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Active Management (active + management)
Selected AbstractsTRANSFORMING ENRON: THE VALUE OF ACTIVE MANAGEMENTJOURNAL OF APPLIED CORPORATE FINANCE, Issue 4 2001Vince Kaminski Soon after Enron was formed as a regulated gas pipeline company in 1985, economic events forced a dramatic reorganization of the company. The result was the creation of an unregulated energy trading operation whose mission was to capitalize on opportunities arising from the deregulation of the natural gas market The initial form of the new business was that of a "gas bank" in which Enron became an intermediary between buyers and sellers of gas, locking in the spread as profit. Since there was no source of liquidity to the market, Enron had to develop its own risk management system. Furthermore, the need to respond quickly to rapidly changing market conditions required that Enron flatten its organizational structure and hire new people whose skills were better suited to the new decentralized organization. The focus of the new Enron accordingly became human and intellectual capital, not physical assets. Employees were encouraged to move about the firm to staff new business ventures. And in what may well be a unique feature in corporate America, Enron's top management today uses its human capital flows to guide its allocations of financial capital. Other aspects of the Enron model include attempts to capitalize on the option (as opposed to current DCF) value of assets, recognition of the value of networks in adding value to trading platforms, and the use of mark-to-market accounting for business transactions as a means of ensuring transparency and promoting timely decision-making. [source] What is the Slowest-Yet-Normal Cervical Dilation Rate Among Nulliparous Women With Spontaneous Labor Onset?JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 4 2010Jeremy L. Neal ABSTRACT Objective: To integrate research literature that has provided insights into the cervical dilation rate that may best describe the slowest-yet-normal dilation rate among nulliparous women when beginning with criteria commonly associated with active labor onset. Data Sources: A literature search from 1950 through 2008 was conducted using the Medline electronic database, reference lists from identified articles, and other key references. Study Selection: Research reports written in English with a focus on the cervical dilation and/or labor duration of low-risk, nulliparous women with spontaneous labor onset. Data Extraction: Classic and contemporary research literature was reviewed and organized under the following subheadings: Friedman Studies, Partograph Studies, Active Management of Labor Studies, Additional Studies. Data Synthesis: An integrative review of the literature approximated the slowest-yet-normal cervical dilation rate for nulliparous women when beginning with criteria commonly associated with active labor. Conclusions: The slowest-yet-normal linear dilation rate approximates 0.5 cm/hour for low-risk, nulliparous women with spontaneous labor onset when starting at dilatations traditionally associated with active labor onset. However, this linear rate must be evaluated judiciously in light of the physiological acceleration of dilation that occurs during typical labor. Given this, cervical dilation for this population is likely slower than 0.5 cm/hour in earlier active labor and faster in more advanced active labor. Faster dilation expectations (e.g., 1 cm/hour) likely contribute to an overdiagnosis of dystocia ("slow, abnormal progression of labor") in contemporary practice and, subsequently, to an overuse of interventions aimed at accelerating labor progress. [source] Pyogenic liver abscesses: a comparison of older and younger patientsHPB, Issue 3 2001JA Alvarez Background Pyogenic liver abscess is a life-threatening disease. Few studies have specifically explored the way in which the clinical features and management of elderly patients with pyogenic liver abscess differ from those of younger individuals. Methods A retrospective study was undertaken to evaluate whether older patients with pyogenic liver abscess have distinctive presenting features or whether their management and outcome differ from that of younger patients. A total of 133 patients with liver abscess treated in five hospitals during 13 years comprised two groups: 78 patients aged 60 years or above (older group) and 55 patients below age 60 years (younger group). Clinical features, laboratory data, imaging and microbiological findings, management and outcome were determined in each group. Results The older group contained more patients with associated diseases (p = 0.03), nausea and vomiting at presentation (p = 0.02), higher APACHE II (Acute Physiological and Chronic Health Evaluation II scale) score (p < 0.001) and blood urea nitrogen (p < 0.001) and serum creatinine levels (p = 0.002). Multiple abscess (p = 0.05) and bilobar (p = 0.03) abscess were also commoner in this group. By contrast, in the younger group men predominated (p = 0.01), and there was a higher overall complication rate (p = 0.05). Time to diagnosis, hospital mortality rate and other variables analysed were similar in both groups. Discussion Elderly patients with pyogenic liver abscess have some subtle differences in clinical and laboratory presentation, but these do not appear to delay diagnosis. Active management is tolerated well, with a lower morbidity rate than in younger patients and no difference in the mortality rate. [source] Portfolio Concentration and Investment Manager Performance,INTERNATIONAL REVIEW OF FINANCE, Issue 3-4 2005SIMONE BRANDS ABSTRACT This study examines the relationship between investment performance and concentration in active equity portfolios. Active management is dependent on the success of two important components in the investment process , stock selection skill and portfolio management. Our study documents a positive relationship between fund performance and portfolio concentration. The relationship is stronger for stocks in which active managers hold overweight positions, as well as for stocks outside the largest 50 stocks listed on the Australian Stock Exchange (ASX). We find that more concentrated funds tend to be those implementing growth styles, having smaller aggregate assets under management, being institutions that are not affiliated with a bank or life-office entity, whose funds experience past period outflows, and who are benchmarked to narrower indexes than the S&P/ASX 300. [source] Modelling the effectiveness of contraception for controlling introduced populations of elephant in South AfricaAFRICAN JOURNAL OF ECOLOGY, Issue 4 2009Robin L. Mackey Abstract Re-introduced African elephant (Loxodonta africana Blumenbach) populations are growing at very high rates in many of southern Africa's reserves, have attained densities higher than previously thought possible and may be exhibiting irruptive growth. Active management of such populations is necessary to prevent the potentially negative effects on habitat and biodiversity that are associated with elephant overpopulation. One potentially feasible method of elephant management is immunocontraception, but very little is known about the long-term effectiveness of this method. Using demographic data from three South African elephant populations, we made model projections of the effects of contraception on population growth rates to determine whether contraception may be a feasible management tool for elephant. In comparison with noncontracepted populations, realistic reductions in population growth rate after 20 years of contraception were projected to be up to c. 64%, with 50% being a very feasible target. Through its ability to reduce population growth rates, immunocontraception should be an effective tool for preventing or minimizing irruption in elephants and, perhaps, other introduced ungulate species. Résumé Le taux de croissance des populations réintroduites d'éléphants d'Afrique (Loxodonta africana Blumenbach) est très élevé dans les réserves d'Afrique australe; elles ont atteint des densités plus élevées qu'on ne l'avait cru possible et elles pourraient présenter une croissance irruptive. La gestion active de telles populations est nécessaire pour empêcher les effets potentiellement négatifs liés à une surpopulation d'éléphants. Une méthode éventuellement possible pour la gestion des éléphants est l'immuno-contraception, mais on sait très peu de choses sur l'efficacitéà long terme de cette méthode. En utilisant les données démographiques portant sur trois populations d'éléphants d'Afrique du Sud, nous avons modélisé des projections des effets de la contraception sur le taux de croissance des populations pour déterminer si la contraception peut constituer un outil de gestion envisageable pour les éléphants. En comparaison avec les populations sans contraception, des projections réalistes de la réduction du taux de croissance de populations après 20 ans de contraception se chiffraient à environ 64%,50% représentant un objectif tout à fait réaliste. Par sa capacité de réduire le taux de croissance de la population, l'immuno-contraception devrait être un outil efficace pour empêcher ou pour réduire au minimum l'irruption des éléphants et, peut-être, celle d'autres espèces ongulés introduits. [source] A dendro-ecological study of forest overstorey productivity following the invasion of the non-indigenous shrub Lonicera maackiiAPPLIED VEGETATION SCIENCE, Issue 1 2007K.M. Hartman Gleason & Cronquist (1991) for vascular plants Abstract Question: Will a non-indigenous, invasive, understorey shrub, such as Lonicera maackii (Amur honeysuckle) have an impact on the productivity of overstorey trees in hardwood forests? Location: Trees from 12 invaded and four non-invaded sites were sampled in hardwood forests of southwestern Ohio, US. Methods: Changes in radial and basal area tree growth in the ten years prior to L. maackii invasion vs. ten years after invasion were examined using dendrochronological techniques. Intervention analysis was used to detect growth changes 25 years prior to and 25 years following invasion, and estimates of load impacts for L. maackii population and biomass were also calculated. Results: We found that the rate of radial and basal area growth of overstorey trees was reduced significantly in eleven out of twelve invaded sites. Non-invaded sites did not exhibit this consistent pattern of reduced growth. For invaded vs. non-invaded sites, the mean basal area growth was reduced by 15.8%, and the overall rate of basal area growth was reduced by 53.1%. Intervention analysis revealed that the first significant growth reductions were 6.25 ± 1.24 (mean ± SE) years after invasion with the greatest frequency of negative growth changes occurring 20 years after invasion. In invaded stands, 41% of trees experienced negative growth changes. In terms of invasive load estimates per 1000 L. maackii individuals, radial tree growth was reduced by 0.56 mm.a,1, and basal area growth was reduced by 0.74 cm2.a,1, Given these findings, significant economic losses could occur in hardwood forests of Ohio. Conclusions: To our knowledge, this is the first study using dendrochronological techniques to investigate the impact of a non-indigenous, understorey plant on overstorey tree growth. Active management will likely be needed to maintain forest productivity in L. maackii impacted landscapes. [source] Wildfire Policy and Public Lands: Integrating Scientific Understanding with Social Concerns across LandscapesCONSERVATION BIOLOGY, Issue 4 2004MICHAEL P. DOMBECK administración de bosques; fuego no controlado; política; Servicio Forestal Estados Unidos; tierras públicas Abstract:,Efforts to suppress wildfires have become increasingly problematic in recent years as costs have risen, threats to firefighter safety have escalated, and detrimental impacts to ecosystems have multiplied. Wildfires that escape initial suppression often expand into large, high-intensity summer blazes. Lost is the legacy of smaller fires that likely burned outside extreme weather and fuel conditions and resulted in less severe impacts. Despite the recognized need for modifications to existing policies and practices, resource agencies have been slow to respond. The spread of exotic species, climate change, and increasing human development in wildlands further complicates the issue. New policies are needed that integrate social and ecological needs across administrative boundaries and broad landscapes. These policies should promote a continuum of treatments with active management and reduction of fuel hazard in wildland-urban interface zones and reintroduction of fire in wildlands. Management goals should focus on restoration of the long-term ecological health of the land. Projects that reduce fuel loads but compromise the integrity of soil, water supplies, or watersheds will do more harm than good in the long run. Despite significant ecological concerns, learning to live with fire remains primarily a social issue that will require greater political leadership, agency innovation, public involvement, and community responsibility. Resumen:,En años recientes, los esfuerzos para suprimir los fuegos no controlados se han vuelto cada vez más problemáticos por el incremento de costos, el aumento de las amenazas a la seguridad de bomberos y se la multiplicio, de los impactos perjudiciales a los ecosistemas. Los incendios que escapan la supresión inicial a menudo se expanden a grandes conflagraciones estivales de alta intensidad. Se ha perdido el legado de fuegos menores que probablemente se llevaban a cabo en condiciones climáticas y de combustible extremas que tenían impactos menos severos. A pesar del reconocimiento de la necesidad de modificaciones a las políticas y prácticas actuales, las agencias han respondido lentamente. La expansión de especies exóticas, el cambio climático y el incremento del desarrollo humano en áreas silvestres complican el problema aún más. Se requieren políticas nuevas que integren necesidades sociales y ecológicas más allá de límites administrativos y en paisajes amplios. Estas políticas deben promover un continuo de tratamientos con gestión activa y reducción de riesgo de combustión en la interfase área silvestre-urbana y la reintroducción de fuego en áreas silvestres. Las metas de la gestión deben enfocar en la restauración de la salud ecológica a largo plazo. Los proyectos que reducen la carga de combustible pero que comprometen la integridad del suelo, las reservas de agua o cuencas hidrológicas no serán de mucha utilidad en el largo plazo. A pesar de preocupaciones ecológicas significativas, aprender a vivir con fuego seguirá siendo un aspecto social que requerirá de mayor liderazgo político, innovación de agencias, participación del público y responsabilidad comunitaria. [source] Is food availability limiting African Penguins Spheniscus demersus at Boulders?IBIS, Issue 1 2006A comparison of foraging effort at mainland, island colonies The African Penguin Spheniscus demersus (Vulnerable) formed three new colonies during the 1980s, two on the South African mainland (Stony Point and Boulders) and one on Robben Island. One of the mainland colonies, at Boulders, Simon's Town, is in a suburban area, resulting in conflict with humans. Growth of the Boulders colony was initially rapid, largely through immigration, but has since slowed, possibly as a result of density-dependent effects either on land (where there has been active management to limit the spread of the colony) or at sea. We test the latter hypothesis by comparing the foraging effort of Penguins feeding small chicks at island and mainland sites, and relate this to the foraging area available to birds. Three-dimensional foraging paths of African Penguins were reconstructed using GPS and time,depth loggers. There were no intercolony differences in the rate at which birds dived during the day (33 dives/h), in diving depths (mean 17 m, max. 69 m) or in travelling speeds. The maximum speed recorded was 2.85 m/s, with birds travelling faster when commuting (average 1.18 m/s) than when foraging (0.93 m/s) or resting at sea (0.66 m/s during the day, 0.41 m/s at night). There were strong correlations between foraging trip duration, foraging range and total distance travelled. Foraging effort was correlated with chick age at Robben Island, but not at Boulders. Contrary to Ashmole's hypothesis, birds from Boulders (c. 1000 pairs) travelled further (46,53 km) and foraged for longer (13.2 h) than did birds from Robben Island (c. 7000 pairs) and Dassen Island (c. 21 000 pairs) (33 km, 10.3 h). The mean foraging range also differed significantly between mainland (18,20 km) and island colonies (9 km). The area available to central-place-foraging seabirds breeding on the mainland is typically less than that for seabirds breeding on islands, but the greater foraging range of Boulders birds results in an absolute foraging area roughly twice that of island colonies, and the area per pair is an order of magnitude greater for the relatively small Boulders colony. Ashmole's hypothesis assumes relatively uniform prey availability among colonies, but our results suggest this does not apply in this case. The greater foraging effort of Boulders birds probably reflects reduced prey availability in False Bay, and thus the recent slowing in growth at the colony may be the result of differential immigration rather than management actions to limit the spatial growth of the colony. [source] Interventions to reduce the incidence of falls in older adult patients in acute-care hospitals: a systematic reviewINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 4 2009Cindy Stern BHS(Hons) Abstract Aim, Falls can cause serious physical and emotional injuries to patients leading to poor quality of life and increased length of hospital stay. The aim of this study was to present the best available evidence regarding the effectiveness of risk assessment or other interventions that aimed to minimise the number of falls. Methods, A systematic review of randomised controlled trials was undertaken to determine the effectiveness of interventions that were designed to reduce the incidence of falls in older acute-care patients. Only trials published between 1998 and 2008 were considered. Results, Only seven studies were included in the review, indicating the evidence on this topic is sparse. There is some evidence to suggest that implementing the following interventions in acute hospitals may be effective in reducing the amount of falls of older adult inpatients: ,,A multidisciplinary multifactorial intervention program consisting of falls risk alert card, an exercise program, an education program and the use of hip protectors after approximately 45 days ,,A one-on-one patient education package entailing information on risk factors and preventative strategies for falls as well as goal setting ,,A targeted fall risk factor reduction intervention that includes a fall risk factor screen, recommended interventions encompassing local advice and a summary of the evidence There is also some evidence to suggest that implementing a multidisciplinary multifactorial intervention that consists of systematic assessment and treatment of fall risk factors, as well as active management of postoperative complications, can reduce the amount of falls in patients following surgery for femoral neck fracture. Conclusion, There is some evidence to suggest that certain multifactorial interventions are more effective than others and that increasing patient education or targeting fall risk factors may be of benefit. Further high-quality research is needed in order to ascertain effective fall-prevention strategies in acute-care facilities. [source] Coping with type-2 diabetes: the role of sense of coherence compared with active managementJOURNAL OF ADVANCED NURSING, Issue 6 2000Birgitta Sandén-Eriksson PhD Coping with type-2 diabetes: the role of sense of coherence compared with active management Changes in lifestyle, particularly in dietary and exercise habits, are necessary for the majority of patients with type-2 diabetes but are difficult to carry out. However, Antonovsky describes a salutogenic health perspective grounded in patients' developing what he terms ,a sense of coherence' (SOC). Can a strong SOC help diabetes patients to control the disease? The aim of this study was to analyse the relationship between SOC and treatment results measured as glucolysed haemoglobine (HbA1c) in patients with type-2 diabetes. The aim was further to test the relationship between treatment results and an index of patients' participation in active management and emotional state. Eighty-eight patients answered a questionnaire containing 13 statements about sense of coherence (SOC-13), questions about self-assessed health, diabetes activity such as self-management of diet, exercise and self-control of blood sugar and emotional acceptance. There was no direct relationship between SOC-13 and treatment results measured as HbA1c but there was a positive correlation between SOC-13, self-assessed health and HbA1c (P < 0·02). Self-assessed health was seen as a mediating factor. The better patients' estimation of their own health, the higher were SOC-13 scores and the lower HbA1c. There was also a strong positive correlation between low levels of HbA1c and high levels of an index of active management and emotional acceptance of diabetes (P < 0·001). [source] Effect of induced body condition score differences on physiological response, productive and reproductive performance of Malpura ewes kept in a hot, semi-arid environmentJOURNAL OF ANIMAL PHYSIOLOGY AND NUTRITION, Issue 2 2010V. Sejian Summary This study was undertaken to study the influence of induced body condition score (BCS) differences on physiological response, productive and reproductive performance of Malpura ewes to optimise BCS for these ewes for maximising production making it economically viable. The study was conducted for a period of 1 year using thirty healthy Malpura ewes (2,4 year old). The animals were randomly divided and different BCS was induced within three groups named Group I (BCS 2.5; n = 10), Group II (BCS 3.0,3.5; n = 10) and Group III (BCS 4.0; n = 10). The parameters included in the study were allometric measurements, physiological response, wool yield and reproductive performance. BCS had a significant influence on allometric measurements, respiration rate and different reproductive parameters studied, while wool production differed significantly during spring and non-significantly during autumn. The results revealed that the reproductive performance of Malpura ewes with a BCS of 3.0,3.5 was better in comparison with the groups with lower and higher BCS. It may be concluded from this study that an active management of breeding sheep flock to achieve a BCS of 3.0,3.5 may prove to result in an economically viable return from these flocks. [source] Vegetation and disturbance history of a rare dwarf pitch pine community in western New England, USAJOURNAL OF BIOGEOGRAPHY, Issue 10-11 2002Glenn Motzkin Abstract Aim, This study documents the vegetation history and age-structure of a rare, ridgetop dwarf pine,oak community and compares the dynamics of this unusual vegetation with similar dwarf pine communities found elsewhere in the north-eastern United States (US). Location, The study area is located on the summit of Mt Everett in the Taconic Mountains of south-western Berkshire County, Massachusetts, USA (42°06,N 73°26,W). Methods, Vegetation composition, tree age-structure, physical site characteristics, and evidence of fire and other disturbances were determined for twelve 15 × 15 m plots in dwarf pine,oak vegetation and two plots in oak forests on the summit. Age-structure analyses, tree-ring patterns, and historical records of human and natural disturbance were used to investigate the long-term history and dynamics of the summit vegetation. Results, The summit of Mt Everett has been dominated by dwarf pines (1,3 m tall) and ericaceous shrubs similar to the modern vegetation throughout the historical period; there is no evidence that tall-stature forests occurred on the site at any point in the past few centuries. The summit supports uneven-aged stands; pitch pine (Pinus rigida) recruitment began in the 1830s and occurred in every decade since the 1860s. Average pitch pine age is seventy-eight with a range of 12,170 years. Red oak (Quercus rubra) and red maple (Acer rubrum) increased in importance in the twentieth century, with most stems establishing from 1940 to 1980. Pitch pine radial growth rates averaged <0.5 mm year,1 while red oak and red maple averaged 1.0 and 0.8 mm year,1, respectively. In some areas, hardwoods have overtopped pitch pines, apparently resulting in pitch pine mortality. Whereas most dwarf pitch pine communities occur on sites that burn frequently and have a high degree of cone serotiny, we found no evidence of recent fires or cone serotiny. Small amounts of macroscopic charcoal that we documented may have resulted from fires in the pre-European or early historical periods. Conclusions, Harsh edaphic conditions and chronic low-level disturbances on the summit, including frequent winter storms, have apparently contributed to the establishment, long-term persistence, and slow radial growth of dwarf pitch pines on Mt Everett. The ability of dwarf pines to persist on a site in the absence of frequent fire is highly unusual among North-eastern barrens and has not been well-incorporated into previous conceptual ecological models of these communities. Our results suggest that even among North-eastern barrens, the summit of Mt Everett is characterized by highly unusual vegetation and dynamics. The site has long been recognized as regionally significant and should be afforded the strictest conservation protection. With no evident history of human disturbance or recent fire, there is no apparent need for immediate active management of the site. [source] Pain, physical functioning and quality of life of individuals awaiting total joint replacement: a longitudinal studyJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2008Gretl A. McHugh PhD MSc Abstract Objectives, To investigate if pain, physical function and the quality of life changed among adults with osteoarthritis while on the waiting list for hip or knee joint replacement. Methods, A longitudinal study of patients listed for primary hip or knee joint replacement. Participants were interviewed at baseline (n = 105) and followed up at 3 (n = 84), 6 (n = 47) and 9 months (n = 24), or until their joint replacement. Measurement tools used were a visual analogue scale (VAS), Western Ontario and McMaster's Universities (WOMAC) Osteoarthritis Index and the Medical Outcomes Study Short Form Health Survey (SF-36). Results, Baseline data indicated high levels of pain as measured by VAS [mean 7.0 (SD 2.2)] and WOMAC pain [mean 11.2 (SD 3.5)]. At baseline, the mean physical function measured by WOMAC was 40.3 (SD 12.1). At the 3-month follow-up, there was significant deterioration in VAS pain scores (0.6; 95% CI mean difference 0.3, 1.0); WOMAC pain scores (1.2; 95% CI mean difference 0.7, 1.8) and WOMAC physical function scores (4.8; 95% CI mean difference 2.8, 6.7) compared with baseline. Conclusion, The often long wait for joint replacement surgery and deterioration in pain and physical function has highlighted the need for active management by health professionals while patients are on the waiting list. [source] Review article: current antiviral therapy of chronic hepatitis BALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2008W. S. AYOUB Summary Background, The long-term goals of therapy for chronic hepatitis B are to reduce serum HBV DNA to low or undetectable levels and ultimately reduce or prevent the development of cirrhosis and hepatocellular carcinoma. Aim, To review the current treatment of chronic hepatitis B, with a focus on diagnosis and management of resistance and active management of suboptimal responses. Methods, A systematic review of the literature, with a focus on recent guidelines, was undertaken. Results, Among the six drugs licensed for the treatment of chronic hepatitis B in the US, the preferred agents in 2008 will include entecavir, peginterferon alfa-2a, possibly telbivudine, and tenofovir following licensure. When using an oral agent, a major focus of management is on the selection of a drug with high potency and low rate of resistance, and active on-treatment management to optimize therapy. Preventing the sequelae of antiviral drug resistance and appropriate management when resistance is initially detected are also the major focus of current management. The addition of an antiviral agent that is not cross-resistant is critical to restore suppression of viral replication. Conclusions, Newer agents and modified treatment strategies, especially using combination therapy, hold promise to optimize the management of patients with chronic hepatitis B by achieving the high potency and the lowest rate of resistance. [source] Does epidural analgesia delay the diagnosis of lower limb compartment syndrome in children?PEDIATRIC ANESTHESIA, Issue 2 2009DOUG J.G. JOHNSON MBChB MRCP FRCA Summary One of the cardinal symptoms of compartment syndrome is pain. A literature review was undertaken in order to assess the association of epidural analgesia and compartment syndrome in children, whether epidural analgesia delays the diagnosis, and to identify patients who might be at risk. Evidence was sought to offer recommendations in the use of epidural analgesia in patients at risk of developing compartment syndrome of the lower limb. Increasing analgesic use, increasing/breakthrough pain and pain remote to the surgical site were identified as important early warning signs of impending compartment syndrome in the lower limb of a child with a working epidural. The presence of any should trigger immediate examination of the painful site, and active management of the situation (we have proposed one clinical pathway). Avoidance of dense sensory or motor block and unnecessary sensory blockade of areas remote to the surgical site allows full assessment of the child and may prevent any delay in diagnosis of compartment syndrome. Focusing on excluding the diagnosis of compartment syndrome rather than failure of analgesic modality is vital. In the pediatric cases reviewed there was no clear evidence that the presence of an epidural had delayed the diagnosis. [source] Selective intrauterine growth restriction in monochorionic diamniotic twin pregnanciesPRENATAL DIAGNOSIS, Issue 8 2010Dan V. Valsky Abstract Selective intrauterine growth restriction (sIUGR) occurs in 10 to 15% of monochorionic (MC) twins, and it is associated with a substantial increase in perinatal mortality and morbidity. Clinical evolution is largely influenced by the existence of intertwin placental anastomoses: pregnancies with similar degrees of fetal weight discordance are associated with remarkable differences in clinical behavior and outcome. We have proposed a classification of sIUGR into three types according to umbilical artery (UA) Doppler findings (I-normal, II-absent/reverse end-diastolic flow, III-intermittent absent/reverse end-diastolic flow), which correlates with distinct clinical behavior, placental features and may assist in counseling and management. In terms of prognosis, sIUGR can roughly be divided in two groups: type I cases, with a fairly good outcome, and types II and III, with a substantial risk for a poor outcome. Management of types II and III may consist in expectant management until deterioration of the IUGR fetus is observed, with the option of cord occlusion if this occurs before viability. Alternatively, active management can be considered electively, including cord occlusion or laser coagulation. Both therapies seem to increase the chances of intact survival of the larger fetus, while they entail, or increase the chances of, intrauterine demise of the IUGR fetus. Copyright © 2010 John Wiley & Sons, Ltd. [source] Managerial complexity in project-based operations: A grounded model and its implications for practicePROJECT MANAGEMENT JOURNAL, Issue S1 2008Harvey Maylor Abstract This article reports an investigation into project managers' perceptions of managerial complexity. Based on a multistage empirical study, elements of "what makes a project complex to manage" were identified and classified under the dimensions of mission, organization, delivery, stakeholder, or team,the MODeST model. Further, the data showed that these elements had both structural and dynamic qualities and that the elements are interdependent. Project managers are shown to be embedded in this complexity. The practical implications of the research include the ability to describe managerial complexity in a manner consistent with the actuality of the lived project environment. This provides a framework for the description of the level of managerial challenge or difficulty, which will allow the assessment of individual and organizational responses to it in the future. Further, the opportunity exists for active management of complexity. [source] Isolated Plexiform Neurofibroma: Treatment with Three-Dimensional Conformal Radiotherapy,THE LARYNGOSCOPE, Issue 7 2004Thomas C. Robertson MD Abstract Objectives: To present a case of an unusual benign tumor of the tongue treated successfully with radiotherapy. Study Design: Case report. Methods: Retrospective chart review. Results: A 60-year-old man presented with a painful submucosal lesion of the tongue base. Computed tomography showed an infiltrative soft-tissue mass involving the left base of the tongue. Operative biopsy revealed plexiform neurofibroma. Because of the patient's operative risk and the potential morbidity of surgical resection, he was treated with three-dimensional conformal radiotherapy (3DCRT). His treatment was accomplished using a five-field arrangement treating exclusively the mass lesion to a total tumor dose of 60 Gy. After treatment, the patient's tongue pain resolved, and he noted minimal transient xerostomia. Serial follow-up radiographic examinations showed the base of tongue mass to be slightly smaller 4 months after treatment. The most recent follow-up magnetic resonance image reveals a further decrease in size of the mass. The patient is now over 3 years out from treatment. Conclusions: Solitary plexiform neurofibroma of the tongue base is a rare tumor. These benign neoplasms are usually treated with either observation or surgical excision. This case demonstrates that, when significant symptoms necessitate active management, these lesions may be successfully treated with minimal morbidity using 3DCRT. The ability of this technique to deliver a conformal radiation dose to the tumor volume while sparing the surrounding normal tissues may expand the application of radiotherapy in the treatment of these benign lesions of the head and neck. [source] Management history and climate as key factors driving natterjack toad population trends in BritainANIMAL CONSERVATION, Issue 5 2010A. L. McGrath Abstract Along with other amphibian populations in Europe and elsewhere, natterjack toad Bufo calamita populations in Britain have declined since at least 1960. Conservation management since the 1970s has aimed to halt the decline and maintain viable populations at key sites throughout the species' recent historical range. Here, we assess population trends from 1985 to 2006 at 20 British B. calamita sites and evaluate the role of active management in maintaining good conservation status. We investigated the effects of 25 climatic, site-characteristic and conservation management variables on population trends using general linear models. In single-variable analyses, rainfall variables showed negative relationships with population trends. Among the site characteristics, being located at the very edge of the species' range (northern Irish Sea coast) and occurrence of common toad (B. bufo) were negatively related to B. calamita population trends. Management history (populations established via translocation as opposed to native populations) had a significant positive effect; as had sites that received greater translocation releases, undergone Species Recovery Programme management, and where common toad was absent. In multiple-variable analyses, the combined effects of management history and average pre-breeding season rainfall accounted for inter-site variation in population trends. The rainfall effects in single- and multiple-variable analyses were strongly influenced by three sites with very high rainfall whilst no clear effect was apparent for the remaining sites. This study highlights the role of climatic factors in population decline, and the importance of conservation management in stabilizing population trends. Climate change over the next 50,100 years is predicted to have limited impacts on most B. calamita populations in Britain, but strongly positive impacts on the most threatened populations located at the very edge of species' range that will benefit from reduced precipitation. A need for active conservation management will remain for the foreseeable future. [source] Effect of agro-forestry and landscape changes on common buzzards (Buteo buteo) in the Alps: implications for conservationANIMAL CONSERVATION, Issue 1 2005Fabrizio Sergio In Italy, pre-Alpine forests, once managed through coppice silviculture, are being converted to mature woodland, while land abandonment is causing woodland expansion and erosion of open habitats. Based on habitat-selection analyses, we predicted the impact of such changes on common buzzards (Buteo buteo), which depend on forested and open areas for nesting and foraging. Compared to availability, at a micro-scale buzzards selected nests higher above ground and on trees frequently covered by ivy. At the landscape-scale, buzzards avoided roads and conspecifics, while selecting rugged areas with high habitat heterogeneity, probably related to a varied food supply. Productivity was related to the availability of arid habitats, probably because of their richness in main prey species. Finally, population density was negatively related to the abundance of eagle owls (Bubo bubo), a potential predator of adults and nestlings, and positively related to the availability of woodland, a low predation-risk habitat rich in food and nest-sites. Therefore, buzzard settlement, density and productivity depended on the complex interplay of food availability, human persecution and predation risk. Thus, the current landscape changes would benefit buzzards by providing more nest-sites, but would be detrimental because of the lower productivity associated with the disappearance of dry open areas. Proposed conservation guidelines focus on conversion of coppice woodland to mature forests and active management of dry heath, a conservation sensitive habitat, through controlled burning. [source] Evidence-Based Strategies for Reducing Cesarean Section Rates: A Meta-AnalysisBIRTH, Issue 1 2007Nils Chaillet PhD ABSTRACT: Background: Canada's cesarean section rate reached an all-time high of 22.5 percent of in-hospital deliveries in 2002 and was associated with potential maternal and neonatal complications. Clinical practice guidelines represent an appropriate mean for reducing cesarean section rates. The challenge now lies in implementing these guidelines. Objectives of this meta-analysis were to assess the effectiveness of interventions for reducing the cesarean section rate and to assess the impact of this reduction on maternal and perinatal mortality and morbidity. Methods: The Cochrane Library, EMBASE, and MEDLINE were consulted from January 1990 to June 2005. Additional studies were identified by screening reference lists from identified studies and expert suggestions. Studies involving rigorous evaluation of a strategy for reducing overall cesarean section rates were identified. Randomized controlled trials, controlled before-and-after studies, and interrupted time series studies were evaluated according to Effective Practice and Organisation of Care Group criteria. Results: Among the 10 included studies, a significant reduction of cesarean section rate was found by random meta-analysis (pooled RR = 0.81 [0.75, 0.87]). No evidence of publication bias was identified. Audit and feedback (pooled RR = 0.87 [0.81, 0.93]), quality improvement (pooled RR = 0.74 [0.70, 0.77]), and multifaceted strategies (pooled RR=0.73 [0.68, 0.79]) were effective for reducing the cesarean section rate. However, quality improvement based on active management of labor showed mixed effects. Design of studies showed a higher effect for noncontrolled studies than for controlled studies (pooled RR = 0.76 [0.72, 0.81] vs 0.92 [0.88, 0.96]). Studies including an identification of barriers to change were more effective than other interventions for reducing the cesarean section rate (pooled RR = 0.74 [0.71, 0.78] vs 0.88 [0.82, 0.94]). Among included studies, no significant differences were found for perinatal and neonatal mortality and perinatal and maternal morbidity with respect to the mode of delivery. Only 1 study showed a significant reduction of neonatal and perinatal mortality (p < 0.001). Conclusions: The cesarean section rate can be safely reduced by interventions that involve health workers in analyzing and modifying their practice. Our results suggest that multifaceted strategies, based on audit and detailed feedback, are advised to improve clinical practice and effectively reduce cesarean section rates. Moreover, these findings support the assumption that identification of barriers to change is a major key to success. (BIRTH 34:1 March 2007) [source] Amniotomy for Shortening Spontaneous LabourBIRTH, Issue 2 2001W.D. Fraser A substantive amendment to this systematic review was last made on 25 June 1999. Cochrane reviews are regularly checked and updated if necessary. ABSTRACT Background: Early amniotomy has been advocated as a component of the active management of labour. Several randomised trials comparing routine amniotomy to an attempt to conserve the membranes have been published. Their limited sample sizes limit their ability to address the effects of amniotomy on indicators of maternal and neonatal morbidity. Objectives: To study the effects of amniotomy on the rate of Cesarean delivery and on other indicators of maternal and neonatal morbidity (Apgar less than 7 at 5 minutes, admission to NICU). Search strategy: The register of clinical trials maintained and updated by the Cochrane Pregnancy and Childbirth Group. Selection criteria: All acceptably controlled trials of amniotomy during first stage of labour were eligible. Data collection and analysis: Data were extracted by two trained reviewers from published reports. Trials were assigned methodological quality scores based on a standardised rating system. Typical odds ratios (ORs) were calculated using Peto's method. Main results: Amniotomy was associated with a reduction in labour duration of between 60 and 120 minutes. There was a marked trend toward an increase in the risk of Cesarean delivery: OR = 1.26; 95% Confidence Interval (CI) = 0.96,1.66. The likelihood of a 5-minute Apgar score less than 7 was reduced in association with early amniotomy (OR = 0.54; 95% CI = 0.30,0.96). Groups were similar with respect to other indicators of neonatal status (arterial cord pH, NICU admissions). There was a statistically significant association of amniotomy with a decrease in the use of oxytocin: OR = 0.79; 95% CI = 0.67,0.92. Reviewers' conclusions: Routine early amniotomy is associated with both benefits and risks. Benefits include a reduction in labour duration and a possible reduction in abnormal 5-minute Apgar scores. The meta-analysis provides no support for the hypothesis that routine early amniotomy reduces the risk of Cesarean delivery. Indeed there is a trend toward an increase in Cesarean section. An association between early amniotomy and Cesarean delivery for fetal distress is noted in one large trial. This suggests that amniotomy should be reserved for women with abnormal labour progress. Citation: Fraser WD, Turcot L, Krauss I, Brisson-Carrol G. Amniotomy for shortening spontaneous labour (Cochrane Review). In: The Cochrane Library, 1, 2001. Oxford: Update Software. MeSH: Amnion/*surgery; Cesarean Section; Female; Human; *Labor; Labor Complications/*prevention & control; Pregnancy The preceding reports are abstracts of regularly updated, systematic reviews prepared and maintained by the Cochrane Collaboration. The full text of the reviews are available in The Cochrane Library (ISSN 1464-780X). The Cochrane Library is prepared and published by Update Software Ltd. All rights reserved. See www.update-software.com or contact Update Software, info@update.co.uk, for information on subscribing to The Cochrane Library in your area. Update Software Ltd, Summertown Pavilion, Middle Way, Oxford OX2 7LG, United Kingdom. (Tel: +44 1865 513902; Fax: +44 1865 516918). [source] | |||||||||||||||||||