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Management Issues (management + issues)
Selected AbstractsPediatric Short Bowel Syndrome: Pathophysiology, Nursing Care, and Management IssuesJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 3 2000Louise D. Jakubik ISSUES AND PURPOSE. A comprehensive overview of the etiology, pathophysiology, nursing care, and medical and surgical management of the child with short bowel syndrome (SBS), which follows massive anatomical or functional loss of the small intestine. CONCLUSIONS. The outlook for children with SBS has improved due to recent advances in parenteral and enteral nutrition, pharmacologic interventions, and surgical options. PRACTICE IMPLICATIONS. Nurses whose practice reflects an in-depth knowledge of the etiology, pathophysiology, medical and surgical management, nursing interventions, and complications of SBS will be equipped to provide quality care for children and families affected by SBS. [source] Management issues for women with epilepsy,Focus on pregnancy (an evidence-based review): II.EPILEPSIA, Issue 5 2009Teratogenesis, perinatal outcomes Summary A committee assembled by the American Academy of Neurology (AAN) reassessed the evidence related to the care of women with epilepsy (WWE) during pregnancy, including antiepileptic drug (AED) teratogenicity and adverse perinatal outcomes. It is highly probable that intrauterine first-trimester valproate (VPA) exposure has higher risk of major congenital malformations (MCMs) compared to carbamazepine (CBZ), and possibly compared to phenytoin (PHT) or lamotrigine (LTG). It is probable that VPA as part of polytherapy and possible that VPA as monotherapy contribute to the development of MCMs. AED polytherapy probably contributes to the development of MCMs and reduced cognitive outcomes compared to monotherapy. Intrauterine exposure to VPA monotherapy probably reduces cognitive outcomes and monotherapy exposure to PHT or phenobarbital (PB) possibly reduces cognitive outcomes. Neonates of WWE taking AEDs probably have an increased risk of being small for gestational age and possibly have an increased risk of a 1-minute Apgar score of <7. If possible, avoidance of VPA and AED polytherapy during the first trimester of pregnancy should be considered to decrease the risk of MCMs. If possible, avoidance of VPA and AED polytherapy throughout pregnancy should be considered and avoidance of PHT and PB throughout pregnancy may be considered to prevent reduced cognitive outcomes. [source] Pediatric systemic lupus erythematosus: Management issues in primary practiceJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 6 2006FNP (Instructor), Tiwaporn Pongmarutani MSN Abstract Purpose: To provide nurse practitioners (NPs) with an update on pediatric systemic lupus erythematosus (SLE) with an emphasis on management considerations for primary care practitioners. Data sources: An extensive literature review was conducted using both Medline and CINAHL databases. Research articles reflecting the most compelling findings were included in this review. Conclusions: NPs who care for children with SLE may be able to prevent or delay the morbidities associated with this disease and its treatments, if they keep abreast of the new information evolving in this realm of rheumatologic diseases. Implications for practice: As more is learned about pediatric SLE, better treatments have evolved such that the survival rates have increased. The primary care of pediatric SLE patients that is focused on preventing or delaying SLE morbidities may help to restore, maintain, or improve the quality of life for these patients. [source] Life with continuous subcutaneous insulin infusion (CSII) therapy: child and parental perspectives and predictors of metabolic controlPEDIATRIC DIABETES, Issue 2 2001Aristides k Maniatis Abstract: Objective:, The purpose of this study was twofold (i): to evaluate metabolic control in patients receiving CSII therapy in a routine pediatric diabetes clinic by describing reasons for initiating therapy and daily management issues, including needle fear; and (ii) to assess the change in parental involvement and anxiety once their child initiated CSII therapy. Research design and methods: The study included 52 subjects (aged 7.6,23.6 yr) from a general pediatric diabetes clinic. Management issues were defined as diet, exercise, home blood glucose monitoring (HBGM) frequency, and self/staff assessment of needle fear. Characteristics were analyzed both according to a 0.5% change in HbA1c status (decreased vs. stable vs. increased) compared with pre-CSII therapy, and final HbA1c achieved (, 8.1 vs. > 8.1%). Results: The primary recommendation source for CSII use was most often the physician/diabetes team (48.1%), followed by a combination of the former with a personal referral source (32.7%). The most common reason (71.2%) for CSII initiation was a combination of wanting to achieve better metabolic control, dislike of insulin injections, and/or increased flexibility in daily living. Over one-quarter (26.9%) of subjects were identified as being needle-fearful, and this characteristic was predictive of final metabolic control (3/25 subjects ,,8.1% vs. 11/27 subjects >,8.1%, p =,0.03). On CSII therapy, dietary carbohydrate consistency was highly variable, and most subjects (65.3%) exclusively used an insulin to carbohydrate ratio for insulin bolus dosage calculation. The most common adjustment strategy (63.5%) for exercise was a combination of decreasing the insulin basal rate, disconnecting the pump, and/or eating extra carbohydrates. For the total cohort, the frequency of HBGM significantly increased on CSII therapy (4.31,4.85 tests/day, p =,0.02). Females did not have a significant change in HBGM frequency, while the youngest subjects had the highest HBGM frequency. Parental involvement and anxiety primarily stayed the same or decreased, regardless of the child's age (, 18 vs. > 18 yr) or metabolic control. Conclusions:, Analyses of the various characteristics identified only needle fearfulness as being predictive of poor metabolic control. Interestingly, poor control with CSII therapy did not result in a significant increase in parental involvement and/or anxiety. [source] Isolated noncompaction of the ventricular myocardium: contemporary Diagnosis and ManagementCLINICAL CARDIOLOGY, Issue 4 2007Michael P. Chrissoheris M.D. Abstract Noncompaction of the ventricular myocardium is a rare form of cardiomyopathy that has been described since the early 1990s. However, noncompaction remains frequently overlooked, in part due to the limited awareness of its unique clinical and imaging characteristics. Contemporary diagnosis has been facilitated by the introduction of specific morphologic criteria by echocardiography and cardiac magnetic resonance. Management issues revolve around the management of heart failure, arrhythmias, and thromboembolic events in order to prevent the significant morbidity and even mortality that has been associated with this entity. Finally, the genetics of noncompaction have been diverse and an issue of clinical importance as it relates to screening of first-degree relatives of affected patients. Two recent cases are presented and many of the contemporary issues in diagnosis and management, based on an extensive review of the literature, are addressed. Copyright © 2007 Wiley Periodicals, Inc. [source] Prevalence of responsible hospitality policies in licensed premises that are associated with alcohol-related harmDRUG AND ALCOHOL REVIEW, Issue 2 2002JUSTINE B. DALY Abstract This study aimed to determine the prevalence of responsible hospitality policies in a group of licensed premises associated with alcohol-related harm. During March 1999, 108 licensed premises with one or more police-identified alcohol-related incidents in the previous 3 months received a visit from a police officer. A 30-item audit checklist was used to determine the responsible hospitality policies being undertaken by each premises within eight policy domains: display required signage (three items); responsible host practices to prevent intoxication and under-age drinking (five items); written policies and guidelines for responsible service (three items); discouraging inappropriate promotions (three items); safe transport (two items); responsible management issues (seven items); physical environment (three items) and entry conditions (four items). No premises were undertaking all 30 items. Eighty per cent of the premises were undertaking 20 of the 30 items. All premises were undertaking at least 17 of the items. The proportion of premises undertaking individual items ranged from 16% to 100%. Premises were less likely to report having and providing written responsible hospitality documentation to staff, using door charges and having entry/re-entry rules. Significant differences between rural and urban premises were evident for four policies. Clubs were significantly more likely than hotels to have a written responsible service of alcohol policy and to clearly display codes of dress and conditions of entry. This study provides an indication of the extent and nature of responsible hospitality policies in a sample of licensed premises that are associated with a broad range of alcohol related harms. The finding that a large majority of such premises appear to adopt responsible hospitality policies suggests a need to assess the validity and reliability of tools used in the routine assessment of such policies, and of the potential for harm from licensed premises. [source] Landscape issues in plant ecologyECOGRAPHY, Issue 2 2002Sylvie De Blois In the last decade, we have seen the emergence and consolidation of a conceptual framework that recognizes the landscape as an ecological unit of interest. Plant ecologists have long emphasized landscape-scale issues, but there has been no recent attempt to define how landscape concepts are now integrated in vegetation studies. To help define common research paradigms in both landscape and plant ecology, we discuss issues related to three main landscape concepts in vegetation researches, reviewing theoretical influences and emphasizing recent developments. We first focus on environmental relationships, documenting how vegetation patterns emerge from the influence of local abiotic conditions. The landscape is the physical environment. Disturbances are then considered, with a particular attention to human-driven processes that often overrule natural dynamics. The landscape is a dynamic space. As environmental and historical processes generate heterogeneous patterns, we finally move on to stress current evidence relating spatial structure and vegetation dynamics. This relates to the concept of a landscape as a patch-corridor-matrix mosaic. Future challenges involve: 1) the capacity to evaluate the relative importance of multiple controlling processes at broad spatial scale; 2) better assessment of the real importance of the spatial configuration of landscape elements for plant species and finally; 3) the integration of natural and cultural processes and the recognition of their interdependence in relation to vegetation management issues in human landscapes. [source] Predicting species distribution: offering more than simple habitat modelsECOLOGY LETTERS, Issue 9 2005Antoine Guisan Abstract In the last two decades, interest in species distribution models (SDMs) of plants and animals has grown dramatically. Recent advances in SDMs allow us to potentially forecast anthropogenic effects on patterns of biodiversity at different spatial scales. However, some limitations still preclude the use of SDMs in many theoretical and practical applications. Here, we provide an overview of recent advances in this field, discuss the ecological principles and assumptions underpinning SDMs, and highlight critical limitations and decisions inherent in the construction and evaluation of SDMs. Particular emphasis is given to the use of SDMs for the assessment of climate change impacts and conservation management issues. We suggest new avenues for incorporating species migration, population dynamics, biotic interactions and community ecology into SDMs at multiple spatial scales. Addressing all these issues requires a better integration of SDMs with ecological theory. [source] Best available techniques (BAT) in the Finnish pulp and paper industry , a critical reviewENVIRONMENTAL POLICY AND GOVERNANCE, Issue 3 2005Kimmo Silvo Abstract In this multiple-case study the BAT-associated techniques and relative emission levels presented in the EU's best available techniques (BAT) reference document for the pulp and paper industry (PP-BREF) are compared with the techniques applied and the relative emission levels achieved in the Finnish pulp and paper industry. Information on the emissions of 24 Finnish pulp and paper plants was compiled from the national databases maintained by the Finnish Environment Institute. Moreover, a supportive study was conducted on the use of the PP-BREF in the environmental permitting process. The techniques applied in the studied plants represented the BAT as defined in the PP-BREF to a high degree, but the emission levels showed a larger variation. Possible reasons for this variation were discussed. A BAT emission index (BEI) was designed to trace the degree to which the BAT-associated emission levels were achieved as a whole. The BEI appeared to be a useful indicator for assessing the BAT-related environmental performance of the plants. An important area for improvement, identified from the point of view of the applicability of the PP-BREF in the permit process, was the information on waste management issues. Moreover, a consistent cross-media assessment in the PP-BREF was called for. Copyright © 2005 John Wiley & Sons, Ltd and ERP Environment. [source] Maximizing resource recovery from waste streamsENVIRONMENTAL PROGRESS & SUSTAINABLE ENERGY, Issue 4 2003Tim Grant Resource conservation and waste management have become two sides of the same argument. According to the Institutefor Local Self Reliance in the US., the recycling revolution begun in the l960s was a reaction "to the levels of waste in our economy and the pollution and suffering these habits cause worldwide" [1,2]. However, the recycling targetsetting of the early 1990s was focused on diversion from landfill, and it has taken another 10 years for the focus to shift back to the resource values approach, driven largely by the application of Life Cycle Assessment to the waste management system. This paper examines materials in the waste stream to determine the "value proposition" in each material group, and to examine options for efficient resource use and recovery. Specifically, it discusses waste management issues associated with clean fill, food waste, timber waste, concrete and bricks, green waste, paper and board, metals, plastics, and glass. [source] A pilot study comparing a type 1 nurse-led diabetes clinic with a conventional doctor-led diabetes clinicEUROPEAN DIABETES NURSING, Issue 1 2004J Charlton Diabetes Nurse Specialist Abstract A prospective comparative pilot study was designed to assess and compare care delivered by a diabetes specialist nurse (DSN) and standard doctor-led care for patients with type 1 diabetes. The philosophy was to provide an individualised, patient-centred, lifestyle-based approach. In all, 60 patients with type 1 diabetes were randomised to either the nurse-led clinic (NLC) or a conventional clinic. NLC patients received medical input during their annual screening appointment. In the nurse-led system patients prioritised relevant issues with the aid of a ,Waiting Area Menu'. The menu consisted of pertinent topics relevant to living with diabetes. Care interventions were then agreed and targets discussed. To date the results of DSN intervention include: 60% of patients changing to a more appropriate insulin regimen; 36% changing equipment following update from the DSN; 20% needing initiation of cardiovascular medication; and 26% being referred to other health care professionals. The mean HbA1c changed by -0.25% in the NLC group and by -0.06% in the control group (ns). During the pilot there were several barriers which we had not anticipated. These included staffing resources, and organisational and time management issues. However, feedback from patient questionnaires demonstrated that the majority of patients preferred the NLC. Copyright © 2004 FEND. [source] Developing co-management in an artisanal gill net fishery of a deep hydro-electric reservoir in Sri LankaFISHERIES MANAGEMENT & ECOLOGY, Issue 5 2002S. NATHANAEL Abstract Victoria, is a recently (1984) impounded, deep, hydro-electric reservoir in Sri Lanka with an established commercial fishery. Participatory appraisal of the fishing community revealed decreasing reliance on fishing income with many fishermen moving away to supplementary occupations because of declining fish catches. Illegal fishing and theft of fishing gear resulting from open access, difficulties encountered in enforcing fisheries regulations and the need for fishermen to find alternative sources of income during low water levels are the major management problems. The top,down centralized management approach previously practised was ineffective in addressing any of these issues. Therefore, the possibilities and limitations for introducing co-management as an alternative management strategy were discussed. Financial hardship coupled with perceived benefits through state sponsored welfare schemes caused a positive attitude change among fishermen, making them respond favourably to fishery management. Establishing a licensing system for controlled access, ensuring greater user-group participation through equitable distribution of state sponsored benefits among members, attempting to enforce penalties for illegal fishing linked with surprise checks to enforce management regulations, and obtaining stakeholder perceptions regarding management issues are some of the recent steps taken by the Fishermen's Co-operative Society which would positively contribute towards developing effective co-management in this reservoir. [source] Triggers for Late Twentieth Century Reform of Australian Coastal ManagementGEOGRAPHICAL RESEARCH, Issue 3 2000B. G. Thom This paper identifies four triggers that underpinned the late 20th century reform of coastal management in Australia. These have operated across federal, state and local levels of government. The triggers are global environmental change, sustainable development, integrated resource management, and community awareness of management issues and participation in decision making. This reform has been driven by international and national forces. A number of inquiries into coastal management in Australia culminated in the production of a national coastal policy in 1995. This has led to fundamental changes in coastal management and to the recognition of the inevitability of changes in coastal systems. Federal policies and programs are being translated into action at the state and local government levels through a variety of funding mechanisms and programs. These involve capacity building, a memorandum of understanding between all levels of government, an enhanced role for state advisory or co-ordinating bodies, and an increased role for public participation. [source] Tragedy Reshapes the American Workplace: A Symposium with Lynn MartinGLOBAL BUSINESS AND ORGANIZATIONAL EXCELLENCE, Issue 4 2002Sandra L. Williams In March 2002, the Midwest Workplace Symposium was sponsored by the Union League Club of Chicago. The discussion explored leadership needs, cultural management issues, and the reshaping of attitudes and values at American businesses in the post-9/11 environment. A panel of business experts gathered to share observations and provide insight into future challenges facing domestic and international commerce. The honorable Lynn Martin, former Secretary of Labor, facilitated the group. This article details salient portions of their discussion. © 2002 Wiley Periodicals, Inc. [source] CEOs with a functional background in operations: Reviewing their performance and prevalence in the top postHUMAN RESOURCE MANAGEMENT, Issue 5 2010Burak Koyuncu Abstract With this study, we update research by Ocasio and Kim (1999) by testing whether the trends that favored the prevalence of CEOs with an operations background in the 1980s and early 1990s continued between 1992 and 2005. Given that supply chain management became a top business priority during this period, we expect a greater prevalence of CEOs with an operations background. This is because, traditionally, executives belonging to the operations function have assumed responsibility for supply chain management issues. Our results, based on a sample of 437 CEOs who lead large-sized U.S. firms in eight industries, provide partial support for the hypothesis that CEOs with a functional background in operations attain higher post-succession performance than CEOs with other functional backgrounds. In addition, we find that the likelihood that newly appointed CEOs have a background in operations is greater in succession events that have taken place more recently and in situations that occurred in the face of poor firm financial performance. © 2010 Wiley Periodicals, Inc. [source] Barriers to reducing the use of restraints in residential elder care facilitiesJOURNAL OF ADVANCED NURSING, Issue 6 2007Kirsten Moore Abstract Title.,Barriers to reducing the use of restraints in residential elder care facilities Aim., This paper is a report of a study to compare perspectives of staff in residential elder care facilities with those of residents and family members from the same facilities about barriers to reducing the use of physical, chemical and environmental restraints. Background., There is growing research evidence of the potential risk of physical and emotional harm of restraining residents in residential elder care facilities. Despite the potential harms, restraints continue to be a common practice in facilities across Australia. Little research has been undertaken to explore the barriers to reducing the use of restraints. Method., Eighteen individual interviews were conducted with staff, general practitioners and a pharmacist and three focus groups were conducted with a total of 12 residents and 17 family members associated with three residential elder care facilities in Melbourne, Australia in 2004. Findings., The three participating facilities were committed to reducing the use of restraints, although physical, chemical and environmental restraints were used in all three facilities. Barriers to reducing restraint use included fear of resident injury, staff and resource limitations, lack of education and information about alternatives to restraints, environmental constraints, policy and management issues, beliefs and expectations (of staff, family and residents), inadequate review practices and communication barriers. Conclusion., Further education and support for staff and family members in evidence-based practice in relation to resident care and restraint use is needed in at least some residential elder care facilities. [source] The Governance of Rural Land in a Liberalised WorldJOURNAL OF AGRICULTURAL ECONOMICS, Issue 3 2007Ian Hodge Abstract Liberalisation of agricultural policies reduces the influence of policy on land-use decisions, but environmental policy objectives remain. Governance provides an approach that recognises the role of institutions and collective action. The formulation of environmental policy objectives in terms of the provision of public goods raises questions as to the role of economic valuation and as to whether the definition of ,goods' may misdirect policy attention. An alternative approach relates to ecosystem services and sees management issues in terms of ecosystem resilience and the adaptive governance of socio-ecological systems. Governance involves a mix of regulation, markets, government incentives and collective action. Regulation sets the domain within which markets operate and social judgements as to property rights are required as a basis for exchanges. Depending on commodity prices, agri-environment schemes may be required either to reduce agricultural production intensity or to keep land under production. The diffuse nature of the environmental benefits and costs of land uses, the complexity of ecosystems and the need to co-ordinate land management decisions indicate a role for local adaptive co-management of land resources. Governments play a major role in supporting the institutional framework within which this can take place. [source] Host culling as an adaptive management tool for chronic wasting disease in white-tailed deer: a modelling studyJOURNAL OF APPLIED ECOLOGY, Issue 2 2009Gideon Wasserberg Summary 1Emerging wildlife diseases pose a significant threat to natural and human systems. Because of real or perceived risks of delayed actions, disease management strategies such as culling are often implemented before thorough scientific knowledge of disease dynamics is available. Adaptive management is a valuable approach in addressing the uncertainty and complexity associated with wildlife disease problems and can be facilitated by using a formal model. 2We developed a multi-state computer simulation model using age, sex, infection-stage, and seasonality as a tool for scientific learning and managing chronic wasting disease (CWD) in white-tailed deer Odocoileus virginianus. Our matrix model used disease transmission parameters based on data collected through disease management activities. We used this model to evaluate management issues on density- (DD) and frequency-dependent (FD) transmission, time since disease introduction, and deer culling on the demographics, epizootiology, and management of CWD. 3Both DD and FD models fit the Wisconsin data for a harvested white-tailed deer population, but FD was slightly better. Time since disease introduction was estimated as 36 (95% CI, 24,50) and 188 (41,>200) years for DD and FD transmission, respectively. Deer harvest using intermediate to high non-selective rates can be used to reduce uncertainty between DD and FD transmission and improve our prediction of long-term epidemic patterns and host population impacts. A higher harvest rate allows earlier detection of these differences, but substantially reduces deer abundance. 4Results showed that CWD has spread slowly within Wisconsin deer populations, and therefore, epidemics and disease management are expected to last for decades. Non-hunted deer populations can develop and sustain a high level of infection, generating a substantial risk of disease spread. In contrast, CWD prevalence remains lower in hunted deer populations, but at a higher prevalence the disease competes with recreational hunting to reduce deer abundance. 5Synthesis and applications. Uncertainty about density- or frequency-dependent transmission hinders predictions about the long-term impacts of chronic wasting disease on cervid populations and the development of appropriate management strategies. An adaptive management strategy using computer modelling coupled with experimental management and monitoring can be used to test model predictions, identify the likely mode of disease transmission, and evaluate the risks of alternative management responses. [source] Water eutrophication in China and the combating strategiesJOURNAL OF CHEMICAL TECHNOLOGY & BIOTECHNOLOGY, Issue 9 2007Wei Liu Abstract This paper reviews the current eutrophication status of China's lakes. Details of the most eutrophic ,Three Lakes', i.e. Dianchi Lake, Taihu Lake and Chaohu Lake, are given. Based on an explanation of its causes, policies and technologies currently in practice in addition to research towards combating the eutrophication are illustrated using some specific cases. Finally, some management issues and long-term combating strategies are discussed. Copyright © 2007 Society of Chemical Industry [source] Paradox of participation: giving or taking part?JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY, Issue 3 2004Kerlijn Quaghebeur Abstract In this article we address our experiences with a so-called participatory approach in a Vietnamese-Belgian water management project. This project aimed, in its social science component, at stimulating and studying processes of reflexive social learning and of participation and negotiation on local water management issues and on project activities. In this article we intend to show how specific project-related strategies and attempts towards facilitating participation fail and how other initiatives seem to succeed or at least to elicit valuable processes of negotiation and learning. We start from the commonly held view on participation as committed to reverse or subvert power relations. However, our research experiences indicate that participation is always part of an operation of power, governing people to behave themselves in a particular determined way. From this Foucauldian governmental perspective, we are able to reconsider the success and failure of participatory approaches, not so much in terms of the effectiveness of their application, but rather in terms of the possibility to refuse ,participatory' government. Copyright © 2004 John Wiley & Sons, Ltd. [source] A new look at manufacturing using CAM-I's capacity management modelJOURNAL OF CORPORATE ACCOUNTING & FINANCE, Issue 3 2003Andrew Muras A capacity management model helps managers evaluate capacity by providing a visual presentation of problem areas. This can lead to much-needed insight to address many management issues in manufacturing and production. This article outlines an application of the capacity model developed by the Consortium for Advanced Manufacturing-International (CAM-I), along with the synergistic efforts of product costing and process improvement initiatives. © 2003 Wiley Periodicals, Inc. [source] Risk management issues in the reuse of single-use medical devicesJOURNAL OF HEALTHCARE RISK MANAGEMENT, Issue 3 2000DFASHRM, John C. West JD The future of the practice of reusing single-use medical devices is currently uncertain because the U.S. Food and Drug Administration is poised to promulgate regulations on the subject. This article deals with the risk issues associated with contracting with an external vendor to perform this function under current FDA regulations and provides guidance for minimizing these risks. [source] Multiple Endocrine Neoplasia , IntroductionJOURNAL OF INTERNAL MEDICINE, Issue 1 2005S. J. MARX Abstract. Each multiple endocrine neoplasia (MEN) syndrome expresses striking features of hormone oversecretion from its own characteristic group of tissues. Additional expressions include non-hormonal tumours in each MEN syndrome and selected cancers in some syndromes. The complexity of its stereotyped features results in difficult management issues that often justify cooperation across multiple specialties. MEN syndromes, though rare, have long received intense study as models for more common diseases. The syndromal nature often with a large pedigree has promoted recent discovery of the main gene that differs for each of the six MEN syndromes. Each mutant gene has been introduced into clinical decision-making and into further clarification of tumorigenesis. This mini-symposium is related to the 9th International Workshop on Multiple Endocrine Neoplasia in June 2004; it consists of six manuscripts. They report new developments in clinical practices and in basic understandings about this rapidly advancing field. [source] Awake upper airway obstruction in children with spastic quadriplegic cerebral palsyJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1-2 2006Dominic J Wilkinson Objective: Some children with severe cerebral palsy develop symptoms of upper airway obstruction (UAO) while awake. The aetiology, natural history and treatment of this complication have not previously been systematically described. This study documents a case series of children with severe cerebral palsy admitted to hospital because of severe awake UAO and reviews the relevant literature. Methods: The case records of children admitted to hospital with UAO while awake over an 8-month period were reviewed. Details of antecedent illness, comorbidities, acute management and follow up were collated. One case is presented in detail. Results: Eight children were admitted with UAO. Seven children required intensive care admission. One child died, and two underwent tracheostomy. Nasendoscopy showed pharyngeal collapse without anatomical obstruction in the majority. One child was discovered to have a brainstem malignancy. Conclusions: Upper airway obstruction is a potentially severe and life-threatening complication of cerebral palsy. In this series, a majority of children had obstruction related to pharyngeal hypotonia and collapse. This can lead to prolonged hospitalization and intensive care admission. It may raise difficult management issues. [source] DEVELOPMENT AND EVALUATION OF MULTIPLE-OBJECTIVE DECISION-MAKING METHODS FOR WATERSHED MANAGEMENT PLANNING,JOURNAL OF THE AMERICAN WATER RESOURCES ASSOCIATION, Issue 2 2002France Lamy ABSTRACT: Making decisions for environmental management is a complex task due to the multiplicity and diversity of technological choices. Furthermore, the exploitation of natural resources and the preservation of the natural environment imply objectives that are often in conflict within a sustainable development paradigm. Managers and other decision makers require techniques to assist them in understanding strategic decision making. This paper illustrates the use of a multiple-objective decision-making methodology and an integrative geographical information system-based decision-making tool developed to help watershed councils prioritize and evaluate restoration activities at the watershed level. Both were developed through a multidisciplinary approach. The decision-making tool is being applied in two watersheds of Oregon's Willamette River Basin. The results suggest that multiple-objective methods can provide a valuable tool in analyzing complex watershed management issues. [source] Knowledge management and decision support for electrical power utilitiesKNOWLEDGE AND PROCESS MANAGEMENT: THE JOURNAL OF CORPORATE TRANSFORMATION, Issue 4 2001G. M. West This paper describes a case study for a knowledge management project carried out in conjunction with two major UK electrical utilities. The focus of the work is on the design of protection schemes for electrical power transmission systems. A brief overview is provided of the traditional protection system design processes implemented within both companies and the associated shortcomings relating to the management of the data, information and knowledge throughout this process. The development of the Design Engineering Knowledge Application System (DEKAS), designed to address the knowledge management issues within both companies, is described, and the perceived benefits this system offers the existing protection design and application process of each company will be discussed. Copyright © 2001 John Wiley & Sons, Ltd. [source] A fish kill event, hypoxia and other limnological impacts associated with early wet season flow into a lake on the Mary River floodplain, tropical northern AustraliaLAKES & RESERVOIRS: RESEARCH AND MANAGEMENT, Issue 3-4 2003Simon A. Townsend Abstract The Mary River, in the Australian wet/dry tropics, flows seasonally to inundate a coastal floodplain. In the dry season, the river reduces to a series of disconnected lakes located along the main river channel. This paper examines the impact of riverine inflow, at the beginning of the wet season, on the limnology of Shady Camp Lake, and addresses broader water quality management issues. The first wet season flow of Mary River carried a high biological oxygen demand that reduced the lake's oxygen concentration. The resulting hypoxic conditions prompted fish avoidance behaviour and caused the death of at least 200 fish. There is no evidence of any direct anthropogenic pollution causing the event. After reaching near anoxic conditions, dissolved oxygen concentrations recovered several weeks later, although they remained low. The water quality of the Mary River was characterized by an initial pulse of water with high concentrations of organic carbon, suspended particulate material, colour, total nitrogen and total phosphorus. Phytoplankton biomass, measured as chlorophyll a, did not increase because of nitrogen limitation attributed to low nitrate and ammonia concentrations in the inflow waters. The low concentrations of available nitrogen were probably a result of denitrification, which would have been enhanced by the warm temperatures and low oxygen concentrations. The oxygen sag in Shady Camp Lake caused by the inflow of the Mary River exemplifies the vulnerability of floodplain channel lakes to riverine waters and underscores the need to manage catchment practices to minimize the concentration of labile organic material in the river and its associated oxygen demand. [source] Review article: the management of lower gastrointestinal bleedingALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11 2005J. J. Farrell Summary Several recent advances have been made in the evaluation and management of acute lower gastrointestinal bleeding. This review focuses on the management of lower gastrointestinal bleeding, especially acute severe bleeding. The aim of the study was to critically review the published literature on important management issues in lower gastrointestinal bleeding, including haemodynamic resuscitation, diagnostic evaluation, and endoscopic, radiologic, and surgical therapy, and to develop an algorithm for the management of lower gastrointestinal bleeding, based on this literature review. Publications pertaining to lower gastrointestinal bleeding were identified by searches of the MEDLINE database for the years 1966 to December 2004. Clinical trials and review articles were specifically identified, and their reference citation lists were searched for additional publications not identified in the database searches. Clinical trials and current clinical recommendations were assessed by using commonly applied criteria. Specific recommendations are made based on the evidence reviewed. Approximately, 200 original and review articles were reviewed and graded. There is a paucity of high-quality evidence to guide the management of lower gastrointestinal bleeding, and current endoscopic, radiologic, and surgical practices appear to reflect local expertise and availability of services. Endoscopic literature supports the role of urgent colonoscopy and therapy where possible. Radiology literature supports the role of angiography, especially after a positive bleeding scan has been obtained. Limited surgical data support the role of segmental resection in the management of persistent lower gastrointestinal bleeding after localization by either colonoscopy or angiography. There is limited high-quality research in the area of lower gastrointestinal bleeding. Recent advances have improved the endoscopic, radiologic and surgical management of this problem. However, treatment decisions are still often based on local expertise and preference. With increased access to urgent therapeutic endoscopy for the management of acute upper gastrointestinal bleeding, diagnostic and therapeutic colonoscopy can be expected to play an increasing role in the management of acute lower gastrointestinal bleeding. [source] A ,reformed' litigator describes a creative complex litigation management approachALTERNATIVES TO THE HIGH COST OF LITIGATION, Issue 4 2009Thomas L. Aldrich An international healthcare company installed a flexible, comprehensive process that drives its investigations into early resolution and litigation management issues. Thomas L. Aldrich, of Glenview, Ill., provides the details. [source] Clinical overview of the synucleinopathiesMOVEMENT DISORDERS, Issue S6 2003Maria J. Martí MD Abstract The term synucleinopathies is used to name a group of neurodegenerative disorders characterized by fibrillary aggregates of ,-synuclein protein in the cytoplasm of selective populations of neurons and glia. These disorders include Parkinson's disease (PD), dementia with Lewy bodies (DLB), pure autonomic failure (PAF), and multiple system atrophy (MSA). Clinically, they are characterized by a chronic and progressive decline in motor, cognitive, behavioural, and autonomic functions, depending on the distribution of the lesions. Because of clinical overlap, differential diagnosis is sometimes very difficult. Parkinsonism is the predominant symptom of PD, but it can be indistinguishable from the parkinsonism of DLB and MSA. Autonomic dysfunction, which is an isolated finding in PAF, may be present in PD and DLB, but is usually more prominent and appears earlier in MSA. DLB could be the same disease as PD but with widespread cortical pathological states, leading to dementia, fluctuating cognition, and the characteristic visual hallucinations. The deposition of aggregates of synuclein in neurons and glia suggests that a common pathogenic mechanism may exist for these disorders. Even though synuclein may play an important role in disease development in these disorders, in light of the different symptom complex and prognosis and management issues that characterize each disorder, we think that the term synucleinopathy has little practical value as a diagnostic term for the clinician. Clinicians should attempt to reach standard clinical diagnosis on patients, such as PD, PAF, or MSA. © 2003 Movement Disorder Society [source] | ||||||||||||||||||||||||||||||||||||||||||||||