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Alternative Regime (alternative + regime)
Selected AbstractsManagement of night-time urinary incontinence in residential settings for older people: an investigation into the effects of different pad changing regimes on skin healthJOURNAL OF CLINICAL NURSING, Issue 3 2003Mandy Fader BSc Summary ,,Absorbent pads are the main method of managing urinary incontinence in residential settings for older people. ,,Improvements in technology have resulted in highly absorbent products which may be worn all night, but the effects of prolonged pad wearing on aged skin are unknown. ,,The aim of this study was to examine the effects of two different pad changing regimes on skin health. ,,A cross-over design was used. ,,Subjects from residential settings were randomly allocated to one of two pad changing regimes: a frequent pad changing regime or a less frequent pad changing regime. Each regime lasted 4 weeks and was followed by the alternative regime. ,,Skin measurements were taken twice during each regime using (i) the Diastron Erythema meter, (ii) a visual grading scale, (iii) the Servomed evaporimeter, and (iv) a pH meter. The primary outcome variable was the Diastron Erythema meter index. ,,Eighty-one subjects completed the study. ,,No significant differences were found in the severity of erythema, or skin pH, between regimes. Measurements of trans-epidermal water loss were significantly higher in the less frequent pad changing regime indicating that skin was ,wetter' (P = 0.01; 95% CI: 2.89,21.39). ,,Five subjects developed grade 2 pressure ulcers (abrasions) during the less frequent pad changing regime, but none in the frequent pad changing regime; this result was not significant (P = 0.1; 95% CI: 0,1.09). ,,No evidence was found that a less frequent pad changing regime has an effect on skin erythema or pH. ,,There is evidence that skin is wetter which may make it more vulnerable to friction and abrasion. ,,The statistically non-significant finding of greater incidence of grade 2 pressure ulcers is a cause for concern and merits further investigation because of the clinical significance of loss of skin integrity. [source] 4264: Regression of choroidal melanoma after primary chemotherapyACTA OPHTHALMOLOGICA, Issue 2010NE BECHRAKIS Purpose To describe the local regression of an intraocular choroidal melanoma after primary chemotherapy with fotemustine. Methods A 30 y.o. young man presented with drop of visual acuity in his lest eye to 0,8. The right eye was unremarkable with VA 1,2. On the same time he developed upper abdominal pain. On ophthalmic examination a circumpapillary choroidal melanoma was detected with possible optic nerve infiltration on his left eye. Ultrasound and MRI scan of the upper abdomen revealed a diffuse metastatic liver disease. Results In consultation with the department of oncology it was decided to prescribe systemic chemotherapy with fotemustine. After 4 cycles of chemotherapy, there was impressive local regression of the choroidal tumour and the liver metastases. Unfortunately after the initial response and the stable intraocular situation, there was tumour progression in other sites such as subcutaneous and lung metastases. After administration of some cycles of cisplatin as an alternative regime, the patient succumbed to the metastatic disease. Conclusion This case demonstrates that intravenous fotemustine can be effective for a limited time period as a primary treatment option in a case of choroidal melanoma, without other local treatment. [source] Multiple stressors and regime shifts in shallow aquatic ecosystems in antipodean landscapesFRESHWATER BIOLOGY, Issue 2010JENNY DAVIS Summary 1. Changes in land management (land use and land cover) and water management (including extraction of ground water and diversion of surface waters for irrigation) driven by increases in agricultural production and urban expansion (and fundamentally by population growth) have created multiple stressors on global freshwater ecosystems that we can no longer ignore. 2. The development and testing of conceptual ecological models that examine the impact of stressors on aquatic ecosystems, and recognise that responses may be nonlinear, is now essential for identifying critical processes and predicting changes, particularly the possibility of catastrophic regime shifts or ,ecological surprises'. 3. Models depicting gradual ecological change and three types of regime shift (simple thresholds, hysteresis and irreversible changes) were examined in the context of shallow inland aquatic ecosystems (wetlands, shallow lakes and temporary river pools) in southwestern Australia subject to multiple anthropogenic impacts (hydrological change, eutrophication, salinisation and acidification). 4. Changes in hydrological processes, particularly the balance between groundwater-dominated versus surface water-dominated inputs and a change from seasonal to permanent water regimes appeared to be the major drivers influencing ecological regime change and the impacts of eutrophication and acidification (in urban systems) and salinisation and acidification (in agricultural systems). 5. In the absence of hydrological change, urban wetlands undergoing eutrophication and agricultural wetlands experiencing salinisation appeared to fit threshold models. Models encompassing alternative regimes and hysteresis appeared to be applicable where a change from a seasonal to permanent hydrological regime had occurred. 6. Irreversible ecological change has potentially occurred in agricultural landscapes because the external economic driver, agricultural productivity, persists independently of the impact on aquatic ecosystems. 7. Thematic implications: multiple stressors can create multiple thresholds that may act in a hierarchical fashion in shallow, lentic systems. The resulting regime shifts may follow different models and trajectories of recovery. Challenges for ecosystem managers and researchers include determining how close a system may be to critical thresholds and which processes are essential to maintaining or restoring the system. This requires an understanding of both external drivers and internal ecosystem dynamics, and the interactions between them, at appropriate spatial and temporal scales. [source] A Proposed Monetary Regime for Small Commodity Exporters: Peg the Export Price (,PEP')INTERNATIONAL FINANCE, Issue 1 2003Jeffrey Frankel On the one hand, the big selling points of floating exchange rates , monetary independence and accommodation of terms of trade shocks , have not lived up to their promise. On the other hand, proposals for credible institutional monetary commitments to nominal anchors have each run aground on their own peculiar shoals. Rigid pegs to the dollar are dangerous when the dollar appreciates. Money targeting does not work when there is a velocity shock. CPI targeting is not viable when there is a large import price shock. And the gold standard fails when there are large fluctuations in the world gold market. This paper advances a new proposal called PEP: peg the export price. Most applicable for countries that are specialized in the production of a particular mineral or agricultural product, the proposal calls on them to commit to fix the price of that commodity in terms of domestic currency. A series of simulations shows how such a proposal would have worked for oil producers over the period 1970,2000. The paths of real oil prices, exports, and debt are simulated under alternative regimes. An illustrative finding is that countries that suffered a declining world market in oil or other export commodities in the late 1990s would under the PEP proposal have automatically experienced a depreciation and a boost to exports when it was most needed. The argument for PEP is that it simultaneously delivers automatic accommodation to terms of trade shocks, as floating exchange rates are supposed to do, while retaining the credibility-enhancing advantages of a nominal anchor, as dollar pegs are supposed to do. [source] | ||||||||||