louisiana is underway, guided by Louisiana's Comprehensive Master Plan for a Sustainable Coast. This 50-year, $50-billion plan prescribes 109 protection and restoration projects to reduce land loss, maintain and restore coastal environments and sustain communities. Nowhere else has a restoration and protection program of this scale been developed or implemented, and critical to its success is the optimized usage of limited fluvial and offshore sediment resources, and a keen understanding of the complex interactions of various geological/geophysical processes in ecosystem restoration. A comprehensive sediment management plan has been developed to identify and delineate potential sediment sources for restoration, and to provide a framework for managing sediment resources wisely, cost effectively, and in a systematic manner. The Louisiana Sediment Management Plan provides regional strategies for improved comprehensive management of Louisiana's limited sediment resources. Adaptive management via a robust system-wide monitoring plays an important role along with a regional approach for the efficient management of sediment resources.

  19. Does Eccentric Exercise Reduce Pain and Improve Strength in Physically Active Adults With Symptomatic Lower Extremity Tendinosis? A Systematic Review

    Science.gov (United States)

    Wasielewski, Noah J; Kotsko, Kevin M

    2007-01-01

    Objective: To critically review evidence for the effectiveness of eccentric exercise to treat lower extremity tendinoses. Data Sources: Databases used to locate randomized controlled trials (RCTs) included PubMed (1980–2006), CINAHL (1982–2006), Web of Science (1995–2006), SPORT Discus (1980–2006), Physiotherapy Evidence Database (PEDro), and the Cochrane Collaboration Database. Key words included tendon, tendonitis, tendinosis, tendinopathy, exercise, eccentric, rehabilitation, and therapy. Study Selection: The criteria for trial selection were (1) the literature was written in English, (2) the research design was an RCT, (3) the study participants were adults with a clinical diagnosis of tendinosis, (4) the outcome measures included pain or strength, and (5) eccentric exercise was used to treat lower extremity tendinosis. Data Extraction: Specific data were abstracted from the RCTs, including eccentric exercise protocol, adjunctive treatments, concurrent physical activity, and treatment outcome. Data Synthesis: The calculated post hoc statistical power of the selected studies (n = 11) was low, and the average methodologic score was 5.3/10 based on PEDro criteria. Eccentric exercise was compared with no treatment (n = 1), concentric exercise (n = 5), an alternative eccentric exercise protocol (n = 1), stretching (n = 2), night splinting (n = 1), and physical agents (n = 1). In most trials, tendinosis-related pain was reduced with eccentric exercise over time, but only in 3 studies did eccentric exercise decrease pain relative to the control treatment. Similarly, the RCTs demonstrated that strength-related measures improved over time, but none revealed significant differences relative to the control treatment. Based on the best evidence available, it appears that eccentric exercise may reduce pain and improve strength in lower extremity tendinoses, but whether eccentric exercise is more effective than other forms of therapeutic exercise for the resolution

  20. Nonoperative treatment of symptomatic spondylolysis.

    Science.gov (United States)

    Kurd, Mark F; Patel, Deepan; Norton, Robert; Picetti, George; Friel, Brian; Vaccaro, Alexander R

    2007-12-01

    Symptomatic spondylolysis resulting from a stress fracture of the pars interarticularis is a cause of low back pain in the juvenile and adolescent patient. Treatment is conservative in the majority of cases. To analyze the outcome of patients with symptomatic isthmic spondylolysis treated nonoperatively with a custom fit thoracolumbar orthosis and activity cessation for 3 months followed by an organized physical therapy program. Retrospective case series. Four hundred thirty-six juvenile and adolescent patients with spondylolysis. Pain improvement, hamstring flexibility, range of motion, resolution of back spasms, and return to previous activities. Retrospective review of 436 juvenile and adolescent patients with symptomatic spondylolysis confirmed by single-photon emission computed tomography or computed tomography. Clinical outcomes were assessed through patient history and physical examination. Ninety-five percent of patients achieved excellent results according to a modified Odom's Criteria. The remaining 5% of patients achieved good results as they required occasional nonsteroidal anti-inflammatory drugs to relieve pain. Back spasms were resolved and hamstring tightness and range of motion returned to normal in all patients. All patients returned to their preinjury activity level. No patients went on to surgery. Symptomatic juvenile and adolescent patients with an isthmus spondylolysis may be effectively managed with a custom fit thoracolumbar orthosis brace and activity cessation for approximately 3 months followed by an organized physical therapy program.

  1. The Low-FODMAP diet in the Irritable Bowel Syndrome: Is it currently an ineffective nutritional treatment? Symptomatic improvement

    Directory of Open Access Journals (Sweden)

    Cristina Álvarez Díaz

    2017-10-01

    Full Text Available Introductions: Irritable bowel syndrome (IBS is one of the most prevalent functional gastrointestinal disorders in the population. It is a complex and multifactorial disease in which biological, psychological and social factors act at multiple levels on the disease. Diagnosed according to ROMA IV and characterized mainly by abdominal pain and change in bowel habits, it does not have a standard treatment, so it focuses on minimizing gastrointestinal symptoms. The FODMAP diet has been appeared as an effective treatment of IBS. Objectives: The main objective of this study was to test the efficacy of the FODMAP diet in its different phases of nutrition therapy in order to reduce gastrointestinal symptoms and to increase quality of life. Methods: A prospective experimental study with duration of twelve weeks was designed under one case, a 35-year-old woman suffering from IBS for 7 years. The dietary treatment was divided into three phases, which was being realised with 12 different diets, dietary education and dietary advice, assessment symptoms, quality of life, type of stool, diet adherence and satisfaction about the nutrition therapy. Results: The gastrointestinal symptoms and quality of life improved in comparison to the start of the study, as well did the stool in outbreak crisis and routinely situations. By contrast, no relation between the reintroduced foods that produced symptoms with FODMAP’s content was found. Conclusions: The nutritional treatment of FODMAP diet is an effective treatment for IBS because it reduces the gastrointestinal symptoms, increases the quality of life and the control of the patient towards the diet.

  2. Can We Improve Indicator Design for Complex Sustainable Development Goals?

    NARCIS (Netherlands)

    Burford, Gemma; Tamas, P.A.; Harder, Marie K.

    2016-01-01

    A conceptual framework was constructed for United Nations’ complex Sustainable Development Goal (SDG) Target 4.7 focusing on education for sustainable development (ESD), and used to analyse the usefulness and character of indicators produced from a values-based approach called ESDinds, compared to a

  3. Effects of hydroxychloroquine on symptomatic improvement in primary Sjögren syndrome: the JOQUER randomized clinical trial.

    Science.gov (United States)

    Gottenberg, Jacques-Eric; Ravaud, Philippe; Puéchal, Xavier; Le Guern, Véronique; Sibilia, Jean; Goeb, Vincent; Larroche, Claire; Dubost, Jean-Jacques; Rist, Stéphanie; Saraux, Alain; Devauchelle-Pensec, Valérie; Morel, Jacques; Hayem, Gilles; Hatron, Pierre; Perdriger, Aleth; Sene, Damien; Zarnitsky, Charles; Batouche, Djilali; Furlan, Valérie; Benessiano, Joelle; Perrodeau, Elodie; Seror, Raphaele; Mariette, Xavier

    2014-07-16

    blood levels of the drug. Hydroxychloroquine had no efficacy in patients with anti-SSA autoantibodies, high IgG levels, or systemic involvement. During the first 24 weeks, there were 2 serious adverse events in the hydroxychloroquine group and 3 in the placebo group; in the last 24 weeks, there were 3 serious adverse events in the hydroxychloroquine group and 4 in the placebo group. Among patients with primary Sjögren syndrome, the use of hydroxychloroquine compared with placebo did not improve symptoms during 24 weeks of treatment. Further studies are needed to evaluate longer-term outcomes. clinicaltrials.gov Identifier: NCT00632866.

  4. Making change last: applying the NHS institute for innovation and improvement sustainability model to healthcare improvement.

    Science.gov (United States)

    Doyle, Cathal; Howe, Cathy; Woodcock, Thomas; Myron, Rowan; Phekoo, Karen; McNicholas, Chris; Saffer, Jessica; Bell, Derek

    2013-10-26

    The implementation of evidence-based treatments to deliver high-quality care is essential to meet the healthcare demands of aging populations. However, the sustainable application of recommended practice is difficult to achieve and variable outcomes well recognised. The NHS Institute for Innovation and Improvement Sustainability Model (SM) was designed to help healthcare teams recognise determinants of sustainability and take action to embed new practice in routine care. This article describes a formative evaluation of the application of the SM by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London (CLAHRC NWL). Data from project teams' responses to the SM and formal reviews was used to assess acceptability of the SM and the extent to which it prompted teams to take action. Projects were classified as 'engaged,' 'partially engaged' and 'non-engaged.' Quarterly survey feedback data was used to explore reasons for variation in engagement. Score patterns were compared against formal review data and a 'diversity of opinion' measure was derived to assess response variance over time. Of the 19 teams, six were categorized as 'engaged,' six 'partially engaged,' and seven as 'non-engaged.' Twelve teams found the model acceptable to some extent. Diversity of opinion reduced over time. A minority of teams used the SM consistently to take action to promote sustainability but for the majority SM use was sporadic. Feedback from some team members indicates difficulty in understanding and applying the model and negative views regarding its usefulness. The SM is an important attempt to enable teams to systematically consider determinants of sustainability, provide timely data to assess progress, and prompt action to create conditions for sustained practice. Tools such as these need to be tested in healthcare settings to assess strengths and weaknesses and findings disseminated to aid development. This

  5. Plants for Sustainable Improvement of Indoor Air Quality

    NARCIS (Netherlands)

    Brilli, Federico; Fares, Silvano; Ghirardo, Andrea; Visser, de Pieter; Calatayud, Vicent; Muñoz, Amalia; Annesi-Maesano, Isabella; Sebastiani, Federico; Alivernini, Alessandro; Varriale, Vincenzo; Menghini, Flavio

    2018-01-01

    Indoor pollution poses a serious threat to human health. Plants represent a sustainable but underexploited solution to enhance indoor air quality. However, the current selection of plants suitable for indoors fails to consider the physiological processes and mechanisms involved in phytoremediation.

  6. Using membrane transporters to improve crops for sustainable food production

    Science.gov (United States)

    With the global population predicted to grow by at least 25% by 2050, the need for sustainable production of nutritious foods is critical for human and environmental well-being. Recent advances show that specialized plant membrane transporters can be utilized to enhance yields of staple crops, incre...

  7. Improving Sustainable Living Education through the Use of Formative Experiments

    Science.gov (United States)

    Wynveen, Brooklynn J.

    2017-01-01

    Experts agree that overconsumption is a major problem in Western culture today, particularly in the United States. Thus, it is important to promote sustainable behaviour among the general public. However, existing educational programming geared towards promoting such behaviour remains appealing largely to environmentally motivated audiences, as…

  8. Improving sustainability through intelligent cargo and adaptive decision making

    NARCIS (Netherlands)

    Dalmolen, S.; Cornelisse, E.; Stoter, A.; Hofman, W.J.; Bastiaansen, H.J.M.; Punter, L.M.; Knoors, F.

    2012-01-01

    In the current society, logistics is faced with the challenge to meet more stringent sustainability goals. Shippers and transport service providers both aim to reduce the carbon footprint of their logistic operations. To do so, optimal use of logistics resources and physical infrastructure should be

  9. No Difference Between Latiglutenase and Placebo in Reducing Villous Atrophy or Improving Symptoms in Patients With Symptomatic Celiac Disease.

    Science.gov (United States)

    Murray, Joseph A; Kelly, Ciarán P; Green, Peter H R; Marcantonio, Annette; Wu, Tsung-Teh; Mäki, Markku; Adelman, Daniel C

    2017-03-01

    phase 2 study of patients with symptomatic celiac disease and histologic evidence of significant duodenal mucosal injury, latiglutenase did not improve histologic and symptom scores when compared with placebo. There were no significant differences in change from baseline between groups. ClinicalTrials.gov no: NCT01917630. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

  10. Using membrane transporters to improve crops for sustainable food production

    Science.gov (United States)

    Schroeder, Julian I.; Delhaize, Emmanuel; Frommer, Wolf B.; Guerinot, Mary Lou; Harrison, Maria J.; Herrera-Estrella, Luis; Horie, Tomoaki; Kochian, Leon V.; Munns, Rana; Nishizawa, Naoko K.; Tsay, Yi-Fang; Sanders, Dale

    2013-01-01

    With the global population predicted to grow by at least 25 per cent by 2050, the need for sustainable production of nutritious foods is critical for human and environmental health. Recent advances show that specialized plant membrane transporters can be used to enhance yields of staple crops, increase nutrient content and increase resistance to key stresses, including salinity, pathogens and aluminium toxicity, which in turn could expand available arable land. PMID:23636397

  11. Moderating the Role of Firm Size in Sustainable Performance Improvement through Sustainable Supply Chain Management

    Directory of Open Access Journals (Sweden)

    Jing Wang

    2018-05-01

    Full Text Available In the context of the Chinese government’s strategy for sustainable development, the study of sustainable supply chain management (SSCM for enterprises has important practical significance. Drawing data from 172 Chinese firms, the model studied the moderating role of firm size on the SSCM practices and the sustainable performance of the firms (economic, environmental, and social, using hierarchical regression analysis on SPSS 22.0. The results suggest that SSCM practices and firm size are positively related to the firm’s environmental and social performance. Firm size moderates the effect of SSCM practices on economic performance. Additionally, SSCM internal practices have a significant positive impact on the economic performance of large enterprises, but not so much on the economic performance of the Small and medium enterprises(SMEs. This paper proposes a comprehensive SSCM practice performance model that identifies firm size as a moderating role. Through research on the moderating effect of firm size, the implementation and recommendation of SSCM for different firm size are given.

  12. Sustainability in the Higher Education System: An Opportunity to Improve Quality and Image

    Directory of Open Access Journals (Sweden)

    Daniela M. Salvioni

    2017-05-01

    Full Text Available In view of the increasing importance attributed to social responsibility and stakeholder relationship management, more universities have expanded their research topics and their educational programs through the years. High attention is dedicated to the dominant principles and values of internal and external relations, to the innovation processes designed to ensure an approach to sustainable development. However, less attention is dedicated to the sustainability governance orientation and to the development of a strong institutional culture of sustainability, which is a key success factor to improve the quality and the image. This article observes the sustainability governance orientation, through the analysis of the information on the websites of three fair groups of universities in the international Top 500-ARWU (Academic Ranking of World Universities 2015 ranking. The aim is to verify if there is a link between the degree of sustainability culture in the management and the positioning of the universities in the international ranking. In addition, the analysis is compared with self-assessment data carried out by the same universities in terms of performance sustainability through the STARS (Sustainability Tracking, Assessment & Rating System online platform. As principal consideration, we have noted that the best universities in the ranking have a management approach based on a shared vision of sustainability development of their university leaders, who play an essential role affirming and disseminating a sustainability culture. All this opens broader future implications intended to highlight the importance of management sustainability as a quality improvement factor of universities.

  13. Relationship between sustainable development initiatives and improved company financial performance: A South African perspective

    Directory of Open Access Journals (Sweden)

    Darelle Groenewald

    2016-05-01

    Research purpose: The study analysed the relationship between sustainability performance and FP in South African listed companies. Motivation for the study: Some South African listed companies acknowledge in their sustainability reports that there is a link between sustainability development and long-term shareholder value. This implies that FP is linked to sustainable development performance. This relationship has not been researched for South African listed companies and therefore needs to be investigated. Research design, approach and method: A similar research method was used as for an international study. Forty-five listed South African companies were selected as the sample. Their sustainable development reports were used for analysis. Data were analysed with the use of content and a canonical correlation analysis. Main findings: The results of the study revealed that an overall positive relationship exists between sustainability performance and FP. Practical implications: South African companies that have a high involvement and focus on specific sustainable development initiatives that are integrated into overall sustainable development strategy can deliver improved FP for the organisation and deliver long-term value to its shareholders. Contribution: Six sustainable development aspects were found to be significantly correlated with improved FP and if incorporated into a company’s sustainable development strategy can lead to increased successes.

  14. Integrated Systems Mitigate Land Degradation and Improve Agricultural System Sustainability

    Science.gov (United States)

    Landblom, Douglas; Senturklu, Songul; Cihacek, Larry; Brevik, Eric

    2017-04-01

    Rain-fed agricultural production supported by exogenous inputs is not sustainable because a continuous influx of expensive inputs (fertilizer, chemicals, fossil fuel, labor, tillage, and other) is required. Alternatives to traditional management allow natural occurring dynamic soil processes to provide the necessary microbial activity that supports nutrient cycling in balance with nature. Research designed to investigate the potential for integrated systems to replace expensive inputs has shown that healthy soils rich in soil organic matter (SOM) are the foundation upon which microbial nutrient cycling can reduce and eventually replace expensive fertilizer. No-till seed placement technology effectively replaces multiple-pass cultivation conserving stored soil water in semi-arid farming systems. In multi-crop rotations, cool- and warm-season crops are grown in sequence to meet goals of the integrated farming and ranching system, and each crop in the rotation complements the subsequent crop by supplying a continuous flow of essential SOM for soil nutrient cycling. Grazing animals serve an essential role in the system's sustainability as non-mechanized animal harvesters that reduce fossil fuel consumption and labor, and animal waste contributes soil nutrients to the system. Integrated systems' complementarity has contributed to greater soil nutrient cycling and crop yields, fertilizer reduction or elimination, greater yearling steer grazing net return, reduced cow wintering costs grazing crop residues, increased wildlife sightings, and reduced environmental footprint. Therefore, integrating crop and animal systems can reverse soil quality decline and adopting non-traditional procedures has resulted in a wider array of opportunities for sustainable agriculture and profitability.

  15. Sustainability and Efficiency Improvements of Gas-Cooled High Temperature Reactors

    NARCIS (Netherlands)

    Marmier, A.

    2012-01-01

    The work presented in this thesis covers three fundamental aspects of High Temperature Reactor (HTR) performance, namely fuel testing under irradiation for maximized safety and sustainability, fuel architecture for improved economy and sustainability, and a novel Balance of Plant concept to enable

  16. Greener on the Other Side: Cultivating Community and Improvement through Sustainability Practices

    Science.gov (United States)

    Sterrett, William L.; Kensler, Lisa; McKey, Tania

    2016-01-01

    Sustainability practices that lead to greener schools are often overlooked in leadership preparation programs and in school improvement efforts. An urban middle school principal recognizes the potential to build community, foster a healthy learning environment, and redefine her school through focusing on sustainability practices in a collaborative…

  17. Sustaining Continuous Improvement: A Longitudinal and Regional Study

    Directory of Open Access Journals (Sweden)

    Henry J. Quesada-Pineda

    2013-09-01

    companies, no changes in perception were found during the period of study for any of the factors. For the other two, however, changes were perceived in at least one of the five constructs in the study. Changes were also found across the regions included. By leveraging the quantitative analysis with qualitative data collected through interviews and visits to the case study companies, we were able to explain the changes in perception and single out the best CI management process to sustain CI in the long term.

  18. Slow fashion and sustainability in Spain: How can local manufacturing improve sustainability and how do consumers respond?

    OpenAIRE

    Karaosman, Hakan; Morales Alonso, Gustavo; Brun, Alessandro

    2014-01-01

    "Slow Fashion" attempts to offset the demand for fast fashion and mass production (Fletcher, 2007). Consumers' response to sustainability-based practices is a limited discourse and studies for slow fashion concept are scarce. This study thus aims to enlighten the subject of how slow fashion concept could improve local economies and how Spanish consumers respond to such initiatives. This paper is based on an exploratory qualitative research for which focus group interviews including three grou...

  19. Can Social Protection Improve Sustainable Development Goals for Adolescent Health?

    Science.gov (United States)

    Cluver, Lucie D; Orkin, F Mark; Meinck, Franziska; Boyes, Mark E; Yakubovich, Alexa R; Sherr, Lorraine

    2016-01-01

    The first policy action outlined in the Sustainable Development Goals (SDGs) is the implementation of national social protection systems. This study assesses whether social protection provision can impact 17 indicators of five key health-related SDG goals amongst adolescents in South Africa. We conducted a longitudinal survey of adolescents (10-18 years) between 2009 and 2012. Census areas were randomly selected in two urban and two rural health districts in two South African provinces, including all homes with a resident adolescent. Household receipt of social protection in the form of 'cash' (economic provision) and 'care' (psychosocial support) social protection, and health-related indicators within five SDG goals were assessed. Gender-disaggregated analyses included multivariate logistic regression, testing for interactions between social protection and socio-demographic covariates, and marginal effects models. Social protection was associated with significant adolescent risk reductions in 12 of 17 gender-disaggregated SDG indicators, spanning SDG 2 (hunger); SDG 3 (AIDS, tuberculosis, mental health and substance abuse); SDG 4 (educational access); SDG 5 (sexual exploitation, sexual and reproductive health); and SDG 16 (violence perpetration). For six of 17 indicators, combined cash plus care showed enhanced risk reduction effects. Two interactions showed that effects of care varied by poverty level for boys' hunger and girls' school dropout. For tuberculosis, and for boys' sexual exploitation and girls' mental health and violence perpetration, no effects were found and more targeted or creative means will be needed to reach adolescents on these challenging burdens. National social protection systems are not a panacea, but findings suggest that they have multiple and synergistic positive associations with adolescent health outcomes. Such systems may help us rise to the challenges of health and sustainable development.

  20. Can Social Protection Improve Sustainable Development Goals for Adolescent Health?

    Directory of Open Access Journals (Sweden)

    Lucie D Cluver

    Full Text Available The first policy action outlined in the Sustainable Development Goals (SDGs is the implementation of national social protection systems. This study assesses whether social protection provision can impact 17 indicators of five key health-related SDG goals amongst adolescents in South Africa.We conducted a longitudinal survey of adolescents (10-18 years between 2009 and 2012. Census areas were randomly selected in two urban and two rural health districts in two South African provinces, including all homes with a resident adolescent. Household receipt of social protection in the form of 'cash' (economic provision and 'care' (psychosocial support social protection, and health-related indicators within five SDG goals were assessed. Gender-disaggregated analyses included multivariate logistic regression, testing for interactions between social protection and socio-demographic covariates, and marginal effects models.Social protection was associated with significant adolescent risk reductions in 12 of 17 gender-disaggregated SDG indicators, spanning SDG 2 (hunger; SDG 3 (AIDS, tuberculosis, mental health and substance abuse; SDG 4 (educational access; SDG 5 (sexual exploitation, sexual and reproductive health; and SDG 16 (violence perpetration. For six of 17 indicators, combined cash plus care showed enhanced risk reduction effects. Two interactions showed that effects of care varied by poverty level for boys' hunger and girls' school dropout. For tuberculosis, and for boys' sexual exploitation and girls' mental health and violence perpetration, no effects were found and more targeted or creative means will be needed to reach adolescents on these challenging burdens.National social protection systems are not a panacea, but findings suggest that they have multiple and synergistic positive associations with adolescent health outcomes. Such systems may help us rise to the challenges of health and sustainable development.

  1. [Sustainable process improvement with application of 'lean philosophy'].

    Science.gov (United States)

    Rouppe van der Voort, Marc B V; van Merode, G G Frits; Veraart, Henricus G N

    2013-01-01

    Process improvement is increasingly being implemented, particularly with the aid of 'lean philosophy'. This management philosophy aims to improve quality by reducing 'wastage'. Local improvements can produce negative effects elsewhere due to interdependence of processes. An 'integrated system approach' is required to prevent this. Some hospitals claim that this has been successful. Research into process improvement with the application of lean philosophy has reported many positive effects, defined as improved safety, quality and efficiency. Due to methodological shortcomings and lack of rigorous evaluations it is, however, not yet possible to determine the impact of this approach. It is, however, obvious that the investigated applications are fragmentary, with a dominant focus on the instrumental aspect of the philosophy and a lack of integration in a total system, and with insufficient attention to human aspects. Process improvement is required to achieve better and more goal-oriented healthcare. To achieve this, hospitals must develop integrated system approaches that combine methods for process design with continuous improvement of processes and with personnel management. It is crucial that doctors take the initiative to guide and improve processes in an integral manner.

  2. Levee Setbacks: An Innovative, Cost Effective, and Sustainable Solution for Improved Flood Risk management

    Science.gov (United States)

    2017-06-30

    ER D C/ EL S R- 17 -3 Levee Setbacks: An Innovative , Cost-Effective, and Sustainable Solution for Improved Flood Risk Management En vi...EL SR-17-3 June 2017 Levee Setbacks: An Innovative , Cost-Effective, and Sustainable Solution for Improved Flood Risk Management David L. Smith...alternative view point is necessary. ERDC/EL SR-17-3 4 Levee setbacks are a relatively recent innovation in Corps flood risk management practice

  3. Nursing unit leaders' influence on the long-term sustainability of evidence-based practice improvements.

    Science.gov (United States)

    Fleiszer, Andrea R; Semenic, Sonia E; Ritchie, Judith A; Richer, Marie-Claire; Denis, Jean-Louis

    2016-04-01

    To describe how actions of nursing unit leaders influenced the long-term sustainability of a best practice guidelines (BPG) program on inpatient units. Several factors influence the initial implementation of evidence-based practice improvements in nursing, with leadership recognized as essential. However, there is limited knowledge about enduring change, including how frontline nursing leaders influence the sustainability of practice improvements over the long term. A qualitative descriptive case study included 39 in-depth interviews, observations, and document reviews. Four embedded nursing unit subcases had differing levels of program sustainability at 7 years (average) following implementation. Higher levels of BPG sustainability occurred on units where formal leadership teams used an integrated set of strategies and activities. Two key strategies were maintaining priorities and reinforcing expectations. The coordinated use of six activities (e.g., discussing, evaluating, integrating) promoted the continuation of BPG practices among staff. These leadership processes, fostering exchange and learning, contributed to sustainability-promoting environments characterized by teamwork and accountability. Unit leaders are required to strategically orchestrate several overlapping and synergistic efforts to achieve long-term sustainability of BPG-based practice improvements. As part of managing overall unit performance, unit leaders may influence practice improvement sustainability by aligning vision, strategies, and activities. © 2015 John Wiley & Sons Ltd.

  4. Leadership and Context Connectivity: Merging Two Forces for Sustainable School Improvement

    Science.gov (United States)

    Marishane, Nylon Ramodikoe

    2016-01-01

    School improvement is admittedly the main business of school leadership. However, while there is agreement on the importance of school improvement, sustaining this improvement remains a challenge. The challenge seems to lie in the disconnection between the leader and the context in which the school operates. This chapter presents contextual…

  5. Efficacy and safety of a fixed-dose combination of dutasteride and tamsulosin treatment (Duodart(®) ) compared with watchful waiting with initiation of tamsulosin therapy if symptoms do not improve, both provided with lifestyle advice, in the management of treatment-naïve men with moderately symptomatic benign prostatic hyperplasia: 2-year CONDUCT study results.

    Science.gov (United States)

    Roehrborn, Claus G; Oyarzabal Perez, Igor; Roos, Erik P M; Calomfirescu, Nicolae; Brotherton, Betsy; Wang, Fang; Palacios, Juan Manuel; Vasylyev, Averyan; Manyak, Michael J

    2015-09-01

    To investigate whether a fixed-dose combination (FDC) of 0.5 mg dutasteride and 0.4 mg tamsulosin is more effective than watchful waiting with protocol-defined initiation of tamsulosin therapy if symptoms did not improve (WW-All) in treatment-naïve men with moderately symptomatic benign prostatic hyperplasia (BPH) at risk of progression. This was a multicentre, randomised, open-label, parallel-group study (NCT01294592) in 742 men with an International Prostate Symptom Score (IPSS) of 8-19, prostate volume ≥30 mL and total serum PSA level of ≥1.5 ng/mL. Patients were randomised to FDC (369 patients) or WW-All (373) and followed for 24 months. All patients were given lifestyle advice. The primary endpoint was symptomatic improvement from baseline to 24 months, measured by the IPSS. Secondary outcomes included BPH clinical progression, impact on quality of life (QoL), and safety. The change in IPSS at 24 months was significantly greater for FDC than WW-All (-5.4 vs -3.6 points, P tamsulosin. FDC therapy with dutasteride and tamsulosin, plus lifestyle advice, resulted in rapid and sustained improvements in men with moderate BPH symptoms at risk of progression with significantly greater symptom and QoL improvements and a significantly reduced risk of BPH progression compared with WW plus initiation of tamsulosin as per protocol. © 2015 The Authors. BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

  6. Role of continual environmental performance improvement in achieving sustainability in uranium production

    International Nuclear Information System (INIS)

    Jarrell, J.P.; Chad, G.M.S.

    2002-01-01

    Although the term sustainable development is commonly used today, there is not yet a commonly accepted definition. Various ways of measuring sustainability have been proposed. To show how these issues are being effectively addressed in modern uranium developments, we will review some methods of defining the environmental component of sustainable development in the mining and mineral-processing sector. Environmental impacts associated with uranium extraction and processing in modern facilities are modest. Air and water emissions are well controlled. Waste materials are subject to comprehensive management programmes. The size of the impacted area is smaller than in other energy sectors, providing good opportunity to minimize land impact. Experience over the past three decades facilitated gradual, persistent, but cumulatively significant environmental improvements in the uranium production sector. Cameco's uranium mining and processing facilities exemplify these improvements. These improvements can be expected to continue, supporting our argument of Cameco's environmental sustainability. (author)

  7. Sustainable production. The ultimate result of a continuous improvement

    NARCIS (Netherlands)

    Ron, de A.J.

    1998-01-01

    To fulfil market requirements, companies have introduced cost awareness, quality programs and techniques to become flexible. These items should be handled as a continuous process of improvement. The cost awareness implies that e.g. material waste is avoided during production, the quality programs

  8. Indonesian Private University Lecturer Performance Improvement Model to Improve a Sustainable Organization Performance

    Science.gov (United States)

    Suryaman

    2018-01-01

    Lecturer performance will affect the quality and carrying capacity of the sustainability of an organization, in this case the university. There are many models developed to measure the performance of teachers, but not much to discuss the influence of faculty performance itself towards sustainability of an organization. This study was conducted in…

  9. Sustained improvement of intractable rheumatoid arthritis after total lymphoid irradiation

    International Nuclear Information System (INIS)

    Field, E.H.; Strober, S.; Hoppe, R.T.

    1983-01-01

    Total lymphoid irradiation (TLI) was administered to 11 patients who had intractable rheumatoid arthritis that was unresponsive to conventional medical therapy, including aspirin, multiple nonsteroidal antiinflammatory drugs, gold salts, and D-penicillamine. Total lymphoid irradiation was given as an alternative to cytotoxic drugs such as azathioprine and cyclophosphamide. After radiotherapy, 9 of the 11 patients showed a marked improvement in clinical disease activity as measured by morning stiffness, joint tenderness, joint swelling, and overall functional abilities. The mean improvement of disease activity in all patients ranged from 40-70 percent and has persisted throughout a 13-28 month followup period. This improvement permitted the mean daily steroid dose to be reduced by 54%. Complications included severe fatigue and other constitutional symptoms during radiotherapy, development of Felty's syndrome in 1 patient, and an exacerbation of rheumatoid lung disease in another. After therapy, all patients exhibited a profound T lymphocytopenia, and a reversal in their T suppressor/cytotoxic cell to helper cell ratio. The proliferative responses of peripheral blood mononuclear cells to phytohemagglutinin, concanavalin A, and allogeneic leukocytes (mixed leukocyte reaction) were markedly reduced, as was in vitro immunoglobulin synthesis after stimulation with pokeweed mitogen. Alterations in T cell numbers and function persisted during the entire followup period, except that the mixed leukocyte reaction showed a tendency to return to normal values

  10. State of logistics: research priorities for sustained improvement

    CSIR Research Space (South Africa)

    Van Dyk, E

    2006-06-01

    Full Text Available to that of South Africa’s trading partners such as the USA, where the logistics costs were 8.6% of the GDP for 2004. Transport costs are rising globally and as a transport-intensive economy, the effect thereof is magnified in South Africa. South Africa... with respect to supply chain innovation collaborate across industry boundaries to improve the utilisation of the constrained national infrastructure; » In cost-sensitive industries, firm-level innovation dominates at the expense of channel-level innovation...

  11. Ergonomics as a tool to improve the sustainability of the workforce.

    Science.gov (United States)

    Meyer, Felipe; Eweje, Gabriel; Tappin, David

    2017-01-01

    The sustainability of the workforce is threatened due to working conditions. One of the reasons for this is an imbalance between the working conditions and the capacity of the workers. The objective of the paper, based on a literature review, is to explore the relationship between two main concepts, beginning with sustainability, and finished with ergonomics. Based on that relationship, determine if ergonomics could be helpful to improve the sustainability of the workforce. Literature review was based on two keywords: sustainability and ergonomics. The focus was on create a theoretical path between these two concepts. The literature review draws on 100 journal articles, books, conference proceedings, thesis and reports. The results of the literature review highlights that an ergonomics approach is helpful and appropriate to determine the mismatch between people capacity and system demand. In that sense, the literature review reveals that both disciplines, ergonomics and sustainability, share the same principles and that the mix of both has significant potential. However, the literature also shows a lack of empirical information that proves that potential. The review first posits that sustainability principles could be helpful to improve the working conditions, and second, that an ergonomics approach provides information related with working conditions, organizations' problems and the needs of workers that would be helpful to create a sustainability workforce.

  12. Avoiding failure: tools for successful and sustainable quality-improvement projects

    Energy Technology Data Exchange (ETDEWEB)

    Donnelly, Lane F. [Texas Children' s Hospital, Department of Radiology, Houston, TX (United States)

    2017-06-15

    Involvement in successful and sustained quality improvement can be a very rewarding experience. However, it can be very difficult work. Up to 70% of attempted organizational change is not sustained. There are many reasons why quality-improvement projects might not be successful. In this article, the author reviews items associated with an increased or decreased likelihood of success. Such items have been categorized as structural issues, human issues and environmental context. This paper is intended to serve those embarking on quality-improvement projects as a resource to help position them for success. (orig.)

  13. Avoiding failure: tools for successful and sustainable quality-improvement projects

    International Nuclear Information System (INIS)

    Donnelly, Lane F.

    2017-01-01

    Involvement in successful and sustained quality improvement can be a very rewarding experience. However, it can be very difficult work. Up to 70% of attempted organizational change is not sustained. There are many reasons why quality-improvement projects might not be successful. In this article, the author reviews items associated with an increased or decreased likelihood of success. Such items have been categorized as structural issues, human issues and environmental context. This paper is intended to serve those embarking on quality-improvement projects as a resource to help position them for success. (orig.)

  14. Avoiding failure: tools for successful and sustainable quality-improvement projects.

    Science.gov (United States)

    Donnelly, Lane F

    2017-06-01

    Involvement in successful and sustained quality improvement can be a very rewarding experience. However, it can be very difficult work. Up to 70% of attempted organizational change is not sustained. There are many reasons why quality-improvement projects might not be successful. In this article, the author reviews items associated with an increased or decreased likelihood of success. Such items have been categorized as structural issues, human issues and environmental context. This paper is intended to serve those embarking on quality-improvement projects as a resource to help position them for success.

  15. The Sustainable Improvement of Manufacturing for Nano-Titanium

    Directory of Open Access Journals (Sweden)

    Chia-Nan Wang

    2016-04-01

    Full Text Available Scientists have found that nanomaterials possess many outstanding features in their tiny grain structure compared to other common materials. Titanium at the nano-grain scale shows many novel characteristics which demonstrate suitability for use in surgical implants. In general, equal channel angular pressing (ECAP is the most popular and simple process to produce nano-titanium. However, ECAP is time-consuming, power-wasting, and insufficiently produces the ultrafine grain structure. Therefore, the objective of this research is to propose a new method to improve the ECAP’s performances to reach the ultrafine grain structure, and also to save production costs, based on the innovation theory of Teoriya Resheniya Izobreatatelskih Zadatch (TRIZ. Research results show that the process time is reduced by 80%, and 94% of the energy is saved. Moreover, the grain size of the diameter for nano-titanium can be reduced from 160 nanometers (nm to 80 nm. The results are a 50% reduction of diameter and a 75% improvement of volume. At the same time, the method creates a refined grain size and good mechanical properties in the nano-titanium. The proposed method can be applied to produce any nanomaterial as well as biomaterials.

  16. The use of social media for improving sustainable energy and building operation

    DEFF Research Database (Denmark)

    Knudsen, Helene Hjort

    2015-01-01

    This paper will draw perspectives of the experiences from the housing estate “Eight House”, using the social intranet media “Borigo”. How can Social Intranet Media support sustainable building operation with an overall aim of improving the residents’ sustainable practice? Can local operational...... managers of the residential area function as change agents in the process? What kind of process is needed? Can the use of social media support communities of practice?...

  17. Creating Sustainable Education Projects in Roatán, Honduras through Continuous Process Improvement

    Science.gov (United States)

    Raven, Arjan; Randolph, Adriane B.; Heil, Shelli

    2010-01-01

    The investigators worked together with permanent residents of Roatán, Honduras on sustainable initiatives to help improve the island's troubled educational programs. Our initiatives focused on increasing the number of students eligible and likely to attend a university. Using a methodology based in continuous process improvement, we developed…

  18. Improving Decision Making for Sustainability: A Case Study from New Zealand

    Science.gov (United States)

    Geertshuis, Susan

    2009-01-01

    Purpose: The purpose of this paper is to describe and evidence a means of improving decision making within a sustainable resource management context. Design/methodology/approach: A set of competencies required by effective decision makers is developed. Methods of improving decision making are reviewed and used to develop a continuing education…

  19. MRI of symptomatic shoulders

    International Nuclear Information System (INIS)

    Kikukawa, Kenshi; Segata, Tateki; Kunitake, Katsuhiko; Morisawa, Keizo; Harada, Masataka; Hirano, Mako

    2004-01-01

    The purpose of this study was to determine the prevalence of cuff tear and acromioclavicular joint (ACJ) osteoarthrosis by magnetic resonance imaging (MRI) evaluation in symptomatic shoulders. MRI was performed on 124 shoulders in 115 patients whose age ranged from 16 to 83 years (average: 58.0 years). There were 74 men (79 shoulders) and 41 women (45 shoulders). The patients were divided into three groups according to age; A group (10 shoulders: 16-29 years), B group (43 shoulders: 30-59 years), and C group (71 shoulders: 60-83 years). Rotator cuff tears and ACJ osteoarthrosis were graded on scales 0 to 3 (normal, increased signal intensity, incomplete, complete), and 1 to 4 (none, mild, moderate, severe), respectively. There was a significant difference in the severity of the cuff tears and the ACJ osteoarthrosis with respect to age. Twenty percent of the shoulders were graded incomplete or complete cuff tears in group A, 88% in group B, and 93% in group C. No shoulders were graded moderate or severe ACJ changes in group A, 63% in group B, and 93% in group C. There was a definite correlation between the cuff tears and ACJ osteoarthrosis. MRI of the symptomatic shoulders indicated well correlation between the rotator cuff tears and ACJ osteoarthrosis. (author)

  20. Sustainability of healthcare improvement: what can we learn from learning theory?

    Directory of Open Access Journals (Sweden)

    Hovlid Einar

    2012-08-01

    Full Text Available Abstract Background Changes that improve the quality of health care should be sustained. Falling back to old, unsatisfactory ways of working is a waste of resources and can in the worst case increase resistance to later initiatives to improve care. Quality improvement relies on changing the clinical system yet factors that influence the sustainability of quality improvements are poorly understood. Theoretical frameworks can guide further research on the sustainability of quality improvements. Theories of organizational learning have contributed to a better understanding of organizational change in other contexts. To identify factors contributing to sustainability of improvements, we use learning theory to explore a case that had displayed sustained improvement. Methods Førde Hospital redesigned the pathway for elective surgery and achieved sustained reduction of cancellation rates. We used a qualitative case study design informed by theory to explore factors that contributed to sustain the improvements at Førde Hospital. The model Evidence in the Learning Organization describes how organizational learning contributes to change in healthcare institutions. This model constituted the framework for data collection and analysis. We interviewed a strategic sample of 20 employees. The in-depth interviews covered themes identified through our theoretical framework. Through a process of coding and condensing, we identified common themes that were interpreted in relation to our theoretical framework. Results Clinicians and leaders shared information about their everyday work and related this knowledge to how the entire clinical pathway could be improved. In this way they developed a revised and deeper understanding of their clinical system and its interdependencies. They became increasingly aware of how different elements needed to interact to enhance the performance and how their own efforts could contribute. Conclusions The improved understanding of

  1. Sustainability of healthcare improvement: what can we learn from learning theory?

    Science.gov (United States)

    Hovlid, Einar; Bukve, Oddbjørn; Haug, Kjell; Aslaksen, Aslak Bjarne; von Plessen, Christian

    2012-08-03

    Changes that improve the quality of health care should be sustained. Falling back to old, unsatisfactory ways of working is a waste of resources and can in the worst case increase resistance to later initiatives to improve care. Quality improvement relies on changing the clinical system yet factors that influence the sustainability of quality improvements are poorly understood. Theoretical frameworks can guide further research on the sustainability of quality improvements. Theories of organizational learning have contributed to a better understanding of organizational change in other contexts. To identify factors contributing to sustainability of improvements, we use learning theory to explore a case that had displayed sustained improvement. Førde Hospital redesigned the pathway for elective surgery and achieved sustained reduction of cancellation rates. We used a qualitative case study design informed by theory to explore factors that contributed to sustain the improvements at Førde Hospital. The model Evidence in the Learning Organization describes how organizational learning contributes to change in healthcare institutions. This model constituted the framework for data collection and analysis. We interviewed a strategic sample of 20 employees. The in-depth interviews covered themes identified through our theoretical framework. Through a process of coding and condensing, we identified common themes that were interpreted in relation to our theoretical framework. Clinicians and leaders shared information about their everyday work and related this knowledge to how the entire clinical pathway could be improved. In this way they developed a revised and deeper understanding of their clinical system and its interdependencies. They became increasingly aware of how different elements needed to interact to enhance the performance and how their own efforts could contribute. The improved understanding of the clinical system represented a change in mental models of

  2. The SUSTAIN Project: A European Study on Improving Integrated Care for Older People Living at Home

    Science.gov (United States)

    Stoop, Annerieke; Billings, Jenny; Leichsenring, Kai; Ruppe, Georg; Tram, Nhu; Barbaglia, María Gabriela; Ambugo, Eliva A.; Zonneveld, Nick; Paat-Ahi, Gerli; Hoffmann, Henrik; Khan, Usman; Stein, Viktoria; Wistow, Gerald; Lette, Manon; Jansen, Aaltje P.D.; Nijpels, Giel; Baan, Caroline A.

    2018-01-01

    Introduction: Integrated care programmes are increasingly being put in place to provide care to older people who live at home. Knowledge of how to further develop integrated care and how to transfer successful initiatives to other contexts is still limited. Therefore, a cross-European research project, called Sustainable Tailored Integrated Care for Older People in Europe (SUSTAIN), has been initiated with a twofold objective: 1. to collaborate with local stakeholders to support and monitor improvements to established integrated care initiatives for older people with multiple health and social care needs. Improvements focus on person-centredness, prevention orientation, safety and efficiency; 2. to make these improvements applicable and adaptable to other health and social care systems, and regions in Europe. This paper presents the overall structure and approach of the SUSTAIN project. Methods: SUSTAIN uses a multiple embedded case study design. In three phases, SUSTAIN partners: (i) conduct interviews and workshops with stakeholders from fourteen established integrated care initiatives to understand where they would prefer improvements to existing ways of working; (ii) collaborate with local stakeholders to support the design and implementation of improvement plans, evaluate implementation progress and outcomes per initiative, and carry out overarching analyses to compare the different initiatives, and; (iii) translate knowledge and experience to an online roadmap. Discussion: SUSTAIN aims to generate evidence on how to improve integrated care, and apply and transfer the knowledge gained to other health and social care systems, and regions. Lessons learned will be brought together in practical tools to inform and support policy-makers and decision-makers, as well as other stakeholders involved in integrated care, to manage and improve care for older people living at home. PMID:29632456

  3. Evaluating the Improvement of Sustainability of Sports Industry Policy Based on MADM

    Directory of Open Access Journals (Sweden)

    Kuang-Hua Hu

    2016-06-01

    Full Text Available The influence of globalization on sports has turned out to be a popular issue widely discussed by researchers. Improvement to the sustainability of sports industry policy is an important and challenging issue, and related are inherently multiple attribute decision making (MADM problems that can be strategically important to economic systems. The purpose of this study is to set up a new sustainability sports industry policy evaluation model that addresses the main causal factors and amends the priorities. A MADM model is combined with DEMATEL, DANP, and VIKOR for the evaluation and improvement of the sustainability of sports industry policy. The improvement priorities according to the domain expert interviews are in the following order: promotion and assistance of government policy (A, sports venues and facilities (D, enterprise sponsorship of sports quality (E, expert human resources (B, and finally sports competitions and events (C.

  4. Prerequisites for sustainable care improvement using the reflective team as a work model.

    Science.gov (United States)

    Jonasson, Lise-Lotte; Carlsson, Gunilla; Nyström, Maria

    2014-01-01

    Several work models for care improvement have been developed in order to meet the requirement for evidence-based care. This study examines a work model for reflection, entitled the reflective team (RT). The main idea behind RTs is that caring skills exist among those who work closest to the patients. The team leader (RTL) encourages sustainable care improvement, rooted in research and proven experience, by using a lifeworld perspective to stimulate further reflection and a developmental process leading to research-based caring actions within the team. In order to maintain focus, it is important that the RTL has a clear idea of what sustainable care improvement means, and what the prerequisites are for such improvement. The aim of the present study is, therefore, to explore the prerequisites for improving sustainable care, seeking to answer how RTLs perceive these and use RTs for concrete planning. Nine RTLs were interviewed, and their statements were phenomenographically analysed. The analysis revealed three separate qualitative categories, which describe personal, interpersonal, and structural aspects of the prerequisites. In the discussion, these categories are compared with previous research on reflection, and the conclusion is reached that the optimal conditions for RTs to work, when focussed on sustainable care improvement, occur when the various aspects of the prerequisites are intertwined and become a natural part of the reflective work.

  5. Improving the Sustainability of Office Partition Manufacturing: Balancing Options for Reducing Emissions of Volatile Organic Compounds

    Directory of Open Access Journals (Sweden)

    Marc A. Rosen

    2009-06-01

    Full Text Available Options are examined to improve the sustainability of office partition manufacturing by reducing volatile organic compounds (VOC emissions. Base VOC emissions for a typical plant are estimated using a mass balance approach. Pollution prevention and sustainability measures are assessed using realistic criteria and weightings. Sustainability has been considered from an industry perspective, considering factors like economics, environmental impact, quality, health and safety. Through a case study, it is demonstrated that several advantageous options are available for reducing VOC emissions in manufacturing office furniture partitions, and thereby enhancing the sustainability of that industrial operation. The measures deemed most viable include implementing several best management practices, not painting of non-visible parts, switching gluing processes, recycling solvent and modifying attachments. The results are intended to be balanced so as to improve their acceptability and adoptability by industry. It appears that it would be advantageous for manufacturers of office panels to evaluate the feasibility of these measures and to implement the most appropriate. The results are likely extendable to other operations in the wood furniture industry, and would improve their sustainability.

  6. IMPROVING BIOMASS LOGISTICS COST WITHIN AGRONOMIC SUSTAINABILITY CONSTRAINTS AND BIOMASS QUALITY TARGETS

    Energy Technology Data Exchange (ETDEWEB)

    J. Richard Hess; Kevin L. Kenney; Christopher T. Wright; David J. Muth; William Smith

    2012-10-01

    Equipment manufacturers have made rapid improvements in biomass harvesting and handling equipment. These improvements have increased transportation and handling efficiencies due to higher biomass densities and reduced losses. Improvements in grinder efficiencies and capacity have reduced biomass grinding costs. Biomass collection efficiencies (the ratio of biomass collected to the amount available in the field) as high as 75% for crop residues and greater than 90% for perennial energy crops have also been demonstrated. However, as collection rates increase, the fraction of entrained soil in the biomass increases, and high biomass residue removal rates can violate agronomic sustainability limits. Advancements in quantifying multi-factor sustainability limits to increase removal rate as guided by sustainable residue removal plans, and mitigating soil contamination through targeted removal rates based on soil type and residue type/fraction is allowing the use of new high efficiency harvesting equipment and methods. As another consideration, single pass harvesting and other technologies that improve harvesting costs cause biomass storage moisture management challenges, which challenges are further perturbed by annual variability in biomass moisture content. Monitoring, sampling, simulation, and analysis provide basis for moisture, time, and quality relationships in storage, which has allowed the development of moisture tolerant storage systems and best management processes that combine moisture content and time to accommodate baled storage of wet material based upon “shelf-life.” The key to improving biomass supply logistics costs has been developing the associated agronomic sustainability and biomass quality technologies and processes that allow the implementation of equipment engineering solutions.

  7. Will a single periarticular lidocaine-corticosteroid injection improve the clinical efficacy of intraarticular hyaluronic acid treatment of symptomatic knee osteoarthritis?

    Science.gov (United States)

    Ertürk, Cemil; Altay, Mehmet Akif; Altay, Nuray; Kalender, Ali Murat; Öztürk, İbrahim Avşin

    2016-11-01

    A local injection of corticosteroid-lidocaine into the periarticular soft tissue structures is used commonly for rapid pain relief. It is hypothesized that knee pain associated with knee osteoarthritis would be relieved quickly and effectively in patients receiving intraarticular hyaluronic acid combined with a periarticular lidocaine-corticosteroid injection. To test this hypothesis, the clinical effect of the combined treatment with hyaluronic acid injection alone in patients with symptomatic knee osteoarthritis as compared in this prospective single-blinded randomized trial. This study included 70 patients. Group 1 (n = 35) received intraarticular hyaluronic acid injections only, whereas group 2 (n = 35) received intraarticular hyaluronic acid injections combined with a single local injection of corticosteroid-lidocaine. Injections were administered to the most painful areas of the anterior or posterior medial condyle of the femur or tibia. The outcome was measured by independent assessors (blinded to treatment) using a linear VAS pain scale and WOMAC and HSS knee scores. Assessments were performed at baseline and at 1, 3, 6, 12, 26, and 52 weeks. During the first 3 weeks, group 2 patients showed significantly better all scores than did group 1 patients (p hyaluronic acid alone in patients with knee osteoarthritis and can be considered a useful adjunctive treatment modality. This combined method may provide early return to patient's daily activity. Therapeutic study, Level I.

  8. Toward a sustainable cement industry in 2020 : improvement of the environmental, health & safety performance

    NARCIS (Netherlands)

    2001-01-01

    This background document concentrates on technical and managerial aspects of Environmental, Health & Safety Performance (EHS) control in the cement industry. It gives an overview of options for improvement toward a sustainable cement production in 2020. Energy consumption and use of alternative

  9. Hyper-Realistic, Team-Centered Fleet Surgical Team Training Provides Sustained Improvements in Performance.

    Science.gov (United States)

    Hoang, Tuan N; Kang, Jeff; Siriratsivawong, Kris; LaPorta, Anthony; Heck, Amber; Ferraro, Jessica; Robinson, Douglas; Walsh, Jonathan

    2016-01-01

    The high-stress, fast-paced environment of combat casualty care relies on effective teamwork and communication which translates into quality patient care. A training course was developed for U.S. Navy Fleet Surgical Teams to address these aspects of patient care by emphasizing efficiency and appropriate patient care. An effective training course provides knowledge and skills to pass the course evaluation and sustain the knowledge and skills acquired over time. The course included classroom didactic hours, and hands-on simulation sessions. A pretest was administered before the course, a posttest upon completion, and a sustainment test 5 months following course completion. The evaluation process measured changes in patient time to disposition and critical errors made during patient care. Naval Base San Diego, with resuscitation and surgical simulations carried out within the shipboard medical spaces. United States Navy medical personnel including physicians of various specialties, corpsmen, nurses, and nurse anesthetists deploying aboard ships. Time to disposition improved significantly, 11 ± 3 minutes, from pretest to posttest, and critical errors improved by 4 ± 1 errors per encounter. From posttest to sustainment test, time to disposition increased by 3 ± 1, and critical errors decreased by 1 ± 1. This course showed value in improving teamwork and communication skills of participants, immediately upon completion of the course, and after 5 months had passed. Therefore, with ongoing sustainment activities within 6 months, this course can substantially improve trauma care provided by shipboard deployed Navy medical personnel to wounded service members. Published by Elsevier Inc.

  10. Nuclear Weapons Sustainment: Improvements Made to Budget Estimates Report, but Opportunities Remain to Further Enhance Transparency

    Science.gov (United States)

    2015-12-01

    Enhance Transparency Report to Congressional Committees December 2015 GAO-16-23 United States Government Accountability Office United...SUSTAINMENT Improvements Made to Budget Estimates Report, but Opportunities Remain to Further Enhance Transparency Why GAO Did This Study DOD and DOE are...modernization plans and (2) complete, transparent information on the methodologies used to develop those estimates. GAO analyzed the departments

  11. Does compliance to patient safety tasks improve and sustain when radiotherapy treatment processes are standardized?

    Science.gov (United States)

    Simons, Pascale A M; Houben, Ruud; Benders, Jos; Pijls-Johannesma, Madelon; Vandijck, Dominique; Marneffe, Wim; Backes, Huub; Groothuis, Siebren

    2014-10-01

    To realize safe radiotherapy treatment, processes must be stabilized. Standard operating procedures (SOP's) were expected to stabilize the treatment process and perceived task importance would increase sustainability in compliance. This paper presents the effects on compliance to safety related tasks of a process redesign based on lean principles. Compliance to patient safety tasks was measured by video recording of actual radiation treatment, before (T0), directly after (T1) and 1.5 years after (T2) a process redesign. Additionally, technologists were surveyed on perceived task importance and reported incidents were collected for three half-year periods between 2007 and 2009. Compliance to four out of eleven tasks increased at T1, of which improvements on three sustained (T2). Perceived importance of tasks strongly correlated (0.82) to compliance rates at T2. The two tasks, perceived as least important, presented low base-line compliance, improved (T1), but relapsed at T2. The reported near misses (patient-level not reached) on accelerators increased (P improvements sustained after 1.5 years, indicating increased stability. Perceived importance of tasks correlated positively to compliance and sustainability. Raising the perception of task importance is thus crucial to increase compliance. The redesign resulted in increased willingness to report incidents, creating opportunities for patient safety improvement in radiotherapy treatment. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Can We Improve Training for Health Professionals to Sustain Local Health Development?

    Science.gov (United States)

    King, Stephen

    2016-01-01

    Can we improve training for health professionals? We explore specific variables that need to be accounted for to achieve sustainable local health development through training. A problem-based approach with appreciation of the need for making changes is suggested as the only authentic basis for training. PMID:28090174

  13. Healthcare quality in Ghana : Improving healthcare quality and health worker motivation to promote sustainable health insurance

    NARCIS (Netherlands)

    Alhassan, R.K.

    2017-01-01

    This thesis is about promoting a sustainable National Health Insurance Scheme (NHIS) in Ghana through improved client-centred quality care and effective community engagement in quality care assessment. The thesis comprises of two main parts. Part one reports on findings from baseline surveys

  14. Symptomatic unruptured cerebral aneurysms. Features and surgical outcome

    International Nuclear Information System (INIS)

    Date, Isao

    2010-01-01

    Development of less invasive imaging studies, such as magnetic resonance angiography, has increased the chances that unruptured cerebral aneurysms are found. The rupture risk of 'symptomatic' aneurysms is higher than for 'asymptomatic' aneurysms; so 'symptomatic' aneurysms are more often surgically treated. Many reviews examine 'asymptomatic' unruptured cerebral aneurysms, but few evaluate 'symptomatic' aneurysms. The author has treated many patients with symptomatic unruptured cerebral aneurysms and found that improved cranial nerve signs can be expected if the surgical treatment is performed before the symptoms become irreversible; the critical period is approximately 3 months. It is important to suppress the pulsation of the aneurysms compressing the cranial nerves; both a clipping procedure and endovascular coiling are effective. Cranial nerve signs are more commonly the symptoms of unruptured cerebral aneurysms, but large to giant aneurysms can also be the causes of hemiparesis, hydrocephalus, epilepsy, or even cerebral infarction. This review summarizes the features and surgical outcome of symptomatic unruptured cerebral aneurysms. (author)

  15. Sustaining a quality improvement culture in local health departments applying for accreditation.

    Science.gov (United States)

    Verma, Pooja; Moran, John W

    2014-01-01

    This article focuses on local health departments (LHDs) that are advanced in accreditation and quality improvement (QI) efforts and the barriers and facilitators associated with sustaining improvements and building an organizational culture of QI. To understand the barriers and facilitators associated with building and sustaining progress toward a QI culture in LHDs. Quantitative data from a self-reporting survey and qualitative data from telephone interviews. Twenty-two LHDs across the United States responded to the survey. Ten of the 22 LHD respondents participated in telephone interviews. QI lead staff at LHDs that are advanced in accreditation preparation and QI. Self-reported LHD survey ratings against indicators for a QI culture, and the identified barriers and facilitators around sustaining QI initiatives. Of the 6 domains of a QI culture measured in the survey, the percentages of respondents that scored themselves highly to at least 1 indicator in each domain are as follows: leadership commitment (100%); employee empowerment (100%); teamwork and collaboration (100%); continuous process improvement (86%); customer focus (72%); and QI infrastructure (64%). Qualitative data from 10 telephone interviews revealed that key barriers to sustaining progress around QI included staff turnover, budget cuts, and major crises or events that arise as priority. Key facilitators included leadership commitment, accreditation, and dedication of resources and staff time to QI. When engaging in QI, LHDs should consider investing efforts in gaining leadership support and dedicating staff time early in the QI journey to ensure that QI efforts and initiatives are sustained. Local health departments interested in developing a QI culture should also consider pursuing accreditation, as it provides a structured framework for continuous improvement. They should also actively develop QI knowledge and skills among all staff members to minimize the negative impact of staff turnover.

  16. Lean Transformation Guidance: Why Organizations Fail To Achieve and Sustain Excellence Through Lean Improvement

    Directory of Open Access Journals (Sweden)

    Mohammed Hamed Ahmed

    2013-06-01

    Full Text Available Many companies are complaining that lean didn’t achieve their long-term goals, and the improvement impact was very short-lived. 7 out of each 10 lean projects fail as companies try to use lean like a toolkit, copying and pasting the techniques without trying to adapt the employee’s culture, manage the improvement process, sustain the results, and develop their leaders. When the Toyota production system was created, the main goal was to remove wastes from the shop floor using some lean techniques and tools. What was not clear is that this required from Toyota a long process of leadership development, and a high commitment to training and coaching their employee. A Failure to achieve and sustain the improvement is a problem of both management and leadership as well as the improper understanding of the human behavior, and the required culture to success.

  17. City logistics initiatives aimed at improving sustainability by changing the context of urban area

    Directory of Open Access Journals (Sweden)

    Tadić Snežana R.

    2014-01-01

    Full Text Available City logistics is a field that attracts increasing attention of professionals and scientific community and international organizations. Research on problems of urban areas' logistics gives different results and practical solutions. City logistics flows are characterized by partiality, spatial dispersion of generators, diversity in terms of the logistics chains structure, frequency of a large number of smaller shipments, dynamism, stochasticity etc. Problems and the complexity of logistics in urban areas as well as significant decline in the quality of life in modern cities have caused the development of initiatives and concepts of city logistics which should allow the sustainable development of urban areas. The first part of this paper presents the problems of city logistics and impact of logistics activities on urban areas in terms of economic, environmental and social sustainability. The second part presents city logistics initiatives that involve the change of urban area context, in order to improve its sustainability.

  18. An agenda for assessing and improving conservation impacts of sustainability standards in tropical agriculture.

    Science.gov (United States)

    Milder, Jeffrey C; Arbuthnot, Margaret; Blackman, Allen; Brooks, Sharon E; Giovannucci, Daniele; Gross, Lee; Kennedy, Elizabeth T; Komives, Kristin; Lambin, Eric F; Lee, Audrey; Meyer, Daniel; Newton, Peter; Phalan, Ben; Schroth, Götz; Semroc, Bambi; Van Rikxoort, Henk; Zrust, Michal

    2015-04-01

    Sustainability standards and certification serve to differentiate and provide market recognition to goods produced in accordance with social and environmental good practices, typically including practices to protect biodiversity. Such standards have seen rapid growth, including in tropical agricultural commodities such as cocoa, coffee, palm oil, soybeans, and tea. Given the role of sustainability standards in influencing land use in hotspots of biodiversity, deforestation, and agricultural intensification, much could be gained from efforts to evaluate and increase the conservation payoff of these schemes. To this end, we devised a systematic approach for monitoring and evaluating the conservation impacts of agricultural sustainability standards and for using the resulting evidence to improve the effectiveness of such standards over time. The approach is oriented around a set of hypotheses and corresponding research questions about how sustainability standards are predicted to deliver conservation benefits. These questions are addressed through data from multiple sources, including basic common information from certification audits; field monitoring of environmental outcomes at a sample of certified sites; and rigorous impact assessment research based on experimental or quasi-experimental methods. Integration of these sources can generate time-series data that are comparable across sites and regions and provide detailed portraits of the effects of sustainability standards. To implement this approach, we propose new collaborations between the conservation research community and the sustainability standards community to develop common indicators and monitoring protocols, foster data sharing and synthesis, and link research and practice more effectively. As the role of sustainability standards in tropical land-use governance continues to evolve, robust evidence on the factors contributing to effectiveness can help to ensure that such standards are designed and

  19. The sustainability of improvements from continuing professional development in pharmacy practice and learning behaviors.

    Science.gov (United States)

    McConnell, Karen J; Delate, Thomas; Newlon, Carey L

    2015-04-25

    To assess the long-term sustainability of continuing professional development (CPD) training in pharmacy practice and learning behaviors. This was a 3-year posttrial survey of pharmacists who had participated in an unblinded randomized controlled trial of CPD. The online survey assessed participants' perceptions of pharmacy practice, learning behaviors, and sustainability of CPD. Differences between groups on the posttrial survey responses and changes from the trial's follow-up survey to the posttrial survey responses within the intervention group were compared. Of the 91 pharmacists who completed the original trial, 72 (79%) participated in the sustainability survey. Compared to control participants, a higher percentage of intervention participants reported in the sustainability survey that they had utilized the CPD concept (45.7% vs 8.1%) and identified personal learning objectives (68.6% vs 43.2%) during the previous year. Compared to their follow-up survey responses, lower percentages of intervention participants reported identifying personal learning objectives (94.3% vs 68.6%), documenting their learning plan (82.9% vs 22.9%) and participating in learning by doing (42.9% vs 14.3%) in the sustainability survey. In the intervention group, many of the improvements to pharmacy practice items were sustained over the 3-year period but were not significantly different from the control group. Sustainability of a CPD intervention over a 3-year varied. While CPD-trained pharmacists reported utilizing CPD concepts at a higher rate than control pharmacists, their CPD learning behaviors diminished over time.

  20. Relationships Between Functional Outcomes and Symptomatic Improvement in Atomoxetine-Treated Adult Patients with Attention-Deficit/Hyperactivity Disorder: Post Hoc Analysis of an Integrated Database

    NARCIS (Netherlands)

    Bruyckere, K. De; Bushe, C.; Bartel, C.; Berggren, L.; Kan, C.C.; Dittmann, R.W.

    2016-01-01

    BACKGROUND: Atomoxetine treatment is associated with improvements in functional outcomes in patients with attention-deficit/hyperactivity disorder (ADHD), although relationships between improvements in these outcomes and reductions in ADHD symptoms have not been comprehensively investigated in

  1. Life cycle considerations for improving sustainability assessments in seafood awareness campaigns.

    Science.gov (United States)

    Pelletier, Nathan; Tyedmers, Peter

    2008-11-01

    It is widely accepted that improving the sustainability of seafood production requires efforts to reverse declines in global fisheries due to overfishing and to reduce the impacts to host ecosystems from fishing and aquaculture production technologies. Reflective of on-going dialogue amongst participants in an international research project applying Life Cycle Assessment to better understand and manage global salmon production systems, we argue here that such efforts must also address the wider range of biophysical, ecological, and socioeconomic impacts stemming from the material and energetic throughput associated with these industries. This is of particular relevance given the interconnectivity of global environmental change, ocean health, and the viability of seafood production in both fisheries and aquaculture. Although the growing popularity of numerous ecolabeling, certification, and consumer education programs may be making headway in influencing Western consumer perceptions of the relative sustainability of alternative seafood products, we also posit that the efficacy of these initiatives in furthering sustainability objectives is compromised by the use of incomplete criteria. An emerging body of Life Cycle Assessment research of fisheries and aquaculture provides valuable insights into the biophysical dimensions of environmental performance in alternative seafood production and consumption systems, and should be used to inform a more holistic approach to labeling, certifying, and educating for sustainability in seafood production. More research, however, must be undertaken to develop novel techniques for incorporating other critical dimensions, in particular, socioeconomic considerations, into our sustainability decision-making.

  2. A Systems Thinking Approach To The Sustainability Of Quality Improvement Programmes

    Directory of Open Access Journals (Sweden)

    Van Dyk, Dirk Johannes

    2014-05-01

    Full Text Available The challenge for organisations to continually provide the best return on investment for their shareholders has become increasingly difficult through globalisation of the market place. There are many responses a company could make to these challenges for example, new product development, increased market capitalisation, cost reduction initiatives, and quality management. This last response focuses on, but is not restricted to, customer satisfaction, continuous improvement, and environmental impact. Continuous improvement addresses waste in the business design and manufacturing processes, which could lead to improved profit margins. The sustainability of quality improvement programmes remains a challenge. Causality can be studied, using Six Sigma tools, to relate cause and effect. But these tools do not always allow the user to study and understand feedback from other factors, such as soft human issues, in the improvement process system, typically referred to as feedback causality. System dynamics may improve this understanding. Quality improvement programmes in the heavy engineering manufacturing environment are not researched to the same degree as those in the automotive manufacturing environment. The purpose of this paper is to share results from research into the sustainability of quality improvement programmes, and the development of an appropriate system dynamics model, using qualitative case study data gathered and coded in a heavy engineering manufacturing environment.

  3. A Review of Sustainability Enhancements in the Beef Value Chain: State-of-the-Art and Recommendations for Future Improvements.

    Science.gov (United States)

    Maia de Souza, Danielle; Petre, Ruaraidh; Jackson, Fawn; Hadarits, Monica; Pogue, Sarah; Carlyle, Cameron N; Bork, Edward; McAllister, Tim

    2017-03-22

    The beef sector is working towards continually improving its sustainability in order to achieve environmentally, socially and economically desirable outcomes, all of which are of increasing concern to consumers. In this context, the Global Roundtable for Sustainable Beef (GRSB) provides guidance to advance the sustainability of the beef industry, through increased stakeholder engagement and the formation of national roundtables. Recently, the 2nd Global Conference on Sustainable Beef took place in Banff, Alberta, Canada, hosted by the GRSB and the Canadian Roundtable for Sustainable Beef. Conference attendees discussed the various initiatives that are being developed to address aspects of beef sustainability. This paper reviews the main discussions that occurred during this event, along with the key lessons learned, messages, and strategies that were proposed to improve the sustainability of the global beef industry.

  4. A Review of Sustainability Enhancements in the Beef Value Chain: State-of-the-Art and Recommendations for Future Improvements

    Directory of Open Access Journals (Sweden)

    Danielle Maia de Souza

    2017-03-01

    Full Text Available The beef sector is working towards continually improving its sustainability in order to achieve environmentally, socially and economically desirable outcomes, all of which are of increasing concern to consumers. In this context, the Global Roundtable for Sustainable Beef (GRSB provides guidance to advance the sustainability of the beef industry, through increased stakeholder engagement and the formation of national roundtables. Recently, the 2nd Global Conference on Sustainable Beef took place in Banff, Alberta, Canada, hosted by the GRSB and the Canadian Roundtable for Sustainable Beef. Conference attendees discussed the various initiatives that are being developed to address aspects of beef sustainability. This paper reviews the main discussions that occurred during this event, along with the key lessons learned, messages, and strategies that were proposed to improve the sustainability of the global beef industry.

  5. A Novel Feed-Forward Modeling System Leads to Sustained Improvements in Attention and Academic Performance.

    Science.gov (United States)

    McDermott, Ashley F; Rose, Maya; Norris, Troy; Gordon, Eric

    2016-01-28

    This study tested a novel feed-forward modeling (FFM) system as a nonpharmacological intervention for the treatment of ADHD children and the training of cognitive skills that improve academic performance. This study implemented a randomized, controlled, parallel design comparing this FFM with a nonpharmacological community care intervention. Improvements were measured on parent- and clinician-rated scales of ADHD symptomatology and on academic performance tests completed by the participant. Participants were followed for 3 months after training. Participants in the FFM training group showed significant improvements in ADHD symptomatology and academic performance, while the control group did not. Improvements from FFM were sustained 3 months later. The FFM appeared to be an effective intervention for the treatment of ADHD and improving academic performance. This FFM training intervention shows promise as a first-line treatment for ADHD while improving academic performance. © The Author(s) 2016.

  6. Earth Science Informatics Community Requirements for Improving Sustainable Science Software Practices: User Perspectives and Implications for Organizational Action

    Science.gov (United States)

    Downs, R. R.; Lenhardt, W. C.; Robinson, E.

    2014-12-01

    Science software is integral to the scientific process and must be developed and managed in a sustainable manner to ensure future access to scientific data and related resources. Organizations that are part of the scientific enterprise, as well as members of the scientific community who work within these entities, can contribute to the sustainability of science software and to practices that improve scientific community capabilities for science software sustainability. As science becomes increasingly digital and therefore, dependent on software, improving community practices for sustainable science software will contribute to the sustainability of science. Members of the Earth science informatics community, including scientific data producers and distributers, end-user scientists, system and application developers, and data center managers, use science software regularly and face the challenges and the opportunities that science software presents for the sustainability of science. To gain insight on practices needed for the sustainability of science software from the science software experiences of the Earth science informatics community, an interdisciplinary group of 300 community members were asked to engage in simultaneous roundtable discussions and report on their answers to questions about the requirements for improving scientific software sustainability. This paper will present an analysis of the issues reported and the conclusions offered by the participants. These results provide perspectives for science software sustainability practices and have implications for actions that organizations and their leadership can initiate to improve the sustainability of science software.

  7. Implementing for Sustainability: Promoting Use of a Measurement Feedback System for Innovation and Quality Improvement.

    Science.gov (United States)

    Douglas, Susan; Button, Suzanne; Casey, Susan E

    2016-05-01

    Measurement feedback systems (MFSs) are increasingly recognized as evidence-based treatments for improving mental health outcomes, in addition to being a useful administrative tool for service planning and reporting. Promising research findings have driven practice administrators and policymakers to emphasize the incorporation of outcomes monitoring into electronic health systems. To promote MFS integrity and protect against potentially negative outcomes, it is vital that adoption and implementation be guided by scientifically rigorous yet practical principles. In this point of view, the authors discuss and provide examples of three user-centered and theory-based principles: emphasizing integration with clinical values and workflow, promoting administrative leadership with the 'golden thread' of data-informed decision-making, and facilitating sustainability by encouraging innovation. In our experience, enacting these principles serves to promote sustainable implementation of MFSs in the community while also allowing innovation to occur, which can inform improvements to guide future MFS research.

  8. Focused process improvement events: sustainability of impact on process and performance in an academic radiology department.

    Science.gov (United States)

    Rosenkrantz, Andrew B; Lawson, Kirk; Ally, Rosina; Chen, David; Donno, Frank; Rittberg, Steven; Rodriguez, Joan; Recht, Michael P

    2015-01-01

    To evaluate sustainability of impact of rapid, focused process improvement (PI) events on process and performance within an academic radiology department. Our department conducted PI during 2011 and 2012 in CT, MRI, ultrasound, breast imaging, and research billing. PI entailed participation by all stakeholders, facilitation by the department chair, collection of baseline data, meetings during several weeks, definition of performance metrics, creation of an improvement plan, and prompt implementation. We explore common themes among PI events regarding initial impact and durability of changes. We also assess performance in each area pre-PI, immediately post-PI, and at the time of the current study. All PI events achieved an immediate improvement in performance metrics, often entailing both examination volumes and on-time performance. IT-based solutions, process standardization, and redefinition of staff responsibilities were often central in these changes, and participants consistently expressed improved internal leadership and problem-solving ability. Major environmental changes commonly occurred after PI, including a natural disaster with equipment loss, a change in location or services offered, and new enterprise-wide electronic medical record system incorporating new billing and radiology informatics systems, requiring flexibility in the PI implementation plan. Only one PI team conducted regular post-PI follow-up meetings. Sustained improvement was frequently, but not universally, observed: in the long-term following initial PI, measures of examination volume showed continued progressive improvements, whereas measures of operational efficiency remained stable or occasionally declined. Focused PI is generally effective in achieving performance improvement, although a changing environment influences the sustainability of impact. Thus, continued process evaluation and ongoing workflow modifications are warranted. Copyright © 2015 American College of Radiology

  9. Comparing Kaolin and Pinolene to Improve Sustainable Grapevine Production during Drought

    OpenAIRE

    Brillante, Luca; Belfiore, Nicola; Gaiotti, Federica; Lovat, Lorenzo; Sansone, Luigi; Poni, Stefano; Tomasi, Diego

    2016-01-01

    Viticulture is widely practiced in dry regions, where the grapevine is greatly exposed to water stress. Optimizing plant water use efficiency (WUE) without affecting crop yield, grape and wine quality is crucial to limiting use of water for irrigation and to significantly improving viticulture sustainability. This study examines the use in vineyards of particle film technology (engineered kaolin) and compares it to a film-forming antitranspirant (pinolene), traditionally used to limit leaf wa...

  10. The Sustainable Office. An exploration of the potential for factor 20 environmental improvement of office accommodation

    OpenAIRE

    Van den Dobbelsteen, A.A.J.F.

    2004-01-01

    Sustainable development is the goal of a balance between economy and the environment, whilst establishing a better spread prosperity across the world. In order to make this possible, the environmental load of our commodities needs to be reduced by a factor of 20. This factor 20 can also be translated to the office market. The PhD research presented in this thesis focussed on finding solutions effectively contributing to factor 20 environmental improvement of office accommodation. In order to ...

  11. Symptomatic splenomegaly and palliative radiotherapy

    International Nuclear Information System (INIS)

    Yaneva, M.; Vlaikova, M.

    2005-01-01

    We analysed the effect of irradiation of an enlarged spleen in some hematologic diseases: chronic myelaemia, osteomyelophybrosis and chronic lymphadenosis, where splenectomy had been contraindicated and where pain has been a leading symptom and also the discomfort because of an enlarged spleen. For 20 years in the Clinic of Radiotherapy have been treated 23 patients with the above mentioned diseases. We have irradiated all patients using X-ray and later- Co-60. To reach a palliative effect we have irradiated patients with single doses from 50 cGy to 100 cGy with an interval of 2-3 days between each fraction, but the total doses have been different- from 400 cGy to 1500 cGy. The enlarged spleen has reached the pelvis in 3 cm to 17 cm below the costal margin, and in some patients has crossed the median line of the body going in some centimetres on the other side. The reduction of splenic size and volume is as follows: full reduction in 6 patients (26.1%) and partial in 17 (73.9%). All patients resulted in decreases in pain and tension in abdomen and the total discomfort. No serious side haematologic effects were encountered. Our experience indicates that cautious splenic irradiation can be a safe and useful therapeutic alternative. The symptomatic palliation in patients, where splenectomy is not an option, is effective and is an additional alternative for an improvement of their general condition

  12. Asthma disease management-Australian pharmacists' interventions improve patients' asthma knowledge and this is sustained.

    Science.gov (United States)

    Saini, Bandana; LeMay, Kate; Emmerton, Lynne; Krass, Ines; Smith, Lorraine; Bosnic-Anticevich, Sinthia; Stewart, Kay; Burton, Deborah; Armour, Carol

    2011-06-01

    To assess any improvements in knowledge of asthma patients after a tailored education program delivered by pharmacists and measure the sustainability of any improvements. To ascertain patients' perceptions about any changes in their knowledge. Ninety-six specially trained pharmacists recruited patients based on their risk of poor asthma control. A tailored intervention was delivered to patients based on individual needs and goals, and was conducted at three or four time points over six months. Asthma knowledge was assessed at the beginning and end of the service, and six and 12 months after it had ended. Patients' perceptions of the impact of the service on their knowledge were explored qualitatively in interviews. The 96 pharmacists recruited 570 patients, 398 (70%) finished. Asthma knowledge significantly improved as a result of the service (7.65 ± 2.36, n=561, to 8.78 ± 2.14, n=393). This improvement was retained for at least 12 months after the service. Patients reported how the knowledge and skills gained had led to a change in the way they managed their asthma. Improvements in knowledge are achievable and sustainable if pharmacists used targeted educational interventions. Pharmacist educational interventions are an efficient way to improve asthma knowledge in the community. Crown Copyright © 2011. Published by Elsevier Ireland Ltd. All rights reserved.

  13. Dissecting the Yale-Brown Obsessive-Compulsive Scale severity scale to understand the routes for symptomatic improvement in obsessive-compulsive disorder.

    Science.gov (United States)

    Costa, Daniel L da Conceição; Barbosa, Veronica S; Requena, Guaraci; Shavitt, Roseli G; Pereira, Carlos A de Bragança; Diniz, Juliana B

    2017-10-01

    We aimed to investigate which items of the Yale-Brown Obsessive-Compulsive Severity Scale best discriminate the reduction in total scores in obsessive-compulsive disorder patients after 4 and 12 weeks of pharmacological treatment. Data from 112 obsessive-compulsive disorder patients who received fluoxetine (⩽80 mg/day) for 12 weeks were included. Improvement indices were built for each Yale-Brown Obsessive-Compulsive Severity Scale item at two timeframes: from baseline to week 4 and from baseline to week 12. Indices for each item were correlated with the total scores for obsessions and compulsions and then ranked by correlation coefficient. A correlation coefficient ⩾0.7 was used to identify items that contributed significantly to reducing obsessive-compulsive disorder severity. At week 4, the distress items reached the threshold of 0.7 for improvement on the obsession and compulsion subscales although, contrary to our expectations, there was greater improvement in the control items than in the distress items. At week 12, there was greater improvement in the time, interference, and control items than in the distress items. The use of fluoxetine led first to reductions in distress and increases in control over symptoms before affecting the time spent on, and interference from, obsessions and compulsions. Resistance did not correlate with overall improvement. Understanding the pathway of improvement with pharmacological treatment in obsessive-compulsive disorder may provide clues about how to optimize the effects of medication.

  14. After The Demonstration: What States Sustained After the End of Federal Grants to Improve Children's Health Care Quality.

    Science.gov (United States)

    Ireys, Henry T; Brach, Cindy; Anglin, Grace; Devers, Kelly J; Burton, Rachel

    2018-02-01

    Introduction Under the CHIPRA Quality Demonstration Grant Program, CMS awarded $100 million through 10 grants that 18 state Medicaid agencies implemented between 2010 and 2015. The program's legislatively-mandated purpose was to evaluate promising ideas for improving the quality of children's health care provided through Medicaid and CHIP. As part of the program's multifaceted evaluation, this study examined the extent to which states sustained key program activities after the demonstration ended. Methods We identified 115 potentially sustainable elements within states' CHIPRA demonstrations and analyzed data from grantee reports and key informant interviews to assess sustainment outcomes and key influential factors. We also assessed sustainment of the projects' intellectual capital. Results 56% of potentially sustainable elements were sustained. Sustainment varied by topic area: Elements related to quality measure reporting and practice facilitation were more likely to be sustained than others, such as parent advisors. Broad contextual factors, the state's Medicaid environment, implementation partners' resources, and characteristics of the demonstration itself all shaped sustainment outcomes. Discussion Assessing sustainment of key elements of states' CHIPRA quality demonstration projects provides insight into the fates of the "promising ideas" that the grant program was designed to examine. As a result of the federal government's investment in this grant program, many demonstration states are in a strong position to extend and spread specific strategies for improving the quality of care for children in Medicaid and CHIP. Our findings provide insights for policymakers and providers working to improve the quality of health care for low income children.

  15. Improving the Reverse Logistics Respecting Principles of Sustainable Development in an Industrial Company

    Science.gov (United States)

    Fidlerová, Helena; Mĺkva, Miroslava

    2016-06-01

    Reverse logistics, the movement of materials back up the supply chain, is recognised by many organisations as an opportunity for adding value. The paper considers the theoretical framework and the conception of reverse logistics in literature and practice. The objective of the article is to propose tangible solutions which eliminate the imbalances in reverse logistics and improve the waste management in the company. The case study focuses on the improvement in the process of waste packaging in the context of sustainable development as a part of reverse logistics in the surveyed industrial company in Slovakia.

  16. Lean Transformation Guidance: Why Organizations Fail To Achieve and Sustain Excellence Through Lean Improvement

    OpenAIRE

    Mohammed Hamed Ahmed

    2013-01-01

    Many companies are complaining that lean didn’t achieve their long-term goals, and the improvement impact was very short-lived. 7 out of each 10 lean projects fail as companies try to use lean like a toolkit, copying and pasting the techniques without trying to adapt the employee’s culture, manage the improvement process, sustain the results, and develop their leaders. When the Toyota production system was created, the main goal was to remove wastes from the shop floor us...

  17. The sustainability of a community pharmacy intervention to improve the quality use of asthma medication.

    Science.gov (United States)

    Bereznicki, B; Peterson, G; Jackson, S; Walters, E H; Gee, P

    2011-04-01

    A previously published asthma intervention used a software application to data mine pharmacy dispensing records and generate a list of patients with potentially suboptimal management of their asthma; in particular, a high rate of provision of reliever medication. These patients were sent educational material from their community pharmacists and advised to seek a review of their asthma management from their general practitioner. The intervention resulted in a 3-fold improvement in the ratio of dispensed preventer medication (inhaled corticosteroids) to reliever medication (short-acting beta-2 agonists). This follow-up study aimed to determine the long-term effects of the intervention programme on the preventer-to-reliever (P:R) ratio. The same data mining software was modified so that it could re-identify patients who were originally targeted for the intervention. Community pharmacists who participated in the previous intervention installed the modified version of the software. The dispensing data were then de-identified, encrypted and transferred via the Internet to a secure server. The follow-up dispensing data for all patients were compared with their pre- and post-intervention data collected originally. Of the 1551 patients who were included in the original study, 718 (46·3%) were eligible to be included in the follow-up study. The improved P:R ratio was sustained for at least 12 months following the intervention (P < 0·01). The sustained increase in the P:R ratio was attributed to significant decreases in the average daily usage of reliever medication (P < 0·0001). The follow-up study demonstrated a sustained improvement in the ratio of dispensed preventer medication to reliever medication for asthma. The intervention has the potential to show long-lasting and widespread improvements in asthma management, improved health outcomes for patients, and ultimately, a reduced burden on the health system. © 2010 Blackwell Publishing Ltd.

  18. International Conference on Effective Nuclear Regulatory Systems: Sustaining Improvements Globally. Book of Abstracts

    International Nuclear Information System (INIS)

    2016-01-01

    The objective of this conference is to review and assess ways of further improving the effectiveness of regulatory systems for nuclear facilities and activities for both nuclear safety and nuclear security. The action items in the summary presented by the President of the conference held in 2013 in Ottawa, the lessons of the Fukushima Daiichi accident, the discussions at other international conferences and at international experts’ meetings conducted within the framework of the IAEA Action Plan on Nuclear Safety, as well as the CNS and the principles outlined in the Vienna Declaration on Nuclear Safety, will continue to have a significant impact on regulatory systems. All the aforementioned need to be taken into account to sustain improvements to regulatory systems. The expected outcomes of the conference are: - Enhanced safety and security of nuclear installations worldwide; - Challenges in regulating radiation sources and radioactive waste addressed; - Enhanced international cooperation for sustaining regulatory effectiveness; - Strengthened and sustained regulatory competence for nuclear safety and security; and - Strategies and actions for the future identified, as well as issues for consideration by governments, regulatory bodies and international organizations.

  19. A hybrid decision support system for sustainable office building renovation and energy performance improvement

    Energy Technology Data Exchange (ETDEWEB)

    Juan, Yi-Kai [Department of Architecture, National Taiwan University of Science and Technology (NTUST) (China); Center for Sustainable Development and Global Competitiveness, Stanford University (United States); Gao, Peng [Department of Traffic and Transportation Engineering, Tongji University (China); Wang, Jie [Center for Sustainable Development and Global Competitiveness, Stanford University (United States)

    2010-03-15

    Energy consumption of buildings accounts for around 20-40% of all energy consumed in advanced countries. Over the last decade, more and more global organizations are investing significant resources to create sustainably built environments, emphasizing sustainable building renovation processes to reduce energy consumption and carbon dioxide emissions. This study develops an integrated decision support system to assess existing office building conditions and to recommend an optimal set of sustainable renovation actions, considering trade-offs between renovation cost, improved building quality, and environmental impacts. A hybrid approach that combines A* graph search algorithm with genetic algorithms (GA) is used to analyze all possible renovation actions and their trade-offs to develop the optimal solution. A two-stage system validation is performed to demonstrate the practical application of the hybrid approach: zero-one goal programming (ZOGP) and genetic algorithms are adopted to validate the effectiveness of the algorithm. A real-world renovation project is introduced to validate differences in energy performance projected for the renovation solution suggested by the system. The results reveal that the proposed hybrid system is more computationally effective than either ZOGP or GA alone. The system's suggested renovation actions would provide substantial energy performance improvements to the real project if implemented. (author)

  20. Improving sustainability during hospital design and operation a multidisciplinary evaluation tool

    CERN Document Server

    Bottero, Marta; Buffoli, Maddalena; Lettieri, Emanuele

    2015-01-01

    This book describes the Sustainable High Quality Healthcare (SustHealth) project, which had the goal of developing an original multidisciplinary evaluation tool that can be applied to assess and improve hospitals’ overall sustainability. The comprehensive nature of the appraisal offered by this tool exceeds the scope of most current rating systems, which typically permit a thorough evaluation of relevant environmental factors when designing a new building but fail to consider social and economic impacts of the design phase or the performance of the hospital’s operational structure in these fields. The multidisciplinary evaluation system was developed, from its very inception through to its testing, by following a scientific experimental method in which a global perspective was constantly maintained, as opposed to a focus only on specific technical issues. Application of the SustHealth rating tool to a currently functioning hospital, or one under design, will identify weaknesses and guide users to potentia...

  1. Decision Support For Digester Algae Integration For Improved Environmental And Economic Sustainability

    Energy Technology Data Exchange (ETDEWEB)

    2017-06-28

    The Idaho National Laboratory (INL) has teamed with University of Idaho and Boise State University to make the use of ADs more attractive by implementing a two-stage AD and coupling additional processes to the system. The addition of a polyhydroxyalkanoate (PHA) reactor, algae cultivation system, and a biomass treatment system such as fast-pyrolysis or hydrothermal liquefaction (HTL) would further sequester carbon and nutrients, as well as add valuable products that can be sold or used on-site to mitigate costs. The Decision-support for Digester-Algae IntegRation for Improved Environmental and Economic Sustainability (DAIRIEES) technoeconomic model will play a key role in evaluating the effectiveness and viability of this system to achieve economic and environmental sustainability by the dairy industry.

  2. International cooperation to improve access to and sustain effectiveness of antimicrobials.

    Science.gov (United States)

    Årdal, Christine; Outterson, Kevin; Hoffman, Steven J; Ghafur, Abdul; Sharland, Mike; Ranganathan, Nisha; Smith, Richard; Zorzet, Anna; Cohn, Jennifer; Pittet, Didier; Daulaire, Nils; Morel, Chantal; Rizvi, Zain; Balasegaram, Manica; Dar, Osman A; Heymann, David L; Holmes, Alison H; Moore, Luke S P; Laxminarayan, Ramanan; Mendelson, Marc; Røttingen, John-Arne

    2016-01-16

    Securing access to effective antimicrobials is one of the greatest challenges today. Until now, efforts to address this issue have been isolated and uncoordinated, with little focus on sustainable and international solutions. Global collective action is necessary to improve access to life-saving antimicrobials, conserving them, and ensuring continued innovation. Access, conservation, and innovation are beneficial when achieved independently, but much more effective and sustainable if implemented in concert within and across countries. WHO alone will not be able to drive these actions. It will require a multisector response (including the health, agriculture, and veterinary sectors), global coordination, and financing mechanisms with sufficient mandates, authority, resources, and power. Fortunately, securing access to effective antimicrobials has finally gained a place on the global political agenda, and we call on policy makers to develop, endorse, and finance new global institutional arrangements that can ensure robust implementation and bold collective action. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Identifying a practice-based implementation framework for sustainable interventions for improving the evolving working environment

    DEFF Research Database (Denmark)

    Højberg, Helene; Nørregaard Rasmussen, Charlotte Diana; Osborne, Richard H.

    2018-01-01

    Our aim was to identify implementation components for sustainable working environment interventions in the nursing assistant sector to generate a framework to optimize the implementation of workplace improvement initiatives. The implementation framework was informed by: 1) an industry advisory...... group, 2) interviews with key stakeholder, 3) concept mapping workshops, and 4) an e-mail survey. Thirty five stakeholders were interviewed and contributed in the concept mapping workshops. Eleven implementation components were derived across four domains: 1) A supportive organizational platform, 2......) An engaged workplace with mutual goals, 3) The intervention is sustainably fitted to the workplace, and 4) the intervention is an attractive choice. The highest rated component was “Engaged and Active Management” (mean 4.1) and the lowest rated was “Delivered in an Attractive Form” (mean 2.8). The framework...

  4. Sustainable technological development in chemistry. Improving the quality of life through chemistry and agriculture

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-08-01

    The importance of agricultural products, their potential conversion to energy sources and their applications for fibre-reinforced construction materials is emphasized. Another potentially important technology is the conversion of sunlight into electricity such as occurs in the leaves of plants. Parallels with nature exist, even though conversions with inorganic materials have, until now, been promising. The ability to control chemical reactions is the subject throughout all the following chapters. The goal is to achieve high reaction efficiencies and to use fewer basic materials, both of which will lead to a reduction in environmental stress. Sustainable developments in chemistry can be described by two approaches: (1) Improvements in society, with challenges for chemistry; and (2) Improvement in the chemical sector itself. Both approaches are dealt with in this report. Five areas for development have been chosen in the discussions for `DTO-Chemie`: Integrated plant conversion (IPC), in particular Valorisation of plant parts for raw materials and energy; Biomass conversion (C1 Chemistry), in particular Technologies for (among others) C1-based chemicals and energy carriers; Photovoltaic cells (PSC), in particular Technologies for the conversion of solar light into electricity; Process Technology in Fine chemistry (PFC), in particular Methodology of manufacturing processes for Fine chemicals; and Sustainable Construction Materials (FRC); in particular Techniques for using fibre-reinforced composites in construction applications. These areas can be viewed as clusters of technologies, with a strong chemistry and agricultural component, which are necessary for achieving a sustainable future. Furthermore, it is important to recognise that technology requires a progressive development (technology lifecycle). The five areas of technology development are tested against a number of criteria: (1) Sustainability / leap / volume; (2) Horizon 2050; (3) Commitment from industry

  5. The lean approach for improvement of the sustainability of a remanufacturing process

    Directory of Open Access Journals (Sweden)

    Paulina Golińska

    2014-09-01

    Full Text Available Background: The lean production is a well-established managerial concept, which helps companies to provide the customer value and to reduce cost. Recently it gains a lot of attention among the remanufacturers. In this paper the assumption is made that remanufacturing process is more sustainable, if there will be efficient utilization of the resources. The resource utilization is efficient when there is no waste of resources. The implementation of lean principles and tools into a remanufacturing process can benefit to improved sustainability but also it suffers some constrains, which are identified in this paper. Methods: The research methodology consists of a literature review, where research papers from the Scopus, Science Direct and Business Source Premier databases were used. The search criterion was the phrase "lean remanufacturing". On the basis of literature review the lean remanufacturing problems are identified. The framework for lean remanufacturing analysis was established. Author presents also case studies on assessment of the leanness of remanufacturing process and discusses the potential for waste elimination in order to improve sustainability of remanufacturing process. Results: Problem identification and analysis framework of lean remanufacturing process is discussed. The case studies results are analysed in the context of the finding of the literature review. The advantages and constrains of lean remanufacturing are discussed. Conclusions: A remanufacturing process is more complex than the respective production process. The implementation of lean production principles and tools into remanufacturing process is at a very early stage comparing to the traditional manufacturing. There are evidences from the industrial studies and the academic research on lean remanufacturing benefits. There is a need to distinguish between lean remanufacturing on an operational and a strategic level. From the perspective of sustainability of

  6. Nurses Improving the Care of Healthsystem Elders: creating a sustainable business model to improve care of hospitalized older adults.

    Science.gov (United States)

    Capezuti, Elizabeth A; Bricoli, Barbara; Briccoli, Barbara; Boltz, Marie P

    2013-08-01

    The Nurses Improving the Care of Healthsystem Elders (NICHE) program helps its more than 450 member sites to build the leadership capabilities to enact system-level change that targets the unique needs of older adults and embeds evidence-based geriatrics knowledge into practice. NICHE received expansion funding to establish a sustainable business model for operations while positioning the program to continue as a leader in innovative senior care programs. The expansion program focused on developing an internal business infrastructure, expanding NICHE-specific resources, creating a Web platform, increasing the number of participating NICHE hospitals, enhancing and expanding the NICHE benchmarking service, supporting research that generates evidence-based practices, fostering interorganizational collaboration, developing sufficient diversified revenue sources, and increasing the penetration and level of activity of current NICHE sites. These activities (improved services, Web-based tools, better benchmarking) added value and made it feasible to charge hospitals an annual fee for access and participation. NICHE does not stipulate how institutions should modify geriatric care; rather, NICHE principles and tools are meant to be adapted to each site's unique institutional culture. This article describes the historical context, the rationale, and the business plan that has resulted in successful organizational outcomes, including financial sustainability of the business operations of NICHE. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

  7. Outcomes after operative management of symptomatic rib nonunion.

    Science.gov (United States)

    Gauger, Erich M; Hill, Brian W; Lafferty, Paul M; Cole, Peter A

    2015-06-01

    To report the outcomes of rib reconstruction after painful nonunion. Retrospective case series. Level I trauma center. Between November 2007 and May 2013, 10 patients who presented with 16 rib nonunions and disabling pain were treated with reconstruction of their nonunited rib fractures. Rib nonunion reconstruction predominately with iliac crest bone graft and a tension band plate with a locked precontoured plating system for ribs. Demographic data, mechanism of injury, and number of rib nonunions were recorded. Operative procedure, length of follow-up, complications, Short Form Survey 36, and a patient questionnaire were also captured and documented. Eight of the 10 patients sustained their original fractures from a fall. Outcomes were available for the 10 patients at a mean follow-up of up of 18.6 months (range, 3-46 months). All 16 ribs went on to union with a mean time from reconstruction to union of 14.7 weeks (range, 12-24 weeks). At final follow-up, the mean mental and physical component Short Form Survey 36 scores were 54.4 and 43.5, respectively. Eight of the 10 patients were able to return to work and/or previous activities without limitations. Complications included 1 wound infection that resolved after irrigation and debridement with adjunctive antibiotics. One symptomatic implant was removed. Ten patients with 16 symptomatic rib nonunions were reconstructed using autologous bone graft and implant/mesh fixation manifesting in successful union with improved patient function and a low rate of complications. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  8. Innovation in user-centered skills and performance improvement for sustainable complex service systems.

    Science.gov (United States)

    Karwowski, Waldemar; Ahram, Tareq Z

    2012-01-01

    In order to leverage individual and organizational learning and to remain competitive in current turbulent markets it is important for employees, managers, planners and leaders to perform at high levels over time. Employee competence and skills are extremely important matters in view of the general shortage of talent and the mobility of employees with talent. Two factors emerged to have the greatest impact on the competitiveness of complex service systems: improving managerial and employee's knowledge attainment for skills, and improving the training and development of the workforce. This paper introduces the knowledge-based user-centered service design approach for sustainable skill and performance improvement in education, design and modeling of the next generation of complex service systems. The rest of the paper cover topics in human factors and sustainable business process modeling for the service industry, and illustrates the user-centered service system development cycle with the integration of systems engineering concepts in service systems. A roadmap for designing service systems of the future is discussed. The framework introduced in this paper is based on key user-centered design principles and systems engineering applications to support service competitiveness.

  9. Adaptation to climate change in industry: improving resource efficiency through sustainable production applications.

    Science.gov (United States)

    Alkayal, Emrah; Bogurcu, Merve; Ulutas, Ferda; Demirer, Göksel Niyazi

    2015-01-01

    The objective of this study was to investigate the climate change adaptation opportunities of six companies from different sectors through resource efficiency and sustainable production. A total of 77 sustainable production options were developed for the companies based on the audits conducted. After screening these opportunities with each company's staff, 19 options were selected and implemented. Significant water savings (849,668 m3/year) were achieved as a result of the applications that targeted reduction of water use. In addition to water savings, the energy consumption was reduced by 3,607 MWh, which decreased the CO2 emissions by 904.1 tons/year. Moreover, the consumption of 278.4 tons/year of chemicals (e.g., NaCl, CdO, NaCN) was avoided, thus the corresponding pollution load to the wastewater treatment plant was reduced. Besides the tangible improvements, other gains were achieved, such as improved product quality, improved health and safety conditions, reduced maintenance requirements, and ensured compliance with national and EU regulations. To the best of the authors' knowledge, this study is the first ever activity in Turkey devoted to climate change adaptation in the private sector. This study may serve as a building block in Turkey for the integration of climate change adaptation and mitigation approach in the industry, since water efficiency (adaptation) and carbon reduction (mitigation) are achieved simultaneously.

  10. Sustained swimming improves fish dietary nutrient assimilation efficiency and body composition of juvenile Brycon amazonicus

    Directory of Open Access Journals (Sweden)

    Gustavo Alberto Arbeláez-Rojas

    Full Text Available ABSTRACT Sustained swimming (SS usually promotes beneficial effects in growth and feed conversion of fishes. Although feed efficiency is improves at moderate water velocity, more information is required to determine the contributions of this factor on growth and body composition. Body composition and efficiency responses to the use of nutrients were determined in juvenile matrinxa Brycon amazonicus (Spix and Agassiz, 1829 fed with two dietary amounts of protein, 28 or 38% of crude protein (CP, and subjected to sustained swimming at a constant speed of 1.5 body lengths s−1 (BL s−1 or let to free swimming. The fish body composition under SS and fed with 28% of dietary protein showed 22% of increased in bulk protein and a 26% of decrease in water content in the white muscle. Red muscle depicted 70% less water content and a 10% more lipid. Nutrient retention was enhanced in fish subjected to SS and a higher gain of ethereal extract sustained was observed in the white muscle of exercised fish fed with 38% CP. The interaction between swimming and dietary protein resulted in a larger bulk of lipid in red muscle. Fish fed with 28% CP under SS at 1.5 BL s−1 presented the best utilization of dietary nutrients and body composition. Thus, this fish farming procedure is proposed as a promising management strategy for rearing matrinxa.

  11. France's Financial (Eco)system. Improving the integration of sustainability factors

    International Nuclear Information System (INIS)

    Morel, Romain; Cochran, Ian; Robins, Nick

    2015-11-01

    In the run-up of the COP21, much international attention is focused on France. While mainly related to climate change negotiations, this creates an opportunity to take a broader look at French domestic policies and practices on sustainability. This report presents the French financial system and draws lessons from the French ongoing experience in improving the integration of sustainability issues that could be shared with other countries. The present report summarizes and analyses the key initiatives and dynamics at stake in France. It focuses on both the climate-related issues that have recently received significant attention and the development of broader Environmental, Social and Governance (ESG) issues over the past twenty years. The dynamics that have shaped the last two decades have both led to and been influenced by the emergence of an 'ecosystem' of commercial, public and non-profit actors and experts involved in the appropriation and integration of sustainability issues across the sector. Using the framework of analysis presented in the UNEP Inquiry global report, this case study examines the landscape of actors, private initiatives and public policy that has driven the emergence of this ecosystem and helped foster capacity building and the acquisition of expertise among sectoral actors. (authors)

  12. Probabilistic evaluation of integrating resource recovery into wastewater treatment to improve environmental sustainability.

    Science.gov (United States)

    Wang, Xu; McCarty, Perry L; Liu, Junxin; Ren, Nan-Qi; Lee, Duu-Jong; Yu, Han-Qing; Qian, Yi; Qu, Jiuhui

    2015-02-03

    Global expectations for wastewater service infrastructure have evolved over time, and the standard treatment methods used by wastewater treatment plants (WWTPs) are facing issues related to problem shifting due to the current emphasis on sustainability. A transition in WWTPs toward reuse of wastewater-derived resources is recognized as a promising solution for overcoming these obstacles. However, it remains uncertain whether this approach can reduce the environmental footprint of WWTPs. To test this hypothesis, we conducted a net environmental benefit calculation for several scenarios for more than 50 individual countries over a 20-y time frame. For developed countries, the resource recovery approach resulted in ∼154% net increase in the environmental performance of WWTPs compared with the traditional substance elimination approach, whereas this value decreased to ∼60% for developing countries. Subsequently, we conducted a probabilistic analysis integrating these estimates with national values and determined that, if this transition was attempted for WWTPs in developed countries, it would have a ∼65% probability of attaining net environmental benefits. However, this estimate decreased greatly to ∼10% for developing countries, implying a substantial risk of failure. These results suggest that implementation of this transition for WWTPs should be studied carefully in different temporal and spatial contexts. Developing countries should customize their approach to realizing more sustainable WWTPs, rather than attempting to simply replicate the successful models of developed countries. Results derived from the model forecasting highlight the role of bioenergy generation and reduced use of chemicals in improving the sustainability of WWTPs in developing countries.

  13. National Options for a Sustainable Nuclear Energy System: MCDM Evaluation Using an Improved Integrated Weighting Approach

    Directory of Open Access Journals (Sweden)

    Ruxing Gao

    2017-12-01

    Full Text Available While the prospects look bright for nuclear energy development in China, no consensus about an optimum transitional path towards sustainability of the nuclear fuel cycle has been achieved. Herein, we present a preliminary study of decision making for China’s future nuclear energy systems, combined with a dynamic analysis model. In terms of sustainability assessment based on environmental, economic, and social considerations, we compared and ranked the four candidate options of nuclear fuel cycles combined with an integrated evaluation analysis using the Multi-Criteria Decision Making (MCDM method. An improved integrated weighting method was first applied in the nuclear fuel cycle evaluation study. This method synthesizes diverse subjective/objective weighting methods to evaluate conflicting criteria among the competing decision makers at different levels of expertise and experience. The results suggest that the fuel cycle option of direct recycling of spent fuel through fast reactors is the most competitive candidate, while the fuel cycle option of direct disposal of all spent fuel without recycling is the least attractive for China, from a sustainability perspective. In summary, this study provided a well-informed decision-making tool to support the development of national nuclear energy strategies.

  14. Towards an Improved Integration of Sustainability in Finance - The French (eco)system. Executive summary

    International Nuclear Information System (INIS)

    Morel, Romain; Cochran, Ian; Robins, Nick

    2015-11-01

    In the run-up of the COP21, much international attention is focused on France. While mainly related to climate change negotiations, this creates an opportunity to take a broader look at French domestic policies and practices on sustainability. This report presents the French financial system and draws lessons from the French ongoing experience in improving the integration of sustainability issues that could be shared with other countries. The present report summarizes and analyses the key initiatives and dynamics at stake in France. It focuses on both the climate-related issues that have recently received significant attention and the development of broader Environmental, Social and Governance (ESG) issues over the past twenty years. The dynamics that have shaped the last two decades have both led to and been influenced by the emergence of an 'ecosystem' of commercial, public and non-profit actors and experts involved in the appropriation and integration of sustainability issues across the sector. Using the framework of analysis presented in the UNEP Inquiry global report, this case study examines the landscape of actors, private initiatives and public policy that has driven the emergence of this ecosystem and helped foster capacity building and the acquisition of expertise among sectoral actors. (authors)

  15. Product recovery optimization in closed-loop supply chain to improve sustainability in manufacturing

    DEFF Research Database (Denmark)

    Govindan, Kannan; Jha, P. C.; Garg, Kiran

    2016-01-01

    that emerge from that business’s economical, environmental and social dimensions. In this paper, we propose a multi-objective mixed integer mathematical problem for a generic closed-loop supply chain (CLSC) network to rationalise how a system’s product recovery helps to improve manufacturing sustainability....... The CLSC network proposed in this study consists of a hybrid manufacturing facility, warehouse, distribution centres, collection centres and a hybrid recovery facility (HRF). The proposed model determines the best location for the HRF and optimal flow of products, recovered parts and material...

  16. STUDY OF FACTORS INFLUENCING EARLY SYMPTOMATIC IMPROVEMENT, RETURN TO NORMOXIA AND RADIOLOGICAL RESOLUTION IN SWINE FLU PATIENTS WITH RESPIRATORY FAILURE IN RICU

    Directory of Open Access Journals (Sweden)

    Vamsidhar Reddy Manne

    2017-05-01

    Full Text Available BACKGROUND Since 2009, swine influenza outbreaks have been recorded virtually every year, although their extent and severity have varied widely. Localised outbreaks are taking place at variable intervals, usually every 1-3 years. The most recent outbreak has been from December 2016 through April 2017. We still are in the midst of one. This study of factors influencing early clinical and radiological improvement and reversion to normoxia in swine flu patients with respiratory failure helps in saving precious lives. MATERIALS AND METHODS This is a cross-sectional study conducted at RICU, Department of Pulmonary Medicine, S.V.R.R. Government General Hospital/S.V. Medical College, Tirupathi, Andhra Pradesh, between January 2017 and April 2017. Study sample was the total number of swine flu patients admitted to the RICU of the Department of Pulmonary Medicine with respiratory failure. RESULTS Out of 42 patients who tested positive for swine flu, 37 had respiratory failure and were immediately admitted in RICU. Oxygen support, oseltamivir and higher antibiotics were immediately started, injectable steroids given where necessary. Comorbidities were meticulously managed. 19 were males and 18 were females. 21 patients (>50% were above 50 years. Cough and breathlessness were present in all patients (100%. At admission, all 37 showed SpO2 <85% and at discharge all of them were normoxic. 18 patients had either multilobar pneumonia or ARDS on CXR, which had resolved by the time of discharge. The shortest duration of stay was 7 days and the longest duration of stay was 11 days. 35 patients were discharged and 2 patients died. CONCLUSION Good oxygenation, starting of oseltamivir on day 1 of admission prevents further complications and hastens recovery. Swine flu patients with normal chest x-ray and no comorbidities can still end up with respiratory failure. Steroids decrease cough and breathlessness, but have no role in hastening recovery. No residual symptoms

  17. Working toward a sustainable laboratory quality improvement programme through country ownership: Mozambique’s SLMTA story

    Directory of Open Access Journals (Sweden)

    Jessina Masamha

    2014-11-01

    Full Text Available Background: Launched in 2009, the Strengthening Laboratory Management Toward Accreditation (SLMTA programme has emerged as an innovative approach for the improvement of laboratory quality. In order to ensure sustainability, Mozambique embedded the SLMTA programme within the existing Ministry of Health (MOH laboratory structure. Objective: This article outlines the steps followed to establish a national framework for quality improvement and embed the SLMTA programme within existing MOH laboratory systems. Methods: The MOH adopted SLMTA as the national laboratory quality improvement strategy, hired a dedicated coordinator and established a national laboratory quality technical working group comprising mostly personnel from key MOH departments. The working group developed an implementation framework for advocacy, training, mentorship, supervision and audits. Emphasis was placed on building local capacity for programme activities. After receiving training, a team of 25 implementers (18 from the MOH and sevenfrom partner organisations conducted baseline audits (using the Stepwise Laboratory Quality Improvement Process Towards Accreditation [SLIPTA] checklist, workshops and site visits in six reference and two central hospital laboratories. Exit audits were conducted in six of the eight laboratories and their results are presented. Results: The six laboratories demonstrated substantial improvement in SLIPTA checklistscores; median scores increased from 35% at baseline to 57% at exit. It has been recommended that the National Tuberculosis Reference Laboratory apply for international accreditation. Conclusion: Successful implementation of SLMTA requires partnership between programme implementers, whilst effectiveness and long-term viability depend on country leadership, ownership and commitment. Integration of SLMTA into the existing MOH laboratory system will ensure durability beyond initial investments. The Mozambican model holds great promise that

  18. Working toward a sustainable laboratory quality improvement programme through country ownership: Mozambique's SLMTA story.

    Science.gov (United States)

    Masamha, Jessina; Skaggs, Beth; Pinto, Isabel; Mandlaze, Ana Paula; Simbine, Carolina; Chongo, Patrina; de Sousa, Leonardo; Kidane, Solon; Yao, Katy; Luman, Elizabeth T; Samogudo, Eduardo

    2014-01-01

    Launched in 2009, the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme has emerged as an innovative approach for the improvement of laboratory quality. In order to ensure sustainability, Mozambique embedded the SLMTA programme within the existing Ministry of Health (MOH) laboratory structure. This article outlines the steps followed to establish a national framework for quality improvement and embedding the SLMTA programme within existing MOH laboratory systems. The MOH adopted SLMTA as the national laboratory quality improvement strategy, hired a dedicated coordinator and established a national laboratory quality technical working group comprising mostly personnel from key MOH departments. The working group developed an implementation framework for advocacy, training, mentorship, supervision and audits. Emphasis was placed on building local capacity for programme activities. After receiving training, a team of 25 implementers (18 from the MOH and seven from partner organisations) conducted baseline audits (using the Stepwise Laboratory Quality Improvement Process Towards Accreditation [SLIPTA] checklist), workshops and site visits in six reference and two central hospital laboratories. Exit audits were conducted in six of the eight laboratories and their results are presented. The six laboratories demonstrated substantial improvement in audit scores; median scores increased from 35% at baseline to 57% at exit. It has been recommended that the National Tuberculosis Reference Laboratory apply for international accreditation. Successful implementation of SLMTA requires partnership between programme implementers, whilst effectiveness and long-term viability depend on country leadership, ownership and commitment. Integration of SLMTA into the existing MOH laboratory system will ensure durability beyond initial investments. The Mozambican model holds great promise that country leadership, ownership and institutionalisation can set the stage for

  19. Ensuring Support for Research and Quality Improvement (QI) Networks: Four Pillars of Sustainability?An Emerging Framework

    OpenAIRE

    Holve, Erin

    2013-01-01

    Multi-institutional research and quality improvement (QI) projects using electronic clinical data (ECD) hold great promise for improving quality of care and patient outcomes but typically require significant infrastructure investments both to initiate and maintain the project over its duration. Consequently, it is important for these projects to think holistically about sustainability to ensure their long-term success. Four ?pillars? of sustainability are discussed based on the experiences of...

  20. A Review of Sustainability Enhancements in the Beef Value Chain: State-of-the-Art and Recommendations for Future Improvements

    Science.gov (United States)

    Maia de Souza, Danielle; Petre, Ruaraidh; Jackson, Fawn; Hadarits, Monica; Pogue, Sarah; Carlyle, Cameron N.; Bork, Edward; McAllister, Tim

    2017-01-01

    Simple Summary To better address consumer concerns, the beef sector is working on strategies to enhance the sustainability of all aspects of the beef supply chain. Among these strategies are (1) the development of science-based frameworks and indicators capable of measuring progress at all stages of beef production; (2) the engagement of different stakeholders along the beef supply chain at regional and global levels; and (3) the improvement of communication among stakeholders and transparency towards consumers. Progress on these three fronts was presented during the 2nd Global Conference on Sustainable Beef, hosted by the Global and Canadian Roundtables for Sustainable Beef. During the event, there was a clear understanding that the beef industry is substantially advancing efforts to continuously improve its sustainability, both at regional and global levels, by developing assessment frameworks and indicators to measure progress. However, it is also clear that the beef sector has a need to more clearly define the concept of beef sustainability, strengthen cooperation and exchange of information among national roundtables for sustainable beef, as well as improve the flow of information along the supply chain. An improved transparency in the beef sector will help consumers make more informed decisions about food products. Abstract The beef sector is working towards continually improving its sustainability in order to achieve environmentally, socially and economically desirable outcomes, all of which are of increasing concern to consumers. In this context, the Global Roundtable for Sustainable Beef (GRSB) provides guidance to advance the sustainability of the beef industry, through increased stakeholder engagement and the formation of national roundtables. Recently, the 2nd Global Conference on Sustainable Beef took place in Banff, Alberta, Canada, hosted by the GRSB and the Canadian Roundtable for Sustainable Beef. Conference attendees discussed the various

  1. Improving patient care by making small sustainable changes: a cardiac telemetry unit's experience.

    Science.gov (United States)

    Braaten, Jane S; Bellhouse, Dorothy E

    2007-01-01

    With the introduction of each new drug, technology, and regulation, the processes of care become more complicated, creating an elaborate set of procedures connecting various hospital units and departments. Using methods of Adaptive Design and the Toyota Production System, a nursing unit redesigned work systems to achieve sustainable improvements in productivity, staff and patient satisfaction, and quality outcomes. The first hurdle of redesign was identifying problems, to which staff had become so accustomed with various work arounds that they had trouble seeing the process bottlenecks. Once the staff identified problems, they assumed they could solve the problem because they assumed they knew the causes. Utilizing root cause analysis, asking, "why, why, why," was essential to unearthing the true cause of a problem. Similarly, identifying solutions that were simple and low cost was an essential step in problem solving. Adopting new procedures and sustaining the commitment to identify and signal problems was a last and critical step toward realizing improvement, requiring a manager to function as "teacher/coach" rather than "fixer/firefighter".

  2. Sustainability impact assessment to improve food security of smallholders in Tanzania

    International Nuclear Information System (INIS)

    Schindler, Jana; Graef, Frieder; König, Hannes Jochen; Mchau, Devotha; Saidia, Paul; Sieber, Stefan

    2016-01-01

    The objective of this paper was to assess the sustainability impacts of planned agricultural development interventions, so called upgrading strategies (UPS), to enhance food security and to identify what advantages and risks are assessed from the farmer's point of view in regards to social life, the economy and the environment. We developed a participatory methodological procedure that links food security and sustainable development. Farmers in four different case study villages in rural Tanzania chose their priority UPS. For these UPS, they assessed the impacts on locally relevant food security criteria. The positive impacts identified were mainly attributed to increased agricultural production and its related positive impacts such as increased income and improved access to necessary means to diversify the diet. However, several risks of certain UPS were also indicated by farmers, such as increased workload, high maintenance costs, higher competition among farmers, loss of traditional knowledge and social conflicts. We discussed the strong interdependence of socio-economic and environmental criteria to improve food security for small-scale farmers and analysed several trade-offs in regards to UPS choices and food security criteria. We also identified and discussed the advantages and challenges of our methodological approach. In conclusion, the participatory impact assessment on the farmer level allowed a locally specific analysis of the various positive and negative impacts of UPS on social life, the economy and the environment. We emphasize that only a development approach that considers social, economic and environmental challenges simultaneously can enhance food security.

  3. Sustainability impact assessment to improve food security of smallholders in Tanzania

    Energy Technology Data Exchange (ETDEWEB)

    Schindler, Jana, E-mail: jana.schindler@zalf.de [Leibniz Centre for Agricultural Landscape Research (ZALF), Institute of Land Use Systems, Eberswalder Straße 84, 15374 Müncheberg (Germany); Humboldt Universität zu Berlin, Faculty of Agriculture and Horticulture, Invalidenstr. 42, 10099 Berlin (Germany); Graef, Frieder, E-mail: graef@zalf.de [Leibniz Centre for Agricultural Landscape Research (ZALF), Institute of Land Use Systems, Eberswalder Straße 84, 15374 Müncheberg (Germany); König, Hannes Jochen, E-mail: hkoenig@zalf.de [Leibniz Centre for Agricultural Landscape Research (ZALF), Institute of Land Use Systems, Eberswalder Straße 84, 15374 Müncheberg (Germany); Mchau, Devotha, E-mail: dvtmchau@yahoo.com [Agricultural Research Institute (ARI Hombolo/Makutupora), P. O. Box 1676, Dodoma (Tanzania, United Republic of); Saidia, Paul, E-mail: saidiapaul@gmail.com [Sokoine University of Agriculture (SUA) Morogoro, Department of Crop Science and Production, P O. Box 3005, Morogoro (Tanzania, United Republic of); Sieber, Stefan, E-mail: stefan.sieber@zalf.de [Leibniz Centre for Agricultural Landscape Research (ZALF), Institute of Socio-Economics, Eberswalder Straße 84, 15374 Müncheberg (Germany)

    2016-09-15

    The objective of this paper was to assess the sustainability impacts of planned agricultural development interventions, so called upgrading strategies (UPS), to enhance food security and to identify what advantages and risks are assessed from the farmer's point of view in regards to social life, the economy and the environment. We developed a participatory methodological procedure that links food security and sustainable development. Farmers in four different case study villages in rural Tanzania chose their priority UPS. For these UPS, they assessed the impacts on locally relevant food security criteria. The positive impacts identified were mainly attributed to increased agricultural production and its related positive impacts such as increased income and improved access to necessary means to diversify the diet. However, several risks of certain UPS were also indicated by farmers, such as increased workload, high maintenance costs, higher competition among farmers, loss of traditional knowledge and social conflicts. We discussed the strong interdependence of socio-economic and environmental criteria to improve food security for small-scale farmers and analysed several trade-offs in regards to UPS choices and food security criteria. We also identified and discussed the advantages and challenges of our methodological approach. In conclusion, the participatory impact assessment on the farmer level allowed a locally specific analysis of the various positive and negative impacts of UPS on social life, the economy and the environment. We emphasize that only a development approach that considers social, economic and environmental challenges simultaneously can enhance food security.

  4. A Plan for Academic Biobank Solvency-Leveraging Resources and Applying Business Processes to Improve Sustainability.

    Science.gov (United States)

    Uzarski, Diane; Burke, James; Turner, Barbara; Vroom, James; Short, Nancy

    2015-10-01

    Researcher-initiated biobanks based at academic institutions contribute valuable biomarker and translational research advances to medicine. With many legacy banks once supported by federal funding, reductions in fiscal support threaten the future of existing and new biobanks. When the Brain Bank at Duke University's Bryan Alzheimer's Disease Center (ADRC) faced a funding crisis, a collaborative, multidisciplinary team embarked on a 2-year biobank sustainability project utilizing a comprehensive business strategy, dedicated project management, and a systems approach involving many Duke University entities. By synthesizing and applying existing knowledge, Duke Translational Medicine Institute created and launched a business model that can be adjusted and applied to legacy and start-up academic biobanks. This model provides a path to identify new funding mechanisms, while also emphasizing improved communication, business development, and a focus on collaborating with industry to improve access to biospecimens. Benchmarks for short-term Brain Bank stabilization have been successfully attained, and the evaluation of long-term sustainability metrics is ongoing. © 2015 Wiley Periodicals, Inc.

  5. A Plan for Academic Biobank Solvency—Leveraging Resources and Applying Business Processes to Improve Sustainability

    Science.gov (United States)

    Burke, James; Turner, Barbara; Vroom, James; Short, Nancy

    2015-01-01

    Abstract Researcher‐initiated biobanks based at academic institutions contribute valuable biomarker and translational research advances to medicine. With many legacy banks once supported by federal funding, reductions in fiscal support threaten the future of existing and new biobanks. When the Brain Bank at Duke University's Bryan Alzheimer's Disease Center (ADRC) faced a funding crisis, a collaborative, multidisciplinary team embarked on a 2‐year biobank sustainability project utilizing a comprehensive business strategy, dedicated project management, and a systems approach involving many Duke University entities. By synthesizing and applying existing knowledge, Duke Translational Medicine Institute created and launched a business model that can be adjusted and applied to legacy and start‐up academic biobanks. This model provides a path to identify new funding mechanisms, while also emphasizing improved communication, business development, and a focus on collaborating with industry to improve access to biospecimens. Benchmarks for short‐term Brain Bank stabilization have been successfully attained, and the evaluation of long‐term sustainability metrics is ongoing. PMID:25996355

  6. Development of Sustainable Landscape Designs for Improved Biomass Production in the U.S. Corn Belt

    Science.gov (United States)

    Bonner, Ian J.

    Demand for renewable and sustainable energy options has resulted in a significant commitment by the US Government to research pathways for fuel production from biomass. The research presented in this thesis describes one potential pathway to increase the amount of biomass available for biofuel production by integrating dedicated energy crops into agricultural fields. In the first chapter an innovative landscape design method based on subfield placement of an energy crop into row crop fields in central Iowa is used to reduce financial loss for farmers, increase and diversify biomass production, and improve soil resources. The second chapter explores how subfield management decisions may be made using high fidelity data and modeling to balance concerns of primary crop production and economics. This work provides critical forward looking support to agricultural land managers and stakeholders in the biomass and bioenergy industry for pathways to improving land stewardship and energy security.

  7. Investigating the loss of work productivity due to symptomatic leiomyoma.

    Science.gov (United States)

    Hasselrot, Klara; Lindeberg, Mia; Konings, Peter; Kopp Kallner, Helena

    2018-01-01

    Leiomyoma affects up to 50% of fertile women, leading to morbidity such as bleeding or pain. The effect of symptomatic leiomyoma on the productivity of employed women is understudied. The present study investigates productivity loss in a Swedish setting in women with symptomatic leiomyoma compared to healthy women. Women seeking care for leiomyoma and heavy menstrual bleeding (HMB) were recruited at nine Swedish sites. Healthy controls with self-perceived mild to normal menstruation were recruited at routine visits. Cases and controls were employed without option to work from home. After recruitment, all women reported the work productivity and activity impairment (WPAI) questionnaire, the pictorial blood assessment chart (PBAC) and pain on the visual analog scale (VAS). Women with symptomatic leiomyoma (n = 88) missed more working time during menses compared to asymptomatic controls (n = 34): 7.6 vs 0.2% p = 0.003. The proportion of impairment while working was also significantly higher in women with symptomatic leiomyoma (43.8 vs 12.1% p100). Symptomatic leiomyoma leads to loss of working hours as well as loss of productivity during working hours, and affects women in other daily activities. Increased awareness of the impact of leiomyomas on women's lives is needed, and timely and appropriate management of the symptomatic leiomyomas could improve work productivity and quality of life.

  8. Working Relationships for Sustainability: Improving Work-based Relationships in Local Government to bring about Sustainability Goals

    Directory of Open Access Journals (Sweden)

    Jade Herriman

    2012-08-01

    Full Text Available There’s no escape: we are always in relationship. Being aware of this matters. Doing something to build constructive relationships for sustainability, matters even more. This paper considers the connection between good relationships and effective sustainability work in local government. It draws on the collective experiences of four practitioners who have worked over many years in, with or for local government and argues that a good deal of project success is contingent upon the development of positive relationships with stakeholders, contractors, communities, businesses, colleagues, partners and other agencies and agency officers. Relationships can help or hinder project process, progress and outcomes. This paper identifies some approaches for building quality relationships and uses examples to highlight these strategies. These include: recognising that developing and maintaining resilient relationships and high quality communication is a critical foundation for success; designing projects with explicit relationship outcomes; and allocating time, money and other resources to support the development of effective relationships.

  9. Highly Adoptable Improvement: A Practical Model and Toolkit to Address Adoptability and Sustainability of Quality Improvement Initiatives.

    Science.gov (United States)

    Hayes, Christopher William; Goldmann, Don

    2018-03-01

    Failure to consider the impact of change on health care providers is a barrier to success. Initiatives that increase workload and have low perceived value are less likely to be adopted. A practical model and supporting tools were developed on the basis of existing theories to help quality improvement (QI) programs design more adoptable approaches. Models and theories from the diffusion of innovation and work stress literature were reviewed, and key-informant interviews and site visits were conducted to develop a draft Highly Adoptable Improvement (HAI) Model. A list of candidate factors considered for inclusion in the draft model was presented to an expert panel. A modified Delphi process was used to narrow the list of factors into main themes and refine the model. The resulting model and supporting tools were pilot tested by 16 improvement advisors for face validity and usability. The HAI Model depicts how workload and perceived value influence adoptability of QI initiatives. The supporting tools include an assessment guide and suggested actions that QI programs can use to help design interventions that are likely to be adopted. Improvement advisors reported good face validity and usability and found that the model and the supporting tools helped address key issues related to adoption and reported that they would continue to use them. The HAI Model addresses important issues regarding workload and perceived value of improvement initiatives. Pilot testing suggests that the model and supporting tools are helpful and practical in guiding design and implementation of adoptable and sustainable QI interventions. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

  10. After The Demonstration: What States Sustained After the End of Federal Grants to Improve Children’s Health Care Quality

    Science.gov (United States)

    Brach, Cindy; Anglin, Grace; Devers, Kelly J.; Burton, Rachel

    2018-01-01

    Introduction Under the CHIPRA Quality Demonstration Grant Program, CMS awarded $100 million through 10 grants that 18 state Medicaid agencies implemented between 2010 and 2015. The program’s legislatively-mandated purpose was to evaluate promising ideas for improving the quality of children’s health care provided through Medicaid and CHIP. As part of the program’s multifaceted evaluation, this study examined the extent to which states sustained key program activities after the demonstration ended. Methods We identified 115 potentially sustainable elements within states’ CHIPRA demonstrations and analyzed data from grantee reports and key informant interviews to assess sustainment outcomes and key influential factors. We also assessed sustainment of the projects’ intellectual capital. Results 56% of potentially sustainable elements were sustained. Sustainment varied by topic area: Elements related to quality measure reporting and practice facilitation were more likely to be sustained than others, such as parent advisors. Broad contextual factors, the state’s Medicaid environment, implementation partners’ resources, and characteristics of the demonstration itself all shaped sustainment outcomes. Discussion Assessing sustainment of key elements of states’ CHIPRA quality demonstration projects provides insight into the fates of the “promising ideas” that the grant program was designed to examine. As a result of the federal government’s investment in this grant program, many demonstration states are in a strong position to extend and spread specific strategies for improving the quality of care for children in Medicaid and CHIP. Our findings provide insights for policymakers and providers working to improve the quality of health care for low income children. PMID:29119478

  11. In-school neurofeedback training for ADHD: sustained improvements from a randomized control trial.

    Science.gov (United States)

    Steiner, Naomi J; Frenette, Elizabeth C; Rene, Kirsten M; Brennan, Robert T; Perrin, Ellen C

    2014-03-01

    To evaluate sustained improvements 6 months after a 40-session, in-school computer attention training intervention using neurofeedback or cognitive training (CT) administered to 7- to 11-year-olds with attention-deficit/hyperactivity disorder (ADHD). One hundred four children were randomly assigned to receive neurofeedback, CT, or a control condition and were evaluated 6 months postintervention. A 3-point growth model assessed change over time across the conditions on the Conners 3-Parent Assessment Report (Conners 3-P), the Behavior Rating Inventory of Executive Function Parent Form (BRIEF), and a systematic double-blinded classroom observation (Behavioral Observation of Students in Schools). Analysis of variance assessed community-initiated changes in stimulant medication. Parent response rates were 90% at the 6-month follow-up. Six months postintervention, neurofeedback participants maintained significant gains on Conners 3-P (Inattention effect size [ES] = 0.34, Executive Functioning ES = 0.25, Hyperactivity/Impulsivity ES = 0.23) and BRIEF subscales including the Global Executive Composite (ES = 0.31), which remained significantly greater than gains found among children in CT and control conditions. Children in the CT condition showed delayed improvement over immediate postintervention ratings only on Conners 3-P Executive Functioning (ES = 0.18) and 2 BRIEF subscales. At the 6-month follow-up, neurofeedback participants maintained the same stimulant medication dosage, whereas participants in both CT and control conditions showed statistically and clinically significant increases (9 mg [P = .002] and 13 mg [P < .001], respectively). Neurofeedback participants made more prompt and greater improvements in ADHD symptoms, which were sustained at the 6-month follow-up, than did CT participants or those in the control group. This finding suggests that neurofeedback is a promising attention training treatment for children with ADHD.

  12. Improving the long-term sustainability of health aid: are Global Health Partnerships leading the way?

    Science.gov (United States)

    Dodd, Rebecca; Lane, Christopher

    2010-09-01

    Over the last decade development assistance for health has more than doubled. This increase provides an unprecedented opportunity to scale up health services, and in doing so, achieve the health Millennium Development Goals. However, sustaining scaling up will in turn require sustainable donor support until domestic health financing can substitute for it. The provision of long-term predictable finance is of particular concern in health because the bulk of costs are recurrent and many interventions require sustained, multi-year support to be successful. This is also true for health systems strengthening efforts. As the bulk of new aid resources flow through Global Health Partnerships (GHPs), their ability to make long-term commitments is critical to health systems development. In order to better understand the constraints that prevent development partners from making long-term commitments of health aid, the World Health Organization reviewed the practices of seven major health partners in committing development assistance funds over the long term. The review found increasing evidence of long-term commitments of aid for health in each of the seven agencies. The GHPs and their funders have been at the forefront of this trend, pioneering many of the new approaches. The study concludes that all partners have scope to improve the duration of aid within existing rules and regulations, and that the main constraints to doing so are political. Predictability is even more of a concern in current global economic circumstances, as access to resources begins to be squeezed. In this context it is important that we learn from GHPs, which have successfully tested innovative approaches to both raising and disbursing health funds. The prospects for change associated with the new administration in the United States-the largest health donor and the most unpredictable, but also a major supporter of GHPs-make this task even more urgent.

  13. Factors influencing the long-term sustainment of quality improvements made in addiction treatment facilities: a qualitative study.

    Science.gov (United States)

    Stumbo, Scott P; Ford, James H; Green, Carla A

    2017-11-01

    A greater understanding of the factors that influence long-term sustainment of quality improvement (QI) initiatives is needed to promote organizational ability to sustain QI practices over time, help improve future interventions, and increase the value of QI investments. We approached 83 of 201 executive sponsors or change leaders at addiction treatment organizations that participated in the 2007-2009 NIATx200 QI intervention. We completed semi-structured interviews with 33 individuals between November 2015 and April 2016. NIATx200 goals were to decrease wait time, increase admissions and improve retention in treatment. Interviews sought to understand factors that either facilitated or impeded long-term sustainment of organizational QI practices made during the intervention. We used thematic analysis to organize the data and group patterns of responses. We assessed available quantitative outcome data and intervention engagement data to corroborate qualitative results. We used narrative analysis to group four important themes related to long-term sustainment of QI practices: (1) finding alignment between business- and client-centered practices; (2) staff engagement early in QI process added legitimacy which facilitated sustainment; (3) commitment to integrating data into monitoring practices and the identification of a data champion; and (4) adequate organizational human resources devoted to sustainment. We found four corollary factors among agencies which did not sustain practices: (1) lack of evidence of impact on business practices led to discontinuation; (2) disengaged staff and lack of organizational capacity during implementation period led to lack of sustainment; (3) no data integration into overall business practices and no identified data champion; and (4) high staff turnover. In addition, we found that many agencies' current use of NIATx methods and tools suggested a legacy effect that might improve quality elsewhere, even absent overall sustainment of

  14. Symptomatic Autism in Childhood and Adolescence

    Science.gov (United States)

    Easson, William M.

    1971-01-01

    The frequency of symptomatic autism in children with severe perceptual or intellectual handicaps is noted and early diagnosis and treatment urged to permit healthy child development. Highlighted are some common causes leading to symptomatic autism. (KW)

  15. Hand Hygiene Improvement and Sustainability: Assessing a Breakthrough Collaborative in Western Switzerland.

    Science.gov (United States)

    Staines, Anthony; Amherdt, Isabelle; Lécureux, Estelle; Petignat, Christiane; Eggimann, Philippe; Schwab, Marcos; Pittet, Didier

    2017-12-01

    OBJECTIVE To assess hand hygiene improvement and sustainability associated with a Breakthrough Collaborative. DESIGN Multicenter analysis of hand hygiene compliance through direct observation by trained observers. SETTING A total of 5 publicly funded hospitals in 14 locations, with a total of 1,152 beds, in the County of Vaud, Switzerland. PARTICIPANTS Clinical staff. INTERVENTIONS In total, 59,272 opportunities for hand hygiene were monitored for the duration of the study, for an average of 5,921 per audit (range, 5,449-6,852). An 18-month Hand Hygiene Breakthrough Collaborative was conducted to implement the WHO multimodal promotional strategy including improved access to alcohol-based hand rub, education, performance measurement and feedback, reminders and communication, leadership engagement, and safety culture. RESULTS Overall hand hygiene compliance improved from 61.9% to 88.3% (Pstrategy for content and measurement was associated with significant and substantial improvement in compliance across all professions, all hand hygiene indications, and all participating hospitals. Infect Control Hosp Epidemiol 2017;38:1420-1427.

  16. Improving sustainability by technology assessment and systems analysis: the case of IWRM Indonesia

    Science.gov (United States)

    Nayono, S.; Lehmann, A.; Kopfmüller, J.; Lehn, H.

    2016-09-01

    To support the implementation of the IWRM-Indonesia process in a water scarce and sanitation poor region of Central Java (Indonesia), sustainability assessments of several technology options of water supply and sanitation were carried out based on the conceptual framework of the integrative sustainability concept of the German Helmholtz association. In the case of water supply, the assessment was based on the life-cycle analysis and life-cycle-costing approach. In the sanitation sector, the focus was set on developing an analytical tool to improve planning procedures in the area of investigation, which can be applied in general to developing and newly emerging countries. Because sanitation systems in particular can be regarded as socio-technical systems, their permanent operability is closely related to cultural or religious preferences which influence acceptability. Therefore, the design of the tool and the assessment of sanitation technologies took into account the views of relevant stakeholders. The key results of the analyses are presented in this article.

  17. Automated monitoring: a potential solution for achieving sustainable improvement in hand hygiene practices.

    Science.gov (United States)

    Levchenko, Alexander I; Boscart, Veronique M; Fernie, Geoff R

    2014-08-01

    Adequate hand hygiene is often considered as the most effective method of reducing the rates of hospital-acquired infections, which are one of the major causes of increased cost, morbidity, and mortality in healthcare. Electronic monitoring technologies provide a promising direction for achieving sustainable hand hygiene improvement by introducing the elements of automated feedback and creating the possibility to automatically collect individual hand hygiene performance data. The results of the multiphase testing of an automated hand hygiene reminding and monitoring system installed in a complex continuing care setting are presented. The study included a baseline Phase 1, with the system performing automated data collection only, a preintervention Phase 2 with hand hygiene status indicator enabled, two intervention Phases 3 and 4 with the system generating hand hygiene reminding signals and periodic performance feedback sessions provided, and a postintervention Phase 5 with only hand hygiene status indicator enabled and no feedback sessions provided. A significant increase in hand hygiene performance observed during the first intervention Phase 3 was sustained over the second intervention Phase 4, with the postintervention phase also indicating higher hand hygiene activity rates compared with the preintervention and baseline phases. The overall trends observed during the multiphase testing, the factors affecting acceptability of the automated hand hygiene monitoring system, and various strategies of technology deployment are discussed.

  18. Poverty Alleviation and Environmental Sustainability through Improved Regimes of Technology Transfer

    Directory of Open Access Journals (Sweden)

    Klaus Bosselmann

    2006-06-01

    Full Text Available To achieve the Millennium Development Goals, international technology transfer can play a major role for poverty alleviation and environmental sustainability. At present, there are economic, social and legal (rather than technical barriers preventing the transfer of environmentally sound technology (EST from a wider use in international regimes. Removing these barriers requires greater political and regulatory efforts both domestically and internationally. To enable EST transfer, developed States need to improve domestic market conditions such as removal of negative subsidies and barriers to foreign investment, targeted fiscal incentives and law reforms favouring sustainable production and use of energy. There is no realistic perspective for international EST transfer as long as it is disadvantaged domestically. A coherent EST transfer regime is only possible through greater governmental intervention at the national and international level, including environmental regulations, national systems of innovation, and creating an enabling environment for EST. Such intervention should include effective public-private partnerships, both within and between States. Partnerships, if guided by law, could ensure EST innovation more efficiently than purely State-driven or market-driven EST transfers. In search for a model, the EST transfer regime under the Vienna Ozone Layer Convention and the Montreal Protocol deserves recognition. For example, the clean development mechanism under the Kyoto Protocol allows for considerable scope for EST transfer. The potential of EST transfer for climate change and for meeting the Millennium Development Goals has yet to be realized.

  19. Symptomatic heterotopic suprarenal splenic tissue

    International Nuclear Information System (INIS)

    Heider, J.; Kreft, B.; Winter, P.

    1998-01-01

    We report on a 33-year-old man with symptomatic heterotopic suprarenal splenic tissue. Heterotopic splenic tissue can often be found after posttraumatic splenectomy. It is a result of autotransplantation induced by trauma (splenosis). Additionally it can grow during embryogenic development. Such an accessory spleen is found in 10-44% of all autopsies. In this case report the patient was treated by resection due to increasing flank pain and suspected neoplasm. (orig.) [de

  20. Optimal Treatment of Symptomatic Hemorrhoids

    OpenAIRE

    Song, Seok-Gyu; Kim, Soung-Ho

    2011-01-01

    Hemorrhoids are the most common anorectal complaint, and approximately 10 to 20 percent of patients with symptomatic hemorrhoids require surgery. Symptoms of hemorrhoids, such as painless rectal bleeding, tissue protrusion and mucous discharge, vary. The traditional therapeutic strategies of medicine include surgical, as well as non-surgical, treatment. To alleviate symptoms caused by hemorrhoids, oral treatments, such as fiber, suppositories and Sitz baths have been applied to patients. Othe...

  1. Improvement in the yield and quality of kalmegh (Andrographis paniculata Nees) under the sustainable production system.

    Science.gov (United States)

    Verma, Rajesh Kumar; Verma, Sanjeet K; Pankaj, Umesh; Gupta, Anand K; Khan, Khushboo; Shankar, Karuna

    2015-02-01

    Andrographis paniculata Nees is an annual erect herb with wide medicinal and pharmacological applications due to the presence of andrographolide and other active chemical constituents. The large-scale cultivation of the kalmegh is not in practice. The aim of this study was to establish sustainable production systems of A. paniculata cv CIM-Megha with the application of different bioinoculants and chemical fertilisers. A. paniculata herb and andrographolide yield in the dried leaves was found to be highest (218% and 61.3%, respectively) in treatment T3 (NPK+Bacillus sp.) compared with T1 (control). The soil organic carbon, soil microbial respiration, soil enzymes activity and available nutrients improved significantly with combined application of bioinoculants and chemical fertilisers.

  2. MR Imaging in symptomatic osteochondromas

    International Nuclear Information System (INIS)

    Kim, Soo Young; Kim, Jee Young; Kim, Sang Heum; Chun, Kyung Ah; Park, Young Ha

    1998-01-01

    The purpose of this study is to assess the MR findings of symptomatic osteochondromas. We evaluated 31 patients who between July, 1994 and May, 1997 underwent MR imaging for symptomatic osteochondroma. Fourteen were males and 17 were females, and their ages ranged from 8 to 49 (mean, 23) years. Using T1WI, T2WI and gadolinium-DTPA-enhanced T1WI, images were analysed according to signal intensity in the osseous component of the osteochondroma, thickness of the cartilage cap, and associated change in surrounding soft tissue. Clinical manifestation included a palpable mass or tendency to grow (n=22) and pain on movement (n=9). Complications were of three types : that which followed change in the osseous component of the tumor, associated change in surrounding soft tissue, and malignant transformation. In the osseous component, bone marrow edema or contusion was seen in 21 cases (67.7%), and in two (65%), fracture was observed. In surrounding soft tissue, muscle impingement was seen in 21 cases (67.7%), bursitis was in 7 cases (22.6 %), tenosynovitis in seven (22.6 %), and vascular compression in five (16.1 %). In three cases (9.7%), transformation to chondrosarcoma had occurred; two of these were derived from osteochondromatosis and one from a single osteochondroma. The thickness of the cartilage cap was as follow : 10 mm (n=3). In patients with symptomatic osteochondroma, MR imaging is useful for detecting both complications and malignant transformation. (author). 21 refs., 1 tab., 6 figs

  3. Factors influencing the long-term sustainment of quality improvements made in addiction treatment facilities: a qualitative study

    Directory of Open Access Journals (Sweden)

    Scott P. Stumbo

    2017-11-01

    Full Text Available Abstract Background A greater understanding of the factors that influence long-term sustainment of quality improvement (QI initiatives is needed to promote organizational ability to sustain QI practices over time, help improve future interventions, and increase the value of QI investments. Methods We approached 83 of 201 executive sponsors or change leaders at addiction treatment organizations that participated in the 2007–2009 NIATx200 QI intervention. We completed semi-structured interviews with 33 individuals between November 2015 and April 2016. NIATx200 goals were to decrease wait time, increase admissions and improve retention in treatment. Interviews sought to understand factors that either facilitated or impeded long-term sustainment of organizational QI practices made during the intervention. We used thematic analysis to organize the data and group patterns of responses. We assessed available quantitative outcome data and intervention engagement data to corroborate qualitative results. Results We used narrative analysis to group four important themes related to long-term sustainment of QI practices: (1 finding alignment between business- and client-centered practices; (2 staff engagement early in QI process added legitimacy which facilitated sustainment; (3 commitment to integrating data into monitoring practices and the identification of a data champion; and (4 adequate organizational human resources devoted to sustainment. We found four corollary factors among agencies which did not sustain practices: (1 lack of evidence of impact on business practices led to discontinuation; (2 disengaged staff and lack of organizational capacity during implementation period led to lack of sustainment; (3 no data integration into overall business practices and no identified data champion; and (4 high staff turnover. In addition, we found that many agencies’ current use of NIATx methods and tools suggested a legacy effect that might improve

  4. Comparing Kaolin and Pinolene to Improve Sustainable Grapevine Production during Drought.

    Science.gov (United States)

    Brillante, Luca; Belfiore, Nicola; Gaiotti, Federica; Lovat, Lorenzo; Sansone, Luigi; Poni, Stefano; Tomasi, Diego

    2016-01-01

    Viticulture is widely practiced in dry regions, where the grapevine is greatly exposed to water stress. Optimizing plant water use efficiency (WUE) without affecting crop yield, grape and wine quality is crucial to limiting use of water for irrigation and to significantly improving viticulture sustainability. This study examines the use in vineyards of particle film technology (engineered kaolin) and compares it to a film-forming antitranspirant (pinolene), traditionally used to limit leaf water loss, and to an untreated control. The trial was carried out under field conditions over three growing seasons, during which moderate to very severe plant water stress (down to -1.9 MPa) was measured through stem water potential. Leaf stomatal conductance (gs) and photosynthesis rate (An) were measured during the seasons and used to compute intrinsic WUE (WUEi, defined as An/gs ratio). Leaf temperature was also recorded and compared between treatments. Bunch quantity, bunch and berry weight, sugar accumulation, anthocyanin and flavonoid contents were measured. Finally, microvinifications were performed and resultant wines subjected to sensory evaluation.Results showed that the use of kaolin increased grapevine intrinsic WUE (+18% on average as compared to unsprayed vines) without affecting berry and bunch weight and quantity, or sugar level. Anthocyanin content increased (+35%) in kaolin treatment, and the wine was judged more attractive (p-value wine was the least appreciated. This study demonstrates that particle film technology can improve vine WUEi and wine quality at the same time, while traditional antitranspirants were not as effective for these purposes. This positive effect can be used in interaction with other already-demonstrated uses of particle film technology, such as pest control and sunburn reduction, in order to achieve more sustainable vineyard management.

  5. Comparing Kaolin and Pinolene to Improve Sustainable Grapevine Production during Drought.

    Directory of Open Access Journals (Sweden)

    Luca Brillante

    Full Text Available Viticulture is widely practiced in dry regions, where the grapevine is greatly exposed to water stress. Optimizing plant water use efficiency (WUE without affecting crop yield, grape and wine quality is crucial to limiting use of water for irrigation and to significantly improving viticulture sustainability. This study examines the use in vineyards of particle film technology (engineered kaolin and compares it to a film-forming antitranspirant (pinolene, traditionally used to limit leaf water loss, and to an untreated control. The trial was carried out under field conditions over three growing seasons, during which moderate to very severe plant water stress (down to -1.9 MPa was measured through stem water potential. Leaf stomatal conductance (gs and photosynthesis rate (An were measured during the seasons and used to compute intrinsic WUE (WUEi, defined as An/gs ratio. Leaf temperature was also recorded and compared between treatments. Bunch quantity, bunch and berry weight, sugar accumulation, anthocyanin and flavonoid contents were measured. Finally, microvinifications were performed and resultant wines subjected to sensory evaluation.Results showed that the use of kaolin increased grapevine intrinsic WUE (+18% on average as compared to unsprayed vines without affecting berry and bunch weight and quantity, or sugar level. Anthocyanin content increased (+35% in kaolin treatment, and the wine was judged more attractive (p-value <0.05 and slightly more appreciated (p-value < 0.1 than control. Pinolene did not increase WUEi, limiting An more than gs; grapes with this treatment contained lower sugar and anthocyanin content than control, and the obtained wine was the least appreciated. This study demonstrates that particle film technology can improve vine WUEi and wine quality at the same time, while traditional antitranspirants were not as effective for these purposes. This positive effect can be used in interaction with other already

  6. Constraints in animal health service delivery and sustainable improvement alternatives in North Gondar, Ethiopia

    Directory of Open Access Journals (Sweden)

    Hassen Kebede

    2014-11-01

    Full Text Available Poor livestock health services remain one of the main constraints to livestock production in many developing countries, including Ethiopia. A study was carried out in 11 districts of North Gondar, from December 2011 to September 2012, with the objective of identifying the existing status and constraints of animal health service delivery, and thus recommending possible alternatives for its sustainable improvement. Data were collected by using pre-tested questionnaires and focus group discussion. Findings revealed that 46.34% of the responding farmers had taken their animals to government veterinary clinics after initially trying treatments with local medication. More than 90.00% of the clinical cases were diagnosed solely on clinical signs or even history alone. The antibacterial drugs found in veterinary clinics were procaine penicillin (with or without streptomycin, oxytetracycline and sulphonamides, whilst albendazole, tetramisole and ivermectin were the only anthelmintics. A thermometer was the only clinical aid available in all clinics, whilst only nine (45.00% clinics had a refrigerator. In the private sector, almost 95.00% were retail veterinary pharmacies and only 41.20% fulfilled the requirement criteria set. Professionals working in the government indicated the following problems: lack of incentives (70.00%, poor management and lack of awareness (60.00% and inadequate budget (40.00%. For farmers, the most frequent problems were failure of private practitioners to adhere to ethical procedures (74.00% and lack of knowledge of animal diseases and physical distance from the service centre (50.00%. Of all responding farmers, 58.54% preferred the government service, 21.14% liked both services equally and 20.33% preferred the private service. Farmers’ indiscriminate use of drugs from the black market (23.00% was also mentioned as a problem by private practitioners. Sustainable improvement of animal health service delivery needs increased

  7. Constraints in animal health service delivery and sustainable improvement alternatives in North Gondar, Ethiopia.

    Science.gov (United States)

    Kebede, Hassen; Melaku, Achenef; Kebede, Elias

    2014-11-12

    Poor livestock health services remain one of the main constraints to livestock production in many developing countries, including Ethiopia. A study was carried out in 11 districts of North Gondar, from December 2011 to September 2012, with the objective of identifying the existing status and constraints of animal health service delivery, and thus recommending possible alternatives for its sustainable improvement. Data were collected by using pre-tested questionnaires and focus group discussion. Findings revealed that 46.34% of the responding farmers had taken their animals to government veterinary clinics after initially trying treatments with local medication. More than 90.00% of the clinical cases were diagnosed solely on clinical signs or even history alone. The antibacterial drugs found in veterinary clinics were procaine penicillin (with or without streptomycin), oxytetracycline and sulphonamides, whilst albendazole, tetramisole and ivermectin were the only anthelmintics. A thermometer was the only clinical aid available in all clinics, whilst only nine (45.00%) clinics had a refrigerator. In the private sector, almost 95.00% were retail veterinary pharmacies and only 41.20% fulfilled the requirement criteria set. Professionals working in the government indicated the following problems: lack of incentives (70.00%), poor management and lack of awareness (60.00%) and inadequate budget (40.00%). For farmers, the most frequent problems were failure of private practitioners to adhere to ethical procedures (74.00%) and lack of knowledge of animal diseases and physical distance from the service centre (50.00%). Of all responding farmers, 58.54% preferred the government service, 21.14% liked both services equally and 20.33% preferred the private service. Farmers' indiscriminate use of drugs from the black market (23.00%) was also mentioned as a problem by private practitioners. Sustainable improvement of animal health service delivery needs increased awareness for all

  8. HAS THE INFORMATION SOCIETY SUCCEEDED TO IMPROVE THE COMPETITIVENESS OF EUROPEAN SUSTAINABLE TOURISM ECONOMY?

    Directory of Open Access Journals (Sweden)

    GHITA Simona

    2015-06-01

    Full Text Available Europe represents one of the most significant tourism destinations in the world, but, nowadays, it is more and more important the issue of adapting the tourism demand and supply to the need of sustainability. Information Technologies can help to increase the competitiveness of the tourism industry, creating a bridge between tourism supply and demand. According to the figures presented by the UNWTO, the growth rate of international tourist arrivals in 2013 compared to 2012 was of 5% (meaning 52 million international tourists arrivals, reaching 1,09 billion arrivals in 2013. The highest absolute growth was experienced by Europe (29 million arrivals in 2013, while the highest relative growth was registered in Asia and the Pacific (6%. The average international tourist receipt exceeded US$700 per person, while total tourists’ expenditures leveled more than $1,4 trillion. Tourism sector, including the related industries, contributed in 2013 by 9,5% to the total global Gross Domestic Product (GDP and created approximately 10% of the jobs worldwide. In Romania the ascending trend of tourists’ arrivals in accommodation establishments was interrupted by decreases in 2009 and 2010, due to the global economic-financial crisis. The indicator “Nights spent at tourist accommodation establishments by residents” experienced a similar evolution. Revenues from tourism and its contribution to GDP can be improved through the usage of information technology services. The present paper gives a possible answer to the following questions: can Information Society improve the competitiveness of European Sustainable Tourism Economy? Are there evidences of the impact of modern informational technologies on trends in sustainable tourism economy? In the analysis, the author used EUROSTAT data for European countries, 2000-2013 time-series. Statistical indicators used in the analysis are grouped by three areas of interest: Tourism Area (Arrivals of residents

  9. Strategies of Transition to Sustainable Agriculture in Iran I- Improving Resources Use Efficiency

    Directory of Open Access Journals (Sweden)

    Alireza Koocheki

    2017-12-01

    Full Text Available Introduction Fast switch to sustainable agriculture patterns is not impossible for many farmers. However to achieve perfect sustainable in agro-ecosystems which are friendly with environment, changing conventional to sustainable agriculture should be carried slowly. For this purpose, three effective steps were mentioned: first level is increasing of inputs efficiency such as fertilizer and chemical pesticides which used in conventional agriculture now. Second level is related to changing inputs by friendly environmental inputs as alternative inputs and the final level is redesigning of the agro-ecosystems that its function is based on series of ecological process. On the other hand, achieving sustainable agriculture requires higher efficiency of inputs and many process should be replaced by friendly environmental inputs with chemical inputs and new system is designed based on ecological principles. The objective of this study was to offer approaches for improving inputs use efficiency as first step to transition from conventional to sustainable agriculture. Material and Methods In order to evaluate the transition status from conventional to sustainable agriculture in agro-ecosystems of Iran, scientific resource and researches that was performed about increasing of inputs efficiency as first step to transition from conventional to sustainable agriculture was studied. For this purpose, 177 studies that had been performed about using different inputs and its efficiency in various crops were assessed. Applied inputs included water, nitrogen and herbicides and studied plants included cereals (wheat, barley, rice, maize and sorghum, beans (bean, pea and lentil, oil crops (canola, sunflower, safflower and sesame, medicinal plants, potato, sugar beet and cotton. In this study, average and range of inputs use efficiency in different crops and also the relationship between increasing of inputs application with their use efficiency was assessed. In the

  10. Molecular approaches to improvement of Jatropha curcas Linn. as a sustainable energy crop.

    Science.gov (United States)

    Sudhakar Johnson, T; Eswaran, Nalini; Sujatha, M

    2011-09-01

    With the increase in crude oil prices, climate change concerns and limited reserves of fossil fuel, attention has been diverted to alternate renewable energy sources such as biofuel and biomass. Among the potential biofuel crops, Jatropha curcas L, a non-domesticated shrub, has been gaining importance as the most promising oilseed, as it does not compete with the edible oil supplies. Economic relevance of J. curcas for biodiesel production has promoted world-wide prospecting of its germplasm for crop improvement and breeding. However, lack of adequate genetic variation and non-availability of improved varieties limited its prospects of being a successful energy crop. In this review, we present the progress made in molecular breeding approaches with particular reference to tissue culture and genetic transformation, genetic diversity assessment using molecular markers, large-scale transcriptome and proteome studies, identification of candidate genes for trait improvement, whole genome sequencing and the current interest by various public and private sector companies in commercial-scale cultivation, which highlights the revival of Jatropha as a sustainable energy crop. The information generated from molecular markers, transcriptome profiling and whole genome sequencing could accelerate the genetic upgradation of J. curcas through molecular breeding.

  11. Environmental assessment, continual improvement and adaptive management within the AREVA sustainable development framework

    International Nuclear Information System (INIS)

    Rosaasen, A.; Frostad, S.

    2006-01-01

    COGEMA Resources Inc. (which is part of the AREVA Group) is a Canadian company with its head office in Saskatoon, Saskatchewan. It owns and operates mining and milling facilities in northern Saskatchewan, which produce uranium concentrate. The McClean Lake Operation commenced production in 1999 and its environmental management system represents an integrated approach to environmental assessment, continual improvement and adaptive management based on operational results. In Canada, sustainable development is promoted through the application of the Canadian Environmental Assessment Act (CEAA). Environmental Assessment (EA) is a planning tool, which incorporates environmental considerations before irrevocable decisions are taken. The basic tenet of the Act is the determination of whether the potential environmental effects of a project are adverse, significant and likely, taking into consideration mitigation measures. Thus, project planning and design entails an iterative process that incorporates mitigation measures to minimize potentially significant adverse effects. As part of the EA process conservative approaches are taken to predict potential effects. Several important elements are generated through the EA process including: a set of environmental effects predictions, a compliance and environmental effects monitoring program, a follow-up program to address uncertainties in the prediction of environmental effects, and the identification of contingency measures that could be implemented should non-conservative assumptions be identified in the original assessment framework. The challenge is to integrate each of these elements into the environmental management framework of the operating facility and develop an iterative mechanism to evaluate operational performance relative to what was originally predicted. In Saskatchewan, a requirement of operational licenses is the periodic evaluation of the 'Status of the Environment' surrounding operational facilities. These

  12. Improving Buffalo Milk Production to Sustain the Production of Dadih by Small Farmers in West Sumatera

    Directory of Open Access Journals (Sweden)

    Wirdahayati R B

    2007-12-01

    Full Text Available The swamp buffalo which is found in many Asian regions is mainly raised for meat and draft purposes. However, in West Sumatera, it is also milked and the milk is mostly consumed as “dadih“, a well known traditional product from this area. Dadih is actually a product made from fresh buffalo milk, which is kept in bamboo tube for about 2-3 days under room temperature, without any application or addition of bacteria starter although the end product of this fermentation contains various bacteria, mould and khamir. As the natural fermented milk product, dadih is white in colour and the curd texture like tofu, tastes like yoghurt, and it is generally served as a complementing meal in some traditional occasion as well as delicacy from West Sumatera. Dadih is highly nutritive product, protein and fat contents are higher than those of yoghurt, rich in amino acids and bacteria such as Lactobacillus sp. and low in cholesterol. The raw material for dadih is limited due to the low productivity of fresh buffalo milk which is generally collected for about 0.5 – 2.0 litres/head/day. The effort in sustaining “dadih product“ is directed to the improving the management of the buffalo condition particularly those in lactating period. Feeding improvement is recommended in order to provide an adequate milk for raising its calf and to be milked for making dadih and to support the optimal reproductive activity of the buffalo dam. In future, the assessment on “dadih“ should also include the packaging improvement which can improve and prolong the storage time for the benefit of marketing purposes.

  13. Construction Projects Assessment Based on the Sustainable Development Criteria by an Integrated Fuzzy AHP and Improved GRA Model

    Directory of Open Access Journals (Sweden)

    Seyed Morteza Hatefi

    2018-03-01

    Full Text Available Due to the increasing population and earth pollution, managing construction and infrastructure projects with less damage to the environment and less pollution is very important. Sustainable development aims at reducing damage to the environment, making projects economical, and increasing comfort and social justice. This study proposes fuzzy analytic hierarchy process (AHP and improved grey relational analysis (GRA to assess construction projects based on the sustainable development criteria. For doing so, sustainable development criteria are first identified in economic, social, and environmental dimensions using literature review, and are then customized for urban construction projects using experts’ opinions. After designing questionnaires and collecting data, fuzzy AHP is used for determining the importance of sustainable development criteria and their subcriteria. Then, improved GRA is employed for assessing six recreational, commercial, and official centers in Isfahan regarding the weights of criteria and subcriteria. The proposed fuzzy AHP-improved GRA help us to prioritize construction projects based on the sustainable development criteria. The results of applying fuzzy AHP show that the weights of economic, social, and environmental criteria are equal to 0.330, 0.321, and 0.349, respectively, which are close to each other. This means that the importance of all three aspects of sustainability is almost equal to each other. Furthermore, “Having profits for the society”, “Increasing social justice”, and “Adherence to environmental policies” are identified as the most important indicators of sustainable development in terms of economic, social, and environmental aspects, respectively. Finally, the results of employing improved GRA determine Negin Chaharbagh recreational and commercial complex as the best project.

  14. MR Imaging in symptomatic osteochondromas

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Soo Young; Kim, Jee Young; Kim, Sang Heum; Chun, Kyung Ah; Park, Young Ha [Catholic University of Korea, Seoul (Korea, Republic of)

    1998-06-01

    The purpose of this study is to assess the MR findings of symptomatic osteochondromas. We evaluated 31 patients who between July, 1994 and May, 1997 underwent MR imaging for symptomatic osteochondroma. Fourteen were males and 17 were females, and their ages ranged from 8 to 49 (mean, 23) years. Using T1WI, T2WI and gadolinium-DTPA-enhanced T1WI, images were analysed according to signal intensity in the osseous component of the osteochondroma, thickness of the cartilage cap, and associated change in surrounding soft tissue. Clinical manifestation included a palpable mass or tendency to grow (n=22) and pain on movement (n=9). Complications were of three types : that which followed change in the osseous component of the tumor, associated change in surrounding soft tissue, and malignant transformation. In the osseous component, bone marrow edema or contusion was seen in 21 cases (67.7%), and in two (65%), fracture was observed. In surrounding soft tissue, muscle impingement was seen in 21 cases (67.7%), bursitis was in 7 cases (22.6 %), tenosynovitis in seven (22.6 %), and vascular compression in five (16.1 %). In three cases (9.7%), transformation to chondrosarcoma had occurred; two of these were derived from osteochondromatosis and one from a single osteochondroma. The thickness of the cartilage cap was as follow : < 5 mm (n=16), 5-10 mm (n=12), and > 10 mm (n=3). In patients with symptomatic osteochondroma, MR imaging is useful for detecting both complications and malignant transformation. (author). 21 refs., 1 tab., 6 figs.

  15. Ensuring Support for Research and Quality Improvement (QI) Networks: Four Pillars of Sustainability-An Emerging Framework.

    Science.gov (United States)

    Holve, Erin

    2013-01-01

    Multi-institutional research and quality improvement (QI) projects using electronic clinical data (ECD) hold great promise for improving quality of care and patient outcomes but typically require significant infrastructure investments both to initiate and maintain the project over its duration. Consequently, it is important for these projects to think holistically about sustainability to ensure their long-term success. Four "pillars" of sustainability are discussed based on the experiences of EDM Forum grantees and other research and QI networks. These include trust and value, governance, management, and financial and administrative support. Two "foundational considerations," adaptive capacity and policy levers, are also discussed.

  16. 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.

  17. Desired Diversity and Symptomatic Anxiety

    DEFF Research Database (Denmark)

    Friis Christensen, Jannick; Muhr, Sara Louise

    2018-01-01

    of diversity that, however, constantly change due to the empty form of diversity. Anxiety manifests itself in the obsession of unobtainable idealised forms of diversity as well as in the uncertainty associated with the traumatic experience of always falling short of what is desired in an object...... – the experience of failed diversity. Conclusively, we discuss the productive potential of the power of lack. The impossibility of diversity is what, at once, conditions the possibility of diversity. We therefore suggest that the symptomatic anxiety provoked by the lack should be enjoyed in order to engage...

  18. Role of marine macroalgae in plant protection & improvement for sustainable agriculture technology

    Directory of Open Access Journals (Sweden)

    Seham M. Hamed

    2018-03-01

    Full Text Available Marine macroalgae are plant-like organisms with simple internal structures that generally live in coastal areas. They mainly include different communities of red, brown and green macroalgae. Marine macroalgae commonly occupy intertidal and sublittoral-to-littoral zones on rocks and other hard substrata. They are considered to be an excellent natural biosource in different aspects of agricultural fields. They have great proficiency in improving soil physical and chemical properties. Marine macroalgae are also characterized by producing a large array of biologically active biocidal substances against plant-infecting pathogens. Unfortunately, most available literatures on marine macroalgae and their derivatives mainly focused on their pharmaceutical applications but their potential utilization in sustainable agriculture development is still often regarded as a secondary goal. However, a relatively considerable dataset on marine macroalgae showed that they could play a major role in plant protection and improvement. This review summarizes different aspects of potential macroalgal applications in agriculture. Commercial production and exploitation of specific compounds with interesting biotechnological importance from marine macroalgae including microbicides, nematicides, insecticides, biofertilizers, biostimulators and soil conditioners are highlighted and discussed in detail. Bioactive compounds like fatty acids (in particular polyunsaturated fatty acids (PUFAs, proteins (amino acids, bioflavonoids, sulfated polysaccharides, carotenoids, polyphenols and carbohydrates are considered to have bactericidal, antiviral and fungicidal effects against some plant-infecting pathogens. These biocontrol agents provide multiple benefits and act as useful pointers for improving cultivation practices in diverse habitats. Marine macroalgae can be generally considered as promising multifunctional bioinoculants and ecofriendly environmental tools in recent trends

  19. Characterization of traditional production systems of sugarcane for panela and some prospects for improving their sustainability

    Directory of Open Access Journals (Sweden)

    Joaquín Guillermo Ramírez Gil

    2017-01-01

    Full Text Available Sugarcane used for the production of “panela” (unrefined cane sugar is a crop of great importance for Colombia’s rural economy. Additionally, it serves a fundamental role in the food security and sovereignty of the Colombian population and daily consumption. However, the small production system presents problems of sustainability, as a direct consequence of its technological arrears and loss of interest in this crop. In this study, a characterization of 30 small productive units located in three municipalities in Antioquia was performed with the objective of identifying the problems associated with this production system and stablish the causes associated with loss of area dedicated to this crop in the study area. The results demonstrate that in the region of study, this production system and its associated agro-industry have problems associated with low technological level, poor infrastructure, deficient agro-industry processing and low levels of associativity and marketing. This situation has generated a low economic solvency for the farmers, leading many to abandon this activity and migrate towards other economic sectors. The findings of this study indicate the need to reengineer this production system, for which they could make technological adaptations that improve productivity and product quality and generate added value. On the other hand, must the rural countryside attractive to avoid the loss of labor and make young people become interested in this economic activity. As strategies to improve productivity, we suggest the effective use of information technologies, improve rural living conditions, increase associativity and value added, involve the consumer in the production chain and design development policies for the entire chain of value.

  20. Five-Year Outcomes of Surgically Treated Symptomatic Epiretinal Membranes With and Without Internal Limiting Membrane Peeling.

    Science.gov (United States)

    Sultan, Harris; Wykoff, Charles C; Shah, Ankoor R

    2018-05-01

    The authors evaluated long-term postoperative visual outcomes and recurrence rates following surgery for symptomatic epiretinal membrane (ERM) ± internal limiting membrane (ILM) peeling. This was a retrospective, consecutive case series of 78 patients undergoing vitrectomy for symptomatic ERM between 1/2010 and 4/2012 with follow-up through at least postoperative year 5 (POY5). Outcomes included visual acuity (VA) (Snellen VA converted to logMAR), central retinal thickness (CRT; μm), and ERM recurrence. Subgroup analysis evaluated outcomes related to ILM peeling. Subgroup analysis based on ILM peeling did not find VA (20/50 [0.430 logMAR ± 0.061 logMAR; mean ± SD] vs. 20/60 [0.518 logMAR ± 0.128 logMAR] for ILM vs. non-ILM peeling respectively; P = .513) nor macular thickness (355 μm ± 13 μm vs. 360 μm ± 42 μm; P = .410) to be significantly different at POY5. Recurrence requiring surgery with and without ILM peeling was not statistically significantly different at POY5 (1.6% and 11.8%; P = .118). Vitrectomy for symptomatic ERM led to improved visual and anatomic outcomes with sustained benefit through 5 years. ILM peeling was was associated with reduced ERM recurrence, but this benefit was not statistically significant at POY5. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:296-302.]. Copyright 2018, SLACK Incorporated.

  1. Improvements in crop water productivity increase water sustainability and food security—a global analysis

    International Nuclear Information System (INIS)

    Brauman, Kate A; Foley, Jonathan A; Siebert, Stefan

    2013-01-01

    Irrigation consumes more water than any other human activity, and thus the challenges of water sustainability and food security are closely linked. To evaluate how water resources are used for food production, we examined global patterns of water productivity—food produced (kcal) per unit of water (l) consumed. We document considerable variability in crop water productivity globally, not only across different climatic zones but also within climatic zones. The least water productive systems are disproportionate freshwater consumers. On precipitation-limited croplands, we found that ∼40% of water consumption goes to production of just 20% of food calories. Because in many cases crop water productivity is well below optimal levels, in many cases farmers have substantial opportunities to improve water productivity. To demonstrate the potential impact of management interventions, we calculated that raising crop water productivity in precipitation-limited regions to the 20th percentile of productivity would increase annual production on rainfed cropland by enough to provide food for an estimated 110 million people, and water consumption on irrigated cropland would be reduced enough to meet the annual domestic water demands of nearly 1.4 billion people. (letter)

  2. Improving the actinides recycling in closed fuel cycles, a major step towards nuclear energy sustainability

    International Nuclear Information System (INIS)

    Poinssot, C.; Grandjean, S.; Masson, M.; Bouillis, B.; Warin, D.

    2013-01-01

    Increasing the sustainability of nuclear energy is a longstanding road that requires a stepwise approach to successively tackle the following 3 objectives. First of all, optimize the consumption of natural resource to preserve them for future generations and hence guarantee the energetic independence of the countries (no uranium ore is needed anymore). The current twice-through cycle of Pu implemented by France, UK, Japan and soon China is a first step in this direction and already allows the development and optimization of the relevant industrial processes. It also allows a major improvement regarding the conditioning of the ultimate waste in a durable and robust nuclear glass. Secondly, the recycling of americium could be an interesting option for the future with the deployment of FR fleet to save the repository resource and optimize its use by allowing a denser disposal. It would limit the burden towards the future generations and the need for additional repositories before several centuries. Thirdly, the recycling of the whole minor actinides inventory could be an interesting option for the far-future for strongly decreasing the waste long-term toxicity, down to a few centuries. It would bring the waste issue back within the human history, which should promote its acceptance by the social opinion

  3. Improving sustainability of bio-cogeneration in horticulture; Verbetering duurzaamheid (bio)WKK in de glastuinbouw

    Energy Technology Data Exchange (ETDEWEB)

    Koolwijk, E.; Peeters, S.; Schlatmann, S. [Energy Matters, Driebergen (Netherlands)

    2011-12-15

    Combined Heat and Power (CHP) generating gas engines have become an inseparable part of greenhouses. An overview is given of the technical developments in CHP that could result in cost effectiveness, clean and sustainable operation of the CHP installation. This can be achieved by improving existing or new cogeneration systems: e.g. increasing the electrical or thermal efficiency and reduce emissions. Also attention is paid to alternatives for the gas engine: gas turbine and fuel cell. Finally, the options and state of affairs concerning biofuels, related techniques and potential use of 'green' CO2 were investigated [Dutch] WKK op basis van gasmotoren is de laatste 10 jaar uitgegroeid tot een onlosmakelijk operationeel onderdeel van de hedendaagse glastuinbouw. Een overzicht wordt gegeven van de technische ontwikkelingen rond WKK die er toe kunnen leiden dat WKK kosteneffectiever/rendabeler, schoner en duurzamer bedreven kan worden. Dit kan onder andere door verbeteringen van de bestaande of nog te plaatsen WKK's: verhogen van het elektrisch of thermisch rendement en verlagen van de emissies. Ook is gekeken naar de mogelijke alternatieven voor de gasmotor: gasturbine en brandstofcel. Tevens wordt ingegaan op de mogelijkheden en stand zaken rond biobrandstoffen, de daarbij behorende technieken en mogelijke toepassing van 'groene' CO2.

  4. A program for sustained improvement in preventing ventilator associated pneumonia in an intensive care setting.

    Science.gov (United States)

    Caserta, Raquel A; Marra, Alexandre R; Durão, Marcelino S; Silva, Cláudia Vallone; Pavao dos Santos, Oscar Fernando; Neves, Henrique Sutton de Sousa; Edmond, Michael B; Timenetsky, Karina Tavares

    2012-09-29

    Ventilator-associated pneumonia (VAP) is a common infection in the intensive care unit (ICU) and associated with a high mortality. A quasi-experimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize VAP prevention were performed from October 2008 to December 2010. All of these processes, including the Institute for Healthcare Improvement's (IHI) ventilator bundle plus oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions (CASS), were adopted for patients undergoing mechanical ventilation. We evaluated a total of 21,984 patient-days, and a total of 6,052 ventilator-days (ventilator utilization rate of 0.27). We found VAP rates of 1.3 and 2.0 per 1,000 ventilator days respectively in 2009 and 2010, achieving zero incidence of VAP several times during 12 months, whenever VAP bundle compliance was over 90%. These results suggest that it is possible to reduce VAP rates to near zero and sustain these rates, but it requires a complex process involving multiple performance measures and interventions that must be permanently monitored.

  5. Strategies to enable the adoption of animal biotechnology to sustainably improve global food safety and security.

    Science.gov (United States)

    Tizard, Mark; Hallerman, Eric; Fahrenkrug, Scott; Newell-McGloughlin, Martina; Gibson, John; de Loos, Frans; Wagner, Stefan; Laible, Götz; Han, Jae Yong; D'Occhio, Michael; Kelly, Lisa; Lowenthal, John; Gobius, Kari; Silva, Primal; Cooper, Caitlin; Doran, Tim

    2016-10-01

    The ability to generate transgenic animals has existed for over 30 years, and from those early days many predicted that the technology would have beneficial applications in agriculture. Numerous transgenic agricultural animals now exist, however to date only one product from a transgenic animal has been approved for the food chain, due in part to cumbersome regulations. Recently, new techniques such as precision breeding have emerged, which enables the introduction of desired traits without the use of transgenes. The rapidly growing human population, environmental degradation, and concerns related to zoonotic and pandemic diseases have increased pressure on the animal agriculture sector to provide a safe, secure and sustainable food supply. There is a clear need to adopt transgenic technologies as well as new methods such as gene editing and precision breeding to meet these challenges and the rising demand for animal products. To achieve this goal, cooperation, education, and communication between multiple stakeholders-including scientists, industry, farmers, governments, trade organizations, NGOs and the public-is necessary. This report is the culmination of concepts first discussed at an OECD sponsored conference and aims to identify the main barriers to the adoption of animal biotechnology, tactics for navigating those barriers, strategies to improve public perception and trust, as well as industry engagement, and actions for governments and trade organizations including the OECD to harmonize regulations and trade agreements. Specifically, the report focuses on animal biotechnologies that are intended to improve breeding and genetics and currently are not routinely used in commercial animal agriculture. We put forward recommendations on how scientists, regulators, and trade organizations can work together to ensure that the potential benefits of animal biotechnology can be realized to meet the future needs of agriculture to feed the world.

  6. Do forwarders improve sustainability efficiency? : Evidence from a European DEA Malmquist index calculation

    NARCIS (Netherlands)

    Klumpp, Matthias

    2017-01-01

    Sustainability performance and efficiency is an important topic in transportation and for forwarders. This is shown, for example, by the fact that major logistics service providers LSP publish sustainability reports, often within the annual legal business report. However, in depth research is

  7. Improving sustainability of maize to ethanol processing by plant breeding and process optimization

    NARCIS (Netherlands)

    Slegers, P.M.; Torres Salvador, A.F.; Boxtel, van A.J.B.; Trindade, L.M.

    2017-01-01

    Efficient management of plant resources is essential for a sustainable biobased economy. The biomass conversion efficiency and sustainability performance depend greatly on the choice of feedstock and the applied processing technology. The aim of this research was to enhance the biomass use of maize

  8. Are school meals a viable and sustainable tool to improve the healthiness and sustainability of children´s diet and food consumption?

    DEFF Research Database (Denmark)

    Oostindjer, Marije; Aschemann-Witzel, Jessica; Wang, Qing

    2017-01-01

    . School meal programs are of particular interest for improving public diet because they reach children at a population scale across socio-economic classes and for over a decade of their lives, and because food habits of children are more malleable than those of adults. Current research on the history...... and health implications of school meal programs is reviewed in a cross-national comparative framework, and arguments explored that speak for the need of a new developmental phase of school meals as an integrative learning platform for healthy and sustainable food behavior. Nutritional, social, practical...

  9. Improving Sustainability in Global Supply Chains with Private Certification Standards: Testing An Approach for Assessing Their Performance and Impact Potential

    NARCIS (Netherlands)

    Vermeulen, Walter; Metselaar, Janneke

    Sustainable supply chain governance approaches aim for improvement of environmental and community living conditions at the developing country's side of the global supply chains. Impact evaluation in remote and multiple sourcing countries is hardly done in practice because of its complexity and

  10. Improving Urban Freight Transport Sustainability by Carriers : Best Practices from The Netherlands and the EU Project CityLog

    NARCIS (Netherlands)

    Quak, H.J.

    2012-01-01

    ers face serious challenges in making their urban freight transport efficient and sustainable. Local authorities claim that many carriers are not innovative and do not cooperate in improving their city logistics operations. There are three solution directions to make urban freight transport more

  11. Developing the Potential for Sustainable Improvement in Underperforming Schools: Capacity Building in the Socio-Cultural Dimension

    Science.gov (United States)

    Bennett, Jeffrey V.; Ylimaki, Rose M.; Dugan, Thad M.; Brunderman, Lynnette A.

    2014-01-01

    This mixed-method study examines Arizona principals' capacity-building skills and practices in Tier III schools aimed at developing potential for sustained improvements in student outcomes. Data sources included surveys (62 individuals) and semistructured interviews (29 individuals) of principals and staff (e.g. teachers, instructional coaches,…

  12. Empirical Study on the Sustainability of China’s Grain Quality Improvement: The Role of Transportation, Labor, and Agricultural Machinery

    Science.gov (United States)

    Zhang, Ming; Duan, Fang; Mao, Zisen

    2018-01-01

    As a major part of farming sustainability, the issues of grain production and its quality improvement have been important in many countries. This paper aims to address these issues in China. Based on the data from the main production provinces and by applying the stochastic frontier analysis methodology, we find that the improvement of transportation and the use of agricultural machinery have become the main driving forces for grain quality improvement in China. After further studying different provinces’ potentials of grain quality improvement, we show that grain quality has increased steadily. Therefore, we can conclude China’s grain quality improvement is indeed sustainable. Furthermore, different grains like rice, wheat, and corn share similar characteristics in terms of quality improvement, but the improvement rate for rice is relatively low, while those of corn and wheat are relatively high. Moreover, the overall change of efficiency gain of grain quality improvement is not significant for different provinces. The efficiency gains of the quality improvements for rice and wheat even decrease slightly. In addition, we find that only expanding grain quality improvement potential can simultaneously achieve the dual objectives of improving grain quality and increasing yield. PMID:29401727

  13. Empirical Study on the Sustainability of China's Grain Quality Improvement: The Role of Transportation, Labor, and Agricultural Machinery.

    Science.gov (United States)

    Zhang, Ming; Duan, Fang; Mao, Zisen

    2018-02-05

    As a major part of farming sustainability, the issues of grain production and its quality improvement have been important in many countries. This paper aims to address these issues in China. Based on the data from the main production provinces and by applying the stochastic frontier analysis methodology, we find that the improvement of transportation and the use of agricultural machinery have become the main driving forces for grain quality improvement in China. After further studying different provinces' potentials of grain quality improvement, we show that grain quality has increased steadily. Therefore, we can conclude China's grain quality improvement is indeed sustainable. Furthermore, different grains like rice, wheat, and corn share similar characteristics in terms of quality improvement, but the improvement rate for rice is relatively low, while those of corn and wheat are relatively high. Moreover, the overall change of efficiency gain of grain quality improvement is not significant for different provinces. The efficiency gains of the quality improvements for rice and wheat even decrease slightly. In addition, we find that only expanding grain quality improvement potential can simultaneously achieve the dual objectives of improving grain quality and increasing yield.

  14. Empirical Study on the Sustainability of China’s Grain Quality Improvement: The Role of Transportation, Labor, and Agricultural Machinery

    Directory of Open Access Journals (Sweden)

    Ming Zhang

    2018-02-01

    Full Text Available As a major part of farming sustainability, the issues of grain production and its quality improvement have been important in many countries. This paper aims to address these issues in China. Based on the data from the main production provinces and by applying the stochastic frontier analysis methodology, we find that the improvement of transportation and the use of agricultural machinery have become the main driving forces for grain quality improvement in China. After further studying different provinces’ potentials of grain quality improvement, we show that grain quality has increased steadily. Therefore, we can conclude China’s grain quality improvement is indeed sustainable. Furthermore, different grains like rice, wheat, and corn share similar characteristics in terms of quality improvement, but the improvement rate for rice is relatively low, while those of corn and wheat are relatively high. Moreover, the overall change of efficiency gain of grain quality improvement is not significant for different provinces. The efficiency gains of the quality improvements for rice and wheat even decrease slightly. In addition, we find that only expanding grain quality improvement potential can simultaneously achieve the dual objectives of improving grain quality and increasing yield.

  15. Improving the quality of pork and pork products for the consumer : development of innovative, integrated, and sustainable food production chains of high quality pork products matching consumer demands

    NARCIS (Netherlands)

    Heimann, B.; Christensen, M.; Rosendal Rasmussen, S.; Bonneau, M.; Grunert, K.G.; Arnau, J.; Trienekens, J.H.; Oksbjerg, N.; Greef, de K.H.; Petersen, B.

    2012-01-01

    Improving the quality of pork and pork products for the consumer: development of innovative, integrated, and sustainable food production chains of high quality pork products matching consumer demands.

  16. Intrasellar Symptomatic Salivary Gland Rest

    Directory of Open Access Journals (Sweden)

    Chih-Hao Chen

    2007-05-01

    Full Text Available Ectopic salivary gland tissue in sellar turcica is frequently observed in microscopic examination at autopsy. This tissue is considered clinically silent. Only 2 symptomatic cases have been previously reported. Here we report a 28-year-old woman presenting with galactorrhea and hyperprolactinemia. Magnetic resonance imaging revealed a 6×5-mm nodule in the posterior aspect of the pituitary gland. This nodule showed isointensity on T1- and T2-weighted images and less enhancement on post-contrast T1-weighted images. Transsphenoidal exploration revealed a cystic lesion within the pituitary gland, which consisted of a grayish gelatinous content. The pathologic examination confirmed the diagnosis of salivary gland rest.

  17. Optimal Treatment of Symptomatic Hemorrhoids

    Science.gov (United States)

    Kim, Soung-Ho

    2011-01-01

    Hemorrhoids are the most common anorectal complaint, and approximately 10 to 20 percent of patients with symptomatic hemorrhoids require surgery. Symptoms of hemorrhoids, such as painless rectal bleeding, tissue protrusion and mucous discharge, vary. The traditional therapeutic strategies of medicine include surgical, as well as non-surgical, treatment. To alleviate symptoms caused by hemorrhoids, oral treatments, such as fiber, suppositories and Sitz baths have been applied to patients. Other non-surgical treatments, such as infrared photocoagulation, injection sclerotherapy and rubber band ligation have been used to fixate the hemorrhoid's cushion. If non-surgical treatment has no effect, surgical treatments, such as a hemorrhoidectomy, procedure for prolapsed hemorrhoids, and transanal hemorrhoidal dearterialization are used. PMID:22259741

  18. Sustainability and Efficiency Improvements of Gas-Cooled High Temperature Reactors

    International Nuclear Information System (INIS)

    Marmier, Alain

    2012-01-01

    This thesis covers 3 fundamental aspects of High Temperature Reactor (HTR) performance: fuel testing under irradiation for maximized safety and sustainability, fuel architecture for improved economy and sustainability, and a novel Balance of Plant concept to enable future high-tech process heat applications with minimized R and D. The HTR concept features important inherent and passive safety characteristics: high thermal inertia and good thermal conductivity of the core; a negative Doppler coefficient; high quality of fuel elements and low power density. These features keep the core temperature within safe boundaries and minimise fission product release, even in case of severe accidents. The Very High Temperature reactor (VHTR) is based on the same safety concept as the initial HTR, but it aims at offering better economy with a higher reactor outlet temperature (and thus efficiency) and a high fuel discharge burn-up (and thus better sustainability). The inherent safety features of HTR have been demonstrated in small pebble-bed reactors in practice, but have to be replicated for reactors with industrially relevant size and power. An increase of the power density (in order to increase the helium coolant outlet temperature) leads to higher fuel temperatures and therefore higher fuel failure probability. The core of a pebble-bed reactor consists of 6 cm diameter spheres (pebbles) that form a randomly packed porous bed, which is cooled by high pressure helium. These pebbles contain thousands of 1 mm diameter fuel particles baked into a graphite matrix. These fuel particles, in turn, consist of a fuel kernel with successive coatings of pyrocarbon and silicon carbide layers. The coating layers are designed to contain the fission products that build up during operation of the reactor. The feasibility and performance of the fuel requires experimental verification in view of fuel qualification and licensing. For HTR fuel, the required test string comprises amongst others

  19. FAO/IAEA international symposium on sustainable improvement of animal production and health. Synopses

    International Nuclear Information System (INIS)

    2009-01-01

    The on-going 'Livestock Revolution', a demand-driven increase in livestock production, especially in developing countries, presents both opportunities and risks. The shift in the human diet from plant-based protein sources to animal-based protein sources, consumer demand for safe and quality animal products, and expanding markets for livestock products have raised several challenges such as; cost-effective production of safe and quality animal products, control of emerging and zoonotic diseases, and efficient management of impact of livestock on the environment. However, these changes have also provided many opportunities to benefit the local economy and producers, and reduce poverty. New challenges and opportunities demand innovative ideas and approaches, and mechanisms to take this knowledge to potential users. Many of the approaches will be multidisciplinary in nature and require collaboration with specialists in areas other than animal scientists. Livestock production in developing countries is constrained by low genetic potential of animals, poor nutrition, poor husbandry and infectious diseases. Nuclear techniques, when applied in conjunction with conventional methods, can identify critical points in these areas that can be targeted for cost-effective improvements and interventions. Thus the challenge is to use such technologies to enhance food security and alleviate poverty by supporting sustainable livestock production systems in developing countries through strategic and applied research, technology transfer and capacity building. Topics addressed at the symposium: - Interactions among nutrition, reproduction and genotype; - Livestock-environment interaction / productivity/ climate (water/ land/ plants/heat/ altitude); - Detection and control of transboundary animal diseases, including zoonoses; - Animal product safety and food quality. Each of the papers published in this book of synopses has been indexed separately

  20. Sustained NFκB inhibition improves insulin sensitivity but is detrimental to muscle health.

    Science.gov (United States)

    Zhang, Ning; Valentine, Joseph M; Zhou, You; Li, Mengyao E; Zhang, Yiqiang; Bhattacharya, Arunabh; Walsh, Michael E; Fischer, Katherine E; Austad, Steven N; Osmulski, Pawel; Gaczynska, Maria; Shoelson, Steven E; Van Remmen, Holly; Chen, Hung I; Chen, Yidong; Liang, Hanyu; Musi, Nicolas

    2017-08-01

    Older adults universally suffer from sarcopenia and approximately 60-70% are diabetic or prediabetic. Nonetheless, the mechanisms underlying these aging-related metabolic disorders are unknown. NFκB has been implicated in the pathogenesis of several aging-related pathologies including sarcopenia and type 2 diabetes and has been proposed as a target against them. NFκB also is thought to mediate muscle wasting seen with disuse, denervation, and some systemic diseases (e.g., cancer, sepsis). We tested the hypothesis that lifelong inhibition of the classical NFκB pathway would protect against aging-related sarcopenia and insulin resistance. Aged mice with muscle-specific overexpression of a super-repressor IκBα mutant (MISR) were protected from insulin resistance. However, MISR mice were not protected from sarcopenia; to the contrary, these mice had decreases in muscle mass and strength compared to wild-type mice. In MISR mice, NFκB suppression also led to an increase in proteasome activity and alterations in several genes and pathways involved in muscle growth and atrophy (e.g., myostatin). We conclude that the mechanism behind aging-induced sarcopenia is NFκB independent and differs from muscle wasting due to pathologic conditions. Our findings also indicate that, while suppressing NFκB improves insulin sensitivity in aged mice, this transcription factor is important for normal muscle mass maintenance and its sustained inhibition is detrimental to muscle function. © 2017 The Authors. Aging Cell published by the Anatomical Society and John Wiley & Sons Ltd.

  1. Improved phosphorus use efficiency in agriculture: a key requirement for its sustainable use.

    Science.gov (United States)

    Schröder, J J; Smit, A L; Cordell, D; Rosemarin, A

    2011-08-01

    Mineral phosphorus (P) fertilizers processed from fossil reserves have enhanced food production over the past 50 years and, hence, the welfare of billions of people. Fertilizer P has, however, not only been used to lift the fertility level of formerly poor soils, but also allowed people to neglect the reuse of P that humans ingest in the form of food and excrete again as faeces and urine and also in other organic wastes. Consequently, P mainly moves in a linear direction from mines to distant locations for crop production, processing and consumption, where a large fraction eventually may become either agronomically inactive due to over-application, unsuitable for recycling due to fixation, contamination or dilution, and harmful as a polluting agent of surface water. This type of P use is not sustainable because fossil phosphate rock reserves are finite. Once the high quality phosphate rock reserves become depleted, too little P will be available for the soils of food-producing regions that still require P supplements to facilitate efficient utilization of resources other than P, including other nutrients. The paper shows that the amounts of P applied in agriculture could be considerably smaller by optimizing land use, improvement of fertilizer recommendations and application techniques, modified livestock diets, and adjustment of livestock densities to available land. Such a concerted set of measures is expected to reduce the use of P in agriculture whilst maintaining crop yields and minimizing the environmental impact of P losses. The paper also argues that compensation of the P exported from farms should eventually be fully based on P recovered from 'wastes', the recycling of which should be stimulated by policy measures. Copyright © 2011 Elsevier Ltd. All rights reserved.

  2. Designing urban spaces and buildings to improve sustainability and quality of life in a warmer world

    International Nuclear Information System (INIS)

    Smith, Claire; Levermore, Geoff

    2008-01-01

    It is in cities that the negative impacts of a warming climate will be felt most strongly. The summer time comfort and well-being of the urban population will become increasingly compromised under future scenarios for climate change and urbanisation. In contrast to rural areas, where night-time relief from high daytime temperatures occurs as heat is lost to the sky, the city environment stores and traps heat and offers little respite from high temperatures. This urban heat island effect is responsible for temperature differences of up to 7 deg. C between cities and the country in the UK. We already have experience of the potential hazards of these higher temperatures. The majority of heat-related fatalities during the summer of 2003 were in urban areas. This means that the cooling of the urban environment is a high priority for urban planners and designers. Proven ways of doing this include altering the urban microclimate by modifying its heat absorption and emission, for example through urban greening, the use of high-reflectivity materials, and by increasing openness to allow cooling winds. Buildings themselves can also deliver improved comfort and higher levels of sustainability by taking advantage of exemplary facade, glazing and ventilation designs. In addition, changed behaviour by building occupants can help keep urban areas cool. The technology to reduce the future vulnerability of city dwellers to thermal discomfort is already largely in existence. But there is a need for complementary policy and planning commitments to manage its implementation, especially in existing buildings and urban areas

  3. Survey of sustainability of continuous improvement systems: a comparison of two manufacturing communities in Spain and Mexico

    Directory of Open Access Journals (Sweden)

    Carmen Jaca

    2011-04-01

    Full Text Available Purpose: During the last 50 years industrial companies have adopted continuous improvement systems to improve their competitiveness. However, the maintenance of improvement systems is not an easy matter. Some companies, after an initial period of one to two years, abandon the system for various reasons. This article aims to examine the level of application of Continuous Improvement Systems and the factors which support sustainability over time in two different regions.Design/methodology/approach: In order to obtain a comparative result between two different regions, a survey was conducted in two industrial zones—one in the north of Spain and another in Mexico—that are important industrial clusters these countries. The study was conducted through the analysis of survey data. Specifically, the survey was directed at large industrial enterprises who had participated in activities supported by local foundations for the promotion of quality and improvement.Findings and Originality/value: We suggest the following three keys for sustainable improvement: greater involvement of task forces in the improvement program, a PDCA improvement cycle for improvement and a clear purpose for continuous improvement, integration of the continuous improvement system in the organization, and the establishment of indicators associated with the system.Research limitations/implications: The comparative study focused on only two industrial zones in Spain and Mexico. In that sense, the findings of the research are limited to the Basque zone and geographical zone of Toluca-Lerma.Practical implications: Some of the companies have started to apply some continuous improvement techniques in a sustainability way. Therefore, these findings could be very useful for general and operation managers that are involved in continuous improvement systems in industrial companies in Spain and Mexico.Social implications: As a consequence, slow and small transformations in certain

  4. Improving the Healthiness of Sustainable Construction: Example of Polyvinyl Chloride (PVC

    Directory of Open Access Journals (Sweden)

    Emina Kristina Petrović

    2018-02-01

    Full Text Available With the increasing emphasis on sustainable construction, it has become important to better understand the impacts of common materials. This is especially paramount with the introduction of the United Nations (UN Sustainable Development Goals (SDGs which call for more comprehensive evaluations, adding many aspects of social consideration to the issues of environmental sustainability, including human health. Polyvinyl chloride (PVC/vinyl can be seen as a material with potential for significant adverse effects on a multiplicity of levels, and the construction industry is its single most significant consumer. This article presents a transdisciplinary review of adverse health impacts associated with PVC showing a number of issues: some that could be eliminated through design, but also some which appear inherent to the material itself and therefore unavoidable. The totality of issues revealed in relation to PVC presents a compelling case for a call for complete elimination of use of this material in sustainable construction.

  5. Perspective: Improving nutritional guidelines for sustainable health policies: Current status and perspectives

    DEFF Research Database (Denmark)

    Magni, Paolo; Bier, Dennis M; Pecorelli, Sergio

    2017-01-01

    a constructive coalition among scientists, policy makers, and communication professionals for sustainable health and nutritional policies. Currently, a strong rationale and available data support a personalized dietary approach according to personal variables, including sex and age, circulating metabolic...

  6. Economic analysis of technological innovations to improve sustainability of pangasius production in Vietnam

    NARCIS (Netherlands)

    Ngoc, Pham Thi Anh

    2016-01-01

    In response to increasing concerns about sustainable production, a growing number of European customers expect seafood products to be certified, for example by the Aquaculture Stewardship Council (ASC) certification. Water purification technologies such as Recirculating Aquaculture Systems (RAS)

  7. Riding The Waves Of Quality Improvement : Sustainability and spread in a Dutch quality improvement program for long-term care

    NARCIS (Netherlands)

    S.S. Slaghuis (Sarah)

    2016-01-01

    markdownabstractIncreasingly, sustainability and spread have become part and parcel of organizational strategy in health care. This applies in particular to organizations in the long-term care sector, which faces an increasing care demand, ageing population and labor shortage. Unfortunately,

  8. Possibilities and consequences of the Total Cumulative Exergy Loss method in improving the sustainability of power generation

    International Nuclear Information System (INIS)

    Stougie, Lydia; Kooi, Hedzer J. van der

    2016-01-01

    Highlights: • The TCExL method can be applied to all kinds of technological systems. • All exergy losses during the lifetime of a technological system are considered. • The results of the TCExL method are independent of time and weighting factors. • Applying the TCExL method can improve the sustainability of power generation. • The system with the lowest TCExL score is not always economically favourable. - Abstract: It is difficult to decide which power generation system is the most sustainable when environmental, economic and social sustainability aspects are taken into account. Problems with conventional environmental sustainability assessment methods are that no consensus exists about the applied models and weighting factors and that exergy losses are not considered. Economic sustainability assessment methods do not lead to results that are independent of time because they are influenced by market developments, while social sustainability assessment methods suffer from the availability and qualitative or semi-quantitative nature of data. Existing exergy analysis methods do not take into account all exergy losses and/or are extended with factors or equations that are not commonly accepted. The new Total Cumulative Exergy Loss (TCExL) method is based on fundamental thermodynamic equations and takes into account all exergy losses caused by a technological system during its life cycle, i.e. internal exergy losses, exergy losses caused by emission abatement and exergy losses related to land use. The development of the TCExL method is presented as well as the application of this method and environmental, economic and social sustainability assessment methods to two case studies: power generation in combination with LNG evaporation and Fossil versus renewable energy sources for power generation. According to the results of the assessments, large differences exist between the environmental sustainability assessment and TCExL methods in the sense that different

  9. Identifying Motivation of the Local Governments to Improve the Sustainability Transparency

    Directory of Open Access Journals (Sweden)

    Andrés NAVARRO GALERA

    2015-06-01

    Full Text Available This paper examines the sustainability tran-sparency of governments, i.e., the disclosure of information on the sustainability of their ac-tions. To do so, we identify contributory factors to the online disclosure of environmental, social, economic and general information by local gov-ernments in Nordic countries. Linear regression analysis was used to identify factors inf uencing the online dissemination of government infor-mation on sustainability; a factor analysis, as a precursor to linear regression, led us to reduce 14 explanatory variables to four factors: f nancial risk, demography, professional qualif cations and local government resources. The results obtained show that local f -nancial priorities have a greater impact on the sustainability-related content of governmental websites than does concern for the needs of the population. Furthermore, an organization’s dis-closure of its f nancial risks, together with greater awareness of stakeholders’ demands, could pro-mote transparency in the f eld of environmental, social and economic sustainability, while local demographic characteristics could foster the publication of information on environmental sus-tainability.

  10. Creating and sustainable development of specialized centers as a way to improve quality of medical care

    Directory of Open Access Journals (Sweden)

    V. I. Guzeva

    2016-01-01

    Full Text Available Quality of care is evaluated on the completeness of the survey, the correct diagnosis, treatment efficacy, and its duration. Improving the quality and efficiency of medical care for children with paroxysmal disorders of consciousness is one of topical problems of neurology.Aim. The aim of the work is to justify the relationship between improving the quality of health care and sustainable development in the modern conditions of specialized medical centers on the example of the work on the identification and treatment of children with paroxysmal disorders of consciousness of the Center for diagnosis and treatment of epilepsy, and sleep disorders in children and adolescents at the department neurology, neurosurgery and medical genetics SPbGPMU.Materials and methods. For more accurate diagnosis and treatment at the Center conducted a comprehensive examination, including video-EEG оf 527 children aged 1 month to 18 years. A clinical trial study included medical cases, assessment of neurological and somatic status, the study of seizure types and forms of the disease. Instrumental methods of examination were determined by EEG and MRI studies of the brain.Main results. Comprehensive survey of sick children with monitoring video-EEG revealed that 317 children (60,1% had epileptic paroxysms and 210 children (39,8% – non-epileptic paroxysms. Correction treatment was performed in 284 (89,5% children with epileptic paroxysms and altered the treatment in 190 (90,4% children with epileptic paroxysms.Conclusion. The presented clinical data show the high effectiveness of the Centre in the diagnosis and treatment of children with paroxysmal disorders of consciousness. The accumulated experience in the Center confirms the relevance of the creation of the structure of scientific and educational institutions specialized centers in which patients will be given to high-quality medical care.

  11. Factors associated with symptomatic vulvovaginal candidiasis: a ...

    African Journals Online (AJOL)

    Background: Symptomatic vulvovaginal candidiasis (VVC) is one of the most common problems leading women to seek advice in primary healthcare facilities. Aim: The aim of this study is to describe the associations between some hypothesized factors and the presence of symptomatic VVC. Subjects and Methods: An ...

  12. A Life-cycle Approach to Improve the Sustainability of Rural Water Systems in Resource-Limited Countries

    Directory of Open Access Journals (Sweden)

    Nicholas Stacey

    2012-11-01

    Full Text Available A WHO and UNICEF joint report states that in 2008, 884 million people lacked access to potable drinking water. A life-cycle approach to develop potable water systems may improve the sustainability for such systems, however, a review of the literature shows that such an approach has primarily been used for urban systems located in resourced countries. Although urbanization is increasing globally, over 40 percent of the world’s population is currently rural with many considered poor. In this paper, we present a first step towards using life-cycle assessment to develop sustainable rural water systems in resource-limited countries while pointing out the needs. For example, while there are few differences in costs and environmental impacts for many improved rural water system options, a system that uses groundwater with community standpipes is substantially lower in cost that other alternatives with a somewhat lower environmental inventory. However, a LCA approach shows that from institutional as well as community and managerial perspectives, sustainability includes many other factors besides cost and environment that are a function of the interdependent decision process used across the life cycle of a water system by aid organizations, water user committees, and household users. These factors often present the biggest challenge to designing sustainable rural water systems for resource-limited countries.

  13. A Scorecard Framework Proposal for Improving Software Factories’ Sustainability: A Case Study of a Spanish Firm in the Financial Sector

    Directory of Open Access Journals (Sweden)

    César Álvarez

    2015-12-01

    Full Text Available Financial institutions and especially banks have always been at the forefront of innovation in management policies in order to improve their performance, and banking is probably one of the sectors that more effectively measures productivity and efficiency in virtually all aspects of its business. However, there is one area that still fails: the productivity of its software development projects. For years banking institutions have chosen to outsource their software projects using software firms created by them for this purpose, but up until a few years ago, the deadline for the delivery of the projects was more important than the efficiency with which they were developed. The last economic crisis has forced financial institutions to review and improve the software development efficiency related to their software factories to achieve a sustainable and feasible model. The sustainability of these software factories can be achieved by improving their strategic management, and the Balanced Scorecard (BSC framework can be very useful in order to obtain this. Based on the concepts and practices of the BSC, this paper proposes a specific model to establish this kind of software factory as a way of improving their sustainability and applies it to a large Spanish firm specializing in financial sector software. We have included a preliminary validation plan as well as the first monitoring results. The adoption is still very recent and more data are needed to measure all the perspectives so no definitive conclusions can be drawn.

  14. SURGERY OF SYMPTOMATIC MYOCARDIAL BRIDGING

    Directory of Open Access Journals (Sweden)

    N. Maghamipour N. Safaei

    2007-06-01

    Full Text Available Myocardial bridging with systolic compression of the left anterior descending coronary artery (LAD may be associated with myocardial ischemia. In symptomatic myocardial bridging unresponsive to medical treatment, surgical unroofing of the left LAD can be performed. Little information is available about the long-term prognosis of patients with this coronary anomaly after the surgical unroofing, so we decided to evaluate the result of this operation. A total of 26 patients underwent surgical unroofing of myocardial bridging. Patients had a myocardial bridge of at least 3 cm in length in the middle of LAD and with more than 70% compression during systole. Unroofing was performed with cardiopulmonary bypass in 16 and with off pump technique in 10 patients. In 6 patients repeat angiographies for control of myotomy were done. In one of them a nonsignificant 20% narrowing was seen. Postoperative scintigraphic and angiographic studies demonstrated restoration of coronary flow and myocardial perfusion without residual myocardial bridges under beta-stimulation in 24 patients. Two patients had residual narrowing. With off pump technique, 1 patient had perforation of the right ventricle and 1 patient underwent reoperation because of incomplete unroofing during the first operation. None of the patients with cardiopulmonary bypass technique had residual chest pain or other complications. Surgical unroofing of myocardial bridging with the aid of cardiopulmonary bypass is a safe and easy procedure with low operative risk and with excellent functional results.

  15. Supply Chains in the Apparel Industry: Do Transnational Initiatives for Social Sustainability Improve Workers’ Situation?

    Directory of Open Access Journals (Sweden)

    Claude Meier

    2015-06-01

    Full Text Available Non-state driven Transnational Initiatives for Social Sustainability (TISSs have increasingly attempted to approach social issues like labour laws in global supply chains. The reason is that state-laws are territorially confined. But can TISSs contribute to effective solutions of issues on which they are focused? This examination presents a theoretical framework explaining the effectiveness of TISSs. For the empirical case study, the Business Social Compliance Initiative (BSCI and the Fair Wear Foundation (FWF were selected. Data was collected from expert interviews and documents. The results led to the conclusion that stakeholder-involving approaches are adequate to support social sustainability in the future.

  16. Treatment of symptomatic splenomegaly with low doses of radiotherapy: Retrospective analysis and review of the literature

    Directory of Open Access Journals (Sweden)

    Carolina de la Pinta

    2017-09-01

    Conclusion: Low doses of radiation therapy for treatment of symptomatic splenomegaly were effective, with a low rate of side effects. Splenic pain and abdominal discomfort completely improved and cytopenias rised to secure levels.

  17. Effectiveness of vision therapy in school children with symptomatic convergence insufficiency

    Directory of Open Access Journals (Sweden)

    Jung Un Jang

    2017-01-01

    Conclusion: Among convergence insufficiency symptoms, the following improved in particular: near point of convergence, exophoria, and near positive fusional vergence. These findings suggest that vision therapy is very effective to recover from symptomatic convergence insufficiency.

  18. Built to last? The sustainability of health system improvements, interventions and change strategies: a study protocol for a systematic review.

    Science.gov (United States)

    Braithwaite, Jeffrey; Testa, Luke; Lamprell, Gina; Herkes, Jessica; Ludlow, Kristiana; McPherson, Elise; Campbell, Margie; Holt, Joanna

    2017-11-12

    The sustainability of healthcare interventions and change programmes is of increasing importance to researchers and healthcare stakeholders interested in creating sustainable health systems to cope with mounting stressors. The aim of this protocol is to extend earlier work and describe a systematic review to identify, synthesise and draw meaning from studies published within the last 5 years that measure the sustainability of interventions, improvement efforts and change strategies in the health system. The protocol outlines a method by which to execute a rigorous systematic review. The design includes applying primary and secondary data collection techniques, consisting of a comprehensive database search complemented by contact with experts, and searching secondary databases and reference lists, using snowballing techniques. The review and analysis process will occur via an abstract review followed by a full-text screening process. The inclusion criteria include English-language, peer-reviewed, primary, empirical research articles published after 2011 in scholarly journals, for which the full text is available. No restrictions on location will be applied. The review that results from this protocol will synthesise and compare characteristics of the included studies. Ultimately, it is intended that this will help make it easier to identify and design sustainable interventions, improvement efforts and change strategies. As no primary data were collected, ethical approval was not required. Results will be disseminated in conference presentations, peer-reviewed publications and among policymaker bodies interested in creating sustainable health systems. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  19. Self-Alert Training: Volitional Modulation of Autonomic Arousal Improves Sustained Attention

    Science.gov (United States)

    O'Connell, Redmond G.; Bellgrove, Mark A.; Dockree, Paul M.; Lau, Adam; Fitzgerald, Michael; Robertson, Ian H.

    2008-01-01

    The present study examines a new alertness training strategy (Self-Alert Training, SAT) designed to explore the relationship between the top-down control processes governing arousal and sustained attention. In order to maximally target frontal control systems SAT combines a previously validated behavioural self-alerting technique [Robertson, I.…

  20. The Sustainable Office. An exploration of the potential for factor 20 environmental improvement of office accommodation

    NARCIS (Netherlands)

    Van den Dobbelsteen, A.A.J.F.

    2004-01-01

    Sustainable development is the goal of a balance between economy and the environment, whilst establishing a better spread prosperity across the world. In order to make this possible, the environmental load of our commodities needs to be reduced by a factor of 20. This factor 20 can also be

  1. The Role of Leadership Capacity in Sustaining the School Improvement Initiative of Schoolwide Positive Behavior Supports

    Science.gov (United States)

    Combs, Christine; Martin, Barbara N.

    2011-01-01

    This article examines what occurred within schools successfully implementing and sustaining Schoolwide Positive Behavior Supports through the lens of leadership capacity. Leadership capacity, a broad-based, skillful participation in leadership, promotes the capabilities of many organizational members to lead. Researchers used quantitative analysis…

  2. Logistics collaboration to improve sustainability performance in the Dutch food retail sector

    NARCIS (Netherlands)

    Stellingwerf, H.M.; Bloemhof-Ruwaard, J.M.; Vorst, van der J.G.A.J.; Cruijssen, F.C.A.M.

    2015-01-01

    Purpose: Following recent developments, supply chain actors are rethinking their logistics structures and management practices to arrive at sustainable concepts able to deliver perishable food products to retail outlets responsive, at lower cost, with less food waste and with less environmental

  3. Soil biota enhance agricultural sustainability by improving crop yield, nutrient uptake and reducing nitrogen leaching losses

    NARCIS (Netherlands)

    Bender, S.F.; van der Heijden, M.G.A.|info:eu-repo/dai/nl/240923901

    2015-01-01

    Efficient resource use is a key factor for sustainable production and a necessity for meeting future global food demands. However, the factors that control resource use efficiency in agro-ecosystems are only partly understood. We investigated the influence of soil biota on nutrient leaching,

  4. Integrated Metrics for Improving the Life Cycle Approach to Assessing Product System Sustainability

    Directory of Open Access Journals (Sweden)

    Wesley Ingwersen

    2014-03-01

    Full Text Available Life cycle approaches are critical for identifying and reducing environmental burdens of products. While these methods can indicate potential environmental impacts of a product, current Life Cycle Assessment (LCA methods fail to integrate the multiple impacts of a system into unified measures of social, economic or environmental performance related to sustainability. Integrated metrics that combine multiple aspects of system performance based on a common scientific or economic principle have proven to be valuable for sustainability evaluation. In this work, we propose methods of adapting four integrated metrics for use with LCAs of product systems: ecological footprint, emergy, green net value added, and Fisher information. These metrics provide information on the full product system in land, energy, monetary equivalents, and as a unitless information index; each bundled with one or more indicators for reporting. When used together and for relative comparison, integrated metrics provide a broader coverage of sustainability aspects from multiple theoretical perspectives that is more likely to illuminate potential issues than individual impact indicators. These integrated metrics are recommended for use in combination with traditional indicators used in LCA. Future work will test and demonstrate the value of using these integrated metrics and combinations to assess product system sustainability.

  5. Secure sustainable seafood from developing countries. Require improvements as conditions for market access

    NARCIS (Netherlands)

    Sampson, G.S.; Sanchirico, J.N.; Roheim, C.A.; Bush, S.R.; Taylor, J.E.; Allison, E.A.; Anderson, J.L.; Ban, N.C.; Fujita, R.; Jupiter, S.; Wilson, J.R.

    2015-01-01

    Demand for sustainably certified wild-caught fish and crustaceans is increasingly shaping global seafood markets. Retailers such as Walmart in the United States, Sainsbury's in the United Kingdom, and Carrefour in France, and processors such as Canadianbased High Liner Foods, have promised to source

  6. A quality improvement project sustainably decreased time to onset of active physical therapy intervention in patients with acute lung injury.

    Science.gov (United States)

    Dinglas, Victor D; Parker, Ann M; Reddy, Dereddi Raja S; Colantuoni, Elizabeth; Zanni, Jennifer M; Turnbull, Alison E; Nelliot, Archana; Ciesla, Nancy; Needham, Dale M

    2014-10-01

    Rehabilitation started early during an intensive care unit (ICU) stay is associated with improved outcomes and is the basis for many quality improvement (QI) projects showing important changes in practice. However, little evidence exists regarding whether such changes are sustainable in real-world practice. To evaluate the sustained effect of a quality improvement project on the timing of initiation of active physical therapy intervention in patients with acute lung injury (ALI). This was a pre-post evaluation using prospectively collected data involving consecutive patients with ALI admitted pre-quality improvement (October 2004-April 2007, n = 120) versus post-quality improvement (July 2009-July 2012, n = 123) from a single medical ICU. The primary outcome was time to first active physical therapy intervention, defined as strengthening, mobility, or cycle ergometry exercises. Among ICU survivors, more patients in the post-quality improvement versus pre-quality improvement group received physical therapy in the ICU (89% vs. 24%, P quality improvement versus pre-quality improvement group, there was a shorter median (interquartile range) time to first physical therapy (4 [2, 6] vs. 11 d [6, 29], P quality improvement period was associated with shorter time to physical therapy (adjusted hazard ratio [95% confidence interval], 8.38 [4.98, 14.11], P quality improvement period. The following variables were independently associated with a longer time to physical therapy: higher Sequential Organ Failure Assessment score (0.93 [0.89, 0.97]), higher FiO2 (0.86 [0.75, 0.99] for each 10% increase), use of an opioid infusion (0.47 [0.25, 0.89]), and deep sedation (0.24 [0.12, 0.46]). In this single-site, pre-post analysis of patients with ALI, an early rehabilitation quality improvement project was independently associated with a substantial decrease in the time to initiation of active physical therapy intervention that was sustained over 5 years. Over the entire pre

  7. Efforts to improve and sustain the productive utilization of dry grasslands in Armenia

    Science.gov (United States)

    Mezhunts, Bagrat; Navasardyan, Marine

    2014-05-01

    Armenia is a small mountainous country (29,743 km2) located in the South Caucasus. It lies in the sub-tropical zone and has a continental climate with hot summers (av. +250C) and cold winters (av. -60C). The average precipitation is 550 mm; in the dry-steppe zone it amounts to only 250 mm and with a rainy season in spring-early summer. Altitudinal variation (390-4,095 m) gives rise to a range of climatic zones (from semi-desert to alpine), soil types and plant communities. Besides, Armenia is situated on the crossroads of Caucasian - mesophyllous (humid) and Armeno-Iranian - xerophyllous (arid) floristic provinces, which has made it to a "biodiversity hotspot". Agriculture is important as a source of employment and for domestic food supply. The rural population (ca. 1.2 million) is largely dependent on livestock for their livelihood. The principal feed resource is extensive grasslands (60% of total agricultural lands), but past practices of uncontrolled grazing management has led to low grassland productivity and low proportion of valuable legume forages. Improvement of natural grasslands, enhancement of feed quality, prevention of soil erosion and re-establishment of vegetation cover are key socio-economic challenges and are needed to raise the livelihood of rural population in Armenia. This presentation focuses on present status and trends of dry pastureland degradation, exposed to intensive grazing, and on results from case studies to increase productivity and restore valuable forage species for sustainable use in agriculture. Three different conventional approaches have been applied in these studies including: fertilization with moderate doses of ammonium and potassium nitrate and superphosphate, over-sowing by local legume seeds and implementation of a 2-year rest period in overgrazed areas. From 1986 to 2007, the total yield (TY) in studied dry-steppe pastures decreased by 40%, while at the same time, the proportion of grasses in total yield decreased by 50

  8. Reducing transport costs and improving sustainability simultaneously through horizontal logistics collaboration: a case study

    OpenAIRE

    Van Lier, Tom; Macharis, Cathy; Caris, An; Vrenken, Huub

    2010-01-01

    In this paper the potential of a more systematic bundling of the outbound freight flows out of three neighboring distribution centers (DCs) of the same company, each specialized in a specific product category and each using a separate planning system, is investigated. Most of the outbound flows are currently still transported by truck, so one way to simultaneously achieve lower transport costs and more sustainable logistics is through supply chain collaboration in outbound logistics. This pap...

  9. Selecting and Installing Energy-Efficient Windows to Improve Dwelling Sustainability

    OpenAIRE

    Friedman, Avi; Matheson, Morgan

    2017-01-01

    [EN] Windows play a significant role in achieving comfort in buildings by letting in natural light, solar warmth, fresh air and permitting outdoor views. On the other hand, poor quality windows can be the source of overheating or unwanted infiltration or exfiltration of air. Quality windows, therefore, influence the dwelling’s energy consumption and consequently its sustainability. Heat losses through the building envelope can occur in any of three mechanisms: conduction, convection and radia...

  10. Analysis of an Improved Solar-Powered Hydrogen Generation System for Sustained Renewable Energy Production

    Science.gov (United States)

    2017-12-01

    hydrogen gas by electrolysis. In LT Aviles’ design , distilled water was collected from the ambient air using Peltier dehumidifiers, manufactured by...Figure 13 shows the shelfing along with the entire system. Figure 13. Reconfigured Hydrogen Production Facility Because the system was designed for...POWERED HYDROGEN GENERATION SYSTEM FOR SUSTAINED RENEWABLE ENERGY PRODUCTION by Sen Feng Yu December 2017 Thesis Advisor: Garth V. Hobson Co

  11. Do Forwarders Improve Sustainability Efficiency? Evidence from a European DEA Malmquist Index Calculation

    Directory of Open Access Journals (Sweden)

    Matthias Klumpp

    2017-05-01

    Full Text Available Sustainability performance and efficiency is an important topic in transportation and for forwarders. This is shown, for example, by the fact that major logistics service providers LSP publish sustainability reports, often within the annual legal business report. However, in depth research is missing regarding the efficiency of forwarders regarding the established triple bottom line approach for sustainability, including economic, social, and ecology performance areas. This is especially true for a dynamic time-series perspective, as usually only static analyses for one point in time are presented (in most cases single business years. Therefore, the operations research technique of a data envelopment analysis (DEA Malmquist index calculation is used in order to provide a longitudinal calculation of efficiency, incorporating multiple objectives regarding the triple bottom line approach for European forwarders. Several indicators are tested, including total revenues and assets as input types, profit (EBIT and dividend volume (economic dimension, employment and gender equality in management (social, and carbon-equivalent emissions (environmental as output types.

  12. Cognitive bias in symptomatic and recovered agoraphobics.

    Science.gov (United States)

    Stoler, L S; McNally, R J

    1991-01-01

    Symptomatic agoraphobics, recovered agoraphobics, and normal control subjects completed a series of sentence stems that had either ambiguous or unambiguous meanings, and had either a potentially threatening or a nonthreatening connotation. The written completions made by subjects to these stems were classified as indicating either a biased (i.e. threat-related) or unbiased interpretation of the meaning of the stem, and if a biased interpretation was made, whether the subject indicated efforts at adaptive coping with the perceived threat. Results indicated that symptomatic agoraphobics exhibited strong biases for interpreting information as threatening, relative to normal control subjects. Moreover, recovered agoraphobics resembled symptomatic agoraphobics more than normal control subjects, thus indicating that cognitive biases may persist following cessation of panic attacks and reductions in avoidance behavior. However, recovered agoraphobics also exhibited tendencies to cope adaptively with perceived threats whereas symptomatic agoraphobics did not.

  13. Prevalence of significant bacteriuria among symptomatic and ...

    African Journals Online (AJOL)

    2013-06-10

    Jun 10, 2013 ... bacteriuria in symptomatic and asymptomatic sickle cell patients in Lagos. Materials and Methods: .... over 65 years, treatment with immunosuppressive drugs, the presence of .... toxemia of pregnancy.[7,13] A positive urine ...

  14. A system approach for reducing the environmental impact of manufacturing and sustainability improvement of nano-scale manufacturing

    Science.gov (United States)

    Yuan, Yingchun

    This dissertation develops an effective and economical system approach to reduce the environmental impact of manufacturing. The system approach is developed by using a process-based holistic method for upstream analysis and source reduction of the environmental impact of manufacturing. The system approach developed consists of three components of a manufacturing system: technology, energy and material, and is useful for sustainable manufacturing as it establishes a clear link between manufacturing system components and its overall sustainability performance, and provides a framework for environmental impact reductions. In this dissertation, the system approach developed is applied for environmental impact reduction of a semiconductor nano-scale manufacturing system, with three case scenarios analyzed in depth on manufacturing process improvement, clean energy supply, and toxic chemical material selection. The analysis on manufacturing process improvement is conducted on Atomic Layer Deposition of Al2O3 dielectric gate on semiconductor microelectronics devices. Sustainability performance and scale-up impact of the ALD technology in terms of environmental emissions, energy consumption, nano-waste generation and manufacturing productivity are systematically investigated and the ways to improve the sustainability of the ALD technology are successfully developed. The clean energy supply is studied using solar photovoltaic, wind, and fuel cells systems for electricity generation. Environmental savings from each clean energy supply over grid power are quantitatively analyzed, and costs for greenhouse gas reductions on each clean energy supply are comparatively studied. For toxic chemical material selection, an innovative schematic method is developed as a visual decision tool for characterizing and benchmarking the human health impact of toxic chemicals, with a case study conducted on six chemicals commonly used as solvents in semiconductor manufacturing. Reliability of

  15. Restoration of soil fertility and improvement of cropping systems for sustainable development in the humid savannahs of the Ivory Coast

    International Nuclear Information System (INIS)

    Bachmann, T.

    2000-01-01

    In late 1998, FAO launched a Technical Co-operation Project to assist the government of the Ivory Coast in rural development by promoting agricultural production as the main source of economic growth, and by improving the management of natural resources. The sustainable development of the humid-savannah region and western highlands is being allotted primary consideration. The goal of the project is to replace traditional shifting cultivation with more-sustainable production systems. This paper describes the origins and scope of the problem and the research strategies being considered and employed. The project will be executed in three phases: constraint analysis and formulation of a pilot project, execution of the pilot project (1999-2003), and long-term extension (15 years) from 2004, based on the data generated in the pilot phase. (author)

  16. Restoration of soil fertility and improvement of cropping systems for sustainable development in the humid savannahs of the Ivory Coast

    Energy Technology Data Exchange (ETDEWEB)

    Bachmann, T [Food and Agriculture Organization of the United Nations, Rome (Italy)

    2000-06-01

    In late 1998, FAO launched a Technical Co-operation Project to assist the government of the Ivory Coast in rural development by promoting agricultural production as the main source of economic growth, and by improving the management of natural resources. The sustainable development of the humid-savannah region and western highlands is being allotted primary consideration. The goal of the project is to replace traditional shifting cultivation with more-sustainable production systems. This paper describes the origins and scope of the problem and the research strategies being considered and employed. The project will be executed in three phases: constraint analysis and formulation of a pilot project, execution of the pilot project (1999-2003), and long-term extension (15 years) from 2004, based on the data generated in the pilot phase. (author)

  17. Osteosynthesis for symptomatic ulnar styloid nonunion

    International Nuclear Information System (INIS)

    Kajiwara, Ryoji; Kimori, Kenji; Kawagoe, Hiroyuki; Tsuge, Kenya; Ikuta, Yosikazu

    2008-01-01

    We reviewed cases of osteosynthesis for symptomatic ulnar styloid nonunion. Since 1998, 13 cases of ulnar styloid nonunion have been treated by osteosynthesis. The patients were 10 men and 3 women, with a mean age of 27 years (range 11-65). The nonunion site was located in the middle in one case, in the base in 8 cases, and in the epiphyseal region in 4 cases. Osteosynthesis was performed with tension band wiring in all cases, and cancellous bone graft was performed in 12 of 13 cases. Distal radioulnar joint (DRUJ) instability was found by radiograph or CT in four cases; in two of these, osteosynthesis alone did not improve DRUJ instability and additional DRUJ stabilization was performed. One patient whose treatment failed to correct nonunion did not seek further treatment. In another case, an additional surgery was performed 1 week after the initial surgery to correct displacement of the fragment. The mean follow-up period was 15 months (range 8-45 months). According to Hauck's criteria, final pain was evaluated as excellent in nine cases, good in three cases, including the case resulting in nonunion, and fair in one case. (author)

  18. Community Markets for Conservation (COMACO) links biodiversity conservation with sustainable improvements in livelihoods and food production.

    Science.gov (United States)

    Lewis, Dale; Bell, Samuel D; Fay, John; Bothi, Kim L; Gatere, Lydiah; Kabila, Makando; Mukamba, Mwangala; Matokwani, Edwin; Mushimbalume, Matthews; Moraru, Carmen I; Lehmann, Johannes; Lassoie, James; Wolfe, David; Lee, David R; Buck, Louise; Travis, Alexander J

    2011-08-23

    In the Luangwa Valley, Zambia, persistent poverty and hunger present linked challenges to rural development and biodiversity conservation. Both household coping strategies and larger-scale economic development efforts have caused severe natural resource degradation that limits future economic opportunities and endangers ecosystem services. A model based on a business infrastructure has been developed to promote and maintain sustainable agricultural and natural resource management practices, leading to direct and indirect conservation outcomes. The Community Markets for Conservation (COMACO) model operates primarily with communities surrounding national parks, strengthening conservation benefits produced by these protected areas. COMACO first identifies the least food-secure households and trains them in sustainable agricultural practices that minimize threats to natural resources while meeting household needs. In addition, COMACO identifies people responsible for severe natural resource depletion and trains them to generate alternative income sources. In an effort to maintain compliance with these practices, COMACO provides extension support and access to high-value markets that would otherwise be inaccessible to participants. Because the model is continually evolving via adaptive management, success or failure of the model as a whole is difficult to quantify at this early stage. We therefore test specific hypotheses and present data documenting the stabilization of previously declining wildlife populations; the meeting of thresholds of productivity that give COMACO access to stable, high-value markets and progress toward economic self-sufficiency; and the adoption of sustainable agricultural practices by participants and other community members. Together, these findings describe a unique, business-oriented model for poverty alleviation, food production, and biodiversity conservation.

  19. Improving the Environmental Sustainability of Flash Geothermal Power Plants—A Case Study

    Directory of Open Access Journals (Sweden)

    Lorenzo Bruscoli

    2015-11-01

    Full Text Available The sustainability of geothermal energy production is analyzed with reference to a production plant located in a specific area (Monte Amiata, Italy. Four solutions combining a flash power plant with an Organic Rankine Cycle in a hybrid configuration are analyzed in terms of production of electricity, exergy balance and emissions level (CO2, H2S, Hg. The different solutions correspond to increasing environmental performance, and for the most advanced case achieve near-zero emissions (complete reinjection of the natural resource, including incondensable gases. The results show that this can be achieved at the price of a progressive reduction of electrical productivity.

  20. Sustained participation in annual continuous quality improvement activities improves quality of care for Aboriginal and Torres Strait Islander children.

    Science.gov (United States)

    McAullay, Daniel; McAuley, Kimberley; Bailie, Ross; Mathews, Veronica; Jacoby, Peter; Gardner, Karen; Sibthorpe, Beverly; Strobel, Natalie; Edmond, Karen

    2018-02-01

    To determine whether participation in the continuous quality improvement (CQI) Audit and Best Practice for Chronic Disease programme improved care and outcomes for Indigenous children. Data were collected from 59 Australian primary health-care centres providing services to Indigenous people and participating in the programme (February 2008 and December 2013). Indigenous children aged less than 2 years and centres that completed three or more consecutive annual audits within the 6-year study period were included. Crude and adjusted logistic generalised estimating equation models were used to examine the effect of year of audit on the delivery of care. Odds ratio (OR) and 95% confidence interval (CI) were calculated. Outcomes were related to age-relevant health issues, including prevention and early intervention. These included administrative, health check, anticipatory guidance and specific health issues. During the audit period, there were 2360 files from 59 centres. Those that had a recall recorded, improved from 84 to 95% (OR 2.44, 95% CI 1.44-4.11). Hearing assessments improved from 52 to 89% (OR 1.37, 95% CI 1.22-1.54). Improvement in anticipatory guidance, treatment and follow-up of medical conditions was almost universal. We documented significant improvements in quality of care of Indigenous children. Outcomes and their corresponding treatment and follow-ups improved over time. This appears to be related to services participating in annual CQI activities. However, these services may be more committed to CQI than others and therefore possibly better performing. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  1. A dual strategy to improve psychotic patients’ compliance using sustained release quetiapine oral disintegrating tablets

    Directory of Open Access Journals (Sweden)

    Refaat Ahmed

    2016-12-01

    Full Text Available Quetiapine (QT is a short acting atypical antipsychotic drug effective in schizophrenia and bipolar disorder. This study aims at designing a novel dosage form of sustained release taste-masked QT orally disintegrating tablets (ODTs based on solid lipid micro-pellets (SLMPs. QT SLMPs were prepared using the hot melt extrusion technique and utilizing three lipid carriers: Compritol, Precirol and white beeswax either alone or in mixtures. They showed sustained QT release and a taste masking effect. The selected QT SLMP was further blended with an aqueous solution containing polyvinylpyrollidone (2.5 %, croscarmellose sodium (2 % and mannitol (50 %; it was then lyophilized into ODT in a mass ratio of 1:2, respectively. ODTs containing QT SLMPs showed: average wetting time (40.92 s, average oral disintegration time (21.49 s, average hardness (16.85 N and also imparted suitable viscosity to suspend pellets during the lyophilization process. In conclusion, lyophilization is a promising technique for the formulation of multiparticulate systems into ODTs.

  2. Sustained reductions in time to antibiotic delivery in febrile immunocompromised children: results of a quality improvement collaborative.

    Science.gov (United States)

    Dandoy, Christopher E; Hariharan, Selena; Weiss, Brian; Demmel, Kathy; Timm, Nathan; Chiarenzelli, Janis; Dewald, Mary Katherine; Kennebeck, Stephanie; Langworthy, Shawna; Pomales, Jennifer; Rineair, Sylvia; Sandfoss, Erin; Volz-Noe, Pamela; Nagarajan, Rajaram; Alessandrini, Evaline

    2016-02-01

    Timely delivery of antibiotics to febrile immunocompromised (F&I) paediatric patients in the emergency department (ED) and outpatient clinic reduces morbidity and mortality. The aim of this quality improvement initiative was to increase the percentage of F&I patients who received antibiotics within goal in the clinic and ED from 25% to 90%. Using the Model of Improvement, we performed Plan-Do-Study-Act cycles to design, test and implement high-reliability interventions to decrease time to antibiotics. Pre-arrival interventions were tested and implemented, followed by post-arrival interventions in the ED. Many processes were spread successfully to the outpatient clinic. The Chronic Care Model was used, in addition to active family engagement, to inform and improve processes. The study period was from January 2010 to January 2015. Pre-arrival planning improved our F&I time to antibiotics in the ED from 137 to 88 min. This was sustained until October 2012, when further interventions including a pre-arrival huddle decreased the median time to antibiotics within 60 min to >90%. In September 2014, we implemented a rapid response team to improve reliable venous access in the ED, which increased our mean percentage of patients receiving timely antibiotics to its highest rate (95%). This stepwise approach with pre-arrival planning using the Chronic Care Model, followed by standardisation of processes, created a sustainable improvement of timely antibiotic delivery in F&I patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  3. Improvements in concentration, working memory and sustained attention following consumption of a natural citicoline-caffeine beverage.

    Science.gov (United States)

    Bruce, Steven E; Werner, Kimberly B; Preston, Brittany F; Baker, Laurie M

    2014-12-01

    This study examined the neurocognitive and electrophysiological effects of a citicoline-caffeine-based beverage in 60 healthy adult participants enrolled in a randomized, double-blind, placebo-controlled trial. Measures of electrical brain activity using electroencephalogram (EEG) and neuropsychological measures examining attention, concentration and reaction time were administered. Compared to placebo, participants receiving the citicoline-caffeine beverage exhibited significantly faster maze learning times and reaction times on a continuous performance test, fewer errors in a go/no-go task and better accuracy on a measure of information processing speed. EEG results examining P450 event-related potentials revealed that participants receiving the citicoline-caffeine beverage exhibited higher P450 amplitudes than controls, suggesting an increase in sustained attention. Overall, these findings suggest that the beverage significantly improved sustained attention, cognitive effort and reaction times in healthy adults. Evidence of improved P450 amplitude indicates a general improvement in the ability to accommodate new and relevant information within working memory and overall enhanced brain activation.

  4. Agroecology and sustainable food systems: Participatory research to improve food security among HIV-affected households in northern Malawi.

    Science.gov (United States)

    Nyantakyi-Frimpong, Hanson; Mambulu, Faith Nankasa; Bezner Kerr, Rachel; Luginaah, Isaac; Lupafya, Esther

    2016-09-01

    This article shares results from a long-term participatory agroecological research project in northern Malawi. Drawing upon a political ecology of health conceptual framework, the paper explores whether and how participatory agroecological farming can improve food security and nutrition among HIV-affected households. In-depth interviews were conducted with 27 farmers in HIV-affected households in the area near Ekwendeni Trading Centre in northern Malawi. The results show that participatory agroecological farming has a strong potential to meet the food, dietary, labour and income needs of HIV-affected households, whilst helping them to manage natural resources sustainably. As well, the findings reveal that place-based politics, especially gendered power imbalances, are imperative for understanding the human impacts of the HIV/AIDS epidemic. Overall, the study adds valuable insights into the literature on the human-environment dimensions of health. It demonstrates that the onset of disease can radically transform the social relations governing access to and control over resources (e.g., land, labour, and capital), and that these altered social relations in turn affect sustainable disease management. The conclusion highlights how the promotion of sustainable agroecology could help to partly address the socio-ecological challenges associated with HIV/AIDS. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Improving water, sanitation, and hygiene in schools in Indonesia: A cross-sectional assessment on sustaining infrastructural and behavioral interventions.

    Science.gov (United States)

    Karon, Andrew J; Cronin, Aidan A; Cronk, Ryan; Hendrawan, Reza

    2017-05-01

    Water, sanitation, and hygiene (WASH) in schools are important for child health, development, and educational performance; yet coverage in Indonesian schools remains low. To address this deficiency, UNICEF and partners conducted a WASH intervention in 450 schools across three provinces in Indonesia. A survey evaluating the sustainability of infrastructure and behavioral interventions in comparison to control districts was conducted one year after completion of the intervention. The survey data were also compared with national government data to assess the suitability of government data to report progress on the Sustainable Development Goals (SDGs). Logistic regression was used to explore associations between WASH conditions and behaviors. Intervention schools were more likely to have handwashing stations with soap and water. In multivariable analyses, schools with a toilet operation and maintenance fund were more likely to have functional toilets. Students who learn hygiene skills from their teachers were less likely to defecate openly, more likely to share hygiene knowledge with their parents, and more likely to wash their hands. Survey data were comparable with government data, suggesting that Indonesian government monitoring may be a reliable source of data to measure progress on the SDGs. This research generates important policy and practice findings for scaling up and sustaining WASH in schools and may help improve WASH in schools programs in other low-resource contexts. Copyright © 2017 Elsevier GmbH. All rights reserved.

  6. SCOPEOUT: sustainability and spread of quality improvement activities in long-term care- a mixed methods approach.

    Science.gov (United States)

    Cranley, Lisa A; Hoben, Matthias; Yeung, Jasper; Estabrooks, Carole A; Norton, Peter G; Wagg, Adrian

    2018-03-12

    Interventions to improve quality of care for residents of long-term care facilities, and to examine the sustainability and spread of such initiatives, remain a top research priority. The purpose of this exploratory study was to assess the extent to which activities initiated in a quality improvement (QI) collaborative study using care aide led teams were sustained or spread following cessation of the initial project and to identify factors that led to its success. This study used an exploratory mixed methods study design and was conducted in seven residential long-term care facilities in two Canadian provinces. Sustainability and spread of QI activities were assessed by a questionnaire over five time points for 18 months following the collaborative study with staff from both intervention with non-intervention units. Semi-structured interviews were conducted with care managers at six and 12 months. QI team success in applying the QI model was ranked as high, medium, or low using criteria developed by the research team. Descriptive statistics, bivariate analyses, and General Estimating Equations were used to analyze the data. Interview data were analyzed using thematic analysis. In total, 683 surveys were received over the five time periods from 476 unique individuals on a facility unit. Seven managers were interviewed. A total of 533 surveys were analyzed. While both intervention and non-intervention units experienced a decline over time in all outcome measures, this decline was significantly less pronounced on intervention units. Facilities with medium and high success ranking had significantly higher scores in all four outcomes than facilities with a low success ranking. Care aides reported significantly less involvement of others in QI activities, less empowerment and less satisfaction with the quality of their work life than regulated care providers. Manager interviews provided evidence of sustainability of QI activities on the intervention units in four of

  7. Improvement in autologous human fat transplant survival with SVF plus VEGF-PLA nano-sustained release microspheres.

    Science.gov (United States)

    Li, Liqun; Pan, Shengsheng; Ni, Binting; Lin, Yuanshao

    2014-08-01

    Early neovascularization is important for autologous fat transplant survival. SVF cells are ideal seed cells. Both vascular endothelial growth factor (VEGF) and SVF cells can promote neovascularization. However, the half-life (about 50 min) of VEGF is too short to sustain an adequate local concentration. We have investigated whether VEGF-polylactic acid (PLA) nano-sustained release microspheres plus SVF cells can improve neovascularization and survival of transplanted fat tissues. SVF cells were harvested and constructed VEGF-PLA nano-sustained release microspheres in vitro. Human fat tissues was mixed with SVF cells plus VEGF-PLA, SVF cells alone or Dulbecco's modified Eagle's medium as the control. These three mixtures were injected into random sites in 18 nude mice. Two months later, the transplants were weighed and examined histologically; and capillaries were counted to quantify neovascularization. Hematoxylin-eosin (HE) and anti-VEGF stains were applied to reveal cell infiltration. The mean wet weight of fat in the SVF plus VEGF-PLA, SVF alone, and control transplants were 0.18 ± 0.013 g, 0.16 ± 0.015 g, and 0.071 ± 0.12 g, respectively; the differences between groups were statistically significant. More vessels were present in the SVF plus VEGF-PLA transplants than in the other two types. Transplants mixed with SVF cells also had an acceptable density of capillaries. Histological analysis revealed that both the SVF plus VEGF-PLA and SVF alone transplants, but not the control transplants, were composed of adipose tissue, and had less fat necrosis and less fibrosis than control specimens. SVF plus VEGF-PLA transplants had significantly greater capillary density and VEGF expression than the other two transplant groups. Thus transplanted fat tissue survival and quality can be enhanced by the addition of VEGF-PLA nano-sustained release microspheres plus SVF cells. © 2014 International Federation for Cell Biology.

  8. A Continuous Quality Improvement Airway Program Results in Sustained Increases in Intubation Success.

    Science.gov (United States)

    Olvera, David J; Stuhlmiller, David F E; Wolfe, Allen; Swearingen, Charles F; Pennington, Troy; Davis, Daniel P

    2018-02-21

    Airway management is a critical skill for air medical providers, including the use of rapid sequence intubation (RSI) medications. Mediocre success rates and a high incidence of complications has challenged air medical providers to improve training and performance improvement efforts to improve clinical performance. The aim of this research was to describe the experience with a novel, integrated advanced airway management program across a large air medical company and explore the impact of the program on improvement in RSI success. The Helicopter Advanced Resuscitation Training (HeART) program was implemented across 160 bases in 2015. The HeART program includes a novel conceptual framework based on thorough understanding of physiology, critical thinking using a novel algorithm, difficult airway predictive tools, training in the optimal use of specific airway techniques and devices, and integrated performance improvement efforts to address opportunities for improvement. The C-MAC video/direct laryngoscope and high-fidelity human patient simulation laboratories were implemented during the study period. Chi-square test for trend was used to evaluate for improvements in airway management and RSI success (overall intubation success, first-attempt success, first-attempt success without desaturation) over the 25-month study period following HeART implementation. A total of 5,132 patients underwent RSI during the study period. Improvements in first-attempt intubation success (85% to 95%, p improving RSI intubation performance in a large air medical company.

  9. Appeals to consumer responsibility and improving structural conditions as means to promote sustainable consumer behavior

    DEFF Research Database (Denmark)

    Thøgersen, John

    for their acts or (b) structural conditions determined by governments? In field experiments with large samples of ordinary consumers, the behavioral effects of perceptions of responsibility/personal moral norms and of altering an important structural condition are quantified by measuring a relevant behavior......-developed public transit service. The results suggest that there is often more to gain from changing structural conditions to be more facilitating for the desired behavior than from a campaign targeting consumer feelings of responsibility.......Environmental policy-makers increasingly emphasize consumers' responsibility for environmental side effects of their acts, but is this justified? This paper investigates which is the most important limiting factor for sustainable consumption: (a) the extent to which consumers assume responsibility...

  10. The Hardwood Tree Improvement and Regeneration Center: its strategic plans for sustaining the hardwood resource

    Science.gov (United States)

    Charles H. Michler; Michael J. Bosela; Paula M. Pijut; Keith E. Woeste

    2003-01-01

    A regional center for hardwood tree improvement, genomics, and regeneration research, development and technology transfer will focus on black walnut, black cherry, northern red oak and, in the future, on other fine hardwoods as the effort is expanded. The Hardwood Tree Improvement and Regeneration Center (HTIRC) will use molecular genetics and genomics along with...

  11. Changing classroom practices: the role of school-wide capacity for sustainable improvement

    NARCIS (Netherlands)

    Sleegers, P.J.C.; Thoonen, E.E.J.; Oort, F.J.; Peetsma, T.T.D.

    2014-01-01

    Purpose: Elementary schools have been confronted with large-scale educational reforms as strategies to improve the educational quality. While building school-wide capacity for improvement is considered critical for changing teachers’ classroom practices, there is still little empirical evidence for

  12. Changing classroom practices: the role of school-wide capacity for sustainable improvement

    NARCIS (Netherlands)

    Sleegers, P.J.C.; Thoonen, Eric E.J.; Oort, Frans J.; Peetsma, Thea T.D.

    2015-01-01

    Purpose – Elementary schools have been confronted with large-scale educational reforms as strategies to improve the educational quality. While building school-wide capacity for improvement is considered critical for changing teachers’ classroom practices, there is still little empirical evidence for

  13. Performance Improvement in 503A Compounding Pharmacies: A PLAN FOR ASSESSMENT, IMPLEMENTATION, AND SUSTAINED SUCCESS.

    Science.gov (United States)

    Pritchett, Jon; Mixon, William; O'Connell, Kevin

    2016-01-01

    Performance improvement is the continual effort to objectively assess current performance and then restructure the practices that support it to more closely achieve desired performance. A plan for performance improvement, unlike other approaches to correcting problems in job fulfillment, is a systematic method used to first find the root causes of areas of concern and then apply corrections to remedy those deficits. Implementing a performance improvement plan that can be easily adapted to ensure compliance with evolving and increasingly complex state and federal regulations is crucial to a successful compounding practice. In this article, we discuss the need for performance improvement in 503A compounding pharmacies, list the steps necessary to develop such a plan, and present three case reports of performance improvement plans in differing compounding settings.

  14. Biofertilizers function as key player in sustainable agriculture by improving soil fertility, plant tolerance and crop productivity.

    Science.gov (United States)

    Bhardwaj, Deepak; Ansari, Mohammad Wahid; Sahoo, Ranjan Kumar; Tuteja, Narendra

    2014-05-08

    Current soil management strategies are mainly dependent on inorganic chemical-based fertilizers, which caused a serious threat to human health and environment. The exploitation of beneficial microbes as a biofertilizer has become paramount importance in agriculture sector for their potential role in food safety and sustainable crop production. The eco-friendly approaches inspire a wide range of application of plant growth promoting rhizobacteria (PGPRs), endo- and ectomycorrhizal fungi, cyanobacteria and many other useful microscopic organisms led to improved nutrient uptake, plant growth and plant tolerance to abiotic and biotic stress. The present review highlighted biofertilizers mediated crops functional traits such as plant growth and productivity, nutrient profile, plant defense and protection with special emphasis to its function to trigger various growth- and defense-related genes in signaling network of cellular pathways to cause cellular response and thereby crop improvement. The knowledge gained from the literature appraised herein will help us to understand the physiological bases of biofertlizers towards sustainable agriculture in reducing problems associated with the use of chemicals fertilizers.

  15. Improving the food waste composting facilities site selection for sustainable development using a hybrid modified MADM model.

    Science.gov (United States)

    Liu, Kung-Ming; Lin, Sheng-Hau; Hsieh, Jing-Chzi; Tzeng, Gwo-Hshiung

    2018-05-01

    With the growth of population and the development of urbanization, waste management has always been a critical global issue. Recently, more and more countries have found that food waste constitutes the majority of municipal waste, if they are disposed of properly, will bring more benefits in sustainable development. Regarding the issue of selecting and improving the location to make the disposal facility towards achieving the aspiration level for sustainable development, since it involves multiple and complicated interaction factors about environment, society, and economy which have to be considered properly in the decision-making process of mutual influence relationship. It is basically a multiple attribute decision making (MADM) issue, a difficult problem which has been obsessing the governments of many countries is widely studied and discussed. This study uses the new hybrid modified MADM model, as follows, first to build an influential network relation map (INRM) via DEMATEL technique, next to confirm the influential weightings via DANP (DEMATEL-based ANP), and then to construct a decision-making model via a hybrid modified VIKOR method to improve and select the location for remaining the best disposal facilities. Finally, an empirical case study is illustrated to demonstrate that the proposed model can be effective and useful. In finding the process of decision making, environmental pollution is the main concern of many people in the area, but actually it is the resistance by the general public that has to be considered with first priority. Copyright © 2018. Published by Elsevier Ltd.

  16. Biofertilizers function as key player in sustainable agriculture by improving soil fertility, plant tolerance and crop productivity

    Science.gov (United States)

    2014-01-01

    Current soil management strategies are mainly dependent on inorganic chemical-based fertilizers, which caused a serious threat to human health and environment. The exploitation of beneficial microbes as a biofertilizer has become paramount importance in agriculture sector for their potential role in food safety and sustainable crop production. The eco-friendly approaches inspire a wide range of application of plant growth promoting rhizobacteria (PGPRs), endo- and ectomycorrhizal fungi, cyanobacteria and many other useful microscopic organisms led to improved nutrient uptake, plant growth and plant tolerance to abiotic and biotic stress. The present review highlighted biofertilizers mediated crops functional traits such as plant growth and productivity, nutrient profile, plant defense and protection with special emphasis to its function to trigger various growth- and defense-related genes in signaling network of cellular pathways to cause cellular response and thereby crop improvement. The knowledge gained from the literature appraised herein will help us to understand the physiological bases of biofertlizers towards sustainable agriculture in reducing problems associated with the use of chemicals fertilizers. PMID:24885352

  17. Improvement of Renal Function by Long-Term Sustained Eculizumab Treatment in a Patient with Paroxysmal Nocturnal Hemoglobinuria

    Directory of Open Access Journals (Sweden)

    Haruhiko Ninomiya

    2015-01-01

    Full Text Available Chronic kidney disease (CKD is one of the major manifestations of paroxysmal nocturnal hemoglobinuria (PNH. CKD in PNH is induced mainly by intravascular hemolysis of PNH-affected red blood cells (RBC missing the glycosylphosphatidylinositol-anchored proteins with complement-regulatory activities, CD55 and CD59. CKD develops by heme absorption in the proximal tubules resulting in the interstitial deposition of iron in the kidneys. We administered eculizumab to a patient with PNH, who was one of 29 patients enrolled in the AEGIS clinical trial, an open-label study of eculizumab in Japan. The patient was complicated by stage 3 CKD with impaired estimated glomerular filtration rate (eGFR, at grade G3b, and had obvious proteinuria (2-3+, 1-2 g/day. In a two-year extension to the 12-week AEGIS study, eGFR improved significantly, and the eGFR has since been maintained at grade G2 without proteinuria by sustained eculizumab treatment (>6 years. Renal function improved and maintained by long-term sustained eculizumab treatment, presumably by clearance of iron from the kidney as well as inhibition of the production of anaphylatoxin C5a, even in advanced stages of CKD, is one of the benefits of eculizumab treatment in PNH.

  18. A neural network to predict symptomatic lung injury

    International Nuclear Information System (INIS)

    Munley, M.T.; Lo, J.Y.

    1999-01-01

    A nonlinear neural network that simultaneously uses pre-radiotherapy (RT) biological and physical data was developed to predict symptomatic lung injury. The input data were pre-RT pulmonary function, three-dimensional treatment plan doses and demographics. The output was a single value between 0 (asymptomatic) and 1 (symptomatic) to predict the likelihood that a particular patient would become symptomatic. The network was trained on data from 97 patients for 400 iterations with the goal to minimize the mean-squared error. Statistical analysis was performed on the resulting network to determine the model's accuracy. Results from the neural network were compared with those given by traditional linear discriminate analysis and the dose-volume histogram reduction (DVHR) scheme of Kutcher. Receiver-operator characteristic (ROC) analysis was performed on the resulting network which had Az=0.833±0.04. (Az is the area under the ROC curve.) Linear discriminate multivariate analysis yielded an Az=0.813±0.06. The DVHR method had Az=0.521±0.08. The network was also used to rank the significance of the input variables. Future studies will be conducted to improve network accuracy and to include functional imaging data. (author)

  19. Factors that influence therapeutic outcomes in symptomatic gastroesophageal reflux disease.

    LENUS (Irish Health Repository)

    Quigley, Eamonn M M

    2012-02-03

    The term "symptomatic gastroesophageal reflux disease" (GERD) refers to those patients who present with the typical GERD symptoms of heartburn and regurgitation, yet do not have endoscopic evidence of esophagitis. The primary goals of managing symptomatic GERD are to control symptoms and improve quality of life. A clinical assessment of the GERD patient can identify important clinical features, such as atypical and extraesophageal symptoms for which acid-suppressive agents tend to be less effective. Performing an endoscopy can further identify the patient as having nonerosive reflux disease, erosive esophagitis, or Barrett\\'s esophagus-diagnoses which can help determine treatment but may not prove predictive of therapeutic response. Determining acid exposure through pH testing can predict therapeutic response, with those revealing an abnormal acid exposure time being more responsive to acid-suppressive therapy. However, the performance of an endoscopy and pH testing on each patient is clearly not practical. Whereas the natural history of symptomatic GERD is still largely undefined, acid-suppressive therapy appears to be the best approach available for both the short-term and long-term management of this disease.

  20. Applying the Advancing Excellence in America's Nursing Homes Circle of Success to improving and sustaining quality.

    Science.gov (United States)

    Bakerjian, Debra; Zisberg, Anna

    2013-01-01

    Looking forward to the Quality Assurance Performance Improvement (QAPI) program to be implemented and required in 2014, and as nursing home staff provide care for residents with increasingly complex health issues, knowledge of how to implement quality improvement (QI) is imperative. The nursing home administrator and director of nursing (DON) provide overall leadership, but it is the primary responsibility of the DON and other registered nurse staff to implement and manage the day to day QI process. This article describes potential roles of nursing leaders and key components of a QI project using a pressure ulcer case study exemplar to illustrate a quality improvement process. The authors suggest specific methods that RN leaders can employ using the Advancing Excellence Campaign Circle of Success as an organizing framework along with evidence-based resources. Nursing home leaders could use this article as a guideline for implementing any clinical quality improvement process. Copyright © 2013 Mosby, Inc. All rights reserved.

  1. Should symptomatic menopausal women be offered hormone therapy?

    Science.gov (United States)

    Lobo, Rogerio A; Bélisle, Serge; Creasman, William T; Frankel, Nancy R; Goodman, Neil E; Hall, Janet E; Ivey, Susan Lee; Kingsberg, Sheryl; Langer, Robert; Lehman, Rebecca; McArthur, Donna Behler; Montgomery-Rice, Valerie; Notelovitz, Morris; Packin, Gary S; Rebar, Robert W; Rousseau, MaryEllen; Schenken, Robert S; Schneider, Diane L; Sherif, Katherine; Wysocki, Susan

    2006-01-01

    Many physicians remain uncertain about prescribing hormone therapy for symptomatic women at the onset of menopause. The American Society for Reproductive Medicine (ASRM) convened a multidisciplinary group of healthcare providers to discuss the efficacy and risks of hormone therapy for symptomatic women, and to determine whether it would be appropriate to treat women at the onset of menopause who were complaining of menopausal symptoms. Numerous controlled clinical trials consistently demonstrate that hormone therapy, administered via oral, transdermal, or vaginal routes, is the most effective treatment for vasomotor symptoms. Topical vaginal formulations of hormone therapy should be preferred when prescribing solely for the treatment of symptoms of vulvar and vaginal atrophy. Data from the Women's Health Initiative indicate that the overall attributable risk of invasive breast cancer in women receiving estrogen plus progestin was 8 more cases per 10,000 women-years. No increased risk for invasive breast cancer was detected for women who never used hormone therapy in the past or for those receiving estrogen only. Hormone therapy is not effective for the treatment of cardiovascular disease and that the risk of cardiovascular disease with hormone therapy is principally in older women who are considerably postmenopause. Healthy symptomatic women should be offered the option of hormone therapy for menopausal symptoms. Symptom relief with hormone therapy for many younger women (at the onset of menopause) with menopausal symptoms outweighs the risks and may provide an overall improvement in quality of life. Hormone therapy should be individualized for symptomatic women. This involves tailoring the regimen and dose to individual needs.

  2. Improvement of beef cattle genetics provided increasing sustainability of beef cattle production and protein consumption in Thailand

    Energy Technology Data Exchange (ETDEWEB)

    Boonyanuwat, K. [Beef Cattle Research and Development Group, Division of Animal Husbandry, Department of Livestock Development, Bangkok (Thailand)], E-mail: kalayabo@yahoo.com; Sirisom, P [Tak Livestock Breeding and Research Center, Meung (Thailand); Putharatanung, A [Nongkwang Livestock Research and Breeding Center, Photharam (Thailand)

    2009-07-01

    The rural innovation research and development (R and D) in beef cattle genetics, biotechnology, climate science and production systems, supported profitable and sustainable beef cattle production in Thailand. Department of Livestock Development (DLD) undertakes R and D to achieve continuous improvement in genetics, production technologies to improve productivity, profitability and sustainability of beef cattle production and quality of products. Efficiencies were achieved through improvements in genetics, nutrition and grazing management, use of information, meat science, and reduction in ruminant methane production. This function was essential to maintain long-term production competitiveness and achieve sustained economic growth in rural Thailand, where the beef cattle production was the important livestock production, accounting for 36.99% of the value of livestock production in Thailand. Molecular, quantitative genetics, and biotechnology tool were being combined in the development of genetic improvement. In 2006, beef meat was imported 1,842.53 thousand tons (0.41% of all consumption, 120.84 baht/kg). For the big size cattle, such as Tak cattle, Kabinburi cattle (Thai synthetic breeds by DLD, Tak = 62.5 Charoles-Brahman, Kabinburi = 50 Simental- Brahman), and cross breed cattle, they were in fattening period for 6-12 month. Fattening group, they were raised for restaurant, hotel, super market, and steak house. Data were collected from 2 parts: 1) 354 cattle of experimental trial in DLD part, and 2) 492 fattening cattle of small holders in Tak province and Nakorn Pathom province during October 2004-September 2007. Data collecting was separated into 2 parts (performance data and reference). Data were adjusted by group location month and year to analyze for growth, carcass performance and economic performances). There were 5 breeds of fattening beef cattle: 1) Thai Native, 2) Thai Brahman, 3) Kabinburi, 4) Tak, and 5) Tajima-Native. The first group was around 41

  3. Using forum-based competitions to improve sustainability and motivation in higher education GNSS learning - Chances and risks

    Science.gov (United States)

    Mayer, M.

    2012-04-01

    The learning strategies of students seem often to be economically adapted to framework requirements in order to achieve best possible examination performances, especially. For this reason, teachers often detect surface level learning characteristics (e.g., accepting facts uncritically, isolated fact storage, fact memorisation) within the learning concepts of students. Therefore, knowledge sustainability is often suffering. This is detectable when trying to build on knowledge of earlier lectures or lecture courses. In order to improve the sustainability of geodetic knowledge, case studies were carried out at the Geodetic Institute of the Karlsruhe Institute of Technology (Karlsruhe, Germany) within the lecture course "Introduction into GNSS positioning". The lecture course "Introduction into GNSS positioning" is a compulsory part of the Bachelor study course "Geodesy and Geoinformatics" and also a supplementary module of the Bachelor study course "Geophysics". The lecture course is aiming for transferring basic knowledge and basic principles of Global Navigation Satellite Systems (e.g., GPS). During the winter semesters 2010/11 and 2011/12 ten resp. 15 students visited this compulsory attendance lecture course. In addition to classroom lectures and practical training (e.g., field exercises), a forum-based competition was included and tested using the forum feature of the learning management system ILIAS. According to the Bologna Declaration, a special focus of the innovative competition concept is on competence-related learning. The developed eLearning-related competition concept supports and motivates the students to learn more sustainable. In addition, the students have to be creative and have to deal with GNSS factual knowledge in order to win the competition. Within the presentation, the didactical concept of the enriched blended learning lecture course and the competition-based case study are discussed. The rules of the competition are presented in detail

  4. Quality of life long-term after body contouring surgery following bariatric surgery: sustained improvement after 7 years.

    Science.gov (United States)

    van der Beek, Eva S J; Geenen, Rinie; de Heer, Francine A G; van der Molen, Aebele B Mink; van Ramshorst, Bert

    2012-11-01

    Bariatric surgery for morbid obesity results in massive weight loss and improvement of health and quality of life. A downside of the major weight loss is the excess of overstretched skin, which may influence the patient's quality of life by causing functional and aesthetic problems. The purpose of the current study was to evaluate the patient's quality of life long-term after body contouring following bariatric surgery. Quality of life was measured with the Obesity Psychosocial State Questionnaire in 33 post-bariatric surgery patients 7.2 years (range, 3.2 to 13.3 years) after body contouring surgery. Data were compared with previous assessments 4.1 years (range, 0.7 to 9.2 years) after body contouring surgery of the quality of life at that time and before body contouring surgery. Compared with appraisals of quality of life before body contouring surgery, a significant, mostly moderate to large, sustained improvement of quality of life was observed in post-bariatric surgery patients 7.2 years after body contouring surgery in six of the seven psychosocial domains. A small deterioration occurred between 4.1- and 7.2-year follow-up on two of the seven domains except for the domain efficacy toward eating, which showed a significant improvement. At 7-year follow-up, 18 patients (55 percent) were satisfied with the result of body contouring surgery. This study indicates a sustained quality-of-life improvement in post-bariatric surgery patients after body contouring surgery. This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity. Therapeutic, IV.

  5. Picture archiving and communication systems lead to sustained improvements in reporting times and productivity: results of a 5-year audit

    Energy Technology Data Exchange (ETDEWEB)

    Mackinnon, A.D.; Billington, R.A.; Adam, E.J.; Dundas, D.D. [Department of Radiology, St Georges Hospital NHS Trust, London (United Kingdom); Patel, U. [Department of Radiology, St Georges Hospital NHS Trust, London (United Kingdom)], E-mail: Uday.Patel@stgeorges.nhs.uk

    2008-07-15

    Aim: To evaluate the impact of picture archiving and communications systems (PACS) on reporting times and productivity in a large teaching hospital. Materials and methods: Reporting time, defined as the time taken from patient registration to report availability, and productivity, defined as the number of reports issued per whole time equivalent (WTE) radiologist per month, were studied for 2 years pre- and 3 years post-PACS installation. Mean reporting time was calculated for plain radiographs and specialist radiology techniques [computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and nuclear medicine]. Productivity, total department workload, and unreported film rates were also assessed. Pre- and post-PACS findings were compared. Results: Between 2002-2006 the number of radiological patient episodes increased by 30% from 11,531/month to 15,057/month. This was accompanied by a smaller increase in WTE reporting radiologists, from 32 to 37 (15%). Mean reporting times have improved substantially post-PACS, plain radiograph reporting time decreased by 26% (from 6.8 to 5 days; p = 0.002) and specialty modalities by 24% (4.1 to 3.1 days; p < 0.001). Radiologist productivity has increased by 18% (337 films to 407 films/WTE radiologist/month). Unreported films have decreased from 5 to 4% for plain radiographs and are steady for specialty modalities (< 1%). In most areas improvements have been sustained over a 3-year period. Conclusion: Since the introduction of PACS, reporting times have decreased by 25% and the productivity improved by 18%. Sustained improvements are felt to reflect the efficiencies and cultural change that accompanied the introduction of PACS and digital dictation.

  6. Translating Developmental Origins: Improving the Health of Women and Their Children Using a Sustainable Approach to Behaviour Change

    Directory of Open Access Journals (Sweden)

    Mary Barker

    2017-03-01

    Full Text Available Theories of the developmental origins of health and disease imply that optimising the growth and development of babies is an essential route to improving the health of populations. A key factor in the growth of babies is the nutritional status of their mothers. Since women from more disadvantaged backgrounds have poorer quality diets and the worst pregnancy outcomes, they need to be a particular focus. The behavioural sciences have made a substantial contribution to the development of interventions to support dietary changes in disadvantaged women. Translation of such interventions into routine practice is an ideal that is rarely achieved, however. This paper illustrates how re-orientating health and social care services towards an empowerment approach to behaviour change might underpin a new developmental focus to improving long-term health, using learning from a community-based intervention to improve the diets and lifestyles of disadvantaged women. The Southampton Initiative for Health aimed to improve the diets and lifestyles of women of child-bearing age through training health and social care practitioners in skills to support behaviour change. Analysis illustrates the necessary steps in mounting such an intervention: building trust; matching agendas and changing culture. The Southampton Initiative for Health demonstrates that developing sustainable; workable interventions and effective community partnerships; requires commitment beginning long before intervention delivery but is key to the translation of developmental origins research into improvements in human health.

  7. BIM-Based 4D Simulation to Improve Module Manufacturing Productivity for Sustainable Building Projects

    Directory of Open Access Journals (Sweden)

    Joosung Lee

    2017-03-01

    Full Text Available Modular construction methods, where products are manufactured beforehand in a factory and then transported to the site for installation, are becoming increasingly popular for construction projects in many countries as this method facilitates the use of the advanced technologies that support sustainability in building projects. This approach requires dual factory–site process management to be carefully coordinated and the factory module manufacturing process must therefore be managed in a detailed and quantitative manner. However, currently, the limited algorithms available to support this process are based on mathematical methodologies that do not consider the complex mix of equipment, factories, personnel, and materials involved. This paper presents three new building information modeling-based 4D simulation frameworks to manage the three elements—process, quantity, and quality—that determine the productivity of factory module manufacturing. These frameworks leverage the advantages of 4D simulation and provide more precise information than existing conventional documents. By utilizing a 4D model that facilitates the visualization of a wide range of data variables, manufacturers can plan the module manufacturing process in detail and fully understand the material, equipment, and workflow needed to accomplish the manufacturing tasks. Managers can also access information about material quantities for each process and use this information for earned value management, warehousing/storage, fabrication, and assembly planning. By having a 4D view that connects 2D drawing models, manufacturing errors and rework can be minimized and problems such as construction delays, quality lapses, and cost overruns vastly reduced.

  8. A program for sustained improvement in preventing ventilator associated pneumonia in an intensive care setting

    Directory of Open Access Journals (Sweden)

    Caserta Raquel A

    2012-09-01

    Full Text Available Abstract Background Ventilator-associated pneumonia (VAP is a common infection in the intensive care unit (ICU and associated with a high mortality. Methods A quasi-experimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize VAP prevention were performed from October 2008 to December 2010. All of these processes, including the Institute for Healthcare Improvement’s (IHI ventilator bundle plus oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions (CASS, were adopted for patients undergoing mechanical ventilation. Results We evaluated a total of 21,984 patient-days, and a total of 6,052 ventilator-days (ventilator utilization rate of 0.27. We found VAP rates of 1.3 and 2.0 per 1,000 ventilator days respectively in 2009 and 2010, achieving zero incidence of VAP several times during 12 months, whenever VAP bundle compliance was over 90%. Conclusion These results suggest that it is possible to reduce VAP rates to near zero and sustain these rates, but it requires a complex process involving multiple performance measures and interventions that must be permanently monitored.

  9. Electrospun Blank Nanocoating for Improved Sustained Release Profiles from Medicated Gliadin Nanofibers

    Directory of Open Access Journals (Sweden)

    Xinkuan Liu

    2018-03-01

    Full Text Available Nanomaterials providing sustained release profiles are highly desired for efficacious drug delivery. Advanced nanotechnologies are useful tools for creating elaborate nanostructure-based nanomaterials to achieve the designed functional performances. In this research, a modified coaxial electrospinning was explored to fabricate a novel core-sheath nanostructure (nanofibers F2, in which a sheath drug-free gliadin layer was successfully coated on the core ketoprofen (KET-gliadin nanocomposite. A monolithic nanocomposite (nanofibers F1 that was generated through traditional blending electrospinning of core fluid was utilized as a control. Scanning electron microscopy demonstrated that both nanofibers F1 and F2 were linear. Transmission electron microscopy verified that nanofibers F2 featured a clear core-sheath nanostructure with a thin sheath layer about 25 nm, whereas their cores and nanofibers F1 were homogeneous KET-gliadin nanocomposites. X-ray diffraction patterns verified that, as a result of fine compatibility, KET was dispersed in gliadin in an amorphous state. In vitro dissolution tests demonstrated that the thin blank nanocoating in nanofibers F2 significantly modified drug release kinetics from a traditional exponential equation of nanofibers F1 to a zero-order controlled release model, linearly freeing 95.7 ± 4.7% of the loaded cargoes over a time period of 16 h.

  10. Electrospun Blank Nanocoating for Improved Sustained Release Profiles from Medicated Gliadin Nanofibers.

    Science.gov (United States)

    Liu, Xinkuan; Shao, Wenyi; Luo, Mingyi; Bian, Jiayin; Yu, Deng-Guang

    2018-03-22

    Nanomaterials providing sustained release profiles are highly desired for efficacious drug delivery. Advanced nanotechnologies are useful tools for creating elaborate nanostructure-based nanomaterials to achieve the designed functional performances. In this research, a modified coaxial electrospinning was explored to fabricate a novel core-sheath nanostructure (nanofibers F2), in which a sheath drug-free gliadin layer was successfully coated on the core ketoprofen (KET)-gliadin nanocomposite. A monolithic nanocomposite (nanofibers F1) that was generated through traditional blending electrospinning of core fluid was utilized as a control. Scanning electron microscopy demonstrated that both nanofibers F1 and F2 were linear. Transmission electron microscopy verified that nanofibers F2 featured a clear core-sheath nanostructure with a thin sheath layer about 25 nm, whereas their cores and nanofibers F1 were homogeneous KET-gliadin nanocomposites. X-ray diffraction patterns verified that, as a result of fine compatibility, KET was dispersed in gliadin in an amorphous state. In vitro dissolution tests demonstrated that the thin blank nanocoating in nanofibers F2 significantly modified drug release kinetics from a traditional exponential equation of nanofibers F1 to a zero-order controlled release model, linearly freeing 95.7 ± 4.7% of the loaded cargoes over a time period of 16 h.

  11. A program for sustained improvement in preventing ventilator associated pneumonia in an intensive care setting

    Science.gov (United States)

    2012-01-01

    Background Ventilator-associated pneumonia (VAP) is a common infection in the intensive care unit (ICU) and associated with a high mortality. Methods A quasi-experimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize VAP prevention were performed from October 2008 to December 2010. All of these processes, including the Institute for Healthcare Improvement’s (IHI) ventilator bundle plus oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions (CASS), were adopted for patients undergoing mechanical ventilation. Results We evaluated a total of 21,984 patient-days, and a total of 6,052 ventilator-days (ventilator utilization rate of 0.27). We found VAP rates of 1.3 and 2.0 per 1,000 ventilator days respectively in 2009 and 2010, achieving zero incidence of VAP several times during 12 months, whenever VAP bundle compliance was over 90%. Conclusion These results suggest that it is possible to reduce VAP rates to near zero and sustain these rates, but it requires a complex process involving multiple performance measures and interventions that must be permanently monitored. PMID:23020101

  12. Using manure as fertilizer for maize could improve sustainability of milk production

    Directory of Open Access Journals (Sweden)

    José D. Jiménez-Calderón

    2018-04-01

    Full Text Available This study evaluated the effect of organic or chemical fertilization of maize on cow performance, economic outcomes, and greenhouse gas emission. Each type of maize silage according its different fertilization was used in two rations offered to two different groups of nine Friesian-Holstein cows throughout 4 months. The production cost of the maize silage was 8.8% lower for organic than for chemical fertilization. Both silages had similar nutritive value, except a higher concentration of starch in maize with organic fertilization, which allowed a reduction in the proportion of concentrate in the ration, saving 25.3 eurocents per cow in the daily ration, generating a positive balance of 21.8 eurocents per cow and day. The milk yield and composition were unaffected depending on the type of fertilization, whereas the estimation of CH4 and N2O emissions with chemical fertilization was higher than emissions with organic fertilization. As a result, it is possible to increase the sustainability and profitability of dairy production with reuse and recycling of manure.

  13. I Have a Dream: Organic Movements Include Gene Manipulation to Improve Sustainable Farming

    Directory of Open Access Journals (Sweden)

    Gerhart U. Ryffel

    2017-03-01

    Full Text Available Several papers in a Special Issue of Sustainability have recently discussed various aspects to evaluate whether organic farming and gene manipulation are compatible. A special emphasis was given to new plant breeding techniques (NPBTs. These new approaches allow the most predictable genetic alterations of crop plants in ways that the genetically modified plant is identical to a plant generated by conventional breeding. The articles of the Special Issue present the arguments pro and contra the inclusion of the plants generated by NPBTs in organic farming. Organic movements have not yet made a final decision whether some of these techniques should be accepted or banned. In my view these novel genetically manipulated (GM crops could be used in such a way as to respect the requirements for genetically manipulated organisms (GMOs formulated by the International Federation of Organic Movements (IFOAM. Reviewing the potential benefits of disease-resistant potatoes and bananas, it seems possible that these crops support organic farming. To this end, I propose specific requirements that the organic movements should proactively formulate as their standards to accept specific GM crops.

  14. Using manure as fertilizer for maize could improve sustainability of milk production

    International Nuclear Information System (INIS)

    Jiménez-Calderón, J.M.; Martínez-Fernández, A.; Prospero-Bernal, F.; Velarde-Guillén, J.; Arriaga-Jordán, C.M.; Vicente, F.

    2018-01-01

    This study evaluated the effect of organic or chemical fertilization of maize on cow performance, economic outcomes, and greenhouse gas emission. Each type of maize silage according its different fertilization was used in two rations offered to two different groups of nine Friesian-Holstein cows throughout 4 months. The production cost of the maize silage was 8.8% lower for organic than for chemical fertilization. Both silages had similar nutritive value, except a higher concentration of starch in maize with organic fertilization, which allowed a reduction in the proportion of concentrate in the ration, saving 25.3 eurocents per cow in the daily ration, generating a positive balance of 21.8 eurocents per cow and day. The milk yield and composition were unaffected depending on the type of fertilization, whereas the estimation of CH4 and N2O emissions with chemical fertilization was higher than emissions with organic fertilization. As a result, it is possible to increase the sustainability and profitability of dairy production with reuse and recycling of manure.

  15. Carbon Footprint estimation for a Sustainable Improvement of Supply Chains: State of the Art

    Directory of Open Access Journals (Sweden)

    Pilar Cordero

    2013-07-01

    Full Text Available Purpose: This paper examines the current methodologies and approaches developed to estimate carbon footprint in supply chains and the studies existing in the literature review about the application of these methodologies and other new approaches proposed by some authors.Design/methodology/approach: Literature review about methodologies developed by some authors for determining greenhouse gases emissions throughout the supply chain of a given sector or organization.Findings and Originality/value: Due to its usefulness for the design and management of a sustainable supply chain management, methodologies for calculating carbon footprint across the supply chain are recommended by many authors not only to reduce GHG emissions but also to optimize it in a cost-effective manner. Although these approaches are in first stages of development and the literature is scarce, different methodologies for estimating CF emissions which include EIO analysis models and standardized methods and guidance have been developed, some of them applicable to supply chains especially methodologies for calculating CF of a specific economic sector supply chain in a territory or country and for calculating CF of an organization applicable to the estimation of GHG emissions of a specific company supply chain.

  16. ThedaCare's business performance system: sustaining continuous daily improvement through hospital management in a lean environment.

    Science.gov (United States)

    Barnas, Kim

    2011-09-01

    For 2003-2008, ThedaCare, a community health system in Wisconsin, achieved significant improvements in quality and the elimination of waste through the development of an improvement system, which included Value Stream analysis, rapid improvement events, and projects applied to specific processes. However, to meet its continuous daily improvement goals, particularly the goal of increasing productivity by 10% annually, ThedaCare needed to change the way its managers and leaders (in its hospital division) conduct and manage their daily work. Accordingly, it developed its Business Performance System (BPS) to achieve and sustain continuous daily improvement. BUILDING THE BPS: ThedaCare devised a multipart pilot project, consisting of "learning to see" and then, "problem solving." On completion of the 15-week alpha phase (6 units) in July 2009, the BPS was spread to the beta pilot (12 units; September 2009-January 2010) and then to cohort 3 (10 units; September 2010-January 2011). Each alpha unit improved performance on (1) the key driver metric of increasing productivity from 2008 to year-end 2009 (by 1%-11%) and (2) its respective safety/ quality drivers over the respective 2008 baselines. For 2010, improvements across the alpha, beta, and cohort 3 units were found for 11 of the 14 safety/quality drivers-85% of the 11 customer satisfaction drivers, 83% of 6 people engagement drivers; and 48% of 23 financial stewardship drivers. The tools developed for the BPS have enabled teams to see, prioritize, and pursue continuous daily improvement opportunities. Unit leaders now have a structured management reporting system to reduce variation in their management styles. Leaders all now follow leadership standard work, and their daily work is now consistently aligned with the hospital and system strategy.

  17. Improving energy efficiency: Strategies for supporting sustained market evolution in developing and transitioning countries

    Energy Technology Data Exchange (ETDEWEB)

    Meyers, S.

    1998-02-01

    This report presents a framework for considering market-oriented strategies for improving energy efficiency that recognize the conditions of developing and transitioning countries, and the need to strengthen the effectiveness of market forces in delivering greater energy efficiency. It discusses policies that build markets in general, such as economic and energy pricing reforms that encourage competition and increase incentives for market actors to improve the efficiency of their energy use, and measures that reduce the barriers to energy efficiency in specific markets such that improvement evolves in a dynamic, lasting manner. The report emphasizes how different policies and measures support one another and can create a synergy in which the whole is greater than the sum of the parts. In addressing this topic, it draws on the experience with market transformation energy efficiency programs in the US and other industrialized countries.

  18. Indigenous health: effective and sustainable health services through continuous quality improvement.

    Science.gov (United States)

    Bailie, Ross S; Si, Damin; O'Donoghue, Lyn; Dowden, Michelle

    2007-05-21

    The Australian government's Healthy for Life program is supporting capacity development in Indigenous primary care using continuous quality improvement (CQI) techniques. An important influence on the Healthy for Life program has been the ABCD research project. The key features contributing to the success of the project are described. The ABCD research project: uses a CQI approach, with an ongoing cycle of gathering data on how well organisational systems are functioning, and developing and then implementing improvements; is guided by widely accepted principles of community-based research, which emphasise participation; and adheres to the principles and values of Indigenous health research and service delivery. The potential for improving health outcomes in Aboriginal and Torres Strait Islander communities using a CQI approach should be strengthened by clear clinical and managerial leadership, supporting service organisations at the community level, and applying participatory-action principles.

  19. Age Management and Sustainable Careers for the Improvement of the Quality of Ageing at Work.

    Science.gov (United States)

    Marcaletti, Francesco

    2014-01-01

    Prolonging working careers by increasing the statutory age for retirement has become compulsory in most Western societies in order to tackle the shrinking of the labour force, preserve economic productivity, foster knowledge transfer and reduce the risks of financial imbalances in social security systems. This imperative currently results in working careers that already exceed 40 years and come to an end after the age of 65 (e.g. in Italy). Over the next few decades, both career length and retirement age are expected to rise. Thus, creating more inclusive workplaces by increasing their quality is the precondition of a win-win situation for both employers and employees, regardless of age. A request for support in the development of sustainable careers from both private and public labour organisations has led to innovating the mainstream methodologies and research tools in the field of age management. Based on the key elements of the mainstream "work ability concept" - i.e. health, competencies, motivation and work organisation - the Quality of Ageing at Work questionnaire (QAW-q), developed by a team from the WWELL Research Centre, broadens its perspective by surveying elements bridging intra-organisational dimensions and which affect employees' conditions and external socio-institutional constraints: i.e. work-life balance, economic stability, professional identity and relationships in the workplace. The QAW-q is designed to analyse the influence of the different meanings of age (chronological age, seniority within the company and in the labour market) and correlate them with the different dimensions at individual and organisational levels; all these dimensions are weighted by the effect exerted by the passage of time. The results of the QAW-q survey, taken by employees of both private and public companies, serve as a basis for the implementation of measures addressing all the relevant dimensions of the human resource management cycle.

  20. Electrospun collagen-based nanofibres: A sustainable material for improved antibiotic utilisation in tissue engineering applications.

    Science.gov (United States)

    Hall Barrientos, Ivan J; Paladino, Eleonora; Szabó, Peter; Brozio, Sarah; Hall, Peter J; Oseghale, Charles I; Passarelli, Melissa K; Moug, Susan J; Black, Richard A; Wilson, Clive G; Zelkó, Romana; Lamprou, Dimitrios A

    2017-10-05

    For the creation of scaffolds in tissue engineering applications, it is essential to control the physical morphology of fibres and to choose compositions which do not disturb normal physiological function. Collagen, the most abundant protein in the human body, is a well-established biopolymer used in electrospinning compositions. It shows high in-vivo stability and is able to maintain a high biomechanical strength over time. In this study, the effects of collagen type I in polylactic acid-drug electrospun scaffolds for tissue engineering applications are examined. The samples produced were subsequently characterised using a range of techniques. Scanning electron microscopy analysis shows that the fibre morphologies varied across PLA-drug and PLA-collagen-drug samples - the addition of collagen caused a decrease in average fibre diameter by nearly half, and produced nanofibres. Atomic force microscopy imaging revealed collagen-banding patterns which show the successful integration of collagen with PLA. Solid-state characterisation suggested a chemical interaction between PLA and drug compounds, irgasan and levofloxacin, and the collagen increased the amorphous regions within the samples. Surface energy analysis of drug powders showed a higher dispersive surface energy of levofloxacin compared with irgasan, and contact angle goniometry showed an increase in hydrophobicity in PLA-collagen-drug samples. The antibacterial studies showed a high efficacy of resistance against the growth of both E. coli and S. Aureus, except with PLA-collagen-LEVO which showed a regrowth of bacteria after 48h. This can be attributed to the low drug release percentage incorporated into the nanofibre during the in vitro release study. However, the studies did show that collagen helped shift both drugs into sustained release behaviour. These ideal modifications to electrospun scaffolds may prove useful in further research regarding the acceptance of human tissue by inhibiting the potential

  1. Sustainable Land-Use Planning to Improve the Coastal Resilience of the Social-Ecological Landscape

    Directory of Open Access Journals (Sweden)

    Min Kim

    2017-06-01

    Full Text Available The dynamics of land-use transitions decrease the coastal resilience of the social-ecological landscape (SEL, particularly in light of the fact that it is necessary to analyze the causal relationship between the two systems because operations of the social system and the ecological system are correlated. The purpose of this study is to analyze the dynamics of the coastal SEL and create a sustainable land-use planning (SLUP strategy to enhance coastal resilience. The selected study site was Shindu-ri, South Korea, where land-use transitions are increasing and coastal resilience is therefore decreasing. Systems thinking was used to analyze the study, which was performed in four steps. First, the issues affecting the coastal area in Shindu-ri were defined as coastal landscape management, the agricultural structure, and the tourism industry structure. Second, the main variables for each issue were defined, and causal relationships between the main variables were created. Third, a holistic causal loop diagram was built based on both dynamic thinking and causal thinking. Fourth, five land-uses, including those of the coastal forest, the coastal grassland, the coastal dune, the agricultural area, and developed sites, were selected as leverage points for developing SLUP strategies to increase coastal resilience. The results show that “decrease in the size of the coastal forest”, “decrease in the size of the coastal dune”, and “increase in the size of the coastal grasslands” were considered parts of a land-use plan to enhance the resilience of the Shindu-ri SEL. This study developed integrated coastal land-use planning strategies that may provide effective solutions for complex and dynamic issues in the coastal SEL. Additionally, the results may be utilized as basic data to build and implement coastal land-use planning strategies.

  2. Improvement characteristics shown in holistic regeneration of Ballymun toward sustainable community

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yeunsook; Lim, Soohyun; Kim, Gunhyoung [Department of Housing and Interior Design, Yonsei University, Seoul (Korea)

    2010-02-15

    Substantial numbers of urban and residential environments constructed in the 20th century are experiencing degeneration and the importance of challenging to revitalize community holistically is getting more seriously recognized. There, however, has been limitation in grasping the holistic regeneration information as urban regeneration usually goes through a long-term and complicated procedure. Yet, the urban and housing regeneration's direction is required to be holistic in the 21st Century. Any precedent case that had tried the holistic regeneration needs to be checked thoroughly and thereby the result needs to be applied to the future attempts as a reference and knowledge base. The purpose of this study was to delineate improvement characteristics that appeared during the course of holistic regeneration in Ballymun of Ireland. This research is an archival research in nature which also used content analysis technique since it deals with reports and newsletters as archival records that were accumulated on a regular base throughout the whole process. The leading projects continued over ten years of improvement were scrutinized in the perspective of physical, social, economic, cultural, and environmental dimensions of regeneration. The main results were, first, a series of improvement activities and projects to regenerate each of five dimensions were delineated for comprehensive understanding. Second, connected patterns for synergistic improvement were identified and patterns were described to show the detailed contents as examples. This study would provide communities that face holistic regeneration, an insight, planning skills, creative and realistic ideas for implementation, thereby empowers planning capability toward holistic regeneration. (author)

  3. Econometric analysis of improved maize varieties and sustainable agricultural practices (SAPs) in Eastern Zambia

    NARCIS (Netherlands)

    Manda, J.

    2016-01-01

    Maize is the principle food staple in Zambia, providing both food and income for most of the rural populace. It is estimated that over 50% of the daily caloric intake is derived from maize; with an average consumption of over 85kg per year. Because of the importance of maize, a number of improved

  4. Limiting Size of Fish Fillets at the Center of the Plate Improves the Sustainability of Aquaculture Production

    Directory of Open Access Journals (Sweden)

    Stephen F. Cross

    2011-07-01

    Full Text Available North American dining customers like to have a singular large piece of protein in the center of the plate. When fish is the protein of choice, the portion size from many species is limited by the overall size of the fish. Therefore, for these species, the means to achieve a singular larger portion of “center of the plate” protein is to grow a larger animal. However, fish become less efficient in converting feed to protein as they age. A second option would be to provide two smaller fillets originating from younger, more efficient fish. Here, the sustainability ramifications of these two protein provisioning strategies (single large or two small fillets are considered for three species of fish produced in aquaculture. Growth data for channel catfish (Ictalurus punctatus produced in ponds, rainbow trout (Oncorhynchus mykiss in raceways, and sablefish (Anoplopoma fimbria in marine net pens, were modeled to assess the total biomass and overall food conversion ratio for the production of small, medium or large fish. The production of small fish added an additional 50% or more biomass per year for trout, catfish, and sablefish compared to the production of large fish. Feed conversion ratios were also improved by nearly 10% for the smaller compared to larger fish of each species. Thus, even though all of these species tend to be considered aquaculture species of low environmental impact (and hence “green” or sustainable options, the product form requested by retailers and served by chefs can further increase the sustainability of these species.

  5. CORK Study in Cystic Fibrosis: Sustained Improvements in Ultra-Low-Dose Chest CT Scores After CFTR Modulation With Ivacaftor.

    Science.gov (United States)

    Ronan, Nicola J; Einarsson, Gisli G; Twomey, Maria; Mooney, Denver; Mullane, David; NiChroinin, Muireann; O'Callaghan, Grace; Shanahan, Fergus; Murphy, Desmond M; O'Connor, Owen J; Shortt, Cathy A; Tunney, Michael M; Eustace, Joseph A; Maher, Michael M; Elborn, J Stuart; Plant, Barry J

    2018-02-01

    Ivacaftor produces significant clinical benefit in patients with cystic fibrosis (CF) with the G551D mutation. Prevalence of this mutation at the Cork CF Centre is 23%. This study assessed the impact of cystic fibrosis transmembrane conductance regulator modulation on multiple modalities of patient assessment. Thirty-three patients with the G551D mutation were assessed at baseline and prospectively every 3 months for 1 year after initiation of ivacaftor. Change in ultra-low-dose chest CT scans, blood inflammatory mediators, and the sputum microbiome were assessed. Significant improvements in FEV 1 , BMI, and sweat chloride levels were observed post-ivacaftor treatment. Improvement in ultra-low-dose CT imaging scores were observed after treatment, with significant mean reductions in total Bhalla score (P < .01), peribronchial thickening (P = .035), and extent of mucous plugging (P < .001). Reductions in circulating inflammatory markers, including interleukin (IL)-1β, IL-6, and IL-8 were demonstrated. There was a 30% reduction in the relative abundance of Pseudomonas species and an increase in the relative abundance of bacteria associated with more stable community structures. Posttreatment community richness increased significantly (P = .03). Early and sustained improvements on ultra-low-dose CT scores suggest it may be a useful method of evaluating treatment response. It paralleled improvement in symptoms, circulating inflammatory markers, and changes in the lung microbiota. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  6. Outcomes management: incorporating and sustaining processes critical to using outcome data to guide practice improvement.

    Science.gov (United States)

    Hodges, Kay; Wotring, James R

    2012-04-01

    An outcomes management system (OMS) greatly facilitates an organization or state achieving requirements regarding accountability and use of empirically based interventions. A case example of the authors' experience with a successful and enduring OMS is presented, followed by a review of the literature and a proposed model delineating the key components and benefits of an OMS. Building capacity to measure performance requires embedding utilization of youth-specific, clinically meaningful outcome data into the organization's processes and structures. An OMS measures outcomes associated with services, facilitates implementation of evidence-based practices, informs case decision making, enables better and more efficient clinical management, and provides aggregated information used to improve services. A case-specific supervisory model based on instantaneously available information, including progress to date, helps maximize consumer outcomes. Continuous quality improvement activities, which are databased and goal-oriented, become a positive change management tool. This paper describes organizational processes that facilitate the development of a highly functional OMS.

  7. Application of microorganisms in concrete: a promising sustainable strategy to improve concrete durability.

    Science.gov (United States)

    Wang, Jianyun; Ersan, Yusuf Cagatay; Boon, Nico; De Belie, Nele

    2016-04-01

    The beneficial effect of microbially induced carbonate precipitation on building materials has been gradually disclosed in the last decade. After the first applications of on historical stones, promising results were obtained with the respect of improved durability. An extensive study then followed on the application of this environmentally friendly and compatible material on a currently widely used construction material, concrete. This review is focused on the discussion of the impact of the two main applications, bacterial surface treatment and bacteria based crack repair, on concrete durability. Special attention was paid to the choice of suitable bacteria and the metabolic pathway aiming at their functionality in concrete environment. Interactions between bacterial cells and cementitious matrix were also elaborated. Furthermore, recommendations to improve the effectiveness of bacterial treatment are provided. Limitations of current studies, updated applications and future application perspectives are shortly outlined.

  8. Exercise Therapy Augments the Ischemia-Induced Proangiogenic State and Results in Sustained Improvement after Stroke

    Directory of Open Access Journals (Sweden)

    Man He

    2013-04-01

    Full Text Available The induction of angiogenesis will stimulate endogenous recovery mechanisms, which are involved in the long-term repair and restoration process of the brain after an ischemic event. Here, we tested whether exercise influences the pro-angiogenic factors and outcomes after cerebral infarction in rats. Wistar rats were exposed to two hours of middle-cerebral artery occlusion and reperfusion. Different durations of treadmill training were performed on the rats. The expression of matrix metalloproteinase 2 (MMP2 and vascular endothelial growth factor (VEGF-related genes and proteins were higher over time post-ischemia, and exercise enhanced their expression. Sixteen days post-ischemia, the regional cerebral blood flow in the ischemic striatum was significantly increased in the running group over the sedentary. Although no difference was seen in infarct size between the running and sedentary groups, running evidently improved the neurobehavioral score. The effects of running on MMP2 expression, regional cerebral blood flow and outcome were abolished when animals were treated with bevacizumab (BEV, a VEGF-targeting antibody. Exercise therapy improves long-term stroke outcome by MMP2-VEGF-dependent mechanisms related to improved cerebral blood flow.

  9. How to reconcile environmental and economic performance to improve corporate sustainability: corporate environmental strategies in the European paper industry.

    Science.gov (United States)

    Wagner, Marcus

    2005-07-01

    This paper discusses the relationship between environmental and economic performance and the influence of corporate strategies with regard to sustainability and the environment. After formulating a theoretical model, results are reported from an empirical analysis of the European paper manufacturing industry. New data are used to test hypotheses derived from the theoretical model, using environmental performance indices representing different corporate environmental strategy orientations. In particular, an emissions-based index largely reflecting end-of-pipe strategies and an inputs-based index reflecting integrated pollution prevention are distinguished. For the emissions-based index, a predominantly negative relationship between environmental and economic performance is found, whereas for the inputs-based index no significant link is found. This is consistent with the theoretical model, which predicts the possibility of different relationships. The results also show that for firms with pollution prevention-oriented corporate environmental strategies, the relationship between environmental and economic performance is more positive, thus making improvements in corporate sustainability more likely. Based on this last insight, managerial implications of this are discussed with regard to strategy choices, investment decisions and operations management.

  10. The impact of project-based learning on improving student learning outcomes of sustainability concepts in transportation engineering courses

    Science.gov (United States)

    Fini, Elham H.; Awadallah, Faisal; Parast, Mahour M.; Abu-Lebdeh, Taher

    2018-05-01

    This paper describes an intervention to enhance students' learning by involving students in brainstorming activities about sustainability concepts and their implications in transportation engineering. The paper discusses the process of incorporating the intervention into a transportation course, as well as the impact of this intervention on students' learning outcomes. To evaluate and compare students' learning as a result of the intervention, the Laboratory for Innovative Technology and Engineering Education survey instrument was used. The survey instrument includes five constructs: higher-order cognitive skills, self-efficacy, ease of learning subject matter, teamwork, and communication skills. Pre- and post-intervention surveys of student learning outcomes were conducted to determine the effectiveness of the intervention on enhancing students' learning outcomes. The results show that the implementation of the intervention significantly improved higher-order cognitive skills, self-efficacy, teamwork, and communication skills. Involving students in brainstorming activities related to sustainability concepts and their implications in transportation proved to be an effective teaching and learning strategy.

  11. Dual-drug delivery by porous silicon nanoparticles for improved cellular uptake, sustained release, and combination therapy.

    Science.gov (United States)

    Wang, Chang-Fang; Mäkilä, Ermei M; Kaasalainen, Martti H; Hagström, Marja V; Salonen, Jarno J; Hirvonen, Jouni T; Santos, Hélder A

    2015-04-01

    Dual-drug delivery of antiangiogenic and chemotherapeutic drugs can enhance the therapeutic effect for cancer therapy. Conjugation of methotrexate (MTX) to porous silicon (PSi) nanoparticles (MTX-PSi) with positively charged surface can improve the cellular uptake of MTX and inhibit the proliferation of cancer cells. Herein, MTX-PSi conjugates sustained the release of MTX up to 96 h, and the released fragments including MTX were confirmed by mass spectrometry. The intracellular distribution of the MTX-PSi nanoparticles was confirmed by transmission electron microscopy. Compared to pure MTX, the MTX-PSi achieved similar inhibition of cell proliferation in folate receptor (FR) over-expressing U87 MG cancer cells, and a higher effect in low FR-expressing EA.hy926 cells. Nuclear fragmentation analysis demonstrated programmed cell apoptosis of MTX-PSi in the high/low FR-expressing cancer cells, whereas PSi alone at the same dose had a minor effect on cell apoptosis. Finally, the porous structure of MTX-PSi enabled a successful concomitant loading of another anti-angiogenic hydrophobic drug, sorafenib, and considerably enhanced the dissolution rate of sorafenib. Overall, the MTX-PSi nanoparticles can be used as a platform for combination chemotherapy by simultaneously enhancing the dissolution rate of a hydrophobic drug and sustaining the release of a conjugated chemotherapeutic drug. Copyright © 2015 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  12. Sustainable smallholder intensification through improved water management requires adjusted fertilizer recommendation

    Science.gov (United States)

    Gedfew, Muluye; Schmitter, Petra; Nakawuka, Prossie; Tilahun, Seifu A.; Steenhuis, Tammo; Langan, Simon

    2017-04-01

    found for pepper. The N and K balances were less negative when farmers used organic fertilizers aside from inorganic fertilizers compared to those farmers who only applied Urea and Di-Ammonium Phosphate (DAP). Furthermore, the largest negative nutrient balances were obtained for the water management leading to the highest crop and water productivity (i.e. CWR). Hence, introducing sustainable water management practices in irrigation requires associated fertilizer recommendations to compensate for the increased yields obtained, avoiding land degradation in the long term.

  13. Surgically Treated Symptomatic Prolapsed Lumbar and Sacral ...

    African Journals Online (AJOL)

    Background and Objective: There are various postulated possible causes of surgically symptomatic prolapsed intervertebral discs in the lumbar and sacral regions. They may be acting singularly or collectively. Yet, these factors, which could vary in different environments, have not been satisfactorily confirmed. The intention ...

  14. Distribution pattern of surgically treated symptomatic prolapsed ...

    African Journals Online (AJOL)

    Background: The pattern of distribution of surgically treated symptomatic prolapsed lumbar and sacral intervertebral discs has been published, though scantily, especially in males. We decided to look at our own series, compare and contrast ours with some of those published. Materials and Methods: We treated 88 locations ...

  15. A Setting for a Field-based Class for Improved Understanding of Sustainability Through the Evaluation of Aquaculture and Fisheries

    Science.gov (United States)

    Macko, S. A.; O'Connell, M. T.

    2015-12-01

    An improved understanding of sustainability is increasingly a subject in educational settings. Marine science classes are perfect settings of establishing sustainability awareness owing to declining populations of organisms and perceived collapse in fisheries worldwide. Students in oceanography classes often request more direct exposure to actual ocean situations or field trips. During regular session (13 week) or shorter term (4 week) summer classes such long trips are logistically difficult owing to large numbers of students involved or timing. This new approach to such a course supplement addresses the requests by utilizing local resources and short field trips for a limited number of students (20) to locations in which Ocean experiences are available, and are often supported through education and outreach components. The vision of the class was a mixture of classroom time, readings, along with paper and laboratories. In addition, short day-long trips to locations where the ocean was "captured" were also used to supplement the experience as well as speakers involved with aquaculture. Central Virginia is a fortunate location for such a class, with close access for travel to the Chesapeake Bay and numerous field stations, museums with ocean-based exhibits (the Smithsonian and National Zoo) that address both extant and extinct Earth history, as well as national/state aquaria in Baltimore and Virginia Beach. Furthermore, visits to local seafood markets at local grocery stores, or larger city markets in Washington, Baltimore and Virginia Beach, enhance the exposure to productivity in the ocean, and viability of the fisheries sustainability. The course could then address not only the particulars of the marine science, but also aspects of sustainability with discussions on ethics, including keeping animals in captivity or overfishing of particular species and the special difficulties that arise from captive or culturing ocean populations. In addition, the class was

  16. Symptomatic Congenital Cytomegalovirus Infection in Children of Seropositive Women

    Directory of Open Access Journals (Sweden)

    Ines Mack

    2017-06-01

    Full Text Available Cytomegalovirus (CMV is the most frequent congenital virus infection worldwide. The risk of congenital CMV (cCMV transmission is highest in seronegative women who acquire primary CMV infection during pregnancy. A growing body of evidence indicates that secondary CMV infections in pregnant women with preconceptual immunity (either through reactivation of latent virus or re-infection with a new strain of CMV contribute to a much greater proportion of symptomatic cCMV than was previously thought. Here, we describe a case of symptomatic cCMV infection in the newborn of a woman with proven immunity prior to pregnancy. Diagnosis was confirmed by CMV PCR from amniotic fluid and fetal MR imaging. The newborn presented with typical cCMV symptoms including jaundice, hepatosplenomegaly, cholestasis, petechiae, small head circumference, and sensorineural hearing loss, the most common neurologic sequela. CMV was detected in infant blood and urine by PCR, and intravenous ganciclovir was initiated and continued orally for 6 weeks totally. Apart from persisting right-sided deafness, the child exhibited normal neurological development up through the last follow-up at 4.5 years. To date, the most effective strategy to prevent vertical CMV transmission is hygiene counseling for women of childbearing age, which, in our case, and in concordance with recent literature, applies to seronegative, as well as seropositive, women. Once an expecting mother shows seroconversion or signs of an active CMV infection, there are no established procedures to reduce the risk of transmission, or therapeutic options for the fetus with signs of infection. After birth, symptomatic infants can be treated with ganciclovir to inhibit viral replication and improve hearing ability and neurodevelopmental outcome. A comprehensive review of the literature, including our case study, reveals the most current and significant diagnostic and treatment options available. In conclusion, the triad

  17. Sustained IGF-1 Secretion by Adipose-Derived Stem Cells Improves Infarcted Heart Function.

    Science.gov (United States)

    Bagno, Luiza L; Carvalho, Deivid; Mesquita, Fernanda; Louzada, Ruy A; Andrade, Bruno; Kasai-Brunswick, Taís H; Lago, Vivian M; Suhet, Grazielle; Cipitelli, Debora; Werneck-de-Castro, João Pedro; Campos-de-Carvalho, Antonio C

    2016-01-01

    The mechanism by which stem cell-based therapy improves heart function is still unknown, but paracrine mechanisms seem to be involved. Adipose-derived stem cells (ADSCs) secrete several factors, including insulin-like growth factor-1 (IGF-1), which may contribute to myocardial regeneration. Our aim was to investigate whether the overexpression of IGF-1 in ADSCs (IGF-1-ADSCs) improves treatment of chronically infarcted rat hearts. ADSCs were transduced with a lentiviral vector to induce IGF-1 overexpression. IGF-1-ADSCs transcribe100- to 200-fold more IGF-1 mRNA levels compared to nontransduced ADSCs. IGF-1 transduction did not alter ADSC immunophenotypic characteristics even under hypoxic conditions. However, IGF-1-ADSCs proliferate at higher rates and release greater amounts of growth factors such as IGF-1, vascular endothelial growth factor (VEGF), and hepatocyte growth factor (HGF) under normoxic and hypoxic conditions. Importantly, IGF-1 secreted by IGF-1-ADSCs is functional given that Akt-1 phosphorylation was remarkably induced in neonatal cardiomyocytes cocultured with IGF-1-ADSCs, and this increase was prevented with phosphatidylinositol 3-kinase (PI3K) inhibitor treatment. Next, we tested IGF-1-ADSCs in a rat myocardial infarction (MI) model. MI was performed by coronary ligation, and 4 weeks after MI, animals received intramyocardial injections of either ADSCs (n = 7), IGF-1-ADSCs (n = 7), or vehicle (n = 7) into the infarcted border zone. Left ventricular function was evaluated by echocardiography before and after 6 weeks of treatment, and left ventricular hemodynamics were assessed 7 weeks after cell injection. Notably, IGF-1-ADSCs improved left ventricular ejection fraction and cardiac contractility index, but did not reduce scar size when compared to the ADSC-treated group. In summary, transplantation of ADSCs transduced with IGF-1 is a superior therapeutic approach to treat MI compared to nontransduced ADSCs, suggesting that gene and cell

  18. ROLE AND IMPORTANCE OF TECHNOLOGY DEVELOPMENT AND IMPROVEMENT EMERGENCY ASSISTANCE AND SUSTAINABLE DEVELOPMENT AND ENVIRONMENTAL PROTECTION IN ROMANIA

    Directory of Open Access Journals (Sweden)

    Ionel NUTA

    2015-08-01

    Full Text Available Year 2014 was considered by NASA and NOAA hottest year in history. Combined temperature of the atmosphere and oceans has increased overall by 0.68 degrees Celsius, and the devastating effects of climate changes produced irreversible consequences on the sustainability of the planet earth. Increasing the frequency, intensity and complexity of their manifestation caused initiation and development of global policies aimed at mitigating climate change priority, reducing the risk of natural disasters or anthropological costs and negative effects to society and the environment. In order to fulfill the responsibilities assumed by Romania as a member of international bodies is necessary to search and apply new solutions as revolutionary and effective, especially autonomous enabling technology development and improvement of emergency intervention and replacement of emergency autonomous robotic systems. Autonomous robotic systems allow execution of prevention and management of emergencies in areas difficult to reach, hostile life and result in increasing their efficiency.

  19. Symptomatic Control in End-of-Life Patients

    Directory of Open Access Journals (Sweden)

    Mariana Alves

    2017-01-01

    Full Text Available End-of-life patients present a variety of symptoms that cause suffering for them and their respective families. Health professionals throughout their university, internship and medical careers are ill-prepared to manage and improve the quality of life of these patients. This article aims to provide basic skills in the symptomatic management of end-of-life patients, focusing in particular on the control of pain, dyspnoea, fatigue, nausea, vomiting and anorexia. It also aims to draw attention to basic concepts of control concerning refractory symptoms and palliative sedation.

  20. Sustaining innovation and improvement in the treatment of childhood cancer: lessons from high-income countries.

    Science.gov (United States)

    Pritchard-Jones, Kathy; Pieters, Rob; Reaman, Gregory H; Hjorth, Lars; Downie, Peter; Calaminus, Gabriele; Naafs-Wilstra, Marianne C; Steliarova-Foucher, Eva

    2013-03-01

    Cancer in children and adolescents is rare and biologically very different from cancer in adults. It accounts for 1·4% of all cancers worldwide, although this proportion ranges from 0·5% in Europe to 4·8% in Africa, largely because of differences in age composition and life expectancy. In high-income countries, survival from childhood cancer has reached 80% through a continuous focus on the integration of clinical research into front-line care for nearly all children affected by malignant disease. However, further improvement must entail new biology-driven approaches, since optimisation of conventional treatments has in many cases reached its limits. In many instances, such approaches can only be achieved through international collaborative research, since rare cancers are being subdivided into increasingly smaller subgroups on the basis of their molecular characteristics. The long-term effect of anticancer treatment on quality of life must also be taken into account because more than one in 1000 adults in high-income countries are thought to be survivors of cancer in childhood or adolescence. The introduction of drugs that are less toxic and more targeted than those currently used necessitates a partnership between clinical and translational researchers, the pharmaceutical industry, drug regulators, and patients and their families. This therapeutic alliance will ensure that efforts are focused on the unmet clinical needs of young people with cancer. Most children with cancer live in low-income and middle-income countries, and these countries account for 94% of all deaths from cancer in people aged 0-14 years. The immediate priority for these children is to improve access to an affordable, best standard of care in each country. Every country should have a national cancer plan that recognises the unique demographic characteristics and care needs of young people with cancer. Centralisation of the complex components of treatment of these rare diseases is essential

  1. Combining Sustainable Land Management Technologies to Combat Land Degradation and Improve Rural Livelihoods in Semi-arid Lands in Kenya.

    Science.gov (United States)

    Mganga, K Z; Musimba, N K R; Nyariki, D M

    2015-12-01

    Drylands occupy more than 80% of Kenya's total land mass and contribute immensely to the national economy and society through agriculture, livestock production, tourism, and wild product harvesting. Dryland ecosystems are areas of high climate variability making them vulnerable to the threats of land degradation. Consequently, agropastoralists inhabiting these ecosystems develop mechanisms and technologies to cope with the impacts of climate variability. This study is aimed to; (1) determine what agropastoralists inhabiting a semi-arid ecosystem in Kenya attribute to be the causes and indicators of land degradation, (2) document sustainable land management (SLM) technologies being undertaken to combat land degradation, and (3) identify the factors that influence the choice of these SLM technologies. Vegetation change from preferred indigenous forage grass species to woody vegetation was cited as the main indicator of land degradation. Land degradation was attributed to recurrent droughts and low amounts of rainfall, overgrazing, and unsustainable harvesting of trees for fuelwood production. However, despite the challenges posed by climate variability and recurrent droughts, the local community is engaging in simple SLM technologies including grass reseeding, rainwater harvesting and soil conservation, and dryland agroforestry as a holistic approach combating land degradation and improving their rural livelihoods. The choice of these SLM technologies was mainly driven by their additional benefits to combating land degradation. In conclusion, promoting such simple SLM technologies can help reverse the land degradation trend, improve agricultural production, food security including access to food, and subsequently improve livelihoods of communities inhabiting dryland ecosystems.

  2. Combining Sustainable Land Management Technologies to Combat Land Degradation and Improve Rural Livelihoods in Semi-arid Lands in Kenya

    Science.gov (United States)

    Mganga, K. Z.; Musimba, N. K. R.; Nyariki, D. M.

    2015-12-01

    Drylands occupy more than 80 % of Kenya's total land mass and contribute immensely to the national economy and society through agriculture, livestock production, tourism, and wild product harvesting. Dryland ecosystems are areas of high climate variability making them vulnerable to the threats of land degradation. Consequently, agropastoralists inhabiting these ecosystems develop mechanisms and technologies to cope with the impacts of climate variability. This study is aimed to; (1) determine what agropastoralists inhabiting a semi-arid ecosystem in Kenya attribute to be the causes and indicators of land degradation, (2) document sustainable land management (SLM) technologies being undertaken to combat land degradation, and (3) identify the factors that influence the choice of these SLM technologies. Vegetation change from preferred indigenous forage grass species to woody vegetation was cited as the main indicator of land degradation. Land degradation was attributed to recurrent droughts and low amounts of rainfall, overgrazing, and unsustainable harvesting of trees for fuelwood production. However, despite the challenges posed by climate variability and recurrent droughts, the local community is engaging in simple SLM technologies including grass reseeding, rainwater harvesting and soil conservation, and dryland agroforestry as a holistic approach combating land degradation and improving their rural livelihoods. The choice of these SLM technologies was mainly driven by their additional benefits to combating land degradation. In conclusion, promoting such simple SLM technologies can help reverse the land degradation trend, improve agricultural production, food security including access to food, and subsequently improve livelihoods of communities inhabiting dryland ecosystems.

  3. What Is There in Seeds? Vertically Transmitted Endophytic Resources for Sustainable Improvement in Plant Growth

    Directory of Open Access Journals (Sweden)

    Raheem Shahzad

    2018-01-01

    Full Text Available Phytobeneficial microbes, particularly endophytes, such as fungi and bacteria, are concomitant partners of plants throughout its developmental stages, including seed germination, root and stem growth, and fruiting. Endophytic microbes have been identified in plants that grow in a wide array of habitats; however, seed-borne endophytic microbes have not been fully explored yet. Seed-borne endophytes are of great interest because of their vertical transmission; their potential to produce various phytohormones, enzymes, antimicrobial compounds, and other secondary metabolites; and improve plant biomass and yield under biotic and abiotic stresses. This review addresses the current knowledge on endophytes, their ability to produce metabolites, and their influence on plant growth and stress mitigation.

  4. Improved measurement for mothers, newborns and children in the era of the Sustainable Development Goals.

    Science.gov (United States)

    Marchant, Tanya; Bryce, Jennifer; Victora, Cesar; Moran, Allisyn C; Claeson, Mariam; Requejo, Jennifer; Amouzou, Agbessi; Walker, Neff; Boerma, Ties; Grove, John

    2016-06-01

    An urgent priority in maternal, newborn and child health is to accelerate the scale-up of cost-effective essential interventions, especially during labor, the immediate postnatal period and for the treatment of serious infectious diseases and acute malnutrition.  Tracking intervention coverage is a key activity to support scale-up and in this paper we examine priorities in coverage measurement, distinguishing between essential interventions that can be measured now and those that require methodological development. We conceptualized a typology of indicators related to intervention coverage that distinguishes access to care from receipt of an intervention by the population in need.  We then built on documented evidence on coverage measurement to determine the status of indicators for essential interventions and to identify areas for development. Contact indicators from pregnancy to childhood were identified as current indicators for immediate use, but indicators reflecting the quality of care provided during these contacts need development. At each contact point, some essential interventions can be measured now, but the need for development of indicators predominates around interventions at the time of birth and interventions to treat infections. Addressing this need requires improvements in routine facility based data capture, methods for linking provider and community-based data, and improved guidance for effective coverage measurement that reflects the provision of high-quality care. Coverage indicators for some essential interventions can be measured accurately through household surveys and be used to track progress in maternal, newborn and child health.  Other essential interventions currently rely on contact indicators as proxies for coverage but urgent attention is needed to identify new measurement approaches that directly and reliably measure their effective coverage.

  5. Improving sustainability of maritime transport through utilization of Liquefied Natural Gas (LNG) for propulsion

    International Nuclear Information System (INIS)

    Burel, Fabio; Taccani, Rodolfo; Zuliani, Nicola

    2013-01-01

    Today, most merchant vessels use Heavy Fuel Oils (HFOs) for ship propulsion. These fuels are cost effective but they produce significant amounts of noxious emissions. In order to comply with International Maritime Organization (IMO) rules, Liquefied Natural Gas (LNG) is becoming an interesting option for merchant ships. The aim of the research presented in this paper is to analyse the economic upturn that can result from the use of LNG as fuel for merchant ships and to assess the effects of its utilization in terms of environmental impact. In the first part of the study, a statistical analysis of maritime traffic is carried out in order to identify which merchant ship types could most benefit from using LNG as fuel for ship propulsion. Traffic data of world ships related to the months of May 2008, 2009 and 2010 are analysed. Roll-on/Roll-off vessels (RoRo) and tanker ships spend most of their sailing time in Emission Control Areas (ECA) consequently appear to be the best candidates for LNG use. In particular, the use of LNG is most profitable for tanker ships in the range of 10,000–60,000 DWT (deadweight). In the second part of the study, operational costs and pollutant emission reduction, following LNG implementation, are calculated for a 33,000 DWT tanker ship. Results show that LNG leads to a reduction of 35% of operational costs and 25% of CO 2 emissions. The possibility of improving energy efficiency on board is analysed considering that combustion gases, produced by LNG, are cleaner, thus simplifying the introduction of exhaust gas heat recovery. Two options are considered: simple heat recovery and heat recovery to drive a turbine (ORC). The results show that it is possible to achieve a reduction in fuel consumption of up to 15%. - Highlights: • Ship propulsion accounts for a large amount of noxious emissions in costal/harbour areas. • Today price differential between fuel oil and natural gas is increasing. • The use of Liquefied Natural Gas as fuel

  6. Sustainable Sanitation—A Cost-Effective Tool to Improve Plant Yields and the Environment

    Directory of Open Access Journals (Sweden)

    Päivi Karinen

    2010-01-01

    Full Text Available Human urine and faeces are products formed every day in every human society. The volume and fertilisation value of urine is higher than that of faeces. This paper reviews data that urine has been used successfully as a fertiliser for cereals and some vegetables. According to the literature, urine fertilised plants may have produced higher, similar or slightly lower yields than mineral fertilized plants but they invariably resulted in higher yields than non-fertilised plants. There have been no microbiological risks associated with any products. The taste and chemical quality of the products are similar to plants treated with mineral fertilisers. Separating toilets, where urine and faeces are separated already in the toilet, could be beneficial not only in poor but also in the industrialized countries. A separating toilet could be installed also in old buildings and it could allow individuals to live in coastal areas, mountainous or other sensitive environments. In poor areas, urine fertilisation could increase food production also in home plots and reduce hunger. It could also combat water contamination and help to reduce diseases caused by enteric micro-organisms. If urine were to be viewed as a resource rather than a waste product, more families could be encouraged to install low-cost toilets which would especially improve the wellbeing of women.

  7. Improving spatial prioritisation for remote marine regions: optimising biodiversity conservation and sustainable development trade-offs

    Science.gov (United States)

    Moore, Cordelia H.; Radford, Ben T.; Possingham, Hugh P.; Heyward, Andrew J.; Stewart, Romola R.; Watts, Matthew E.; Prescott, Jim; Newman, Stephen J.; Harvey, Euan S.; Fisher, Rebecca; Bryce, Clay W.; Lowe, Ryan J.; Berry, Oliver; Espinosa-Gayosso, Alexis; Sporer, Errol; Saunders, Thor

    2016-08-01

    Creating large conservation zones in remote areas, with less intense stakeholder overlap and limited environmental information, requires periodic review to ensure zonation mitigates primary threats and fill gaps in representation, while achieving conservation targets. Follow-up reviews can utilise improved methods and data, potentially identifying new planning options yielding a desirable balance between stakeholder interests. This research explored a marine zoning system in north-west Australia-a biodiverse area with poorly documented biota. Although remote, it is economically significant (i.e. petroleum extraction and fishing). Stakeholder engagement was used to source the best available biodiversity and socio-economic data and advanced spatial analyses produced 765 high resolution data layers, including 674 species distributions representing 119 families. Gap analysis revealed the current proposed zoning system as inadequate, with 98.2% of species below the Convention on Biological Diversity 10% representation targets. A systematic conservation planning algorithm Maxan provided zoning options to meet representation targets while balancing this with industry interests. Resulting scenarios revealed that conservation targets could be met with minimal impacts on petroleum and fishing industries, with estimated losses of 4.9% and 7.2% respectively. The approach addressed important knowledge gaps and provided a powerful and transparent method to reconcile industry interests with marine conservation.

  8. Sustainable improvement of animal health care by systematic quality risk management according to the HACCP concept.

    Science.gov (United States)

    Noordhuizen, J P; Welpelo, H J

    1996-12-01

    This paper addresses the principles of the Hazard Analysis Critical Control Point (HACCP) concept as applied to animal health management strategy. Characteristics of the concept were analysed and compared with those of current animal health care strategies for disease risk identification and herd health management, insurance, and certification. HACCP is a hybrid strategy of quality control at both production process and product level. Animal health is considered a particular quality feature. We show that process control (expressed in terms of controlling both general and specific disease risk factors) and product control (expressed in terms of testing animals or animal products for specific disease agents) could form the basis for improving animal health. We conclude that HACCP provides ample opportunity for preventive health action and risk management at a relatively low cost in terms of labour, finance and documentation expenditure, at both the farm and sector level. Epidemiological field studies are currently needed to identify critical control points and to design HACCP procedures for livestock producers. In the long run, HACCP based animal health care can be further developed into a quality control systems approach to cover all aspects that are related, either directly or indirectly, to animal health.

  9. ASPECTS OF SUSTAINABLE DEVELOPMENT OF THE TOURISM IN MEHEDINTI COUNTY IN TERMS OF QUALITY IMPROVEMENT

    Directory of Open Access Journals (Sweden)

    Roxana, MARINESCU

    2014-11-01

    Full Text Available Tourism is an important component of the economic and social life of a country. The importance of the role of tourism in the national economy is given by the complexity of this phenomenon, the scope of activities necessary for its emergence, maintenance and development. Tourism plays an important role on the human level too, due to its positive effects for the tourists and also for the population of the host countries. For tourist, the tourism means creating conditions and opportunities for rest, relaxation, culture or getting in touch with other people, and for the local people tourism is a mean of raising the standards of living, improving the living conditions. By its nature, the tourism represents an economic activity located at the crossroads of other branches. In this tourism universe, the power of the consumer does not cease to exist, that is why the quality is one of the first requirements as customer or tourist satisfaction is greatly dependent on the quality of the services. In order to enter into the international tourism competition is needed the modernization, recovery and development of the Romanian tourism and creation of modern and competitive tourism products on the tourism market.

  10. Improving Thermal and Electrical Efficiency in Photovoltaic Thermal Systems for Sustainable Cooling System Integration

    Directory of Open Access Journals (Sweden)

    Mohammad Alobaid

    2018-06-01

    Full Text Available Research into photovoltaic thermal systems is important in solar technologies as photovoltaic thermal systems are designed to produce both electrical and thermal energy, this can lead to improved performance of the overall system. The performance of photovoltaic thermal systems is based on several factors that include photovoltaic thermal materials, design, ambient temperature, inlet and outlet fluid temperature and photovoltaic cell temperature. The aim of this study is to investigate the effect of photovoltaic thermal outlet water temperatures and solar cell temperature on both electrical and thermal efficiency for different range of inlet water temperature. To achieve this, a mathematical model of a photovoltaic thermal system was developed to calculate the anticipated system performance. The factors that affect the efficiency of photovoltaic thermal collectors were discussed and the outlet fluid temperature from the photovoltaic thermal is investigated in order to reach the highest overall efficiency for the solar cooling system. An average thermal and electrical efficiency of 65% and 13.7%, respectively, was achieved and the photovoltaic thermal mathematical model was validated with experimental data from literature.

  11. Symptomatic Non-parasitic benign hepatic cyst: Evaluation of ...

    African Journals Online (AJOL)

    HussamHassan

    Rarely, however, the cysts become symptomatic and are then best treated surgically. The optimal surgical treatment is debatable. ... the liver, including multiple cysts arising in the ..... aspiration and ethanol sclerosis of a large, symptomatic,.

  12. Single doses of Panax ginseng (G115) reduce blood glucose levels and improve cognitive performance during sustained mental activity.

    Science.gov (United States)

    Reay, Jonathon L; Kennedy, David O; Scholey, Andrew B

    2005-07-01

    Single doses of the traditional herbal treatment Panax ginseng have recently been shown to elicit cognitive improvements in healthy young volunteers. The mechanisms by which ginseng improves cognitive performance are not known. However, they may be related to the glycaemic properties of some Panax species. Using a double-blind, placebo-controlled, balanced crossover design, 30 healthy young adults completed a 10 min test battery at baseline, and then six times in immediate succession commencing 60 min after the day's treatment (placebo, 200mg G115 or 400mg G115). The 10 min battery comprised a Serial Threes subtraction task (2 min); a Serial Sevens task (2 min); a Rapid Visual Information Processing task (5 min); then a 'mental fatigue' visual analogue scale. Blood glucose was measured prior to each day's treatment, and before, during and after the post-dose completions of the battery. Both the 200mg and 400mg treatments led to significant reductions in blood glucose levels at all three post-treatment measurements (p 0.005 in all cases). The most notable behavioural effects were associated with 200mg of ginseng and included significantly improved Serial Sevens subtraction task performance and significantly reduced subjective mental fatigue throughout all (with the exception of one time point in each case) of the post-dose completions of the 10 min battery (p 0.05). Overall these data suggest that Panax ginseng can improve performance and subjective feelings of mental fatigue during sustained mental activity. This effect may be related to the acute gluco-regulatory properties of the extract.

  13. Anterior pseudoarthrectomy for symptomatic Bertolotti's syndrome.

    Science.gov (United States)

    Malham, Gregory M; Limb, Rebecca J; Claydon, Matthew H; Brazenor, Graeme A

    2013-12-01

    Painful L5/S1 pseudoarthrosis has been previously managed with posterior excision and/or lumbar fusion. To our knowledge, the anterior approach for L5/S1 pseudoarthrectomy in the treatment of Bertolotti's syndrome has not been described. We present two patients with severe symptomatic L5/S1 pseudoarthroses that were successfully excised via an anterior retroperitoneal approach with 2 year clinical and radiological follow-up. The literature regarding surgical treatments for Bertolotti's syndrome is reviewed. The technique for an anterior retroperitoneal approach is described. This approach has been safe and effective in providing long term symptomatic relief to our two patients. Further studies comparing the outcomes of anterior versus posterior pseudoarthrectomy will guide the management of this condition. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Uterine artery embolization for the treatment of symptomatic fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kyung Ah; Kim, Man Deuk; Kim, Hee Jin; Lee, Mee Hwa; Cho, Jin Ho; Cha, Sun Hee; Yoon, Sang Wook; Ahn, Eun Hee [Bundang CHA General Hospital Pochon CHA University, Sungnam (Korea, Republic of)

    2005-07-15

    The aim of this study was to determine the potential usefulness of uterine artery embolization (UAE) for the management of uterine leiomyoma. Sixty nine patients (mean age; 40.3 years, age range; 31-52 years) who underwent UAE for symptomatic fibroids (with menorrhagia, dysmenorrhoea and bulk-related symptoms) from January 2000 to December 2000 were retrospectively analyzed. The mean follow-up period was 3.5 months (range: 1-8 months). The fibroids ranged in size from 2.0 cm to 13.2 cm with a mean size of 5.8 cm. We performed embolization using polyvinyl alcohol particles (250-710 {mu} m). The improvement of the clinical symptoms was analyzed. Reduction of the uterine and predominant fibroid volumes was assessed using MRI. Symptom improvement for the menorrhagia (87.5%), dysmenorrhoea (83.3%) and the bulk-related symptoms (79.2%) was reported. Complications includes ovarian failure in four patients (5.8% of the total patients, mean age: 43.3 yrs) and infection in three patients (4.3% of the total patients) who underwent conservative management with intravenous antibiotics and analgesics. The volume reduction rate of the uterus and the predominant fibroids after uterine artery embolization were 36.3% and 56.6%, respectively. UAE is a promising new treatment for symptomatic fibroids and may be a valuable alternative to hysterectomy.

  15. Symptomatic portal vein occlusion: treated by interventional radiological techniques

    International Nuclear Information System (INIS)

    Wang Maoqiang; Gu Xiaofang; Guan Jun; Wang Zhongpu; Liu Fengyong; Wang Zhiqiang

    2004-01-01

    Objective: To evaluate the efficacy and safety of the interventional radiological techniques for management of symptomatic portal vein (PV) occlusion. Methods: Nine patients with PV trunk occlusion were treated using interventional procedures. Four patients presented with abdominal pain, distention, and malabsorption; five presented with portal hypertension and repeated bleeding from esophagogastric varices. The etiologic factors were identified in all 9 patients, including post-transplantation of the liver in 2, hepatocellular carcinoma (HCC) associated with PV tumor thrombus in 3, post abdominal operative state in 1, and PV thrombosis in 3 cases. The portal access was established via a percutaneous transhepatic route in 4, and via a transjugular intrahepatic portosystemic shunt ( TIPS) approach in 5 patients. The interventional procedures included stent placement in 4, balloon angioplasty in 6, and catheter directed pharmacologic and mechanical thrombolysis in 7 patients. Results: The technical success was achieved in all cases. No complications related to the procedure occurred. Portal flow was reestablished in all patients after the procedures. Clinical improvement was seen in 3 patients with symptomatic PV thrombosis, characterized by progressive reduction of abdominal pain, distention, and diarrhea. Follow-up time ranged from 4 to 36 months. One patient with HCC died of multiple organs metastases at 11 months after the treatment . One patient died of intraabdominal sepsis and multiple organs failure 12 days after the procedure even though the antegrade flow was re-established in the main trunk of the PV. Patency of the PV trunk was confirmed by follow-up color Doppler ultrasound scan in the rest 7 patients, without recurrence of variceal bleeding or PV thrombus. Conclusions: Interventional minimally invasive procedures, including balloon angioplasty, stent placement, catheter directed local pharmacologic and mechanical thrombolysis, are safe and effective in

  16. Promoting sustainability in quality improvement: an evaluation of a web-based continuing education program in blood pressure measurement.

    Science.gov (United States)

    Block, Lauren; Flynn, Sarah J; Cooper, Lisa A; Lentz, Caroline; Hull, Tammie; Dietz, Katherine B; Boonyasai, Romsai T

    2018-01-10

    The accuracy of blood pressure measurement is variable in office-based settings. Even when staff training programs are effective, knowledge and skills decay over time, supporting the need for ongoing staff training. We evaluated whether a web-based continuing education program in blood pressure measurement reinforced knowledge and skills among clinical staff and promoted sustainability of an existing quality improvement program. Medical assistants and nurses at six primary care clinics within a health system enrolled in a 30-min online educational program designed to refresh their knowledge of blood pressure measurement. A 20-question pre- and post-intervention survey addressed learners' knowledge and attitudes. Direct observation of blood pressure measurement technique before and after the intervention was performed. Differences in responses to pre- and post-module knowledge and attitudes questions and in observation data were analyzed using chi-square tests and simple logistic regression. All 88 clinical staff members participated in the program and completed the evaluation survey. Participants answered 80.6% of questions correctly before the module and 93.4% afterwards (p blood pressure measurement were high at baseline and did not improve significantly. Prior to the intervention, staff adhered to 9 of 18 elements of the recommended technique during at least 90% of observations. Following the program, staff was more likely to explain the protocol, provide a rest period, measure an average blood pressure, and record the average blood pressure, but less likely to measure blood pressure with the arm at heart level and use the right arm. We designed, implemented, and evaluated a web-based educational program to improve knowledge, skills, and attitudes in blood pressure measurement and use of an automated device among nurses and medical assistants in ambulatory care. The program reinforced knowledge related to recommended blood pressure measurement technique

  17. A protocol for sustained reduction of Total Parenteral Nutrition and cost savings by improvement of nutritional care in hospitals.

    Science.gov (United States)

    van Schaik, Rian; Van den Abeele, Kurt; Melsens, Glenn; Schepens, Peter; Lanssens, Truus; Vlaemynck, Bernadette; Devisch, Maria; Niewold, Theo A

    2016-10-01

    Malnutrition and the use of Total Parenteral Nutrition (TPN) contribute considerably to hospital costs. Recently, we reported on the introduction of malnutrition screening and monitoring of TPN use in our hospital, which resulted in a large (40%) reduction in TPN and improved quality of nutritional care in two years (2011/12). Here, we aimed to assure continuation of improved care by developing a detailed malnutrition screening and TPN use protocol involving instruction tools for hospital staff, while monitoring the results in the following two years (2013/14). A TPN decision tree for follow up of TPN in patients and a TP-EN instruction card for caregivers was introduced, showing TPN/EN introduction schedules based on the energy needs of patients according to EB guidelines, also addressing the risk of refeeding syndrome. TPN patients were monitored by dietitians and TPN usage and costs were presented to the (medical) staff. Screening and treatment of malnourished patients by dietitians is simultaneously ongoing. In 2014 48% of patients, hospitalized for at least 48 h, were screened on malnutrition, 17% of them were diagnosed at risk, 7.9% malnourished and treated by dietitians. TPN usage dropped by 53% and cost savings of 51% were obtained due to 50% decrease of TPN users in 2014 versus 2010. TPN over EN ratio dropped from 2.4 in 2010 to 1.2 in 2014. Sustained improvement of nutritional care and reduction of TPN usage and costs is possible by introduction of procedures embedded in the existing structures. Copyright © 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

  18. Improving graduation rates for African Americans in drug court: Importance of human relationships and barriers to gaining and sustaining employment.

    Science.gov (United States)

    Gallagher, John Robert; Nordberg, Anne; Dibley, Alyssa R

    2017-11-16

    Drug courts have been an important part of the criminal justice system since 1989. They continue to expand throughout the United States because nearly three decades of research has shown that they are more effective than other interventions, such as traditional probation. There is a pattern, though, in some drug courts where African Americans are less likely to graduate than their Caucasian counterparts. This qualitative study explores this phenomenon by asking African American participants (n = 31) their views on the most helpful aspects of drug court and how drug court could be more helpful in supporting them in graduating the program. Participants felt that the respect and compassion they received from the drug court judge and their case managers, as well as the camaraderie they developed with other participants, was an aspect of drug court that supported them in graduating the program. Next, participants felt that graduation rates would improve if drug court better supported them in gaining employment or sustaining the employment they already had. Implications for drug court practice are discussed.

  19. A framework of connections between soil and people can help improve sustainability of the food system and soil functions.

    Science.gov (United States)

    Ball, Bruce C; Hargreaves, Paul R; Watson, Christine A

    2018-04-01

    Globally soil quality and food security continue to decrease indicating that agriculture and the food system need to adapt. Improving connection to the soil by knowledge exchange can help achieve this. We propose a framework of three types of connections that allow the targeting of appropriate messages to different groups of people. Direct connection by, for example, handling soil develops soil awareness for management that can be fostered by farmers joining groups on soil-focused farming such as organic farming or no-till. Indirect connections between soil, food and ecosystem services can inform food choices and environmental awareness in the public and can be promoted by, for example, gardening, education and art. Temporal connection revealed from past usage of soil helps to bring awareness to policy workers of the need for the long-term preservation of soil quality for environmental conservation. The understanding of indirect and temporal connections can be helped by comparing them with the operations of the networks of soil organisms and porosity that sustain soil fertility and soil functions.

  20. Physicochemical Properties of Sea Water and Bittern in Indonesia: Quality Improvement and Potential Resources Utilization for Marine Environmental Sustainability

    Directory of Open Access Journals (Sweden)

    Mirna Apriani

    2018-05-01

    Full Text Available The traditional salt production in Indonesia was investigated to report the preparation and processing of salt, determine the characteristics of sea water and bittern as well as explore the potential of bittern management with appropriate technology. Field study and comprehensive analysis were performed so as to better understand the salt making, providing valuable information for the proposal of targeted management strategies in salt quality improvement and wastewater recovery. The results show that Na^+,Cl^- and Ca^(2+ in East Java Province bittern were found greater than the majority of values found in the literature. The highest concentrations of Na^+,Cl^- and Ca^(2+ were measured in Camplong-Sampang District. The highest concentrations of Mg^(2+and trace metals were recorded in Panceng-Gresik District. The trace metals found in sea water and bittern need particular concern to be removed without disposing of sea water minerals. The potential number of bittern in Indonesia promoted the development of the bittern management for magnesium recovery and achieving marine environment sustainability. High purified material recovery can be achieved by using crystallization technology.

  1. Climate change: A threat towards achieving ‘Sustainable Development Goal number two’ (end hunger, achieve food security and improved nutrition and promote sustainable agriculture in South Africa

    Directory of Open Access Journals (Sweden)

    Shingirai S. Mugambiwa

    2017-02-01

    Full Text Available This article aims to assess the impacts of climate change towards the achievement of Sustainable Development Goal number two (SDG 2 as well as examining the poverty alleviation strategies by subsistence farmers in South Africa. Widespread hunger and poverty continue to be among the most life-threatening problems confronting mankind. Available statistics show that global poverty remains a serious challenge around the world. Across the globe, one in five people lives on less than $1 a day and one in seven suffers from chronic hunger. Similarly, the developing world is adversely affected by poverty and hunger. In the sub-Saharan Africa, research has revealed a higher prevalence of hunger, malnutrition, poverty and food insecurity. SDG 2 focuses more on eliminating hunger and promoting sustainable agriculture. The study employed an exploratory design and a qualitative method. Snowball sampling was used in selecting relevant sources which led the researchers to other research work on the same field through keywords and reference lists. The researchers employed discourse analysis to analyse data. The study discovered that there are numerous potential effects climate change could have on agriculture. It affects crop growth and quality and livestock health. Farming practices could also be affected as well as animals that could be raised in particular climatic areas. The impact of climate change as well as the susceptibility of poor communities is very immense. The article concludes that climate change reduces access to drinking water, negatively affects the health of people and poses a serious threat to food security.

  2. Two cycles of plasma rich in growth factors (PRGF-Endoret) intra-articular injections improve stiffness and activities of daily living but not pain compared to one cycle on patients with symptomatic knee osteoarthritis.

    Science.gov (United States)

    Vaquerizo, Víctor; Padilla, Sabino; Aguirre, José Javier; Begoña, Leire; Orive, Gorka; Anitua, Eduardo

    2017-05-19

    To assess the clinical efficacy and safety of a treatment based on one cycle versus two cycles of intra-articular injections of plasma rich in growth factors (PRGF-Endoret) on patients with knee osteoarthritis (OA). Ninety patients with knee OA were included and evaluated. A total of 48 patients received one cycle (OC group) (3 injections on a weekly basis), while 42 patients received two cycles of PRGF-Endoret (TC group) spaced 6 months between them. Patients were evaluated with LEQUESNE and WOMAC scores before treatment and after 48 weeks. Safety assessment was also performed. A significant reduction of all assessed outcome measures was shown for both groups at 48 weeks compared with baseline values (P PRGF did not show a significantly higher pain reduction compared with one cycle treatment. However, two cycles of PRGF showed a significant improvement in WOMAC stiffness, LEQUESNE MCD, LEQUESNE ADV and LEQUESNE global subscales. Therefore, patients treated with two cycles present an improvement in quality of life. II.

  3. Improvement of cellular uptake, in vitro antitumor activity and sustained release profile with increased bioavailability from a nanoemulsion platform.

    Science.gov (United States)

    Choudhury, Hira; Gorain, Bapi; Karmakar, Sanmoy; Biswas, Easha; Dey, Goutam; Barik, Rajib; Mandal, Mahitosh; Pal, Tapan Kumar

    2014-01-02

    Paclitaxel, a potential anticancer agent against solid tumors has been restricted from its oral use due to poor water solubility as well as Pgp efflux property. The present study was aimed to improve the oral bioavailability of paclitaxel through development of (o/w) nanoemulsion consisting of Capryol 90 as internal phase with Tween 20 as emulsifier with water as an external phase. Formulations were selected from the nanoemulsion region of pseudo-ternary phase diagrams, formulated by aqueous titration method. The developed nanoemulsion has been characterized by its thermodynamic stability, morphology, droplet size, zeta potential, viscosity where in vitro release was evaluated through dialysis. Paclitaxel nanoemulsion exhibited thermodynamical stability with low viscosity, nano-sized oil droplets in water with low poly-dispersity index. The shelf life of the paclitaxel nanoemulsion was found to be approximately 2.38 years. Increased permeability through the Caco-2 cell monolayer and decreased efflux is great advantageous for nanoemulsion formulation. The effects of paclitaxel nanoemulsion on breast cancer cell proliferation, morphology and DNA fragmentation were analyzed in vitro which showed significant anti-proliferation and decreased IC50 values in nanoemulsion group which may be due to enhanced uptake of paclitaxel through the oil core. Moreover, the absolute oral bioavailability and sustained release profile of the paclitaxel nanoemulsion evaluated in mouse model was found to improve up to 55.9%. The concentration of paclitaxel in mice plasma was determined by our validated LC-MS/MS method. By reviewing the significant outcome of the present investigation based on stability study, Caco-2 permeability, cell proliferative assay and pharmacokinetic profile it may be concluded that the oral nanoemulsion has got encouraging advantages over the presently available formulations of this injectable chemotherapeutic drug. Copyright © 2013 Elsevier B.V. All rights

  4. Principals Management Support Practices to Promote Teachers' Instructional Improvement for Sustainable Development in Secondary Education in Anambra State, Nigeria

    Science.gov (United States)

    Victor, Akinfolarin Akinwale; Emetarom, Uche Grace

    2017-01-01

    This study ascertained the principals management support practices to promote teachers instructional improvement for sustainable development in secondary education in Anambra State. Two specific purposes were formulated and two research questions guided the study. The study adopted a descriptive survey design. The study was conducted in the six…

  5. Uterine artery embolisation for symptomatic adenomyosis-Mid-term results

    International Nuclear Information System (INIS)

    Bratby, M.J.; Walker, W.J.

    2009-01-01

    Purpose: To evaluate the role of uterine artery embolisation (UAE) in the treatment of adenomyosis. Materials and methods: 27 women with symptomatic adenomyosis diagnosed on magnetic resonance imaging (MRI) underwent UAE between 1998 and 2004. Clinical evaluation using a standardised questionnaire was made at regular intervals after embolisation to assess patient outcome. Results: The diagnosis of adenomyosis was confirmed histologically by transvaginal biopsy in 5 women. There were 14 women with associated uterine fibroids. Diffuse adenomyosis was identified in 18 women. A focal adenomyoma was present in another 8 women. In 1 patient adenomyosis was not classified. All patients except one underwent bilateral uterine artery embolisation. There was an initial favourable clinical response, with improvement of menorrhagia in 79% (13/16) of patients at 12 months. Follow-up data was available on a total of 14 patients at 2 and 3 years after embolisation. 45.5% (5/11) reported a deterioration in menorrhagia symptoms at 2 years. Conclusion: UAE for symptomatic adenomyosis is effective in the short-term but there is a high rate of recurrence of clinical symptoms 2 year following treatment.

  6. Uterine artery embolisation for symptomatic adenomyosis-Mid-term results

    Energy Technology Data Exchange (ETDEWEB)

    Bratby, M.J. [Radiology Department, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU2 7XX (United Kingdom); Walker, W.J. [Radiology Department, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU2 7XX (United Kingdom)], E-mail: wjwalker@doctors.org.uk

    2009-04-15

    Purpose: To evaluate the role of uterine artery embolisation (UAE) in the treatment of adenomyosis. Materials and methods: 27 women with symptomatic adenomyosis diagnosed on magnetic resonance imaging (MRI) underwent UAE between 1998 and 2004. Clinical evaluation using a standardised questionnaire was made at regular intervals after embolisation to assess patient outcome. Results: The diagnosis of adenomyosis was confirmed histologically by transvaginal biopsy in 5 women. There were 14 women with associated uterine fibroids. Diffuse adenomyosis was identified in 18 women. A focal adenomyoma was present in another 8 women. In 1 patient adenomyosis was not classified. All patients except one underwent bilateral uterine artery embolisation. There was an initial favourable clinical response, with improvement of menorrhagia in 79% (13/16) of patients at 12 months. Follow-up data was available on a total of 14 patients at 2 and 3 years after embolisation. 45.5% (5/11) reported a deterioration in menorrhagia symptoms at 2 years. Conclusion: UAE for symptomatic adenomyosis is effective in the short-term but there is a high rate of recurrence of clinical symptoms 2 year following treatment.

  7. Symptomatic thoracic spinal cord herniation: case series and technical report.

    Science.gov (United States)

    Hawasli, Ammar H; Ray, Wilson Z; Wright, Neill M

    2014-09-01

    Idiopathic spinal cord herniation (ISCH) is an uncommon condition located predominantly in the thoracic spine and often associated with a remote history of a major traumatic injury. ISCH has an incompletely described presentation and unknown etiology. There is no consensus on the treatment algorithm and surgical technique, and there are few data on clinical outcomes. In this case series and technical report, we describe the atypical myelopathy presentation, remote history of traumatic injury, radiographic progression, treatment, and outcomes of 5 patients treated at Washington University for symptomatic ISCH. A video showing surgical repair is presented. In contrast to classic compressive myelopathy symptomatology, ISCH patients presented with an atypical myelopathy, characterized by asymmetric motor and sensory deficits and early-onset urinary incontinence. Clinical deterioration correlated with progressive spinal cord displacement and herniation observed on yearly spinal imaging in a patient imaged serially because of multiple sclerosis. Finally, compared with compressive myelopathy in the thoracic spine, surgical treatment of ISCH led to rapid improvement despite a long duration of symptoms. Symptomatic ISCH presents with atypical myelopathy and slow temporal progression and can be successfully managed with surgical repair.

  8. Neighbourhood facilities for sustainability

    CSIR Research Space (South Africa)

    Gibberd, Jeremy T

    2013-01-01

    Full Text Available . In this paper these are referred to as ‘Neighbourhood Facilities for Sustainability’. Neighbourhood Facilities for Sustainability (NFS) are initiatives undertaken by individuals and communities to build local sustainable systems which not only improve...

  9. Are school meals a viable and sustainable tool to improve the healthiness and sustainability of children´s diet and food consumption? A cross-national comparative perspective.

    Science.gov (United States)

    Oostindjer, Marije; Aschemann-Witzel, Jessica; Wang, Qing; Skuland, Silje Elisabeth; Egelandsdal, Bjørg; Amdam, Gro V; Schjøll, Alexander; Pachucki, Mark C; Rozin, Paul; Stein, Jarrett; Lengard Almli, Valerie; Van Kleef, Ellen

    2017-12-12

    There is little agreement among governments, institutions, scientists and food activists as to how to best tackle the challenging issues of health and sustainability in the food sector. This essay discusses the potential of school meals as a platform to promote healthy and sustainable food behavior. School meal programs are of particular interest for improving public diet because they reach children at a population scale across socio-economic classes and for over a decade of their lives, and because food habits of children are more malleable than those of adults. Current research on the history and health implications of school meal programs is reviewed in a cross-national comparative framework, and arguments explored that speak for the need of a new developmental phase of school meals as an integrative learning platform for healthy and sustainable food behavior. Nutritional, social, practical, educational, economical, political, and cultural perspectives and challenges linked to the implementation of healthy and sustainable school meals are discussed. Finally, the need for long-term interventions and evaluations is highlighted and new research directions are proposed.

  10. Sustained release of growth hormone and sodium nitrite from biomimetic collagen coating immobilized on silicone tubes improves endothelialization.

    Science.gov (United States)

    Salehi-Nik, Nasim; Malaie-Balasi, Zahra; Amoabediny, Ghassem; Banikarimi, Seyedeh Parnian; Zandieh-Doulabi, Behrouz; Klein-Nulend, Jenneke

    2017-08-01

    Biocompatibility of biomedical devices can be improved by endothelialization of blood-contacting parts mimicking the vascular endothelium's function. Improved endothelialization might be obtained by using biomimetic coatings that allow local sustained release of biologically active molecules, e.g. anti-thrombotic and growth-inducing agents, from nanoliposomes. We aimed to test whether incorporation of growth-inducing nanoliposomal growth hormone (nGH) and anti-thrombotic nanoliposomal sodium nitrite (nNitrite) into collagen coating of silicone tubes enhances endothelialization by stimulating endothelial cell proliferation and inhibiting platelet adhesion. Collagen coating stably immobilized on acrylic acid-grafted silicone tubes decreased the water contact angle from 102° to 56°. Incorporation of 50 or 500nmol/ml nNitrite and 100 or 1000ng/ml nGH into collagen coating decreased the water contact angle further to 48°. After 120h incubation, 58% nitrite and 22% GH of the initial amount of sodium nitrite and GH in nanoliposomes were gradually released from the nNitrite-nGH-collagen coating. Endothelial cell number was increased after surface coating of silicone tubes with collagen by 1.6-fold, and with nNitrite-nGH-collagen conjugate by 1.8-3.9-fold after 2days. After 6days, endothelial cell confluency in the absence of surface coating was 22%, with collagen coating 74%, and with nNitrite-nGH-collagen conjugate coating 83-119%. In the absence of endothelial cells, platelet adhesion was stimulated after collagen coating by 1.3-fold, but inhibited after nNitrite-nGH-collagen conjugate coating by 1.6-3.7-fold. The release of anti-thrombotic prostaglandin I 2 from endothelial cells was stimulated after nNitrite-nGH-collagen conjugate coating by 1.7-2.2-fold compared with collagen coating. Our data shows improved endothelialization and blood compatibility using nNitrite-nGH-collagen conjugate coating on silicone tubes suggesting that these coatings are highly suitable

  11. [From symptomatic stability to functional recovery in the pharmacological treatment of schizophrenia and unipolar depression].

    Science.gov (United States)

    Wikinski, Silvia

    2009-01-01

    This work summarizes the efficacy of pharmacotherapy in the chronic course of schizophrenia and unipolar depresion. It is aimed to answer three questions: does it cure these diseases? Does it exert any significant effect on the symptomatic presentation of the disorders? Which is its action on the social dysfunction provoked by schizophrenia or depression? A conceptual analysis of available bibliography was performed. It could be concluded that antypsychotics improve the symptomatic course of schizophrenia, although their efficacy is limited, and that these drugs does not act on the social dysfunction provoked by the disease. With respect to depression, it could be concluded that a significant proportion of patients remain symptomatic despite receiveng adequate treatments. No data about efficacy of pharmacotherapy on the dysfunction resultant from unipolar depression is available.

  12. Palliative radiotherapy for symptomatic osseous metastases

    International Nuclear Information System (INIS)

    Shigematsu, Naoyuki; Ito, Hisao; Toya, Kazuhito; Ko, Weijey; Kutsuki, Shouji; Tsukamoto, Nobuhiro; Kubo, Atsushi; Dokiya, Takushi; Yorozu, Atsunori.

    1995-01-01

    Bone matastases are one of the most common and serious conditions requiring radiotherapy, but there is still a considerable lack of agreement on optimal radiation schedule. We analyzed patients with symptomatic osseous matastases from lung (72 patients) and breast (63 patients) carcinoma treated by palliative radiotherapy between 1983 and 1992. In this series, the incidences of symptomatic bone metastases appearing within 2 years after the first diagnosis of the primary lesion were 96% and 36% for lung and breast carcinomas, respectively. Thirty percent of bone metastases from breast carcinoma were diagnosed more than 5 years after the first diagnosis. Thus careful follow-up must be carried out for a prolonged period. Pain relief was achieved at almost the same rate for bone metastases from lung and breast carcinomas (81% and 85%, respectively), an the rapid onset of pain relief (15 Gy or less) was obtained in about half the patients for both diseases. The rapid onset of pain relief and the lack of association between the onset of pain relief and primary tumor argued against the conventional theory that tumor shrinkage is a component of the initial response. In contrast to the fact that almost all lung carcinoma patients had very poor prognoses, one third of the breast carcinoma patients were alive more than 2 years after palliative radiotherapy. Thust, the late effects of radiation, such as radiation myelopathy, must be always considered especially in breast carcinoma patients even when it is 'just' palliative radiotherapy for bone metastases. (author)

  13. Symptomatic subsyndromal depression in hospitalized hypertensive patients.

    Science.gov (United States)

    Chiaie, Roberto Delle; Iannucci, Gino; Paroli, Marino; Salviati, Massimo; Caredda, Maria; Pasquini, Massimo; Biondi, Massimo

    2011-12-01

    Clinicians generally agree on the association between depression and hypertension. Less clear is if the nature of the link is direct or indirect and if this should be considered confined only to syndromal forms or if it concerns also subsyndromal affective presentations. This study investigated the nature of the association between hypertension and subsyndromal depression in hospitalized hypertensive patients. 196 hypertensive and 96 non hypertensive inpatients underwent a SCID interview, to exclude patients positive for any Axis I or Axis II diagnosis. Symptomatic Subsyndromal Depression (SSD) was identified according to criteria proposed by Judd. Psychopathological assessment was performed with Anxiety Sensitivity Index (ASI) and Hopkins Symptom Checklist-90 (SCL-90). Clinical assessments included blood pressure measurement, evaluation of general health conditions and screening cardiovascular risk factors (smoke, alcohol, body weight, sedentary life style). Hypertensives met more frequently criteria for SSD. They also scored higher on ASI and SCL-90. However, those with more severe physical conditions, if compared with more healthy patients, did not show increased psychopathological severity. Similarly, psychopathological symptom severity did not differ among hypertensives positive for other cardiovascular risk factors, commonly more frequent among depressed subjects. Further analyses are needed to explore the potential advantage obtained on blood pressure control by treating SSD. Hospitalized hypertensives, more frequently satisfied criteria for Symptomatic Subsyndromal Depression. These milder affective forms are probably directly linked to the presence of hypertension, rather than being indirectly associated to physical impairment or to higher prevalence of other cardiovascular risk factors. Copyright © 2011. Published by Elsevier B.V.

  14. Radiological features of a symptomatic splenic hamartoma

    International Nuclear Information System (INIS)

    Thompson, S.E.; Walsh, E.A.; Cramer, B.C.; Pushpanathan, C.C.; Hollett, P.; Ingram, L.; Price, D.

    1996-01-01

    Symptomatic splenic hamartomas are rare in the pediatric age group, with only four previous reports in the literature. Splenic hamartoma has been reported as a solid homogeneous mass without calcification on CT and ultrasound (US), and only one previous report of the findings on MRI has been published. We report a case of a large symptomatic splenic hamartoma in a 14-year-old girl who presented with splenomegaly, pancytopenia and growth retardation. A solid mass with multiple punctate foci resembling calcifications was seen on US. The mass was heterogeneous and better demarcated on enhanced CT. Radiocolloid scintigraphy demonstrated uptake within the lesion, but less than that of normal spleen. The mass was isointense relative to normal splenic tissue on T1-weighted MRI (0.5 T) and of increased intensity with T2 weighting. At splenectomy, a red pulp hamartoma was identified, which contained nodules of hyalinization and necrosis thought to account for the punctate foci seen on US. (orig.). With 4 figs

  15. Review of acute symptomatic urolithiasis in Auckland.

    Science.gov (United States)

    Loeff, Stephanie; Saluja, Manmeet; Rice, Michael

    2018-02-02

    To evaluate the incidence of acute symptomatic urolithiasis in the Auckland region. Associated epidemiological factors and stone characteristics were also studied and compared to previous research conducted in order to analyse trends. All patients that presented acutely with symptomatic urolithiasis to the Auckland District Health Board (AHDB) between July 2014 and June 2015 were studied. Clinical data was obtained from medical records and population data was based on estimates provided by the Ministry of Health. Two-tailed tests and the Pearson Chi-Square tests were used for analysis. Overall, 1,125 patients (1,328 events) presented with an incidence of 85 per 100,000 per year, which was lower than that reported in 2006. The highest incidence was found among the Middle Eastern ethnic subgroup (0.130 %), followed by Māori (0.102%), Asian (0.087%), European (0.084%) and Pacific (0.041%) ethnicity. Males were more likely to be affected than females. Urolithiasis was most common in the fifth decade of life (25%). Forty-seven percent of the study population presented with multiple stones and 64% had recurrent urolithiasis or were 'high risk' stone formers. Distal ureteric stones Auckland. This deviation could be attributed to the large influx of Asian immigrants observed in this period of time. A caucasian male, between 40-49 years, with a calculus <5mm in the distal ureter with a history of a previous urolithiasis has the highest chance to present with renal colic.

  16. Radiological features of a symptomatic splenic hamartoma

    Energy Technology Data Exchange (ETDEWEB)

    Thompson, S.E. [Department of Radiology, Janeway Child Health Centre and Memorial University of Newfoundland, Janeway Place, St. John`s, NF A1A 1R8 (Canada); Walsh, E.A. [Department of Radiology, Janeway Child Health Centre and Memorial University of Newfoundland, Janeway Place, St. John`s, NF A1A 1R8 (Canada); Cramer, B.C. [Department of Radiology, Janeway Child Health Centre and Memorial University of Newfoundland, Janeway Place, St. John`s, NF A1A 1R8 (Canada); Pushpanathan, C.C. [Department of Pathology, Janeway Child Health Centre and Memorial University of Newfoundland, St. John`s, NF (Canada); Hollett, P. [Department of Nuclear Medicine, Health Sciences Centre and Memorial University of Newfoundland, St. John`s, NF (Canada); Ingram, L. [Department of Pediatrics, Janeway Child Health Centre and Memorial University of Newfoundland, St. John`s, NF (Canada); Price, D. [Department of Surgery, Janeway Child Health Centre and Memorial University of Newfoundland, St. John`s, NF (Canada)

    1996-09-01

    Symptomatic splenic hamartomas are rare in the pediatric age group, with only four previous reports in the literature. Splenic hamartoma has been reported as a solid homogeneous mass without calcification on CT and ultrasound (US), and only one previous report of the findings on MRI has been published. We report a case of a large symptomatic splenic hamartoma in a 14-year-old girl who presented with splenomegaly, pancytopenia and growth retardation. A solid mass with multiple punctate foci resembling calcifications was seen on US. The mass was heterogeneous and better demarcated on enhanced CT. Radiocolloid scintigraphy demonstrated uptake within the lesion, but less than that of normal spleen. The mass was isointense relative to normal splenic tissue on T1-weighted MRI (0.5 T) and of increased intensity with T2 weighting. At splenectomy, a red pulp hamartoma was identified, which contained nodules of hyalinization and necrosis thought to account for the punctate foci seen on US. (orig.). With 4 figs.

  17. The Kuwait-Scotland eHealth Innovation Network (KSeHIN): a sustainable approach to quality improvement in healthcare.

    Science.gov (United States)

    Conway, N T; Wotayan, R Al; Alkuzam, A; Al-Refaei, F F; Badawi, D; Barake, R; Bell, A; Boyle, G; Chisholm, S; Connell, J; Emslie-Smith, A; Goddard, C A; Greene, S A; Halawa, N; Judson, A; Kelly, C; Ker, J; Scott, M; Shaltout, A; Sukkar, F; Wake, D; Morris, A; Sibbald, D; Behbehani, K

    2014-01-01

    The rising prevalence of obesity and diabetes in Kuwait represents a significant challenge for the country's healthcare system. Diabetes care in Scotland has improved by adopting a system of managed clinical networks supported by a national informatics platform. In 2010, a Kuwait-Dundee collaboration was established with a view to transforming diabetes care in Kuwait. This paper describes the significant progress that has been made to date. The Kuwait-Scotland eHealth Innovation Network (KSeHIN) is a partnership among health, education, industry and government. KSeHIN aims to deliver a package of clinical service development, education (including a formal postgraduate programme and continuing professional development) and research underpinned by a comprehensive informatics system. The informatics system includes a disease registry for children and adults with diabetes. At the patient level, the system provides an overview of clinical and operational data. At the population level, users view key performance indicators based on national standards of diabetes care established by KSeHIN. The national childhood registry (CODeR) accumulates approximately 300 children a year. The adult registry (KHN), implemented in four primary healthcare centres in 2013, has approximately 4000 registered patients, most of whom are not yet meeting national clinical targets. A credit-bearing postgraduate educational programme provides module-based teaching and workplace-based projects. In addition, a new clinical skills centre provides simulator-based training. Over 150 masters students from throughout Kuwait are enrolled and over 400 work-based projects have been completed to date. KSeHIN represents a successful collaboration between multiple stakeholders working across traditional boundaries. It is targeting patient outcomes, system performance and professional development to provide a sustainable transformation in the quality of diabetes healthcare for the growing population of

  18. Cost and sustainability of a successful package of interventions to improve vaccination coverage for children in urban slums of Bangladesh.

    Science.gov (United States)

    Hayford, K; Uddin, M J; Koehlmoos, T P; Bishai, D M

    2014-04-25

    To estimate the incremental economic costs and explore satisfaction with a highly effective intervention for improving immunization coverage among slum populations in Dhaka, Bangladesh. A package of interventions based on extended clinic hours, vaccinator training, active surveillance, and community participation was piloted in two slum areas of Dhaka, and resulted in an increase in valid fully immunized children (FIC) from 43% pre-intervention to 99% post-intervention. Cost data and stakeholder perspectives were collected January-February 2010 via document review and 10 key stakeholders interviews to estimate the financial and opportunity costs of the intervention, including uncompensated time, training and supervision costs. The total economic cost of the 1-year intervention was $18,300, comprised of external management and supervision (73%), training (11%), coordination costs (1%), uncompensated staff time and clinic costs (2%), and communications, supplies and other costs (13%). An estimated 874 additional children were correctly and fully immunized due to the intervention, at an average cost of $20.95 per valid FIC. Key stakeholders ranked extended clinic hours and vaccinator training as the most important components of the intervention. External supervision was viewed as the most important factor for the intervention's success but also the costliest. All stakeholders would like to reinstate the intervention because it was effective, but additional funding would be needed to make the intervention sustainable. Targeting slum populations with an intensive immunization intervention was highly effective but would nearly triple the amount spent on immunization per FIC in slum areas. Those committed to increasing vaccination coverage for hard-to-reach children need to be prepared for substantially higher costs to achieve results. Copyright © 2014. Published by Elsevier Ltd.

  19. Improvements in Cycling Time Trial Performance Are Not Sustained Following the Acute Provision of Challenging and Deceptive Feedback

    Directory of Open Access Journals (Sweden)

    Hollie S Jones

    2016-09-01

    Full Text Available TThe provision of performance-related feedback during exercise is acknowledged as an influential external cue used to inform pacing decisions. The provision of this feedback in a challenging or deceptive context allows research to explore how feedback can be used to improve performance and influence perceptual responses. However, the effects of deception on both acute and residual responses have yet to be explored, despite potential application for performance enhancement. Therefore, this study investigated the effects of challenging and deceptive feedback on perceptual responses and performance in self-paced cycling time trials (TT and explored whether changes in performance are sustained in a subsequent TT following the disclosure of the deception.Seventeen trained male cyclists were assigned to either an accurate or deceptive feedback group and performed four 16.1 km cycling TTs; 1 and 2 ride-alone baseline TTs where a fastest baseline (FBL performance was identified, 3 a TT against a virtual avatar representing 102% of their FBL performance (PACER, and 4 a subsequent ride-alone TT (SUB. The deception group, however, were initially informed that the avatar accurately represented their FBL, but prior to SUB were correctly informed of the nature of the avatar. Affect, self-efficacy and RPE were measured every quartile. Both groups performed PACER faster than FBL and SUB (p < 0.05 and experienced lower affect (p = 0.016, lower self-efficacy (p = 0.011, and higher RPE (p < 0.001 in PACER than FBL. No significant differences were found between FBL and SUB for any variable. The presence of the pacer rather than the manipulation of performance beliefs acutely facilitates TT performance and perceptual responses. Revealing that athletes’ performance beliefs were falsely negative due to deceptive feedback provision has no effect on subsequent perceptions or performance. A single experiential exposure may not be sufficient to produce meaningful

  20. Using the D-DANP-mV Model to Explore the Continuous System Improvement Strategy for Sustainable Development of Creative Communities.

    Science.gov (United States)

    Xiong, Lei; Teng, Cheng-Lein; Zhu, Bo-Wei; Tzeng, Gwo-Hshiung; Huang, Shan-Lin

    2017-10-27

    With globalization, the notion of "creative city" has become a core concept of many cities in the world development policies, with real properties being upgraded or used to change, renewal is being conducted, and creative industries are emerging. This trend has reached its peak in the past decade, with different forms and scales gathering global development momentum among the creative communities to promote the development of creative economies. In recent years, however, there was still skepticism about the sustainability of the current creative communities. Many scholars have pointed out that signs of unsustainability have begun to appear in many creative communities. To overcome these obstacles, the development of rational and highly effective improvement strategy requires a dynamic thinking process. Therefore, this study employs the DEMATEL-based ANP with modified VIKOR (D-DANP-mV) model in presenting an assessment framework for the sustainability of creative communities. This system is used to assess the sustainability of current creative communities and determine how to solve their problems. Thus, continuous and systemic improvement strategies can be developed to achieve the aim of sustainable development. Two creative communities in Taiwan, Taichung Cultural and Creative Industries Park (TCCIP), and Shen-Ji New Village (SJNV), are used as case studies in this study. Based on the concept of systematic improvement from fundamental issues, the results indicate that the improvement priorities can be determined by applying the D-DANP-mV model. This approach is different from those found by a conventional method with the hypothesis of independent criteria (e.g., diversification of creative talents in TCCIP), and cannot use for performance improvement (e.g., only can be used for ranking and selection among alternatives). Considering these points, unreasonable premises, biased errors, and lack of some real application functions in the process of resource allocation

  1. Using the D-DANP-mV Model to Explore the Continuous System Improvement Strategy for Sustainable Development of Creative Communities

    Science.gov (United States)

    Xiong, Lei; Teng, Cheng-Lein; Zhu, Bo-Wei; Tzeng, Gwo-Hshiung; Huang, Shan-Lin

    2017-01-01

    With globalization, the notion of “creative city” has become a core concept of many cities in the world development policies, with real properties being upgraded or used to change, renewal is being conducted, and creative industries are emerging. This trend has reached its peak in the past decade, with different forms and scales gathering global development momentum among the creative communities to promote the development of creative economies. In recent years, however, there was still skepticism about the sustainability of the current creative communities. Many scholars have pointed out that signs of unsustainability have begun to appear in many creative communities. To overcome these obstacles, the development of rational and highly effective improvement strategy requires a dynamic thinking process. Therefore, this study employs the DEMATEL-based ANP with modified VIKOR (D-DANP-mV) model in presenting an assessment framework for the sustainability of creative communities. This system is used to assess the sustainability of current creative communities and determine how to solve their problems. Thus, continuous and systemic improvement strategies can be developed to achieve the aim of sustainable development. Two creative communities in Taiwan, Taichung Cultural and Creative Industries Park (TCCIP), and Shen-Ji New Village (SJNV), are used as case studies in this study. Based on the concept of systematic improvement from fundamental issues, the results indicate that the improvement priorities can be determined by applying the D-DANP-mV model. This approach is different from those found by a conventional method with the hypothesis of independent criteria (e.g., diversification of creative talents in TCCIP), and cannot use for performance improvement (e.g., only can be used for ranking and selection among alternatives). Considering these points, unreasonable premises, biased errors, and lack of some real application functions in the process of resource

  2. Using the D-DANP-mV Model to Explore the Continuous System Improvement Strategy for Sustainable Development of Creative Communities

    Directory of Open Access Journals (Sweden)

    Lei Xiong

    2017-10-01

    Full Text Available With globalization, the notion of “creative city” has become a core concept of many cities in the world development policies, with real properties being upgraded or used to change, renewal is being conducted, and creative industries are emerging. This trend has reached its peak in the past decade, with different forms and scales gathering global development momentum among the creative communities to promote the development of creative economies. In recent years, however, there was still skepticism about the sustainability of the current creative communities. Many scholars have pointed out that signs of unsustainability have begun to appear in many creative communities. To overcome these obstacles, the development of rational and highly effective improvement strategy requires a dynamic thinking process. Therefore, this study employs the DEMATEL-based ANP with modified VIKOR (D-DANP-mV model in presenting an assessment framework for the sustainability of creative communities. This system is used to assess the sustainability of current creative communities and determine how to solve their problems. Thus, continuous and systemic improvement strategies can be developed to achieve the aim of sustainable development. Two creative communities in Taiwan, Taichung Cultural and Creative Industries Park (TCCIP, and Shen-Ji New Village (SJNV, are used as case studies in this study. Based on the concept of systematic improvement from fundamental issues, the results indicate that the improvement priorities can be determined by applying the D-DANP-mV model. This approach is different from those found by a conventional method with the hypothesis of independent criteria (e.g., diversification of creative talents in TCCIP, and cannot use for performance improvement (e.g., only can be used for ranking and selection among alternatives. Considering these points, unreasonable premises, biased errors, and lack of some real application functions in the process of

  3. Sustained exercise-trained juvenile black carp (Mylopharyngodon piceus at a moderate water velocity exhibit improved aerobic swimming performance and increased postprandial metabolic responses

    Directory of Open Access Journals (Sweden)

    Xiuming Li

    2018-02-01

    Full Text Available The objectives of this study were to examine whether sustained exercise training at four water velocities, i.e. nearly still water (control, 1 body length (BL s−1, 2 BL s−1 and 4 BL s−1, has effects on swimming performance and digestive metabolism in juvenile black carp (Mylopharyngodon piceus. The results demonstrated that fish subjected to sustained training at 2 and 4 BL s−1 showed significantly higher critical swimming speed (Ucrit and maximum metabolic rate (MMR over the control group. Fish subjected to sustained training at 1 and 2 BL s−1 showed a significantly (30 and 54% prolonged duration, 14 and 17% higher postprandial ṀO2 increment (i.e. ṀO2peak, and 62 and 92% more energy expended on specific dynamic action (SDA, respectively, after consuming a similar meal over fish kept in nearly still water. These results suggest that (1 sustained exercise training at a higher speed (2 or 4 BL s−1 had a positive influence on the aerobic swimming performance of juvenile M. piceus, which may be associated with improved aerobic metabolism; and (2 sustained exercise training at a lower speed (1 or 2 BL s−1 resulted in elevated postprandial metabolic responses in juvenile M. piceus.

  4. Symptomatic Primary (AL Amyloidosis of the Stomach and Duodenum

    Directory of Open Access Journals (Sweden)

    Reidar Fossmark

    2013-01-01

    Full Text Available Primary (AL amyloidosis of the gastrointestinal tract is relatively rare, and symptomatic amyloidosis of the stomach is even more seldom. We present the case of a patient who was referred to upper endoscopy because of weight loss, nausea, and vomiting. Large areas of intramucosal hemorrhages were seen, and biopsies resulted in profuse bleeding stopped with endoscopic clips. The biopsies showed amyloid depositions and further workup revealed that the patient also had cardiac and neuropathic involvements. The patient started treatment with dexamethasone, melphalan and bortezomib. After treatment was started the nausea and epigastric discomfort improved, and a reduction in the biochemical markers troponin T, NT-proBNP, and M-component was observed. Gastric amyloidosis is rarely seen at upper endoscopy in patients without a previously established diagnosis, but the unusual endoscopic findings and bleeding tendency after biopsy should be kept in mind by gastroenterologists.

  5. Current management of symptomatic intracranial stenosis.

    Science.gov (United States)

    Taylor, Robert A; Weigele, John B; Kasner, Scott E

    2011-08-01

    Intracranial arterial stenosis (IAS) is the cause of about 10% of all ischemic strokes in the United States, but may account for about 40% of strokes in some populations. After a stroke or transient ischemic attack due to IAS, patients face a 12% annual risk of recurrent stroke on medical therapy, with most strokes occurring in the first year. Warfarin is no better than aspirin in preventing recurrent strokes but poses a higher risk of serious bleeding and death. Groups with the highest risk of recurrent stroke are those with high-grade (≥ 70%) stenosis, those with recent symptom onset, those with symptoms precipitated by hemodynamic maneuvers, and women. Endovascular treatment of IAS is a rapidly evolving therapeutic option. Antiplatelet agents are currently recommended as the primary treatment for symptomatic IAS, with endovascular therapy reserved for appropriate high-risk cases refractory to medical therapy.

  6. Subsyndromal symptomatic depression: a new concept.

    Science.gov (United States)

    Sadek, N; Bona, J

    2000-01-01

    Although DSM-IV acknowledged the clinical significance of some subthreshold forms of unipolar depression, such as minor depression (MinD) and recurrent brief depression (RBD), clinicians continued to struggle with the concept of "subthreshold" depression. A substantial number of patients continued to present with depressive symptoms that still did not satisfy any DSM-IV diagnosis. Generally, these patients failed to complain of anhedonia and depressed mood, a criterion that DSM-IV mandates for any diagnosis of depression. Therefore, researchers reexamined the question of whether this cluster of depressive symptoms, in the absence of anhedonia and depressed mood, was clinically significant. Some researchers labeled this cluster of symptoms, "subsyndromal symptomatic depression" (SSD). Specifically, SSD is defined as a depressive state having two or more symptoms of depression of the same quality as in major depression (MD), excluding depressed mood and anhedonia. The symptoms must be present for more than 2 weeks and be associated with social dysfunction. Using Medline Search, the authors reviewed the literature on the epidemiology, demographics, clinical characteristics, and psychosocial impairment of SSD. SSD is found to be comparable in demographics and clinical characteristics to MD, MinD, and dysthymia. SSD is also associated with significant psychosocial dysfunction as compared with healthy subjects. Further; it has significant risk for suicide and future MD. Few studies have been conducted on the treatment of SSD. The high prevalence of SSD, the significant psychosocial impairment associated with it, and the chronicity of its course make subsyndromal symptomatic depression a matter for serious consideration by clinicians and researchers.

  7. Alternative treatment of symptomatic pancreatic fistula.

    Science.gov (United States)

    Wiltberger, Georg; Schmelzle, Moritz; Tautenhahn, Hans-Michael; Krenzien, Felix; Atanasov, Georgi; Hau, Hans-Michael; Moche, Michael; Jonas, Sven

    2015-06-01

    The management of symptomatic pancreatic fistula after pancreaticoduodenectomy is complex and associated with increased morbidity and mortality. We here report continuous irrigation and drainage of the pancreatic remnant to be a feasible and safe alternative to total pancreatectomy. Between 2005 and 2011, patients were analyzed, in which pancreaticojejunal anastomosis was disconnected because of grade C fistula, and catheters for continuous irrigation and drainage were placed close to the pancreatic remnant. Clinical data were monitored and quality of life was evaluated. A total of 13 of 202 patients undergoing pancreaticoduodenectomy required reoperation due to symptomatic pancreatic fistula. Ninety-day mortality of these patients was 15.3%. Median length of stay on the intensive care unit and total length of stay was 18 d (range 3-45) and 46 d (range 33-96), respectively. Patients with early reoperation (<10 d) had significantly decreased length of stay on the intensive care unit and operation time (P < 0.05). Global health status after a median time of 22 mo (range 6-66) was nearly identical, when compared with that of a healthy control group. Mean follow-up was 44.4 mo (±27.2). Four patients (36.6 %) died during the follow-up period; two patients from tumor recurrence, one patient from pneumonia, and one patient for unknown reasons. Treatment of pancreatic fistula by continuous irrigation and drainage of the preserved pancreatic remnant is a simple and feasible alternative to total pancreatectomy. This technique maintains a sufficient endocrine function and is associated with low mortality and reasonable quality of life. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Sustainable energy development strategies in the rural Thailand: The case of the improved cooking stove and the small biogas digester

    Energy Technology Data Exchange (ETDEWEB)

    Limmeechokchai, Bundit [Sirindhorn International Institute of Technology, Thammasat University, P.O. Box 22 Thammasat Rangsit Post Office, Pathumthani 12121 (Thailand); Chawana, Saichit [The Joint Graduate School of Energy and Environment, King Mongkut' s University of Technology Thonburi, Bangkok 10140 (Thailand)

    2007-06-15

    This paper presents the strategies to overcome barriers to the adoption of improved cooking stove (ICS) and small biogas digester (SBD) technologies in Thailand. Firstly, to obtain the appropriate strategies to implement the ICS and the SBD, a pattern of energy consumption in the residential sector is investigated. Then the potential of reduction of energy consumption and corresponding emissions by the ICS and the SBD is assessed. The identification and ranking of barriers to the adoption of the ICS and the SBD technologies are also investigated. In this study the Long-range Energy Alternatives Planning System (LEAP) model is used to assess the energy consumption and the corresponding emissions reduction. Then, the Analytic Hierarchy Process (AHP) model is used to identify and rank the barriers. Results from the LEAP model show that the cumulative total energy consumption and corresponding emissions reductions during the period 2002-2030 by the ICS are 27,887.7 ktoe and 10,041.0 thousand tonnes of CO{sub 2} equivalent, respectively. An average emissions reduction cost per tonne of CO{sub 2} equivalent per year is US$ 0.95 for a fuel wood cooking stove and US$ 0.35 for a charcoal cooking stove. Regarding the SBD, the cumulative total liquefied petroleum gas (LPG) consumption reduction and CO{sub 2} mitigation are 5780.9ktoe and 1548.8 thousand tonnes of CO{sub 2} equivalent during the period 2002-2030, respectively. Results from AHP analysis of ranking of barriers show that the three most important barriers in the adoption of the ICS are (i) high investment cost, (ii) lack of information, and (iii) lack of financial sources. For the SBD, the three most important barriers are (i) high investment cost, (ii) lack of financial sources, and (iii) lack of experts and skilled manpower. The sustainable energy triangle strategy (SETS) is implemented to overcome barriers in the adoption of the ICS. Results show that the traditional cooking stoves are successfully replaced

  9. Estimating the clinical and economic benefit associated with incremental improvements in sustained virologic response in chronic hepatitis C.

    Science.gov (United States)

    McEwan, Phil; Ward, Thomas; Bennett, Hayley; Kalsekar, Anupama; Webster, Samantha; Brenner, Michael; Yuan, Yong

    2015-01-01

    Hepatitis C virus (HCV) infection is one of the principle causes of chronic liver disease. Successful treatment significantly decreases the risk of hepatic morbidity and mortality. Current standard of care achieves sustained virologic response (SVR) rates of 40-80%; however, the HCV therapy landscape is rapidly evolving. The objective of this study was to quantify the clinical and economic benefit associated with increasing levels of SVR. A published Markov model (MONARCH) that simulates the natural history of hepatitis C over a lifetime horizon was used. Discounted and non-discounted life-years (LYs), quality-adjusted life-years (QALYs) and cost of complication management were estimated for various plausible SVR rates. To demonstrate the robustness of projections obtained, the model was validated to ten UK-specific HCV studies. QALY estimates ranged from 18.0 years for those treated successfully in fibrosis stage F0 to 7.5 years (discounted) for patients in fibrosis stage F4 who remain untreated. Predicted QALY gains per 10% improvement in SVR ranged from 0.23 (F0) to 0.64 (F4) and 0.58 (F0) to 1.35 (F4) in 40 year old patients (discounted and non-discounted results respectively). In those aged 40, projected discounted HCV-related costs are minimised with successful treatment in F0/F1 (at approximately £ 300), increasing to £ 49,300 in F4 patients who remain untreated. Validation of the model to published UK cost-effectiveness studies produce R2 goodness of fit statistics of 0.988, 0.978 and of 0.973 for total costs, QALYs and incremental cost effectiveness ratios, respectively. Projecting the long-term clinical and economic consequences associated with chronic hepatitis C is a necessary requirement for the evaluation of new treatments. The principle analysis demonstrates the significant impact on expected costs, LYs and QALYs associated with increasing SVR. A validation analysis demonstrated the robustness of the results reported.

  10. Factors associated with sustainability of 2 quality improvement programs after achieving early implementation success. A qualitative case study.

    Science.gov (United States)

    Ament, Stephanie M C; Gillissen, Freek; Moser, Albine; Maessen, José M C; Dirksen, Carmen D; von Meyenfeldt, Maarten F; van der Weijden, Trudy

    2017-12-01

    Sustainability of innovations is a relatively new concept in health care research and has become an issue of growing interest. The current study explored factors related to the sustainability of 2 multidisciplinary hospital-based programs 3 to 6 years after achieving early implementation success. An exploratory qualitative study was conducted into 2 implementation cases, an Enhanced Recovery After Surgery program for colorectal surgery and a short-stay program for breast cancer surgery. Semistructured interviews were held with key persons involved in the care process in 14 hospitals from both cases minimally 3 years after the implementation, between March 2012 and May 2013. The Consolidated Framework for Implementation Research was used to direct the development of the interview guide, during data collection and during analysis. A directed content analysis was performed. A total of 21 interviews with 26 individuals were held, 18 regarding the Enhanced Recovery After Surgery case and 8 regarding the short-stay program case. Respondents mentioned the following factors associated with sustainability of the programs: modification and adaptability of the program, cost-effectiveness, institutionalization into existing systems, short communication lines within the multidisciplinary team, an innovative culture, benefits for patients, cosmopolitanism, the existence of external policies and incentives, trust and belief in the program, and spread of the program to other settings. Two factors are not covered by the Consolidated Framework for Implementation Research, ie, modification of the program over the years and spread of the program to other contexts. The factors associated with sustainability put forward in both cases were largely the same. Leadership and the implementation project were not mentioned as having influenced the long-term sustainability of the benefits achieved. Sustainability of the innovations is influenced by determinants stemming from all ecological

  11. Old women with a recent fall history show improved muscle strength and function sustained for six months after finishing training

    DEFF Research Database (Denmark)

    Beyer, Nina; Simonsen, Lene; Bülow, Jens

    2007-01-01

    Restricted physical activity as a consequence of chronic disease or injury is a predictor of functional decline. The aim of this study was to test the hypothesis that a 6- month multidimensional training program would have sustained beneficial effects upon the physiological, functional and psycho...... and psychological condition of old women with a recent history of falls.......Restricted physical activity as a consequence of chronic disease or injury is a predictor of functional decline. The aim of this study was to test the hypothesis that a 6- month multidimensional training program would have sustained beneficial effects upon the physiological, functional...

  12. Improving exergetic and sustainability parameters of a DI diesel engine using polymer waste dissolved in biodiesel as a novel diesel additive

    International Nuclear Information System (INIS)

    Aghbashlo, Mortaza; Tabatabaei, Meisam; Mohammadi, Pouya; Pourvosoughi, Navid; Nikbakht, Ali M.; Goli, Sayed Amir Hossein

    2015-01-01

    Highlights: • Exergy analysis of diesel engine fuelled with various SBE biodiesel–diesel blends containing EPS. • Profound effect of engine speed and load on exergetic performance parameters of diesel engine. • Selection of B5 containing 50 g EPS/L biodiesel as the best mixture. • Potential application of the applied framework for optimizing sustainability index of IC engines. - Abstract: Exergy analysis of a DI diesel engine running on several biodiesel/diesel blends (B5) containing various quantities of expanded polystyrene (EPS) was carried out. Neat diesel and B5 were also investigated during the engine tests. The biodiesel used was produced using waste oil extracted from spend bleaching earth (SBE). The experiments were conducted to assess the effects of fuel type, engine speed, and load on thermal efficiency, exergetic parameters, and sustainability index of the diesel engine. The obtained results revealed that the exergetic parameters strongly depended on the engine speed and load. Generally, increasing engine speed remarkably decreased the exergy efficiency and sustainability index of the diesel engine. However, increasing engine load initially enhanced the exergy efficiency and sustainability index, while its further augmentation did not profoundly affect these parameters. The maximum exergy efficiency and sustainability index of the diesel engine (i.e. 40.21% and 1.67, respectively) were achieved using B5 containing 50 g EPS/L biodiesel. Generally, the approach presented herein could be a promising strategy for energy recovery from polymer waste, emissions reduction, and performance improvement. The findings of the present study also confirmed that exergy analysis could be employed to minimize the irreversibility and losses occurring in modern engines and to enhance the sustainability index of combustion processes.

  13. Sustainability of a Community-Based CHOICE Program to Improve the Health and Nutrition Status of Mothers and Infants in Indonesia.

    Science.gov (United States)

    Eder, Clara; Khatiwada, Lila Kumar; Schooley, Janine

    2018-02-10

    Objectives Few studies have been undertaken to determine whether and how project results are sustained. University of Notre Dame (ND) and Project Concern International conducted a Post-Project Sustainability Study (PSS) of a USAID-funded program (CHOICE), implemented in Indonesia, Banten province, between 2003 and 2007, in order to determine lasting effects and improve PSS methodologies. Methods Sustainability was measured through a comparison of data collected on mother-infant pairs in 2014 with final evaluation data from 2007; and through a comparison of 2014 data collected from the CHOICE villages and comparison villages. Results The analysis showed positive differences in multiple indicators in CHOICE villages between 2007 and 2014, including births attended by skilled personnel (Mean Difference 48.56, 95% CI 38.68 to 58.43) and treatment of diarrhea (MD 16.42, 95% CI - 0.94 to 33.37). However, only one statistically significant difference between intervention and comparison groups in 2014 was observed, infants with diarrhea whose mothers sought advice or treatment (MD - 5.48, 95% CI - 9.55 to 1.39), showing more mothers in intervention group sought advice or treatment. Because contextual factors were not studied in detail and baseline data was not available for the comparison villages, it is difficult to determine the reasons for the results. Given that longitudinal data was not collected, it is also difficult to determine whether results fluctuated between 2007 and 2014. Conclusions for practice This PSS contributes to the limited body of knowledge in sustainability research. Lessons learned from this study will increase potential for sustainable impact of projects, as more rigorous measurement will lead to greater overall understanding of how sustainability actually "happens".

  14. Use of the Crawford tube for symptomatic epiphora without nasolacrimal obstruction

    Directory of Open Access Journals (Sweden)

    Nyu-Xia Tong

    2016-02-01

    Full Text Available AIM: To evaluate the effectiveness of the Crawford tube in treating symptomatic epiphora without nasolacrimal obstruction. METHODS: A protocol was adopted for the management of symptomatic epiphora without nasolacrimal obstruction. Patients who suffered symptomatic epiphora without nasolacrimal obstruction in both eyes were included in the study. One eye was treated with Crawford tube intubation and the other eye was treated with medication therapy. Degree of watering, patient satisfaction, and symptomatic improvement were carefully evaluated by one of the authors at the end of the follow-up period, after Crawford tube removal, to ascertain functional results. RESULTS: Thirty-seven adult patients (37 eyes underwent Crawford tube intubation for functional epiphora. The mean follow-up time after removal of the tube was 14.8±4.8mo. The procedure was an overall success in 28 eyes (75.7%, with symptoms improving significantly. Two eyes (5.4% were relieved of indoor epiphora, two (5.4% had minimal epiphora outdoors, but only with wind or cold, and five (13.5% continued to experience tearing both indoors and outdoors. Thirty of the patients (81% expressed satisfaction with the procedure. CONCLUSION: Crawford tube insertion is an effective, safe, simple, and relatively noninvasive treatment strategy for functional lacrimal system obstruction.

  15. Effects of Combined Training with Breathing Resistance and Sustained Physical Exertion to Improve Endurance Capacity and Respiratory Muscle Function in Healthy Young Adults

    OpenAIRE

    Kido, Satoshi; Nakajima, Yasuhiro; Miyasaka, Tomoya; Maeda, Yusuke; Tanaka, Toshiaki; Yu, Wenwei; Maruoka, Hiroshi; Takayanagi, Kiyomi

    2013-01-01

    [Purpose] In this study, combined training with breathing resistance and sustained physical exertion was carried out to evaluate its physiological effects and its effect on improve endurance capacity. [Subjects and Methods] The subjects were nine healthy adults (mean age 20.4, SD ? 1.7?years). The combined training group (n = 5) carried out 6 weeks of combined training using a cycle ergometer, with exercise load tests and respiratory function tests performed before and after the training. The...

  16. The Impact of Project-Based Learning on Improving Student Learning Outcomes of Sustainability Concepts in Transportation Engineering Courses

    Science.gov (United States)

    Fini, Elham H.; Awadallah, Faisal; Parast, Mahour M.; Abu-Lebdeh, Taher

    2018-01-01

    This paper describes an intervention to enhance students' learning by involving students in brainstorming activities about sustainability concepts and their implications in transportation engineering. The paper discusses the process of incorporating the intervention into a transportation course, as well as the impact of this intervention on…

  17. Improving diet sustainability through evolution of food choices: review of epidemiological studies on the environmental impact of diets.

    Science.gov (United States)

    Perignon, Marlène; Vieux, Florent; Soler, Louis-Georges; Masset, Gabriel; Darmon, Nicole

    2017-01-01

    The Food and Agriculture Organization defines sustainable diets as nutritionally adequate, safe, healthy, culturally acceptable, economically affordable diets that have little environmental impact. This review summarizes the studies assessing, at the individual level, both the environmental impact and the nutritional quality or healthiness of self-selected diets. Reductions in meat consumption and energy intake were identified as primary factors for reducing diet-related greenhouse gas emissions. The choice of foods to replace meat, however, was crucial, with some isocaloric substitutions possibly increasing total diet greenhouse gas emissions. Moreover, nutritional adequacy was rarely or only partially assessed, thereby compromising the assessment of diet sustainability. Furthermore, high nutritional quality was not necessarily associated with affordability or lower environmental impact. Hence, when identifying sustainable diets, each dimension needs to be assessed by relevant indicators. Finally, some nonvegetarian self-selected diets consumed by a substantial fraction of the population showed good compatibility with the nutritional, environmental, affordability, and acceptability dimensions. Altogether, the reviewed studies revealed the scarcity of standardized nationally representative data for food prices and environmental indicators and suggest that diet sustainability might be increased without drastic dietary changes. © The Author(s) 2016. Published by Oxford University Press on behalf of the International Life Sciences Institute.

  18. Approaches to raw sugar quality improvement as a route to sustaining a reliable supply of purified industrial sugar feedstocks

    Science.gov (United States)

    Energy costs in the sugar industry are outstripping costs of manufacture, particularly in refineries. This, as well as increasing transportation costs and the need to meet manufacturers’ tight specifications, has increased the demand for a sustainable supply of purified, raw sugar. Agricultural com...

  19. A Feasibility Study of Sustainable Distributed Generation Technologies to Improve the electrical System on the Duck Valley Reservation

    Energy Technology Data Exchange (ETDEWEB)

    Herman Atkins, Shoshone-Paiute; Mark Hannifan, New West Technologies

    2005-06-30

    A range of sustainable energy options were assessed for feasibility in addressing chronic electric grid reliability problems at Duck Valley IR. Wind power and building energy efficiency were determined to have the most merit, with the Duck Valley Tribes now well positioned to pursue large scale wind power development for on- and off-reservation sales.

  20. Evaluation of Sustained Value Creation with the DOD’s Financial Improvement and Audit Readiness (FIAR) Plan

    Science.gov (United States)

    2006-12-01

    so, can this change effort be sustained over the long-term? Previously published academic frameworks for evaluating public sector organizations will... frameworks for evaluating public sector organizations will be used for each question. Benefits of this study will identify elements of value created...INTENTIONALLY LEFT BLANK xiii GLOSSARY OF ACRONYMS BEA Business Enterprise Architecture BEP Business Enterprise Priority BMMP Business Management

  1. Sustainable Sizing.

    Science.gov (United States)

    Robinette, Kathleen M; Veitch, Daisy

    2016-08-01

    To provide a review of sustainable sizing practices that reduce waste, increase sales, and simultaneously produce safer, better fitting, accommodating products. Sustainable sizing involves a set of methods good for both the environment (sustainable environment) and business (sustainable business). Sustainable sizing methods reduce (1) materials used, (2) the number of sizes or adjustments, and (3) the amount of product unsold or marked down for sale. This reduces waste and cost. The methods can also increase sales by fitting more people in the target market and produce happier, loyal customers with better fitting products. This is a mini-review of methods that result in more sustainable sizing practices. It also reviews and contrasts current statistical and modeling practices that lead to poor fit and sizing. Fit-mapping and the use of cases are two excellent methods suited for creating sustainable sizing, when real people (vs. virtual people) are used. These methods are described and reviewed. Evidence presented supports the view that virtual fitting with simulated people and products is not yet effective. Fit-mapping and cases with real people and actual products result in good design and products that are fit for person, fit for purpose, with good accommodation and comfortable, optimized sizing. While virtual models have been shown to be ineffective for predicting or representing fit, there is an opportunity to improve them by adding fit-mapping data to the models. This will require saving fit data, product data, anthropometry, and demographics in a standardized manner. For this success to extend to the wider design community, the development of a standardized method of data collection for fit-mapping with a globally shared fit-map database is needed. It will enable the world community to build knowledge of fit and accommodation and generate effective virtual fitting for the future. A standardized method of data collection that tests products' fit methodically

  2. Symptomatic relapse of HIV-associated cryptococcal meningitis in ...

    African Journals Online (AJOL)

    Objectives. Cryptococcal meningitis is the most common cause of adult meningitis in southern Africa. Much of this disease burden is thought to be due to symptomatic relapse of previously treated infection. We studied the contribution of inadequate secondary fluconazole prophylaxis to symptomatic relapses of cryptococcal ...

  3. Impulsiveness, overactivity, and poorer sustained attention improve by chronic treatment with low doses of l-amphetamine in an animal model of Attention-Deficit/Hyperactivity Disorder (ADHD).

    Science.gov (United States)

    Sagvolden, Terje

    2011-03-30

    ADHD is currently defined as a cognitive/behavioral developmental disorder where all clinical criteria are behavioral. Overactivity, impulsiveness, and inattentiveness are presently regarded as the main clinical symptoms. There is no biological marker, but there is considerable evidence to suggest that ADHD behavior is associated with poor dopaminergic and noradrenergic modulation of neuronal circuits that involve the frontal lobes. The best validated animal model of ADHD, the Spontaneously Hypertensive Rat (SHR), shows pronounced overactivity, impulsiveness, and deficient sustained attention. The primary objective of the present research was to investigate behavioral effects of a range of doses of chronic l-amphetamine on ADHD-like symptoms in the SHR. The present study tested the behavioral effects of 0.75 and 2.2 mg l-amphetamine base/kg i.p. in male SHRs and their controls, the Wistar Kyoto rat (WKY). ADHD-like behavior was tested with a visual discrimination task measuring overactivity, impulsiveness and inattentiveness. The striking impulsiveness, overactivity, and poorer sustained attention seen during baseline conditions in the SHR were improved by chronic treatment with l-amphetamine. The dose-response curves were, however, different for the different behaviors. Most significantly, the 0.75 mg/kg dose of l-amphetamine improved sustained attention without reducing overactivity and impulsiveness. The 2.2 mg/kg dose improved sustained attention as well as reduced SHR overactivity and impulsiveness. The effects of l-amphetamine to reduce the behavioral symptoms of ADHD in the SHR were maintained over the 14 days of daily dosing with no evidence of tolerance developing.

  4. Understanding water deficit stress-induced changes in the basic metabolism of higher plants - biotechnologically and sustainably improving agriculture and the ecoenvironment in arid regions of the globe.

    Science.gov (United States)

    Shao, Hong-Bo; Chu, Li-Ye; Jaleel, C Abdul; Manivannan, P; Panneerselvam, R; Shao, Ming-An

    2009-01-01

    Water is vital for plant growth, development and productivity. Permanent or temporary water deficit stress limits the growth and distribution of natural and artificial vegetation and the performance of cultivated plants (crops) more than any other environmental factor. Productive and sustainable agriculture necessitates growing plants (crops) in arid and semiarid regions with less input of precious resources such as fresh water. For a better understanding and rapid improvement of soil-water stress tolerance in these regions, especially in the water-wind eroded crossing region, it is very important to link physiological and biochemical studies to molecular work in genetically tractable model plants and important native plants, and further extending them to practical ecological restoration and efficient crop production. Although basic studies and practices aimed at improving soil water stress resistance and plant water use efficiency have been carried out for many years, the mechanisms involved at different scales are still not clear. Further understanding and manipulating soil-plant water relationships and soil-water stress tolerance at the scales of ecology, physiology and molecular biology can significantly improve plant productivity and environmental quality. Currently, post-genomics and metabolomics are very important in exploring anti-drought gene resources in various life forms, but modern agriculturally sustainable development must be combined with plant physiological measures in the field, on the basis of which post-genomics and metabolomics have further practical prospects. In this review, we discuss physiological and molecular insights and effects in basic plant metabolism, drought tolerance strategies under drought conditions in higher plants for sustainable agriculture and ecoenvironments in arid and semiarid areas of the world. We conclude that biological measures are the bases for the solutions to the issues relating to the different types of

  5. Neurological outcomes in symptomatic congenital cytomegalovirus-infected infants after introduction of newborn urine screening and antiviral treatment.

    Science.gov (United States)

    Nishida, Kosuke; Morioka, Ichiro; Nakamachi, Yuji; Kobayashi, Yoko; Imanishi, Takamitsu; Kawano, Seiji; Iwatani, Sota; Koda, Tsubasa; Deguchi, Masashi; Tanimura, Kenji; Yamashita, Daisuke; Nibu, Ken-Ichi; Funakoshi, Toru; Ohashi, Masanobu; Inoue, Naoki; Iijima, Kazumoto; Yamada, Hideto

    2016-02-01

    Newborn screening for urinary cytomegalovirus (CMV) and early introduction of antiviral treatment are expected to improve neurological outcomes in symptomatic congenital CMV-infected infants. This cohort study prospectively evaluated neurological outcomes in symptomatic congenital CMV-infected infants following the introduction of hospital-based newborn urinary CMV screening and antiviral treatment. Following institutional review board approval and written informed consent from their parents, newborns were prospectively screened from 2009 to 2014 for urinary CMV-DNA by PCR within 1 week after birth at Kobe University Hospital and affiliated hospitals. CMV-positive newborns were further examined at Kobe University Hospital, and those diagnosed as symptomatic were treated with valganciclovir for 6 weeks plus immunoglobulin. Clinical neurological outcomes were evaluated at age ⩾12 months and categorized by the presence and severity of neurologic sequelae. Urine samples of 6348 newborns were screened, with 32 (0.50%) positive for CMV. Of these, 16 were diagnosed with symptomatic infection and 12 received antiviral treatment. Four infants developed severe impairment (33%), three developed mild impairment (25%), and five developed normally (42%). This is the first Japanese report of neurological assessments in infants with symptomatic congenital CMV infection who received early diagnosis and antiviral treatment. Urinary screening, resulting in early diagnosis and treatment, may yield better neurological outcomes in symptomatic congenital CMV-infected infants. Copyright © 2015 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  6. Sustained Remission Improves Physical Function in Patients with Established Rheumatoid Arthritis, and Should Be a Treatment Goal

    DEFF Research Database (Denmark)

    Einarsson, Jon Thorkell; Geborek, Pierre; Saxne, Tore

    2016-01-01

    of the strongest predictors of longterm outcomes. The purpose of this study was to investigate the physical function over a long time in patients with RA who achieved sustained remission (SR) compared with that of patients occasionally achieving remission [non-sustained remission (NSR)]. METHODS: Patients with RA...... treated with antitumor necrosis factor and included in the South Swedish Arthritis Treatment Group register were eligible for this study. We identified patients with a Disease Activity Score at 28 joints (DAS28) achieved...... SR, i.e., remission during consecutive visits for at least 6 months. The course of functional status was assessed using the HAQ at each visit. RESULTS: Of the 2416 patients, 1177 (48.7%) reached DAS28 remission at some point. SR was achieved by 382 (15.8%) for the DAS28 and 186 (7.7%) for the SDAI...

  7. Sustainability Evaluation of Power Grid Construction Projects Using Improved TOPSIS and Least Square Support Vector Machine with Modified Fly Optimization Algorithm

    Directory of Open Access Journals (Sweden)

    Dongxiao Niu

    2018-01-01

    Full Text Available The electric power industry is of great significance in promoting social and economic development and improving people’s living standards. Power grid construction is a necessary part of infrastructure construction, whose sustainability plays an important role in economic development, environmental protection and social progress. In order to effectively evaluate the sustainability of power grid construction projects, in this paper, we first identified 17 criteria from four dimensions including economy, technology, society and environment to establish the evaluation criteria system. After that, the grey incidence analysis was used to modify the traditional Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS, which made it possible to evaluate the sustainability of electric power construction projects based on visual angle of similarity and nearness. Then, in order to simplify the procedure of experts scoring and computation, on the basis of evaluation results of the improved TOPSIS, the model using Modified Fly Optimization Algorithm (MFOA to optimize the Least Square Support Vector Machine (LSSVM was established. Finally, a numerical example was given to demonstrate the effectiveness of the proposed model.

  8. TECHNOLOGICAL INNOVATION AND BUSINESS DIVERSIFICATION: SUSTAINABILITY LIVELIHOODS IMPROVEMENT SCENARIO OF RICE FARMER HOUSEHOLD IN SUB-OPTIMAL LAND

    Directory of Open Access Journals (Sweden)

    Adriani D.

    2017-09-01

    Full Text Available The increased role of the sub-optimal land to support food security continue to be encouraged in Indonesia, given the more limited expansion for potential land. But until recently, development of sub-optimal land becomes not an easy thing. Ecological and technical barriers became the main issue. A series of these issues resulted in a high number of underemproleymeny and poverty in agriculture region. Technological inovation of agriculture and the business diversification can be seen be the solution to those issues. This research aims to analyze the impact of the technological innovation and business diversification on underemployment, working time, household income and also sustainable livelihoods of farmers on the sub-optimal land. The research was carried out in Pemulutan District, Ogan Ilir Regency, South Sumatra Province, Indonesia. The objects of research are farmers which adopter and non adopter technological innovation, and also work outside of paddy farming (business diversification. The research method is the survey. Method of sampling is stratified random sampling. Data obtained in the field analyses using descriptive statistics and inferesia. The results showed there are positive impact of technological innovation on the allocation of working time farmer households, the numbers underemployment, household income and livelihood sustainability. Determinant factors for farmers in applying technology and business diversification are paddy farming income, off-farm income, and age. The use of technology and business diversification proves to be one of the positive scenarios for sustainable livelihood of farmers in sub-optimal land.

  9. Assessing the impacts of sustainable agricultural practices for water quality improvements in the Vouga catchment (Portugal) using the SWAT model.

    Science.gov (United States)

    Rocha, João; Roebeling, Peter; Rial-Rivas, María Ermitas

    2015-12-01

    The extensive use of fertilizers has become one of the most challenging environmental issues in agricultural catchment areas. In order to reduce the negative impacts from agricultural activities and to accomplish the objectives of the European Water Framework Directive we must consider the implementation of sustainable agricultural practices. In this study, we assess sustainable agricultural practices based on reductions in N-fertilizer application rates (from 100% to 0%) and N-application methods (single, split and slow-release) across key agricultural land use classes in the Vouga catchment, Portugal. The SWAT model was used to relate sustainable agricultural practices, agricultural yields and N-NO3 water pollution deliveries. Results show that crop yields as well as N-NO3 exportation rates decrease with reductions in N-application rates and single N-application methods lead to lower crop yields and higher N-NO3 exportation rates as compared to split and slow-release N-application methods. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. Acute symptomatic hyponatremia in a flight attendant.

    Science.gov (United States)

    Madero, Magdalena; Monares, Enrique; Domínguez, Aurelio Méndez; Ayus, Juan Carlos

    2015-08-01

    Acute symptomatic hyponatremia after thiazide diuretic initiation is a medical emergency. Here we describe the case of a flight attendant who developed acute hyponatremia during a flight and the potential risk factors for developing this condition. A 57-year-old flight attendant with history of essential hypertension was recently started on a thiazide diuretic. As she did routinely when working, she increased her water intake during a flight from London to Mexico City. She complained of nausea and headache during the flight. Upon arrival, she developed severe disorientation and presented to the hospital emergency room (ER) with a Glasgow scale of 12, hypoxia, and a generalized tonic clonic seizure. Her laboratory results on arrival were consistent with severe hyponatremia (serum Na 116 mEql/L) and severe cerebral edema by CT scan. She was treated with hypertonic saline, with complete resolution of the neurologic symptoms. We describe high water intake and hypoxia related to decreased partial pressure of oxygen in the cabin as the two main risk factors for thiazide-induced acute hyponatremia in this case.

  11. The Council of Academic Hospitals of Ontario (CAHO) Adopting Research to Improve Care (ARTIC) Program: Reach, Sustainability, Spread and Lessons Learned from an Implementation Funding Model.

    Science.gov (United States)

    Moore, Julia E; Grouchy, Michelle; Graham, Ian D; Shandling, Maureen; Doyle, Winnie; Straus, Sharon E

    2016-05-01

    Despite evidence on what works in healthcare, there is a significant gap in the time it takes to bring research into practice. The Council of Academic Hospitals of Ontario's Adopting Research to Improve Care program addresses this research-to-practice gap by incorporating the following components into its funding program: strategic selection of evidence for implementation, education and training for implementation, implementation supports, executive champions and governance, and evaluation. Funded projects have been sustained (76% reported full sustainability) and spread to over 200 new sites. Lessons learned include the following: assess readiness, develop tailored implementation materials, consider characteristics of implementation supports, protect champion time and consider evaluation feasibility. Copyright © 2016 Longwoods Publishing.

  12. Capacity Development and Strengthening for Energy Policy formulation and implementation of Sustainable Energy Projects in Indonesia CASINDO. Deliverable No. 19. Development or improvement of infrastructure for knowledge valorisation

    Energy Technology Data Exchange (ETDEWEB)

    Wijnker, M. [Eindhoven University of Technology TUE, Eindhoven (Netherlands)

    2011-11-15

    The overall objective of the CASINDO programme is to establish a self-sustaining and self-developing structure at both the national and regional level to build and strengthen human capacity to enable the provinces of North Sumatra, Yogyakarta, Central Java, West Nusa Tenggara and Papua to formulate sound policies for renewable energy and energy efficiency and to develop and implement sustainable energy projects. All five universities managed to organise workshops visited each by 30-60 participants. At these workshops the relationship and possibilities for co-operation between university, industry, companies, communities etc. were discussed. In total 13-14 workshops have been organised. Most workshops focussed on a specific topic interesting to both local industry and university. Although the contents, audience and (in-depth) discussions were very different at each university, it can be said that ties with local industry in all regions have been improved.

  13. Integrated clinical and quality improvement coaching in Son La Province, Vietnam: a model of building public sector capacity for sustainable HIV care delivery.

    Science.gov (United States)

    Cosimi, Lisa A; Dam, Huong V; Nguyen, Thai Q; Ho, Huyen T; Do, Phuong T; Duc, Duat N; Nguyen, Huong T; Gardner, Bridget; Libman, Howard; Pollack, Todd; Hirschhorn, Lisa R

    2015-07-17

    The global scale-up of antiretroviral therapy included extensive training and onsite support to build the capacity of HIV health care workers. However, traditional efforts aimed at strengthening knowledge and skills often are not successful at improving gaps in the key health systems required for sustaining high quality care. We trained and mentored existing staff of the Son La provincial health department and provincial HIV clinic to work as a provincial coaching team (PCT) to provide integrated coaching in clinical HIV skills and quality improvement (QI) to the HIV clinics in the province. Nine core indicators were measured through chart extraction by clinic and provincial staff at baseline and at 6 month intervals thereafter. Coaching from the team to each of the clinics, in both QI and clinical skills, was guided by results of performance measurements, gap analyses, and resulting QI plans. After 18 months, the PCT had successfully spread QI activities, and was independently providing regular coaching to the provincial general hospital clinic and six of the eight district clinics in the province. The frequency and type of coaching was determined by performance measurement results. Clinics completed a mean of five QI projects. Quality of HIV care was improved throughout all clinics with significant increases in seven of the indicators. Overall both the PCT activities and clinic performance were sustained after integration of the model into the Vietnam National QI Program. We successfully built capacity of a team of public sector health care workers to provide integrated coaching in both clinical skills and QI across a province. The PCT is a feasible and effective model to spread and sustain quality activities and improve HIV care services in a decentralized rural setting.

  14. Vegetarian diet as a risk factor for symptomatic gallstone disease.

    Science.gov (United States)

    McConnell, T J; Appleby, P N; Key, T J

    2017-06-01

    Previous small studies have shown either no difference or a lower risk of symptomatic gallstone disease in vegetarians than in non-vegetarians. This study examined the incidence of symptomatic gallstone disease in a cohort of British vegetarians and non-vegetarians, and investigated the associations between nutrient intake and risk of symptomatic gallstone disease. The data were analysed from 49 652 adults enroled in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Oxford study, one-third of whom were vegetarian. The linked databases of hospital records were used to identify incident cases. Risk by diet group was estimated using Cox proportional hazards models. Further analysis quantified risk by intakes of selected macronutrients. There were 1182 cases of symptomatic gallstone disease during 687 822 person-years of follow-up (mean=13.85 years). There was a large significant association between increasing body mass index (BMI) and risk of developing symptomatic gallstone disease (overall trend Pvegetarians had a moderately increased risk compared with non-vegetarians (HR: 1.22; 95% CI: 1.06-1.41; P=0.006). Although starch consumption was positively associated with gallstones risk (P=0.002 for trend), it did not explain the increased risk in vegetarians. There is a highly significant association of increased BMI with risk of symptomatic gallstone disease. After adjusting for BMI, there is a small but statistically significant positive association between vegetarian diet and symptomatic gallstone disease.

  15. A meta-analysis of the effect of angiotensin-converting enzyme inhibitors on functional capacity in patients with symptomatic left ventricular systolic dysfunction

    DEFF Research Database (Denmark)

    Abdulla, Jawdat; Abildstrøm, Steen Zabell; Køber, Lars Valeur

    2004-01-01

    AIM: To determine by meta-analysis whether angiotensin-converting enzyme (ACE) inhibitors improve exercise tolerance in patients with symptomatic left ventricular systolic dysfunction (LVSD). METHODS AND RESULTS: After literature search 13 multi-centre double blind parallel group trials that eval......% compared with placebo. CONCLUSION: In addition to the pronounced effect on mortality and morbidity in patients with symptomatic LVSD, ACE inhibitors have improving effect on functional capacity measured as exercise tolerance time....

  16. Grassland Sustainability

    Science.gov (United States)

    Deborah U. Potter; Paulette L. Ford

    2004-01-01

    In this chapter we discuss grassland sustainability in the Southwest, grassland management for sustainability, national and local criteria and indicators of sustainable grassland ecosystems, and monitoring for sustainability at various scales. Ecological sustainability is defined as: [T]he maintenance or restoration of the composition, structure, and processes of...

  17. Leveraging Educational, Research and Facility Expertise to Improve Global Seismic Monitoring: Preparing a Guide on Sustainable Networks

    Science.gov (United States)

    Nybade, A.; Aster, R.; Beck, S.; Ekstrom, G.; Fischer, K.; Lerner-Lam, A.; Meltzer, A.; Sandvol, E.; Willemann, R. J.

    2008-12-01

    Building a sustainable earthquake monitoring system requires well-informed cooperation between commercial companies that manufacture components or deliver complete systems and the government or other agencies that will be responsible for operating them. Many nations or regions with significant earthquake hazard lack the financial, technical, and human resources to establish and sustain permanent observatory networks required to return the data needed for hazard mitigation. Government agencies may not be well- informed about the short-term and long-term challenges of managing technologically advanced monitoring systems, much less the details of how they are built and operated. On the relatively compressed time scale of disaster recovery efforts, it can be difficult to find a reliable, disinterested source of information, without which government agencies may be dependent on partial information. If system delivery fails to include sufficient development of indigenous expertise, the performance of local and regional networks may decline quickly, and even data collected during an early high-performance period may be degraded or lost. Drawing on unsurpassed educational capabilities of its members working in close cooperation with its facility staff, IRIS is well prepared to contribute to sustainability through a wide variety of training and service activities that further promote standards for network installation, data exchange protocols, and free and open access to data. Members of the Consortium and staff of its Core Programs together could write a guide on decisions about network design, installation and operation. The intended primary audience would be government officials seeking to understand system requirements, the acquisition and installation process, and the expertise needed operate a system. The guide would cover network design, procurement, set-up, data use and archiving. Chapters could include advice on network data processing, archiving data (including

  18. [Nootropics and antioxidants in the complex therapy of symptomatic posttraumatic epilepsy].

    Science.gov (United States)

    Savenkov, A A; Badalian, O L; Avakian, G N

    2013-01-01

    To study the possibility of application of nootropics and antioxidants in the complex antiepileptic therapy, we examined 75 patients with symptomatic focal posttraumatic epilepsy. A statistically significant reduction in the number of epileptic seizures, improvement of cognitive function and quality of life of the patients as well as a decrease in the severity of depression and epileptic changes in the EEG were identified. The potentiation of antiepileptic activity of basic drugs, normalization of brain's electrical activity and reduction in EEG epileptiform activity, in particular coherent indicators of slow-wave activity, were noted after treatment with the antioxidant mexidol. A trend towards the improvement of neuropsychological performance and quality of life was observed. There was a lack of seizure aggravation typical of many nootropic drugs. Thus, phenotropil and mexidol can be recommended for complex treatment of symptomatic posttraumatic epilepsy.

  19. Pediatric intracerebral hemorrhage: acute symptomatic seizures and epilepsy.

    Science.gov (United States)

    Beslow, Lauren A; Abend, Nicholas S; Gindville, Melissa C; Bastian, Rachel A; Licht, Daniel J; Smith, Sabrina E; Hillis, Argye E; Ichord, Rebecca N; Jordan, Lori C

    2013-04-01

    Seizures are believed to be common presenting symptoms in neonates and children with spontaneous intracerebral hemorrhage (ICH). However, few data are available on the epidemiology of acute symptomatic seizures or the risk for later epilepsy. To define the incidence of and explore risk factors for seizures and epilepsy in children with spontaneous ICH. Our a priori hypotheses were that younger age at presentation, cortical involvement of ICH, acute symptomatic seizures after presentation, ICH due to vascular malformation, and elevated intracranial pressure requiring urgent intervention would predict remote symptomatic seizures and epilepsy. Prospective cohort study conducted between March 1, 2007, and January 1, 2012. Three tertiary care pediatric hospitals. Seventy-three pediatric subjects with spontaneous ICH including 20 perinatal (≥37 weeks' gestation to 28 days) and 53 childhood subjects (>28 days to Acute symptomatic seizures (clinically evident and electrographic-only seizures within 7 days), remote symptomatic seizures, and epilepsy. Acute symptomatic seizures occurred in 35 subjects (48%). Acute symptomatic seizures as a presenting symptom of ICH occurred in 12 perinatal (60%) and 19 childhood (36%) subjects (P = .07). Acute symptomatic seizures after presentation occurred in 7 children. Electrographic-only seizures were present in 9 of 32 subjects (28%) with continuous electroencephalogram monitoring. One-year and 2-year remote symptomatic seizure-free survival rates were 82% (95% CI, 68-90) and 67% (95% CI, 46-82), respectively. One-year and 2-year epilepsy-free survival rates were 96% (95% CI, 83-99) and 87% (95% CI, 65-95), respectively. Elevated intracranial pressure requiring acute intervention was a risk factor for seizures after presentation (P = .01; Fisher exact test), remote symptomatic seizures, and epilepsy (P = .03, and P = .04, respectively; log-rank test). Presenting seizures are common in perinatal and childhood ICH. Continuous

  20. Improving the Sustainability of Farming Practices through the Use of a Symbiotic Approach for Anaerobic Digestion and Digestate Processing

    Directory of Open Access Journals (Sweden)

    Frank Pierie

    2017-09-01

    Full Text Available The dairy sector in the Netherlands aims for a 30% increase in efficiency and 30% carbon dioxide emission reduction compared to the reference year of 1990, and a 20% share of renewable energy, all by the year 2020. Anaerobic Digestion (AD can play a substantial role in achieving these aims. However, results from this study indicate that the AD system is not fully optimized in combination with farming practices regarding sustainability. Therefore, the Industrial Symbiosis concept, combined with energy and environmental system analysis, Life Cycle Analysis and modeling is used to optimize a farm-scale AD system on four indicators of sustainability (i.e., energy efficiency, carbon footprint, environmental impacts and costs. Implemented in a theoretical case, where a cooperation of farms share biomass feedstocks, a symbiotic AD system can significantly lower external energy consumption by 72 to 92%, carbon footprint by 71 to 91%, environmental impacts by 68 to 89%, and yearly expenditures by 56 to 66% compared to a reference cooperation. The largest reductions and economic gains can be achieved when a surplus of manure is available for upgrading into organic fertilizer to replace fossil fertilizers. Applying the aforementioned symbiotic concept to the Dutch farming sector can help to achieve the stated goals indicated by the Dutch agricultural sector for the year 2020.

  1. Identifying conservation priorities and management strategies based on ecosystem services to improve urban sustainability in Harbin, China.

    Science.gov (United States)

    Qu, Yi; Lu, Ming

    2018-01-01

    Rapid urbanization and agricultural development has resulted in the degradation of ecosystems, while also negatively impacting ecosystem services (ES) and urban sustainability. Identifying conservation priorities for ES and applying reasonable management strategies have been found to be effective methods for mitigating this phenomenon. The purpose of this study is to propose a comprehensive framework for identifying ES conservation priorities and associated management strategies for these planning areas. First, we incorporated 10 ES indicators within a systematic conservation planning (SCP) methodology in order to identify ES conservation priorities with high irreplaceability values based on conservation target goals associated with the potential distribution of ES indicators. Next, we assessed the efficiency of the ES conservation priorities for meeting the designated conservation target goals. Finally, ES conservation priorities were clustered into groups using a K-means clustering analysis in an effort to identify the dominant ES per location before formulating management strategies. We effectively identified 12 ES priorities to best represent conservation target goals for the ES indicators. These 12 priorities had a total areal coverage of 13,364 km 2 representing 25.16% of the study area. The 12 priorities were further clustered into five significantly different groups ( p -values between groups urban and agricultural areas, thereby preventing urban and agriculture sprawl and guiding sustainable urban development.

  2. Design of Dwellings and Interior Family Space in China: Understanding the History of Change and Opportunities for Improved Sustainability Practices

    Directory of Open Access Journals (Sweden)

    Adrian Pitts

    2014-10-01

    Full Text Available This paper reviews briefly the recent history of dwelling design in China. It notes the rapid changes that have taken place since the 1980s and identifies the way contemporary procurement processes leave out the final fit-out and decoration/refurbishment. A range of stakeholders were interviewed, and access was gained to drawings and other technical data that indicated how the secondary processes were carried out. These are largely ungoverned by regulation in the same way necessary for initial design. The key group is the occupants who drive the fit-out and decoration according to personal and cultural requirements, but often with less than perfect understanding of sustainability. The interior design industry has developed rapidly over the same period and was initially lacking in professional knowledge and understanding (something which can still be found. Advice provided to dwelling occupants was based more on appearance than function and efficiency. Over the same period, beneficial modifications to construction processes have been introduced in relation to structural design, and it should be possible to do the same for sustainability-related design issues. The paper advocates: more regulation; better assessment techniques; more information and guidance for home-owners; and a greater focus on energy issues.

  3. Can We Improve Indicator Design for Complex Sustainable Development Goals? A Comparison of a Values-Based and Conventional Approach

    Directory of Open Access Journals (Sweden)

    Gemma Burford

    2016-08-01

    Full Text Available A conceptual framework was constructed for United Nations’ complex Sustainable Development Goal (SDG Target 4.7 focusing on education for sustainable development (ESD, and used to analyse the usefulness and character of indicators produced from a values-based approach called ESDinds, compared to a UN process. The analysis shows that the latter generated very few indicators concerning the wider aspects of knowledge such as ‘critical thinking’ or ‘learning to learn’. The values-based approach, created for a different purpose, produced complementary if not better coverage of Target 4.7, including finely-developed concepts for competencies and less tangible aspects. It is suggested that the UN process would benefit from ESDinds design elements such as intersubjective and slightly disruptive elements, purposeful contextualisation at group level, and a holistic and inductive consideration of values. The use of a reference ‘fuzzy framework’ of slightly generalised proto-indicators suited for deep contextualisation locally is recommended, rather than any rigid global-level indicator with unclear local value. It is recommended that ESD practitioners immediately develop localised interpretations of valid measures for whatever final Target 4.7 indicator is selected by the UN, as this localisation process will itself cause important learning towards local ESD achievements.

  4. Assessing the Impact of Sustainability Improvement Options on the Agri-food Supply Chain Governance Structures: Development of an Evaluation Tool

    Directory of Open Access Journals (Sweden)

    Cosimo Rota

    2014-10-01

    Full Text Available The competitiveness of a supply chain is driven by the ability of supply chain governance structures to adapt to the chains’ continuously changing technical and organizational characteristics. The present study addresses the adoption of sustainability improvement options in the area of organization and management in the agri-food sector; within this framework the study proposes a tool for assessing the impact of sustainability oriented processes on the supply chain governance structures, in turn influencing the competitiveness of the supply chain. Two different approaches, proposed by (Gereffi et al., 2005 and (Hobbs and Young, 2000 have been linked to provide a theoretical framework for the tool development. The proposed new conceptual framework links the dimensions defining five different governance structures complexity of transaction, ability to codify and capabilities in the supply-base (Gereffi et al., to the product characteristics, regulatory and technology aspects defined by Hobbs and Young as drivers influencing the vertical coordination of supply chains. The method suggested for measuring the relations between improvement options and the chain governance structure is the adoption of experts’ evaluations. This method improves the tool capacity to provide a context-related supply chain governance structure assessment and management.

  5. Improving productivity in agriculture. One of the five key areas to sustainable development where progress is possible with the resources and technologies at our disposal today

    International Nuclear Information System (INIS)

    2002-01-01

    Despite progress made since the 1996 World Food Summit that set the goal of halving the number of undernourished people by the 2015, serious food insecurity persists in many parts of the world. Although more food is being produced worldwide than ever before, some 800 million people are still chronically malnourished. Improving agricultural productivity is a driving force for both economic and social development. When agriculture falters, income sources are lost, social ties are disrupted, and, as a result, societies become more mobile. Up-to-date technologies, improved plant and animal stock, and better soil and water management practices not only combat food insecurity, they are also important to achieving sustainable agriculture practices essential to maintaining an appropriate balance between conservation and use of all the resources required to grow crops and raise livestock. Through its programme in Food and Agriculture operated with the Food and Agriculture Organization (FAO), the International Atomic Energy Agency (IAEA) works to enhance capacities at national and international levels for identifying and alleviating constraints to sustainable food security by facilitating development and adoption of nuclear and related biotechnologies. With an annual budget of nearly $10 million, this programme helps Member States to improve productivity in agriculture, particularly through better water and soil management practices, efficient crop nutrition, and control of insect pests

  6. Efficacy and Tolerability of Tamsulosin 0.4 mg in Patients with Symptomatic Benign Prostatic Hyperplasia

    OpenAIRE

    Chung, Jae-Wook; Choi, Seock Hwan; Kim, Bum Soo; Kim, Tae-Hwan; Yoo, Eun Sang; Kim, Chun Il; Lee, Kyung Seop; Kwon, Tae Gyun

    2011-01-01

    Purpose To evaluate the efficacy and tolerability of tamsulosin 0.4 mg once daily in Korean patients with symptomatic benign prostatic hyperplasia (BPH) and investigate whether tamsulosin 0.4 mg can improve symptoms in patients with refractory lower urinary tract symptoms (LUTS) who were previously receiving tamsulosin 0.2 mg once daily. Materials and Methods A total of 116 patients from 3 urology centers participated. All study subjects entered a nonblind phase consisting of 8 weeks of tamsu...

  7. Pediatric symptomatic Rathke cleft cyst compared with cystic craniopharyngioma.

    Science.gov (United States)

    Hayashi, Yasuhiko; Kita, Daisuke; Fukui, Issei; Sasagawa, Yasuo; Oishi, Masahiro; Okajima, Michiko; Tachibana, Osamu; Nakada, Mitsutoshi

    2016-09-01

    Symptomatic Rathke cleft cysts (RCCs) are rarely detected in neuroradiological screening and are less commonly found in children than in adults. However, when RCCs are observed in children, it is important to carefully distinguish a RCC from a cystic craniopharyngioma (CP) even if surgically treated or conservatively followed up. We conducted a retrospective review of clinical data from 11 patients with symptomatic RCCs whose ages were under 18 years and compared the data with data from 15 age- and sex-matched patients with cystic CP who were treated at our institute. The mean age of the patients with RCCs was 12.2 years (range, 6-18). There were six males and five females. As initial symptoms, nine patients presented with headache, while two each had impaired visual function, diabetes insipidus, and activity loss. The 14 patients with CP suffered from impaired visual function. Magnetic resonance imaging (MRI) mainly showed hyperintensity on T1-weighted images (WIs) and hypointensity on T2-WI in patients with RCC. However, patients with CP had characteristic hyperintensity on T2-WI. The average maximum diameter of the RCCs was 19.0 mm on average (range, 8-33 mm). The RCCs were thus significantly smaller than CPs (34.9 mm; range, 21-54 mm). The RCCs were usually oval or dumbbell-shaped and regular in appearance, while the larger CPs were lobular and irregular. A preoperative endocrinological evaluation revealed insufficiencies in four axes in five patients with RCC. Postoperative endocrinological status improved in three patients, remained unchanged in three, and worsened in one. The gonadotropin axis was damaged in a majority (nine) of the patients with CP preoperatively. Postoperative evaluation revealed deficits in five axes in 14 patients with CP, which is a significantly different trend than observed in patients with RCC. Eight patients underwent surgical procedures (transsphenoidal surgery (TSS) in four, craniotomy in four). Two of these patients

  8. ACUTE NEUROINFECTIONS AND SYMPTOMATIC EPILEPSY IN CHILDREN: CAUSAL RELATIONSHIP (review

    Directory of Open Access Journals (Sweden)

    E. Yu. Gorelik

    2017-01-01

    Full Text Available Convulsions in case of acute neuroinfections can both complicate the disease course and transfer to symptomatic epilepsy which is one of the most important medical and social problems. The review article presents the data on epidemiology of convulsive disorder and symptomatic epilepsy in case of neuroinfections in children. There are considered the current immune and biochemical aspects of epileptogenesis in case of infectious pathology. There is given the information on neurophysiological and radial features of symptomatic epilepsy developed in case of neuroinfections of different etiology. There is underlined the practical significance of timely complex etio-pathogenetic therapy for neuroinfections complicated by convulsion that allows to reduce the frequency of symptomatic epilepsy development. There are presented the data on the results of transcranial magnetic stimulation in case of refractory epilepsy.

  9. LivestockPlus — The sustainable intensification of forage-based agricultural systems to improve livelihoods and ecosystem services in the tropics

    Directory of Open Access Journals (Sweden)

    I. Rao

    2015-05-01

    Full Text Available As global demand for livestock products (such as meat, milk and eggs is expected to double by 2050, necessary increases to future production must be reconciled with negative environmental impacts that livestock cause. This paper describes the LivestockPlus concept and demonstrates how the sowing of improved forages can lead to the sustainable intensification of mixed crop-forage-livestock-tree systems in the tropics by producing multiple social, economic and environmental benefits. Sustainable intensification not only improves the productivity of tropical forage-based systems but also reduces the ecological footprint of livestock production and generates a diversity of ecosystem services (ES such as improved soil quality and reduced erosion, sedimentation and greenhouse gas (GHG emissions. Integrating improved grass and legume forages into mixed production systems (crop-livestock, tree-livestock, crop-tree-livestock can restore degraded lands and enhance system resilience to drought and waterlogging associated with climate change. When properly managed tropical forages accumulate large amounts of carbon in soil, fix atmospheric nitrogen (legumes, inhibit nitrification in soil and reduce nitrous oxide emissions (grasses, and reduce GHG emissions per unit livestock product. The LivestockPlus concept is defined as the sustainable intensification of forage-based systems, which is based on 3 interrelated intensification processes: genetic intensification - the development and use of superior grass and legume cultivars for increased livestock productivity; ecological intensification - the development and application of improved farm and natural resource management practices; and socio-economic intensification - the improvement of local and national institutions and policies, which enable refinements of technologies and support their enduring use. Increases in livestock productivity will require coordinated efforts to develop supportive government, non

  10. A Proposal on the Restoration of Nostoc flagelliforme for Sustainable Improvement in the Ecology of Arid Steppes in China

    Directory of Open Access Journals (Sweden)

    Xiang Gao

    2016-06-01

    Full Text Available Nostoc flagelliforme, a filamentous nitrogen-fixing cyanobacterium, is widely distributed in arid steppes of the west and northwestern parts of China. However, as a food delicacy this species has been overexploited from 1970 to 2000. Moreover, overgrazing, land reclamation and the removal of medicinal herbs have caused severely reduced vegetation coverage there. In this communication, a badly damaged but slowly rehabilitating N. flagelliforme-inhibiting steppe is described, and the rehabilitation of desertified steppes by the renewed growth of N. flagelliforme is proposed. The restoration of this dominant nitrogen supplier would be an ecologically sustainable solution for supplementing current measures already taken in the desertified regions. In addition, a goal of 50%–60% vegetation coverage is proposed by the N. flagelliforme restoration.

  11. How could you use the ergonomics 'knowhow' transfer management to enhance human working for sustainable improvements in industrially developing countries?

    Science.gov (United States)

    Helali, Faramarz

    2012-01-01

    This paper describes the different strategic understanding from getting ergonomics intervention programmes' conversations to 'Tip', including minimizing strategies; tipping point strategies; and maximizing strategies from building ergonomics intervention techniques. Those have indicated to different recognitions: 1) when amplification of the 'problem' is necessary; 2) when amplification of the 'tipping point' is necessary, and 3) when amplification of the 'success' is necessary. The practical applications and implications of the ergonomics intervention techniques are drawn from the findings of framing positive questions: 1) what is successful ergonomics intervention technique right now (Appreciative)? 2) What do we need to change for a better future (Imagine)? 3) How do we do this (Design)? 4) Who takes action and with what consequences (Act)? This requires re-framing of the ergonomics intervention techniques in an appreciative way, because of, the future action needs to be inspired by those things that participants feel are worth valuing, worth celebrating and sustaining.

  12. The Capacity-Building Stewardship Model: assessment of an agricultural network as a mechanism for improving regional agroecosystem sustainability

    Directory of Open Access Journals (Sweden)

    Alison J. Duff

    2017-03-01

    Full Text Available Working lands have potential to meet agricultural production targets while serving as reservoirs of biological diversity and as sources of ecological services. Yet agricultural policy creates disincentives for this integration of conservation and production goals. While necessary, the development of a policy context that promotes agroecosystem sustainability will take time, and successful implementation will depend on a receptive agricultural audience. As the demands placed on working lands grow, there is a need for regional support networks that build agricultural producers' capacity for land stewardship. We used a social-ecological system framework to illustrate the Healthy Grown Potato Program as an agricultural network case study. Our Capacity-Building Stewardship Model reflects a 20-year experience working in collaboration with potato growers certified under an ecolabel in Wisconsin, USA. The model applies an evolving, modular farm stewardship standard to the entire farm - croplands and noncroplands. The model demonstrates an effective process for facilitating communication and shared learning among program participants, including agricultural producers, university extension specialists, nonprofit conservation partners, and industry representatives. The limitation of the model in practice has been securing funding to support expansion of the program and to ensure that the ecolabel standard is responsive to changes in the social-ecological system. Despite this constraint, the Capacity-Building Stewardship Model reveals an important mechanism for building regional commitment to conservation, with agricultural producers in a leadership role as architects, adopters, and advocates for stewardship behavior. Our experience provides important insight for the application of agri-environment schemes on private lands. The durability of a conservation ethic on working farms is likely to be enhanced when networks engage and support producers in an

  13. Identifying conservation priorities and management strategies based on ecosystem services to improve urban sustainability in Harbin, China

    Directory of Open Access Journals (Sweden)

    Yi Qu

    2018-04-01

    Full Text Available Rapid urbanization and agricultural development has resulted in the degradation of ecosystems, while also negatively impacting ecosystem services (ES and urban sustainability. Identifying conservation priorities for ES and applying reasonable management strategies have been found to be effective methods for mitigating this phenomenon. The purpose of this study is to propose a comprehensive framework for identifying ES conservation priorities and associated management strategies for these planning areas. First, we incorporated 10 ES indicators within a systematic conservation planning (SCP methodology in order to identify ES conservation priorities with high irreplaceability values based on conservation target goals associated with the potential distribution of ES indicators. Next, we assessed the efficiency of the ES conservation priorities for meeting the designated conservation target goals. Finally, ES conservation priorities were clustered into groups using a K-means clustering analysis in an effort to identify the dominant ES per location before formulating management strategies. We effectively identified 12 ES priorities to best represent conservation target goals for the ES indicators. These 12 priorities had a total areal coverage of 13,364 km2 representing 25.16% of the study area. The 12 priorities were further clustered into five significantly different groups (p-values between groups < 0.05, which helped to refine management strategies formulated to best enhance ES across the study area. The proposed method allows conservation and management plans to easily adapt to a wide variety of quantitative ES target goals within urban and agricultural areas, thereby preventing urban and agriculture sprawl and guiding sustainable urban development.

  14. The Relationship Between Traumatic Brain Injury and Rates of Chronic Symptomatic Illness in 202 Gulf War Veterans.

    Science.gov (United States)

    Chao, Linda L

    2018-05-18

    Although not a "signature injury" of Operation Desert Shield/Desert Storm (i.e., Gulf War, GW), some GW veterans have a history traumatic brain injury (TBI). For example, a previous study found that 12.2% of the GW veterans from the Fort Devens Cohort Study had self-reported TBIs. The present study sought to build upon this finding by examining the relationship between TBI and chronic symptomatic illness in a different sample of GW veterans. Participants were 202 GW veterans recruited from 2014 to 2018 at the San Francisco Veterans Affairs Medical Center as part of a VA-funded study on the effects of predicted exposure to low levels of sarin and cyclosarin on brain structure and function. The Ohio State University TBI identification method was used to determine lifetime history of TBI. The Kansas Gulf War Military History and Health Questionnaire was used to assess symptoms and to determine cases of Kansas Gulf War Illness (GWI) and Centers for Disease Control and Prevention (CDC) Chronic Multisymptom Illness (CMI). Nearly half (47%) the sample had a history of TBI, but only 7% of the TBIs were sustained in injuries that occurred during the GW. Most of the TBIs were sustained in injuries that occurred prior to (73%) or after (34%) the GW. History of TBI was not associated with higher rates of symptomatic illness when it was narrowly defined (i.e., Kansas GWI cases or cases of severe CMI). History of TBI was only associated with higher rates of symptomatic illness when it is broadly defined (i.e., CDC CMI or mild-moderate CMI). There was suggestive evidence that veterans who sustained TBIs during the GW (only seven in the present sample) have poorer functional outcomes compared with GW veterans with non-GW related TBIs. While TBIs were uncommon during the GW, many GW veterans sustained TBIs prior or after the GW. Because TBI and GWI/CMI share some overlapping symptoms, history of TBI may appear to be associated with increased rates of chronic symptomatic illness in

  15. Arthroscopic treatment of symptomatic type D medial plica

    OpenAIRE

    Uysal, Mustafa; Asik, Mehmet; Akpinar, Sercan; Ciftci, Feyyaz; Cesur, Necip; Tandogan, Reha N.

    2007-01-01

    We aimed to review the results of subtotal arthroscopic resection of symptomatic type D medial plica. We retrospectively evaluated 23 knees with symptomatic type D medial plica in 22 patients without other intra-articular pathology. All patients complained of chronic knee pain that had not been alleviated by medical treatment or physical therapy. In only three (13%) of the patients studied was the plica diagnosed pre-operatively with magnetic resonance imaging. The type D medial plicae in our...

  16. The incidence of symptomatic malrotation post gastroschisis repair.

    LENUS (Irish Health Repository)

    Abdelhafeez, A

    2011-12-01

    Gastroschisis is known to be associated with abnormal bowel rotation. Currently, the broadly accepted practice is not to perform Ladd\\'s procedure routinely at the time of closure of gastroschisis defects. However the incidence of symptomatic malrotation and volvulus post gastroschisis repair is unknown; this incidence is important in view of the current practice of bedside gastroschisis closure. This study examined the incidence of symptomatic malrotation and volvulus following gastroschisis repair.

  17. Factors Predicting a Good Symptomatic Outcome After Prostate Artery Embolisation (PAE).

    Science.gov (United States)

    Maclean, D; Harris, M; Drake, T; Maher, B; Modi, S; Dyer, J; Somani, B; Hacking, N; Bryant, T

    2018-02-26

    As prostate artery embolisation (PAE) becomes an established treatment for benign prostatic obstruction, factors predicting good symptomatic outcome remain unclear. Pre-embolisation prostate size as a predictor is controversial with a handful of papers coming to conflicting conclusions. We aimed to investigate if an association existed in our patient cohort between prostate size and clinical benefit, in addition to evaluating percentage volume reduction as a predictor of symptomatic outcome following PAE. Prospective follow-up of 86 PAE patients at a single institution between June 2012 and January 2016 was conducted (mean age 64.9 years, range 54-80 years). Multiple linear regression analysis was performed to assess strength of association between clinical improvement (change in IPSS) and other variables, of any statistical correlation, through Pearson's bivariate analysis. No major procedural complications were identified and clinical success was achieved in 72.1% (n = 62) at 12 months. Initial prostate size and percentage reduction were found to have a significant association with clinical improvement. Multiple linear regression analysis (r 2  = 0.48) demonstrated that percentage volume reduction at 3 months (r = 0.68, p < 0.001) had the strongest correlation with good symptomatic improvement at 12 months after adjusting for confounding factors. Both the initial prostate size and percentage volume reduction at 3 months predict good symptomatic outcome at 12 months. These findings therefore aid patient selection and counselling to achieve optimal outcomes for men undergoing prostate artery embolisation.

  18. Management of symptomatic thrombocytopenia associated with dengue haemorrhagic fever

    International Nuclear Information System (INIS)

    Jameel, T.; Saleem, I.U.; Mehmood, K.; Tanvir, I.; Saadia, A.

    2010-01-01

    Introduction: Immune - mediated destruction of platelets is thought to be the mechanism of thrombocytopenia seen after the viraemic phase of dengue haemorrhagic fever (DHF). Immuno - suppressants such as steroids, immune globulin and Anti D immune globulin are effective in the treatment of this type of immune thrombocytopenic purpura. Objective: To evaluate the efficacy of oral Prednisolone in the rate of resolution of thrombocytopenia and monitoring of complications in patients recovering from Dengue haemorrhagic fever. Method: A controlled study was carried out on diagnosed cases Dengue haemorrhagic patients presenting with sever thrombocytopenia and symptoms like confluent ecchymosis, epistaxis and purpuric rashes. In study was conducted in Ittefaq hospital (trust) Lahore, during the period of October to December 2008. Treatment group received steroids in two forms i.e. first line therapy prednisolone (1 mg / kg) orally or as second line therapy of initial I/V high dose (prednisolone) in pulse doses i.e. 40 mg / bd for four days and later oral prednisolone as in first line therapy with omeprazole 20 mg / bd in addition to standard treatment. Control group received standard supportive care only. Results: A total of 341 suspected patients were admitted in hospital. Serological diagnosis was confirmed in 166 patients. CBC revealed platelet count . 100 x 109 / l in 106 patients. A group of symptomatic febrile patients have platelet count < 20 x 109 / l was selected for therapeutic intervention. first line therapy (oral prednisolone was stated in 43 patients. In Fourteen patients second line therapy (high dose dexamethasone pulse) therapy was instituted. Seven of them attained complete response whereas two patients achieved partial response. Four patients were shifted to Anti D therapy. Three deaths occurred during our study. Rest of all the patients improved and were discharged in due course of time. Conclusion: This small scale preliminary study shows promising

  19. Carbohydrate administration during a day of sustained aerobic activity improves vigilance, as assessed by a novel ambulatory monitoring device, and mood.

    Science.gov (United States)

    Lieberman, Harris R; Falco, Christina M; Slade, Steven S

    2002-07-01

    The brain requires a continuous supply of glucose to function adequately. During aerobic exercise, peripheral glucose requirements increase and carbohydrate supplementation improves physical performance. The brain's utilization of glucose also increases during aerobic exercise. However, the effects of energy supplementation on cognitive function during sustained aerobic exercise are not well characterized. The effects of energy supplementation, as liquid carbohydrate, on cognitive function during sustained aerobic activity were examined. A double-blind, placebo-controlled, between-subjects design was used. Young, healthy men (n = 143) were randomly assigned to 1 of 3 treatment groups. The groups received either a 6% (by vol) carbohydrate (35.1 kJ/kg), 12% (by vol) carbohydrate (70.2 kJ/kg), or placebo beverage in 6 isovolumic doses, and all groups consumed 2 meals (3200 kJ). Over the 10-h study, the subjects performed physically demanding tasks, including a 19.3-km road march and two 4.8-km runs, interspersed with rest and other activities. Wrist-worn vigilance monitors, which emitted auditory stimuli (20/h) to which the subjects responded as rapidly as possible, and a standardized self-report mood questionnaire were used to assess cognitive function. Vigilance consistently improved with supplemental carbohydrates in a dose-related manner; the 12% carbohydrate group performed the best and the placebo group the worst (P Mood-questionnaire results corroborated the results from the monitors; the subjects who received carbohydrates reported less confusion (P = 0.040) and greater vigor (P = 0.025) than did those who received the placebo. Supplemental carbohydrate beverages enhance vigilance and mood during sustained physical activity and interspersed rest. In addition, ambulatory monitoring devices can continuously assess the effects of nutritional factors on cognition as individuals conduct their daily activities or participate in experiments.

  20. Clinicopathological study of asymptomatic gastric cancer and symptomatic gastric cancer

    International Nuclear Information System (INIS)

    Sato, Toshiteru

    2008-01-01

    Gastric cancer can be classified into two categories based on the absence or presence of symptoms at diagnosis. Differences in clinicopathological features and prognoses between asymptomatic gastric cancer (ACG) and symptomatic gastric cancer (SGC) can be used to inform diagnosis strategies and ultimately improve survival rates. All cases of gastric cancer (239 AGC, 323 SGC) diagnosed in our hospital between 1997 and 1999 were used in this study. ACG patients showed significantly higher frequency of males, cases of early cancer, cases found by a mass screening program, cases treated by endoscopic resection, cases treated by curative operation, cases of type 0 macroscopic finding, cases of histologically-differentiated type, and stage I cases. By contrast, SGC patients showed significantly higher numbers of cases treated by chemotherapy alone or best support care, cases of type 2, 3, and 4 macroscopic findings, cases occupying the whole stomach, and cases of stage II, III, IV. Statistically significant differences were also found for the 5-year survival rate (83.3% in AGC, 41.2% in SGC), the incidence of early cancer (90.1% in AGC, 83.7% in SGC), and for advanced cancer (38.7% in AGC, 22.7% in SGC). The higher incidence of advanced cases in SGC than in AGC (40.0% vs. 13.0%), coupled with the low 5-year survival rate of advanced SGC (22.7%), provides strong evidence of the importance of diagnosing gastric cancer during its asymptomatic period. (author)

  1. Restoration of soil fertility and improvement of cropping systems for sustainable development in the humid savannahs of Cote d'Ivoire

    International Nuclear Information System (INIS)

    Bachmann, T.

    1999-01-01

    The present FAO-project addresses the soil fertility problems by combining organic with inorganic nutrient sources and actively involving farmers and other beneficiaries in an integrated, long-term development process. A major objective of the project is the participatory on-farm testing and validation of available technological innovations for soil fertility improvement. The results should fulfill two main requirements: (i) provide the farmer with a short-term production increase and (ii) improve/maintain soil fertility in the medium and long-term. The strategic framework of the project is based on the following three main elements: the need to take into account all aspects of soil fertility restoration including areas concerned, cost of fertility restoration, and economic profitability and sustainability; - the need to test all fertility improving measures at farm level in representative agro-ecozones of the humid and sub-humid savannas before their extension at large; the need to identify major macro-economic constraints (e.g. marketing) which impede sustainable agricultural development in the savannah region. The primary goal of the project is to replace traditional shifting cultivation in the humid savannas of the country by economically, ecologically and socially more sustainable production systems. In order to achieve this development objective the project focuses on the following main issues: restoration of soil fertility through improved land and crop management and more efficient use of mineral and organic fertilizers; crop diversification through more efficient use of water resources (irrigation); introduction of new cropping systems which have been successfully tested in countries with similar agro-ecological conditions; adapting traditional land tenure to the market economy; involving the private sector in all aspects of regional development assisted by Government through the creation of a favorable environment. Phase 1: constraint analysis and

  2. Sustainable Food & Sustainable Economics

    OpenAIRE

    Alvarez, Mavis Dora

    2012-01-01

    Cuba today is immersed in a very intense process of perfecting its agricultural production structures with the goal of making them more efficient and sustainable in their economic administration and in their social and environmental management. Agricultural cooperatives in Cuba have the responsibility of producing on 73% of the country's farmland. Their contributions are decisive to developing agricultural production and to ensuring more and better food for the population, in addition to redu...

  3. Socio-economic issues in smallholder dairy production and the role of international support for achieving sustainable improvements

    International Nuclear Information System (INIS)

    Nell, A.J.; Schiere, J.B.

    2002-01-01

    In many developing countries urban and peri-urban agriculture is becoming increasingly important as a source of food for the city. A great variety of urban and peri-urban agriculture and livestock production systems are developing, ranging from large intensive market-oriented and factory type production units to small backyard family subsistence production; from landless farms exclusively based on external inputs to more land-based production in the city outskirts and peri-urban areas, partially or entirely based on farm grown inputs. The production systems also range from units established by wealthy business people looking for good investment and profit opportunities, and sometimes making use of their connections to circumvent some of the city regulations, to impoverished city dwellers who depend on their livestock as their main source of food and income. Urban and peri-urban livestock (including dairy) production systems exist with all possible variations and combinations between these extremes, in terms of scale, type, function etc. In looking at small and medium scale commercial dairy farms it is important to realise and understand the diversity of farms and farmers. Dutch research has identified 4 main farming styles in pig farming, the same type of farming styles could probably be identified in commercial farming in developing countries. Such a framework for different farming styles explains priorities and preferences of the farmer and the type of messages the farmer might be interested in. Maximisation of the (short-term or even long-term) economic result is by no means always the main aim of the farmer, sustainability, maintenance of family property and conservation of nature are also frequently guiding principles for interventions in farm management. Research into the opportunities and the sustainability of the commercial small to medium scale dairy production system should involve a careful and thorough analysis of the system. It should not only include

  4. Leveraging Earth Observations to Improve Data Resolution and Tracking of Sustainable Development Goals in Water Resources and Public Health

    Science.gov (United States)

    Akanda, A. S.; Nusrat, F.; Hasan, M. A.; Fallatah, O.

    2017-12-01

    Water scarcity affects more than 40 per cent of the world population and is projected to rise substantially, affecting safe water and sanitation access globally. The recently released WHO/UNICEF Joint Monitoring Programme (JMP) 2017 report on global water and sanitation access paints a grim picture across the planet; approximately 30% people worldwide, or 2.1 billion, still lack access to safe, readily available clean water, and 60% people worldwide, or 4.5 billion ppl, lack safely managed sanitation. Meanwhile, demand for water and competition for water resources are sharply rising amid growing uncertainty of climate change and its impacts on water resources. The United Nations Agenda 2030 Sustainable Development Goals (SDGs) call for substantially increasing water-use efficiency across all sectors and ensuring sustainable withdrawals and supply of freshwater to address water scarcity, providing clean water and sanitation for all, increasing international cooperation over transboundary surface and groundwater resources (under Goal 6), as well as ending preventable deaths of newborns and children under 5 years of age, and end the epidemics of neglected tropical and water-borne diseases (under Goal 3). Data availability in developing regions, especially at the appropriate resolution in both space and time, has been a recurring problem for various technological and institutional reasons. Earth observation techniques provide the most cost-effective and encompassing tool to monitor these regions, large transboundary river basins and aquifer systems, and water resources vulnerabilities to climate change around the globe. University of Rhode Island, with US and international collaborators, is using earth observations to develop tools to analyze, monitor and support decision-makers to track their progress towards SDGs with better data resolution and accuracy. Here, we provide case studies on 1) providing safe water and sanitation access South Asia through safe water

  5. The alpha-2A adrenoceptor agonist guanfacine improves sustained attention and reduces overactivity and impulsiveness in an animal model of Attention-Deficit/Hyperactivity Disorder (ADHD

    Directory of Open Access Journals (Sweden)

    Sagvolden Terje

    2006-12-01

    Full Text Available Abstract Background ADHD is currently defined as a cognitive/behavioral developmental disorder where all clinical criteria are behavioral. Overactivity, impulsiveness, and inattentiveness are presently regarded as the main clinical symptoms. There is no biological marker, but there is considerable evidence to suggest that ADHD behavior is associated with poor dopaminergic and noradrenergic modulation of neuronal circuits that involve the frontal lobes. The best validated animal model of ADHD, the Spontaneously Hypertensive Rat (SHR, shows pronounced overactivity, impulsiveness, and deficient sustained attention. While dopamine release is decreased in SHR prefrontal cortex, norepinephrine concentrations are elevated. The noradrenergic system appears to be hyperactive as a result of impaired alpha-2A adrenoceptor regulation. Thus, the present study tested behavioral effects of the centrally acting alpha-2A adrenoceptor agonist guanfacine on SHR behavior. Methods The present study tested behavioral effects of guanfacine at doses of 0.075, 0.15, 0.30 and 0.60 mg base/kg i.p. in both male SHRs and their controls, the Wistar Kyoto rat (WKY. ADHD-like behavior was tested with a visual discrimination task measuring overactivity, impulsiveness and inattentiveness. Results The striking impulsiveness, overactivity, and reduced sustained attention during baseline conditions in the SHR improved by treatment with guanfacine. The most pronounced improvement in SHR behavior was seen following the two highest doses (0.3 and 0.6 mg/kg of guanfacine when SHR behaviors virtually normalized. The positive effects of the drug were most marked towards the end of the session. Conclusion The results indicate that guanfacine improved poor noradrenergic modulation of neuronal circuits that involve the frontal lobes in an animal model of ADHD. The present results support the beneficial effects of guanfacine on ADHD behavior reported clinically and experimentally in primate

  6. Quality of life in uncomplicated symptomatic diverticular disease: is it another good reason for treatment?

    Science.gov (United States)

    Comparato, Giuseppe; Fanigliulo, Libera; Aragona, Giovanni; Cavestro, Giulia M; Cavallaro, Lucas G; Leandro, Gioacchino; Pilotto, Alberto; Nervi, Giorgio; Soliani, Paolo; Sianesi, Mario; Franzé, Angelo; Di Mario, Francesco

    2007-01-01

    Quality of life (QoL) is becoming a major issue in the evaluation of any therapeutic intervention. To assess the QoL in patients with uncomplicated symptomatic diverticular disease (DD) and to elucidate the influence of two different treatments either on symptoms or QoL. 58 outpatients affected by uncomplicated symptomatic DD, admitted in our Gastroenterological Unit from October 2003 to March 2004, were enrolled. Patients were randomly assigned to two different treatments consisting of rifaximin or mesalazine for 10 days every month for a period of 6 months. QoL was evaluated by means of an SF-36 questionnaire and clinical evaluation was registered by means of a global symptomatic score (GSS) at baseline and after 6 months. At baseline, lower values in all SF-36 domains were confirmed in patients with DD. Both rifaximin and mesalazine groups showed a significant reduction of their mean GSS (p < 0.01 and p < 0.001, respectively) and improvement of SF-36 mean scores after therapy, even though treatment with mesalazine showed better results. DD has a negative impact on QoL. Cyclic treatment with poorly absorbable antibiotics or anti-inflammatory drugs relieves symptoms and improves QoL. 2007 S. Karger AG, Basel

  7. Magnetic Resonance Imaging-Guided Focused Ultrasound Surgery for the Treatment of Symptomatic Uterine Fibroids

    Directory of Open Access Journals (Sweden)

    Laura Geraci

    2017-01-01

    Full Text Available Uterine fibroids, the most common benign tumor in women of childbearing age, may cause symptoms including pelvic pain, menorrhagia, dysmenorrhea, pressure, urinary symptoms, and infertility. Various approaches are available to treat symptomatic uterine fibroids. Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS represents a recently introduced noninvasive safe and effective technique that can be performed without general anesthesia, in an outpatient setting. We review the principles of MRgFUS, describing patient selection criteria for the treatments performed at our center and we present a series of five selected patients with symptomatic uterine fibroids treated with this not yet widely known technique, showing its efficacy in symptom improvement and fibroid volume reduction.

  8. Magnetic Resonance Imaging-Guided Focused Ultrasound Surgery for the Treatment of Symptomatic Uterine Fibroids.

    Science.gov (United States)

    Geraci, Laura; Napoli, Alessandro; Catalano, Carlo; Midiri, Massimo; Gagliardo, Cesare

    2017-01-01

    Uterine fibroids, the most common benign tumor in women of childbearing age, may cause symptoms including pelvic pain, menorrhagia, dysmenorrhea, pressure, urinary symptoms, and infertility. Various approaches are available to treat symptomatic uterine fibroids. Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) represents a recently introduced noninvasive safe and effective technique that can be performed without general anesthesia, in an outpatient setting. We review the principles of MRgFUS, describing patient selection criteria for the treatments performed at our center and we present a series of five selected patients with symptomatic uterine fibroids treated with this not yet widely known technique, showing its efficacy in symptom improvement and fibroid volume reduction.

  9. Making aid work better for recipients and improving national planning processes for sustainable development in the bargain

    Energy Technology Data Exchange (ETDEWEB)

    Geoghegan, Tighe

    2007-03-15

    As DFID's new White Paper on poverty acknowledges, aid relationships are always about power, and despite the emphasis on country ownership in today's international aid system, the deck remains heavily stacked in favour of donors. For example, the Paris Declaration – the defining international statement on aid today – very much reflects prevailing Western ideas about governance, management effectiveness, and economic efficiency that may have little meaning or relevance in many developing country contexts. Despite aid's donor bias, at least some recipient countries, such as Tanzania and Vietnam, have nonetheless successfully introduced structures and mechanisms to help them set their own directions with less donor interference. Through impressive processes of stakeholder consultation that reflect indigenous social, cultural and political contexts rather than homogenised international norms, these two countries have also recently produced national strategies that are well-grounded in the principles of sustainable development. Such experiences offer a strong argument for a new approach to aid relationships, that gives recipients greater autonomy and flexibility and acknowledges the shortcomings in donor expertise and in homogenised approaches to aid.

  10. Progesterone for Symptomatic Perimenopause Treatment - Progesterone politics, physiology and potential for perimenopause.

    Science.gov (United States)

    Prior, J C

    2011-01-01

    Perimenopause, women's normal midlife reproductive transition, is highly symptomatic for about 20% of women who are currently inaccurately counseled and inappropriately treated with oral contraceptives, menopausal hormone therapy or hysterectomy. About 80% of perimenopausal women experience vasomotor symptoms (VMS), 25% have menorrhagia, and about 10% experience mastalgia. The majority of women describe varying intensities of sleep, -coping or mood difficulties. Women are more symptomatic because common knowledge inaccurately says that estradiol (E2) levels are dropping/deficient. Evidence shows that with disturbed brain-ovary feedbacks, E2 levels average 26% higher and soar erratically - some women describe feeling pregnant! Also, ovulation and progesterone (P4) levels become insufficient or absent. The most symptomatic women have higher E2 and lower P4 levels. Because P4 and E2 complement/counterbalance each other's tissue effects, oral micronized P4 (OMP4 300 mg at -bedtime) is a physiological therapy for treatment-seeking, symptomatic perimenopausal women. Given cyclically (cycle d 14-27, or 14 on/off) in menstruating midlife women, OMP4 decreases cyclic VMS, improves sleep and premenstrual mastalgia. Menorrhagia is treated with ibuprofen 200mg/6h plus OMP4 cycle d 4-28. For insulin resistance, metformin plus cyclic or daily OMP4 decreases insulin resistance and weight gain. Non-responsive migraines need daily OMP4 plus usual therapies. VMS and insomnia in late perimenopause respond to daily OMP4. In summary, OMP4 is a physiology-based therapy that improves sleep, treats VMS, does not increase breast proliferation or cancer risk, increases bone formation and has beneficial cardiovascular effects. A controlled trial is testing OMP4 for perimenopausal VMS - more evidence-based data are needed.

  11. Assessing demand for improved sustainable sanitation in low-income informal settlements of urban areas: a critical review.

    Science.gov (United States)

    Okurut, Kenan; Kulabako, Robinah Nakawunde; Chenoweth, Jonathan; Charles, Katrina

    2015-01-01

    Sanitation improvement is crucial in saving lives that are lost due to water contamination. Progress towards achieving full sanitation coverage is still slow in low-income informal settlements in most developing countries. Furthermore, resources are being wasted on installing facilities that are later misused or never used because they do not meet the local demand. Understanding demand for improved sanitation in the local context is critical if facilities are to be continually used. Various approaches that attempt to change peoples' behaviours or create demand have been reviewed to identify what they are designed to address. A multi-disciplinary research team using mixed methods is re-emphasised as a comprehensive approach for assessing demand for improved sanitation in low-income informal settlements, where the sanitation situation is more challenging than in other areas. Further research involving a multi-disciplinary research team and use of mixed methods to assess sanitation demand in informal settlements is needed.

  12. USING BENCHMARKING TO IMPROVE THE FINANCIAL AND SOCIAL SUSTAINABILITY OF COMMERCIAL GOAT MEAT, CASHMERE AND MOHAIR FARMS IN AUSTRALIA

    Directory of Open Access Journals (Sweden)

    Bruce Allan McGregor

    2009-02-01

    Full Text Available Production and financial benchmarking was undertaken with commercially motivated mohair, cashmere and goat meat farmers in Australia. There were large differences in animal and fleece production and financial returns between the best and worst performing farms. Farmers and industry groups reported that the process and results were helpful and resulted in them changing management practices. Benchmarking demonstrated that there is substantial scope to increase productivity and profitability through improved genetic selection and improved management of pastures, breeding flocks and in kid survival and growth.

  13. Sipuleucel-T: Autologous Cellular Immunotherapy for Men with Asymptomatic or Minimally Symptomatic Metastatic Castrate Resistant Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Robert B. Sims

    2011-01-01

    Full Text Available Sipuleucel T is an autologous cellular immunotherapy designed to stimulate an immune response in men diagnosed with asymptomatic or minimally symptomatic metastatic castrate resistant (hormone refractory prostate cancer. Sipuleucel T improves overall survival and provides an additional treatment option for this patient population.

  14. Using Sustainable Materials in the Design of Sports Halls in Order to Improve the Quality of Sports Spaces

    Directory of Open Access Journals (Sweden)

    Hussein Hassani

    2017-01-01

    Full Text Available Abstract The establishment of any urban element in the location of the city follows certain rules and principles that in the case of observing the success and efficiency of that element will result in that specific location. Therefore, this study has been conducted with the aim to find out the most proper place among sports complexes in Urmia to redesign. In this regard, requirements and obligations of location finding were identified after studying international experiences and study the top regulations and documents, then, effective parameters were categorized in the two levels of main indices and options according to AHP. In following, information received from opinions of experts, managers and professionals were determined in determine the importance of the indexes and analysis and weights of indexes. Finally, Urmia two thousand seater sports hall was selected among other candidate places as the best place to redesign and also environmental problems are considered as an important situation in construction. Waste Management has activated the warning signs and alerts to the environment. Reuse, recycle and reduce the wastes is the only ways to recycle created wastes. However, these executive cases have more space for progress. In this study, we investigate the use of building materials in two-thousand seater sports hall of Young house of Urmia that emphasis is on the recyclable materials. Recycling as one of the strategies is to minimize wastes. And ultimately Sport Cultural of Young house has been redesigned from sustainable materials and suggestion was designed and presented with more details ranging from architectural maps and sections and the main structure of the stadium in three-dimensional.

  15. Long-term manure applications improve soil productivity and sustain high crop yield for acidic red soils

    Science.gov (United States)

    Intensive use of chemical nitrogen (N) fertilizers has resulted in severely reduced productivity of red soils (Ferralic Cambisol) due to accelerated acidification. Manure has been shown to be effective in improving soil productivity by preventing or reversing the acidification process, but little in...

  16. Improving the sustainability of fatty acid methyl esters (Fame – biodiesel) – assessment of options for industry and agriculture

    NARCIS (Netherlands)

    Jungmeier, G.; Pucker, J.; Ernst, M.; Haselbacher, P.; Lesschen, J.P.; Kraft, A.; Schulzke, T.; Loo, van E.N.

    2016-01-01

    The life cycle based greenhouse gas (GHG) balances of Fatty Acid Methyl Esters (FAME also called “Biodiesel”) from various resources have been set in the Renewable Energy Directive (RED). Due to technology and scientific progress there are various options to improve the GHG balances of FAME. In

  17. Co-production as deep engagement: Improving and sustaining access to clean water in Ghana and Nigeria

    NARCIS (Netherlands)

    Mangai, M.S.; Vries, M.S. de

    2018-01-01

    PURPOSE – While there is an urgent need for clean water in Ghana and Nigeria, governments lack the financial means to do much to address this need. This does not mean that improving access to clean water is impossible. On the contrary, this paper argued that engaging citizens through

  18. Determinants and the perceived effects of adoption of sustainable improved food crop technologies by smallholder farmers along the value chain in Nigeria

    Directory of Open Access Journals (Sweden)

    Abiodun Elijah Obayelu

    2016-06-01

    Full Text Available Adoption of improved agricultural technologies is fundamental to transformation of sustainable farming system, and a driving force for increasing agricultural productivity. This study provides empirical evidence on the determinants, and the perceived effects of adoption of improved food crop technologies in Nigeria. It is a cross-sectional survey of available technologies and 1,663 farm households in Nigeria. Data were analyzed with both descriptive and inferential statistics. The findings revealed very low technology adoption index. Available food crop production technologies used by sampled respondents were assessed as effective, appropriate, readily available, affordable, durable, user and gender friendly, with requisite skill to use them. However, processing technologies such as cabinet dryer were observed as unaffordable, not durable, not gender or users friendly. Packaging machines are also not users or gender friendly; washing machine not affordable, durable and gender friendly. Grain processing technologies like De-stoner, grading, and packaging machines are still not locally available and affordable. While parboilers have a negative impact on product quality, farmers’ health and the environment, tomato grinding machines have positive impact on the quality of the product, health of the users, yield and negatively affect the environment. The main determinants of adoption are the crop types, farm size and locations. Adoption of herbicide and inorganic fertilizer were influenced by travel cost to nearest place of acquisition, while the age of farmer has a positive and significant influence on the adoption of pesticide, water management and cassava harvester. Interestingly, male farmers only exhibit greater likelihood of adopting land preparation, inorganic and organic fertilizer technologies compared to their female counterpart. Therefore, policy options that consider all users at the development stages, favour reduction of travel cost

  19. Public strategies for improving eHealth integration and long‐term sustainability in public health care systems: Findings from an Italian case study

    Science.gov (United States)

    Nuti, Sabina

    2017-01-01

    Summary eHealth is expected to contribute in tackling challenges for health care systems. However, it also imposes challenges. Financing strategies adopted at national as well regional levels widely affect eHealth long‐term sustainability. In a public health care system, the public actor is among the main “buyers” eHealth. However, public interventions have been increasingly focused on cost containment. How to match these 2 aspects? This article explores some central issues, mainly related to financial aspects, in the development of effective and valuable eHealth strategies in a public health care system: How can the public health care system (as a “buyer”) improve long‐term success and sustainability of eHealth solutions? What levers are available to match in the long period different interests of different stakeholders in the eHealth field? A case study was performed in the Region of Tuscany, Italy. According to our results, win‐win strategies should be followed. Investments should take into account the need to long‐term finance solutions, for sustaining changes in health care organizations for obtaining benefits. To solve the interoperability issues, the concept of the “platform approach” emerged, based on collaboration within and between organizations. Private sector as well as beneficiaries and final users of the eHealth solutions should participate in their design, provision, and monitoring. For creating value for all, the evidence gap and the financial needs could be addressed with a pull mechanism of funding, aimed at paying according to the outcomes produced by the eHealth solution, on the base of an ongoing monitoring, measurement, and evaluation of the outcomes. PMID:28791771

  20. Symptomatic treatments for amyotrophic lateral sclerosis/motor neuron disease.

    Science.gov (United States)

    Ng, Louisa; Khan, Fary; Young, Carolyn A; Galea, Mary

    2017-01-10

    Motor neuron disease (MND), which is also known as amyotrophic lateral sclerosis (ALS), causes a wide range of symptoms but the evidence base for the effectiveness of the symptomatic treatment therapies is limited. To summarise the evidence from Cochrane Systematic Reviews of all symptomatic treatments for MND. We searched the Cochrane Database of Systematic Reviews (CDSR) on 15 November 2016 for systematic reviews of symptomatic treatments for MND. We assessed the methodological quality of the included reviews using the Assessment of Multiple Systematic Reviews (AMSTAR) tool and the GRADE approach. We followed standard Cochrane study (review) selection and data extraction procedures. We reported findings narratively and in tables. We included nine Cochrane Systematic Reviews of interventions to treat symptoms in people with MND. Three were empty reviews with no included randomised controlled trials (RCTs); however, all three reported on non-RCT evidence and the remaining six included mostly one or two studies. We deemed all of the included reviews of high methodological quality. Drug therapy for painThere is no RCT evidence in a Cochrane Systematic Review exploring the efficacy of drug therapy for pain in MND. Treatment for crampsThere is evidence (13 RCTs, N = 4012) that for the treatment of cramps in MND, compared to placebo:- memantine and tetrahydrocannabinol (THC) are probably ineffective (moderate-quality evidence);- vitamin E may have little or no effect (low-quality evidence); and- the effects of L-threonine, gabapentin, xaliproden, riluzole, and baclofen are uncertain as the evidence is either very low quality or the trial specified the outcome but did not report numerical data.The review reported adverse effects of riluzole, but it is not clear whether other interventions had adverse effects. Treatment for spasticityIt is uncertain whether an endurance-based exercise programme improved spasticity or quality of life, measured at three months after the

  1. One week treatment with the IL-1 receptor antagonist anakinra leads to a sustained improvement in insulin sensitivity in insulin resistant patients with type 1 diabetes mellitus.

    Science.gov (United States)

    van Asseldonk, Edwin J P; van Poppel, Pleun C M; Ballak, Dov B; Stienstra, Rinke; Netea, Mihai G; Tack, Cees J

    2015-10-01

    Inflammation associated with obesity is involved in the development of insulin resistance. We hypothesized that anti-inflammatory treatment with the Interleukin-1 receptor antagonist anakinra would improve insulin sensitivity. In an open label proof-of-concept study, we included overweight patients diagnosed with type 1 diabetes with an HbA1c level over 7.5%. Selecting insulin resistant patients with longstanding type 1 diabetes allowed us to study the effects of anakinra on insulin sensitivity. Patients were treated with 100mg anakinra daily for one week. Insulin sensitivity, insulin need and blood glucose profiles were measured before, after one week and after four weeks of follow-up. Fourteen patients completed the study. One week of anakinra treatment led to an improvement of insulin sensitivity, an effect that was sustained for four weeks. Similarly, glucose profiles, HbA1c levels and insulin needs improved. In conclusion, one week of treatment with anakinra improves insulin sensitivity in patients with type 1 diabetes. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Personalized game suite: a unified platform to sustain and improve the quality of life of Parkinson's disease patients.

    OpenAIRE

    Sofia B.Dias; Jose .A Diniz.; Stelios K. Hadjidimitriou; Vasileios Charisis; Evdokimos Konstantinidis; Panagiotis Bamidis; Leontios J. Hadjileontiadis

    2016-01-01

    The use of apps/games in healthcare interventions is gaining popularity, but there is still a gap in the understanding on how these types of interventions are used for the management of Parkinson disease (PD). In fact, gamification in healthcare (mHealth) can help people initiate healthier activities in various areas, such as losing weight, sleeping more, making healthier food choices, improving fitness, and monitoring health metrics. In this vein, there are six key elements ...

  3. Consumer Neuroscience : Pricing research to gain and sustain a cutting edge competitive advantage by improving customer value and profitability

    OpenAIRE

    Kumlehn, Malte

    2011-01-01

    This is the first study that exclusively focuses on gaining knowledge of the vast opportunities that Neuroscientific pricing research offers for marketing purposes. The findings of this study provide evidence of the importance to improve customer and organizational decision making. The findings further highlight the crucial importance of Neuroscientific pricing research. Moreover, evidence is provided that fundamental and well formulated models and concepts need to be developed in the discipl...

  4. Dual Inoculation with Mycorrhizal and Saprotrophic Fungi Applicable in Sustainable Cultivation Improves the Yield and Nutritive Value of Onion

    OpenAIRE

    Albrechtova, Jana; Latr, Ales; Nedorost, Ludovit; Pokluda, Robert; Posta, Katalin; Vosatka, Miroslav

    2012-01-01

    The aim of this paper was to test the use of dual microbial inoculation with mycorrhizal and saprotrophic fungi in onion cultivation to enhance yield while maintaining or improving the nutritional quality of onion bulbs. Treatments were two-factorial: (1) arbuscular mycorrhizal fungi (AMF): the mix corresponding to fungal part of commercial product Symbivit (Glomus etunicatum, G. microaggregatum, G. intraradices, G. claroideum, G. mosseae, and G. geosporum) (M1) or the single-fungus inoculum ...

  5. Sustainable MSD prevention: management for continuous improvement between prevention and production. Ergonomic intervention in two assembly line companies.

    Science.gov (United States)

    Caroly, S; Coutarel, F; Landry, A; Mary-Cheray, I

    2010-07-01

    To increase output and meet customers' needs, companies have turned to the development of production management systems: Kaizen, one piece flow, Kanban, etc. The aim of such systems is to accelerate decisions, react to environmental issues and manage various productions. In the main, this type of management system has led to the continuous improvement of production performance. Consequently, such production management systems can have unexpected negative effects on operators' health and safety. Conversely, regulation and control systems focusing on work-related risks have obliged firms to implement health and safety management systems such as OHSAS 18001. The purpose of this type of system, also based on continuous improvement, is to reduce risks, facilitate work-related activities and identify solutions in terms of equipment and tools. However, the prevention actions introduced through health and safety systems often result in other unexpected and unwanted effects on production. This paper shows how companies can improve the way they are run by taking into account both types of management system. Copyright 2010 Elsevier Ltd. All rights reserved.

  6. Improving sustainability in the remediation of contaminated soils by the use of compost and energy valorization by Paulownia fortunei.

    Science.gov (United States)

    Madejón, Paula; Domínguez, María Teresa; Díaz, Manuel Jesús; Madejón, Engracia

    2016-01-01

    The plantation of fast growing trees in contaminated sites, in combination with the use of organic wastes, could partially solve a dual environmental problem: the disposal of these wastes and the improvement of soil quality in these degraded soils. This study evaluated the effects of two compost on the quantity and quality of Paulownia fortunei biomass and on syngas production by biomass gasification, produced by plants growing on trace elements contaminated soils. Compost increased biomass production to values similar to those produced in non-contaminated soils, due to the improvement in plant nutritional status. Moreover, biomass quality for gasification was increased by compost addition. Trace element accumulation in the biomass was relatively low and not related to biomass production or the gas quality obtained through gasification. Thus, P. fortunei plantations could pose an opportunity to improve the economic balance of the revegetation of contaminated soils, given that other commercial uses such as food or fodder crop production is not recommended in these soils. Copyright © 2015 Elsevier B.V. All rights reserved.

  7. Identifying a practice-based implementation framework for sustainable interventions for improving the evolving working environment: Hitting the Moving Target Framework.

    Science.gov (United States)

    Højberg, Helene; Rasmussen, Charlotte Diana Nørregaard; Osborne, Richard H; Jørgensen, Marie Birk

    2018-02-01

    Our aim was to identify implementation components for sustainable working environment interventions in the nursing assistant sector to generate a framework to optimize the implementation of workplace improvement initiatives. The implementation framework was informed by: 1) an industry advisory group, 2) interviews with key stakeholder, 3) concept mapping workshops, and 4) an e-mail survey. Thirty five stakeholders were interviewed and contributed in the concept mapping workshops. Eleven implementation components were derived across four domains: 1) A supportive organizational platform, 2) An engaged workplace with mutual goals, 3) The intervention is sustainably fitted to the workplace, and 4) the intervention is an attractive choice. The highest rated component was "Engaged and Active Management" (mean 4.1) and the lowest rated was "Delivered in an Attractive Form" (mean 2.8). The framework provides new insights into implementation in an evolving working environment and is aiming to assist with addressing gaps in effectiveness of workplace interventions and implementation success. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  8. Sustainable pyrolytic sludge-char preparation on improvement of closed-loop sewage sludge treatment: Characterization and combined in-situ application.

    Science.gov (United States)

    Jin, Zhengyu; Chang, Fengmin; Meng, Fanlin; Wang, Cuiping; Meng, Yao; Liu, Xiaoji; Wu, Jing; Zuo, Jiane; Wang, Kaijun

    2017-10-01

    Aiming at closed-loop sustainable sewage sludge treatment, an optimal and economical pyrolytic temperature was found at 400-450 °C considering its pyrolysis efficiency of 65%, fast cracking of hydrocarbons, proteins and lipids and development of aromatized porous structure. Fourier-transform infrared (FTIR) and X-ray diffraction (XRD) tests demonstrated the development of adsorptive functional groups and crystallographic phases of adsorptive minerals. The optimal sludge-char, with a medium specific surface area of 39.6 m 2  g -1 and an iodine number of 327 mgI 2 g -1 , performed low heavy metals lixiviation. The application of sludge-char in raw sewage could remove 30% of soluble chemical oxygen demand (SCOD), along with an acetic acid adsorption capacity of 18.0 mg g -1 . The developed mesopore and/or macropore structures, containing rich acidic and basic functional groups, led to good biofilm matrices for enhanced microbial activities and improved autotrophic nitrification in anoxic stage of an A/O reactor through adsorbed extra carbon source, and hence achieved the total nitrogen (TN) removal up to 50.3%. It is demonstrated that the closed-loop sewage sludge treatment that incorporates pyrolytic sludge-char into in-situ biological sewage treatment can be a promising sustainable strategy by further optimization. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. MR imaging of symptomatic osteochondromas with pathological correlation

    International Nuclear Information System (INIS)

    Mehta, M.; Knapp, T.; White, L.M.; Wunder, J.S.; Bell, R.S.

    1998-01-01

    Objective. To demonstrate the value of MR imaging in the diagnosis and differentiation of the various symptomatic complications of osteochondromas, providing pathological correlation with emphasis on the usefulness of MR imaging as a single imaging modality in these patients. Design. We retrospectively reviewed all MR examinations of clinically symptomatic osteochondromas (30 patients) performed at our institution between March 1990 and October 1997. Patients. Thirty patients had clinically symptomatic osteochondromas during the study period. Twenty patients were male and 10 were female. There were five cases of multiple osteochondromatosis. Pathological correlation was available in 24 patients. Results and conclusion. Symptomatic complications included fracture (7%), osseous deformity limiting range of motion (23%), vascular injury (7%), neurological compromise (10%), bursa formation (27%) and malignant transformation (27%). MR imaging was able to diagnose or suggest the etiology for the clinical symptomatology in all cases, demonstrating that it is an ideal imaging modality in the diagnostic evaluation of symptomatic complications of osteochondromas and often avoids the need for further imaging. (orig.)

  10. Sustained Improvements in Dynamic Balance and Landing Mechanics After a 6-Week Neuromuscular Training Program in College Women's Basketball Players.

    Science.gov (United States)

    Pfile, Kate R; Gribble, Phillip A; Buskirk, Gretchen E; Meserth, Sara M; Pietrosimone, Brian G

    2016-08-01

    Epidemiological data demonstrate the need for lower-extremity injury-prevention training. Neuromuscular-control (NMC) programs are immediately effective at minimizing lower-extremity injury risk and improving sport-related performance measures. Research investigating lasting effects after an injury-prevention program is limited. To determine whether dynamic balance, landing mechanics, and hamstring and quadriceps strength could be improved after a 6-wk NMC intervention and maintained for a season. Prospective case series. Controlled laboratory. 11 Division I women's basketball players (age 19.40 ± 1.35 y, height 178.05 ± 7.52 cm, mass 72.86 ± 10.70 kg). Subjects underwent testing 3 times, completing the Star Excursion Balance Test (SEBT), Landing Error Scoring System (LESS), and isometric strength testing for the hamstrings and quadriceps muscles. Pretest and posttest 1 occurred immediately before and after the intervention, respectively, and posttest 2 at the end of the competitive season, 9 mo after posttest 1. Subjects participated in eighteen 30-min plyometric and NMC-training sessions over a 6-wk period. The normalized SEBT composite score, normalized peak isometric hamstrings:quadriceps (H:Q) ratio, and the LESS total score. The mean composite reach significantly improved over time (F2,10 = 6.96, P = .005) where both posttest scores were significantly higher than pretest (70.41% ± 4.08%) (posttest 1 73.48% ± 4.19%, t10 = -3.11, P = .011) and posttest 2 (74.2% ± 4.77%, t10 = -3.78, P = .004). LESS scores significantly improved over time (F2,10 = 6.29, P = .009). The pretest LESS score (7.30 ± 3.40) was higher than posttest 1 (4.9 ± 1.20, t10 = 2.71, P = .024) and posttest 2 (5.44 ± 1.83, t10 = 2.58, P = .030). There were no statistically significant differences (P > .05) over time for the H:Q ratio when averaging both legs (F2,10 = 0.83, P = .45). A 6-wk NMC program improved landing mechanics and dynamic balance over a 9-mo period in women

  11. Strategic sustainability performance plan

    Science.gov (United States)

    2010-06-01

    In October 2009, President Obama signed Executive Order (EO) 13514 that sets sustainability : goals for Federal agencies and focuses on making improvements in environmental, energy and : economic performance. The Executive Order requires Federal agen...

  12. Stent angioplasty for the treatment of symptomatic stenosis of middle cerebral artery

    International Nuclear Information System (INIS)

    Lu Huisheng; Niu Huiming; Chao Yuanxiang; Li Xiaoning; Wu Dingfeng; Zhang Chenhong; Yang Jie; Zhang Liang

    2010-01-01

    Objective: To investigate the safety and feasibility of endovascular stent angioplasty in treating symptomatic stenosis of middle cerebral artery. Methods: Endovascular angioplasty with coronary stents was performed in 27 patients with symptomatic stenosis of middle cerebral artery. The clinical results were reviewed and analyzed. Results: Of the total 27 patients, successful placement of the coronary stents was achieved in 24. Angiography immediately after the procedure showed that the stenotic degree of the diseased artery was markedly decreased from preoperative (80 ± 19)% to postoperative (8 ±4)%, the improvement was very obvious. Percutaneous transcatheter angioplasty had to be employed in two cases because of the failure of stent placement. A mean follow-up period of 18 months was carried out. During the following up period no transient cerebral ischemia attack occurred in 25 patients and no newly-developed cerebral infarction in region fed by the responsible vessels occurred either.Re-irrigation cerebral hemorrhage was seen in one patient, which occurred three hours after the placement of the stent. In one case the placed stent fell off and immigrated into the siphon of internal carotid artery, and the displaced stent was took out later with a catching apparatus. In another case re-stenosis occurred six months after the stenting. Conclusion: Percutaneous endovascular stent angioplasty is a safe and effective treatment for symptomatic stenosis of middle cerebral artery, although its long-term results need to be further evaluated. (authors)

  13. Role of symptomatic treatment in comparison to antibiotics in uncomplicated urinary tract infections

    International Nuclear Information System (INIS)

    Jamil, M.N.; Khan, R.M.; Sultan, B.; Farooq, U.

    2017-01-01

    Uncomplicated urinary tract infections (UTIs) are the most common bacterial infections among women presenting to primary care causing rapidly increasing strains of resistant bacteria to the growing antibiotic industry. Restricting antibiotics to necessary indications is the only solution. The objectives of the study were to compare the efficacy of symptomatic treatment vs antibiotic in patients with uncomplicated UTI, in terms of individual symptom score, i.e., frequency, urgency, dysuria, supra pubic pain scores and total symptoms scores. Methods: A randomized control trial (RCT) in 100 women (15-50 years) with symptoms of urinary frequency, urgency, dysuria and pain supra pubic region, associated with uncomplicated UTI, at Urology department, AMI, Abbottabad. Two treatment strategies were compared in uncomplicated UTI patient). Patients were randomized to antibiotic or symptomatic treatment groups on consecutive non-probability basis (50 in each group) given for 05 days. Efficacy of medications was assessed by comparing pre and post treatment symptom scores along with the post treatment scores of both groups compared to see statistical significance of difference by independent samples t-test. Results: There was a statistically significant difference in symptoms improvement in both treatment arms of all scores, i.e., p-value=0.000. Whereas only dysuria score was able to show a statistically significance of difference in post Rx scores comparison of both groups, p-value=0.004. Conclusions: Symptomatic treatment is not inferior to antibiotic treatment when proper patient selection is undertaken, resulting in decreased need for unnecessary antibiotics use. (author)

  14. Symptomatic Chiari malformation in infancy and adolescence

    International Nuclear Information System (INIS)

    Fukushima, Takeo; Matsuda, Toshihiro; Tsugu, Hitoshi; Sakamoto, Seisaburou; Tomonaga, Masamichi; Asakawa, Koji; Mitsudome, Akihisa; Hashimoto, Takahisa.

    1994-01-01

    Of the 7 children and adolescents with Chiari malformation reported here 5 had Chiari type 1 and 2 had Chiari type 2 disease. All 5 Chiari type 1 patients had syringomyelia and scoliosis, but the Chiari type 2 patients did not. All the patients except one with localized syringomyelia (case 3) underwent posterior decompression with suboccipital craniectomy, upper cervical laminectomy and duraplasty, and their clinical signs and symptoms improved. Case 3 received a syringo-subarachnoid shunt and improved clinically. Motor function was restored better than sensory function. Cranial nerve signs were cleared up in the Chiari type 2 patients. In the Chiari type 1 patients postoperative neurological improvement correlated well with the collapse of syringomyelia. Cine MR imaging was useful in the evaluation of CSF dynamics at the cranio-vertebral junction and in the syringomyelic cavity before and after surgery. (author)

  15. Identification of Symptomatic Fetuses Infected with Cytomegalovirus Using Amniotic Fluid Peptide Biomarkers.

    Directory of Open Access Journals (Sweden)

    Cyrille Desveaux

    2016-01-01

    Full Text Available Cytomegalovirus (CMV is the most common cause of congenital infection, and is a major cause of sensorineural hearing loss and neurological disabilities. Evaluating the risk for a CMV infected fetus to develop severe clinical symptoms after birth is crucial to provide appropriate guidance to pregnant women who might have to consider termination of pregnancy or experimental prenatal medical therapies. However, establishing the prognosis before birth remains a challenge. This evaluation is currently based upon fetal imaging and fetal biological parameters, but the positive and negative predictive values of these parameters are not optimal, leaving room for the development of new prognostic factors. Here, we compared the amniotic fluid peptidome between asymptomatic fetuses who were born as asymptomatic neonates and symptomatic fetuses who were either terminated in view of severe cerebral lesions or born as severely symptomatic neonates. This comparison allowed us to identify a 34-peptide classifier in a discovery cohort of 13 symptomatic and 13 asymptomatic neonates. This classifier further yielded 89% sensitivity, 75% specificity and an area under the curve of 0.90 to segregate 9 severely symptomatic from 12 asymptomatic neonates in a validation cohort, showing an overall better performance than that of classical fetal laboratory parameters. Pathway analysis of the 34 peptides underlined the role of viral entry in fetuses with severe brain disease as well as the potential importance of both beta-2-microglobulin and adiponectin to protect the injured fetal brain infected with CMV. The results also suggested the mechanistic implication of the T calcium channel alpha-1G (CACNA1G protein in the development of seizures in severely CMV infected children. These results open a new field for potential therapeutic options. In conclusion, this study demonstrates that amniotic fluid peptidome analysis can effectively predict the severity of congenital CMV

  16. Moving past the rhetoric: Policy considerations that can make Sino-African relations to improve Africa's climate change resilience and the attainment of the sustainable development goals

    Directory of Open Access Journals (Sweden)

    Dumisani Chirambo

    2016-12-01

    Full Text Available Climate change is a threat to the attainment of the Sustainable Development Goals (SDGs in sub-Saharan Africa as its impacts can lead to increased incidences of poverty and inequality which can subsequently lead to a 12% decline in the Human Development Index (HDI for sub-Saharan Africa. Emerging countries such as China have the potential to support Africa to achieve the SDGs by pioneering South–South Climate Finance (SSCF modalities. In order to increase knowledge on climate informed development and the role of China in global climate governance, the paper examined various research articles, case studies, policy briefs and project reports. Sino-African aid, investments and trade were noted as essential in mitigating Africa's climate change vulnerabilities which induce poverty traps and inequality. Some African countries were noted to have a comparative advantage in environmental standards over China but lacked the initiative to use this comparative advantage to enhance the Forum on China–Africa Cooperation (FOCAC and assist China to have a sustainable growth trajectory. The paper concludes that SSCF modalities can enhance climate risk management in Africa if they focus on improving financial inclusion and improving climate finance flows towards climate change adaptation activities in Africa. Additionally, to increase the effectiveness and impact of Chinese climate finance support to Africa, African policymakers should not allow political and market forces to decide how climate related support from China should be allocated as decisions based on political and market forces could potentially promote an inequitable distribution of funds and ignore the most vulnerable countries and regions.

  17. Sustained improvements in peripheral venous catheter care in non-intensive care units: a quasi-experimental controlled study of education and feedback.

    Science.gov (United States)

    Fakih, Mohamad G; Jones, Karen; Rey, Janice E; Berriel-Cass, Dorine; Kalinicheva, Tatyana; Szpunar, Susanna; Saravolatz, Louis D

    2012-05-01

    Peripheral venous catheters (PVCs) can be associated with serious infectious complications. We evaluated the effect of education and feedback on process measures to improve PVC care and infectious complications. Quasi-experimental controlled crossover study with sampling before and after education. An 804-bed tertiary care teaching hospital. Nurses and patients in 10 non-intensive care units. We implemented a process to improve PVC care in 10 non-intensive care units. The 4 periods (each 3 months in duration) included a preintervention period and a staggered educational intervention among nurses. During intervention period 1, 5 units participated in the intervention (group A), and 5 units served as a control group (group B). Group B underwent the intervention during intervention period 2, and both groups A and B received feedback on performance during intervention period 3. Process measures were evaluated twice monthly, and feedback was given to nurses directly and to the unit manager on a monthly basis. During the preintervention period, there were no significant differences between groups A and B. Of 4,904 intravascular catheters evaluated, 4,434 (90.4%) were peripheral. By the end of the study, there were significant improvements in processes, compared with the preintervention period, including accurate documentation of dressing (from 442 cases [38%] to 718 cases [59%]; P feedback to nurses increases and sustains compliance with processes to reduce the risk of infection from PVCs.

  18. A little similarity goes a long way: the effects of peripheral but self-revealing similarities on improving and sustaining interracial relationships.

    Science.gov (United States)

    West, Tessa V; Magee, Joe C; Gordon, Sarah H; Gullett, Lindy

    2014-07-01

    Integrating theory on close relationships and intergroup relations, we construct a manipulation of similarity that we demonstrate can improve interracial interactions across different settings. We find that manipulating perceptions of similarity on self-revealing attributes that are peripheral to the interaction improves interactions in cross-race dyads and racially diverse task groups. In a getting-acquainted context, we demonstrate that the belief that one's different-race partner is similar to oneself on self-revealing, peripheral attributes leads to less anticipatory anxiety than the belief that one's partner is similar on peripheral, nonself-revealing attributes. In another dyadic context, we explore the range of benefits that perceptions of peripheral, self-revealing similarity can bring to different-race interaction partners and find (a) less anxiety during interaction, (b) greater interest in sustained contact with one's partner, and (c) stronger accuracy in perceptions of one's partners' relationship intentions. By contrast, participants in same-race interactions were largely unaffected by these manipulations of perceived similarity. Our final experiment shows that among small task groups composed of racially diverse individuals, those whose members perceive peripheral, self-revealing similarity perform superior to those who perceive dissimilarity. Implications for using this approach to improve interracial interactions across different goal-driven contexts are discussed.

  19. Commentary: A call to leadership: the role of the academic medical center in driving sustainable health system improvement through performance measurement.

    Science.gov (United States)

    Nedza, Susan M

    2009-12-01

    As the government attempts to address the high cost of health care in the United States, the issues being confronted include variations in the quality of care administered and the inconsistent application of scientifically proven treatments. To improve quality, methods of measurement and reporting with rewards or, eventually, penalties based on performance, must be developed. To date, well-intentioned national policy initiatives, such as value-based purchasing, have focused primarily on the measurement of discrete events and on attempts to construct incentives. While important, the current approach alone cannot improve quality, ensure equitability, decrease variability, and optimize value. Additional thought-leadership is required, both theoretical and applied. Academic medical centers' (AMCs') scholarly and practical participation is needed. Although quality cannot be sustainably improved without measurement, the existing measures alone do not ensure quality. There is not enough evidence to support strong measure development and, further, not enough insight regarding whether the existing measures have their intended effect of enhancing health care delivery that results in quality outcomes for patients. Perhaps the only way that the United States health care system will achieve a standard of quality care is through the strong embrace, effective engagement, intellectual insights, educational contributions, and practical applications in AMCs. Quality will never be achieved through public policies or national initiatives alone but instead through the commitment of the academic community to forward the science of performance measurement and to ensure that measurement leads to better health outcomes for our nation.

  20. Gallbladder-associated symptomatic hepatic choristoma: Should you resect?

    Directory of Open Access Journals (Sweden)

    Salah Termos

    Full Text Available Introduction: Hepatic choristomas or ectopic livers are uncommon, and occur due to a failure of embryological liver development. They pose a risk of carcinogenesis, with transformation to hepatocellular carcinoma (HCC being described in the literature (Arakawa et al., 1999. It is often a silent clinical finding that can occur anywhere in the body and is usually diagnosed incidentally during abdominal surgical procedures or autopsies (Eiserth et al., 1940. We present the case of a patient with a symptomatic ectopic liver that was detected preoperatively, and removed laparoscopically with the gallbladder. Presentation of case: A 73-year-old lady was referred to our unit for a gallbladder tumor on ultrasound which was done for biliary colic. Tumor markers were normal. Computed tomography (CT scan showed an enhanced soft tissue lesion measuring about 3 × 1.5 cm interposed between the gallbladder and liver. Laparoscopic exploration revealed a bean-shaped hepatic choristoma attached to the liver on the medial wall of the gallbladder. The lesion was removed by en-bloc resection during laparoscopic cholecystectomy and extracted carefully in an endobag. Histopathological examination confirmed the absence of carcinogenesis. Discussion and conclusion: Hepatic choristomas (HC are a rare entity, usually identified during abdominal surgeries. It had been reported in several studies with different presentations. Awareness of this unexpected finding and familiarity of its potential complications and carcinogenesis will improve care delivery when encountered. Surgical treatment should be considered when the choristoma is not attached to the liver, in light of its potential transformation into HCC. Keywords: Case report, Hepatic choristoma (HC, Hepar succenturiatum, Ectopic liver (EL, Hepatocellular carcinoma (HCC, Gallbladder

  1. Clinical and neurocognitive outcome in symptomatic isovaleric acidemia

    Directory of Open Access Journals (Sweden)

    Grünert Sarah C

    2012-01-01

    Full Text Available Abstract Background Despite its first description over 40 years ago, knowledge of the clinical course of isovaleric acidemia (IVA, a disorder predisposing to severe acidotic episodes during catabolic stress, is still anecdotal. We aimed to investigate the phenotypic presentation and factors determining the neurological and neurocognitive outcomes of patients diagnosed with IVA following clinical manifestation. Methods Retrospective data on 21 children and adults with symptomatic IVA diagnosed from 1976 to 1999 were analyzed for outcome determinants including age at diagnosis and number of catabolic episodes. Sixteen of 21 patients were evaluated cross-sectionally focusing on the neurological and neurocognitive status. Additionally, 155 cases of patients with IVA published in the international literature were reviewed and analyzed for outcome parameters including mortality. Results 57% of study patients (12/21 were diagnosed within the first weeks of life and 43% (9/21 in childhood. An acute metabolic attack was the main cause of diagnostic work-up. 44% of investigated study patients (7/16 showed mild motor dysfunction and only 19% (3/16 had cognitive deficits. No other organ complications were found. The patients' intelligence quotient was not related to the number of catabolic episodes but was inversely related to age at diagnosis. In published cases, mortality was high (33% if associated with neonatal diagnosis, following manifestation at an average age of 7 days. Conclusions Within the group of "classical" organic acidurias, IVA appears to be exceptional considering its milder neuropathologic implications. The potential to avoid neonatal mortality and to improve neurologic and cognitive outcome under early treatment reinforces IVA to be qualified for newborn screening.

  2. Sustainable Marketing

    NARCIS (Netherlands)

    Dam, van Y.K.

    2017-01-01

    In this article, three different conceptions of sustainable marketing are discussed and compared. These different conceptions are referred to as social, green, and critical sustainable marketing. Social sustainable marketing follows the logic of demand-driven marketing management and places the

  3. A Hybrid Backward-Forward Iterative Model for Improving Capacity Building of Earth Observations for Sustainable Societal Application

    Science.gov (United States)

    Hossain, F.; Iqbal, N.; Lee, H.; Muhammad, A.

    2015-12-01

    When it comes to building durable capacity for implementing state of the art technology and earth observation (EO) data for improved decision making, it has been long recognized that a unidirectional approach (from research to application) often does not work. Co-design of capacity building effort has recently been recommended as a better alternative. This approach is a two-way street where scientists and stakeholders engage intimately along the entire chain of actions from design of research experiments to packaging of decision making tools and each party provides an equal amount of input. Scientists execute research experiments based on boundary conditions and outputs that are defined as tangible by stakeholders for decision making. On the other hand, decision making tools are packaged by stakeholders with scientists ensuring the application-specific science is relevant. In this talk, we will overview one such iterative capacity building approach that we have implemented for gravimetry-based satellite (GRACE) EO data for improved groundwater management in Pakistan. We call our approach a hybrid approach where the initial step is a forward model involving a conventional short-term (3 day) capacity building workshop in the stakeholder environment addressing a very large audience. In this forward model, the net is cast wide to 'shortlist' a set of highly motivated stakeholder agency staffs who are then engaged more directly in 1-1 training. In the next step (the backward model), these short listed staffs are then brought back in the research environment of the scientists (supply) for 1-1 and long-term (6 months) intense brainstorming, training, and design of decision making tools. The advantage of this backward model is that it allows for a much better understanding for scientists of the ground conditions and hurdles of making a EO-based scientific innovation work for a specific decision making problem that is otherwise fundamentally impossible in conventional

  4. A concise guide to sustainable PEMFCs: recent advances in improving both oxygen reduction catalysts and proton exchange membranes.

    Science.gov (United States)

    Scofield, Megan E; Liu, Haiqing; Wong, Stanislaus S

    2015-08-21

    The rising interest in fuel cell vehicle technology (FCV) has engendered a growing need and realization to develop rational chemical strategies to create highly efficient, durable, and cost-effective fuel cells. Specifically, technical limitations associated with the major constituent components of the basic proton exchange membrane fuel cell (PEMFC), namely the cathode catalyst and the proton exchange membrane (PEM), have proven to be particularly demanding to overcome. Therefore, research trends within the community in recent years have focused on (i) accelerating the sluggish kinetics of the catalyst at the cathode and (ii) minimizing overall Pt content, while simultaneously (a) maximizing activity and durability as well as (b) increasing membrane proton conductivity without causing any concomitant loss in either stability or as a result of damage due to flooding. In this light, as an example, high temperature PEMFCs offer a promising avenue to improve the overall efficiency and marketability of fuel cell technology. In this Critical Review, recent advances in optimizing both cathode materials and PEMs as well as the future and peculiar challenges associated with each of these systems will be discussed.

  5. Sustained improvements in students' mental health literacy with use of a mental health curriculum in Canadian schools.

    Science.gov (United States)

    Mcluckie, Alan; Kutcher, Stan; Wei, Yifeng; Weaver, Cynthia

    2014-12-31

    Enhancement of mental health literacy for youth is a focus of increasing interest for mental health professionals and educators alike. Schools are an ideal site for addressing mental health literacy in young people. Currently, there is limited evidence regarding the impact of curriculum-based interventions within high school settings. We examined the effect of a high-school mental health curriculum (The Guide) in enhancing mental health literacy in Canadian schools. We conducted a secondary analysis on surveys of students who participated in a classroom mental health course taught by their usual teachers. Evaluation of students' mental health literacy (knowledge/attitudes) was completed before and after classroom implementation and at 2-month follow-up. We used paired-samples t-tests and Cohen's d value to determine the significance and impact of change. There were 265 students who completed all surveys. Students' knowledge significantly improved between pre- and post-tests (p mental health. This is the first study to demonstrate the positive impact of a curriculum-based mental health literacy program in a Canadian high school population.

  6. A proposal for improving sustainability practice through the implementations of reuse and recycle technique in Malaysian construction industry

    Science.gov (United States)

    Osman, Wan Nadzri; Nawi, Mohd Nasrun Mohd; Saad, Rohaizah; Anuar, Herman Shah; Ibrahim, Siti Halipah

    2016-08-01

    Construction and demolition waste is often seen as the major contributor to the solid waste stream that is going to landfill, hence, making it the area of focus for improvement. In the construction industry, reuse and recycle principles have been promoted in order to reduce waste and protect the environment. Construction and demolition waste including demolished concrete, bricks and masonry, wood and other materials such as dry wall, glass, insulation, roofing, wire, pipe, rock and soil constitute a significant component of the total waste. Without proper reuse and recycle policies, these construction and demolition wastes would quickly fill all the remaining landfill space, which has already been growing in scarce around this region. Based on the feedback received, on average, a third of respondents said they currently have a lotto benefit from the use of reduce and reuse. In addition, they also agreed that the existing policies help and support the min carrying out the reduce and reuse practices. Respondents also agreed that other stakeholders in the construction industry currently have an excellent awareness in term of implementation of the reduce and reuse in their practices.

  7. Dual inoculation with mycorrhizal and saprotrophic fungi applicable in sustainable cultivation improves the yield and nutritive value of onion.

    Science.gov (United States)

    Albrechtova, Jana; Latr, Ales; Nedorost, Ludovit; Pokluda, Robert; Posta, Katalin; Vosatka, Miroslav

    2012-01-01

    The aim of this paper was to test the use of dual microbial inoculation with mycorrhizal and saprotrophic fungi in onion cultivation to enhance yield while maintaining or improving the nutritional quality of onion bulbs. Treatments were two-factorial: (1) arbuscular mycorrhizal fungi (AMF): the mix corresponding to fungal part of commercial product Symbivit (Glomus etunicatum, G. microaggregatum, G. intraradices, G. claroideum, G. mosseae, and G. geosporum) (M1) or the single-fungus inoculum of G. intraradices BEG140 (M2) and (2) bark chips preinoculated with saprotrophic fungi (mix of Gymnopilus sp., Agrocybe praecox, and Marasmius androsaceus) (S). The growth response of onion was the highest for the M1 mix treatment, reaching nearly 100% increase in bulb fresh weight. The effectiveness of dual inoculation was proved by more than 50% increase. We observed a strong correlation (r = 0.83) between the growth response of onion bulbs and AM colonization. All inoculation treatments but the single-fungus one enhanced significantly the total antioxidant capacity of bulb biomass, was the highest values being found for M1, S + M1, and S + M2. We observed some induced enhancement of the contents of mineral elements in bulb tissue (Mg and K contents for the M2 and M2, S, and S + M2 treatments, resp.).

  8. Dual Inoculation with Mycorrhizal and Saprotrophic Fungi Applicable in Sustainable Cultivation Improves the Yield and Nutritive Value of Onion

    Directory of Open Access Journals (Sweden)

    Jana Albrechtova

    2012-01-01

    Full Text Available The aim of this paper was to test the use of dual microbial inoculation with mycorrhizal and saprotrophic fungi in onion cultivation to enhance yield while maintaining or improving the nutritional quality of onion bulbs. Treatments were two-factorial: (1 arbuscular mycorrhizal fungi (AMF: the mix corresponding to fungal part of commercial product Symbivit (Glomus etunicatum, G. microaggregatum, G. intraradices, G. claroideum, G. mosseae, and G. geosporum (M1 or the single-fungus inoculum of G. intraradices BEG140 (M2 and (2 bark chips preinoculated with saprotrophic fungi (mix of Gymnopilus sp., Agrocybe praecox, and Marasmius androsaceus (S. The growth response of onion was the highest for the M1 mix treatment, reaching nearly 100% increase in bulb fresh weight. The effectiveness of dual inoculation was proved by more than 50% increase. We observed a strong correlation (r=0.83 between the growth response of onion bulbs and AM colonization. All inoculation treatments but the single-fungus one enhanced significantly the total antioxidant capacity of bulb biomass, was the highest values being found for M1, S + M1, and S + M2. We observed some induced enhancement of the contents of mineral elements in bulb tissue (Mg and K contents for the M2 and M2, S, and S+M2 treatments, resp..

  9. Inorganic phosphorus along with biofertilizers improves profitability and sustainability in soybean (Glycine max–potato (Solanum tuberosum cropping system

    Directory of Open Access Journals (Sweden)

    Sushmita Munda

    2018-04-01

    Full Text Available Present study was conducted to assess role of phosphorus (P fertilization on economics, energy efficiency, P use indices and soil P balance in soybean [Glycine max (L. Merril]–potato (Solanum tuberosum L. cropping system during 2008–09 and 2009–10. Treatments in soybean as main plots consisted of two sources and two levels of phosphorus with or without biofertilizers [phosphorus solubilizing bacteria, PSB and arbuscular mycorrhizae, AM]. Three levels of P were applied to potato as subplots. System productivity was calculated in terms of soybean equivalent yield and found to be better with biofertilizers treated plots. When applied in combination with biofertilizers, 50% recommended dose of P (RDP as diammonium phosphate (DAP recorded B:C ratio at par with 100% RDP. Direct application of 100% RDP to potato resulted in significantly higher returns, enhancing the net returns. Application of biofertilizers alone increased the energy use efficiency over no biofertilizer application. Irrespective of source (DAP or rock phosphate treatments with biofertilizers had improved P use indices and apparent soil P balance even at 50% RDP. This indicates the role of biofertilizers in P solubilization and making it available to plant. Biofertilizers application can help cutting down the fertilizer P application in soybean–potato cropping system without any considerable reduction in yield and economic returns. Keywords: AM, B:C ratio, P use indices, PSB, Rock phosphate, Agronomic use efficiency

  10. Cork for sustainable product design

    NARCIS (Netherlands)

    Mestre, A.C.; Gil, L.

    2011-01-01

    Sustainable Product Design is currently accepted as one of the most promising trends in the “Sustainable Development” movement. It is often seen as a facilitation tool to implement Sustainability in practice, by improving the life cycle and eco-efficiency of products, by promoting dematerialization

  11. Improving the Sustainability of Transportation: Environmental and Functional Benefits of Right Turn By-Pass Lanes at Roundabouts

    Directory of Open Access Journals (Sweden)

    Marco Guerrieri

    2015-05-01

    Full Text Available The functional performances of conventional roundabouts (single-lane and multi-lane and innovative roundabouts (spiral, flower, C and turbo can be improved through right-turn bypass lanes controlled by stop, yield or free-flow signs. The article presents evaluations of the emissions of air pollutants (carbon dioxide, nitrogen oxides, particle pollution (PM10 and PM2.5, fuel consumption and construction, management, energetic and environmental costs in roundabouts without or with bypass lanes (controlled by stop, yield or free-flow. The suggested methodology has a general character and can be applied as a multi-parametric criterion for choosing road intersections, although, in the present paper, it has been employed only for a case study. For the aims of this research, we employed recent closed-form formulations to determine roundabout performances; moreover, we used the COPERT IV® software to estimate air emissions in nine different types of vehicles. Numerous traffic simulations were carried out. The variation in the maximum hourly traffic Qmax and annual traffic QTOT provided the appropriate domains of the examined geometric layouts, both in functional and environmental terms and with regard to generalized costs, estimated for a 10-year period. It resulted that the introduction of right-turn bypasses in all arms of conventional roundabouts with a one ring lane and one lane at the entries (single-lane roundabouts is the most cost-effective when the flows entering the roundabout are higher than Qmax = 2000 veh/h. Moreover, free-flow bypass lanes always provide greater capacity and lower delays than stop- or yield-signaled bypasses. However, with extremely high Qmax values, stop-controlled bypasses guarantee lower fuel consumption, while those with a yield sign lower total costs.

  12. Chest Compressions during Sustained Inflations Improve Recovery When Compared to a 3:1 Compression:Ventilation Ratio during Cardiopulmonary Resuscitation in a Neonatal Porcine Model of Asphyxia.

    Science.gov (United States)

    Li, Elliott S; Görens, Immanuel; Cheung, Po-Yin; Lee, Tze-Fun; Lu, Min; O'Reilly, Megan; Schmölzer, Georg M

    2017-01-01

    Recently, sustained inflations (SI) during chest compression (CC) (CC+SI) have been suggested as an alternative to the current approach during neonatal resuscitation. No previous study compared CC+SI using CC rates of 90/min to the current 3:1 compression:ventilation ratio (C:V). To determine whether CC+SI versus a 3:1 C:V reduces the time to the return of spontaneous circulation (ROSC) and improves hemodynamic recovery in newborn piglets with asphyxia-induced bradycardia. Term newborn piglets were anesthetized, intubated, instrumented, and exposed to 45-min normocapnic hypoxia followed by asphyxia. Cardiopulmonary resuscitation (CPR) was initiated when the heart rate decreased to 25% of baseline. Piglets were randomized into 3 groups: CC during SI at a rate of 90 CC/min (SI+CC 90, n = 8), a 3:1 C:V using 90 CC and 30 inflations (3:1, n = 8), or a sham group (n = 6). Cardiac function, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment. CC+SI significantly reduced the median (IQR) time of ROSC, i.e., 34 s (28-156 s) versus 210 s (72-300 s) in the 3:1 group (p = 0.048). CC+SI also significantly reduced the requirement for 100% oxygen, improved respiratory parameters, and resulted in a similar hemodynamic recovery. CC+SI during CPR significantly improved ROSC in a porcine model of neonatal resuscitation. This is of considerable clinical relevance because improved respiratory and hemodynamic parameters potentially minimize morbidity and mortality in newborn infants. © 2017 S. Karger AG, Basel.

  13. Estimation and improvement of the RF government plan for providing the sustainable social-economic development of Russia in 2016

    Directory of Open Access Journals (Sweden)

    Dmitriy V. Manushin

    2016-09-01

    interestfree loans for initial setting of personal farms for the citizens who have received free land from the state to intensify the work in the field of infrastructure projects implementation to solve organizational problems of state management of society and the economy etc. Practical significance implementation of the proposed measures will improve the crisis management in the Russian macroeconomics.

  14. Sustained long-term improvement with clozapine in schizophrenia Clozapina na esquizofrenia grave: melhora duradoura e sustentada

    Directory of Open Access Journals (Sweden)

    RICARDO DE OLIVEIRA-SOUZA

    1999-03-01

    Full Text Available The present paper reports the long-term use of clozapine in a prospective sample of 46 chronic schizophrenics. In six months, 21 subjects had been excluded for a number of reasons. In four of them the reasons for exclusion were related to lack of response or adverse effects. The median daily clozapine dose was 400 mg in the remaining 25 patients. As a whole, there were remarkable improvements in core dimensions of psychopathology, global cognitive status, and level of functioning. We confirmed that clozapine is effective in a subgroup of schizophrenics with the severest forms of the disease. If tolerated after the first few months it leads to progressive gains in several domains of behavior. Clozapine should be tried in every patient with schizophrenia in whom positive symptoms, disorganization, or bizarre behavior are a matter of incapacitation despite efforts to keep them under control with other drugs.O presente estudo, prospectivo, relata o uso de longo-prazo da clozapina em 46 esquizofrênicos graves, com mais de cinco anos de doença. Com seis meses de uso da droga, 21 indivíduos haviam sido excluídos por diversas razões. Em quatro, a exclusão se deveu a efeitos adversos ou ausência de resposta. A dose mediana de clozapina foi de 400 mg nos demais 25 pacientes. No todo, observamos melhora em dimensões de psicopatologia, estado cognitivo global, e nível funcional. Concluímos que a clozapina é eficaz em um subgrupo de esquizofrênicos com formas graves da doença. Se tolerada depois dos primeiros meses, produz benefícios progressivos em diversos domínios do comportamento. Clozapina deve ser tentada em todo paciente com esquizofrenia incapacitado por sintomas positivos, desorganização, e/ou comportamentos bizarros, que persistem a despeito de esforços para mantê-los sob controle com outras drogas.

  15. Towards Sustainable Aquafeeds: Complete Substitution of Fish Oil with Marine Microalga Schizochytrium sp. Improves Growth and Fatty Acid Deposition in Juvenile Nile Tilapia (Oreochromis niloticus)

    Science.gov (United States)

    Sarker, Pallab K.; Kapuscinski, Anne R.; Lanois, Alison J.; Livesey, Erin D.; Bernhard, Katie P.; Coley, Mariah L.

    2016-01-01

    We conducted a 84-day nutritional feeding experiment with dried whole cells of DHA-rich marine microalga Schizochytrium sp. (Sc) to determine the optimum level of fish-oil substitution (partial or complete) for maximum growth of Nile tilapia. When we fully replaced fish oil with Schizochytrium (Sc100 diet), we found significantly higher weight gain and protein efficiency ratio (PER), and lower (improved) feed conversion ratio (FCR) and feed intake compared to a control diet containing fish oil (Sc0); and no significant change in SGR and survival rate among all diets. The Sc100 diet had the highest contents of 22:6n3 DHA, led to the highest DHA content in fillets, and consequently led to the highest DHA:EPA ratios in tilapia fillets. Schizochytrium sp. is a high quality candidate for complete substitution of fish oil in juvenile Nile tilapia feeds, providing an innovative means to formulate and optimize the composition of tilapia juvenile feed while simultaneously raising feed efficiency of tilapia aquaculture and to further develop environmentally and socially sustainable aquafeeds. Results show that replacing fish oil with DHA-rich marine Sc improves the deposition of n3 LC PUFA levels in tilapia fillet. These results support further studies to lower Schizochytrium production costs and to combine different marine microalgae to replace fish oil and fishmeal into aquafeeds. PMID:27258552

  16. Symptomatic Raccoon Dogs and Sarcoptic Mange Along an Urban Gradient.

    Science.gov (United States)

    Saito, Masayuki U; Sonoda, Yoichi

    2017-06-01

    We quantitatively evaluated the effects of landscape factors on the distribution of symptomatic raccoon dogs with sarcoptic mange along an urban gradient. We used 246 camera traps (182 traps from April 2005 to December 2006; 64 traps from September 2009 to October 2010) to record the occurrence of asymptomatic and symptomatic raccoon dogs at 21 survey sites along an urban-rural gradient in the Tama Hills area of Tokyo. Each occurrence was explained in terms of the surrounding forest, agricultural, and grassland areas and additional factors (i.e., seasonal variations and survey methods) at various spatial scales using a generalized additive mixed model (GAMM). In our analysis, a 1000-m radius was identified as the important spatial scale for asymptomatic and symptomatic raccoon dog occurrence. The peak of the predicted occurrence probability of asymptomatic raccoon dogs appeared in the intermediate forest landscape as opposed to non-forest and forest landscapes. However, a high occurrence probability of symptomatic raccoon dogs was detected in non-forest and intermediate forest landscapes (i.e., urban and suburban) as opposed to a forest landscape, presumably because of animals occurring at much higher densities in more urbanized areas. Therefore, our results suggest that human-modified landscapes play an important role in the high occurrence of sarcoptic mange in raccoon dogs.

  17. Results of surgical excision of urethral prolapse in symptomatic patients.

    Science.gov (United States)

    Hall, Mary E; Oyesanya, Tola; Cameron, Anne P

    2017-11-01

    Here, we present the clinical presentation and surgical outcomes of women with symptomatic urethral prolapse presenting to our institution over 20 years, and seek to provide treatment recommendations for management of symptomatic urethral prolapse and caruncle. A retrospective review of medical records from female patients who underwent surgery for symptomatic urethral prolapse from June 1995 to August 2015 was performed. Surgical technique consisted of a four-quadrant excisional approach for repair of urethral prolapse. A total of 26 patients were identified with a mean age of 38.8 years (range 3-81). The most common presentations were vaginal bleeding, hematuria, pain, and dysuria. All patients underwent surgical excision of urethral prolapse via a standard approach. Follow-up data was available in 24 patients. Six patients experienced temporary postoperative bleeding, and one patient required placement of a Foley catheter for tamponade. One patient experienced temporary postoperative urinary retention requiring Foley catheter placement. Three patients had visible recurrence of urethral prolapse, for which one later underwent re-excision. Surgical excision of urethral prolapse is a reasonable treatment option in patients who have tried conservative management without relief, as well as in those who present with severe symptoms. Possible complications following excision include postoperative bleeding and recurrence, and patients must be counseled accordingly. In this work, we propose a treatment algorithm for symptomatic urethral prolapse. © 2017 Wiley Periodicals, Inc.

  18. Mammographic profiles of women with symptomatic breast diseases ...

    African Journals Online (AJOL)

    Methods: This was a prospective descriptive analytical study of women with symptomatic breast diseases who had mammography between January 2012 and December 2016 at our health facilities. Data sheet was developed to record the patients' biodata, indication for referral, and mammographic findings. Results: During ...

  19. Dural diverticulum with a symptomatic cerebrospinal fluid leak

    Directory of Open Access Journals (Sweden)

    Nicholas Armstrong, MD

    2016-03-01

    Full Text Available A case report of a 63-year-old female patient with a cervical spinal dural diverticulum and intracranial hypotension secondary to a symptomatic CSF leak after minor trauma. The patient responded well after the cervical approach epidural blood patch procedure.

  20. Symptomatic Tarlov Cysts: Surgical Treatment by Subcutaneous Infusion Port.

    Science.gov (United States)

    Huang, Ying; Zhu, Tong; Lin, Hongyi; Li, Jing; Zeng, Tao; Lin, Jian

    2018-05-01

    The treatment of Tarlov cysts is challenging and difficult. The objective of our study was to describe the security and efficacy of the subcutaneous infusion port for drainage of symptomatic Tarlov cysts. The authors executed a retrospective review of data from 5 symptomatic Tarlov cysts patients who were treated using a subcutaneous infusion port from June 2014 to July 2017. Numerical Rating Scale scores and the Japanese Orthopedic Association scores of back pain were analyzed. Complications and adverse effects on postoperative days 1, 7, 14, and 28 were also analyzed. The mean follow-up was 12.6 months. Five adults (3 females and 2 males) who had been symptomatic received a subcutaneous infusion port. After treatment, all patients experienced pain relief and pain alleviation lasted from 1 day to 3 years without complications and adverse effects. A subcutaneous infusion port is a useful treatment option for symptomatic Tarlov cysts. When the patients' symptoms returned and the cysts repressurized, we quickly and simply drained the cysts by using the infusion port. Copyright © 2018 Elsevier Inc. All rights reserved.

  1. Symptomatic HIV infection in infancy - clinical and laboratory ...

    African Journals Online (AJOL)

    in infancy - clinical and laboratory markers of infection. M P Meyer, Z Latief, C Haworlh, 5 Salie,. A van Dyk. Objective. To investigate the usefulness of immunological tests in the diagnosis of HIV infection in young symptomatic children « 15 months of age). Design. Tests were evaluated in HIV-infected (HIV antibody- and ...

  2. Uterine artery embolisation as an effective choice for symptomatic ...

    African Journals Online (AJOL)

    2016-03-31

    Mar 31, 2016 ... Symptomatic uterine leiomyomas can cause pain, heavy bleeding, pressure effects and reduced fertility. ... percent of patients reported being satisfied, 12% partially satisfied and 7% not satisfie