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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. 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.

  3. 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.

  4. Sustainable healthcare: how to assess and improve healthcare structures' sustainability.

    Science.gov (United States)

    Buffoli, M; Capolongo, S; Bottero, M; Cavagliato, E; Speranza, S; Volpatti, L

    2013-01-01

    Sustainability is a broad and debated subject, often difficult to be defined and applied into real projects, especially when dealing with a complex scenario as the one of healthcare. Many research studies and evaluation systems have handled this topic from different perspectives, but many limits and criticalities still have to be overcome to properly cope with actual needs. The Sustainable Healthcare project has been developed through three main phases: a deep study of the state of the art, unraveling pros and cons of available sustainability scoring systems; an accurate analysis of the stakeholders network and their needs; the realization of an objective evaluation framework, through scientific methods, as the ANP. The newly developed evaluation system takes into consideration all the three pillars of sustainability, analyzing social, environmental and economic sustainability through a set of criteria, specified by measurable indicators. So the system identifies both global sustainability and specific critical areas, pointing out possible strategic solutions to improve sustainability. The evaluation is achieved through technical analyses and qualitative surveys, which eventually allow to quantitatively assess sustainability, through a sound scoring method. This study proposes an innovative evaluation method to determine the sustainability of a hospital, already existing or in the design phase, within the European context. The Sustainable Healthcare system overcomes some of the current evaluation systems' limits by establishing a multidisciplinary approach and being an easy-to-use tool. This protocol is intended to be of support in the identification of the main hospital's weaknesses and in setting priorities for implementation of the solutions.

  5. 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.

  6. 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.

  7. Effect of symptomatic pseudomeningocele on improvement in pain, disability, and quality of life following suboccipital decompression for adult Chiari malformation type I.

    Science.gov (United States)

    Parker, Scott L; Godil, Saniya S; Zuckerman, Scott L; Mendenhall, Stephen K; Tulipan, Noel B; McGirt, Matthew J

    2013-11-01

    Suboccipital decompression is a common procedure for patients with Chiari malformation Type I (CMI). Published studies have reported complication rates ranging from 3% to 40%, with pseudomeningocele being one of the most common complications. To date, there are no studies assessing the effect of this complication on long-term outcome. Therefore, the authors set out to assess the effect of symptomatic pseudomeningocele on patient outcomes following suboccipital decompression for CM-I. The study comprised 50 adult patients with CM-I who underwent suboccipital craniectomy and C-1 laminectomy with or without duraplasty. Clinical presentation, radiological studies, operative variables, and complications were assessed for each case. Baseline and 1-year postoperative patient-reported outcomes were assessed to determine improvement in pain, disability, and quality of life. The extent of improvement was compared for patients with and without development of a postoperative symptomatic pseudomeningocele. A symptomatic pseudomeningocele developed postoperatively in 9 patients (18%). There was no difference with regard to clinical, radiological, or operative variables for patients with or without a postoperative pseudomeningocele. Patients without a pseudomeningocele had significant improvement in all 9 patient-reported outcome measures assessed. On the other hand, patients with pseudomeningocele only had significant improvement in headache (as measured on the Numeric Rating Scale) and headache-related disability (as measured on the Headache Disability Index) but no improvement in quality of life. Twenty-nine (71%) of 41 patients without a pseudomeningocele reported improvement in health status postoperatively compared with only 3 (33%) of 9 patients with a postoperative pseudomeningocele (p = 0.05). Surgical management of CM-I in adults provides significant and sustained improvement in pain, disability, general health, and quality of life. Development of a postoperative

  8. Sustainable Community Based Interventions for Improving ...

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

    Sustainable community based interventions for improving environment and health for communities in slums of Banda, Kampala City, Uganda : final technical report (2007-2011). Rapports. Eco-Health project start-up/methodological workshop , Sports View Hotel, Kireka, 11th-13th July 2007 : sustainable community based ...

  9. 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...

  10. Detector sustainability improvements at LCLS

    Science.gov (United States)

    Browne, Michael C.; Carini, Gabriella; DePonte, Daniel P.; Galtier, Eric C.; Hart, Philip A.; Koralek, J. D.; Mitra, Ankush; Nakahara, Kazutaka

    2017-06-01

    The Linac Coherent Light Source (LCLS) poses a number of daunting and often unusual challenges to maintaining X-ray detectors, such as proximity to liquid-sample injectors, complex setups with moving components, intense X-ray and optical laser light, and Electromagnetic Pulse (EMP). The Detector and Sample Environment departments at LCLS are developing an array of engineering, monitoring, and administrative controls solutions to better address these issues. These include injector improvements and monitoring methods, fast online damage recognition algorithms, EMP mapping and protection, actively cooled filters, and more.

  11. Sustainable Community Based Interventions for Improving ...

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

    Sustainable Community Based Interventions for Improving Environment and Health in the Banda Slums, Kampala (Uganda). Rapid urbanization is one of the major challenges of the 21st century. About 12 000 people live in Banda parish in eastern Kampala. The area is swampy and prone to episodes of cholera. Incidence ...

  12. 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.

  13. Oxfordshire Community Stroke Project classification improves prediction of post-thrombolysis symptomatic intracerebral hemorrhage.

    Science.gov (United States)

    Sung, Sheng-Feng; Chen, Solomon Chih-Cheng; Lin, Huey-Juan; Chen, Chih-Hung; Tseng, Mei-Chiun; Wu, Chi-Shun; Hsu, Yung-Chu; Hung, Ling-Chien; Chen, Yu-Wei

    2014-03-01

    The Oxfordshire Community Stroke Project (OCSP) classification is a simple stroke classification system with value in predicting clinical outcomes. We investigated whether and how the addition of OCSP classification to the Safe Implementation of Thrombolysis in Stroke (SITS) symptomatic intracerebral hemorrhage (SICH) risk score improved the predictive performance. We constructed an extended risk score by adding an OCSP component, which assigns 3 points for total anterior circulation infarcts, 0 point for partial anterior circulation infarcts or lacunar infarcts. Patients with posterior circulation infarcts were assigned an extended risk score of zero. We analyzed prospectively collected data from 4 hospitals to compare the predictive performance between the original and the extended scores, using area under the receiver operating characteristic curve (AUC) and net reclassification improvement (NRI). In a total of 548 patients, the rates of SICH were 7.3% per the National Institute of Neurological Diseases and Stroke (NINDS) definition, 5.3% per the European-Australasian Cooperative Acute Stroke Study (ECASS) II, and 3.5% per the SITS-Monitoring Study (SITS-MOST). Both scores effectively predicted SICH across all three definitions. The extended score had a higher AUC for SICH per NINDS (0.704 versus 0.624, P = 0.015) and per ECASS II (0.703 versus 0.612, P = 0.016) compared with the SITS SICH risk score. NRI for the extended risk score was 22.3% (P = 0.011) for SICH per NINDS, 21.2% (P = 0.018) per ECASS II, and 24.5% (P = 0.024) per SITS-MOST. Incorporation of the OCSP classification into the SITS SICH risk score improves risk prediction for post-thrombolysis SICH.

  14. Symptomatic improvement and reduced hospitalization for patients attending a cardiomyopathy clinic.

    Science.gov (United States)

    Smith, L E; Fabbri, S A; Pai, R; Ferry, D; Heywood, J T

    1997-11-01

    The major costs associated with the management of congestive heart failure (CHF) are inpatient costs. Outcome studies are therefore important to establish whether intensive outpatient care for heart failure can reduce these costs while at the same time improving outcomes in this disabling disorder. Care delivered in a cardiomyopathy clinic might result in objective improvement in cardiac function and symptoms while reducing hospital admissions and emergency department visits. The outcomes of 21 patients treated for 6 months in a cardiomyopathy clinic are evaluated. New patients referred to the clinic with ejection fraction (EF) Heart Failure questionnaire was completed at initial and final visits. All patients underwent baseline and final echocardiogram, radionuclide left ventriculogram, and cardiopulmonary exercise testing. Patients were followed by a nurse practitioner and a cardiologist with maximization of standard treatment. Congestive heart failure-related hospitalizations and clinic and emergency room visits for both 6-month periods before and during the study were determined. There was significant (p Heart failure score increased 23 points; New York Heart Association class decreased from 2.6 to 2.2; EF increased from 0.24 to 0.36; diastolic and systolic left ventricular dimensions decreased from 65 to 59 mm and from 57 to 50 mm, respectively. The number of clinic visits increased 5-fold, whereas there were 86% (14 to 2, p = 0.017) and 100% (8 to 0, p = 0.002) reductions in the number of CHF hospitalizations and emergency visits. There was one death during follow-up. Managing patients in a cardiomyopathy clinic may result in a better quality of life, with both symptomatic improvement and decreased hospitalizations.

  15. Trail Making Test A improves performance characteristics of the International HIV Dementia Scale to identify symptomatic HAND.

    Science.gov (United States)

    Chalermchai, Thep; Valcour, Victor; Sithinamsuwan, Pasiri; Pinyakorn, Suteeraporn; Clifford, David; Paul, Robert H; Tipsuk, Somporn; Fletcher, James L K; Degruttola, Victor; Ratto-Kim, Silvia; Hutchings, Nicholas; Shikuma, Cecilia; Ananworanich, Jintanat

    2013-04-01

    Although HIV-associated dementia (HAD) occurs in less than 5 % of individuals with access to combination antiretroviral therapy, rates of milder forms of HIV-associated neurocognitive disorder (HAND) are much higher. We sought to define an optimal cut point for the International HIV Dementia Scale (IHDS) in Thailand for the identification of symptomatic HAND, defined as both HAD and mild neurocognitive disorder. We then sought to determine if adding a simple test from a larger neuropsychological battery could improve the performance characteristics for identifying symptomatic HAND. In this study, subjects comprising 75 seropositive adults in Bangkok, Thailand, completed neuropsychological tests and underwent a full neurological assessment. HAND diagnoses were determined by consensus conference using the 2007 Frascati criteria, blinded to the IHDS results. The optimal IHDS cut point was determined by receiver operating characteristic analysis with cross-validation. Individual neuropsychological tests were then evaluated and combined with the IHDS to test performance characteristics. The IHDS was poor at detecting symptomatic HAND at the optimized cut point of ≤ 10 (sensitivity, 53.3 %; specificity, 89.8 %). Trail Making Test A was most effective in improving performance characteristics when combined with the IHDS, with net sensitivity of 86 % and specificity of 79 %. In this setting, the IHDS performed poorly in identifying symptomatic HAND, but was substantially improved by the addition of Trail Making Test A, which typically requires less than 2 min to complete. This combination should be validated in a larger setting since it may address the critical need for HAND screening instruments in international settings.

  16. Cisgenics - A Sustainable Approach for Crop Improvement

    Science.gov (United States)

    Telem, R.S.; Wani, Shabir. H.; Singh, N.B.; Nandini, R.; Sadhukhan, R.; Bhattacharya, S.; Mandal, N.

    2013-01-01

    The implication of molecular biology in crop improvement is now more than three decades old. Not surprisingly, technology has moved on, and there are a number of new techniques that may or may not come under the genetically modified (GM) banner and, therefore, GM regulations. In cisgenic technology, cisgenes from crossable plants are used and it is a single procedure of gene introduction whereby the problem of linkage drag of other genes is overcome. The gene used in cisgenic approach is similar compared with classical breeding and cisgenic plant should be treated equally as classically bred plant and differently from transgenic plants. Therefore, it offers a sturdy reference to treat cisgenic plants similarly as classically bred plants, by exemption of cisgenesis from the current GMO legislations. This review covers the implications of cisgenesis towards the sustainable development in the genetic improvement of crops and considers the prospects for the technology. PMID:24396278

  17. Projecting Lifetime Risk of Symptomatic Knee Osteoarthritis and Total Knee Replacement in Individuals Sustaining a Complete Anterior Cruciate Ligament Tear in Early Adulthood.

    Science.gov (United States)

    Suter, Lisa G; Smith, Savannah R; Katz, Jeffrey N; Englund, Martin; Hunter, David J; Frobell, Richard; Losina, Elena

    2017-02-01

    To estimate the lifetime risk of knee osteoarthritis (OA) and total knee replacement (TKR) in persons sustaining anterior cruciate ligament (ACL) tear by age 25 years. We used the Osteoarthritis Policy Model to project the cumulative incidence of symptomatic knee OA requiring TKR in varying situations: no prevalent or incident injury; isolated ACL tear, surgically treated; isolated ACL tear, nonoperatively treated; or a prevalent history or surgically treated ACL and meniscal tear (MT). We estimated MT prevalence and incidence and increased risk of knee OA associated with ACL injury and MT from published literature. We conducted a range of sensitivity analyses to examine the impact of uncertainty in input parameters. Estimated lifetime risk of symptomatic knee OA was 34% for the cohort with ACL injury and MT, compared to 14% for the no-injury cohort. ACL injury without MT was associated with a lifetime risk of knee OA between 16% and 17%, depending on ACL treatment modality. Estimated lifetime risk of TKR ranged from 6% in the no-injury cohort to 22% for the ACL injury and MT cohort. Subjects in the ACL injury and MT cohort developed OA approximately 1.5 years earlier (55.7 versus 57.1) and underwent TKR approximately 2 years earlier (66 versus 68) than the cohort without knee injuries. Sustaining ACL injury early in adulthood leads to greater lifetime risk and earlier onset of knee OA and TKR; concomitant MTs compound this risk. These data provide insight into the impact of sustainable injury prevention interventions in young adults. © 2016, American College of Rheumatology.

  18. Improving organizational sustainability using a quality perspective

    NARCIS (Netherlands)

    Broekhuis, Manda; Vos, Janita F.J.

    2003-01-01

    This article derives lessons from the quality approach for further developing the organizational sustainability approach. Taking a responsibility perspective on organizational sustainability, four issues emerge that need to be resolved, i.e. what is the responsibility?, what is the responsibility

  19. 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…

  20. Droxidopa for Symptomatic Neurogenic Hypotension.

    Science.gov (United States)

    Ferguson-Myrthil, Nadia

    Droxidopa is a first-in-class, orally available, synthetic amino acid precursor of norepinephrine that received accelerated Food and Drug Administration approval in February 2014 after Orphan Drug status for a debilitating condition known as symptomatic neurogenic orthostatic hypotension. Neurogenic disorders often lead to postural hypotension as a result of poor norepinephrine release from its storage sites. Clinical data suggest increases in standing systolic blood pressure and improvements in many other markers for subjective relief in patients with symptomatic neurogenic hypotension who received droxidopa therapy over 1-2 weeks. Studies evaluating the sustained effects of droxidopa are ongoing. With minimal drug interactions (even with carbidopa use) or adverse effects, droxidopa therapy can be used safely in patients with a variety of neurologic conditions; however, more data are needed to determine its appropriate pharmacotherapeutic role. In all, droxidopa is a safe and effective medication for the treatment of orthostatic dizziness/lightheadedness, or the "feeling that you are about to black out" in adult patients with symptomatic neurogenic orthostatic hypotension secondary to primary autonomic failure (Parkinson's disease, multiple system atrophy, and pure autonomic failure), dopamine beta-hydroxylase deficiency, and nondiabetic autonomic neuropathy.

  1. How to Sustain Change and Support Continuous Quality Improvement

    National Research Council Canada - National Science Library

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

    2016-01-01

    .... 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...

  2. Sustainable care improvement programs supported by undergraduate health care education

    NARCIS (Netherlands)

    C.H.M. Smits (Carolien); A. Harps (Annelies); A.M.V. Stoopendaal (Annemiek); A.M. Kamper (Ad); M.M.H. Strating (Mathilde); R.A. Bal (Roland)

    2017-01-01

    markdownabstractBackground: The Care for Better Region program was developed to achieve sustainable care improvement focusing onfall prevention. Key ingredients involved improvement teams developing and implementing a falls reduction plan, PracticeDevelopment; facilitation of

  3. 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.

  4. Improving sustainability through digitalisation in reverse logistics

    OpenAIRE

    Cullinane, Sharon; Browne, Michael; Karlsson, Elisabeth; Wang, Yingli; Jahn, Carlos; Kersten, Wolfgang; Ringle, Christian M.

    2017-01-01

    Online purchases of clothes are increasing rapidly and with it, the number of returns. Return rates of clothing bought online can be up to 70%, involving high reverse logistics costs to retailers as well as sustainability costs to society. This paper seeks to illustrate how digitalisation can potentially decrease both such costs. The paper is based on a literature review and subsequent empirical research. Qualitative information was obtained through detailed interviews with key personnel a...

  5. Plastic bronchitis: symptomatic improvement after pulmonary arterial stenting in four patients with Fontan circulation.

    Science.gov (United States)

    Tanase, Daniel; Ewert, Peter; Eicken, Andreas

    2015-01-01

    Plastic bronchitis is a severe complication after a Fontan procedure, with an estimated incidence around 1-2% and poor prognosis. We present the cases of four patients with plastic bronchitis after a total cavopulmonary connection with a stenosis of the left pulmonary artery that was stented successfully. In three of the four patients, symptoms improved after catheter intervention in combination with pulmonary vasodilator and inhalative treatment.

  6. 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.

    Science.gov (United States)

    Beier, Jutta; Mroz, Robert; Kirsten, Anne-Marie; Chuecos, Ferran; Gil, Esther Garcia

    2017-01-01

    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. 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. 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; Ppost hoc analysis of symptomatic patients with moderate to severe COPD, aclidinium 400 μg BID provided additional improvements compared with tiotropium 18 μg QD in: 1) bronchodilation, particularly during the nighttime, 2) daily COPD symptoms (E-RS), 3) early-morning and nighttime symptoms, and 4) early-morning limitation of activity.

  7. Using intermittent pneumatic compression therapy to improve quality of life for symptomatic patients with infrapopliteal diffuse peripheral obstructive disease.

    Science.gov (United States)

    Chang, Shih-Tai; Hsu, Jen-Te; Chu, Chi-Ming; Pan, Kuo-Li; Jang, Shih-Jung; Lin, Pi-Chi; Hsu, Hung-Chih; Huang, Kuo-Chin

    2012-01-01

    Although the acute effect of intermittent pneumatic compression (IPC) therapy had been documented for patients with symptomatic peripheral arterial obstructive disease (PAOD), its efficacy in improving quality of life (QOL), especially for those with infrapopliteal diffuse lesions, remains unclear. Thirty-one patients with infrapopliteal diffuse or multiple segmental lesions were enrolled in the study. Based on receipt of IPC therapy (3 h daily for 3 months), patients were allocated to a study (n=23) or control (n=8) group. The 6-min walking test, transcutaneous oxygen tension (TcPO₂), and QOL evaluated with the Short-Form 36 questionnaire were measured at the beginning and end of the study. In the QOL analysis, scores for physical functioning, physical and emotional role functioning, bodily pain, and general and mental health showed significant changes after IPC therapy. In the 6-min walking test, duration, and the initial and absolute claudication distances were significantly increased in the study group. The TcPO₂ also significantly increased in the distal end of the target limb after IPC therapy. Patients at high risk for amputation with infrapopliteal diffuse or multiple segmental lesions can improve their walking ability, TcPO₂ of the target limb and QOL after IPC therapy.

  8. 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.

  9. Removal of symptomatic third molars may improve periodontal status of remaining dentition.

    Science.gov (United States)

    Dicus-Brookes, Carolyn; Partrick, Maura; Blakey, George H; Faulk-Eggleston, Jan; Offenbacher, Steven; Phillips, Ceib; White, Raymond P

    2013-10-01

    To assess the impact of third molar removal on the periodontal status of adjacent second molars and teeth more anterior in the mouth in patients with mild symptoms of pericoronitis. Healthy patients with mild symptoms of pericoronitis affecting at least 1 mandibular third molar were recruited for a study approved by the institutional review board. The subset analyzed in this study had all 4 third molars removed. Data were collected at enrollment and at least 3 months after surgery. Full-mouth periodontal probing was conducted at 6 sites per tooth. A probing depth of at least 4 mm (PD4+) was considered an indicator for periodontal pathology. The presence of a PD4+ on the distal of second molars (D2Ms) or anterior to the D2Ms, the number of PD4+s, and extent scores (percentage of PD4+s of all possible probing sites) were assessed at the patient and jaw levels. The association between patients' pre- and postsurgical periodontal status was assessed using the McNemar exact test. The level of significance was set at .05. The median age of the 69 patients was 21.8 years (interquartile range, 20.2 to 25.2 yr). Forty-five percent were men, and 57% were Caucasian. Significantly more patients (88%) had at least 1 D2M PD4+ at enrollment compared with after surgery (46%; P pericoronitis symptoms improved the periodontal status of the D2Ms and teeth more anterior in the mouth. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Improved survival with primary sclerosing cholangitis. A review of clinicopathologic features and comparison of symptomatic and asymptomatic patients.

    Science.gov (United States)

    Helzberg, J H; Petersen, J M; Boyer, J L

    1987-06-01

    The clinicopathologic features and natural history of primary sclerosing cholangitis were reviewed in 53 patients followed at the Yale Liver Center during the past 30 yr. At presentation, the mean age of patients was 46 yr, and the male to female ratio was 1.4:1. Biliary sclerosis was limited to the intrahepatic ductal system in 21% of the patients. Fifty-three percent of the patients had mild disease without portal hypertension at presentation, and 25% had no symptoms attributable to their liver disease. Long-term follow-up was available for 42 patients and averaged 56 mo. Over this period, 16 patients remained mildly symptomatic, and 11 were asymptomatic. Survival was calculated by a Kaplan-Meier life-table analysis and demonstrated that 75% of the patients were alive 9 yr after the diagnosis of primary sclerosing cholangitis. A multivariate analysis of clinical features revealed that hepatomegaly and a serum bilirubin level greater than 1.5 mg/dl at the onset of disease were independent discriminators of a poor prognosis. Patients referred to this university medical center displayed different clinical characteristics than previously reported in primary sclerosing cholangitis. A higher percentage were older, female, and asymptomatic, and more had disease limited to the intrahepatic ductal system. Survival was also considerably improved in this group of patients and suggests that the long-term prognosis for patients with primary sclerosing cholangitis may be considerably better than previously believed.

  11. GENETIC AND AGRONOMIC IMPROVEMENT FOR SUSTAINABLE

    African Journals Online (AJOL)

    Plantain and Banana improvement Program, International institute of Tropical Agriculture, PMB ... biotechnology techniques for Mom breeding, investigating the post-harvest quality of plantains and, analyzing genotype-by-cropping ... 3 VUYLSTEKE, D. e! of. origin of Muse species (7). considerable genetic diversity has ...

  12. 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

  13. 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.

  14. 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.

  15. 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

  16. Does Reduction Mammaplasty Play a Role in Weight-Loss Motivation and Quality of Life Improvement in Symptomatic Macromastia Patients?

    Directory of Open Access Journals (Sweden)

    Mehmet Çeber

    2016-09-01

    Full Text Available Objective: The purpose of this study was to evaluate whether reduction mammaplasty is a motivator for postoperative weight loss and to understand how this affected specific quality of life parameters. Material and Methods: All patients who underwent a reduction mammaplasty by the senior author at our department between April 2011 and January 2014 were contacted and invited to participate in a standardized telephonic questionnaire. The outcome questionnaire included data on whether the patients felt that the reduction mammaplasty was a motivator for weight loss and specific information regarding their pre- and postoperative weight and dress size. Additional data points queried included quality of life changes, exercise capacity, satisfaction, symptomatic relief (neck and back pain, intertrigo, shoulder grooving, and whether they would undergo the procedure again. Results: Forty-five women participated in the questionnaire. A total of 66.7% (n=30 participants stated that reduction mammaplasty was a motivator for future weight loss (group A, and 33.3% (n=15 participants felt that reduction mammaplasty was not a motivator for future weight loss. When the pre- and postoperative weights of women in group A were compared, there was a significant difference seen following reduction mammaplasty (p<0.001. Group B had a non-significant decrease in weight (p=0.23. The mean weight loss in group A was 6.66±1.44 kg and group B was 1.13±2.16 kg. There was a statistically significant difference in weight loss between the groups (p<0.001. There was a statistically significant difference between pre- and postoperative body mass index (BMI in group A (p<0.001, whereas the difference was not statistically significant in group B. There was a statistically significant difference in BMI between the groups (p<0.001. There was a statistically significant decrease in dress size in group A and B (p<0.001. There was a 73% improvement in postoperative exercise in group A

  17. 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

    . CONCLUSIONS: 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. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02316587....

  18. 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 ...

  19. Facilities Improvement for Sustainability of Existing Public Office ...

    African Journals Online (AJOL)

    Sultan

    Facilities Improvement for Sustainability of Existing Public Office. Buildings in Nigeria. Adeyemi, A. 1*; Martin, D. 2. ; Kasim, R. 2 and Adeyemi, A.I. 2. 1Faculty of Environmental Technology, Abubakar Tafawa Balewa University,. Bauchi. 2Faculty of Technology Management and Business, Universiti Tun Hussein Onn.

  20. Improving the efficiency and sustainability of disinfection at a small ...

    African Journals Online (AJOL)

    driniev

    Improving the efficiency and sustainability of disinfection at a small rural water treatment plant. MNB Momba1*, N Makala1, Z Tyafa1, BM Brouckaert2, CA Buckley2 and PA Thompson3. 1Biochemistry and Microbiology Programme Unit, University of Fort Hare, P/Bag X1314, Alice 5700, South Africa. 2Pollution Research ...

  1. Developing a methodology for sustainable production of improved ...

    African Journals Online (AJOL)

    Mo

    especiaaly in dairy cattle, because the major custodians of the animals, the farmers, were not fully participating in the improvement programmes ... farmer breeder associations is given for both marketing and quality assurance purposes. Key words: ... plans, marketing and sustainability of the existence and production of the ...

  2. Improving environmental sustainability of Thai palm oil production in 2050

    NARCIS (Netherlands)

    Saswattecha, Kanokwan; Kroeze, Carolien; Jawjit, Warit; Hein, Lars

    2017-01-01

    Palm oil production has increased in Thailand with considerable environmental impacts. The aim of this study is to analyse possibilities to examine how the environmental sustainability of Thai palm oil production can be improved in the coming decades. To this end, we integrated a sectoral and a

  3. 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”. L De Beer, SE Terblanché ...

  4. Searching for Sustainable Solutions in Improved Cook Stove ...

    African Journals Online (AJOL)

    The Improved Cook-Stove (ICS) has the potential to contribute to sustainable firewood harvesting and consumption in Malawi because it is energy efficient. However, accelerated uptake, utilisation and production of ICSs put stress on ICS construction materials. Findings from a qualitative case study that explored uptake ...

  5. Reduction mammaplasty improves levels of anxiety, depression and body image satisfaction in patients with symptomatic macromastia in the short and long term.

    Science.gov (United States)

    Pérez-Panzano, Esther; Gascón-Catalán, Ana; Sousa-Domínguez, Ramón; Carrera-Lasfuentes, Patricia; García-Campayo, Javier; Güemes-Sánchez, Antonio

    2017-12-01

    To evaluate the psychological consequences (anxiety, depression and body image dissatisfaction) of symptomatic macromastia and the effectiveness of breast reduction surgery in re-establishing the mental health of the patient in the short and long term. 119 patients over 18 years old who had been diagnosed with symptomatic macromastia were assessed, before surgery, one month after the operation and one year later. Patients completed the Hospital Anxiety and Depression Scale (HADS) and the Body Image Dissatisfaction subscale of the Eating Disorders Inventory (EDI-2). Participants were also asked about their physical appearance, social relationships and their satisfaction with regards to clothing and dress. The average age of the patients was 40.7 (SD = 12.02), 80.2% had a body mass index ≥25 kg/m 2 . Before surgery, we found psychological distress with values indicating clinical anxiety and body image dissatisfaction. Younger women (< 36 years old) were more psychologically affected. At one month after surgery, there were significant improvements: there were lower scores for anxiety (p < 0.001), depression (p < 0.001) and body image dissatisfaction (p < 0.001). When compared with the pre-surgery scores, all these results showed improvement one year after the intervention (p < 0.001). There were also improvements in social relationships (p < 0.001) and satisfaction with clothing and dress. Reduction mammaplasty can alleviate the psychological impact of symptomatic macromastia.

  6. Medial prefrontal cortex activity during memory encoding of pictures and its relation to symptomatic improvement after citalopram treatment in patients with major depression.

    Science.gov (United States)

    Roy, Martin; Harvey, Philippe-Olivier; Berlim, Marcelo T; Mamdani, Firoza; Beaulieu, Marie-Martine; Turecki, Gustavo; Lepage, Martin

    2010-05-01

    Brain imaging studies of major depressive disorder have shown alterations in the brain regions typically involved in episodic memory, including the prefrontal cortex and medial temporal areas. Some studies of major depressive disorder have linked episodic memory performance to treatment response. In this study, we sought to identify brain regions whose activity, measured during the encoding of pictures, predicted symptomatic improvement after 8 weeks of citalopram treatment. We included 20 unmedicated depressed patients. These patients performed an episodic recognition memory task during functional magnetic resonance imaging. During the encoding phase, 150 pictures depicting emotionally positive, negative or neutral content were presented, and the participants were required to classify each picture according to its emotional valence. The same 150 pictures were presented, along with 150 new ones, for a recognition task. We asked participants to distinguish the old pictures from the new ones. We assessed symptom severity by use of the 21-item Hamilton Rating Scale for Depression (HAM-D) at baseline and after 8 weeks of citalopram treatment. We performed subsequent memory effect analyses using SPM2 software. We explored the relation between brain activation during successful encoding of pictures and symptomatic improvement. Patients showed a mean symptomatic improvement of 54.5% on the HAM-D after 8 weeks. Symptomatic improvement was significantly and positively correlated with picture recognition memory accuracy. We also found that the activity of the ventromedial prefrontal cortex and anterior cingulate cortex during successful encoding was significantly correlated with symptomatic improvement. Finally, we found greater activation in the ventromedial prefrontal cortex during the successful encoding of positive pictures in comparison with neutral pictures. During the recognition memory task, 5 participants (among the best responders to treatment) were not included in

  7. Improving the sustainability of global meat and milk production.

    Science.gov (United States)

    Salter, Andrew M

    2017-02-01

    Global demand for meat and dairy products has increased dramatically in recent decades and, through a combination of global population growth, increased lifespan and improved economic prosperity in the developing world will inevitably continue to increase. The predicted increases in livestock production will put a potentially unsustainable burden on global resources, including land for production of crops required for animal feed and fresh water. Furthermore, animal production itself is associated with greenhouse gas production, which may speed up global warming and thereby impact on our ability to produce food. There is, therefore, an urgent need to find methods to improve the sustainability of livestock production. This review will consider various options for improving the sustainability of livestock production with particular emphasis on finding ways to replace conventional crops as sources of animal feeds. Alternatives, such as currently underutilised crops (grown on a marginal land) and insects, reared on substrates not suitable for direct consumption by farm animals, represent possible solutions. Coupled with a moderation of excessive meat consumption in wealthier countries, such strategies may secure the long-term sustainability of meat and milk production and mitigate against the adverse health effects of excessive intake.

  8. Sustaining and Improving Study Abroad Experiences Through Comparative Evaluation.

    Science.gov (United States)

    Johanson, Linda S

    Researchers have related participation in study abroad experiences to many positive outcomes for nursing students; however, educators are faced with the task of not only developing meaningful study abroad opportunities but sustaining and improving them as well. Educators can evaluate repeat study abroad programs by comparing experiences, looking for trends, and conjecturing rationales. To illustrate this process, an example of a study abroad opportunity that has been repeated over 11 years is presented. The first six years have been compared to the most recent five years, revealing three categories of change for evaluation and the resulting course improvements.

  9. Sustained improvement in nutritional outcomes at two paediatric cystic fibrosis centres after quality improvement collaboratives.

    Science.gov (United States)

    Savant, Adrienne P; Britton, LaCrecia J; Petren, Kristofer; McColley, Susanna A; Gutierrez, Hector H

    2014-04-01

    To describe the characteristics of sustained improved nutritional outcomes through the use of quality improvement (QI) methodology. Retrospective analysis of a QI intervention in two institutions, implemented as part of larger national collaboratives. Paediatric cystic fibrosis (CF) programmes in academic centres in Alabama and Illinois. All paediatric patients enrolled in the CF Foundation (CFF) Patient Data Registry were included. Improved and sustained nutrition outcomes occurred through implementation of the CFF practice guidelines for CF nutrition management via care delivery processes, nutritional interventions, team engagement and data display. Mean body mass index (BMI) percentile, percentage of patients less than 50th percentile and percentage less than 10th percentile for all patients aged 2-20 years were tracked through run charts and statistical process control charts. Mann-Whitney U and χ(2) tests were used to determine significance between each centre and national outcomes. Each centre achieved rapid improvement in mean BMI percentile in patients, one centre rising from the 40th percentile in 2001 to the 49th percentile in 2003, the other rising from the 37th percentile in 2003 to the 45th percentile in 2004. These centres have also maintained improved nutritional outcomes, so that they were at the 60th and 55th percentiles, respectively, in 2011. Sustained improvement was accomplished through QI methodology, use of data as a driver for improvement and a change in culture. Participation in collaboratives led to improved nutrition outcomes while a strong culture of QI facilitated sustained improvement.

  10. 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.

  11. ISO 14001:2015: An improved tool for sustainability

    Directory of Open Access Journals (Sweden)

    Luis Miguel Ciravegna Martins da Fonseca

    2015-01-01

    Full Text Available Purpose: ISO 14001 is an International Standard of worldwide acceptance based on the concept that better environmental performance can be achieved when environmental aspects are systematically identified and managed giving a major contribution to Sustainability, through pollution prevention, improved environmental performance and complying with applicable laws.This paper aims to discuss the Sustainability approach through the use of Environmental Management Standards and the current process of ISO 14001:2015 revision. Design/methodology/approach: Revisiting the concept of Sustainability, the status of the revision process of ISO 14001:2015 and its expected outcomes are discussed. Findings and Originality/value: It is one of the first attempts to analyze, within the Sustainability framework, the status of the revision of the future ISO 14001:2015 International Standard that will respond to the latest trends and is expected to further improve Environmental performance by impacting the work of many People and Organizations worldwide and also ensuring it is compatible with other management system standards such as ISO 9001. Research limitations/implications: Since the revision standard is not yet finished some changes might still happen and some of the remarks expressed in this paper might not be consensual within the Environmental Community. Practical implications: There will be a 3 year transition process for the ISO 14001:2015 certification and major benefits like Quality Management Systems with less emphasis on documentation and new/reinforced approaches as consideration of organizational context and (relevant Stakeholders, risk based thinking, life cycle perspective and more emphasis on improving environmental performance. Social implications: The ISO 14001:2015 revision will have major impacts on the more than 300.000 worldwide certified organizations and on the many professionals that work with, hopefully Originality/value: Although 14001

  12. Erratum to: Addressing multimorbidity to improve healthcare and economic sustainability

    Directory of Open Access Journals (Sweden)

    Francesca Colombo

    2016-02-01

    Full Text Available Abstract Erratum to: Colombo F, García-Goñi M, Schwierz C. Addressing multimorbidity to improve healthcare and economic sustainability. J Comorbidity 2016;6(1:21−27. doi: 10.15256/joc.2016.6.74. The first sentence of the Acknowledgements section should read, 'The opinions expressed in this paper are the responsibility of the authors and do not necessarily reflect those of the OECD, the European Commission or its member countries.' Journal of Comorbidity 2016;6(1:33 The original article can be found at: http://dx.doi.org/10.15256/joc.2016.6.74

  13. Improving sustainability of striped catfish (Pangasianodon hypophthalmus) farming in the Mekong Delta, Vietnam through recirculation technology

    NARCIS (Netherlands)

    Nguyen, Nhut

    2016-01-01

    The aim of this thesis was to document improvements in sustainability indicators of striped catfish (Pangasianodon hypophthalmus, Sauvage, 1878) production through the application of recirculation and waste treatment techniques. To be able to document improvements in sustainability, in each system

  14. The rate of symptomatic improvement of congenital nasolacrimal duct obstruction in Japanese infants treated with conservative management during the 1st year of age

    Directory of Open Access Journals (Sweden)

    Hirohiko Kakizaki

    2008-06-01

    Full Text Available Hirohiko Kakizaki1, Yasuhiro Takahashi2, Shinsuke Kinoshita1, Kunihiko Shiraki2, Masayoshi Iwaki11Department of Ophthalmology, Aichi Medical University, Aichi, Japan; 2Department of Ophthalmology and Visual Sciences, Osaka City University Graduate School of Medicine, Osaka, JapanAbstract: This study aimed to examine the rate of symptomatic improvement of congenital nasolacrimal duct obstruction (CNLDO in Japanese infants treated with conservative management within the 1st year of age. Thirty-five lacrimal ducts in 27 patients diagnosed with CNLDO were included in the study. During the observational period, lacrimal ducts were massaged. As well, antibiotic eye drops, to be administered 4 times a day, were sometimes prescribed for obvious conjunctivitis. Two lacrimal ducts in 2 patients were probed before the 1st year of age because of dacryocystitis or severe blepharitis; these patients were included in the unimproved group. Twenty-nine lacrimal ducts in 21 patients resolved during the period (82.9%; with 16 lacrimal ducts resolving before six months of age. Therefore, a comparatively high percentage of resolution for CNLDO (82.9% following conservative management was shown before the 1st year of age in Japanese infants.Keywords: congenital nasolacrimal duct obstruction, symptomatic improvement, conservative management, massage, probing

  15. Addressing multimorbidity to improve healthcare and economic sustainability

    Science.gov (United States)

    Colombo, Francesca; García-Goñi, Manuel; Schwierz, Christoph

    2016-01-01

    Patients with multimorbidity are responsible for more than half of all healthcare utilization, challenging the healthcare budgets of all European nations. Although the European Union is showing signs of a fragile economic recovery, achieving sustainable growth will depend on delivering a combination of fiscal responsibility, structural reforms, and improved efficiency. Addressing the challenges of multimorbidity and providing more effective, affordable, and sustainable care, has climbed the political agenda at a global, European, and national level. Current healthcare systems are poorly adapted to cope with the challenges of patients with multimorbidity. Little is known about the epidemiology and natural history of multimorbidity; the evidence base is weak; clinical guidelines are not always relevant to this population; and financing and delivery systems have not evolved to adequately measure and reward quality and performance. Pockets of innovation are, however, beginning to emerge. In Spain, for example, the ongoing economic crisis has forced regional governments to deliver substantial efficiency savings and, with this in mind, integrated care programmes have been introduced across the country for people with chronic disease and multimorbidity. Early results suggest that formalized integrated care for patients with multimorbidity improves their perceptions of care coordination, reduces hospital and emergency admissions and readmissions, and reduces average costs per capita. Such innovations require meaningful investments at a national level – something that is now supported within the framework of the European Union’s Stability and Growth Pact. PMID:29090168

  16. 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.

  17. 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.

  18. Lanreotide Reduces Liver Volume, But Might Not Improve Muscle Wasting or Weight Loss, in Patients With Symptomatic Polycystic Liver Disease.

    Science.gov (United States)

    Temmerman, Frederik; Ho, Thien Ahn; Vanslembrouck, Ragna; Coudyzer, Walter; Billen, Jaak; Dobbels, Fabienne; van Pelt, Jos; Bammens, Bert; Pirson, Yves; Nevens, Frederik

    2015-12-01

    Polycystic liver disease (PCLD) can induce malnutrition owing to extensive hepatomegaly and patients might require liver transplantation. Six months of treatment with the somatostatin analogue lanreotide (120 mg) reduces liver volume. We investigated the efficacy of a lower dose of lanreotide and its effects on nutritional status. We performed an 18-month prospective study at 2 tertiary medical centers in Belgium from January 2011 through August 2012. Fifty-nine patients with symptomatic PCLD were given lanreotide (90 mg, every 4 weeks) for 6 months. Patients with reductions in liver volume of more than 100 mL (responders, primary end point) continued to receive lanreotide (90 mg) for an additional year (18 months total). Nonresponders were offered increased doses, up to 120 mg lanreotide, until 18 months. Liver volume and body composition were measured by computed tomography at baseline and at months 6 and 18. Patients also were assessed by the PCLD-specific complaint assessment at these time points. Fifty-three patients completed the study; 21 patients (40%) were responders. Nineteen of the responders (90%) continued as responders until 18 months. At this time point, they had a mean reduction in absolute liver volume of 430 ± 92 mL. In nonresponders (n = 32), liver volume increased by a mean volume of 120 ± 42 mL at 6 months. However, no further increase was observed after dose escalation in the 24 patients who continued to the 18-month end point. All subjects had decreased scores on all subscales of the PCLD-specific complaint assessment, including better food intake (P = .04). Subjects did not have a mean change in subcutaneous or visceral fat mass, but did have decreases in mean body weight (2 kg) and total muscle mass (1.06 cm(2)/h(2)). Subjects also had a significant mean reduction in their level of insulin-like growth factor 1, from 19% below the age-adjusted normal range level at baseline to 50% at 18 months (P = .002). In a prospective study, we

  19. 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.

  20. 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

  1. 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

  2. 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.

  3. Improving the Fiscal Sustainability of Teaching Clinics at Dental Schools.

    Science.gov (United States)

    Reinhardt, John W

    2015-12-01

    Educational patient care clinics are becoming an increasingly important source of revenue for dental schools. Revenue from clinics can help offset the rising cost of dental education. In addition, those clinics represent a source of income over which the schools have reasonably direct control. Recently, a group of nine U.S. dental schools conducted a detailed financial survey of their clinics and shared the confidential results with each other. The purpose of their analysis was to develop benchmarks for key factors related to clinical financial productivity and expenses and to define best practices to guide improvements at each school. The survey found significant variations among the nine schools in revenue produced by predoctoral students and by postdoctoral residents. There were similar variations for levels of clinical staffing. By sharing the results of the survey with each other, the individual schools gained a strong understanding of the business strengths or weakness of their own clinical programs. That information gave each school's leaders the opportunity to investigate how they might improve their clinical fiscal sustainability.

  4. Improving measurement technology for the design of sustainable cities

    Science.gov (United States)

    Pardyjak, Eric R.; Stoll, Rob

    2017-09-01

    This review identifies and discusses measurement technology gaps that are currently preventing major science leaps from being realized in the study of urban environmental transport processes. These scientific advances are necessary to better understand the links between atmospheric transport processes in the urban environment, human activities, and potential management strategies. We propose that with various improved and targeted measurements, it will be possible to provide technically sound guidance to policy and decision makers for the design of sustainable cities. This review focuses on full-scale in situ and remotely sensed measurements of atmospheric winds, temperature, and humidity in cities and links measurements to current modeling and simulation needs. A key conclusion of this review is that there is a need for urban-specific measurement techniques including measurements of highly-resolved three-dimensional fields at sampling frequencies high enough to capture small-scale turbulence processes yet also capable of covering spatial extents large enough to simultaneously capture key features of urban heterogeneity and boundary layer processes while also supporting the validation of current and emerging modeling capabilities.

  5. 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

  6. 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

  7. 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

    To critically review evidence for the effectiveness of eccentric exercise to treat lower extremity tendinoses. 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. 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. Specific data were abstracted from the RCTs, including eccentric exercise protocol, adjunctive treatments, concurrent physical activity, and treatment outcome. 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 of tendinosis symptoms remains questionable.

  8. Acupuncture for Primary Sjögren Syndrome (pSS) on symptomatic improvements: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Jiang, Quan; Zhang, Huadong; Pang, Ran; Chen, Jinzhou; Liu, Zhishun; Zhou, Xinyao

    2017-01-19

    Currently, feasible medical treatments are hitherto not satisfying to relieve pSS symptoms, which concerns numbers of clinical doctors. Acupuncture seems to be an alternative to treat pSS and conduces to good symptomatic results. However further research is necessary. This trial is to investigate the efficacy of acupuncture on improving the key symptoms of pSS, which are dryness, pain and fatigue (DPF). The study is designed as a randomized controlled trial of two arms with a single centre. We compare acupuncture with sham acupuncture on symptomatic improvements of pSS. A total of 120 pSS patients, aged at least 18, with DPF, will be randomly assigned to acupuncture or sham acupuncture groups, where they will have needle intervention for 8 weeks with 16 weeks of follow-up. Subjects will be assessed each time before interventions during the 8-week intervention, in week 8 after all interventions and in week 12, 16, 20 and 24 for follow-up with different measurements. The primary outcome are the proportions of subjects that have 30% or greater reduction in at least 2 out of 3 items of DPF in Numeric Analog Scale (NAS) scores (0 = the best, 10 = the severest), calculated between the baseline and the average scores of week 2 to 8. The secondary outcome are related to individual items of NAS scores, EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI), Schirmer test score and unstimulated salivary flow, serum Immunoglobulin G, A and M levels, Medical Outcome Study Short Form 36 Short-Form Health Survey (SF-36), Salivary glands ultrasounds, Hospital Anxiety and Depression (HAD) scale score. The secondary outcome scores are to be collected at baseline, in week 8, 16, and 24. Besides, individual items of NAS will also be collected in week 12 and 20. Moreover, subjects' satisfaction and the proportion of the subjects who identified their allocation will also be measured and analyzed. This study will be

  9. 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.

  10. 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

  11. 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

    2013-05-02

    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.

  12. Grass pollen immunotherapy: symptomatic improvement correlates with reductions in eosinophils and IL-5 mRNA expression in the nasal mucosa during the pollen season.

    Science.gov (United States)

    Wilson, D R; Nouri-Aria, K T; Walker, S M; Pajno, G B; O'Brien, F; Jacobson, M R; Mackay, I S; Durham, S R

    2001-06-01

    Tissue eosinophilia and infiltration by T(H)2-type T cells are characteristic features of allergic rhinitis both after allergen challenge and during natural allergen exposure. Specific immunotherapy inhibits allergen-induced nasal eosinophilia. We sought to assess, in the context of a randomized trial, the relationships between symptomatic improvement after immunotherapy and eosinophil numbers and IL-5 expression in the nasal mucosa during the pollen season. Nasal biopsy specimens were taken from 37 adults with severe summer hay fever at baseline (out of season) and at peak season after 2 years of treatment with a depot grass pollen extract or placebo. Biopsy specimens were processed for immunohistochemistry by using mAbs against eosinophils (EG2), T cells (CD3), and IL-2 receptor-positive cells (CD25), as well as for in situ hybridization by using a sulfur 35-labeled antisense riboprobe directed against IL-5. Immunotherapy significantly reduced symptoms (49%, P =.01) and medication requirements (80%, P =.007) compared with placebo. There was a 400% increase (P =.004) in eosinophils during the pollen season in placebo-treated patients, which was inhibited in the immunotherapy group (20% increase, P =.04 between groups). Seasonal increases were also observed for CD25(+) cells (P =.002), CD3(+) cells (P =.02), and IL-5 mRNA-expressing cells (P =.03) in the placebo group but not in the immunotherapy group. A significant correlation was observed between eosinophils and IL-5 expression (r = 0.5, P pollen immunotherapy may result, at least in part, from inhibition of IL-5-dependent tissue eosinophilia during the pollen season.

  13. 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.

  14. 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…

  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. 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.

  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. 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.

  19. Sustained improvement in blood lipids, coagulation, and fibrinolysis after major weight loss in obese subjects

    National Research Council Canada - National Science Library

    Marckmann, P; Toubro, S; Astrup, A

    1998-01-01

    To study whether major weight loss causes sustained improvement in blood lipids and haemostatic profile in obese subjects, and to compare the influence of two different slimming and maintenance regimens...

  20. [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.

  1. 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.

  2. 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.

  3. Successful pulpal anesthesia for symptomatic irreversible pulpitis.

    Science.gov (United States)

    Drum, Melissa; Reader, Al; Nusstein, John; Fowler, Sara

    2017-04-01

    Profound pulpal anesthesia after a successful inferior alveolar nerve block can be difficult to achieve when the clinical condition is a pulpal diagnosis of symptomatic irreversible pulpitis. The authors reviewed the literature as it relates to the anesthesia necessary for endodontic therapy of patients with painful, vital, mandibular teeth diagnosed with symptomatic irreversible pulpitis. Supplemental anesthetic techniques and medications are available that can be used to improve pulpal anesthesia for patients with the clinical condition of symptomatic irreversible pulpitis. The authors identified treatment recommendations for anesthesia in the case of symptomatic irreversible pulpitis based on a review of the available evidence. Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Darelle Groenewald

    2016-03-01

    Full Text Available Orientation: Companies are under ever-increasing pressure from both internal and external stakeholders to consider the environmental and social impacts of their operations and to mitigate these impacts. This necessitates an investigation into the effect of sustainability initiatives on the financial performance (FP of a company.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.

  6. Improving the efficiency and sustainability of disinfection at a small ...

    African Journals Online (AJOL)

    The Alice Water Treatment Plant (AWTP) has several operating problems, which often result in poor turbidity removal and inadequate disinfection residual. Some progress has been made in upgrading the skills of plant operators, but the plant performance has failed to improve because of faulty equipment, a shortage of ...

  7. Multifunctional Nanocomposites for Improved Sustainability and Protection of Facilities

    Science.gov (United States)

    2015-05-01

    topcoat were not efficient for spore decon- tamination. This result was attributed to chemicals in the paint that blocked the active surface sites or...strength SiO2 nanoparticle / ethylene glycol / Kevlar fabrics Lee et al. 2003 FSP (244 m/s) Shear thickening effect/rigidness ERDC/CERL TR-15-6 7... nanoparticle / polyurethane foam Udden et al. 2009 FSP high-velocity test (800 m/s) Improved mechanical properties Layered silicate / nylon 6

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

    Energy Technology Data Exchange (ETDEWEB)

    Field, E.H.; Strober, S.; Hoppe, R.T.; Calin, A.; Engleman, E.G.; Kotzin, B.L.; Tanay, A.S.; Calin, H.J.; Terrell, C.P.; Kaplan, H.S.

    1983-08-01

    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.

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

    Science.gov (United States)

    Field, E H; Strober, S; Hoppe, R T; Calin, A; Engleman, E G; Kotzin, B L; Tanay, A S; Calin, H J; Terrell, C P; Kaplan, H S

    1983-08-01

    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. Continuing Medical Education via Telemedicine and Sustainable Improvements to Health.

    Science.gov (United States)

    Wang, Fuhmei

    2016-01-01

    Background. This research aims to investigate the quantitative relationship between telemedicine and online continuing medical education (CME) and to find the optimal CME lectures to be delivered via telemedicine to improve the population's health status. Objective. This study examines the following: (1) What factors foster learning processes in CME via telemedicine? (2) What is the possible role of online CME in health improvement? And (3) How optimal learning processes can be integrated with various health services? Methods. By applying telemedicine experiences in Taiwan over the period 1995-2004, this study uses panel data and the method of ordinary least squares to embed an adequate set of phenomena affecting the provision of online CME lectures versus health status. Results. Analytical results find that a nonlinear online CME-health nexus exists. Increases in the provision of online CME lectures are associated with health improvements. However, after the optimum has been reached, greater provision of online CME lectures may be associated with decreasing population health. Conclusion. Health attainment could be partially viewed as being determined by the achievement of the appropriately providing online CME lectures. This study has evaluated the population's health outcomes and responded to the currently inadequate provision of online CME lectures via telemedicine.

  11. Maintaining Perioperative Normothermia: Sustaining an Evidence-Based Practice Improvement Project.

    Science.gov (United States)

    Levin, Rona F; Wright, Fay; Pecoraro, Kathleen; Kopec, Wendy

    2016-02-01

    Unintentional perioperative hypothermia has been shown to cause serious patient complications and, thus, to increase health care costs. In 2009, an evidence-based practice improvement project produced a significant decrease in unintentional perioperative hypothermia in colorectal surgical patients through monitoring of OR ambient room temperature. Project leaders engaged all interdisciplinary stakeholders in the original project, which facilitated the sustainability of the intervention method. An important aspect of sustainability is ongoing monitoring and evaluation of a new intervention method. Therefore, continued evaluation of outcomes of the protocol developed in 2009 was scheduled at specific time points after the initial small test of change with colorectal patients. This article focuses on how attention to sustainability factors during implementation of an improvement project led to the sustainability of a protocol for monitoring OR ambient room temperature with all types of surgical patients five years after the initial project. Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  12. 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.

  13. 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.)

  14. 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.

  15. 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 ma...... 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?...

  16. Pregnancy related symptomatic vertebral hemangioma

    Directory of Open Access Journals (Sweden)

    Meena Gupta

    2014-01-01

    Full Text Available Vertebral hemangiomas are benign vascular tumors of the spine that remain asymptomatic in most cases and incidentally encountered on imaging. Rarely, altered hemodynamic and hormonal changes during pregnancy may expand these benign lesions resulting in severe cord compression. The management of symptomatic vertebral hemangioma during pregnancy is controversial as modalities like radiotherapy and embolization are not suitable and surgery during pregnancy has a risk of preterm labor. Few cases of pregnancy related symptomatic vertebral hemangioma with marked epidural component have been reported in the literature. We report a case of 23-year-old primigravida who developed rapidly progressive paraparesis at 28 weeks of gestation and spine magnetic resonance imaging (MRI revealed upper thoracic vertebral hemangioma with extensive extra-osseous extension and spinal cord compression. Laminectomy and surgical decompression of the cord was performed at 32 weeks of the pregnancy. There was significant improvement in muscle power after a week of surgery. Six weeks postoperatively she delivered a full term normal baby with subsequent improvement of neurologic deficit. Repeat MRI of dorsal spine performed at 3 months postoperatively showed reduced posterior and anterior epidural components of vertebral hemangioma.

  17. 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

  18. 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

  19. Obese (Body Mass Index >30) Patients Have Greater Functional Improvement and Reach Equivalent Outcomes at 12 Months Following Decompression Surgery for Symptomatic Lumbar Stenosis.

    Science.gov (United States)

    Elsayed, Galal; Davis, Matthew C; Dupépé, Esther C; McClugage, Samuel G; Szerlip, Paul; Walters, Beverly C; Hadley, Mark N

    2017-09-01

    To evaluate effect of obesity on 12-month functional outcomes after surgery for lumbar stenosis in adult patients. Data were collected on patients treated with lumbar laminectomy for symptomatic lumbar spinal stenosis as part of an observational registry and analyzed using a retrospective cohort study design. Patients with body mass index (BMI) >30 were compared with patients with BMI 30 had significantly more back pain (P lumbar spinal stenosis may require longer to recover after decompression but can expect to reach equivalent outcomes of similarly treated patients with BMI <30. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Microfiltration of vinasse: sustainable strategy to improve its nutritive potential.

    Science.gov (United States)

    Amaral, Míriam C S; Andrade, Laura H; Neta, Luzia S F; Magalhães, Natalie C; Santos, Fábio S; Mota, Gabriel E; Carvalho, Roberto B

    2016-01-01

    The purpose of this article was to evaluate and establish microfiltration (MF) operating conditions for vinasse (ethanol industries wastewater also known as stillage, slop, distillery effluent or dunder) concentration aiming to improve the use of its nutritive potential. The operating conditions influence permeate flux that has been evaluated by monitoring the flow rate profile during the operation on bench scale in different conditions (feed pH, aeration condition and recovery rate). From the results found, the process scale up was then effected. The bench scale findings showed that the vinasse microfiltration under air flow of 0.5 m(3).h(-1) between membrane fibers, with no pH adjustment, and recovery rate of 93% produced two flows, one of permeate that may be used to wash the sugarcane during the ethanol production processing, and the other of concentrate that contains a high organic compounds and nutrients concentration. This concentrate has additional potentiality of being used as organic compound supplement in contaminated soil bioremediation, and as a supplier of microbial biomass or substrate for biosurfactant production.

  1. 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.

  2. 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.

  3. 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.

  4. 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

  5. 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 patient-level reached) remained constant. Compliance to specific tasks increased after introducing SOP's and 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.

  6. Complexity of pharmacologic treatment required for sustained improvement in outpatients with bipolar disorder

    NARCIS (Netherlands)

    Post, R.M.; Altshuler, L.L.; Frye, M.A.; Suppes, T.; Keck, P.E.; McElroy, S.L.; Leverich, G.S.; Luckenbaugh, D.A.; Rowe, M.; Pizzarello, S.; Kupka, R.W.; Grunze, H.; Nolen, W.A.

    2010-01-01

    Objective: To evaluate the clinical correlates of and types of naturalistic treatments associated with sustained improvement/remission for at least 6 months in outpatients with bipolar disorder. Method: Five hundred twenty-five outpatients with bipolar disorder (77.7% bipolar I) gave informed

  7. Sustaining Improvement in Numeracy: Developing Pedagogical Content Knowledge and Leadership Capabilities in Tandem

    Science.gov (United States)

    Gaffney, Michael; Faragher, Rhonda

    2010-01-01

    Sustainable improvement in student learning achievement in numeracy requires a deliberate focus on two complementary strands of educational endeavour: the practice of effective teaching of mathematics and the exercise of high level school leadership capabilities. In this article, the authors describe the context and findings from their research in…

  8. 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.

  9. 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.

  10. The Sustainable Development Goals cannot be achieved without improving maternal and child nutrition.

    Science.gov (United States)

    Baye, Kaleab

    2017-02-01

    Poor nutrition is a global pandemic with social, economic, and environmental causes and consequences. Of the 17 Sustainable Development Goals (SDGs), only SDG2 explicitly mentions nutrition. Turning the aspirations of the SDGs into reality will require recognition that good nutrition ensured through sustainable agriculture, is simultaneously an absolutely fundamental input and output. Because all of the other SDGs are directly or indirectly linked to improving nutrition, funding to improve nutrition is essential to success for many SDGs. Greater focus on cooperation across disciplines to advance the science of program delivery and to understand the full contribution of nutrition to many desirable outcomes as part of development are surely the ways forward. Missing today's opportunities to advance thinking and program implementation for more effectively improving nutrition for all, especially for women and children, will lead to a wider failure to meet the SDGs.

  11. Sustainability of Key Maine Youth Overweight Collaborative Improvements: A Follow-Up Study

    Science.gov (United States)

    Orr, Joan; O'Brien, Liam M.; Rogers, Victoria W.; Fanburg, Jonathan; Gortmaker, Steven L.

    2014-01-01

    Abstract Background: Primary care is an opportune setting to contribute to obesity prevention and treatment. However, there is limited evidence for effective and sustainable interventions in primary care. The Maine Youth Overweight Collaborative (MYOC) successfully affected office systems, provider behavior, and patient experience. The current study evaluates the effect of MYOC on provider knowledge, beliefs, practices, patient experience, and office systems, in 2012, three years postintervention. Methods: A quasi-experimental field trial was used with all seven original MYOC intervention sites that participated in MYOC between 2004 and 2009 and two non-MYOC control sites. Data from immediately post-MYOC in 2009 served as the baseline comparison. Main outcome measures included rates of recording of BMI percentile in chart, weight classification, use of the 5210 behavioral screening tool, parental reports of counseling received on 5210 topics, and clinician reports of changes in knowledge, beliefs, and practices. Results: Many key MYOC improvements were sustained or improved 3 years postintervention and demonstrated improvements, as compared to control sites. Conclusion: In an environment where obesity has become a priority for healthcare providers and systems, we demonstrate sustainable improvements in clinical decision support and family management of risk behaviors within a primary-care–based approach to addressing overweight risk among children and youth. Some declines were observed for more-complex behavioral and system outcomes. Many opportunities for office system and provider improvements remain. PMID:25046206

  12. 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.

  13. 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.

  14. 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

  15. 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.

  16. Symptomatic vertebral hemangioma: Treatment with radiotherapy

    Directory of Open Access Journals (Sweden)

    Aich Ranen

    2010-01-01

    Full Text Available Background: Vertebrae are the second commonest site among skeletal locations affected by hemangioma, but only about one per cent becomes symptomatic throughout the life. Though surgery, intra vertebral injection of various sclerosing agents have been tried in treating this benign process, no general consensus regarding management has been reached. Radiotherapy is emerging as a low cost, simple, non-invasive but very effective modality of treatment of symptomatic vertebral hemangioma. Aim: This study aims to find out the role of external beam radiotherapy in alleviating the symptoms of symptomatic vertebral hemangiomas without compromising the quality of life. Materials and Methods: Seven consecutive patients with symptomatic vertebral hemangioma were treated with a fixed dose of external beam radiotherapy; and muscle power was assessed before, after treatment and during follow-up. Results: All patients showed improvement of muscle power, which increased with the passage of time. Pain relief with improvement of quality of life was obtained in all the patients. Conclusion: Effect of radiotherapy on vertebral hemangioma is dose-dependent and the dose limiting factor is the spinal cord tolerance. In the present era of IMRT, greater dose can be delivered to the parts of vertebra affected by the hemangioma without compromising the spinal cord tolerance and expected to give better results.

  17. 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.

  18. 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.

  19. The role of productivity in improving the environmental sustainability of ruminant production systems.

    Science.gov (United States)

    Capper, Judith L; Bauman, Dale E

    2013-01-01

    The global livestock industry is charged with providing sufficient animal source foods to supply the global population while improving the environmental sustainability of animal production. Improved productivity within dairy and beef systems has demonstrably reduced resource use and greenhouse gas emissions per unit of food over the past century through the dilution of maintenance effect. Further environmental mitigation effects have been gained through the current use of technologies and practices that enhance milk yield or growth in ruminants; however, the social acceptability of continued intensification and use of productivity-enhancing technologies is subject to debate. As the environmental impact of food production continues to be a significant issue for all stakeholders within the field, further research is needed to ensure that comparisons among foods are made based on both environmental impact and nutritive value to truly assess the sustainability of ruminant products.

  20. Resuscitation Strategies for Burn Injuries Sustained in Austere Environments to Improve Renal Perfusion and Function

    Science.gov (United States)

    2017-10-01

    vascular endothelial growth factor gene transfer on wound healing after burn injury , Crit. Care Med. 31 (2003) 1017–1025. D.M. Burmeister et al. BBA...G.L. Su, D.G. Remick, S.C. Wang, S. Arbabi, Attenuating burn wound inflammatory signaling reduces systemic inflammation and acute lung injury , J...AWARD NUMBER: W81XWH-16-2-0041 TITLE: Resuscitation Strategies for Burn Injuries Sustained in Austere Environments to Improve Renal Perfusion

  1. Improving Potable Water Accessibility And Sustainability Through Efficient Management Of Pipe Water Supply System

    OpenAIRE

    Nakabugo, Stella Mirembe

    2015-01-01

    This paper discusses how to improve potable water accessibility and sustainability through efficient management of pipe water supply system a case study of Uganda, Kampala region. Kampala the capital city of Uganda still faces a challenge to access clean potable water. Water supply coverage is 77.5 % showing at least 22.5 % of the total population has limited access to potable drinking water causing a gap between water supply and water demand. Hypotheses of the paper were that the city's popu...

  2. 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.

  3. 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.

  4. 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.

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

    Directory of Open Access Journals (Sweden)

    Fidlerová Helena

    2016-06-01

    Full Text Available 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.

  6. Symptomatic Bochdalek hernia in an adult.

    Science.gov (United States)

    Hamid, Kamran S; Rai, Surjit S; Rodriguez, Joaquin A

    2010-01-01

    Bochdalek hernias are congenital diaphragmatic defects resulting from the failure of posterolateral diaphragmatic foramina to fuse in utero. Symptomatic Bochdalek hernias in adults are infrequent and may lead to gastrointestinal dysfunction or severe pulmonary disease. We describe our experience with this rare entity. A retrospective chart review was performed on a single patient for data collection purposes. The patient is a morbidly obese 53-year-old female who presented with epigastric pain and diffuse abdominal tenderness. Computed tomography scans of the chest and abdomen revealed a small posterior diaphragmatic defect containing gastric fundal diverticulum. Laboratory work and imaging revealed no other findings. Laparoscopic repair of the Bochdalek hernia was done via an abdominal approach and utilized primary closure with an AlloDerm patch apposed to the defect. The patient has had significant clinical improvement and continues to do well at 9 months postoperatively. Laparoscopic repair of symptomatic adult Bochdalek hernias can be performed successfully and may result in significant clinical improvement.

  7. Parent-Reported Homework Problems in the MTA Study: Evidence for Sustained Improvement with Behavioral Treatment

    Science.gov (United States)

    Langberg, Joshua M.; Arnold, L. Eugene; Flowers, Amanda M.; Epstein, Jeffery N.; Altaye, Mekibib; Hinshaw, Stephen P.; Swanson, James M.; Kotkin, Ronald; Simpson, Stephen; Molina, Brooke S.G.; Jensen, Peter S.; Abikoff, Howard; Pelham, William E.; Vitiello, Benedetto; Wells, Karen C.; Hechtman, Lily

    2011-01-01

    Parent-report of child homework problems was examined as a treatment outcome variable in the MTA - Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (ADHD). Five hundred seventy-nine children ages 7.0–9.9 were randomly assigned to either medication management, behavioral treatment, combination treatment, or routine community care. Results showed that only participants who received behavioral treatment (behavioral and combined treatment) demonstrated sustained improvements in homework problems in comparison to routine community care. The magnitude of the sustained effect at the 24-month assessment was small to moderate for combined and behavioral treatment over routine community care (d = .37; .40, respectively). Parent ratings of initial ADHD symptom severity was the only variable found to moderate these effects. PMID:20390813

  8. 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.

  9. 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...

  10. Improvement of sustainability indicators when traditional water management changes: a case study in Alicante (Spain

    Directory of Open Access Journals (Sweden)

    Laura Romero

    2017-05-01

    Full Text Available Pressurized water systems are designed to guarantee the flow demanded by each user, considering the minimum required pressure. The pressurized water systems have increased water efficiency since their implantation, but they also increased the consumed energy and therefore, the greenhouse gasses emissions. The present manuscript develops the proposal of the sustainable indicators that were selected through deep review. These indicators are related to social-cultural, economic, and environmental criteria. Furthermore as novelty, they were described and applied on a pressurized water network, complementing the energy indexes usually used in the energy audit. To reach the improvement of the sustainability in water systems, new strategies should be developed to improve all sustainability criteria, included the water and energy efficiency. These strategies were developed and analyzed by using of specific hydraulic software (i.e., EPANET and they were based on operation rules to estimate the hydraulic values (pressure and flow. The operation and the regulation strategies were applied on a particular case study, in which, the energy saving was 12.26%, the cost saving was 15.54%, the reduction of energy footprint of water was 15.04%, and the decrease of GHG was 12.26% although the increase of the distributed volume was 9.07%. Besides, the supply guarantee for both irrigation and urban water distribution systems was increased in the new proposal of water management. Finally, the proposal to replace of a pressure reduction valve by a sustainability recovery machine (e.g., pump working as turbine contributed with a generation of renewable energy equal to 103,710 kWh/year.

  11. 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

  12. 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.

  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. Symptomatic subependymoma with nuclear polymorphism.

    Science.gov (United States)

    Matsumura, A; Ahyai, A; Hori, A

    1987-01-01

    Two patients with symptomatic subependymomas are described. Histologically prominent cellular polymorphism was revealed. The existence of subependymoma with unusually marked polymorphism of the tumor cells should be taken into consideration in diagnosis and treatment.

  15. Achievements and prospects of grass pea (Lathyrus sativus L. improvement for sustainable food production

    Directory of Open Access Journals (Sweden)

    Girish Prasad Dixit

    2016-10-01

    Full Text Available Grass pea offers an attractive choice for sustainable food production, owing to its intrinsic properties including limited water requirement and drought tolerance. However, low productivity and the presence of a neurotoxin (ODAP have posed major obstacles to its genetic improvement. Also, biotechnological investments remain limited and the genome is complex and not well understood. Strategies that allow identification of genotypes with reduced ODAP content, coupling of low ODAP content with enhanced yield, and effective seed detoxification methods merit immediate attention. Breeder-friendly genomic tools are being increasingly made available to improve the efficiency of breeding protocols. To this end, the application of next-generation sequencing has provided a means of leveraging the repertoire of genomic resources for this somewhat neglected crop. In this review, we describe progress achieved in Lathyrus genetic improvement. We also explore potential opportunities in Lathyrus research and identify urgent research needs.

  16. Sanitation and income improvement by local community as sustainable participatory development

    Science.gov (United States)

    Ikemi, M.

    2017-03-01

    Most people in low-income areas such as rural village in Africa and urban slum in Southeast Asia live with limited economic resources and poor sanitation conditions. In order to deal with the situation, many of the people have formed community-based organizations and joined the organization activities for the common purpose of improving these conditions as participatory development. This study attempts to examine and evaluate the impact of the activities in their respective local communities. From the case study in two villages of rural Senegal, self-help effort is considered essential to solve the people’s income and hygiene problems through their community participation for sustainable development. For the implementation, the organizational solidarity, adequate water supply and water management are crucially needed. It is suggested to encourage community-based organizations effectively working for income improvement to also consider practicing for sanitation improvement.

  17. Sustained delivery of VEGF from designer self-assembling peptides improves cardiac function after myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Guo, Hai-dong [Department of Anatomy, School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203 (China); Cui, Guo-hong; Yang, Jia-jun [Department of Neurology, Shanghai No. 6 People' s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200233 (China); Wang, Cun [Institutes of Biomedical Sciences, Fudan University, Shanghai 200032 (China); Zhu, Jing; Zhang, Li-sheng; Jiang, Jun [Department of Anatomy, School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203 (China); Shao, Shui-jin, E-mail: shaoshuijin@163.com [Department of Anatomy, School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203 (China)

    2012-07-20

    Highlights: Black-Right-Pointing-Pointer The designer peptide LRKKLGKA could self-assemble into nanofibers. Black-Right-Pointing-Pointer Injection of LRKKLGKA peptides could promote the sustained delivery of VEGF. Black-Right-Pointing-Pointer Injection of VEGF with LRKKLGKA peptides lead to sufficient angiogenesis. Black-Right-Pointing-Pointer Injection of VEGF with LRKKLGKA peptides improves heart function. -- Abstract: Poor vascularization and insufficient oxygen supply are detrimental to the survival of residual cardiomyocytes or transplanted stem cells after myocardial infarction. To prolong and slow the release of angiogenic factors, which stimulate both angiogenesis and vasculogenesis, we constructed a novel self-assembling peptide by attaching the heparin-binding domain sequence LRKKLGKA to the self-assembling peptide RADA16. This designer self-assembling peptide self-assembled into nanofiber scaffolds under physiological conditions, as observed by atomic force microscopy. The injection of designer self-assembling peptides can efficiently provide the sustained delivery of VEGF for at least 1 month. At 4 weeks after transplantation, cardiac function was improved, and scar size and collagen deposition were markedly reduced in the group receiving VEGF with the LRKKLGKA scaffolds compared with groups receiving VEGF alone, LRKKLGKA scaffolds alone or VEGF with RADA16 scaffolds. The microvessel density in the VEGF with LRKKLGKA group was higher than that in the VEGF with RADA16 group. TUNEL and cleaved caspase-3 expression assays showed that the transplantation of VEGF with LRKKLGKA enhanced cell survival in the infarcted heart. These results present the tailor-made peptide scaffolds as a new generation of sustained-release biomimetic biomaterials and suggest that the use of angiogenic factors along with designer self-assembling peptides can lead to myocardial protection, sufficient angiogenesis, and improvement in cardiac function.

  18. Patient safety reporting systems: sustained quality improvement using a multidisciplinary team and "good catch" awards.

    Science.gov (United States)

    Herzer, Kurt R; Mirrer, Meredith; Xie, Yanjun; Steppan, Jochen; Li, Matthew; Jung, Clinton; Cover, Renee; Doyle, Peter A; Mark, Lynette J

    2012-08-01

    Since 1999, hospitals have made substantial commitments to health care quality and patient safety through individual initiatives of executive leadership involvement in quality, investments in safety culture, education and training for medical students and residents in quality and safety, the creation of patient safety committees, and implementation of patient safety reporting systems. At the Weinberg Surgical Suite at The Johns Hopkins Hospital (Baltimore), a 16-operating-room inpatient/outpatient cancer center, a patient safety reporting process was developed to maximize the usefulness of the reports and the long-term sustainability of quality improvements arising from them. A six-phase framework was created incorporating UHC's Patient Safety Net (PSN): Identify, report, analyze, mitigate, reward, and follow up. Unique features of this process included a multidisciplinary team to review reports, mitigate hazards, educate and empower providers, recognize the identifying/reporting individuals or groups with "Good Catch" awards, and follow up to determine if quality improvements were sustained over time. Good Catch awards have been given in recognition of 29 patient safety hazards identified since 2008; in each of these cases, an initiative was developed to mitigate the original hazard. Twenty-five (86%) of the associated quality improvements have been sustained. Two Good Catch award-winning projects--vials of heparin with an unusually high concentration of the drug that posed a potential overdose hazard and a rapid infusion device that resisted practitioner control--are described in detail. A multidisciplinary team's analysis and mitigation of hazards identified in a patient safety reporting process entailed positive recognition with a Good Catch award, education of practitioners, and long-term follow-up.

  19. 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.

  20. Improved Mechanical Properties and Sustained Release Behavior of Cationic Cellulose Nanocrystals Reinforeced Cationic Cellulose Injectable Hydrogels.

    Science.gov (United States)

    You, Jun; Cao, Jinfeng; Zhao, Yanteng; Zhang, Lina; Zhou, Jinping; Chen, Yun

    2016-09-12

    Polysaccharide-based injectable hydrogels have several advantages in the context of biomedical use. However, the main obstruction associated with the utilization of these hydrogels in clinical application is their poor mechanical properties. Herein, we describe in situ gelling of nanocomposite hydrogels based on quaternized cellulose (QC) and rigid rod-like cationic cellulose nanocrystals (CCNCs), which can overcome this challenge. In all cases, gelation immediately occurred with an increase of temperature, and the CCNCs were evenly distributed throughout the hydrogels. The nanocomposite hydrogels exhibited increasing orders-of-magnitude in the mechanical strength, high extension in degradation and the sustained release time, because of the strong interaction between CCNCs and QC chains mediated by the cross-linking agent (β-glycerophosphate, β-GP). The results of the in vitro toxicity and in vivo biocompatibility tests revealed that the hydrogels did not show obvious cytotoxicity and inflammatory reaction to cells and tissue. Moreover, DOX-encapsulated hydrogels were injected beside the tumors of mice bearing liver cancer xenografts to assess the potential utility as localized and sustained drug delivery depot systems for anticancer therapy. The results suggested that the QC/CCNC/β-GP nanocomposite hydrogels had great potential for application in subcutaneous and sustained delivery of anticancer drug to increase therapeutic efficacy and improve patient compliance.

  1. Improving environmental sustainability of concrete products: Investigation on MWC thermal and mechanical properties

    Energy Technology Data Exchange (ETDEWEB)

    Becchio, Cristina; Corgnati, Stefano Paolo; Kindinis, Andrea [Department of Energetics (DENER), Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Torino (Italy); Pagliolico, Simonetta [Department of Materials Science and Engineering Chemistry (DISMIC), Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Torino (Italy)

    2009-11-15

    This research focuses on the possibility of constituting a more sustainable lightweight concrete, Mineralized Wood Concrete (MWC), substituting natural aggregates with wastes from woodworking activities. Exploiting this type of aggregates, a triple purpose has been achieved: preservation of natural raw materials, reuse of wastes and energy saving. Furthermore, the use of wood aggregates is a way to try to develop a sustainable concrete characterized by high thermal inertia, high thermal resistance and low weight. In this paper, effects of the addition of wood aggregates on mechanical and thermal properties of concrete are studied. Mechanical performances have been investigated with compressive strength tests, while a one-dimensional heat flow model has been used to predict the thermal conductivity of MWC. The use of MWC can be associated with the idea of a different typology of relatively heavy building envelope: this union could competitively answer to the demand of well-insulated building envelope and concurrently characterized by high thermal mass. From this union, a series of other values can be derived: low weight, environmentally friendly, easily industrialized and easy on-site casting. Consequently, applications of wood concrete in building constructions may be an interesting solution in order to improve sustainability and building energy efficiency. (author)

  2. The role of quality control circles in sustained improvement of medical quality.

    Science.gov (United States)

    Wang, Lin-Run; Wang, Yang; Lou, Yan; Li, Ying; Zhang, Xing-Guo

    2013-12-01

    We used quality control circles (QCC) followed by the PDCA Deming cycle and analyzed the application of QCC to the sustained improvement of a medical institution in Zhejiang province. Analyses of the tangible and intangible achievements of QCC revealed that the achievement indices for reductions in internal errors, reductions in costs, improvements in the degree of patient satisfaction, improvements in work quality, and improvements in economic performance were 109.84% ± 16.47%, 135.04% ± 50.33%, 126.26% ± 53.69%, 100.58% ± 22.83%, and 104.07% ± 5.45%, respectively. The improvements in these areas were 61.12% ± 13.2%, 60.47% ± 28.91%, 34.41% ± 22.96%, 49.22% ± 25.39%, and 73.70% ± 5.24%, respectively. The intangible achievements were reflected as follows: 5% of QCC members showed an activity growth value of 1-2 points, 83% 1-2 points, 12% more than 2 points. As a result, QCC activity showed prominent results in fostering long-lasting improvement in the quality of medical institutions in terms of both tangible and intangible factors. In short, QCC can be used as an effective tool to improve medical quality.

  3. [Operative treatment of symptomatic nerve root cysts].

    Science.gov (United States)

    Caspar, W; Nabhan, A; Kelm, J; Loew, C; Ahlhelm, F

    2001-01-01

    Nerve root cysts are often asymptomatic and show a predilective manifestation for the lumbo-sacral spine. Depending on their size and the anatomic relationship to the nerve roots they may cause symptoms such as pain or even neurological deficits. From the therapeutical point of view, different moldalities of intervention are controversially discussed because the clinical importance of this entity is still unclear. There are curative as well as symptomatic therapeutic options. The curative therapy includes surgical excision of the cyst and duraplasty whereas the symptomatic therapy is limited to drainage of the cyst. The purpose of this study was to evaluate the role of surgical excision of the cyst with duraplasty using microsurgical techniques. This study included 13 patients who suffered from pain and neurological deficits with myelographically and MRI proven sacral nerve root cysts. All patients underwent surgery for cyst excision plus duraplasty. Clinical symptoms such as pain and sensory deficits significantly improved in all patients postoperatively. 85 % of the patients showed a full recovery from the previously existing radicular pain and motoric as well as sensory deficits. All patients reported a significant improvement of their preoperative loss in muscle strength. Surgical excision combined with duraplasty using microsurgical techniques has proven to be the method of choice in the treatment of symptomatic sacral nerve root cysts.

  4. 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

  5. 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...

  6. 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

  7. 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.

  8. 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

  9. 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.

  10. Advanced Monitoring and Management Systems for Improving Sustainability in Precision Irrigation

    Directory of Open Access Journals (Sweden)

    Olutobi Adeyemi

    2017-02-01

    Full Text Available Globally, the irrigation of crops is the largest consumptive user of fresh water. Water scarcity is increasing worldwide, resulting in tighter regulation of its use for agriculture. This necessitates the development of irrigation practices that are more efficient in the use of water but do not compromise crop quality and yield. Precision irrigation already achieves this goal, in part. The goal of precision irrigation is to accurately supply the crop water need in a timely manner and as spatially uniformly as possible. However, to maximize the benefits of precision irrigation, additional technologies need to be enabled and incorporated into agriculture. This paper discusses how incorporating adaptive decision support systems into precision irrigation management will enable significant advances in increasing the efficiency of current irrigation approaches. From the literature review, it is found that precision irrigation can be applied in achieving the environmental goals related to sustainability. The demonstrated economic benefits of precision irrigation in field-scale crop production is however minimal. It is argued that a proper combination of soil, plant and weather sensors providing real-time data to an adaptive decision support system provides an innovative platform for improving sustainability in irrigated agriculture. The review also shows that adaptive decision support systems based on model predictive control are able to adequately account for the time-varying nature of the soil–plant–atmosphere system while considering operational limitations and agronomic objectives in arriving at optimal irrigation decisions. It is concluded that significant improvements in crop yield and water savings can be achieved by incorporating model predictive control into precision irrigation decision support tools. Further improvements in water savings can also be realized by including deficit irrigation as part of the overall irrigation management

  11. Bar workers' health and environmental tobacco smoke exposure (BHETSE): symptomatic improvement in bar staff following smoke-free legislation in Scotland.

    Science.gov (United States)

    Ayres, J G; Semple, S; MacCalman, L; Dempsey, S; Hilton, S; Hurley, J F; Miller, B G; Naji, A; Petticrew, M

    2009-05-01

    To examine changes in the health of bar workers after smoke-free legislation was introduced. Longitudinal study following bar workers from before legislation introduction, at 2 months after introduction and at 1 year to control for seasonal differences. Bars across a range of socio-economic settings in Scotland. 371 bar workers recruited from 72 bars. Introduction of smoke-free legislation prohibiting smoking in enclosed public places, including bars. Change in prevalence of self-reported respiratory and sensory symptoms. Of the 191 (51%) workers seen at 1-year follow-up, the percentage reporting any respiratory symptom fell from 69% to 57% (p = 0.02) and for sensory symptoms from 75% to 64% (p = 0.02) following reductions in exposure, effects being greater at 2 months, probably partly due to seasonal effects. Excluding respondents who reported having a cold at either baseline or 1 year, the reduction in respiratory symptoms was similar although greater for "any" sensory symptom (69% falling to 54%, p = 0.011). For non-smokers (n = 57) the reductions in reported symptoms were significant for phlegm production (32% to 14%, p = 0.011) and red/irritated eyes (44% to 18%, p = 0.001). Wheeze (48% to 31%, p = 0.006) and breathlessness (42% to 29%, p = 0.038) improved significantly in smokers. There was no relationship between change in salivary cotinine levels and change in symptoms. Bar workers in Scotland reported significantly fewer respiratory and sensory symptoms 1 year after their working environment became smoke free. As these improvements, controlled for seasonal variations, were seen in both non-smokers and smokers, smoke-free working environments may have potentially important benefits even for smokers.

  12. 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.

  13. Therapeutic strategies in symptomatic portal biliopathy.

    Science.gov (United States)

    Vibert, Eric; Azoulay, Daniel; Aloia, Thomas; Pascal, Gérard; Veilhan, Luc-Antoine; Adam, René; Samuel, Didier; Castaing, Denis

    2007-07-01

    Chronic portal obstruction can lead to formation of portal cavernoma (PC). Half of all patients with PC will develop cholestasis, termed portal biliopathy, and some will progress to symptomatic biliary obstruction. Because of the high hemorrhage risk associated with biliary surgery in patients with PC, the optimal therapeutic strategy is controversial. Retrospective review of a single hepatobiliary center experience, including 64 patients with PC identified 19 patients with concurrent symptomatic biliary obstruction. Ten patients underwent initial treatment with a retroperitoneal splenorenal anastomosis. For the remaining 9 patients, portal biliopathy was managed without portosystemic shunting (PSS). Outcomes, including symptom relief, the number of biliary interventions, and survivals, were studied in these 2 groups. Within 3 months of PSS, 7 of 10 patients (70%) experienced a reduction in biliary obstructive symptoms. Five of these 10 patients subsequently underwent uncomplicated biliary bypass, and none has recurred with biliary symptoms or required biliary intervention with a mean follow-up of 8.2 years. For patients without PSS, repeated percutaneous and endobiliary procedures were required to relieve biliary symptoms. Four of the 9 patients with persistent PC required surgical intrahepatic biliary bypass, which was technically more challenging. With a mean follow-up of 8 years, 1 of these 9 patients died of severe cholangitis, 1 remained jaundiced, and 7 were asymptomatic. This study, which represents the largest published experience with the surgical treatment of patients with symptomatic portal biliopathy, indicates that retroperitoneal splenorenal anastomosis improves outcomes and should be the initial treatment of choice.

  14. Symptomatic dermographism: an inadequately described disease.

    Science.gov (United States)

    Schoepke, N; Młynek, A; Weller, K; Church, M K; Maurer, M

    2015-04-01

    Symptomatic dermographism is the most common form of physical urticaria with a prevalence of 2-5%. However, its clinical picture has rarely been described. To understand more of patients' views about the practical aspects of their condition, its cause and impact on quality of life. Ninety-one of 150 patients with symptomatic dermographism from our specialist urticaria clinic completed a 38-question questionnaire sent them by mail. The mean duration of disease was 6¼ years. In most patients, the condition was continuous, but ~25% had prolonged symptom-free phases. Severity was evaluated as moderate in 45%, severe in 33% and very severe in 6% of respondents. Other responses included: symptoms worse in the evening in 81%; quality of life significantly impaired in 44%; normal life not possible 7%; stress induces acute episodes 44%; other urticarial forms coexist 21%; allergy coexist 48%. A family history was reported in 14%. Almost all patients were taking H1 -anti-histamines, 49% getting marked improvement and 23% becoming symptoms free. It is a survey only of patient opinions. This questionnaire survey confirmed that symptomatic dermographism is a debilitating condition with profound effects on quality of life but its underlying cause and disease mechanisms remain obscure. © 2014 European Academy of Dermatology and Venereology.

  15. 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

  16. 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 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.

  17. 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

  18. Livelihood Sustainability and Community Based Co-Management of Forest Resources in China: Changes and Improvement

    Science.gov (United States)

    Chen, Haiyun; Shivakoti, Ganesh; Zhu, Ting; Maddox, David

    2012-01-01

    Community-based co-management (CBCM) has been applied in some communities near natural reserves in China. This paper uses Gansu Baishuijiang National Natural Reserve in China as a case study for livelihood improvements under CBCM projects. We demonstrate change from 2006 to 2010 in five classes of livelihood capital (social, human, natural, physical and financial capitals), illustrating the effectiveness of CBCM projects. Specifically, there are increases in mean family income and improvements in forest conservation. However, some problems in the design and implementation of CBCM projects remain, including the complicated social and political relationship between government and community, social exclusion and uneven application of benefits within communities, and the lack of integration of indigenous cultures and traditional beliefs. Attention for special groups in community and improving the design of CBCM Projects. Study shows that under the cooperation of government, CBCM projects and local community residents, the harmonious development of sustainable livelihood improvement and forest resources conservation will be an important trend in the future.

  19. Social sustainability in healthcare facilities: a rating tool for analysing and improving social aspects in environments of care.

    Science.gov (United States)

    Capolongo, Stefano; Gola, Marco; di Noia, Michela; Nickolova, Maria; Nachiero, Dario; Rebecchi, Andrea; Settimo, Gaetano; Vittori, Gail; Buffoli, Maddalena

    2016-01-01

    Nowadays several rating systems exist for the evaluation of the sustainability of buildings, but often their focus is limited to environmental and efficiency aspects. Hospitals are complex constructions in which many variables affect hospital processes. Therefore, a research group has developed a tool for the evaluation of sustainability in healthcare facilities. The paper analyses social sustainability issues through a tool which evaluates users' perception from a the quality and well-being perspective. It presents a hierarchical structure composed of a criteria and indicators system which is organised through a weighing system calculated by using the Analytic Network Process. The output is the definition of a tool which evaluates how Humanisation, Comfort and Distribution criteria can affect the social sustainability of a building. Starting from its application, it is evident that the instrument enables the improvement of healthcare facilities through several design and organisational suggestions for achieving healing and sustainable architectures.

  20. City logistics initiatives aimed at improving sustainability within existing context of urban area

    Directory of Open Access Journals (Sweden)

    Tadić Snežana R.

    2014-01-01

    Full Text Available City is the place of the largest concentration of economic and social activities, and the delivery of goods is a prerequisite for the maintenance of urban life and business activities for achieving wealth and development of the city. Logistics systems and processes that enable the realization of commodity flows support employment and generate income, but may also have negative impacts on all essential functions of the city. Therefore, logistics plays an important role in the competitiveness of urban areas and should be an integral part of the city's economy. From the perspective of sustainable development, i.e. social, environmental and economic efficiency, logistics processes primarily urban freight transport, are far from optimal. The growth of road freight transport and traffic congestion, air pollution and other negative impacts on the environment, inefficient use of land and the rising costs of delivery of goods affect the definition and exploration of different initiatives of city logistics. This paper describes the initiatives that do not require large infrastructure investments and do not change the existing urban context, but can improve its sustainability.

  1. 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.

  2. 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.

  3. Agricultural Biodiversity Is Essential for a Sustainable Improvement in Food and Nutrition Security

    Directory of Open Access Journals (Sweden)

    Toby Hodgkin

    2011-01-01

    Full Text Available Agricultural biodiversity has hitherto been valued almost exclusively as a source of traits that can be used in scientific breeding programs to improve the productivity of crop varieties and livestock breeds. We argue that it can make a far greater contribution to increased productivity. In particular, a wider deployment of agricultural biodiversity is an essential component in the sustainable delivery of a more secure food supply. Diversity of kingdoms, species and genepools can increase the productivity of farming systems in a range of growing conditions, and more diverse farming systems are also generally more resilient in the face of perturbations, thus enhancing food security. Diversity can maintain and increase soil fertility and mitigate the impact of pests and diseases. Diversity of diet, founded on diverse farming systems, delivers better nutrition and greater health, with additional benefits for human productivity and livelihoods. Agricultural biodiversity will also be absolutely essential to cope with the predicted impacts of climate change, not simply as a source of traits but as the underpinnings of more resilient farm ecosystems. Many of the benefits of agricultural biodiversity are manifested at different ecological and human scales, and cut across political divisions, requiring a cross-sectoral approach to reassess the role of agricultural biodiversity in sustainable and secure food production.

  4. Sustainable practice improvements: impact of the Comprehensive Advanced Palliative Care Education (CAPCE) program.

    Science.gov (United States)

    Harris, Diane; Hillier, Loretta M; Keat, Nancy

    2007-01-01

    This paper describes an education program designed to improve palliative care practice through the development of workplace hospice palliative care resources (PCRs), and its impact on knowledge transfer and longer-term changes to clinical practice. Evaluation methods included pre- and post-program questionnaires, and a survey of learners' (n=301) perceptions of program learning strategies. Interviews (n=21) were conducted with a purposeful sample of PCRs and representatives from their work sites. Ratings of the sessions indicated that they were relevant to learners' clinical practice. At follow up, the majority of learners (83%) continued to serve as PCRs. Many positive effects were identified, including enhanced pain and symptom management, staff education, and development of care policies and guidelines. Management support, particularly the prioritization of palliative care and staff development, were factors facilitating sustained implementation. These findings highlight the importance of multimodal learning strategies and supportive work environments in the development of PCRs to enhance palliative care practice.

  5. 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

    . 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...... 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...... in the network while it simultaneously maximises profit, saves activity costs, helps to decrease the harmful effects of the manufacturing process and makes a positive impact on societal development. To validate the model, a numerical illustration with the help of a case study from an electrical manufacturing...

  6. Holistic and sustainable health improvement: the contribution of the settings-based approach to health promotion.

    Science.gov (United States)

    Dooris, Mark

    2009-01-01

    Highlighting the need for holistic and sustainable health improvement, this paper starts by reviewing the origins, history and conceptualization of the settings approach to health promotion. It then takes stock of current practice both internationally and nationally, noting its continuing importance worldwide and its inconsistent profile and utilization across the four UK countries. It goes on to explore the applicability and future development of settings-based health promotion in relation to three key issues: inequalities and inclusion; place-shaping and systems-based responses to complex problems. Concluding that the settings approach remains highly relevant to 21st century public health, the paper calls on the new "Royal" to provide much-needed leadership, thereby placing settings-based health promotion firmly on the national agenda across the whole of the UK.

  7. 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

  8. 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

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

    Directory of Open Access Journals (Sweden)

    Hassen Kebede

    2014-02-01

    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

  10. Agro-designing: sustainability-driven, vision-oriented, problem preventing and knowledge-based methodology for improving farming systems sustainability

    OpenAIRE

    Znaor, Darko; Goewie, Eric

    1999-01-01

    ABSTRACT While classical research focuses to problem solving, design is a problem- prevention methodology, and is suitable for multi- and and interdisciplinary research teams with the vision of how to improve the agricultural sustainability. Since organic agriculture is based on the holistic approach and is also problem-prevention oriented in that it refrains from certain inputs and practices, design is an interesting methodology that could be applied more often in organic agriculture. ...

  11. [Symptomatic therapy of pharyngeal pathology].

    Science.gov (United States)

    Turovskiĭ, A B; Kondrashina, V V

    2013-01-01

    The objective of the present work was to describe the current approaches to symptomatic therapy of pharyngeal diseases. The data on the principal pathogens responsible for pharyngeal pathology are presented in conjunction with the specific features of differential treatment of pharyngeal diseases taking into consideration the concrete causative factor. The possibility of using Strepsils pills for resorption is discussed.

  12. Symptomatic Overt Hypothyroidism Post Induction

    Science.gov (United States)

    2017-10-21

    REPORT TYPE 3. DATES COVERED (From - To) 10/2112017 Poster 10/21/2017-10/24/2017 4. TITLE AND SUBTITLE Sa. CONTRACT NUMBER Sy.mptomatic Overt...capacity, diminished DLC0 1. decreased response both hypoxic and hypercapnic ventilatory drive HEME: Anemia (25%-50% of pts) and dysfunction of

  13. 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

  14. Agriculture in Africa: strategies to improve and sustain smallholder production systems.

    Science.gov (United States)

    Jama, Bashir; Pizarro, Gonzalo

    2008-01-01

    Agricultural development lies at the heart of poverty reduction and increased food security of most developing nations. Sub-Saharan Africa (hereafter referred to as Africa) is, however, the only region in the world where per capita agricultural productivity has remained stagnant over the past 40 years. In Asia and Latin America, the use of tailored techniques and technologies has transformed agricultural practice and its productivity, leading to what has been called the "green revolution." The dissemination of uniquely African green revolution technologies has not occurred on the continent. This chapter will argue that the same results in increased productivity and food security can be achieved in Africa if the appropriate investments are made in key interventions: soil fertility improvement, improved seeds, water management, market access, extension services, access to credit, and improvements in weather forecasting. Where these have happened, even partially, the outcome has been remarkable. However, bringing them to scale in ways that sustainably increase agricultural productivity and alleviate poverty requires increased investments and innovative institutional arrangements. Fortunately, several research and development projects on the continent, including the Millennium Villages Project, are providing valuable insights. Finally, this chapter outlines the key remaining challenges.

  15. 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.

  16. Challenges of hemodialysis in a new renal care center: call for sustainability and improved outcome

    Directory of Open Access Journals (Sweden)

    Oluyombo R

    2014-09-01

    Full Text Available Rotimi Oluyombo,1 Oluyomi O Okunola,2 Timothy O Olanrewaju,3 Michael O Soje,1 Omotola O Obajolowo,1 Margaret A Ayorinde11Renal Unit, Internal Medicine Department, Federal Medical Centre, Ido-Ekiti, Ekiti State, 2Renal Unit, Department of Internal Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, 3Renal Division, Internal Medicine Department, Faculty of Health Sciences, University of Ilorin, Ilorin, Kwara State, NigeriaBackground: Nephrologists are faced with enormous challenges in the management of patients with end-stage renal disease, especially in sub-Saharan Africa, where hemodialysis is the most common modality of renal replacement therapy in the region. Therefore, we reviewed our 3 years of experience with hemodialysis services in a tertiary hospital located in a rural community of South West Nigeria. This was with a view to presenting the profile of hemodialysis patients and the challenges they face in sustaining hemodialysis.Methods: We reviewed the case records and hemodialysis registers for 176 patients over the 3 years from November 2010 to December 2013. The data were analyzed using Statistical Package for the Social Sciences version 20 software.Results: Of the 176 patients, 119 (66.9% were males. The mean age of the patients was 44.87±17.21 years. Most were semiskilled or unskilled (111; 63.5% and 29 (16.5% were students. Twenty-six (14.8% had acute kidney injury in the failure stage. Chronic glomerulonephritis, hypertensive nephropathy, and diabetic nephropathy accounted for 45.3%, 23.3%, and 12.1%, respectively, of patients with end-stage renal disease. Only 6.8% of patients could afford hemodialysis beyond 3 months.Conclusion: Sustainability of maintenance hemodialysis is poor in our environment. Efforts should be intensified to improve other modalities of renal replacement therapy, in particular kidney transplantation, which is cost-effective in the long-term. Also, preventive measures such

  17. 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 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.

  18. Worldwide Research on Plant Defense against Biotic Stresses as Improvement for Sustainable Agriculture

    Directory of Open Access Journals (Sweden)

    Estela Gimenez

    2018-02-01

    Full Text Available Agriculture is the basis for food production on a global scale. Sustainable agriculture tries to improve or maintain the quality of food without compromising the environment. As sessile organisms, plants cannot avoid adverse environmental conditions and contact with other living organisms. The damage caused to plants by other living organisms such as parasites and pathogens (virus, bacteria, fungi, nematodes or insects brings about what is known as biotic stress. Plants are constantly exposed to biotic stress, which causes changes in plant metabolism involving physiological damages that lead to a reduction of their productivity. To fight biotic stress, plants have developed sophisticated defense mechanisms. Thus, understanding plant defense mechanisms might prevent important crop and economic losses. In this article, a bibliometric analysis of biotic stress is carried out. Different aspects of the publications are analyzed, such as publication type, research field, journal type, countries and their institutions, as well as the keyword occurrence frequency, and finally special attention is paid to the plant studied by the leading countries and institutions. As expected, journals selected by authors to publish their relevant findings are plant-specific journals. However, it should be noted that the fourth position, in terms of the number of publications per journal, is occupied by BMC Genomics journal. Such a journal considers mainly articles on genomics, which indicates the involvement of genetic factors in the control of biotic stress. Analysis of the keywords used in publications about biotic stress shows the great interest in the biotic–abiotic stress interaction, in the gene expression regulation in plants as well as phytohormones in the current research. In short, the great effort made by the scientific community in the biotic and abiotic stresses field with the aim to understand, regulate and control plant damages caused by biotic stress

  19. Improved Sustainability of Water Supply Options in Areas with Arsenic-Impacted Groundwater

    Directory of Open Access Journals (Sweden)

    Edward A. McBean

    2013-11-01

    Full Text Available The supply of water for rural populations in developing countries continues to present enormous problems, particularly where there is arsenic contamination in the groundwater, as exists over significant parts of Bangladesh. In response, improvements in the sustainability of water supplies are feasible through the use of a combination of water sources wherein rainwater harvesting is employed for a portion of the year. This can potentially reduce the duration of the year during which arsenic-contaminated groundwater is utilized. As demonstrated, a rainwater cistern volume of 0.5 m3 in the Jessore district area of Bangladesh can provide rainwater for periods averaging 266 days of the year, which allows groundwater at 184 µg/L arsenic to be used as a water supply for the remainder of the year. This dual supply approach provides the body burden equivalent to the interim drinking water guideline of arsenic concentration of 50 µg/L for 365 days of the year (assuming the water consumption rate is 4 L/cap/day for a family of five with a rainwater collection area of 15 m2. If the water use rate is 20 L/cap/day, the same cistern can provide water for 150 days of the year; however, although this is insufficient to supply water to meet the body burden equivalent guideline of 50 µg/L. Results are provided also for different rooftop areas, sizes of cisterns and alternative arsenic guidelines [World Health Organization (WHO and Bangladeshi]. These findings provide useful guidelines on supply options to meet sustainability targets of water supply. However, they also demonstrate that the use of cisterns cannot assist the meeting of the 10 µg/L WHO target arsenic body burden, if the arsenic contamination in the groundwater is high (e.g., at 100 µg/L.

  20. 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.

  1. Neurophysiological Evidence of Compensatory Brain Mechanisms Underlying Attentional-Related Processes in Symptomatically Remitted Patients with Schizophrenia

    Directory of Open Access Journals (Sweden)

    Yansong Li

    2017-04-01

    Full Text Available A recent electrophysiological study suggests existing compensatory brain activity as a mechanism for functional recovery of visual attention detection (the capacity for detecting external cues in symptomatically remitted schizophrenia patients. Despite such evidence, little is known about other aspects of attentional-related processes in schizophrenia during clinical remission, such as their capacity to concentrate on the task at hands without being interfered by distracting information. To this end, we recorded event-related brain potentials (ERPs from 20 symptomatically remitted schizophrenia patients and 20 healthy controls while they engaged in a classic Stroop task. Symptomatically remitted patients showed comparable Stroop interference to healthy controls, indicating a degree of functional recovery of such a capacity in these patients. On the neural level, the N450 over the fronto-central and central regions, a component of the ERPs related to conflict detection, was found across both groups, although patients presented a reduced N450 relative to healthy controls. By contrast, the amplitude of the sustained potential (SP (600–800 ms over the parieto-central and parietal regions, a component of the ERPs related to conflict resolution, was significantly increased in patients relative to healthy controls. Furthermore, such increased SP amplitude correlated positively with improved behavioral accuracy in symptomatically remitted patients with schizophrenia. These findings reveal that symptomatically remitted patients with schizophrenia increasingly recruited the parietal activity involving successful conflict resolution to offset reduced conflict detection. Therefore, this provides further insight into compensatory mechanisms potentially involving a degree of functional recovery of attentional-related processes in schizophrenia during clinical remission.

  2. 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.

  3. Outcome of alcohol septal ablation in mildly symptomatic patients with hypertrophic obstructive cardiomyopathy

    DEFF Research Database (Denmark)

    Veselka, Josef; Faber, Lothar; Liebregts, Max

    2017-01-01

    Background- The long-term efficacy and safety of alcohol septal ablation (ASA) in patients with highly symptomatic hypertrophic obstructive cardiomyopathy has been demonstrated. The aim of this study was to evaluate the long-term outcomes of mildly symptomatic patients with hypertrophic obstructive......, and III at the last clinical checkup, respectively. Conclusions- Mildly symptomatic hypertrophic obstructive cardiomyopathy patients treated with ASA had sustained symptomatic and hemodynamic relief with a low risk of developing severe heart failure. Their survival is comparable to the general population....... cardiomyopathy treated with ASA. Methods and Results- We retrospectively evaluated consecutive patients enrolled in the Euro-ASA registry (1427 patients) and identified 161 patients (53±13 years; 27% women) who were mildly symptomatic (New York Heart Association [NYHA] class II) pre-ASA. The median...

  4. 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.

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

    Science.gov (United States)

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

    2013-06-01

    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.

  6. Valganciclovir for symptomatic congenital cytomegalovirus disease.

    Science.gov (United States)

    Kimberlin, David W; Jester, Penelope M; Sánchez, Pablo J; Ahmed, Amina; Arav-Boger, Ravit; Michaels, Marian G; Ashouri, Negar; Englund, Janet A; Estrada, Benjamin; Jacobs, Richard F; Romero, José R; Sood, Sunil K; Whitworth, M Suzanne; Abzug, Mark J; Caserta, Mary T; Fowler, Sandra; Lujan-Zilbermann, Jorge; Storch, Gregory A; DeBiasi, Roberta L; Han, Jin-Young; Palmer, April; Weiner, Leonard B; Bocchini, Joseph A; Dennehy, Penelope H; Finn, Adam; Griffiths, Paul D; Luck, Suzanne; Gutierrez, Kathleen; Halasa, Natasha; Homans, James; Shane, Andi L; Sharland, Michael; Simonsen, Kari; Vanchiere, John A; Woods, Charles R; Sabo, Diane L; Aban, Inmaculada; Kuo, Huichien; James, Scott H; Prichard, Mark N; Griffin, Jill; Giles, Dusty; Acosta, Edward P; Whitley, Richard J

    2015-03-05

    The treatment of symptomatic congenital cytomegalovirus (CMV) disease with intravenous ganciclovir for 6 weeks has been shown to improve audiologic outcomes at 6 months, but the benefits wane over time. We conducted a randomized, placebo-controlled trial of valganciclovir therapy in neonates with symptomatic congenital CMV disease, comparing 6 months of therapy with 6 weeks of therapy. The primary end point was the change in hearing in the better ear ("best-ear" hearing) from baseline to 6 months. Secondary end points included the change in hearing from baseline to follow-up at 12 and 24 months and neurodevelopmental outcomes, with each end point adjusted for central nervous system involvement at baseline. A total of 96 neonates underwent randomization, of whom 86 had follow-up data at 6 months that could be evaluated. Best-ear hearing at 6 months was similar in the 6-month group and the 6-week group (2 and 3 participants, respectively, had improvement; 36 and 37 had no change; and 5 and 3 had worsening; P=0.41). Total-ear hearing (hearing in one or both ears that could be evaluated) was more likely to be improved or to remain normal at 12 months in the 6-month group than in the 6-week group (73% vs. 57%, P=0.01). The benefit in total-ear hearing was maintained at 24 months (77% vs. 64%, P=0.04). At 24 months, the 6-month group, as compared with the 6-week group, had better neurodevelopmental scores on the Bayley Scales of Infant and Toddler Development, third edition, on the language-composite component (P=0.004) and on the receptive-communication scale (P=0.003). Grade 3 or 4 neutropenia occurred in 19% of the participants during the first 6 weeks. During the next 4.5 months of the study, grade 3 or 4 neutropenia occurred in 21% of the participants in the 6-month group and in 27% of those in the 6-week group (P=0.64). Treating symptomatic congenital CMV disease with valganciclovir for 6 months, as compared with 6 weeks, did not improve hearing in the short term

  7. 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.

  8. 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

  9. Innovative Approaches to Improve Sustainability of Physical Distribution in Dutch Agrifood Supply Chains

    NARCIS (Netherlands)

    Pieters, Reinder; Beek, van P.; Glöckner, H.H.; Omta, S.W.F.; Weijers, S.

    2017-01-01

    Sustainability has become an important issue in all aspects of corporate
    policy. This also applies to organizations operating in agrifood supply chains. Most literature on sustainability in the agrifood industry focuses on food security or prevention of food losses. However, little attention has

  10. 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...

  11. 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

    Carriers 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

  12. 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

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

    NARCIS (Netherlands)

    Vermeulen, Walter|info:eu-repo/dai/nl/072613335; 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

  14. Saint Kitts and Nevis - OECS Fiscal Issues : Policies to Achieve Fiscal Sustainability and Improve Efficiency and Equity of Public Expenditures

    OpenAIRE

    World Bank

    2003-01-01

    Despite high levels of per capita incomes and good social service provision, poverty remains a persistent problem in St. Kitts and Nevis. To improve competitiveness, restore rapid economic growth, and ensure its medium-term sustainability in the context of the currency union, the main challenges to the St. Kitts and Nevis government are to (a) tighten fiscal policy, notably through expendi...

  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. 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.

  17. Symptomatic vertebral hemangiomas during pregnancy.

    Science.gov (United States)

    Moles, Alexis; Hamel, Olivier; Perret, Christophe; Bord, Eric; Robert, Roger; Buffenoir, Kevin

    2014-05-01

    Symptomatic vertebral hemangiomas during pregnancy are rare, as only 27 cases have been reported in the literature since 1948. However, symptomatic vertebral hemangiomas can be responsible for spinal cord compression, in which case they constitute a medical emergency, which raises management difficulties in the context of pregnancy. Pregnancy is a known factor responsible for deterioration of these vascular tumors. In this paper, the authors report 2 clinical cases of symptomatic vertebral hemangiomas during pregnancy, including 1 case of spontaneous fracture that has never been previously reported in the literature. The authors then present a brief review of the literature to discuss emergency management of this condition. The first case was a 28-year-old woman at 35 weeks of gestation, who presented with paraparesis. Spinal cord MRI demonstrated a vertebral hemangioma invading the body and posterior arch of T-3 with posterior epidural extension. Laminectomy and vertebroplasty were performed after cesarean section, allowing neurological recovery. The second case involved a 35-year-old woman who presented with spontaneous fracture of T-7 at 36 weeks of gestation, revealing a vertebral hemangioma with no neurological deficit, but it was responsible for pain and local instability. Treatment consisted of postpartum posterior interbody fusion. With a clinical and radiological follow-up of 2 years, no complications and no modification of the hemangiomas were observed. A review of the literature reveals discordant management of these rare cases, which is why the treatment course must be decided by a multidisciplinary team as a function of fetal gestational age and maternal neurological features.

  18. Symptomatic management in multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Pushkar Shah

    2015-01-01

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

  19. 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

  20. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Claire; Levermore, Geoff [Built Environment Research Group, University of Manchester, PO Box 88, Sackville Street, Manchester M60 1QD (United Kingdom)

    2008-12-15

    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 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. (author)

  2. Renewing and improving the business model toward sustainability in theory and practice

    National Research Council Canada - National Science Library

    Del Baldo, Mara; Baldarelli, Maria-Gabriella

    2017-01-01

    The paper aims to analyse and discuss the evolution towards a sustainable business model and to focus on the motivations and the implications on the mission, the governance and the accountability of companies...

  3. 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)

  4. 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.

  5. Improving end-of-life care in nursing homes: implementation and evaluation of an intervention to sustain quality of care.

    Science.gov (United States)

    Finucane, Anne M; Stevenson, Barbara; Moyes, Rhona; Oxenham, David; Murray, Scott A

    2013-09-01

    Internationally, policy calls for care homes to provide reliably good end-of-life care. We undertook a 20-month project to sustain palliative care improvements achieved by a previous intervention. To sustain a high standard of palliative care in seven UK nursing care homes using a lower level of support than employed during the original project and to evaluate the effectiveness of this intervention. Two palliative care nurse specialists each spent one day per week providing support and training to seven care homes in Scotland, United Kingdom; after death audit data were collected each month and analysed. During the sustainability project, 132 residents died. In comparison with the initial intervention, there were increases in (a) the proportion of deceased residents with an anticipatory care plan in place (b) the proportion of those with Do Not Attempt Cardiopulmonary Resuscitation documentation in place and (c) the proportion of those who were on the Liverpool Care Pathway when they died. Furthermore, there was a reduction in inappropriate hospital deaths of frail and elderly residents with dementia. However, overall hospital deaths increased. A lower level of nursing support managed to sustain and build on the initial outcomes. However, despite increased adoption of key end-of-life care tools, hospital deaths were higher during the sustainability project. While good support from palliative care nurse specialists and GPs can help ensure that key processes remain in place, stable management and key champions are vital to ensure that a palliative care approach becomes embedded within the culture of the care home.

  6. 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.

  7. 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.

  8. MR-guided High Intensity Focused Ultrasound Treatment for Symptomatic Uterine Leiomyomata: Long-term Outcomes

    Science.gov (United States)

    Kim, Hyun S.; Baik, Jun-Hyun; Pham, Luu D.; Jacobs, Michael A

    2011-01-01

    PURPOSE To evaluate the long-term clinical outcomes of MR-guided high intensity focused ultrasound (MR-g HIFU) treatments for symptomatic uterine leiomyomata. MATERIAL AND METHODS Patients were recruited for a prospective study for MR-g HIFU treatments of symptomatic leiomyomata, with up to three-year follow-up. The study was approved by the institutional review board and was HIPPA compliant. Clinical assessments were obtained at 3 months, 6 months, 1, 2 and 3 years after MR-g HIFU, as well as uterine fibroid symptom severity scores (SSS) and health-related quality of life questionnaires (UFS-QOL). MRI was performed at each follow-up to assess the efficacy of the treatment at 6 months, 1 year, 2 years and 3 years. RESULTS Fifty one leiomyomata in 40 patients were treated. All patients were treated within the FDA guidelines with leiomyomata localized on MR and treated with sonication. The mean baseline volume of treated leiomyomata was 336.9 cm3. The mean improvement scores for tSSS was 47.8 (p<.001) and for tUFS-QOL was 39.8 (p<.001) at 3 years. The mean volume decrease in treated leiomyomata was 32.0% (p<.001), and, in uterus, the volume decrease was 27.7% (p<.001) at three years. There were no long-term complications. CONCLUSION Long-term follow-up data from MR-g HIFU treatments show sustained symptomatic relief among enrolled patients. Although the results are preliminary, MR-g HIFU for the treatment of uterine leiomyomata may result in acceptable long-term outcomes at three years. PMID:21718955

  9. 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.

  10. Symptomatic sacral perineurial (Tarlov) cysts.

    Science.gov (United States)

    Sajko, Tomislav; Kovać, Damir; Kudelić, Nenad; Kovac, Lana

    2009-12-01

    Sacral perineurial (Tarlov) cysts are rare lesions. Over a seven year period 4000 patients underwent surgery for lumbar disk herniation. In three patients neurological symptoms were caused by large sacral perineurial cysts. Methods of choice for diagnosis of Tarlov cysts are lumbosacral magnetic resonance imaging and computerized tomography myelography. The majority of Tarlov cysts are asymptomatic. In case of large (> or = 1.5 cm) and symptomatic perineurial cyst, as in three patients reported in this article, microsurgical treatment was successful. Although rare, perineurial (Tarlov) cysts must be taken into consideration when approaching to patient with low back and radicular pain. Authors review the medical literature, pathological and pathophysiological features and treatment options of sacral perineurial cysts.

  11. Good to Great: Quality-Improvement Initiative Increases and Sustains Pediatric Health Care Worker Hand Hygiene Compliance.

    Science.gov (United States)

    McLean, Heather S; Carriker, Charlene; Bordley, William Clay

    2017-04-01

    The Joint Commission, the Centers for Disease Control and Prevention, and the World Health Organization challenge hospitals to achieve and sustain compliance with effective hand hygiene (HH) practice; however, many inpatient units fail to achieve a high level of reliability. The aim of the project was to increase and sustain health care worker (HCW) compliance with HH protocols from 87% (level of reliability [LOR] 1) to ≥95% (LOR 2) within 9 months on 2 pediatric inpatient units in an academic children's hospital. This study was a time-series, quality-improvement project. Interventions were tested through multiple plan-do-study-act cycles on 2 pediatric inpatient units. HH compliance audits of HCWs on these units were performed randomly each week by the hospital infection prevention program. Control charts of percentages of HCW HH compliance were constructed with 3-σ (data within 3 SDs from a mean) control limits. These control limits were adjusted after achieving significant improvements in performance over time. Charts were annotated with interventions including (1) increasing awareness, (2) providing timely feedback, (3) empowering patients and families to participate in mitigation, (4) providing focused education, and (5) developing interdisciplinary HH champions. HH compliance rates improved from an average of 87% (LOR 1) to ≥95% (LOR 2) within 9 months, and this improvement has been sustained for >2 years on both pediatric inpatient units. Significant and sustained gains in HH compliance rates of ≥95% (LOR 2) can be achieved by applying high-reliability human-factor interventions. Copyright © 2017 by the American Academy of Pediatrics.

  12. 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.

  13. UTERINE CERVICAL CYTOMORPHOLOGY IN SYMPTOMATIC POSTMENOPAUSAL WOMEN

    Directory of Open Access Journals (Sweden)

    Nisa

    2016-03-01

    Full Text Available BACKGROUND In postmenopausal women, risk of uterine cervical dysplasia and malignancy is increased, especially in those with no history of previous Papanicolaou (Pap smears. Therefore, routine screening can help in reducing morbidity and mortality. AIM To study the uterine cervical cytomorphology in symptomatic postmenopausal women, prevalence of dysplasia/malignancy, to observe the relation of cervical cytomorphology with urogenital symptoms, age of onset and duration of menopause. MATERIALS AND METHODS A total of 102 symptomatic postmenopausal patients underwent Pap smear examination and reporting was done based on The 2001 Bethesda System. RESULTS Out of 102 smears, 101(99.02% cases were satisfactory for reporting. Age ranged from 44 to 79 years with mean and median age of 54.3±6.8 and 52.5 years respectively. Maximum cases were in the 50-59 age group, 57(56.5% cases. Age of onset of menopause varied from 40 to 56 years with mean and median age of 48.6±3.4 and 49 years respectively. Duration of menopause ranged from 1 to 26 years with mean and median duration of 5.78±5.7 and 4.0 years respectively. Negative for intraepithelial lesion or malignancy (NILM and epithelial cell abnormalities (ECA were 86(85.1% and 15(14.9% cases respectively. ECA were most commonly seen in the 60-69 years’ age group, 7(46.7% cases. Overall prevalence of cervical dysplasia was 9(8.9%, with highest prevalence in the 60-69 age group, 5(27.7%; and carcinoma was 3(2.9% with highest in the 60-69 age group, 2(11.1% cases. Vaginal discharge was the commonest urogenital symptom, 40 (39.8% cases. Reactive cellular changes (RCC was the commonest finding in vaginal discharge, 24(60% cases. Maximum cases of ECA, 12(44.4% cases, were associated with postmenopausal bleeding (PMB. Mean age in dysplasia and malignancy (58.6±7.3 years was significantly higher (P54 years (P5 years (P<0.011. CONCLUSION Pap smear examination in symptomatic postmenopausal women will definitely

  14. 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.

  15. 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

  16. 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.

    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,

  17. 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

  18. 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…

  19. Cow-calf reproductive, genetic, and nutritional management to improve the sustainability of whole beef production systems.

    Science.gov (United States)

    White, R R; Brady, M; Capper, J L; McNamara, J P; Johnson, K A

    2015-06-01

    Optimizing efficiency in the cow-calf sector is an important step toward improving beef sustainability. The objective of the study was to use a model to identify the relative roles of reproductive, genetic, and nutritional management in minimizing beef production systems' environmental impact in an economically viable, socially acceptable manner. An economic and environmental diet optimizer was used to identify ideal nutritional management of beef production systems varying in genetic and reproductive technology use. Eight management scenarios were compared to a least cost baseline: average U.S. production practices (CON), CON with variable nutritional management (NUT), twinning cattle (TWN), early weaning (EW), sire selection by EPD using either on-farm bulls (EPD-B) or AI (EPD-AI), decreasing the calving window (CW), or selecting bulls by EPD and reducing the calving window (EPD-CW). Diets to minimize land use, water use, and/or greenhouse gas (GHG) emissions were optimized under each scenario. Increases in diet cost attributable to reducing environmental impact were constrained to less than stakeholder willingness to pay for improved efficiency and reduced environmental impact. Baseline land use, water use, and GHG emissions were 188 m, 712 L, and 21.9 kg/kg HCW beef. The NUT scenario, which assessed opportunities to improve sustainability by altering nutritional management alone, resulted in a simultaneous 1.5% reduction in land use, water use, and GHG emissions. The CW scenario improved calf uniformity and simultaneously decreased land use, water use, and GHG emissions by 3.2%. Twinning resulted in a 9.2% reduction in the 3 environmental impact metrics. The EW scenario allowed for an 8.5% reduction in the 3 metrics. The EPD-AI scenario resulted in an 11.1% reduction, which was comparable to the 11.3% reduction achieved by EPD-B in the 3 metrics. Improving genetic selection by using AI or by purchasing on-farm bulls based on their superior EPD demonstrated

  20. Sustained improvement in clinical preventive service delivery among independent primary care practices after implementing electronic health record systems.

    Science.gov (United States)

    Wang, Jason J; Sebek, Kimberly M; McCullough, Colleen M; Amirfar, Sam J; Parsons, Amanda S; Singer, Jesse; Shih, Sarah C

    2013-08-01

    Studies showing sustained improvements in the delivery of clinical preventive services are limited. Fewer studies demonstrate sustained improvements among independent practices that are not affiliated with hospitals or integrated health systems. This study examines the continued improvement in clinical quality measures for a group of independent primary care practices using electronic health records (EHRs) and receiving technical support from a local public health agency. We analyzed clinical quality measure performance data from a cohort of primary care practices that implemented an EHR at least 3 months before October 2009, the study baseline. We assessed trends for 4 key quality measures: antithrombotic therapy, blood pressure control, smoking cessation intervention, and hemoglobin A1c (HbA1c) testing based on monthly summary data transmitted by the practices. Of the 151 practices, 140 were small practices and 11 were community health centers; average time using an EHR was 13.7 months at baseline. From October 2009 through October 2011, average rates increased for antithrombotic therapy (from 58.4% to 74.8%), blood pressure control (from 55.3% to 64.1%), HbA1c testing (from 46.4% to 57.7%), and smoking cessation intervention (from 29.3% to 46.2%). All improvements were significant. During 2 years, practices showed significant improvement in the delivery of several key clinical preventive services after implementing EHRs and receiving support services from a public health agency.

  1. 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 ...

  2. 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

  3. The impact of healthcare on the environment: improving sustainability in the health service.

    Science.gov (United States)

    Fitzpatrick, Jane

    As the largest employer in the UK, the NHS has a duty to contribute to sustainability in the UK and minimise the impact of healthcare provision on the environment. Nurses also have a responsibility to ensure their practice makes the best use of resources. This article discusses initiatives aimed at supporting organisations and individuals in reducing the negative impact of healthcare on the environment and on human health and wellbeing.

  4. Analysing the sustainability performance and critical improvement factors of urban municipal waste systems - Case study Trondheim

    OpenAIRE

    Unander, Silje Madalena Oliveira

    2017-01-01

    The management of the natural output of consumption, waste, has to become more sustainable. Ideally this would mean that it simply ceased to exist, but as unrealistic that may be, the current discourse in waste legislation and management is on increasing the material recycling rate. This is a part of the circular economy. Analysing waste management systems is crucial to know what effect different measures might have on the actual recycling rate. In turn, these measures might impact the energ...

  5. 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

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

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

    Science.gov (United States)

    Refaat, Ahmed; Sokar, Magda; Ismail, Fatma; Boraei, Nabila

    2016-12-01

    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.

  12. 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.

  13. 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.

  14. 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.

  15. 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

    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...

  16. Improvement of the Sustainability of Existing School Buildings According to the Leadership in Energy and Environmental Design (LEED)? Protocol: A Case Study in Italy

    National Research Council Canada - National Science Library

    Giuliano Dall'O'; Elisa Bruni; Angela Panza

    2013-01-01

      School-age students spend much of their time in school buildings. The sustainability of these buildings should be a priority as better comfort with a high indoor air quality contributes to an improvement in the conditions for learning...

  17. 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...

  18. 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

  19. 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

  20. Perspective: Improving Nutritional Guidelines for Sustainable Health Policies: Current Status and Perspectives.

    Science.gov (United States)

    Magni, Paolo; Bier, Dennis M; Pecorelli, Sergio; Agostoni, Carlo; Astrup, Arne; Brighenti, Furio; Cook, Robert; Folco, Emanuela; Fontana, Luigi; Gibson, Robert A; Guerra, Ranieri; Guyatt, Gordon H; Ioannidis, John Pa; Jackson, Ann S; Klurfeld, David M; Makrides, Maria; Mathioudakis, Basil; Monaco, Alessandro; Patel, Chirag J; Racagni, Giorgio; Schünemann, Holger J; Shamir, Raanan; Zmora, Niv; Peracino, Andrea

    2017-07-01

    A large body of evidence supports the notion that incorrect or insufficient nutrition contributes to disease development. A pivotal goal is thus to understand what exactly is appropriate and what is inappropriate in food ingestion and the consequent nutritional status and health. The effective application of these concepts requires the translation of scientific information into practical approaches that have a tangible and measurable impact at both individual and population levels. The agenda for the future is expected to support available methodology in nutrition research to personalize guideline recommendations, properly grading the quality of the available evidence, promoting adherence to the well-established evidence hierarchy in nutrition, and enhancing strategies for appropriate vetting and transparent reporting that will solidify the recommendations for health promotion. The final goal is to build 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 biomarkers, food quality and intake frequency, lifestyle variables such as physical activity, and environmental variables including one's microbiome profile. There is a strong and urgent need to develop a successful commitment among all the stakeholders to define novel and sustainable approaches toward the management of the health value of nutrition at individual and population levels. Moving forward requires adherence to well-established principles of evidence evaluation as well as identification of effective tools to obtain better quality evidence. Much remains to be done in the near future. © 2017 American Society for Nutrition.

  1. Metacognitive Training in Professional Development Can Improve and Sustain Student Achievement

    CERN Document Server

    Phillips, Jeffrey A; Clemmer, Katharine W

    2016-01-01

    Secondary school students in the United States continue to underachieve in mathematics and science. Improving teacher quality is a core component of improving student achievement. Here we report on a professional development program, the MAST System, that develops the knowledge and skills for teaching mathematics, including metacognitive knowledge and regulation. In this cognitive apprenticeship program, teachers learn to plan, evaluate and adjust to improve student engagement and achievement. Central is the metacognitive practice of defense of instruction. By practicing this reflective approach, teachers become adaptive experts, able to innovate in the classroom. During the two-year intervention, the MAST System resulted in large increases in the California Standards Test mathematics scores, compared to both the district and the state. In addition, improvement continued for several years after the intervention was completed. This continued improvement in student scores indicated that the teachers and schools...

  2. Therapeutic strategies in symptomatic portal biliopathy

    National Research Council Canada - National Science Library

    Vibert, Eric; Azoulay, Daniel; Aloia, Thomas; Pascal, Gérard; Veilhan, Luc-Antoine; Adam, René; Samuel, Didier; Castaing, Denis

    2007-01-01

    Chronic portal obstruction can lead to formation of portal cavernoma (PC). Half of all patients with PC will develop cholestasis, termed portal biliopathy, and some will progress to symptomatic biliary obstruction...

  3. [Tarlov cyst and symptomatic bladder disfuction].

    Science.gov (United States)

    Ruibal Moldes, M; Sánchez Rodríguez-Losada, J; López García, D; Casas Agudo, V; Janeiro País, J M; González Martín, M

    2008-01-01

    Tarlov cysts or perineural cyst are lesions of the nerve roots located at the sacral level and uncertain aetiology. Most of these cysts remain asymptomatic with no clinical relevance. The symptomatic cysts are uncommon and the usual symptoms are pain or radiculopathy. We report the case of a 53-year-old woman witha symptomatic cyst (with a history of frequency and urgency syndrom), that disappears after surgery.

  4. Improving and sustaining quality of child health care through IMCI training and supervision: experience from rural Bangladesh.

    Science.gov (United States)

    Hoque, D M Emdadul; Arifeen, Shams E; Rahman, Muntasirur; Chowdhury, Enayet K; Haque, Twaha M; Begum, Khadija; Hossain, M Altaf; Akter, Tasnima; Haque, Fazlul; Anwar, Tariq; Billah, Sk Masum; Rahman, Ahmed Ehsanur; Huque, Md Hamidul; Christou, Aliki; Baqui, Abdullah H; Bryce, Jennifer; Black, Robert E

    2014-09-01

    The Integrated Management of Childhood Illness (IMCI) strategy includes guidelines for the management of sick children at first-level facilities. These guidelines intend to improve quality of care by ensuring a complete assessment of the child's health and by providing algorithms that combine presenting symptoms into a set of illness classifications for management by IMCI-trained service providers at first-level facilities. To investigate the sustainability of improvements in under-five case management by two cadres of first-level government service providers with different levels of pre-service training following implementation of IMCI training and supportive supervision. Twenty first-level health facilities in the rural sub-district of Matlab in Bangladesh were randomly assigned to IMCI intervention or comparison groups. Health workers in IMCI facilities received training in case management and monthly supportive supervision that involved observations of case management and reinforcement of skills by trained physicians. Health workers in comparison facilities were supervised according to Government of Bangladesh standards. Health facility surveys involving observations of case management were carried out at baseline (2000) and at two points (2003 and 2005) after implementation of IMCI in intervention facilities. Improvement in the management of sick under-five children by IMCI trained service providers with only 18 months of pre-service training was equivalent to that of service providers with 4 years of pre-service training. The improvements in quality of care were sustained over a 2-year period across both cadres of providers in intervention facilities. IMCI training coupled with regular supervision can sustain improvements in the quality of child health care in first-level health facilities, even among workers with minimal pre-service training. These findings can guide government policy makers and provide further evidence to support the scale-up of regular

  5. 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

  6. 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.

  7. 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.

  8. 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.

  9. 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

  10. Molecular Farming in Artemisia annua, a sustainable approach to improve anti-malarial drug production

    Directory of Open Access Journals (Sweden)

    Giuseppe ePulice

    2016-03-01

    Full Text Available Malaria is a parasite infection affecting millions of people worldwide. Even though progresses in prevention and treatment have been developed, 198 million cases of malaria occurred in 2013, resulting in 584000 estimated deaths. 90% of all malaria deaths occurred in Africa, mostly among children under the age of five. This article aims to review malaria’s history, epidemiology and current treatments, with a particular focus on the potential of molecular farming that use metabolic engineering in plants as effective anti-malarial solution. Malaria indeed represents an example of how a health problem on one hand, may eventually influence the proper development of a country due to the burden of the disease, and on the other hand, constitutes an opportunity for lucrative business of diverse stakeholders. In contrast, plant biofarming is here proposed as a sustainable alternative for the production not only of natural herbal repellents used for malaria prevention but also for the production of sustainable anti-malarial drugs like artemisinin used for primary parasite infection treatments.Artemisinin, a sesquiterpene lactone, is a natural anti-malarial compound that can be found in Artemisia annua plant. However, the low concentration of artemisinin in plant makes this molecule relatively expensive and difficult to meet the worldwide demand of Artemisinin Combination Therapies, especially for economically disadvantaged people in developing countries. The biosynthetic pathway of artemisinin, a process that only takes place in glandular secretory trichomes of A. annua, is relatively well elucidated, and significant efforts using plant genetic engineering have been made to increase the production of this compound. These include studies on diverse transcription factors, which all have been shown to regulate artemisinin genetic pathway and other biological processes. Therefore, genetic manipulation of these genes may be used as a cost-effective potential

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

    Science.gov (United States)

    Barker, Mary; Baird, Janis; Tinati, Tannaze; Vogel, Christina; Strömmer, Sofia; Rose, Taylor; Begum, Rufia; Jarman, Megan; Davies, Jenny; Thompson, Sue; Taylor, Liz; Inskip, Hazel; Cooper, Cyrus; Nutbeam, Don; Lawrence, Wendy

    2017-01-01

    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. PMID:28335519

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. Assess and improve the sustainability of water treatment facility using Computational Fluid Dynamics

    Science.gov (United States)

    Zhang, Jie; Tejada-Martinez, Andres; Lei, Hongxia; Zhang, Qiong

    2016-11-01

    Fluids problems in water treatment industry are often simplified or omitted since the focus is usually on chemical process only. However hydraulics also plays an important role in determining effluent water quality. Recent studies have demonstrated that computational fluid dynamics (CFD) has the ability to simulate the physical and chemical processes in reactive flows in water treatment facilities, such as in chlorine and ozone disinfection tanks. This study presents the results from CFD simulations of reactive flow in an existing full-scale ozone disinfection tank and in potential designs. Through analysis of the simulation results, we found that baffling factor and CT10 are not optimal indicators of disinfection performance. We also found that the relationship between effluent CT (the product of disinfectant concentration and contact time) obtained from CT transport simulation and baffling factor depends on the location of ozone release. In addition, we analyzed the environmental and economic impacts of ozone disinfection tank designs and developed a composite indicator to quantify the sustainability of ozone disinfection tank in technological, environmental and economic dimensions.

  18. GenPhilly: a strategy for improving the sustainability of aging in community initiatives.

    Science.gov (United States)

    Clark, Kate

    2014-01-01

    GenPhilly is an innovative, replicable model that was developed in Philadelphia, Pennsylvania, to inspire and engage emerging leaders from a variety of disciplines to promote and sustain an aging-in-community agenda. Administrative support is provided by the Area Agency on Aging, Philadelphia Corporation for Aging, yet it was designed by its members to be peer-led. In this way, young professionals in their 20s and 30s can capitalize on popular culture to create unique professional development opportunities and get younger generations thinking about the type of city in which they themselves want to get older. The group has benefited the field of aging by building awareness of aging services in the wider community; facilitating cross-disciplinary learning and innovation around aging issues; stressing the competitive advantage for emerging leaders from all fields to know about aging issues; strengthening the aging network workforce; breaking down stereotypes about working with older adults; and introducing expertise from outside the aging network to benefit older adults. Encouraging the development of similar groups will not only benefit the field of aging, it will assist the next generation of leaders in many fields to plan better for their communities and for themselves.

  19. Ropinirole in the symptomatic treatment of Parkinson's disease.

    Science.gov (United States)

    Brooks, D J; Torjanski, N; Burn, D J

    1995-01-01

    Ropinirole is a novel, non-ergoline dopamine agonist chemical name with a very high specificity for dopamine D2-like receptors, currently being investigated for the symptomatic treatment of Parkinson's disease. The efficacy of ropinirole has been investigated in three placebo-controlled studies: one using ropinirole as monotherapy in early Parkinson's disease and two using it as an adjunct to L-dopa in patients who are experiencing fluctuations in motor response. Ropinirole therapy for 12 weeks was an effective symptomatic therapy in both patient groups, as measured by either a significant improvement in the motor score of the UPDRS, reduction of awake time spent "off" or a reduction in the dose of L-dopa. Ropinirole therapy was generally well tolerated, the most frequent adverse events being nausea and vomiting which are typical of all dopamine agonists, but unlike other dopamine agonists, CNS side-effects were of the same magnitude as found patients receiving placebo.

  20. 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.

  1. Professional Learning through P-16 Partnership Design: Emergent Lessons Learned toward Improving and Sustaining Partnership Development

    Science.gov (United States)

    Easley, Jacob, II; Ankrum, Julie; McConnell, Bethany; Girard, Nina

    2017-01-01

    The purpose of this paper is to explore the processes and features of one P-16 partnership developed to improve the clinical experience of teacher preparation. The development of partnerships reflects a commitment among institutions to collaborate in a purposeful manner with a keen awareness that each partner must seek to better understand and…

  2. Sustained Self-Regulation of Energy Intake: Initial Hunger Improves Insulin Sensitivity

    Directory of Open Access Journals (Sweden)

    Mario Ciampolini

    2010-01-01

    Results. In trained subjects, significant decreases were found in insulin sensitivity index, insulin and BG peaks, glycated haemoglobin, mean pre-meal BG, standard deviation of diary BG (BG as recorded by subjects' 7-day diary, energy intake, BMI, and body weight when compared to control subjects. Conclusion. The IHMP improved insulin sensitivity and other cardiovascular risk factors over a 5-month period.

  3. Editorial: Novel approaches for improving safety, health benefits and sustainability of grain based foods

    NARCIS (Netherlands)

    Abecassis, J.; Kamp, J.W. van der

    2016-01-01

    Improving the safety of food products and enhancing beneficial health effects is a necessity and a major challenge. In addition to well established practices, often laid down in ISO based systems and procedures for guaranteeing safety and a constant product quality, new approaches are explored in a

  4. Improving Oasis Beach: Creating a sustainable and attractive beach around hotel Oasis in Varadero Cuba

    NARCIS (Netherlands)

    Vrolijk, E.F.; Poelhekke, L.; Schlepers, M.H.; De Boer, G.G.

    2014-01-01

    In the North of Cuba, the Oasis beach area is situated. The beach suffers from structural erosion and earlier measures to deal with this have not succeeded. In this project, a solution is offered to reach two goals: foremost, a beach improvement to the Oasis beach sector and second, a halt to the

  5. 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

  6. 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.

  7. 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.

  8. 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.

  9. Improving sustained drug delivery from ophthalmic lens materials through the control of temperature and time of loading.

    Science.gov (United States)

    Topete, Ana; Oliveira, Andreia S; Fernandes, A; Nunes, T G; Serro, A P; Saramago, B

    2018-02-14

    Although the possibility of using drug-loaded ophthalmic lens to promote sustained drug release has been thoroughly pursued, there are still problems to be solved associated to the different alternatives. In this work, we went back to the traditional method of drug loading by soaking in the drug solution and tried to optimize the release profiles by changing the temperature and the time of loading. Two materials commercially available under the names of CI26Y and Definitive 50 were chosen. CI26Y is used for intraocular lenses (IOLs) and Definitive 50 for soft contact lenses (SCLs). Three drugs were tested: an antibiotic, moxifloxacin, and two anti-inflammatories, diclofenac and ketorolac. Sustained drug release from CI26Y disks for, at least 15 days, was obtained for moxifloxacin and diclofenac increasing the loading temperature up to 60 °C or extending the loading time till two months. The sustained release of ketorolac was limited to about 8 days. In contrast, drug release from Definitive 50 disks could not be improved by changing the loading conditions. An attempt to interpret the impact of the loading conditions on the drug release behavior was done using solid-state NMR and differential scanning calorimetry. These studies suggested the establishment of reversible, endothermic interactions between CI26Y and the drugs, moxifloxacin and diclofenac. The loading temperature had a slight effect on the mechanical and optical properties of drug loaded CI26Y samples, which still kept adequate properties to be used as IOL materials. The in vivo efficacy of CI26Y samples, drug loaded at 60 °C for two weeks, was predicted using a simplified mathematical model to estimate the drug concentration in the aqueous humor. The estimated concentrations were found to comply with the therapeutic needs, at least, for moxifloxacin and diclofenac. Copyright © 2018 Elsevier B.V. All rights reserved.

  10. Management of Symptomatic Tarlov Cysts: A Retrospective Observational Study.

    Science.gov (United States)

    Jiang, Wei; Hu, Zhenming; Hao, Jie

    2017-07-01

    Symptomatic Tarlov cysts are a common cause of chronic pain. Many methods have been reported to treat this disease, with variable results. Most previous reports concerning the treatment methods of symptomatic Tarlov cysts were either sporadic case reports or series of limited cases. This study aimed to further optimize the management for patients with symptomatic Tarlov cysts (TCs) by analyzing the results of 82 patients who were treated with different strategies. Three different strategies were applied to 82 patients with symptomatic TCs and their clinical effects were evaluated in 13 months to 12 years follow-up. A pain management practice, a medical center, major metropolitan city, China. From June 2003 to August 2015, a total number of 82 patients with symptomatic TCs were treated with 3 different methods (microsurgical cyst fenestration and imbrication, C-arm fluoroscopy guided percutaneous fibrin gel injection, and conservative management) in the first affiliated hospital of Chongqing Medical University. The pain severity was assessed according to visual analog scale (VAS), and imaging changes were evaluated by magnetic resonance imaging (MRI). Patient improvements in pain and neurologic function were evaluated during a follow-up the period of 13 months to 12 years. All the patients who underwent microsurgical cyst fenestration and imbrication had either complete (7 patients, 50%) or substantial (7 patients, 50%) resolution of their preoperative symptoms and neurological deficits. However, 3 patients (21%) had cerebrospinal fluid (CSF) leakage and 3 patients (21%) suffered from recurrent symptoms. In C-arm fluoroscopy guided percutaneous fibrin gel injection group, 34 patients (61%) had complete resolution and 22 patients had (39%) substantial resolution, and no CSF leakage or recurrence occurred. Only 3 patients (25%) got substantial resolution in the conservative management group, but 9 patients (75%) had aggravation. An observational study with a

  11. 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.

  12. Sustainable urban water supply in south India: Desalination, efficiency improvement, or rainwater harvesting?

    Science.gov (United States)

    Srinivasan, Veena; Gorelick, Steven M.; Goulder, Lawrence

    2010-10-01

    Indian megacities face severe water supply problems owing to factors ranging from growing population to high municipal pipe leakage rates; no Indian city provides 24/7 water supply. Current approaches to addressing the problem have been "utility centric," overlooking the significance of decentralized activities by consumers, groundwater extraction via private wells, and aquifer recharge by rainwater harvesting. We propose a framework that makes it possible to evaluate a wider range of centralized and decentralized policies than previously considered. The framework was used to simulate water supply and demand in a simulation model of Chennai, India. Three very different policies, supply augmentation, efficiency improvement, and rainwater harvesting, were evaluated using the model. The model results showed that none of the three policies perfectly satisfied our criteria of efficiency, reliability, equity, financial viability, and revenue generation. Instead, a combination of rainwater harvesting and efficiency improvement best meets these criteria.

  13. Sustained delivery of nicotinamide limits cortical injury and improves functional recovery following traumatic brain injury

    OpenAIRE

    Goffus, Andrea M.; Anderson, Gail D; Hoane, Michael R.

    2010-01-01

    Previously, we have demonstrated that nicotinamide (NAM), a neuroprotective soluble B-group vitamin, improves recovery of function following traumatic brain injury (TBI). However, no prior studies have examined whether NAM is beneficial following continuous infusions over 7 days post-TBI. The purpose of this study was to investigate the preclinical efficacy of NAM treatment as it might be delivered clinically; over several days by slow infusion. Rats were prepared with either unilateral contr...

  14. Sustained Delivery of Nicotinamide Limits Cortical Injury and Improves Functional Recovery Following Traumatic Brain Injury

    OpenAIRE

    Goffus, Andrea M.; Anderson, Gail D; Hoane, Michael R.

    2010-01-01

    Previously, we have demonstrated that nicotinamide (NAM), a neuroprotective soluble B-group vitamin, improves recovery of function following traumatic brain injury (TBI). However, no prior studies have examined whether NAM is beneficial following continuous infusions over 7 days post-TBI. The purpose of this study was to investigate the preclinical efficacy of NAM treatment as it might be delivered clinically; over several days by slow infusion. Rats were prepared with either unilateral contr...

  15. Sustained-release microspheres of amifostine for improved radio-protection, patient compliance, and reduced side effects.

    Science.gov (United States)

    Wu, Hong-Yu; Hu, Zhen-Hua; Jin, Tuo

    2016-11-01

    A biweekly administration of sustained-release microsphere dosage form of amifostine, a radioprotective drug used in radiotherapy, was performed to examine the feasibility to minimize injection frequency and blood concentration-associated side effects. Model animal trials indicated that this subcutaneously injecting microspheres, 50-100 μm in diameter, achieved bi-weekly prolonged radio-protective efficacy and, at the same time, significantly reduced skin irritation than the solution form of amifostine given by the same administration route. In addition, the hypertension associated with blood concentration of amifostine was not observed in the drug-treated rats. The animals given the amifostine microspheres and amifostine showed significantly differences in white blood cell, red blood cell, hematocrit, hemoglobin and spleen tissue histopathology after exposed under a cobalt-60 γ-radiation at a dose rate of 1.0 Gy/min for 6 min. The in vitro release profile of amifostine from the micropsheres showed a minor initial burst (less than 20% of total drug loading in the first day of administration), consisting with the side effects observations. The results suggest that amifostine encapsulated in sustained-release microspheres may be an ideal dosage form for prolonged radio-protective efficacy and improved patient compliance.

  16. 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.

  17. Designing an optimum model for protection and improvement of sustainability of natural resources and environment in Iran.

    Science.gov (United States)

    Dinpanah, Gholamreza; Lashgarara, Farhad

    2008-10-01

    More than 100 million hectares of land in Iran is unsustainable, based on available data. Human activity is the most important reason for the destruction of natural resources and ecological unsustainability. These activities lead to negative consequences, including the destruction of plant coverage (43%), misuse of the ecological potential of water and soil resources (23%), lack of balance between livestock and range (22%), and lack of enforcement of erosion and pollution controls (12%). Achievement of sustainable natural resources and environment is not feasible unless numerous factors that influence these processes are considered. To do this we must seek an optimized model that pays attention to these factors. On the other hand, the components of this model include (1) the culture and values of the community, (2) programs and policies, (3) the research system, (4) the extension system, (5) the farmers' organization, and (6) the indigenous knowledge of the community. The methodology of this article is descriptive-analytical, and its main purpose is designing an optimum model for the protection and improvement of sustainability of the natural resources and the environment in Iran.

  18. 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.

  19. 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.

  20. 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

  1. 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.

  2. Sustaining and improving an international service-learning partnership: Evaluation of an evidence-based service delivery model.

    Science.gov (United States)

    Hayward, Lorna M; Li, Li

    2017-06-01

    International service learning (ISL) is an instructional method used by physical therapist educators in the United States (US) to prepare students for rendering culturally competent care. ISL is a faculty led student learning opportunity that includes academic instruction and community service in an international context. Research exists that explores student experiences with ISL, but studies that evaluate ISL partnerships and include global stakeholder feedback are lacking. The purposes of this study were to: 1) integrate a partnership evaluation component into an existing curriculum-based ISL model and 2) through evaluation identify benefits, drawbacks, and suggestions for improving and sustaining the academic-community partnership. Community-based participatory research design using a mixed methods approach was used to evaluate a ISL partnership between a US-based physical therapy program and a service site in Ecuador. Participants were 31 staff working at the global service site. Over three years, 11 interviews were conducted and 26 surveys were administered to global partner staff. Data were analyzed using qualitative thematic content analysis and descriptive statistics. Partnership benefits included the following: continuity of ISL team leadership, targeted rehabilitative efforts, sensitivity to cultural norms, respectful communication, and interaction with local community. Drawbacks were as follows: deficits in cultural awareness, language barriers, and poor treatment carryover. Suggestions for sustaining the relationship incorporated: additional pre-trip communication, education of staff, and improved language skills. As more US teams deliver clinical services abroad, intentional evaluation approaches must include the global stakeholder in the planning, implementation, and evaluation phases to maximize partnerships benefits.

  3. Agricultural sustainable intensification improved nitrogen use efficiency and maintained high crop yield during 1980-2014 in Northern China.

    Science.gov (United States)

    Zhang, Xin; Bol, Roland; Rahn, Clive; Xiao, Guangmin; Meng, Fanqiao; Wu, Wenliang

    2017-10-15

    Global population increase will require rapid increase of food production from existing agricultural land by 2050, which will inevitably mean the increase of agricultural productivity. Due to agricultural sustainable intensification since the 1990s, crop production in Huantai County of northern China has risen to 15tha-1yr-1 for the annual wheat-maize rotation system. We examined the temporal dynamics of nitrogen (N) budget, N losses, and N use efficiency (NUE) during the 35years (1980-2014) in Huantai. The results revealed that atmospheric N deposition increased 220% while reactive N losses decreased by 21.5% from 1980s to 2010s. During 1980-2002, annual N partial factor productivity (PFPN), apparent NUE and N recovery efficiency (REN) increased from 20.3 to 40.7kggrainkg-1Nfert, from 36.5% to 71.0%, and from 32.4% to 57.7%, respectively; meanwhile, reactive N losses intensity, land use intensity and N use intensity decreased by 69.8%, 53.4%, 50.0%, respectively, but without further significant changes after 2002. Overall increases in NUE and decreases in N losses were largely due to the introduction of optimized fertilization practice, mechanization and increased incorporation of crop straw in Huantai. Straw incorporation was also significant in soil N stock accrual and fertility improvement. By 2030, northern China may reach the lowest end of PFPN values in developed countries (>45kggrainkg-1Nfert). These agricultural sustainable intensification practices will be critical in maintaining high grain yields and associated decreases in environmental pollution, although water use efficiency in the region still needs to be improved. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Improving energy and material flows: a contribution to sustainability in megacities

    Energy Technology Data Exchange (ETDEWEB)

    Mejia Dugand, Santiago; Hjelm, Olof; Baas, Leenard (Div. of Environmental Technology and Management, Dept. of Management and Engineering, Linkoepings Universitet, Linkoeping (Sweden)), e-mail: santiago.mejia.dugand@liu.se

    2011-06-15

    As cities have become home for 50% of the world's population, urban systems have definitely caught public attention. The urban metabolism can be improved by transforming their linear behavior into a more circular one. This paper is based on a project initiated by the Div. of Environmental Technology and Management at Linkoeping Univ., financed by Vinnova: Megatech. The aim is to study the megacities of Cairo and Mexico City in order to understand some of the problems they are facing. By improving their energy and material flows behavior, these megacities can benefit from the reduction of their dependence on fossil fuels and virgin materials; the protection of part of their social, economic and productive systems from external factors (e.g. political drawbacks, shortage/distribution problems, international prices); an increased effectiveness of their planning activities-as they would be based to a large extent on their own resources-and the reduction of their environmental burden. An in situ study will take place with the participation of local stakeholders. Information about environmental problems will be collected and potential solutions will be analyzed and suggested. A tentative model is presented, showing how the reinsertion of the outflows into the urban system could benefit these cities. overall environmental performance

  5. Sustained benefits of a community dietetics intervention designed to improve oral nutritional supplement prescribing practices.

    Science.gov (United States)

    Kennelly, S; Kennedy, N P; Corish, C A; Flanagan-Rughoobur, G; Glennon-Slattery, C; Sugrue, S

    2011-10-01

    Healthcare professionals working in the community do not always prescribe oral nutritional supplements (ONS) according to best practice guidelines for the management of malnutrition. The present study aimed to determine the impact of a community dietetics intervention on ONS prescribing practices and expenditure 1 year later. The intervention involved general practitioners (GPs), practice nurses, nurses in local nursing homes and community nurses. It comprised an education programme together with the provision of a new community dietetics service. Changes in health care professionals' nutrition care practices were determined by examining community dietetics records. ONS prescribing volume and expenditure on ONS were assessed using data from the Primary Care Reimbursement Service of the Irish Health Service Executive. Seven out of 10 principal GPs participated in the nutrition education programme. One year later, screening for malnutrition risk was better, dietary advice was provided more often, referral to the community dietetics service improved and ONS were prescribed for a greater proportion of patients at 'high risk' of malnutrition than before (88% versus 37%; P dietetics intervention improved ONS prescribing practices by GPs and nurses, in accordance with best practice guidelines, without increasing expenditure on ONS during the year after intervention. © 2011 The Authors. Journal of Human Nutrition and Dietetics © 2011 The British Dietetic Association Ltd.

  6. 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.

  7. 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.

  8. 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.

  9. Sustained delivery of nicotinamide limits cortical injury and improves functional recovery following traumatic brain injury.

    Science.gov (United States)

    Goffus, Andrea M; Anderson, Gail D; Hoane, Michael

    2010-01-01

    Previously, we have demonstrated that nicotinamide (NAM), a neuroprotective soluble B-group vitamin, improves recovery of function following traumatic brain injury (TBI). However, no prior studies have examined whether NAM is beneficial following continuous infusions over 7 days post-TBI. The purpose of this study was to investigate the preclinical efficacy of NAM treatment as it might be delivered clinically; over several days by slow infusion. Rats were prepared with either unilateral controlled cortical impact (CCI) injuries or sham procedures and divided into three groups: CCI-NAM, CCI-vehicle, and sham. Thirty minutes following CCI, Alzet osmotic mini-pumps were implanted subcutaneously. NAM was delivered at a rate of 50 mg/kg/day for 7 days immediately post-CCI. On day 7 following injury, the pumps were removed and blood draws were collected for serum NAM and nicotinamide adenine dinucleotide (NAD+) analyses. Starting on day 2 post-CCI, animals were tested on a battery of sensorimotor tests (bilateral tactile adhesive removal, locomotor placing, and limb-use asymmetry). Continuous infusion of NAM resulted in a significant serum elevation in NAM, but not NAD+. Statistical analyses of the tactile removal and locomotor placing data revealed that continuous administration of NAM significantly reduced the initial magnitude of the injury deficit and improved overall recovery compared to the vehicle-treated animals. NAM treatment also significantly decreased limb-use asymmetries compared to vehicle-treated animals. The overall extent of the cortical damage was also reduced by NAM treatment. No detrimental effects were seen following continuous infusion. The present results suggest that NAM delivered via a clinically relevant therapeutic regimen may truncate behavioral damage following TBI. Thus our results offer strong support for translation into the clinical population.

  10. Sustained Delivery of Nicotinamide Limits Cortical Injury and Improves Functional Recovery Following Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    Andrea M. Goffus

    2010-01-01

    Full Text Available Previously, we have demonstrated that nicotinamide (NAM, a neuroprotective soluble B-group vitamin, improves recovery of function following traumatic brain injury (TBI. However, no prior studies have examined whether NAM is beneficial following continuous infusions over 7 days post-TBI. The purpose of this study was to investigate the preclinical efficacy of NAM treatment as it might be delivered clinically; over several days by slow infusion. Rats were prepared with either unilateral controlled cortical impact (CCI injuries or sham procedures and divided into three groups: CCI-NAM, CCI-vehicle and sham. Thirty minutes following CCI, Alzet osmotic mini-pumps were implanted subcutaneously. NAM was delivered at a rate of 50 mg/kg/day for 7 days immediately post-CCI. On day 7 following injury, the pumps were removed and blood draws were collected for serum NAM and nicotinamide adenine dinucleotide (NAD+ analyses. Starting on day 2 post-CCI, animals were tested on a battery of sensorimotor tests (bilateral tactile adhesive removal, locomotor placing and limb-use asymmetry. Continuous infusion of NAM resulted in a significant serum elevation in NAM, but not NAD+. Statistical analyses of the tactile removal and locomotor placing data revealed that continuous administration of NAM significantly reduced the initial magnitude of the injury deficit and improved overall recovery compared to the vehicle-treated animals. NAM treatment also significantly decreased limb-use asymmetries compared to vehicle-treated animals. The overall extent of the cortical damage was also reduced by NAM treatment. No detrimental effects were seen following continuous infusion. The present results suggest that NAM delivered via a clinically relevant therapeutic regimen may truncate behavioral damage following TBI. Thus our results offer strong support for translation into the clinical population.

  11. 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.

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

    NARCIS (Netherlands)

    Stougie, L.; van der Kooi, H.J.

    2016-01-01

    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

  13. Soil ecology and agricultural technology; An integrated approach towards improved soil management for sustainable farming

    Science.gov (United States)

    Pulleman, Mirjam; Pérès, Guénola; Crittenden, Stephen; Heddadj, Djilali; Sukkel, Wijnand

    2014-05-01

    Intensive arable food production systems are in need of smart solutions that combine ecological knowledge and farm technology to maximize yields while protecting natural resources. The huge diversity of soil organisms and their interactions is of crucial importance for soil functions and ecosystem services, such as organic matter incorporation and break down, nutrient mineralization, soil structure formation, water regulation and disease and pest control. Soil management decisions that take into account the soil biodiversity and associated functions are thus essential to (i) maintain soil productivity in the long term, (ii) reduce the dependency on external inputs and non-renewables such as fossil fuels, and (iii) make agroecosystems more resilient against biotic and abiotic stresses. Organic farming systems and reduced tillage systems are two approaches that aim to increase soil biodiversity and general soil quality, through improved management of organic matter but differ in their emphasis on the use of chemical inputs for crop protection or soil disturbance, respectively. In North-western Europe experience with and knowledge of reduced tillage systems is still scarce, both in conventional and organic farming. Our study targeted both conventional and organic farming and aimed at 1) documenting reduced tillage practices within different agroecological contexts in NW Europe; 2) evaluating the effects of reduced tillage systems on soil biodiversity and soil ecosystem services; 3) increase understanding of agroecological factors that determine trade-offs between different ecosystem services. Earthworm species and nematode taxa were selected as indicator organisms to be studied for their known response to soil management and effects on soil functions. Additionally, soil organic matter, physical soil parameters and processes, and crop yields have been measured across multiple sites. Data have been collected over several cropping seasons in long term field experiments

  14. Poor symptomatic tuberculosis screening practices in a quarter of health centres in Amhara Region, Ethiopia.

    Science.gov (United States)

    Gebregergs, G B; Alemneh, M; Koye, D N; Kassie, Y; Assefa, M; Ayalew, W; Temesgen, C; Klinkenberg, E; Tadesse, T

    2014-12-21

    In 2011, Ethiopia introduced a strategy of symptomatic tuberculosis (TB) screening for patients attending out-patient services to increase identification of presumptive TB. To assess implementation and factors affecting symptomatic TB screening at out-patient departments in health centres in the Amhara Region, Ethiopia. Using a cross-sectional study design, 86 randomly selected public health centres providing DOTS were included in the study. Data were captured by reviewing TB registers and interviewing key informants at out-patient services. Of 86 health centres, 24 (28%) had poor symptomatic TB screening practices, defined as screening therapy was negatively associated. In all health centres combined, 1.6% of out-patient department attendees were identified as having presumptive TB. A quarter of health centres had poor symptomatic TB screening practices in the out-patient services in this study. Strengthening multidisciplinary teams and expanding partner support are recommended to improve TB screening practices at out-patient services in Ethiopia.

  15. Balanced fertigation and improved sustainability of June bearing strawberry cultivated three years in open polytunnel.

    Science.gov (United States)

    Nestb, Rolf; Guéry, Sébastien

    2017-08-18

    Improved precision fertilization by introducing sensors and remote control to secure fruit yield and reduce nutrient leaching in soil culture. We broadcasted before bedding and mulching 50 g m -2 of a multi-mineral fertilizer. Beds had two plant rows 20 cm apart, with plant distance of 25 cm. Experimental design was split plot with three replications and three treatments. Treatments: fertigation in large plots, cultivar in small plots and year. Plant development in the establishing year had no benefit of fertigation in addition to fertilizer given before bedding. When the yield is 3 kg m -2 a nutrient solution of 6 g N m -2 gave highest yield, using 4 g m -2 from two weeks before harvest and during harvest. 'Florence' and 'Sonata' developed well; however, 'Florence' had mildew on fruits in the last cropping year. 'Korona' presented well the first cropping year, but grew small fruits heavily infested by mildew in the last cropping year. Fertilization had effect on fruit yield. It is discussed how a fertilization schedule for the establishment year and cropping years can be adapted to plant development stages. Mildew infestation on fruits was dependent of cultivar and fertilization. Introducing sensors for recording of growth factors and in situ ion-levels of soil water nutrients, proved valuable.

  16. 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.

  17. 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.

  18. 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.

  19. Improvement of sustainability of irrigation in olive by the accurate management of regulated deficit irrigation

    Science.gov (United States)

    Memmi, Houssem; Moreno, Marta M.; Gijón, M. Carmen; Pérez-López, David

    2015-04-01

    Regulated Deficit Irrigation (RDI) is a useful tool to balance the improvement of productivity and water saving. This methodology is based in keeping the maximum yield with deficit irrigation. The key consists in setting water deficit during a non-sensitive phenological period. In olive, this phenological period is pit hardening, although, the accurate delimitation of the end of this period is nowadays under researching. Another interesting point in this methodology is how deep can be the water stress during the non-sensitive period. In this assay, three treatments were used in 2012 and 2013. A control treatment (T0), irrigated following FAO methodology, without water stress during the whole season and two RDI treatments in which water stress was avoided only during stage I and III of fruit growth. During stage II, widely considered as pit hardening, irrigation was ceased until trees reach the stated water stress threshold. Water status was monitored by means of stem water potential (ψs) measurements. When ψs value reached -2 MPa in T1 treatment, trees were irrigated but with a low amount of water with the aim of keeping this water status for the whole stage II. The same methodology was used for T2 treatment, but with a threshold of -3 MPa. Water status was also controlled by leaf conductance measurements. Fruit size and yield were determined at the end of each season. The statistically design was a randomized complete blocks with four repetitions. The irrigation amount in T1 and T2 was 50% and 65% less than T0 at the end of the study. There were no significant differences among treatments in terms of yield in 2012 (year off) and 2013 (year on).

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

    African Journals Online (AJOL)

    The intention of this study is to share the experience of the author in the occurrence, possible causative factors, and treatment of surgically symptomatic prolapsed lumbar and sacral intervertebral discs in females, and to compare this experience in Switzerland, Nigeria, and Jamaica using surgery records for a period of over ...

  1. Prevalence of Cyclospora cayetanensis among symptomatic and ...

    African Journals Online (AJOL)

    Microsporidia, Giardia lamblia and Hymenolepis nana were also detected in the symptomatic group. There was no significant difference as regards age and residency of Cyclospora positive and negative cases in both groups. In asymptomatic group, Cyclospora infected cases were males while in negative cases, 50% were ...

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

    African Journals Online (AJOL)

    lower back pain (lumbago) and sometimes leg pains (radiation pains ... causative factors, and treatment of surgically symptomatic ... The clinical features of the patients were those of lower back pains, radiating pains, impaired sensation, and pareses in the affected lower limb/s. There was, however, one emergency case.

  3. Prevalence of Chlamydia trachomatis infections in symptomatic ...

    African Journals Online (AJOL)

    Prevalence of Chlamydia trachomatis infections in symptomatic women by polymerase chain reaction (PCR) immunofluorescence and Giemsa stain. ... Abstract. Chlamydia trachomatis is a ubiquitous human pathogen that is responsible for the most prevalent bacterial sexually transmitted disease worldwide. Studies show ...

  4. Endovascular treatment of symptomatic intracranial atherosclerotic disease

    Directory of Open Access Journals (Sweden)

    Syed I Hussain

    2011-02-01

    Full Text Available Abstract: Symptomatic intracranial atherosclerotic disease (ICAD is responsible for approximately 10% of all ischemic strokes in the United States. The risk of recurrent stroke may be as high as 35% in patient with critical stenosis greater than 70% in diameter narrowing. Recent advances in medical and endovascular therapy have placed ICAD at the forefront of clinical stroke research to optimize the best medical and endovascular approach to treat this important underlying stroke etiology. Analysis of symptomatic ICAD studies lead to the question that whether angioplasty and or stenting is a safe, suitable and efficacious therapeutic strategy in patients with critical stenoses that are deemed refractory to medical management. Most of the currently available data in support of angioplasty and or stenting in high risk patients with severe symptomatic ICAD is in the form of case series and randomized trial results of endovascular therapy versus medical treatment are awaited. This is a comprehensive review of the state of the art in the endovascular approach with angioplasty and or stenting of symptomatic intracranial atherosclerotic disease.

  5. 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 ...

  6. 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

  7. 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.

  8. Symptomatic Control in End-of-Life Patients

    OpenAIRE

    Mariana Alves; Rita Abril; Isabel Galriça Neto

    2017-01-01

    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 t...

  9. Symptomatic Control in End-of-Life Patients.

    Science.gov (United States)

    Alves, Mariana; Abril, Rita; Neto, Isabel Galriça

    2017-01-31

    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.

  10. Madelung's disease associated with polyneuropathy and symptomatic hypokalemia

    Directory of Open Access Journals (Sweden)

    Hoi-Fong Chan

    2013-05-01

    Full Text Available Madelung's disease (multiple symmetric lipomatosis is a rare disease characterized by abnormal diffuse lipomatosis in proximal upper limbs and neck. Previous reports have shown that this disease is associated with alcoholism, polyneuropathy, mitochondrial disease, and glucose intolerance. Here, we describe a 46-year-old man having Madelung's disease associated with polyneuropathy and symptomatic hypokalemia. He presented with insidious-onset weakness and numbness in lower limbs for 7 years and recent deterioration of symptoms. Proximal weakness improved with potassium supplement. Our observation may extend the phenotype of Madelung's disease to hypokalemic periodic paralysis.

  11. Efficacy of exercise training in symptomatic patients with hypertrophic cardiomyopathy: results of a structured exercise training program in a cardiac rehabilitation center.

    Science.gov (United States)

    Klempfner, Robert; Kamerman, Tamir; Schwammenthal, Ehud; Nahshon, Amira; Hay, Ilan; Goldenberg, Ilan; Dov, Freimark; Arad, Michael

    2015-01-01

    Recent data suggest that exercise training (ET) confers significant symptomatic and functional improvements in patients with diastolic dysfunction, and thus may be beneficial in patients with hypertrophic cardiomyopathy (HCM). However, there are no data regarding the safety or efficacy of ET in HCM patients. A prospective non-randomized intervention design was used. We enrolled 20 patients with symptomatic HCM, significantly limited in everyday activity, into a supervised cardiac rehabilitation exercise program. Patients were 62 ± 13 years old, in New York Heart Association (NYHA) functional class II (35%) or III (65%), had a mean interventricular septum dimension of 17 ± 5 mm and left ventricular ejection fraction (LVEF) of 53 ± 15%. Left ventricular outflow gradient was present at rest in nine patients (mean 51 ± 24 mm Hg) and six patients had an implantable defibrillator. Exercise prescription was based on heart rate reserve (HRR) determined from a symptom-limited graded exercise stress test. Exercise intensity was gradually increased from 50% to 85% of the HRR over the training period. Patients completed an average of 41 ± 8 hours of aerobic ET. No adverse events or sustained ventricular arrhythmias occurred during the training program. Functional capacity, assessed by a graded exercise test, improved from 4.7 ± 2.2 to 7.2 ± 2.8 metabolic equivalents (METs) (p = 0.01). NYHA functional class improved from baseline by ≥ 1 grade in 10 patients (50%) and none experiencing deterioration during follow-up. The present study suggests that patients with HCM who remain symptomatic despite medical therapy may achieve considerable functional improvement through a supervised ET program. © The European Society of Cardiology 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  12. Midterm outcome of radiofrequency thermal ablation for symptomatic uterine myomas.

    Science.gov (United States)

    Ghezzi, Fabio; Cromi, Antonella; Bergamini, Valentino; Scarperi, Stefano; Bolis, Pierfrancesco; Franchi, Massimo

    2007-11-01

    Over the past decade an increasing demand for uterine-sparing treatment to manage symptomatic uterine myomas has become apparent in women's health care. A preliminary report showed that radiofrequency ablation (RFA) of uterine fibroids under laparoscopic guidance was a safe and effective minimally invasive approach with encouraging short-term results. The purpose of this study was to evaluate the midterm outcomes of radiofrequency ablation (RFA) of uterine myomas in terms of durability of symptom control and level of health-related quality of life. Consecutive women with symptomatic uterine myomas, no plans for future pregnancy, and who declined hysterectomy were offered RFA ablation of uterine fibroids under laparoscopic guidance. Only 25 patients who completed at least the one-year follow-up assessment were included in the study group. Follow-up evaluations were scheduled at 1, 3, 6, 9, and 12 months and thereafter annually following the procedure. Improvement in myoma-related symptoms and impact on quality of life were assessed using a validated questionnaire (UFS-QOL). The median number of myomas treated per patient was 1 (range = 1-3). The median baseline volume of the dominant myoma was 76.8 cm3 (range = 14.8-332.8). No intraoperative or postoperative complications occurred. The median follow-up time was 24 months, with nine women completing three years of follow-up. The median reduction in myoma volume was 68.8% and 77.9% at six months and one year, respectively. No further change in fibroid size was observed at two years and three years. One year after the procedure, one woman (4%) underwent hysterectomy for recurrence of fibroid-related symptoms. Quality-of-life measures showed significant and durable improvement compared with baseline. RFA of symptomatic fibroids seems a valuable alternative to major surgery, with durable symptom relief for most patients and a low chance of recurrence at midterm.

  13. 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

    2017-11-24

    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.

  14. Urban Scale Application of Solar PV to Improve Sustainability in the Building and the Energy Sectors of KSA

    Directory of Open Access Journals (Sweden)

    Muhammad Asif

    2016-11-01

    Full Text Available The Kingdom of Saudi Arabia (KSA is the largest country in the Gulf Cooperation Council (GCC region in terms of population, geographic area, economy, and construction and utility infrastructure. The rapid growth of the building sector in general and residential buildings in particular is creating huge energy and environmental challenges for the country. To address these problems and reduce its reliance on an oil-based energy infrastructure, the country aims to install 9.5 GW of renewable energy by 2030. Traditionally the emphasis has been on large-scale renewable projects. Globally, the recent success of solar energy has been significantly contributed by the application of photovoltaics (PV in buildings. This is an area that has been overlooked in KSA. This study investigates the prospects of application of PV in buildings to improve the sustainability standards in the building and energy sectors of the country by considering the King Fahd University of Petroleum and Minerals (KFUPM as a case study. PVsyst and RetScreen software programs have been used to model the application of PV on building rooftops in KFUPM. The study also discusses the concerned policy. It is found that the rooftop application of PV can annually produce 37,746 MWh of electricity, meeting over 16% of the KFUPM’s total energy requirements.

  15. Surgical Management of Symptomatic Olecranon Traction Spurs.

    Science.gov (United States)

    Alvi, Hasham M; Kalainov, David M; Biswas, Debdut; Soneru, Alexander P; Cohen, Mark S

    2014-07-01

    There is a paucity of information pertaining to the pathoanatomy and treatment of symptomatic olecranon traction spurs. To describe the pathoanatomy of olecranon traction spur formation, a technique for spur resection, and a series of patients who failed conservative care and underwent operative treatment. Case series; Level of evidence, 4. Eleven patients (12 elbows) with a mean age of 42 years (range, 27-62 years) underwent excision of a painful olecranon traction spur after failing conservative care. Charts and imaging studies were reviewed. All patients returned for evaluation and new elbow radiographs at an average of 34 months (range, 10-78 months). Outcome measures included the Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire; the Mayo Elbow Performance Score (MEPS); visual analog scales (VAS) for pain and patient satisfaction; elbow motion; elbow strength; and elbow stability. The traction spur was found in the superficial fibers of the distal triceps tendon in all cases. The mean QuickDASH score was 3 (range, 0-23), the mean MEPS score was 96 (range, 80-100), the mean VAS pain score was 0.8 (range, 0-3), and the mean VAS satisfaction score was 9.6 (range, 7-10). Average elbow motion measured 3° to 138° (preoperative average, 5°-139°). All patients exhibited normal elbow flexion and extension strength, and all elbows were deemed stable. Early postoperative complications involved a wound seroma in 1 case and olecranon bursitis in 1 case: both problems resolved without additional surgery. Two patients eventually developed a recurrent traction spur, 1 of whom underwent successful repeat spur excision 48 months after the index operation. Short- to mid-term patient and examiner-determined outcomes after olecranon traction spur resection were acceptable in our experience. Early postoperative complications and recurrent enthesophyte formation were uncommon. This study provides the treating physician with an improved understanding of

  16. 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

    2017-01-01

    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.

  17. SUSTAINABLE TRANSPORTATION

    Directory of Open Access Journals (Sweden)

    Linda STEG

    2007-01-01

    Full Text Available This paper discusses possible contributions of psychologists to sustainable transportation. It is argued that in order to reach sustainable transportation, among others, behaviour changes of individual car users are needed. As transport policies will be more effective if they target important antecedents of travel behaviour, first, factors influencing such behaviour are discussed. It is argued that car use is very attractive and sometimes even necessary for many different reasons. This implies that a combination of policies is called for, each targeting different factors that support car use and hinder the use of more sustainable modes of transport. Next, the paper elaborates on policy strategies that may be employed to achieve sustainable transportation by changing car use. Increasing the attractiveness of sustainable transport modes by means of pull measures seems not sufficient to reduce the level of car use. Besides, car use should be made less attractive by means of push measures to force drivers to reconsider their travel behaviour. The acceptability of such policies may be increased by clearly communicating the aim of these policies, and the expected positive consequences (e.g., less congestion, improved environmental quality. Moreover, possible negative effects for individual freedom may be compensated by implementing additional policies aimed at facilitating the use of sustainable transport modes.

  18. 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

  19. Improving coastal livelihoods through sustainable aquaculture practices – the case of Tubigon, Bohol, Philippines: a report to the collaborative APEC Grouper Research and Development Network

    OpenAIRE

    Santos, R.; Pador, E.; La Torre, M.

    2003-01-01

    This case study is part of STREAM’s four-country research project, which is exploring how recent advances in sustainable aquaculture have helped and can help improve coastal livelihoods and prevent unsustainable fishing practices in reef fisheries. (Pdf contains 65 pages).

  20. Epidemiology of Acute Symptomatic Seizures among Adult Medical Admissions

    OpenAIRE

    Nwani, Paul Osemeke; Nwosu, Maduaburochukwu Cosmas; Nwosu, Monica Nonyelum

    2016-01-01

    Acute symptomatic seizures are seizures occurring in close temporal relationship with an acute central nervous system (CNS) insult. The objective of the study was to determine the frequency of presentation and etiological risk factors of acute symptomatic seizures among adult medical admissions. It was a two-year retrospective study of the medical files of adults patients admitted with acute symptomatic seizures as the first presenting event. There were 94 cases of acute symptomatic seizures ...

  1. 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.

  2. Symptomatic tarlov cyst following spontaneous subarachnoid hemorrhage.

    Science.gov (United States)

    Kong, Woo Keun; Cho, Keun-Tae; Hong, Seung-Koan

    2011-08-01

    Most of Tarlov or perineurial cysts remain asymptomatic throughout the patient's life. The pathogenesis is still unclear. Hemorrhage has been suggested as one of the possible causes and trauma with resultant hemorrhage into subarachnoid space has been suggested as an origin of these cysts. However, Tarlov cysts related to spontaneous subarachnoid hemorrhage has not been reported. The authors report a case of Tarlov cyst which was symptomatic following spontaneous subarachnoid hemorrhage.

  3. Symptomatic Tarlov Cyst Following Spontaneous Subarachnoid Hemorrhage

    OpenAIRE

    Kong, Woo Keun; Cho, Keun-Tae; Hong, Seung-Koan

    2011-01-01

    Most of Tarlov or perineurial cysts remain asymptomatic throughout the patient's life. The pathogenesis is still unclear. Hemorrhage has been suggested as one of the possible causes and trauma with resultant hemorrhage into subarachnoid space has been suggested as an origin of these cysts. However, Tarlov cysts related to spontaneous subarachnoid hemorrhage has not been reported. The authors report a case of Tarlov cyst which was symptomatic following spontaneous subarachnoid hemorrhage.

  4. 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.

  5. [Blastocystis hominis in symptomatic celiac patients].

    Science.gov (United States)

    Jiménez, Oscar Manuel Villa; Carbonell, Angel Escobedo; García, Olga Marina Hano; Rodríguez, Lisette Wood; Triana, Frank Pérez; Fabián, Licet González

    2012-09-01

    Celiac disease (EC) not diagnosed or treated affect histological, immunological and nutritional status of patients who suffer it. These changes allow infection by parasites that cause no symptoms in immunocompetent patients, such as Blastocystis hominis (Bh). OBJETIVE. To analyze the presence of Bh in symptomatic celiac patients and describe the clinical, histological, immune and nutritional status in these patients. MATERIAL AND METHOD An observational descriptive cross sectional study was performed. Thirty symptomatic celiac patients (18 women, mean age 41 years old, range 19-68 years), assisted at the Institute of Gastroenterology of Cuba from January to December 2009, entered the study. Diarrhea and chronic anemia were the most commonly reported clinical manifestations (22 and 4 patients, respectively). The analysis of more than five Bh per field was more frequent in the group ofpatients studied (63.3%), with statistically significant difference in patients with vilous atrophy and low weight (P < 0.03) compared to cases with less than five Bh per feld. No significant differences were found when the immune status of patients was analyzed. CONCLUSIONS. In symptomatic celiac patients with subtotal-total villous atrophy and low weight the finding of more than five Bh perfield should be considered as opportunistic.

  6. Polymerized-Type I Collagen Downregulates Inflammation and Improves Clinical Outcomes in Patients with Symptomatic Knee Osteoarthritis Following Arthroscopic Lavage: A Randomized, Double-Blind, and Placebo-Controlled Clinical Trial

    Directory of Open Access Journals (Sweden)

    Janette Furuzawa-Carballeda

    2012-01-01

    Full Text Available Objectives. Polymerized-type I collagen (polymerized collagen is a downmodulator of inflammation and cartilage regenerator biodrug. Aim. To evaluate the effect of intraarticular injections of polymerized collagen after arthroscopic lavage on inflammation and clinical improvement in patients with knee osteoarthritis (OA. Methods. Patients (n=19 were treated with 6 intraarticular injections of 2 mL of polymerized collagen (n=10 or 2 mL of placebo (n=9 during 3 months. Followup was 3 months. The primary endpoints included Lequesne index, pain on a visual analogue scale (VAS, WOMAC, analgesic usage, the number of Tregs and proinflammatory/anti-inflammatory cytokine-expressing peripheral cells. Secondary outcomes were Likert score and drug evaluation. Clinical and immunological improvement was determined if the decrease in pain exceeds 20 mm on a VAS, 20% of clinical outcomes, and inflammatory parameters from baseline. Urinary levels of C-terminal crosslinking telopeptide of collagen type II (CTXII and erythrocyte sedimentation rate (ESR were determined. Results. Polymerized collagen was safe and well tolerated. Patients had a statistically significant improvement (P<0.05 from baseline versus polymerized collagen and versus placebo at 6 months on Lequesne index, VAS, ESR, Tregs IL-1β, and IL-10 peripheral-expressing cells. Urinary levels of CTXII were decreased 44% in polymerized collagen versus placebo. No differences were found on incidence of adverse events between groups. Conclusion. Polymerized collagen is safe and effective on downregulation of inflammation in patients with knee OA.

  7. Reverse logistics and sustainability for improving the chain: an overview of the approach in pet recycling in Brazil.

    Directory of Open Access Journals (Sweden)

    Alexandre Formigoni

    2014-12-01

    Full Text Available The study aimed tore assess their verse logistics of PET, and point out the flaws from the deficiencies found, try to indicate way sin the pursuit of sustainability. For this we use two case studies: the first study analyzes three cooperatives and the profile of collectors for PET; according to the census conducted by Associação Brasileira da Indústria do PET, collecting data on there verses trend of the equipment and consumer profile. From data collected, and with the help of a literature review point in the sustainability of PET through a sustainable supply chain.

  8. Clinical and radiologic course of symptomatic spontaneous isolated dissection of the superior mesenteric artery treated with conservative management.

    Science.gov (United States)

    Kim, Hyung-Kee; Jung, Hee Kyung; Cho, Jayun; Lee, Jong-Min; Huh, Seung

    2014-02-01

    To determine the clinical and radiological outcomes of patients with symptomatic spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) who were treated with conservative management. This retrospective study included 27 consecutive patients who were diagnosed with symptomatic SIDSMA and managed conservatively from April 2007 to April 2013. Twenty-six patients were treated using anticoagulation therapy, and one patient with chronic liver disease underwent observation only. For evaluation, patients were divided into two groups, those with a patent false lumen with both entry and re-entry (group I), and those with partial or complete thrombosis of the false lumen (group II). In general, the patients underwent follow-up computed tomography angiography (CTA) 1 week, 1 month, and 6 months after admission. Thereafter, they underwent annual CTAs. There were five group I and 22 group II patients. During hospitalization, none of the patients needed additional endovascular or surgical intervention, and after conservative management, every patient was asymptomatic upon discharge. The mean duration of clinical follow-up was 27.3 months. There was no recurrent abdominal pain associated with SIDSMA, and no invasive procedures due to SIDSMA were needed. During a mean of 17.1 months of CTA follow-up in group I patients, serial CTAs found sustained patent false lumen and no angiographic changes in all patients. Among 22 group II patients, despite anticoagulation and symptomatic relief, CTA 1 week after admission revealed increased stenosis of the true lumen in 84.2% (16/19) of patients including six cases of progressive SMA occlusion. Five patients, including the three patients initially presenting with SMA occlusion, had no interval changes, and only one patient had improved compression of the true lumen. During a mean of 18.0 months of CTA follow-up in group II patients, serial CTAs revealed improvement in the occlusion or stenosis of the true lumen in 89% (16

  9. Evaluation of Sustained Value Creation with the DOD’s Financial Improvement and Audit Readiness (FIAR) Plan

    Science.gov (United States)

    2006-12-01

    can be sustained over the long-term? To address this a second framework was chosen which was developed by Sergio Fernandez of Indiana University and...recent study provides a good basis for evaluating the sustainability of the FIAR Plan. B. THE FERNANDEZ /RAINEY MODEL Sergio Fernandez of Indiana... Sergio Fernandez and Hal Rainey. “Managing Successful Organizational Change in the Public Sector: An Agenda for Research and Practice” in Public

  10. 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

  11. 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

  12. 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

  13. Environmental sustainability of an energy self-sufficient sewage treatment plant: improvements through DEMON and co-digestion.

    Science.gov (United States)

    Schaubroeck, Thomas; De Clippeleir, Haydée; Weissenbacher, Norbert; Dewulf, Jo; Boeckx, Pascal; Vlaeminck, Siegfried E; Wett, Bernhard

    2015-05-01

    It is still not proven that treatment of sewage in a wastewater treatment plant (WWTP) is (in every case) environmentally friendly. To address this matter, we have applied a state-of-the-art life cycle assessment (LCA) to an energy self-sufficient WWTP in Strass (Austria), its supply chain and the valorization of its 'products': produced electricity out of biogas from sludge digestion and the associated stabilized digestate, applied as agricultural fertilizer. Prominent aspects of our study are: a holistic environmental impact assessment, measurement of greenhouse gas emissions (including N2O), and accounting for infrastructure, replacement of conventional fertilizers and toxicity of metals present in the stabilized digestate. Additionally, the environmental sustainability improvement by implementing one-stage partial nitritation/anammox (e.g. DEMON(®)) and co-digestion was also assessed. DEMON on the digesters reject water leads to a considerable saving of natural resources compared to nitritiation/denitritation (about 33% of the life cycle resource input), this through the lowering of sludge consumption for N-removal, and thus increasing electricity production via a higher sludge excess. However, its N2O emission could be restrained through further optimization as it represents a large share (30-66%) of the plants' damaging effect on human health, this through climate change. The co-substrate addition to the digester resulted in no significant improvement of the digestion process but induced net electricity generation. If respective amounts of conventional fertilizers are replaced, the land application of the stabilized digestate is environmentally friendly through prevention of natural resource consumption and diversity loss, but possibly not regarding human health impact due the presence of toxic heavy metals, mainly Zn, in the digestate. The outcomes show that the complete life cycle results in a prevention of resource extraction from nature and a potential

  14. Presentation and management of symptomatic central bone cement embolization.

    Science.gov (United States)

    Barakat, Ahmed Samir; Owais, Tamer; Alhashash, Mohamed; Shousha, Mootaz; El Saghir, Hesham; Lauer, Bernward; Boehm, Heinrich

    2017-08-18

    With more cement augmentation procedures done, the occurrence of serious complications is also expected to rise. Symptomatic central cement embolization is a rare but very serious complication. Moreover, the pathophysiology and treatment of intrathoracic cement embolism remain controversial. In this case series, we are trying to identify various presentations and suggest our emergent management scheme for symptomatic central cement embolization. Retrospective case series of nine patients with symptomatic central cement embolism identified after vertebroplasty with 24 months of follow-up. Level IV. The degree of dyspnea measured by the New York Heart Association (NYHA) score and/or death related to cement embolism induced cardio/respiratory failure at the final follow-up at 24 months. The nine patients, eight females, and one male had a mean age of 70.25 years (range 65-78 years) and were operated between January 2004 and December 2014. They had percutaneous vertebroplasty for osteoporotic non-traumatic and malignant vertebral collapse of dorsal and lumbar vertebrae. Post-vertebroplasty dyspnea and stitching chest pain were striking in the nine patients. After exclusion of cardiac ischemia and medical pulmonary causes for dyspnea, we identified radiopaque lesions on the chest X-ray. Further echocardiography and high-resolution chest CT were performed for optimal localization. Emergent heart surgery was performed in two patients: interventional therapy was conducted in one patient, while the remaining six patients were conservatively treated by anticoagulation. The management decision was taken in the setting of an interdisciplinary meeting depending on localization, fragmentation, and clinical status. All patients of this series showed gradual improvement and an uneventful hospital stay. During our 24-month follow-up phase, eight patients showed no subsequent cardiological and/or respiratory symptoms (NYHA I). However, one mortality due to advanced malignancy

  15. Reduction in symptomatic malaria prevalence through proactive community treatment in rural Senegal.

    Science.gov (United States)

    Linn, Annē M; Ndiaye, Youssoupha; Hennessee, Ian; Gaye, Seynabou; Linn, Patrick; Nordstrom, Karin; McLaughlin, Matt

    2015-11-01

    We piloted a community-based proactive malaria case detection model in rural Senegal to evaluate whether this model can increase testing and treatment and reduce prevalence of symptomatic malaria in target communities. Home care providers conducted weekly sweeps of every household in their village throughout the transmission season to identify patients with symptoms of malaria, perform rapid diagnostic tests (RDT) on symptomatic patients and provide treatment for positive cases. The model was implemented in 15 villages from July to November 2013, the high transmission season. Fifteen comparison villages were chosen from those implementing Senegal's original, passive model of community case management of malaria. Three sweeps were conducted in the comparison villages to compare prevalence of symptomatic malaria using difference in differences analysis. At baseline, prevalence of symptomatic malaria confirmed by RDT for all symptomatic individuals found during sweeps was similar in both sets of villages (P = 0.79). At end line, prevalence was 16 times higher in the comparison villages than in the intervention villages (P = 0.003). Adjusting for potential confounders, the intervention was associated with a 30-fold reduction in odds of symptomatic malaria in the intervention villages (AOR = 0.033; 95% CI: 0.017, 0.065). Treatment seeking also increased in the intervention villages, with 57% of consultations by home care providers conducted between sweeps through routine community case management. This pilot study suggests that community-based proactive case detection reduces symptomatic malaria prevalence, likely through more timely case management and improved care seeking behaviour. A randomised controlled trial is needed to further evaluate the impact of this model. © 2015 John Wiley & Sons Ltd.

  16. 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.

  17. Improvement of the Sustainability of Existing School Buildings According to the Leadership in Energy and Environmental Design (LEED® Protocol: A Case Study in Italy

    Directory of Open Access Journals (Sweden)

    Giuliano Dall'O'

    2013-12-01

    Full Text Available School-age students spend much of their time in school buildings. The sustainability of these buildings should be a priority as better comfort with a high indoor air quality contributes to an improvement in the conditions for learning. Although new school buildings are often built with high standards of sustainability and energy efficiency, the existing school building stock is generally characterised by very poor quality. The energy retrofit of existing school buildings in recent years is part of the policies of the European Union and, consequently, of the Member States. However, rarely do these measures consider aspects other than energy. This paper proposes and discusses a feasibility study which provides a considerable improvement in the environmental quality of 14 school buildings located in northern Italy: the objective is to ensure the requirements for Leadership in Energy and Environmental Design (LEED® certification. The analysis considers both the technical and economic aspects. The study shows that there is a technical feasibility: the credits are between 42 and 54, moreover the major cost (the cost of building envelope and heating systems retrofit is 82.9% of the total cost is due to the improvement of energy efficiency. The improvement of sustainability is therefore a reasonable strategy even if the application of the LEED Protocol in the Italian context involves some critical issues that are discussed in the paper.

  18. Lean maturity, lean sustainability

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Matthiesen, Rikke; Nielsen, Jacob

    2007-01-01

    Although lean is rapidly growing in popularity, its implementation is far from problem free and companies may experience difficulties sustaining long term success. In this paper, it is suggested that sustainable lean requires attention to both performance improvement and capability development...... that support lean capability development and consequently, lean sustainability....

  19. Natural course of symptomatic focal choroidal excavation.

    Science.gov (United States)

    Pierro, Luisa; Casalino, Giuseppe; Introini, Ugo; Gagliardi, Marco; Sergenti, Jessica; Cascavilla, Maria Lucia; Bandello, Francesco

    2015-01-01

    A 32-year-old man was referred to the authors' department for nonspecified macular dystrophy with persistent metamorphopsia in the right eye diagnosed 10 years before and followed using optical coherence tomography. The patient underwent a comprehensive ocular examination, including multimodal imaging evaluation and electrofunctional testing. The diagnosis was consistent with nonconforming focal choroid excavation. Over 10 years, no complications occurred, visual acuity was stable, and optical coherence tomography showed no progression of the lesion during follow-up. In this case, nonconforming symptomatic focal choroid excavation was a nonprogressive condition with good long-term visual outcome. Copyright 2015, SLACK Incorporated.

  20. Clinical analysis and treatment of symptomatic intracranial hemorrhage after deep brain stimulation surgery.

    Science.gov (United States)

    Wang, Xin; Wang, Jing; Zhao, Haikang; Li, Nan; Ge, Shunnan; Chen, Lei; Li, Jiaming; Jing, Jiangpeng; Su, Mingming; Zheng, Zhaohui; Zhang, Jinan; Gao, Guodong; Wang, Xuelian

    2017-04-01

    Symptomatic intracranial hemorrhage (ICH) may lead to permanent neurological disability of patients and has impeded the extensive clinical application of deep brain stimulation (DBS). The present study was conducted to discuss the incidence, prevention, and treatment of symptomatic ICH after DBS surgery. From January 2009 to December 2014, 396 patients underwent DBS with a total of 691 implanted leads. In all, 10 patients had symptomatic ICH. We analyzed these cases' clinical characteristics, including comorbid diagnoses and coagulation profile. We described the onset of ICH, imaging features, clinical manifestations, treatment, neurological impairment, and outcome of DBS. Of the 10 patients with symptomatic ICH, 2 had hypertension. Three cases of ICH occurred within 12 h of the procedure; four cases within 24 h. Five experienced grand mal seizures concurrently with hemorrhage. Unilateral frontal lobe hemorrhage occurred in all cases. In seven cases, hematomas occurred around the electrodes. Some hematomas were not well-circumscribed and had perihematomal edema. Conservative therapy was administered to 8 patients, and 2 patients underwent craniotomy and hematoma evacuation. All electrodes were successfully preserved. Neurological dysfunction in all patients gradually improved. Nine patients ultimately experienced effective symptom relief of Parkinson's disease with DBS. Symptomatic ICH should be identified as soon as possible after implantation surgery and treated effectively to limit neurological deficit and preserve DBS leads.

  1. Estimating the clinical and economic benefit associated with incremental improvements in sustained virologic response in chronic hepatitis C.

    Directory of Open Access Journals (Sweden)

    Phil McEwan

    Full Text Available 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.

  2. 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

  3. 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......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 psychological condition of old women with a recent history of falls....

  4. 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".

  5. ITS contribution to sustain ability and improvement of road transport; Aportacion de los ITS a la sostenibilidad y mejora del transporte por carretera

    Energy Technology Data Exchange (ETDEWEB)

    Jimenez Alonso, F.; Aparicio Izquierdo, F.

    2008-07-01

    The road transport growth has increased those problems that threaten its sustainability: accidents exhaust emissions, congestion, etc. Intelligent Transport Systems (ITS) provide solutions based on electronics, automatic control and communications technologies. In this complex environment where users of different characteristics share the same infrastructure, improvements that cooperative systems (V2V, V2I and management centres) produce are evaluated. Furthermore, main obstacles that make their quick and wide implementation difficult are analyzed. (Author) 12 refs.

  6. Extracellular matrix proteomics identifies molecular signature of symptomatic carotid plaques.

    Science.gov (United States)

    Langley, Sarah R; Willeit, Karin; Didangelos, Athanasios; Matic, Ljubica Perisic; Skroblin, Philipp; Barallobre-Barreiro, Javier; Lengquist, Mariette; Rungger, Gregor; Kapustin, Alexander; Kedenko, Ludmilla; Molenaar, Chris; Lu, Ruifang; Barwari, Temo; Suna, Gonca; Yin, Xiaoke; Iglseder, Bernhard; Paulweber, Bernhard; Willeit, Peter; Shalhoub, Joseph; Pasterkamp, Gerard; Davies, Alun H; Monaco, Claudia; Hedin, Ulf; Shanahan, Catherine M; Willeit, Johann; Kiechl, Stefan; Mayr, Manuel

    2017-04-03

    The identification of patients with high-risk atherosclerotic plaques prior to the manifestation of clinical events remains challenging. Recent findings question histology- and imaging-based definitions of the "vulnerable plaque," necessitating an improved approach for predicting onset of symptoms. We performed a proteomics comparison of the vascular extracellular matrix and associated molecules in human carotid endarterectomy specimens from 6 symptomatic versus 6 asymptomatic patients to identify a protein signature for high-risk atherosclerotic plaques. Proteomics data were integrated with gene expression profiling of 121 carotid endarterectomies and an analysis of protein secretion by lipid-loaded human vascular smooth muscle cells. Finally, epidemiological validation of candidate biomarkers was performed in two community-based studies. Proteomics and at least one of the other two approaches identified a molecular signature of plaques from symptomatic patients that comprised matrix metalloproteinase 9, chitinase 3-like-1, S100 calcium binding protein A8 (S100A8), S100A9, cathepsin B, fibronectin, and galectin-3-binding protein. Biomarker candidates measured in 685 subjects in the Bruneck study were associated with progression to advanced atherosclerosis and incidence of cardiovascular disease over a 10-year follow-up period. A 4-biomarker signature (matrix metalloproteinase 9, S100A8/S100A9, cathepsin D, and galectin-3-binding protein) improved risk prediction and was successfully replicated in an independent cohort, the SAPHIR study. The identified 4-biomarker signature may improve risk prediction and diagnostics for the management of cardiovascular disease. Further, our study highlights the strength of tissue-based proteomics for biomarker discovery. UK: British Heart Foundation (BHF); King's BHF Center; and the National Institute for Health Research Biomedical Research Center based at Guy's and St Thomas' NHS Foundation Trust and King's College London in

  7. Symptomatic and asymptomatic candidiasis in a pediatric intensive care unit.

    Science.gov (United States)

    Arslankoylu, Ali Ertug; Kuyucu, Necdet; Yilmaz, Berna Seker; Erdogan, Semra

    2011-11-21

    This study aimed to examine the incidence, epidemiology, and clinical characteristics of symptomatic and asymptomatic candidiasis in a pediatric intensive care unit (PICU), and to determine the risk factors associated with symptomatic candidiasis. This retrospective study included 67 patients from a 7-bed PICU in a tertiary care hospital that had Candida-positive cultures between April 2007 and July 2009. Demographic and clinical characteristics of the patients, Candida isolates, antimicrobial and antifungal treatments, and previously identified risk factors for symptomatic candidiasis were recorded, and symptomatic and asymptomatic patients were compared. In all, 36 (53.7%) of the patients with Candida-positive cultures had asymptomatic candidiasis and 31 (46.3%) had symptomatic candidiasis. Candida albicans was the most common Candida sp. in the asymptomatic patients (n = 20, 55.6%), versus Candida parapsilosis in the symptomatic patients (n = 15, 48.4%). The incidence of central venous catheter indwelling, blood transfusion, parenteral nutrition, and surgery was higher in the symptomatic patient group than in the asymptomatic patient group (P candidiasis according to forward stepwise multivariate logistic regression analysis (OR: 6.1; 95% CI: 1.798-20.692). Surgery was the only risk factor significantly associated with symptomatic candidiasis and non-albicans Candida species were more common among the patients with symptomatic candidiasis. While treating symptomatic candidiasis in any PICU an increase in the incidence of non-albicans candidiasis should be considered.

  8. A rare cause of symptomatic cluster headache

    Directory of Open Access Journals (Sweden)

    Venkatesan Prasanna Eswaradass

    2015-01-01

    Full Text Available Cluster headache (CH is characterized by recurrent attacks of short-lasting excruciating pain accompanied by signs of autonomic dysfunction. Although neuroimaging results are usually normal in primary headaches, rarely structural lesions may be associated with CH like presentation. Most symptomatic CH is due to pituitary tumors and less commonly due to arteriovenous malformations (AVM and aneurysms. Here we describe a case of 44-year-old male who presented to us with new onset episodic CH with headache features typical. Initially, headache responded to treatment, but later the headache became continuous, severe in intensity and refractory to treatment. Since magnetic resonance imaging was normal, he was subjected to digital substraction angiography (DSA to rule out aneurysm or AVM. DSA revealed indirect carotid-cavernous fistula (CCF. Once the fistula was obliterated with onyx embolization, headache subsided completely. MRI brain is often routinely performed in CH to rule out secondary causes. When MRI brain is normal, detailed vascular imaging with DSA must be performed in patients with CH with especially in those with atypical features. Like continuous pain refractory to treatment, sudden increase in severity in the first episode, minimal or absent autonomic features and abnormal physical findings like persistent ptosis in the headache-free period. Although many cases of symptomatic CH have been reported in literature we report the first case of CCF presenting as CH. Early identification is essential as it is completely curable with endovascular treatment.

  9. Percutaneous alcohol sclerotherapy for symptomatic congenital cysts

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Chong Soo; Chung, Gyung Ho; Lee, Sang Young; Lee, Jeung Min; Son, Myung Hee; Song, Ho Young; Choi, Ki Chul [College of Medicine, Chonbuk National University, Jeonju (Korea, Republic of)

    1992-01-15

    Twenty patients with symptomatic congenital cysts in the liver, kidney, thyroid, and lower neck underwent, ultrasound guided percutaneous aspiration through a drainage catheter with temporary instillation of 95% ethanol into the cyst. Our procedure was based on the method as described by Bean and Rodan(16) in 1985. Additionally, two other steps were added to prevent the dilutional effect of residual cyst fluid. One was the preliminary washing of the cyst with alcohol. The other was to treat with 30% replacement of alcohol every 10 minutes during the treatment secession. Minor complications of transient temperature elevation and haziness occurred, but no major complications were encountered. After the alcohol treatment follow up examinations were performed with computed tomography or ultrasonography at 6 weeks, 6 months, 9 months and 15 months. Although there was diminished size, recurrence was noted in 6 of twenty patients(30%) at 6 weeks and one of twenty patients(5%) at 6 months. There was no recurrence at 9 months and 15 months. The results indicated that percutaneous aspiration and alcohol sclerotherapy are safe and effective therapy for symptomatic congenital cysts.

  10. 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.

  11. Acute Symptomatic Seizures Caused by Electrolyte Disturbances.

    Science.gov (United States)

    Nardone, Raffaele; Brigo, Francesco; Trinka, Eugen

    2016-01-01

    In this narrative review we focus on acute symptomatic seizures occurring in subjects with electrolyte disturbances. Quite surprisingly, despite its clinical relevance, this issue has received very little attention in the scientific literature. Electrolyte abnormalities are commonly encountered in clinical daily practice, and their diagnosis relies on routine laboratory findings. Acute and severe electrolyte imbalances can manifest with seizures, which may be the sole presenting symptom. Seizures are more frequently observed in patients with sodium disorders (especially hyponatremia), hypocalcemia, and hypomagnesemia. They do not entail a diagnosis of epilepsy, but are classified as acute symptomatic seizures. EEG has little specificity in differentiating between various electrolyte disturbances. The prominent EEG feature is slowing of the normal background activity, although other EEG findings, including various epileptiform abnormalities may occur. An accurate and prompt diagnosis should be established for a successful management of seizures, as rapid identification and correction of the underlying electrolyte disturbance (rather than an antiepileptic treatment) are of crucial importance in the control of seizures and prevention of permanent brain damage.

  12. 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.

  13. 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.

  14. Exploring How Knowledge Translation Can Improve Sustainability of Community-Based Health Initiatives for People with Intellectual/Developmental Disabilities

    Science.gov (United States)

    Spassiani, Natasha A.; Parker Harris, Sarah; Hammel, Joy

    2016-01-01

    Community-based health initiatives (CBHI) play an important role in maintaining the health, function and participation of people with intellectual/developmental disabilities (I/DD) living in the community. However, implementation and long-term sustainability of CBHI is challenging. The Promoting Action on Research Implementation in Health Services…

  15. Sustainable solutions to improve road safety in The Netherlands : a `polder model' for a considerably safer road traffic system.

    NARCIS (Netherlands)

    Wegman, F.C.M. & Elsenaar, P.M.W.

    1997-01-01

    A new vision, called `sustainable road safety', has been introduced recently in The Netherlands, hopefully leading to roads and streets with risk rates which are considerably lower than today. The vision forms an essential part of the Dutch road safety policy today. The principles of this approach

  16. Sustaining School Improvement in a High-Need School: Longitudinal Analysis of Robbins Elementary School (USA) from 1993 to 2015

    Science.gov (United States)

    Okilwa, Nathern; Barnett, Bruce

    2017-01-01

    Purpose: The purpose of this paper is to examine how Robbins ES has sustained high academic performance over almost 20 years despite several changes in principals. Design/methodology/approach: The paper analyzed longitudinal data based on: state-level academic and demographic data; two earlier studies of the school; and recent interviews with…

  17. 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.

  18. 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.

  19. 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

  20. Symptomatic Fibroid Management: Systematic Review of the Literature

    OpenAIRE

    Havryliuk, Yelena; Setton, Robert; Carlow, John J.; Shaktman, Barry D.

    2017-01-01

    Background and Objectives: Symptomatic uterine fibroids are a societal and healthcare burden with no clear consensus among medical professionals as to which procedural treatment is most appropriate for each symptomatic patient. Our purpose was to determine whether recommendations can be made regarding best practice based on review and analysis of the literature since 2006. Database: A systematic search of journal articles relevant to the treatment of symptomatic uterine fibroids was performed...

  1. 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.

  2. How Can Local Manufacturing Improve Economic Sustainability? Saint Brissant: a case study of local manufacturing in Spain

    OpenAIRE

    Karaosman, Hakan; Morales Alonso, Gustavo; Grijalvo Martin, Maria Mercedes

    2014-01-01

    Fast-fashion retailers and mass production dominate the fashion and apparel industry. Increased globalization, labor intensity and outsourcing to developing countries are fostering the interest in sustainability within the industry. There is a growth of a new movement attempting to offset the demand for fast fashion, "Slow Fashion" movement. Slow fashion is not time-based but quality-based approach in which designers, buyers, retailers and consumers are more aware of the impacts on workers, c...

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

    OpenAIRE

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

    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, cyano...

  4. 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.

  5. 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.

  6. Liver transplantation for symptomatic centrohepatic biliary cystadenoma.

    Science.gov (United States)

    Romagnoli, Renato; Patrono, Damiano; Paraluppi, Gianluca; David, Ezio; Tandoi, Francesco; Strignano, Paolo; Lupo, Francesco; Salizzoni, Mauro

    2011-05-01

    Biliary cystadenoma is a rare benign cystic tumor of the liver. The mainstay of treatment is complete resection, either by enucleation or by formal hepatectomy, since incomplete removal entails not only constant recurrence but also the risk of malignant transformation to cystadenocarcinoma. A case of symptomatic centrohepatic biliary cystadenoma involving the main vasculobiliary structures of the liver is reported. After an unsuccessful attempt at resection resulting in an intrahepatic biliary injury, relief of jaundice and radical excision were achieved by total hepatectomy and liver transplantation. The patient is now alive and well 4 years after transplant, disease-free, with normal liver and renal function while receiving everolimus monotherapy. This is the first report of liver transplantation performed for the treatment of this tumor. With the case on the background, diagnostic aspects and available therapeutic strategies for biliary cystadenoma are reviewed and discussed. Copyright © 2011. Published by Elsevier Masson SAS.

  7. Contemporary Orthodontic Diagnosis Of Symptomatic TMD

    Directory of Open Access Journals (Sweden)

    C Deepak

    2010-01-01

    Full Text Available Orthodontists have always been interested in the diagnosis and management of Temperomandibular joint disorders, as they are gifted with the skills to move teeth. Moving teeth into ideal positions ,so as to have a perfect gnathological health has always been the aim of finishing cases. Diagnosing and treatment planning for a patient with symptomatic tempero mandibular disorders becomes more imperative as the patient experiences pain with simple movements, like opening the mouth and accompanied headaches. A through clinical examination , mounting of the models (MCD are essential ,in addition the use of newer imaging technology ,the cone beam CT machine for 3 dimensional view of the condyle is mandatory to arrive at a comprehensive diagnosis of the TMD.

  8. 25-Hydroxyvitamin D and symptomatic ischemic stroke

    DEFF Research Database (Denmark)

    Brøndum-Jacobsen, Peter; Nordestgaard, Børge G; Schnohr, Peter

    2013-01-01

    OBJECTIVE: We tested the hypothesis that low plasma concentrations of 25-hydroxyvitamin D are associated with increased risk of symptomatic ischemic stroke in the general population. METHODS: We measured plasma 25-hydroxyvitamin D in 10,170 individuals from the general population, the Copenhagen...... City Heart Study. During 21 years of follow-up, 1,256 and 164 persons developed ischemic and hemorrhagic stroke, respectively. In a meta-analysis of ischemic stroke, we included 10 studies, 58,384 participants, and 2,644 events. RESULTS: Stepwise decreasing plasma 25-hydroxyvitamin D concentrations...... were associated with stepwise increasing risk of ischemic stroke both as a function of seasonally adjusted percentile categories and as a function of clinical categories of 25-hydroxyvitamin D (p for trend ≤ 2 × 10(-3) ). In a Cox regression model comparing individuals with plasma 25-hydroxyvitamin D...

  9. 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.

  10. Prevalence of Metatarsus Adductus in Symptomatic Hallux Valgus and Its Influence on Functional Outcome.

    Science.gov (United States)

    Loh, Bryan; Chen, Jerry Yongqiang; Yew, Andy Khye Soon; Chong, Hwei Chi; Yeo, Malcolm Guan Hin; Tao, Peng; Yeo, Nicholas Eng Meng; Koo, Kevin; Rikhraj Singh, Inderjeet

    2015-11-01

    Metatarsus adductus (MA) increases the risk of developing symptomatic hallux valgus (HV). This study aimed to determine the prevalence of MA in patients with symptomatic HV and to evaluate how it affected the functional outcome after scarf osteotomy. Between January 2007 and June 2012, a total of 206 patients who underwent scarf osteotomy for symptomatic HV at a tertiary hospital were included. The metatarsus adductus angle (MAA) was determined using the Modified Sgarlato method, and these patients were categorized into 2 groups: MA (MAA > 20 degrees); and Control (MAA ≤ 20 degrees). The patients were prospectively followed for 2 years. The prevalence of MA was 33% (68/206) with a mean MAA of 24 ± 4 degrees (range = 20-39). There was a 21 ± 12 degrees and 18 ± 9 degrees improvement in hallux valgus angle for the MA and Control groups, respectively (P = .061), whereas there was a 6 ± 4 degrees and 6 ± 3 degrees improvement in intermetartarsal angle for the MA and Control groups, respectively (P = .475). The visual analog scale, AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale, and Physical and Mental Component Scores were comparable between the 2 groups both preoperatively and at 2 years' follow-up (all P > .05). Two patients in the control group required revision surgery for recurrence symptomatic HV. The authors conclude that MA did not predispose the patient to poorer functional outcome after scarf osteotomy with the advent of good operative techniques. Level II, prospective comparative study. © The Author(s) 2015.

  11. 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

  12. 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 ...

  13. Preoperative prediction model of outcome after cholecystectomy for symptomatic gallstones

    DEFF Research Database (Denmark)

    Borly, L; Anderson, I B; Bardram, Linda

    1999-01-01

    BACKGROUND: After cholecystectomy for symptomatic gallstone disease 20%-30% of the patients continue to have abdominal pain. The aim of this study was to investigate whether preoperative variables could predict the symptomatic outcome after cholecystectomy. METHODS: One hundred and two patients w...

  14. Symptomatic vitelline duct anomalies in children | Ameh | South ...

    African Journals Online (AJOL)

    A wide variety of anomalies may occur as a result of the vitelline duct (VD) failing to obliterate completely. Most reports on symptomatic VD focus on Meckel\\'s diverticulum, while other anomalies are given little attention. A retrospective review was conducted at our institution. According to the records 18 symptomatic children ...

  15. Huge Symptomatic Brenner Tumour Simulating Uterine Fibroid: A ...

    African Journals Online (AJOL)

    Alasia Datonye

    Background. Brenner tumours are rare ovarian neoplasms which are frequently so small and symptomless as to be incidental findings at laparotomies for other conditions. The occurrence of a huge symptomatic Brenner tumour is even rarer in our environment. Our objective is to report a case of huge symptomatic Brenner ...

  16. Symptomatic HIV infection in infancy - clinical and laboratory ...

    African Journals Online (AJOL)

    Symptomatic HIV infection in infancy - clinical and laboratory markers of infection. M.P. Meyer, Z Latief, C Haworth, S Salie, A van Dyk. Abstract. 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 ...

  17. 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.

  18. 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.

  19. 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.

  20. Improving the encapsulation efficiency and sustained release behaviour of chitosan/β-lactoglobulin double-coated microparticles by palmitic acid grafting.

    Science.gov (United States)

    Yang, Han-Joo; Lee, Pei Sia; Choe, Jaehyeog; Suh, Seokjin; Ko, Sanghoon

    2017-04-01

    Chitosan (CS) was grafted with 0.1 and 0.5% (w/v) palmitic acid (PA) to improve its encapsulation efficiency (EE) and sustained release characteristics when forming CS microparticles. Thereafter, PA-grafted CS (PA-CS) microparticles were coated with denatured β-lactoglobulin (βlg), which forms an outer protective layer. The possibility of hydrophobic interaction with the hydrophobic substances in the CS microparticles increased as the proportion of the grafted PA increased. EE was measured as 64.79, 83.72, and 85.00% for the non-grafted, 0.1, and 0.5% PA-CS microparticles, respectively. In simulated small intestinal conditions, 4.66 and 17.55% of the core material release in the PA-CS microparticles were sustained after 180min by 0.1, and 0.5% PA grafting, respectively. PA grafting enables the sustained release in simulated gastrointestinal fluids by enhancing the hydrophobic interaction between CS and the hydrophobic core material. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. 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

  2. Different operative findings of cases predicted to be symptomatic discal pseudocysts after percutaneous endoscopic lumbar discectomy

    Science.gov (United States)

    Shiboi, Ryutaro; Oshima, Yasushi; Kaneko, Takeshi; Takano, Yuichi; Inanami, Hirohiko

    2017-01-01

    Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive treatment for lumbar disc herniation (LDH). This report focused on one of the rare complications of PELD: symptomatic postoperative discal pseudocyst (PDP). A 27-year-old male patient (case 1) presented with recurrent radiculopathy in his left leg. Twenty days previously, he had undergone PELD for left L4/5 LDH and his symptoms temporarily improved. A 14-year-old female patient (case 2) also developed recurrent pain in her left leg. Thirty days previously, she had undergone PELD for left L4/5 LDH and her symptoms disappeared. On the basis of the finding of an expandable round lesion at the evacuated sites of LDH on magnetic resonance imaging (MRI), with low intensity of T1-weighted imaging and high intensity on T2-weighted imaging, we predicted symptomatic PDP in both cases. Given the progressive leg pain in both cases, surgical treatments were adopted (case 1: microendoscopic discectomy, case 2: PELD). During the operation, we confirmed that case 1 was a simple recurrence of LDH and case 2 was symptomatic PDP. Previous studies on symptomatic PDP included cases diagnosed without operative findings. Therefore, it should be carefully considered that such cases might be a simple recurrence of LDH. PMID:28744506

  3. 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.

  4. Endarterectomy for a symptomatic carotid web.

    Science.gov (United States)

    Phair, John; Trestman, Eric B; Yean, Chetra; Lipsitz, Evan C

    2017-10-01

    Background We report a symptomatic carotid web successfully treated with carotid endarterectomy. A healthy 43-year-old woman presented with acute-onset left-sided weakness. Carotid web was evident on computed tomography angiography as a focal filling defect in the right common carotid artery. This right common carotid artery web extended into the ICA created an eddy resulting in turbulent flow. Subsequent acute embolus formation led to embolization and acute stroke. Method Review of the literature was performed using Medline Plus and PubMed databases. Result The patient underwent carotid endarterectomy with primary closure. Procedure was well tolerated and there was an uneventful recovery. Conclusion Arterial webs are a rare arteriopathy and a usual arrangement of fibromuscular intralumenal in-growth with unclear etiology. It is however, an important potential etiology of stroke in patients without traditional atherosclerotic risk factors. Carotid web and atypical carotid fibromuscular dysplasia should be considered in young, otherwise healthy patients presenting with stroke and without the typical risk factors for atherosclerotic carotid disease and stroke.

  5. Obesity and symptomatic osteoarthritis of the knee.

    Science.gov (United States)

    Sridhar, M S; Jarrett, C D; Xerogeanes, J W; Labib, S A

    2012-04-01

    Given the growing prevalence of obesity around the world and its association with osteoarthritis of the knee, orthopaedic surgeons need to be familiar with the management of the obese patient with degenerative knee pain. The precise mechanism by which obesity leads to osteoarthritis remains unknown, but is likely to be due to a combination of mechanical, humoral and genetic factors. Weight loss has clear medical benefits for the obese patient and seems to be a logical way of relieving joint pain associated with degenerative arthritis. There are a variety of ways in which this may be done including diet and exercise, and treatment with drugs and bariatric surgery. Whether substantial weight loss can delay or even reverse the symptoms associated with osteoarthritis remains to be seen. Surgery for osteoarthritis in the obese patient can be technically more challenging and carries a risk of additional complications. Substantial weight loss before undertaking total knee replacement is advisable. More prospective studies that evaluate the effect of significant weight loss on the evolution of symptomatic osteoarthritis of the knee are needed so that orthopaedic surgeons can treat this patient group appropriately.

  6. [Laparoscopic management of symptomatic urachal anomalies].

    Science.gov (United States)

    Sánchez-Ismayel, Alexis; Cruz-González, Germán; Sánchez, Renata; Sánchez-Salas, Rodolfo; Rodríguez, Omaira; Sanabria, Erasmo; Sotelo, Rene; Sánchez-Salas, Rafael E

    2009-03-01

    Acquired urachal anomalies are a rare pathology. Gold-standard treatment for this clinical situation remains the resection of the urachus in its entire tract with or without partial resection of the bladder. Our aim is to up-date authors's experience in the minimally invasive surgical treatment of acquired urachal disease. From 2001 to 2007, 14 patients were operated for acquired urachal disease at our institution. A three portal technique previously described by the authors was employed. The diagnosis of acquired uracal disease was confirmed in all cases and the resection of the urachus in its entire tract performed in cephalocaudal direction onto the bladder. Operative and demographic data was prospectively collected and analysis retrospectively performed. Mean operative time was 63 minutes (45,110), minimal blood loss, and no conversions to open surgery or perioperative complications were verified. The majority of the patients were discharged in the first 24 hours. At a follow-up of 22 months no recurrences of urachal pathology recurrences have been verified. Laparoscopy plays a significant role in the management of symptomatic urachus anomalies. It allows objective confirmation of clinical diagnosis and adequate resection of the urachus in a safe and efficient fashion, while providing the well-known advantages of minimally acces surgery. Preoperative evaluation work-up has minimal impact of therapeutical decision.

  7. 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

  8. Redistribution of myocardial perfusion during permanent dual chamber pacing in symptomatic non-obstructive hypertrophic cardiomyopathy : A quantitative positron emission tomography study

    NARCIS (Netherlands)

    Posma, JL; Blanksma, PK; vanderWall, EE

    Dual chamber pacing causes significant symptomatic improvement in many patients with hypertrophic cardiomyopathy. The mechanism behind this beneficial response is not fully understood. Positron emission tomography showed a redistribution of myocardial flow during pacing in a patient with

  9. Comparison of the Bacterial Composition and Structure in Symptomatic and Asymptomatic Endodontic Infections Associated with Root-Filled Teeth Using Pyrosequencing: e84960

    National Research Council Canada - National Science Library

    Annette Carola Anderson; Ali Al-Ahmad; Fadil Elamin; Daniel Jonas; Yousra Mirghani; Markus Schilhabel; Lamprini Karygianni; Elmar Hellwig; Ateequr Rehman

    2013-01-01

    .... Understanding of the bacterial content could improve treatment protocols. Fifty samples from 25 symptomatic and 25 asymptomatic previously root-filled teeth were collected from Sudanese patients with periradicular lesions...

  10. A multi-professional educational intervention to improve and sustain respondents' confidence to deliver palliative care: A mixed-methods study.

    Science.gov (United States)

    Reed, Elizabeth; Todd, Jennifer; Lawton, Sally; Grant, Robert; Sadler, Clair; Berg, Jane; Lucas, Caroline; Watson, Max

    2017-06-01

    Education has been highlighted as fundamental in equipping healthcare professionals with essential knowledge and skills to provide good end-of-life care. Multiprofessional educational programmes have a positive influence on knowledge, attitude and confidence but few have sought to understand the longer term impact on care delivery. The European Certificate in Essential Palliative Care is an 8-week home-study-based programme for healthcare professionals and is currently run in nine centres. Successful candidates have undertaken the course from their own countries around the world. This article describes the evaluation of the European Certificate in Essential Palliative Care which has been evolving over 15 years. To evaluate the impact an educational intervention has on participants' confidence in palliative care, to determine whether this is sustained over time and explore participants' perception of the influence of the course on confidence. A mixed-method longitudinal approach. A survey using a self-efficacy scale was emailed to 342 candidates who received an educational intervention and semi-structured interviews to a sub-sample of 15 candidates at baseline, 3 and 6 months. At 3 months, candidates had almost 20 times higher odds of being above any given level of confidence than at baseline which was sustained at 6 months. Qualitative analysis identified examples of increased competence and confidence improving palliative care delivery. Findings suggest that the European Certificate in Essential Palliative Care improves confidence in palliative care and that this is sustained over time with evidence of confidence in symptom control, communication and a holistic approach in clinical practice.

  11. Achieving and Sustaining Zero: Preventing Surgical Site Infections After Isolated Coronary Artery Bypass With Saphenous Vein Harvest Site Through Implementation of a Staff-Driven Quality Improvement Process.

    Science.gov (United States)

    Kles, Candis Lee; Murrah, C Patrick; Smith, Kerry; Baugus-Wellmeier, Elizabeth; Hurry, Terri; Morris, Cullen D

    2015-01-01

    Surgical site infections (SSI) increase morbidity and mortality, hospital costs, length of stay, readmissions, and risk of litigation and may impact a facility's reputation. Through implementation of a Six Sigma, interdisciplinary team process and the Contextual Model for change engaged all stakeholders. A total of 44 perioperative processes were evaluated, with 15 processes ultimately altered. Revisions involved identifying inconsistent implementation of procedures and standardizing processes, as well as utilizing new suture techniques and products including disposable electrocardiogram leads and pacing wires, antibiotic-coated sutures, and silver-impregnated midsternal dressings. In isolated coronary artery bypass grafting with donor-site procedures, an incidence of 3.74 per 100 procedures was reduced to 0.7 and ultimately to 0. No patients who underwent coronary artery bypass grafting developed a deep sternal wound infection in over 30 months and 590 procedures, resulting in an estimated cost savings of more than $600 000, from May 2012 through December 2014. A significant reduction in deep sternal wound infections was achieved by working at all levels of the organization through a multidisciplinary approach to create sustained change. Using real-time observations for current practices, areas for improvement were identified. By engaging frontline staff in the process, ownership of the outcomes and adherence to practice change were promoted. The result was a dramatic, rapid, and sustainable improvement in the prevention of deep sternal wound infection.

  12. 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...

  13. A symptomatic giant hepatic hemangioma treated with hepatectomy.

    Science.gov (United States)

    Uetama, Toshifumi; Yoshida, Hiroshi; Hirakata, Atsushi; Yokoyama, Tadashi; Maruyama, Hiroshi; Suzuki, Seiji; Matsutani, Takeshi; Matsushita, Akira; Sasajima, Koji; Uchida, Eiji

    2011-01-01

    We describe a patient with symptomatic giant hepatic hemangioma treated with hepatectomy. A 53-year-old woman presented with upper abdominal distension and appetite loss. The medical history included multiple hepatic hemangiomas that had been detected 2 years earlier but were left untreated. Initial laboratory tests revealed pancytopenia and mild coagulopathy. Computed tomography and magnetic resonance imaging demonstrated a giant hemangioma, 27 cm in diameter, in the enlarged right lobe of the liver. The inferior vena cava was compressed by tumor without thrombus in the infrahepatic vena cava. The portal venous phase of supramesenteric arteriography revealed compression of the portal vein. There were several hemangiomas in the left lobe. Gastric outlet obstruction due to giant hepatic hemangioma in the right lobe was diagnosed. Laparotomy was performed, and a markedly enlarged liver was detected. Right hepatectomy was performed with an anterior approach. The liver-hanging maneuver could not be performed because of tumor compression of the inferior vena cava. Right hepatectomy was performed with intermittent clamping (Pringle maneuver). Hepatic hemangiomas of the left lobe were not resected because the remnant liver would be reduced. The weight of the resected specimen was 2,100 g. Pathologic examination of the surgical specimen confirmed the presence of benign hepatic hemangiomas. The postoperative course was uneventful, and the patient's appetite improved. The patient was discharged 8 days after the operation. Abdominal distension decreased and laboratory data improved after the operation. Computed tomography revealed hypertrophy of the left lobe of the liver after the operation.

  14. Clinical outcomes of symptomatic arterioportal fistulas after transcatheter arterial embolization.

    Science.gov (United States)

    Hirakawa, Masakazu; Nishie, Akihiro; Asayama, Yoshiki; Ishigami, Kousei; Ushijima, Yasuhiro; Fujita, Nobuhiro; Honda, Hiroshi

    2013-02-28

    To evaluate the complications and clinical outcomes of transcatheter arterial embolization (TAE) for symptoms related to severe arterioportal fistulas (APFs). Six patients (3 males, 3 females; mean age, 63.8 years; age range, 60-71 years) with chronic liver disease and severe APFs due to percutaneous intrahepatic treatment (n = 5) and portal vein (PV) tumor thrombosis of hepatocellular carcinoma (n = 1) underwent TAE for symptoms related to severe APFs [refractory ascites (n = 4), hemorrhoidal hemorrhage (n = 1), and hepatic encephalopathy (n = 1)]. Control of symptoms related to APFs and complications were evaluated during the follow-up period (range, 4-57 mo). In all patients, celiac angiography revealed immediate retrograde visualization of the main PV before TAE, indicating severe APF. Selective TAE for the hepatic arteries was performed using metallic coils (MC, n = 4) and both MCs and n-butyl cyanoacrylate (n = 2). Three patients underwent repeated TAEs for residual APFs and ascites. Four patients developed PV thrombosis after TAE. During the follow-up period after TAE, APF obliteration and symptomatic improvement were obtained in all patients. Although TAE for severe APFs may sometimes be complicated by PV thrombosis, TAE can be an effective treatment to improve clinical symptoms related to severe APFs.

  15. Balloon-Assisted Fistula Sealing Procedure for Symptomatic Tarlov Cysts.

    Science.gov (United States)

    Zheng, Xuesheng; Li, Shiting; Sheng, Hansong; Feng, Baohui; Zhang, Nu; Xie, Chaoran

    2016-04-01

    Tarlov cyst is an abnormal expansion of the spinal nerve sleeve, and it communicates with the subarachnoid cavity via a perineural fistula. This study presents our experience of a balloon-assisted fistula sealing procedure in treating Tarlov cyst. Twenty-two patients with symptomatic Tarlov cysts were surgically treated. An emulsion balloon was placed into the lumbar subarachnoid cistern through a trocar, so as to temporarily block cerebrospinal fluid flow, then the thecal sac was opened and the inlet of the fistula was sealed by suture of a muscular patch and reinforced by fibrin glue. Finally, the cyst wall was imbricated and the bony cavity was filled with pedicled muscle flaps. Comparing the preoperative and postoperative pain scores according to visual analog scale, 2 patients were slightly improved and 18 patients were substantially improved, including 3 completely pain-free cases. Only 2 patients were unchanged in pain, and both of them had multiple cysts. As a whole, the postoperative pain score was much better than the preoperative score (2.4 vs. 7.5; P Tarlov cyst, especially for the single cyst. It is a good complement to the cyst wall imbricating procedure. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. 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.

  17. 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

  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. Sustainable restaurants: A research agenda

    African Journals Online (AJOL)

    transition to more sustainable hotel and catering businesses. ... what the determining factors are in a guest's intention to go to a green .... as hedonistic, and if we assume that a sustainable dish costs .... they have further room for improvement.

  20. Methods for Improvement of the Ecosystem Services of Soil by Sustainable Land Management in the Myjava River Basin

    Science.gov (United States)

    Korbeľová, Lenka; Kohnová, Silvia

    2017-03-01

    The main aim of this study is the development of methods for the assessment of the ecosystem services (ESS) of soils within the RECARE project and the participatory identification of measures to combat soil threats caused by floods in the Myjava River basin. The Myjava Hills highlands are known for their rapid runoff response and related muddy floods, which are determined by both the natural and socio-economic conditions. Within the frame of the mentioned project, the ESS framework with detailed relationships between the ecology, societal response, driving forces and also human well-being was identified. Next, to assess the SLM practices in the pilot basin, the stakeholders, who showed an interest in solving the flood protection problems in their areas, took an active part in the process of evaluating, scoring and selecting the best sustainable land management practices (SLM) for the flood protection of soil. From the results which were proposed, the technology of vegetative strips was top rated within the total results among all the SLM measures in all the categories, followed by water-retaining ditches and small wooden dams. Building a polder least meets the proposed SLM criteria.

  1. 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.

  2. Endovascular Management for Symptomatic Chronic Mesenteric Ischemia: A Single-Center Experience.

    Science.gov (United States)

    Guo, Baolei; Guo, Daqiao; Xu, Xin; Chen, Bin; Jiang, Junhao; Yang, Jue; Shi, Zhenyu; Fu, Weiguo

    2017-10-01

    Chronic mesenteric ischemia (CMI) is an uncommon condition encountered by clinicians. Presentation may vary from asymptomatic to classical intestinal ischemia, although a clear pathophysiology has yet to be elucidated. Here, we have presented our institution's experience in the management of symptomatic CMI. From February 2007 to February 2016, a retrospective study was performed of all consecutive patients with symptomatic CMI managed by endovascular treatment (ET). We reviewed these patients' demographics, comorbidities, clinical presentations, and treatment modalities. Perioperative and midterm outcomes included technical success, clinical symptom relief, complications, symptomatic recurrence, mortality, restenosis, and reintervention. Thirty-five mesenteric arteries (74.3% stenotic/25.7% occluded) identified in 32 patients (12 females, 20 males) were treated with endovascular procedures. There were no 30-day deaths; the perioperative complication rate was 12.5%. Overall, the median postprocedural time to symptom relief was 7.6 days (range: 1-30 days). Twenty-two (68.8%) had complete remission of symptom, whereas 7 (21.9%) had partial improvement in symptom after ET. After a mean follow-up of 35.4 (25.9) months, 5 (15.6%) patients developed recurrent symptoms, with 4 requiring reinterventions. The primary patency was 93.7%, 82.6%, and 73.1% at 12, 24, and 36 months, respectively, and the freedom from symptomatic recurrence was 90.6%, 84.0%, 84.0%, and 84.0% at 6, 12, 24, and 36 months, respectively. Endovascular treatment for patients with CMI had a high technical success rate and satisfactory clinical outcomes. Symptomatic recurrence was not frequent but found mainly within 12 months following the initial procedure.

  3. 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.

  4. 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

  5. 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...

  6. 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

  7. A sample theory-based logic model to improve program development, implementation, and sustainability of Farm to School programs.

    Science.gov (United States)

    Ratcliffe, Michelle M

    2012-08-01

    Farm to School programs hold promise to address childhood obesity. These programs may increase students’ access to healthier foods, increase students’ knowledge of and desire to eat these foods, and increase their consumption of them. Implementing Farm to School programs requires the involvement of multiple people, including nutrition services, educators, and food producers. Because these groups have not traditionally worked together and each has different goals, it is important to demonstrate how Farm to School programs that are designed to decrease childhood obesity may also address others’ objectives, such as academic achievement and economic development. A logic model is an effective tool to help articulate a shared vision for how Farm to School programs may work to accomplish multiple goals. Furthermore, there is evidence that programs based on theory are more likely to be effective at changing individuals’ behaviors. Logic models based on theory may help to explain how a program works, aid in efficient and sustained implementation, and support the development of a coherent evaluation plan. This article presents a sample theory-based logic model for Farm to School programs. The presented logic model is informed by the polytheoretical model for food and garden-based education in school settings (PMFGBE). The logic model has been applied to multiple settings, including Farm to School program development and evaluation in urban and rural school districts. This article also includes a brief discussion on the development of the PMFGBE, a detailed explanation of how Farm to School programs may enhance the curricular, physical, and social learning environments of schools, and suggestions for the applicability of the logic model for practitioners, researchers, and policy makers.

  8. 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.

  9. 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

  10. Improvements in physical function and pain sustained for up to 10 years after knee or hip arthroplasty irrespective of mental health status before surgery.

    Science.gov (United States)

    Geeske Peeters, G M E E; Rainbird, Sophia; Lorimer, Michelle; Dobson, Annette J; Mishra, Gita D; Graves, Stephen E

    2017-04-01

    Background and purpose - There are concerns that mental health (MH) may influence outcomes of total knee arthroplasty (TKA) or total hip arthroplasty (THA). We examined effects of poor MH before surgery on long-term outcomes of osteoarthritis-related TKA or THA in women. Patients and methods - The data were from 9,737 middle-aged participants (47-52 years) and 9,292 older participants (73-78 years) in the Australian Longitudinal Study on Women's Health who completed surveys between 1998 and 2013. Dates of arthroplasties were obtained from the Australian Orthopaedics Association National Joint Replacement Registry. Participants without procedures were matched with participants with procedures. Trajectories of the Short-Form 36 scores for physical functioning, bodily pain, social functioning, and mental health based on mixed modeling were plotted for participants with and without surgery (stratified according to mental health, separately for TKA and THA, and for middle-aged and older participants). Results - In middle-aged women with poor and good MH, TKA improved physical function and reduced bodily pain, with improvements sustained up to 10 years after surgery. TKA contributed to restoration of social function in women with good MH, but this was less clear in women with poor MH. In both MH groups, mental health appeared to be unaffected by TKA. Similar patterns were observed after THA, and in older women. Interpretation - Recovery of physical and social function and reductions in pain were sustained for up to 10 years after surgery. Improvements in physical function and pain were also observed in women with poor mental health. Thus, in our view poor mental health should not be a contraindication for arthroplasty.

  11. 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)

    De Rosis, Sabina; Nuti, Sabina

    2017-08-08

    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. © 2017 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.

  12. Mechanisms of symptomatic spinal cord ischemia after TEVAR

    DEFF Research Database (Denmark)

    Czerny, Martin; Eggebrecht, Holger; Sodeck, Gottfried

    2012-01-01

    To test the hypothesis that simultaneous closure of at least 2 independent vascular territories supplying the spinal cord and/or prolonged hypotension may be associated with symptomatic spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR)....

  13. Surgical aspects of symptomatic cholecystolithiasis and acute cholecystitis

    NARCIS (Netherlands)

    Keus, F.; Broeders, I. A. M. J.; van Laarhoven, C. J. H. M.

    2006-01-01

    Indications for cholecystectomy are limited to clearly symptomatic gallstones. Relatively high failure rates of pain relief are probably caused by incorrect selection of patients for the operation. Contraindications for (laparoscopic) cholecystectomy are related to anaesthesiological considerations.

  14. 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.

  15. Symptomatic Diverticulosis Is Characterized By Loose Stools.

    Science.gov (United States)

    Järbrink-Sehgal, M Ellionore; Andreasson, Anna; Talley, Nicholas J; Agréus, Lars; Song, Jeong-Yeop; Schmidt, Peter T

    2016-12-01

    Symptomatic uncomplicated diverticular disease is considered to be a discreet clinical entity distinct from irritable bowel syndrome (IBS), but population-based data are unavailable. We aimed to investigate the prevalence and location of diverticulosis in the general population, and its association with colonic symptoms and mental health. We propose that individuals with diverticulosis would report more constipation and IBS. We performed a population-based study of randomly selected adults born in Sweden (age, 18-70 y; 57.2% women); 745 received a gastroenterology consultation, completed validated abdominal symptom and mental health questionnaires, and were examined by colonoscopy. Logistic regression was used to calculate the associations between diverticulosis and age, sex, gastrointestinal symptoms, anxiety, depression, and self-rated health. Among the 742 participants (54.6% women), 130 (17.5%) had diverticulosis. Age was the strongest predictor of diverticulosis (P diverticulosis was rare in participants younger than 40 years (0.7%). All participants with diverticulosis had sigmoid involvement. Participants with diverticulosis were more likely to report loose stools (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.20-2.96), urgency (OR, 1.64; 95% CI, 1.02-2.63), passing mucus (OR, 2.26; 95% CI, 1.08-4.72), and a high stool frequency (OR, 2.02; 95% CI, 1.11-3.65). Diverticulosis was associated with abdominal pain (OR, 2.10; 95% CI, 1.01-4.36; P = .047) and diarrhea-predominant IBS (OR, 9.55; 95% CI, 1.08-84.08; P = .04) in participants older than 60 years. The presence of anxiety and depression and self-rated health were similar in participants with and without diverticulosis. The prevalence of diverticulosis is age-dependent. Diverticulosis is associated with diarrhea in subjects across all age ranges. In subjects older than age 60, diverticulosis is associated with abdominal pain and diarrhea-predominant IBS. Copyright © 2016 AGA Institute

  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. 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.

  18. 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

  19. 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...

  20. Conservative management of symptomatic knee osteoarthritis: a flawed strategy?

    Directory of Open Access Journals (Sweden)

    Dennis C. Crawford

    2013-02-01

    Full Text Available Conservative management of medial compartment knee osteoarthritis (OA is a misleading term used to describe the application of medical, orthotic, and/or rehabilitative therapies exclusive of surgical interventions. The implication of this nomenclature is that these therapies offer satisfactory symptom relief, alter disease progression, and have limited side effects. Unfortunately, conservative therapeutic options possesses few, if any, characteristics of an ideal treatment, namely one that significantly alleviates pain, improves knee function, and reduces medial compartmental loading without adverse side effects. As uncompensated mechanical loading is a primary culprit in the development and progression of knee OA, we propose that the therapeutic perspective of conservative treatment should shift from pharmacological treatments, which have no influence on joint loading, minimal potential to alter joint function, substantial associated risks, and significant financial costs, towards minimally invasive load absorbing therapeutic interventions. A safe and effective minimally invasive medical device specifically engineered for symptomatic relief of medial knee OA by limiting joint contact forces has the potential to reduce the clinical and economic knee OA burden. This review characterizes the current standard of care recommendations for conservative management of medial compartment knee OA with respect to treatment efficacy, risk profile, and economic burden.

  1. Conductive keratoplasty for symptomatic presbyopia following monofocal intraocular lens implantation.

    Science.gov (United States)

    Ye, Panpan; Xu, Wen; Tang, Xiajing; Yao, Ke; Li, Zhaochun; Xu, Hesheng; Shi, Junting

    2011-07-01

    To evaluate the visual outcomes of conductive keratoplasty for relief of symptomatic presbyopia of pseudophakia with monofocal intraocular lens implantation. It was a prospective clinical study and set in Eye Center, Second Affiliated Hospital, Zhejiang University. This study comprised 27 eyes from 27 patients with presbyopia symptom. The patients received conductive keratoplasty via monovision approach after monofocal intraocular lens implantation and were followed up at 1 week and 1, 3, 6 and 12 months postoperatively. The main outcomes including uncorrected near visual acuity, uncorrected distance visual acuity, best spectacle-corrected visual acuity, manifest refraction spherical equivalent, keratometric astigmatism, contrast and glare sensitivity, spherical aberration and pseudoaccommodation were evaluated. Twelve months after conductive keratoplasty, the binocular uncorrected near visual acuity was significantly improved from logMAR 0.88 ± 0.16 preoperatively to logMAR 0.30 ± 0.13 (P presbyopia of pseudophakia with monofocal intraocular lens implantation. © 2011 The Authors. Clinical and Experimental Ophthalmology © 2011 Royal Australian and New Zealand College of Ophthalmologists.

  2. Epidemiology of Acute Symptomatic Seizures among Adult Medical Admissions

    Directory of Open Access Journals (Sweden)

    Paul Osemeke Nwani

    2016-01-01

    Full Text Available Acute symptomatic seizures are seizures occurring in close temporal relationship with an acute central nervous system (CNS insult. The objective of the study was to determine the frequency of presentation and etiological risk factors of acute symptomatic seizures among adult medical admissions. It was a two-year retrospective study of the medical files of adults patients admitted with acute symptomatic seizures as the first presenting event. There were 94 cases of acute symptomatic seizures accounting for 5.2% (95% CI: 4.17–6.23 of the 1,802 medical admissions during the period under review. There were 49 (52.1% males and 45 (47.9% females aged between 18 years and 84 years. The etiological risk factors of acute symptomatic seizures were infections in 36.2% (n=34 of cases, stroke in 29.8% (n=28, metabolic in 12.8% (n=12, toxic in 10.6% (n=10, and other causes in 10.6% (n=10. Infective causes were more among those below fifty years while stroke was more in those aged fifty years and above. CNS infections and stroke were the prominent causes of acute symptomatic seizures. This is an evidence of the “double tragedy” facing developing countries, the unresolved threat of infectious diseases on one hand and the increasing impact of noncommunicable diseases on the other one.

  3. A Road to Sustainable Development of Chinese Cities: A Perception of Improving Urban Management Efficiency Based on Two-Level Production Factors

    Directory of Open Access Journals (Sweden)

    Ze Xu

    2017-11-01

    Full Text Available It is an inevitable requirement of regional governance and sustainable development to improve urban management efficiency (UME. Different from the previous studies, this paper gives it a new meaning based on the production factors theories. Then the paper analyzes the response of UME to the primary production factors (PPFs characterized by the traditional production factors theory (land, labor, and capital, and the expanded production factors (EPFs reflected by the modern production factors theory (energy and ecology. By analyzing UME in China’s 334 cities on global and local scales, this paper found four characteristics of UME: (1 the striking spatial differences; (2 the strong correlation between management models; (3 the evident development emphasis; and (4 the weak matching linkage. Finally, we put forward the countermeasures of spatial governance, including strengthening the agglomeration effect, promoting diversified development models on different scales, and accelerating resource coordination and sharing.

  4. Co-production as deep engagement: Improving and sustaining access to clean water in Ghana and Nigeria

    OpenAIRE

    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 co-production, as is already being done in developed countries in the fields of care-giving, waste management, healthcare and community policing, could provide a successful strategy. The purpose of this paper is ...

  5. 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.

  6. 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

    NARCIS (Netherlands)

    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; Kleef, van Ellen

    2017-01-01

    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

  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. 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.

  9. 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.

  10. Sustainable agriculture

    National Research Council Canada - National Science Library

    Lichtfouse, Eric

    2009-01-01

    ... : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : 9 Part I CLIMATE CHANGE Soils and Sustainable Agriculture: A Review : : : : : : : : : : : : : : : : : : : : : : : : : : Rattan Lal 15 Soils and Food Sufficiency...

  11. 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

  12. 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.

  13. 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

  14. Aiming to be NEAT: safely improving and sustaining access to emergency care in a tertiary referral hospital.

    Science.gov (United States)

    Sullivan, Clair M; Staib, Andrew; Flores, Judy; Aggarwal, Leena; Scanlon, Alan; Martin, Jennifer H; Scott, Ian A

    2014-11-01

    To implement and evaluate strategies for improving access to emergency department (ED) care in a tertiary hospital. A retrospective pre-post intervention study using routinely collected data involving all patients presenting acutely to the ED of a major tertiary hospital over a 2-year period. Main outcome measures were changes in: the percentage of patients exiting the ED (all patients, patients discharged directly from the ED, patients admitted to inpatient wards); mean patient transit times in the ED; inpatient mortality rates; rates of ED 'did not wait' and re-presentations within 48 h of ED discharge; and selected safety indicators. Qualitative data on staff perceptions of interventions were also gathered. Working groups focused on ED internal processes, ED-inpatient unit interface, hospital-wide discharge processes and performance monitoring and feedback. Twenty-five different reforms were enacted over a 9-month period from April to December 2012. Comparing the baseline period (January-March 2012) with the post-reform period (January-March 2013), the percentage of patients exiting the ED within 4 h rose for all patients presenting to the ED (from 32% to 62%), for patients discharged directly from the ED (from 41% to 75%) and for admitted patients (from 12% to 32%; PNEAT), which stipulate at least 70% of patients in the ED must exit the department within 4h, have spurred hospitals into implementing a wide range of reforms with varying levels of success in achieving such targets. WHAT DOES THIS PAPER ADD?: This study demonstrates how multiple reforms implemented in a poor performing tertiary hospital caused the proportion of patients exiting the ED within 4h to double within 9 months to reach levels comparable with best performing peer hospitals. This was associated with a 26% reduction in in-hospital mortality for admitted patients and no clinically significant adverse effects. It demonstrates the importance of robust governance structures, executive

  15. 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

  16. 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.

  17. Sustainability assessment and complementarity

    Directory of Open Access Journals (Sweden)

    Hugo F. Alrøe

    2016-03-01

    Full Text Available Sustainability assessments bring together different perspectives that pertain to sustainability to produce overall assessments, and a wealth of approaches and tools have been developed in the past decades. However, two major problems remain. The problem of integration concerns the surplus of possibilities for integration; different tools produce different assessments. The problem of implementation concerns the barrier between assessment and transformation; assessments do not lead to the expected changes in practice. We aim to analyze issues of complementarity in sustainability assessment and transformation as a key to better handling the problems of integration and implementation. Based on a generalization of Niels Bohr's complementarity from quantum mechanics, we have identified two forms of complementarity in sustainability assessment, observer stance complementarity and value complementarity. Unlike many other problems of sustainability assessment, complementarity is of a fundamental character connected to the very conditions for observation. Therefore, complementarity cannot be overcome methodologically, only handled better or worse. Science is essential to the societal goal of sustainability, but these issues of complementarity impede the constructive role of science in the transition to more sustainable structures and practices in food systems. The agencies of sustainability assessment and transformation need to be acutely aware of the importance of different perspectives and values and the complementarities that may be connected to these differences. An improved understanding of complementarity can help to better recognize and handle issues of complementarity. These deliberations have relevance not only for sustainability assessment, but more generally for transdisciplinary research on wicked problems.

  18. 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

  19. 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.

  20. 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.

  1. Cranial electrotherapy stimulation for the treatment of chronically symptomatic bipolar patients.

    Science.gov (United States)

    Amr, Mostafa; El-Wasify, Mahmoud; Elmaadawi, Ahmed Z; Roberts, R Jeannie; El-Mallakh, Rif S

    2013-06-01

    The aim of this study was to determine if cranial electrotherapy stimulation (CES) is beneficial in chronically symptomatic bipolar (CSBP) subjects. A retrospective chart review of all consecutive CSBP subjects who were prescribed CES collected demographic and clinical information. The Clinical Global Impression improved significantly [mean (SD), 2.7 (0.6) at baseline vs 2.0 (0.0), t = 0, P < 0.001], but mood symptoms change minimally. There were very few adverse effects of CES. Patients with CSBP continue to experience symptoms with CES but also are modestly improved.

  2. Interconnecting sensors and people to improve the knowledge and sustainable management in rural and alpine environment: the CIRCE project

    Science.gov (United States)

    Cavallo, Eugenio; Biddoccu, Marcella; Bagagiolo, Giorgia; De Marziis, Massimo; Gaia Forni, Emanuela; Alemanno, Laura; Ferraris, Stefano; Canone, Davide; Previati, Maurizio; Turconi, Laura; Arattano, Massimo; Coviello, Velio

    2016-04-01

    Environmental sensor monitoring is continuously developing, both in terms of quantity (i.e. measurement sites), and quality (i.e. technological innovation). Environmental monitoring is carried out by either public or private entities for their own specific purposes, such as scientific research, civil protection, support to industrial and agricultural activities, services for citizens, security, education, and information. However, the acquired dataset could be cross-appealing, hence, being interesting for purposes that diverted from their main intended use. The CIRCE project (Cooperative Internet-of-Data Rural-alpine Community Environment) aimed to gather, manage, use and distribute data obtained from sensors and from people, in a multipurpose approach. The CIRCE project was selected within a call for tender launched by Piedmont Region (in collaboration with CSI Piemonte) in order to improve the digital ecosystem represented by YUCCA, an open source platform oriented to the acquisition, sharing and reuse of data resulting both from real-time and on-demand applications. The partnership of the CIRCE project was made by scientific research bodies (IMAMOTER-CNR, IRPI-CNR, DIST) together with SMEs involved in environmental monitoring and ICT sectors (namely: 3a srl, EnviCons srl, Impresa Verde Cuneo srl, and NetValue srl). Within the project a shared network of agro-meteo-hydrological sensors has been created. Then a platform and its interface for collection, management and distribution of data has been developed. The CIRCE network is currently constituted by a total amount of 171 sensors remotely connected and originally belonging to different networks. They are settled-up in order to monitor and investigate agro-meteo-hydrological processes in different rural and mountain areas of Piedmont Region (NW-Italy), including some very sensitive locations, but difficult to access. Each sensor network differs from each other, in terms of purpose of monitoring, monitored

  3. 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

  4. Coronary calcification among 3477 asymptomatic and symptomatic individuals

    DEFF Research Database (Denmark)

    Øvrehus, Kristian A; Jasinskiene, Jurgita; Sand, Niels P

    2015-01-01

    referred for cardiac CT, to assess whether differences in CAC may be explained by symptoms or traditional cardiovascular risk factors. METHODS: The presence and extent of CAC, gender, family history of coronary artery disease, hypertension, hyperlipidaemia, diabetes and tobacco were compared in 1220......BACKGROUND: Coronary artery calcification (CAC) can be detected by cardiac computed tomography (CT), is associated to cardiovascular risk, and common in asymptomatic individuals and patients referred for cardiac CT. DESIGN: CAC was evaluated in asymptomatic individuals and symptomatic patients...... asymptomatic individuals aged 49-61 years and 2257 age-matched symptomatic patients referred for cardiac CT with suspected coronary artery disease. RESULTS: Symptomatic individuals had a higher frequency of a family history of coronary artery disease (46% vs. 23%, p 

  5. RYGB Produces more Sustained Body Weight Loss and Improvement of Glycemic Control Compared with VSG in the Diet-Induced Obese Mouse Model.

    Science.gov (United States)

    Hao, Zheng; Townsend, R Leigh; Mumphrey, Michael B; Morrison, Christopher D; Münzberg, Heike; Berthoud, Hans-Rudolf

    2017-09-01

    Weight regain and type-2 diabetes relapse has been reported in a significant proportion of vertical sleeve gastrectomy (VSG) patients in some studies, but definitive conclusions regarding the long-term comparative effectiveness of VSG and Roux-en-Y gastric bypass (RYGB) surgery are lacking both in humans and rodent models. This study's objective was to compare the effects of murine models of VSG and RYGB surgery on body weight, body composition, food intake, energy expenditure, and glycemic control. VSG, RYGB, and sham surgery was performed in high-fat diet-induced obese mice, and the effects on body weight and glycemic control were observed for a period of 12 weeks. After the initial weight loss, VSG mice regained significant amounts of body weight and fat mass that were only marginally lower than in sham-operated mice. In contrast, RYGB produced sustained loss of body weight and fat mass up to 12 weeks and drastically improved fasting insulin and HOMA-IR compared with sham-operated mice. Using weight-matched control groups, we also found that the adaptive hypometabolic response to weight loss was blunted by both VSG and RYGB, and that despite large weight/fat regain, fasting insulin and HOMA-IR were markedly improved, but not reversed, in VSG mice. VSG is less effective to lastingly suppress body weight and improve glycemic control compared with RYGB in mice. Given similar observations in many human studies, the run towards replacing RYGB with VSG is premature and should await carefully controlled randomized long-term trials with VSG and RYGB.

  6. 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.

  7. Sustainable Disruptions

    DEFF Research Database (Denmark)

    Friis, Silje Alberthe Kamille; Kjær, Lykke Bloch

    2016-01-01

    Since 2012 the Sustainable Disruptions (SD) project at the Laboratory for Sustainability at Design School Kolding (DK) has developed and tested a set of design thinking tools, specifically targeting the barriers to economically, socially, and environmentally sustainable business development....... The tools have been applied in practice in collaboration with 11 small and medium sized companies (SMEs). The study investigates these approaches to further understand how design thinking can contribute to sustainable transition in a business context. The study and the findings are relevant to organizations...... invested in the issue of sustainable business development, in particular the leaders and employees of SMEs, but also to design education seeking new ways to consciously handle and teach the complexity inherent in sustainable transformation. Findings indicate that the SD design thinking approach contributes...

  8. Computational sustainability

    CERN Document Server

    Kersting, Kristian; Morik, Katharina

    2016-01-01

    The book at hand gives an overview of the state of the art research in Computational Sustainability as well as case studies of different application scenarios. This covers topics such as renewable energy supply, energy storage and e-mobility, efficiency in data centers and networks, sustainable food and water supply, sustainable health, industrial production and quality, etc. The book describes computational methods and possible application scenarios.

  9. Sustainable winegrowing: current perspectives

    Directory of Open Access Journals (Sweden)

    Mariani A

    2015-05-01

    Full Text Available Angela Mariani,1 Antonella Vastola2 1Department of Economic and Legal Studies, University Parthenope, Naples, 2School of Agricultural, Forestry, Food and Environmental Sciences, University of Basilicata, Potenza, Italy Abstract: The winegrowing sector worldwide is strongly committed to improving environmental and social sustainability. The aim of this work, based on a literature review, is to highlight current sustainability perspectives and the related main issues. There is a broad consensus that the challenge to achieve a greater spread of sustainable practices is to enhance environmental and social sustainability while maintaining economic viability. From the producers' point of view, the priority is to bridge the still substantial knowledge gaps in terms of perceived environmental benefits, economic benefits, and costs. Thus, an increased research effort focusing on the costs and benefits of different winegrowing practices and technical assistance with implementation might support their diffusion. Moreover, targeted marketing strategies are needed to: enhance consumers' involvement and their attitude toward sustainable wine; improve understanding and use of sustainable labels and claims; and raise awareness of some environmental credentials of wine packaging, mainly with reference to lightweight glass bottles. Keywords: winegrower, sustainability, wine, consumer, marketing strategies

  10. Carbohydrate administration during a day of sustained aerobic activity improves vigilance, as assessed by a novel ambulatory monitoring device, and mood

    National Research Council Canada - National Science Library

    Lieberman, Harris R; Falco, Christina M; Slade, Steven S

    2002-01-01

    .... 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...

  11. Sustainable transformation

    DEFF Research Database (Denmark)

    Andersen, Nicolai Bo

    This paper is about sustainable transformation with a particular focus on listed buildings. It is based on the notion that sustainability is not just a question of energy conditions, but also about the building being robust. Robust architecture means that the building can be maintained and rebuilt...... theoretical lenses. It is proposed that three parameters concerning the ꞌtransformabilityꞌ of the building can contribute to a more nuanced understanding of sustainable transformation: technical aspects, programmatic requirements and narrative value. It is proposed that the concept of ꞌsustainable...

  12. A sustainable economy

    OpenAIRE

    Pawlak, J. J.

    2008-01-01

    There exists a direct correlation between improvements in standard of living and the consumption of resources. To be able to maintain the standard of living of a modern developed country, society must adapt to an economy based on sustainable processes, energy, and raw materials. The sustainable economy presents itself as a disruptive technology to the traditional economy, which is based largely on non-renewable resources. The issue seems to be more about when will we switch to a sustainabl...

  13. Sustainability of National Cohesion

    Directory of Open Access Journals (Sweden)

    Andrei Mihai Cristea

    2013-09-01

    Full Text Available In the European Union, cohesion policy is the third country after the domestic and social policy, as this policy is a tool for economic growth and also a balancing factor. Through its solidarity funds contribute to the other sectorial policies: the Common Agricultural Policy, social policy, environmental policy. This article aims to demonstrate the importance of cohesion policy in the national economy and how to improve its implementation by ensuring sustainable development and sustainable economic growth

  14. The sustainable company: new challenges and strategies for more sustainability

    Directory of Open Access Journals (Sweden)

    Victor DANCIU

    2013-09-01

    Full Text Available The sustainability becomes a model of development only if countries, industries, businesses and citizens become sustainable. The contribution of the business to a promising future should come from a fully integrated sustainability in its DNA and strategies.This paper focuses on the needed sustainable strategies for scaling up the contribution of the companies to sustainable development in the future. At the beginning, we analyze the main theoretical points of view on sustainability. Then, we explain how companies could achieve the sustainability by following the steps of a difficult process and the present performances in sustainability of large companies around the world. Finally, we suggest four strategies that businesses could design and implement in order to scaling up their sustainability in the future.The research has two important conclusions on sustainability in business. One is that the sustainability pays off if it is integrated in the DNA of the companies. The other conclusion says that the companies will succeed to make the needed transformation for achieving a better sustainability in the future only if they design and perform strategies focused on improving sustainability.

  15. The symptomatic management of multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Schapiro Randall

    2009-01-01

    Full Text Available The management of multiple sclerosis (MS revolves around disease management, symptom management, and person management. Of these, symptom management takes up the bulk of the time of the practicing physician. Some symptoms are easily managed whereas others are more difficult. Decisions have often to be made on whether to treat or to wait and watch. This article discusses the varied symptoms of MS and the approaches to management, which involves rehabilitation, pharmacological treatments, and surgical procedures. The skilled physician managing MS should be familiar with the multiple approaches to improving the quality of life of those with MS. After the diagnosis has been established and the decisions regarding treatment approaches have been made, the talk in a typical office appointment for MS usually turns to symptom management. Thus, the majority of management decisions made by the clinician revolve around that important topic. It is symptom management that will determine quality of life for those with MS, It is the basis for improving function, and, up until twenty years ago, it was the only basis for treating MS. Now, however, we can approach treatment by disease management, symptom management, and person management. The MS specialist must be well versed in all three areas.

  16. An Integrated Plan to Sustainably Enable the City of Riohacha (Colombia to Cope with Increasing Urban Flooding, while Improving Its Environmental Setting

    Directory of Open Access Journals (Sweden)

    Andrea Nardini

    2016-02-01

    Full Text Available This paper describes the emblematic situation of a Colombian coastal town seriously threatened by flooding and presents the whole process undertaken to elaborate an integrated action plan to cope with this problem, while improving the natural and built environment. Such a plan is a product of a project, winner of a National Colombian call for climate change initiatives, which included a thorough modeling process based on the MODCEL urban flood model, an articulated participatory process including a specific structured inquiry mainly aiming at providing data suited for model calibration, a creative phase to propose candidate alternative solutions and a quite integrated evaluation exercise which supported the transparent choice of the most sustainable plan alternative. The approach and the experience can be valuable for many other cases in Colombia and around the world, particularly in developing or emerging countries where data are scarce. The added value of this paper lies in showing a whole, integrated process, well articulated, where all pieces are indispensable but simple enough to be replicated in many cases. It merges the fundamental participatory component with an equally fundamental technical-scientific component of characterization, modeling and integrated evaluation. The multiple steps of the process are illustrated with sufficient detail to allow the reader to grasp what was actually done and why, providing a practical guide for other cases.

  17. The use of music with young children to improve sustained attention during a vigilance task in the presence of auditory distractions.

    Science.gov (United States)

    Wolfe, David E; Noguchi, Laura K

    2009-01-01

    The purpose of this study was to examine the use of music to sustain attention of young children during conditions of auditory distractions. Kindergarten students (N=76) were randomly assigned to one of four conditions/groups: (a) spoken story with no distraction, (b) spoken story with distraction, (c) musical story with no distraction, musical story with distraction. Participants were asked to listen to the story and to identify specific "actions" and "animals" that were presented (i.e., spoken or sung) within the story. A tally of correct responses (child pointed to correct actions/animals at appropriate times) was recorded during the listening task. Observations of participants' behaviors while listening were also made by the experimenter using narrative recording procedures. A one-way ANOVA was computed to assess the difference in mean scores across the four experimental conditions. Significant results were found. Further analysis employing a Tukey post hoc/multiple comparisons test revealed significant differences between the spoken story with distraction condition and the musical story with distraction condition. These statistical results, along with the observations of listening behaviors, were discussed in terms of providing suggestions for future research and in lending support to the use of music with young children to improve vigilance within educational and clinical settings.

  18. Perceptions of Improved Biomass and Liquefied Petroleum Gas Stoves in Puno, Peru: Implications for Promoting Sustained and Exclusive Adoption of Clean Cooking Technologies

    Directory of Open Access Journals (Sweden)

    Jacqueline Hollada

    2017-02-01

    Full Text Available Many households in low- and middle-income countries cook with inefficient biomass-burning stoves, which cause high levels of household air pollution and threaten long-term health. Although clean stoves and fuels are available, uptake and consistent use has been low. Using observations and in-depth interviews, we assessed the attitudes, preferences, and beliefs about traditional versus liquefied petroleum gas (LPG stoves in rural Puno, Peru. A total of 31 in-depth interviews were conducted with primary cooks and their families, health workers, community leaders, and improved stove contractors. Six in-home observations of meal preparation were also conducted. Six major barriers to consistent use of clean stoves were identified: (1 perceived differences in food taste and nutrition by stove type; (2 cooking niches filled by different stoves; (3 social norms related to cooking practices; (4 safety concerns; (5 comparative costs of using different stoves; and (6 lack of awareness and concern about long-term health risks. These findings suggest that to successfully reduce household air pollution, clean cooking programs and policies must consider the many factors influencing adoption beyond health, such as cost, taste, fears, and cultural traditions. These factors could be incorporated into community-based and national efforts to scale-up sustained and exclusive adoption of clean cooking.

  19. Perceptions of Improved Biomass and Liquefied Petroleum Gas Stoves in Puno, Peru: Implications for Promoting Sustained and Exclusive Adoption of Clean Cooking Technologies.

    Science.gov (United States)

    Hollada, Jacqueline; Williams, Kendra N; Miele, Catherine H; Danz, David; Harvey, Steven A; Checkley, William

    2017-02-13

    Many households in low- and middle-income countries cook with inefficient biomass-burning stoves, which cause high levels of household air pollution and threaten long-term health. Although clean stoves and fuels are available, uptake and consistent use has been low. Using observations and in-depth interviews, we assessed the attitudes, preferences, and beliefs about traditional versus liquefied petroleum gas (LPG) stoves in rural Puno, Peru. A total of 31 in-depth interviews were conducted with primary cooks and their families, health workers, community leaders, and improved stove contractors. Six in-home observations of meal preparation were also conducted. Six major barriers to consistent use of clean stoves were identified: (1) perceived differences in food taste and nutrition by stove type; (2) cooking niches filled by different stoves; (3) social norms related to cooking practices; (4) safety concerns; (5) comparative costs of using different stoves; and (6) lack of awareness and concern about long-term health risks. These findings suggest that to successfully reduce household air pollution, clean cooking programs and policies must consider the many factors influencing adoption beyond health, such as cost, taste, fears, and cultural traditions. These factors could be incorporated into community-based and national efforts to scale-up sustained and exclusive adoption of clean cooking.

  20. Locally Sustainable School Lunch Intervention Improves Hemoglobin and Hematocrit Levels and Body Mass Index among Elementary Schoolchildren in Rural West Java, Indonesia.

    Science.gov (United States)

    Sekiyama, Makiko; Roosita, Katrin; Ohtsuka, Ryutaro

    2017-08-12

    School lunch is not provided in public elementary schools in Indonesia, and students frequently buy and eat snacks at school. We hypothesized that providing a traditional Sundanese meal as school lunch would be beneficial for children in rural West Java. To test this hypothesis, we evaluated the effect of a 1-month school lunch intervention aiming at sustainability and based on children's nutritional intake, hemoglobin and hematocrit levels, and body mass index (BMI). A lunch (including rice, vegetable dish, animal protein dish, plant protein dish, and fruit) containing one-third of the recommended daily allowance of energy was offered every school day for 1 month, targeting 68 fourth-grade elementary schoolchildren. At baseline, the prevalence of anemia was 33.3%. The prevalence of stunting and underweight were 32.4% and 2.9%, respectively, whereas that of overweight and obesity combined was 17.6%, indicating a double burden of malnutrition among the subjects. During the intervention, intakes of protein ( p < 0.05), calcium ( p < 0.05), and vitamin C ( p < 0.001) significantly increased, while that of fat significantly decreased ( p < 0.001). After the intervention, hemoglobin ( p < 0.05) and hematocrit ( p < 0.05) levels were significantly improved, thereby almost halving the rate of anemia. These changes were significantly larger in the baseline anemic group than the non-anemic group ( p < 0.01). BMI significantly increased in the baseline underweight/normal group ( p < 0.001) but not in the overweight/obese group. The school lunch intervention significantly improved nutritional intakes and health statuses, implying its potential for reducing anemia and resolving the double burden of malnutrition among rural Indonesian schoolchildren.

  1. Pursuing a Low Meat Diet to Improve Both Health and Sustainability : How Can We Use the Frames that Shape Our Meals?

    NARCIS (Netherlands)

    de Boer, Joop; Aiking, H.

    2017-01-01

    This paper adds to the food, health and sustainability literature by examining the content, merits, and limitations of a frame-based approach to assist consumers on the path to a healthy and sustainable diet, focusing on reducing conventional meat consumption. The paper combined literature on frames

  2. Improved clean development mechanism and joint implementation to promote holistic sustainable development - an integrated policy and methodology for international energy collaboration

    Energy Technology Data Exchange (ETDEWEB)

    Kua Harn Wei

    2007-07-01

    The current Clean Development Mechanism/Joint Implementation framework does not emphasize on wholistic sustainability of energy projects. The Golden Standard was a good example of how this framework can be fine-tuned. However, it does not explicitly incentivize the adoption of the sustainability standards it outlines. A 4-element integrated policy strategy is proposed. A Sustainability Assessment Matrix is constructed to evaluate project proposals' sustainability performance. The Probational Sustainability Performance Demand requires continual monitoring of this performance of approved projects throughout a designated probation period. The involved countries will be awarded Sustainability Credits (measured with the matrix) in installments according to their performance within this period. The Probational Emission Reduction Demand requires investing countries to meet moderated emission reduction targets in order for them to claim the certified emission reductions/ emission reduction credits and their share of Sustainability Credits. These credits are converted into Sustainability Assistance Funds, which can be channeled back to finance either the approved projects or independent renewable energy projects in the involved countries. The MIT Energy Cost Model is used to estimate the required amount and identify the forms of such assistance package. Finally, an integrated policymaking framework is suggested to execute and monitor these interconnected policy elements. (auth)

  3. Sustainable Transportation

    DEFF Research Database (Denmark)

    Hall, Ralph P.; Gudmundsson, Henrik; Marsden, Greg

    2014-01-01

    that relate to the construction and maintenance of transportation infrastructure and the operation or use of the different transportation modes. The concept of sustainable transportation emerged in response to these concerns as part of the broader notion of sustainable development. Given the transportation...

  4. Sustaining dairy

    NARCIS (Netherlands)

    Villarreal Herrera, Georgina

    2017-01-01

    Dairy in Europe has undergone many changes in the last few years—the abolition of milk production quotas being a fundamental one. This study explores these changes in relation to the sustained social and environmental viability of the sector and how dairy processors' sustainability

  5. Sustainable Universities

    DEFF Research Database (Denmark)

    Grindsted, Thomas Skou

    2011-01-01

    . Declarations tend to have impact on three trends. Firstly, there is emerging international consensus on the university’s role and function in relation to sustainable development; secondly, the emergence of national legislation, and thirdly, an emerging international competition to be leader in sustainable...... campus performance....

  6. Sustainable Transition

    DEFF Research Database (Denmark)

    Hansen, Ole Erik; Søndergård, Bent

    2014-01-01

    of agendas/vision, technologies, actors and institutions in the emergent design of an urban mobility system based on an electric car sharing system. Why. Designing for sustainability is a fundamental challenge for future design practices; designers have to obtain an ability to contribute to sustainable...

  7. Sustainable Learning

    Science.gov (United States)

    Cadwell, Louise; Dillon, Robert

    2011-01-01

    Green schools have moved into a new era that focuses on building a culture of sustainability in every aspect of learning in schools. In the early stages of sustainability education, the focus was on recycling and turning off the lights. Now, students and adults together are moving into the areas of advocacy and action that are based on a deep…

  8. Symptomatic Uterine Leiomyoma in a 65-year old Postmenopausal ...

    African Journals Online (AJOL)

    A case of symptomatic uterine leiomyoma coexisting with cervical intraepithelial neoplasia (CIN) III in a 65-year old postmenopausal virgin is reported. She presented with constipation suggestive of intestinal obstruction with no history of previous surgery, and investigations confirmed a calcified uterine leiomyoma. She had ...

  9. Symptomatic Bochdalek Hernia in Pregnancy: A Rare Case Report.

    Science.gov (United States)

    Yetkinel, Selçuk; Pekşen, Çağhan; Kızıltan, Remzi

    2017-01-01

    Symptomatic Bochdalek hernia in pregnancy is quite rare. To the best of our knowledge, there are a total of 44 cases reported in the literature between 1959 and 2016 (Hernández-Aragon et al., 2015; Koca et al., 2016). Difficulty and delay in diagnosis may lead to life-threatening complications. We report a case of Bochdalek hernia during the 30 gestational weeks' pregnancy in whom pregnancy continued after surgical repair which resulted in term birth. Bochdalek hernia is diagnosed with an incidence of 1 in 2200-12500 live births, while symptomatic diaphragm hernia is much less in adults. The actual incidence of diaphragmatic hernias during pregnancy is still unknown. Symptoms may include abdominal distension, recurrent abdominal pain, nausea, vomiting, inability to defecate, dyspnea, and chest pain. The patient with diaphragmatic hernia may be asymptomatic until the late weeks of gestation, as in our case, or herniation may occur during advanced gestational weeks with increased intraabdominal pressure. In conclusion, diagnosis of the diaphragm hernia during pregnancy is very rare. Diagnosis is rarer in symptomatic patients due to its rarity and the duration of diagnosis may, therefore, be delayed. Diaphragm hernia should be kept in mind in symptomatic patients due to its high maternal and fetal mortality rates.

  10. Symptomatic Bochdalek Hernia in Pregnancy: A Rare Case Report

    National Research Council Canada - National Science Library

    Selçuk Yetkinel; Çağhan Pekşen; Remzi Kızıltan

    2017-01-01

    Introduction . Symptomatic Bochdalek hernia in pregnancy is quite rare. To the best of our knowledge, there are a total of 44 cases reported in the literature between 1959 and 2016 (Hernández-Aragon et al., 2015; Koca et al., 2016...

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

    African Journals Online (AJOL)

    HussamHassan

    open surgery in 3 cases and by laparoscopic surgery in 7 patients. The principle of both open and ... Conclusion: with proper selection of patients, laparoscopic deroofing of symptomatic, benign, solitary, non-parasitic hepatic cysts is safe, effective and offers .... pain, nausea, vomiting, or dyspnea. There may be a palpable ...

  12. Urinary tract infections in symptomatic pregnant women attending ...

    African Journals Online (AJOL)

    Urinary tract infections in symptomatic pregnant women attending university of Abuja teaching hospital, Gwagwalada, Nigeria. ... Overall E. coli and Staphylococcus saprophyticus were the predominant bacteria isolated (23.0% and 15.4%). Augumentin and levofloxacin had the best antibiogram profile against most of the ...

  13. Antimicrobial sensitivity pattern of symptomatic urinary tract infection ...

    African Journals Online (AJOL)

    Antimicrobial sensitivity pattern of symptomatic urinary tract infection in pregnancy in Aminu Kano Teaching Hospital. ... Most common was Proteus Mirabilis 24(33.3%), E. Coli 25(25%), staphylococcus Saprophyticus 12(16.6%) Kleibsella aerogenes 10(13.9%), Enterococcus Faecalis 6(8.3%) and Pseudomonas aeriginosa ...

  14. Symptomatic rubella re-infection in early pregnancy and subsequent ...

    African Journals Online (AJOL)

    1990-10-20

    Oct 20, 1990 ... A case of serologically proven symptomatic rubella re-infection in early pregnancy in a healthy multigravida who had been successfully vaccinated is reported to illustrate that the risk to the fetus is considerably less than with primary infection. The infant was infected, as evidenced by specific IgM in cord.

  15. Symptomatic rubella re-infection in early pregnancy and subsequent ...

    African Journals Online (AJOL)

    A case of serologically proven symptomatic rubella re-infection in early pregnancy in a healthy multigravida who had been successfully vaccinated is reported to illustrate that the risk to the fetus is considerably less than with primary infection. The infant was infected, as evidenced by specific IgM in cord blood, but had no ...

  16. Prevalence and associations of symptomatic renal papillary necrosis ...

    African Journals Online (AJOL)

    Aim: To assess the prevalence and associations of symptomatic renal papillary necrosis (RPN) in sickle cell anemia patients. Patients and Methods: The case notes of homozygous hemoglobin (Hb) S patients diagnosed with RPN were retrospectively assessed. Diagnosis was based on microscopic hematuria and positive ...

  17. 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.

  18. An Overview of the Predictors of Symptomatic Urinary Tract Infection ...

    African Journals Online (AJOL)

    students aged 18–30 years studying in the SRMSIMS, Nursing College Bareilly. A structured ... occurrence of symptomatic UTI and girls who were in the habit of using ... reason cited could be that drinking less or infrequently is a common ...

  19. Delayed treatment of symptomatic breast cancer: The experience ...

    African Journals Online (AJOL)

    Background. A cross-sectional study carried out at a teaching hospital in Kaduna, Nigeria, to investigate the extent and reasons for the delay between onset of symptoms and admission for treatment of symptomatic breast cancer. Methods. The patients had histologically proven breast cancer and had been admitted for ...

  20. Symptomatic Bochdalek Hernia in Pregnancy: A Rare Case Report

    Directory of Open Access Journals (Sweden)

    Selçuk Yetkinel

    2017-01-01

    Full Text Available Introduction. Symptomatic Bochdalek hernia in pregnancy is quite rare. To the best of our knowledge, there are a total of 44 cases reported in the literature between 1959 and 2016 (Hernández-Aragon et al., 2015; Koca et al., 2016. Difficulty and delay in diagnosis may lead to life-threatening complications. Case Report. We report a case of Bochdalek hernia during the 30 gestational weeks’ pregnancy in whom pregnancy continued after surgical repair which resulted in term birth. Discussion. Bochdalek hernia is diagnosed with an incidence of 1 in 2200–12500 live births, while symptomatic diaphragm hernia is much less in adults. The actual incidence of diaphragmatic hernias during pregnancy is still unknown. Symptoms may include abdominal distension, recurrent abdominal pain, nausea, vomiting, inability to defecate, dyspnea, and chest pain. The patient with diaphragmatic hernia may be asymptomatic until the late weeks of gestation, as in our case, or herniation may occur during advanced gestational weeks with increased intraabdominal pressure. Conclusion. In conclusion, diagnosis of the diaphragm hernia during pregnancy is very rare. Diagnosis is rarer in symptomatic patients due to its rarity and the duration of diagnosis may, therefore, be delayed. Diaphragm hernia should be kept in mind in symptomatic patients due to its high maternal and fetal mortality rates.

  1. Prevalence of nutritional rickets among symptomatic children and ...

    African Journals Online (AJOL)

    All infants and mothers had no significant history of sun exposure and calcium and vitamin D supplementation. Conclusion: The prevalence of symptomatic NR was high and more prevalent in the age groups of 6-12 months and 1-1.5 years than in the other age groups. Limited or non-sun exposure, insufficient calcium and ...

  2. Human rhinovirus infections in symptomatic and asymptomatic subjects

    Directory of Open Access Journals (Sweden)

    C.N. Camargo

    2012-12-01

    Full Text Available The role of rhinovirus asymptomatic infections in the transmission among close contacts subjects is unknown. We tested health care workers, a pair of one child and a family member and immunocompromised patients (n =191. HRV were detected on 22.9% symptomatic and 3.6% asymptomatic cases suggesting lower transmission among contacts.

  3. Propranolol Treatment of Cavernous Malformations with Symptomatic Hemorrhage.

    Science.gov (United States)

    Zabramski, Joseph M; Kalani, M Yashar S; Filippidis, Aristotelis S; Spetzler, Robert F

    2016-04-01

    Cerebral cavernous malformations are more common than generally thought, affecting approximately 1 in every 250 adults. Most of these lesions are asymptomatic or have a relatively benign course, but a small minority behave aggressively and present with recurrent episodes of symptomatic hemorrhage. A safe and effective medical treatment option for the management of this latter group would be useful. Propranolol has recently been shown to be effective in the treatment of infantile hemangioma, a close pathologic counterpart of cavernous malformations. These results suggest a potential role for propranolol treatment in the management of patients with symptomatic cavernous malformations. Low-dose propranolol (20 mg, three times daily) was used to treat 2 adult female patients in their mid- to late fifties, both of whom had symptomatic cavernous malformations and a history of repeated hemorrhage. Serial magnetic resonance imaging studies after the initiation of propranolol demonstrated regression of the lesions and no evidence of recurrent hemorrhage. Propranolol may offer a safe and effective treatment for patients who have cavernous malformations with symptomatic hemorrhage. Additional studies are needed to confirm these findings. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    African Journals Online (AJOL)

    Background/Purpose: Solitary non-parasitic cysts of the liver are commonly asymptomatic and do not require treatment. Rarely, however, the cysts become symptomatic and are then best treated surgically. The optimal surgical treatment is debatable. The aim of this study was to evaluate the role of deroofing as a safe and ...

  5. Temporary Anorgasmia Following Uterine Artery Embolization for Symptomatic Uterine Fibroids.

    Science.gov (United States)

    Speir, Ethan; Shekhani, Haris; Peters, Gail

    2017-11-01

    We report a rare case of temporary anorgasmia following uterine artery embolization (UAE) performed for symptomatic uterine fibroids. To our knowledge, this is only the second time that this complication has been reported in the literature. We briefly explore the possible pathophysiologic explanations for this complication and review the effects of UAE compared to hysterectomy on sexual functioning in women.

  6. Pelvic occupation: the challenges of treating a symptomatic tarlov cyst.

    Science.gov (United States)

    Khan, Amad; Wilson, Holly Y; Boeris, Davide; Nelson, Richard

    2017-05-04

    Tarlov (perineural) cysts are meningeal dilations of the posterior spinal nerve root sheath located in between the peri- and endoneurium. We present a patient with a symptomatic sacral Tarlov cyst and the technical challenges faced by surgically treating the lesion by disconnection of the cyst from the subarachnoid space.

  7. Mammographic profiles of women with symptomatic breast diseases ...

    African Journals Online (AJOL)

    Objectives: Most patients with breast lesions are usually anxious especially with the knowledge that breast cancer is associated with high rate of mortality and morbidity. The aim of this study is to evaluate the characteristics of breast lesion as depicted by mammography in women with symptomatic breast diseases. Methods: ...

  8. Chronic dehydration and symptomatic upper urinary tract stones in ...

    African Journals Online (AJOL)

    Chronic dehydration and symptomatic upper urinary tract stones in young adults in Ibadan, Nigeria. ... West African Journal of Medicine. Journal Home ... Patients and Methods: We reviewed all cases of renal stones referred to a single Consultant in a Teaching Hospital in Southwestern Nigeria over a two year period.

  9. Baby shampoo nasal irrigations for the symptomatic post-functional endoscopic sinus surgery patient.

    Science.gov (United States)

    Chiu, Alexander G; Palmer, James N; Woodworth, Bradford A; Doghramji, Laurel; Cohen, Michael B; Prince, Anthony; Cohen, Noam A

    2008-01-01

    Symptoms of postnasal drainage and thickened mucus are commonly seen in patients with chronic rhinosinusitis (CRS) recalcitrant to sinus surgery and conventional medical therapies. Chemical surfactants can act as a mucolytic by reducing water surface tension and have the potential to serve as an antimicrobial agent. Baby shampoo is an inexpensive, commercially available solution containing multiple chemical surfactants. This is an in vitro study of its antimicrobial effects on Pseudomonas biofilms with translation to a clinical study for use as an adjuvant nasal wash in patients with CRS who remain symptomatic despite adequate sinus surgery and conventional medical therapies. In vitro testing was performed to determine the optimal concentration of baby shampoo that disrupted preformed bacterial biofilms and inhibited biofilm formation. This concentration was then used in a prospective study of symptomatic post-functional endoscopic sinus surgery (FESS) patients who irrigated twice a day for 4 weeks. Validated outcome forms and objective smell testing was performed before and after therapy. One percent baby shampoo in normal saline was the optimal concentration for inhibition of Pseudomonas biofilm formation. Baby shampoo had no effect on the eradication of preformed Pseudomonas biofilms. Eighteen patients with CRS with an average of 2.8 surgeries were studied after irrigating with 1% baby shampoo solution. Two patients discontinued use because of minor nasal and skin irritations; 46.6% of patients experienced an overall improvement in their subjective symptoms, and 60% of patients noted improvement in specific symptoms of thickened mucus and postnasal drainage. Baby shampoo nasal irrigation has promise as an inexpensive, tolerable adjuvant to conventional medical therapies for symptomatic patients after FESS. Its greatest benefit may be in improving symptoms of thickened nasal discharge and postnasal drainage.

  10. Towards a more sustainable transport infrastructure: how spatial geological data can be utilized to improve early stage Life cycle assessment of road infrastructure

    Science.gov (United States)

    Karlsson, Caroline; Miliutenko, Sofiia; Björklund, Anna; Mörtberg, Ulla; Olofsson, Bo; Toller, Susanna

    2017-04-01

    Environmental impacts during the life cycle stages of transport infrastructure are substantial, including among other greenhouse gas (GHG) emissions, as well as resource and energy use. For transport infrastructure to be sustainable, such issues need to be integrated in the planning process. Environmental Impact Assessment (EIA) is required by the European Union (EU) in order to ensure that all environmental aspects are considered during planning of road infrastructure projects. As a part of this process, the European Commission has suggested the use of the tool life cycle assessment (LCA) for assessing life cycle energy use and GHG emissions. When analyzing life cycle impacts of the road infrastructure itself, it was shown that earthworks and materials used for the road construction have a big share in the total energy use and GHG emissions. Those aspects are largely determined by the geological conditions at the site of construction: parameters such as soil thickness, slope, bedrock quality and soil type. The geological parameters determine the amounts of earthworks (i.e. volumes of soil and rock that will be excavated and blasted), transportation need for excavated materials as well as the availability of building materials. The study presents a new geographic information system (GIS)-based approach for utilizing spatial geological data in three dimensions (i.e. length, width and depth) in order to improve estimates on earthworks during the early stages of road infrastructure planning. Three main methodological steps were undertaken: mass balance calculation, life cycle inventory analysis and spatial mapping of greenhouse gas (GHG) emissions and energy use. The proposed GIS-based approach was later evaluated by comparing with the actual values of extracted material of a real road construction project. The results showed that the estimate of filling material was the most accurate, while the estimate for excavated soil and blasted rock had a wide variation from

  11. Symptomatic vergence disorders in junior high school children in Ghana

    Directory of Open Access Journals (Sweden)

    Charles Darko-Takyi

    2016-03-01

    Full Text Available Background: Optometrists in Ghana are hampered in performing comprehensive binocular vision assessments, because of the lack of appropriate instruments leading to a paucity of data on vergence disorders and their association with asthenopia among Ghanaian school children.Aim: To establish the prevalence of symptomatic vergence disorders among junior high school (JHS children in Cape Coast Metropolis, Ghana, in their habitual (vision states and investigate if there were any associations between these disorders and specific asthenopic symptoms.Methods: A prospective cross-sectional school-based study using a multistage sample of 627 participants aged 12–17 years from JHSs in Cape Coast Metropolis. Participants completed a reliable asthenopic symptoms questionnaire and 220 participants who expressed two or more severe or very severe symptoms were selected for comprehensive binocular vision assessment in their habitual vision state.Results: The prevalence of symptomatic vergence disorders among JHS children in Cape Coast Metropolis was 14.8%. For specific symptomatic vergence disorders, the prevalence was: 1.4% basic esophoria, 1.4% basic exophoria, 8.6% convergence insufficiency, 1.8% convergence excess, 0.8% fusional vergence dysfunctions and 0.8% divergence excess. No participant had symptomatic divergence insufficiency. The study revealed significant associations between some specific symptomatic vergence disorders and specific asthenopic symptoms even though all of these asthenopic symptoms overlapped in other vergence disorders.Conclusion: Presenting complaints of specific asthenopic symptoms does not differentiate between specific types of vergence disorders. A comprehensive binocular vision assessment is vital in the diagnosis and management of these disorders to relieve asthenopia.

  12. The ROKS nomogram for predicting a second symptomatic stone episode.

    Science.gov (United States)

    Rule, Andrew D; Lieske, John C; Li, Xujian; Melton, L Joseph; Krambeck, Amy E; Bergstralh, Eric J

    2014-12-01

    Most patients with first-time kidney stones undergo limited evaluations, and few receive preventive therapy. A prediction tool for the risk of a second kidney stone episode is needed to optimize treatment strategies. We identified adult first-time symptomatic stone formers residing in Olmsted County, Minnesota, from 1984 to 2003 and manually reviewed their linked comprehensive medical records through the Rochester Epidemiology Project. Clinical characteristics in the medical record before or up to 90 days after the first stone episode were evaluated as predictors for symptomatic recurrence. A nomogram was developed from a multivariable model based on these characteristics. There were 2239 first-time adult kidney stone formers with evidence of a passed, obstructing, or infected stone causing pain or gross hematuria. Symptomatic recurrence occurred in 707 of these stone formers through 2012 (recurrence rates at 2, 5, 10, and 15 years were 11%, 20%, 31%, and 39%, respectively). A parsimonious model had the following risk factors for recurrence: younger age, male sex, white race, family history of stones, prior asymptomatic stone on imaging, prior suspected stone episode, gross hematuria, nonobstructing (asymptomatic) stone on imaging, symptomatic renal pelvic or lower-pole stone on imaging, no ureterovesicular junction stone on imaging, and uric acid stone composition. Ten-year recurrence rates varied from 12% to 56% between the first and fifth quintiles of nomogram score. The Recurrence of Kidney Stone nomogram identifies kidney stone formers at greatest risk for a second symptomatic episode. Such individuals may benefit from medical intervention and be good candidates for prevention trials. Copyright © 2014 by the American Society of Nephrology.

  13. Squatting Biomechanics in Individuals with Symptomatic Femoroacetabular Impingement.

    Science.gov (United States)

    Diamond, Laura E; Bennell, Kim L; Wrigley, Tim V; Hinman, Rana S; Oʼdonnell, John; Hodges, Paul W

    2017-08-01

    Identification of the biomechanical alterations in individuals with symptomatic femoroacetabular impingement (FAI) is critical to understand the pathology and inform treatments. Yet hip function in this condition is poorly defined. Squatting requires large hip flexion range and involves motion toward the position of hip impingement; thus, it is likely to expose modified biomechanics in these individuals. This study aimed to determine whether hip and pelvis biomechanics differ between individuals with and without symptomatic FAI during an unconstrained deep squat and a constrained squat designed to limit compensation by the pelvis and trunk. Fifteen participants with symptomatic cam-type or combined (cam plus pincer) FAI who were scheduled for arthroscopic surgery and 14 age- and sex-matched controls without FAI underwent three-dimensional motion analysis during the two squatting tasks. Trunk, pelvis, and hip kinematics and hip kinetics were compared between groups. There were no between-group differences in normalized squat depth for either task. Descent speed was slower for the FAI group during the unconstrained squat (P FAI demonstrated greater pelvic rise (P = 0.01) and hip adduction (P = 0.04) on the symptomatic side than controls. The hip external rotation moment was less in FAI patients during descent (P = 0.04), as was transverse plane hip angle variability (P = 0.04). Individuals with symptomatic FAI can squat to a depth comparable with controls, regardless of task design. When the task is constrained, FAI patients demonstrate greater ipsilateral pelvic rise and maintain a more adducted hip position, which may coincide with a compensatory strategy to avoid end range flexion as the hip approaches impingement. These biomechanical alterations may put additional stress on adjacent regions and have relevance for rehabilitation.

  14. Delayed-onset symptomatic hyphema after ab interno trabeculotomy surgery.

    Science.gov (United States)

    Ahuja, Yachna; Malihi, Mehrdad; Sit, Arthur J

    2012-09-01

    To describe patients who have experienced delayed-onset hyphema after ab interno trabeculotomy surgery with the Trabectome (Neomedix Corp) for open-angle glaucoma. Retrospective case series. study population: Patients at Mayo Clinic, Rochester, Minnesota, who underwent Trabectome surgery between September 1, 2006, and December 31, 2010, and who had symptomatic hyphema at least 2 months after surgery. observation procedure: Patients with blurred vision at least 2 months after Trabectome surgery were examined for the presence of hyphema using a slit lamp and gonioscopy. main outcome measures: Proportion of patients experiencing delayed-onset symptomatic hyphema after Trabectome surgery. Associated factors and clinical course for these patients. Of 262 cases of Trabectome surgery, there were 12 cases of delayed-onset symptomatic hyphema (4.6%). The average age was 74.3 years (range, 66 to 82 years). Median time to onset of hyphema was 8.6 months (range, 2 to 31 months) after surgery. Symptom onset commonly occurred on awakening. The most common characteristic was maintaining a sleep position on the surgical side. Most hyphemas resolved within 1 to 2 weeks, except in 1 patient, who required trabeculectomy for a refractory intraocular pressure spike. This is a series of patients with symptomatic delayed-onset hyphema after Trabectome surgery in the absence of further surgeries or trauma. Likely mechanisms are exertion-related increase in episcleral venous pressure or ocular compression from sleeping on the surgical side, followed by sudden decompression and blood reflux. Symptomatic patients should identify and avoid associated triggers because delayed-onset hyphema may be associated with intermittent intraocular pressure spikes that may require medical or surgical treatment. Copyright © 2012 Elsevier Inc. All rights reserved.

  15. Symptomatic Fibroid Management: Systematic Review of the Literature.

    Science.gov (United States)

    Havryliuk, Yelena; Setton, Robert; Carlow, John J; Shaktman, Barry D

    2017-01-01

    Symptomatic uterine fibroids are a societal and healthcare burden with no clear consensus among medical professionals as to which procedural treatment is most appropriate for each symptomatic patient. Our purpose was to determine whether recommendations can be made regarding best practice based on review and analysis of the literature since 2006. A systematic search of journal articles relevant to the treatment of symptomatic uterine fibroids was performed within PubMed, clinical society websites, and medical device manufacturers' websites. All clinical trials published in English, representing original research, and reporting clinical outcomes associated with interventions for the management of symptomatic uterine fibroids were considered. Each article was screened and selected based on study type, content, relevance, American College of Obstetricians and Gynecologists score, and internal/external validity. Outcomes of interest were patient baseline characteristics, fibroid characteristics, procedural details, complications, and long-term follow-up. Random-effects meta-analyses were used to test the quantitative data. Assessment of 143 full-length articles through January 2016 produced 45 articles for the quantitative analysis. The weighted combined results from hysterectomy trials were compared with those from uterine-preserving fibroid studies (myomectomy, uterine artery embolization, laparoscopic radiofrequency ablation, and magnetic resonance-guided focused ultrasound). We explored trends that might guide clinicians when counseling patients who need treatment of symptomatic fibroids. We found that fibroid therapy is trending toward uterine-conserving treatments and outcomes are comparable across those treatments. Since minimally invasive options are increasing, it is important for the clinician to provide the patient with evidence-based therapeutic strategies.

  16. [Physiotherapeutic proceeding in symptomatic calcaneal spur treatment].

    Science.gov (United States)

    Kociuga, Natalia; Kociuga, Jerzy; Woldańska-Okońska, Marta; Kubsik, Anna

    Calcaneal spur is one of the most common disorders associated with foot pain. According to appearance of pain in each step during the day, it is important to find the most effective method of treatment. This article is a review of medical reports about non-operative treatment method. It shows that ultrasound therapy was the most common physical intervetion used so far, and mostly occurs to be effective. However one of the comparative studies improves higher efficiency of phonopheresis. Another comparative study, shows higher efficiency of combined ultrasound and laser therapy, than exclusive laser therapy. There haven't been found any articles that would evaluate efficacy of electrotherapy and short wave diathermy (electric field) in the treatment of mentioned disorder. Studies that describe the effect of ESWT treatment were also analyzed in this article, and all of them confirm its effectiveness in heel spur therapy, showing no side-effects. Cryotherapy also causes positive effect in treatment of this disorder. However Cryoultrasound therapy that uses the energy of two interconnected terapeutic techniques which is cryotherapy and ultrasounds, proved to be more effective.

  17. Pycnogenol® in postpartum symptomatic hemorrhoids.

    Science.gov (United States)

    Belcaro, G; Gizzi, G; Pellegrini, L; Dugall, M; Luzzi, R; Corsi, M; Ippolito, E; Ricci, A; Cesarone, M R; Ledda, A; Bottari, A; Errichi, B M

    2014-02-01

    The aim of this registry study was to evaluate the efficacy of Pycnogenol® (Horphag Research Ltd.), a standardized extract from the French maritime pine bark, to control signs/symptoms and prevent complications associated with hemorrhoids in the months after delivery in healthy women. Women with hemorrhoids after their second pregnancy were included within the third month after pregnancy. Pycnogenol dosage was 150 mg/day for 6 months. Symptoms for 4th and 3rd degree hemorrhoids were evaluated. The registry groups were comparable. For 4th degree hemorrhoids, main symptoms were reduced after 6 months in all patients, but the group using Pycnogenol in addition to standard best management showed more improvement. In patients with 3rd degree hemorrhoids, symptoms were reduced in both management groups at 6 months; with Pycnogenol the reduction in symptoms scores was significantly better. At 6 months 18/24 subjects (75%) in the Pycnogenol group were symptom-free in comparison with 14/25 (56%) in controls. In the 4th degree hemorrhoid group, 7/10 patients (70%) in the Pycnogenol group were symptom-free at 6 months in comparison with 4/11 subjects (36%) in the best management group. No significant side effects were observed. Pycnogenol appears to positively affect hemorrhoid signs and symptoms in the months after pregnancy.

  18. Packaging for Sustainability

    CERN Document Server

    Lewis, Helen; Fitzpatrick, Leanne

    2012-01-01

    The packaging industry is under pressure from regulators, customers and other stakeholders to improve packaging’s sustainability by reducing its environmental and societal impacts. This is a considerable challenge because of the complex interactions between products and their packaging, and the many roles that packaging plays in the supply chain. Packaging for Sustainability is a concise and readable handbook for practitioners who are trying to implement sustainability strategies for packaging. Industry case studies are used throughout the book to illustrate possible applications and scenarios. Packaging for Sustainability draws on the expertise of researchers and industry practitioners to provide information on business benefits, environmental issues and priorities, environmental evaluation tools, design for environment, marketing strategies, and challenges for the future.

  19. Towards Intelligently - Sustainable Cities?

    Directory of Open Access Journals (Sweden)

    Luca Salvati

    2013-04-01

    Full Text Available In the quest for achieving sustainable cities, Intelligent and Knowledge City Programmes (ICPs and KCPs represent cost-efficient strategies for improving the overall performance of urban systems. However, even though nobody argues on the desirability of making cities “smarter”, the fundamental questions of how and to what extent can ICPs and KCPs contribute to the achievement of urban sustainability lack a precise answer. In the attempt of providing a structured answer to these interrogatives, this paper presents a methodology developed for investigating the modalities through which ICPs and KCPs contribute to the achievement or urban sustainability. Results suggest that ICPs and KCPs efficacy lies in supporting cities achieve a sustainable urban metabolism through optimization, innovation and behavior changes.

  20. Effect of metoprolol on heart rate variability in symptomatic patients with mitral valve prolapse.

    Science.gov (United States)

    Taçoy, Gülten; Balcioğlu, Akif Serhat; Arslan, Uğur; Durakoğlugil, Emre; Erdem, Güliz; Ozdemir, Murat; Cengel, Atiye

    2007-06-01

    Metoprolol is widely used to eliminate symptoms in patients with mitral valve prolapse (MVP), a condition associated with enhanced sympathetic tone. In this study, effects of metoprolol on heart rate variability (HRV) indices were investigated in symptomatic patients with MVP. Thirty-nine symptomatic patients with MVP (26 women, mean age 26 +/- 7 years) and 16 age- and gender-matched controls were studied. After a baseline 24-hour Holter evaluation in all subjects, patients with MVP were started on metoprolol succinate therapy at a dose of 25 to 100 mg/d, and Holter analysis was repeated at the end of 3 months of metoprolol therapy. At the basal evaluation, all time-domain HRV indices with the exception of proportion of adjacent RR intervals differing by >50 ms in the 24-hour recording were significantly lower in patients with MVP than controls (SD of all normal-to-normal [NN] intervals, p = 0.013; SD of average NN intervals calculated during 5-minute periods of the entire recording, p = 0.03; triangular index, p = 0.025; and square root of mean squared differences in successive NN intervals, p = 0.026). After metoprolol treatment, all HRV indices significantly improved compared with baseline (SD of all NN intervals, p = 0.028; SD of average NN intervals calculated during 5-minute periods of the entire recording, p = 0.043; triangular index, p = 0.004; square root of the mean squared differences in successive NN intervals, p = 0.021; and proportion of adjacent RR intervals differing by >50 ms in the 24-hour recording, p = 0.014), and HRV indices after metoprolol treatment were similar to those of the control group (p >0.05). In conclusion, metoprolol significantly improved impaired HRV parameters in symptomatic patients with MVP.