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Management Strategies (management + strategy)
Kinds of Management Strategies Selected AbstractsDesign and Management Strategies for Mixed Public Private Transportation Networks: A Meta-Heuristic ApproachCOMPUTER-AIDED CIVIL AND INFRASTRUCTURE ENGINEERING, Issue 4 2009Avinash Unnikrishnan In this study, private companies are assumed to have a degree of control over highway sections on which they perform maintenance and rehabilitation and capacity expansion activities. The private investors recover the cost of construction by levying tolls. The public agency is assumed to maintain the rest of the network with the objective of minimizing total system generalized cost. The bi-directional impact of roadway utilization on deterioration and deterioration on utilization is modeled in this study. The model accounts for route choice of users and all users are assumed to choose routes that have equal and minimal experienced generalized cost. The nonconvex and discontinuous multi-objective mathematical program is solved using nondominant sorting genetic algorithm-II and the pareto-optimal trade-off surface between the profit of the private company and the total system cost is generated. Computational runs are conducted to demonstrate the suitability and flexibility of the developed framework in modeling various policy decisions such as the presence of noncompete clauses. [source] Management Strategies and Improvement of Performance of Sewer NetworksCOMPUTER-AIDED CIVIL AND INFRASTRUCTURE ENGINEERING, Issue 7 2007Denys Breysse Even when they are conscious about the needs of maintenance to keep the system in a good condition, they lack efficient methods and tools that may help them in taking appropriate decisions. One can say that no really satisfactory and efficient tool exists, enabling the optimization of Inspection, Maintenance, or Rehabilitation (IMR) strategies on such systems. Sewer managers and researchers have been involved for many years in the French National Research Project for Renewal of Non Man Entry Sewer System (RERAU,Réhabilitation des Réseaux d'Assainissement Urbains, in French) to improve their knowledge of these systems and the management policies. During the RERAU project, a specific action has been dedicated to the modeling of asset ageing and maintenance. A special attention has been dedicated to the description of defects and dysfunctions, to the evaluation of performances and its modeling, accounting for its various dimensions (from the point of view of the manager, of the user, of the environment,). After having defined an Index of Technical Performance (ITp), we will introduce the Index of Technical and Economic Performance (ITEp) that is a combined measure of performance (including social costs) and technical costs. This index provides an objective standard tool for managers to compare different alternatives. It is used in the article to compare some simple IMR strategies. It sets the basis of a new method for no-man entry sewer system management, enabling us to analyze the profitableness of investment in terms of both technical and economic performance. [source] Echocardiographic Evaluation of Valvular Regurgitation and Management Strategies: Getting Better All the TimeECHOCARDIOGRAPHY, Issue 3 2000ARA SADANIANTZ M.D., F.A.C.C., F.E.S.C. No abstract is available for this article. [source] Children's Expectations of Pain, Perceptions of Analgesic Efficacy, and Experiences With Nonpharmacologic Pain Management Strategies at Home Following TonsillectomyJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 3 2007Kimberly A. Sutters PURPOSE.,To document children's (ages 6,15 years) descriptions of their pain management at home following tonsillectomy. DESIGN AND METHODS.,Audio-taped interviews of 80 children were transcribed and coded. Data for each response category were tabulated. RESULTS.,Children reported they had more pain after surgery than expected, the pain medicine helped to take their pain away, taking the pain medicine was associated with a negative response by some children, and cold liquids/food by mouth provided pain relief. PRACTICE IMPLICATIONS.,Findings provide insight into children's perspective of pain management at home following tonsillectomy and methods for relieving their pain. [source] A Gender Perspective on Conflict Management Strategies of NursesJOURNAL OF NURSING SCHOLARSHIP, Issue 1 2001Patricia E.B. Valentine Purpose: To apply a gender perspective to synthesis of research findings on conflict management. Organizing Construct: The Thomas-Kilmann Mode Instrument (TKI), for measuring five conflict-handling strategies: avoiding, compromising, collaborating, accommodating, and competing. Method: Nursing research studies with the TKI and other studies are synthesized from perspectives in three gender theories. Conclusions: Findings were that two conflict management strategies, avoiding and compromising, were used predominantly by all categories of nurses. Possible reasons for over- and underuse of the remaining three strategies (collaborating, accommodating, competing) are described. Implications of these findings for nurses and nursing organizations are discussed. [source] Supply Management Strategies for the Future: A Delphi StudyJOURNAL OF SUPPLY CHAIN MANAGEMENT, Issue 3 2005Jeffrey A. Ogden Summary As supply management becomes more involved in strategic decisions, an understanding of the various strategies that it can employ is crucial. This research uses a multiround Delphi study of key procurement and supply management executives to better understand which procurement and supply management strategies may lead to significant improvements over the next 5,10 years. The results indicate that strategies such as increased integration, information sharing and collaboration among supply chain members are most likely to be implemented and will have the largest impact on organizations. However, this integration will not include joint investment or asset sharing, will be limited to one tier in the supply chain, and will not heavily involve e-markets and electronic auctions. [source] Obesity and Pregnancy: Implications and Management Strategies for ProvidersMOUNT SINAI JOURNAL OF MEDICINE: A JOURNAL OF PERSONALIZED AND TRANSLATIONAL MEDICINE, Issue 6 2009Taraneh Shirazian MD Abstract Obesity in pregnancy (pregravid body mass ,30) has been linked to several adverse pregnancy outcomes, including spontaneous abortion, preeclampsia, gestational diabetes, fetal macrosomia, cesarean delivery, and wound complications post,cesarean section. Intrapartum and postpartum management of obese gravidas requires multidisciplinary consultations between obstetricians, anesthesiologists, nurses, and pediatricians in order to improve the pregnancy outcomes of the mother and neonate. The American College of Obstetricians and Gynecologists currently supports risk-reducing strategies for obese pregnant patients, including limiting weight gain to 15 lb (standardized by the Institute of Medicine). Interventions to reduce gestational weight gain may be important modifiable risk factors for maternal and fetal perinatal complications. Interventions have targeted modifications of diet and exercise with educational methods such as radio broadcasts, pamphlets, and counseling. Interventions have also focused on motivational methods, such as individual and group classes, and have been implemented both before conception and immediately after birth. Effective interventions appear to be individualized in approach, but there is a lack of data to support any specific model. Prospective interventional studies are needed to demonstrate the benefits of weight limitation on pregnancy outcomes. Mt Sinai J Med 76:539-545, 2009. © 2009 Mount Sinai School of Medicine [source] Management Strategies for Complex Adaptive Systems Sensemaking, Learning, and ImprovisationPERFORMANCE IMPROVEMENT QUARTERLY, Issue 2 2007Reuben R. McDaniel Jr. Misspecification of the nature of organizations may be a major reason for difficulty in achieving performance improvement. Organizations are often viewed as machine-like, but complexity science suggests that organizations should be viewed as complex adaptive systems. I identify the characteristics of complex adaptive systems and give examples of management errors that may be made when these characteristics are ignored. Command, control and planning are presented as managerial tasks that come to the fore when a machine view of organizations dominates thinking. When we treat organizations as complex adaptive systems the focus of managerial activity changes, and sensemaking, learning and improvisation become appropriate strategies for performance improvement. Each of these is defined and described. A modest research agenda is presented. [source] Educating Physicians to Treat Erectile Dysfunction Patients: Development and Evaluation of a Course on Communication and Management StrategiesTHE JOURNAL OF SEXUAL MEDICINE, Issue 1 2006Loukas Athanasiadis MD ABSTRACT Purpose., To describe the development and assess the outcome of a workshop on erectile dysfunction (ED) management based on participating physicians evaluations. Method., The study involved physicians who attended a workshop offered throughout the country, during a 3-year period. The workshop included tutorials, video-based dramatizations, and role-play sessions. A pilot study investigated the workshop's impact on physicians' attitudes toward patient-centeredness and sexual behavior issues; Patient,Practitioner Orientation Scale (PPOS) and Cross Cultural Attitude Scale (CCAS) were administered before and after the course. New knowledge acquisition, quality of presentation, and workshop's usefulness in their clinical practice were the dimensions used for workshop's evaluation. Analysis used quantitative and qualitative methods. Results., A total of 194 questionnaires were administered during the pilot study and the response rate was 53.6%. A shift in attitudes toward patient-centeredness and less judgmental attitude toward patients' sexual attitudes were revealed (total PPOS score and Sharing subscale: P < 0.05, CCAS: P < 0.001). Six hundred physicians were asked to evaluate the workshops and the response rate was 62.3%. The tutorial session for "medical treatment of ED" (P < 0.001) and the role-play on sexual history taking (P < 0.05) received higher evaluation scores. Qualitative analysis showed that the most frequently reported category referred to the appropriateness of role-play as a teaching and awareness-raising technique (31.25%); a need for changes in clinical practice and communication patterns was identified by 20% of the participants who stressed the necessity for multidisciplinary approach, as well as the adoption of a nonjudgmental attitude toward patients. Conclusion., Training courses on ED management, using a combination of tutorial and interactive sessions, constitute an effective way of providing knowledge, enhancing physicians' communication skills with ED patients, and influencing attitudes toward patient-centeredness in sexual issues. Such results strongly support the establishment of sexual medicine courses at continuing medical education curricula. Athanasiadis L, Papaharitou S, Salpiggidis G, Tsimtsiou Z, Nakopoulou E, Kirana P-S, Moisidis K, and Hatzichristou D. Educating physicians to treat erectile dysfunction patients: development and evaluation of a course on communication and management strategies. J Sex Med 2006;3:47,55. [source] Management Strategies for Stage-D Patients with Acute Heart FailureCLINICAL CARDIOLOGY, Issue 7 2008David Feldman M.D., Ph.D. Abstract Heart Failure (HF) accounted for 3.4 million ambulatory visits in 2000. Current guidelines from the American Heart Association/American College of Cardiology, the Heart Failure Society of America, and the International Society for Heart & Lung Transplantation recommend aggressive pharmacologic interventions for patients with HF. This may include a combination of diuretics, Angiotensin Converting Enzyme inhibitors, ,-blockers, angiotensin receptor blockers, aldosterone antagonists, and digoxin. Nitrates and hydralazine are also indicated as part of standard therapy in addition to ,-blockers and Angiotensin Converting Enzyme inhibitors, especially but not exclusively, for African Americans with left ventricular (LV) systolic dysfunction. For those with acute decompensated HF, additional treatment options include recombinant human B-type natriuretic peptide, and in the future possible newer agents not yet approved for use in the U.S., such as Levosimendan. Medical devices for use in patients with advanced HF include LV assist devices, cardiac resynchronization therapy, and implantable cardioverter defibrillators. For refractory patients, heart transplantation, the gold-standard surgical intervention for the treatment of refractory HF, may be considered. Newer surgical options such as surgical ventricular restoration may be considered in select patients. Copyright © 2007 Wiley Periodicals, Inc. [source] Financial Management Strategy in a Community Welfare Organisation: A Boardroom PerspectiveFINANCIAL ACCOUNTABILITY & MANAGEMENT, Issue 4 2003Lee D. Parker This paper presents the results of a four year participant observation study of boardroom deliberations and resulting financial management strategies in a large not,for,profit religious based community welfare organisation. Employing a complete membership research approach and informed by grounded theory analysis, the study develops a micro,theoretical framework portraying boardroom financial management and accountability strategising. The study finds that the strategic focus on mission financing was conditioned by the contested formulation of strategic objectives, core organisational service philosophies, and executive,board member interaction. A significant observed outcome of the strategic mission financing focus was the management of accountability and disclosure, to which two key strategies were contributory. These were the exercising of financial control and the exercising of relationships management. The findings offer hitherto unavailable insights into strategic financial management and accountability processes and their context at the boardroom level in the religious not,for,profit community welfare sector. [source] How New Product Introductions Affect Sales Management Strategy: The Impact of Type of "Newness" of the New ProductTHE JOURNAL OF PRODUCT INNOVATION MANAGEMENT, Issue 4 2003Kamel Micheal How do firms adjust sales management strategy for new product launch? Does sales management strategy change more radically for different types of new products such as new-to-the-world products versus product revisions? Because firms introducing a new product rely considerably on their sales force in the product launch effort, the types and degree of changes made in managing the selling effort are important issues. Past studies have demonstrated that firms make substantial adjustments in their sales management strategy when they introduce a new product. This study expands on previous investigations by examining whether sales management strategy changes are conditioned by the type of newness of the new product to the market and to the firm. Australian sales managers were asked to respond to a mail questionnaire concerning pre- and post-new product launch sales management activities. Three groups of firms were compared: (1) those with new-to-the-market and new-to-the-firm products (i.e., new-to-the-world products); (2) those with products new to the firm but not new to the market; and (3) those with products that are revisions to the firm and not new to the market. The study finds that firms do not make the most adjustments for products with the greatest degree of market newness,the new-to-the-world types of products,except in the sales management strategy categories of compensation and supervision. In the other sales management strategy categories defined for study,organization, training, quotas and goals, and sales support as well as for all categories in the aggregate,sales management strategy changes were greatest in incidence, as measured both by the percent of firms making changes and the average number of changes per firm, when the new product was new to the firm but not new to the market. These results suggest that, because different types of new products face different competitive environments, there may be greater incentive for a not-new-to-the-market new-to-the-firm product to make changes in sales strategy. Uncertainties about market size and customer location with new-to-the-world products may limit the understanding of what changes to make in the strategy categories of quotas and territories. Similarly, uncertainties about product use and customer acceptance of new-to-the-world products may limit the development of training and sales support materials by these firms. Instead, these firms may rely more on compensation and supervision to direct sales efforts for new-to-the-world products. However, observing the market experience and performance of the first-to-market product can benefit firms launching a not-new-to-market and new-to-the-firm product, allowing them to rely more on strategy changes in training, sales support materials, organizational adjustments such as redeployments, and quotas. [source] Management strategies for plant invasions: manipulating productivity, disturbance, and competitionDIVERSITY AND DISTRIBUTIONS, Issue 3 2004Michael A. Huston ABSTRACT The traditional approach to understanding invasions has focused on properties of the invasive species and of the communities that are invaded. A well-established concept is that communities with higher species diversity should be more resistant to invaders. However, most recently published field data contradict this theory, finding instead that areas with high native plant diversity also have high exotic plant diversity. An alternative environment-based approach to understanding patterns of invasions assumes that native and exotic species respond similarly to environmental conditions, and thus predicts that they should have similar patterns of abundance and diversity. Establishment and growth of native and exotic species are predicted to vary in response to the interaction of plant growth rates with the frequency and intensity of mortality-causing disturbances. This theory distinguishes between the probability of establishment and the probability of dominance, predicting that establishment should be highest under unproductive and undisturbed conditions and also disturbed productive conditions. However, the probability of dominance by exotic species, and thus of potential negative impacts on diversity, is highest under productive conditions. The theory predicts that a change in disturbance regime can have opposite effects in environments with contrasting levels of productivity. Manipulation of productivity and disturbance provides opportunities for resource managers to influence the interactions among species, offering the potential to reduce or eliminate some types of invasive species. [source] Nutrient constraints to tropical agroecosystem productivity in long-term degrading soilsGLOBAL CHANGE BIOLOGY, Issue 12 2008SOLOMON NGOZE Abstract Soil degradation is one of the most serious threats to sustainable crop production in many tropical agroecosystems where extensification rather than intensification of agriculture has occurred. In the highlands of western Kenya, we investigated soil nitrogen (N) and phosphorus (P) constraints to maize productivity across a cultivation chronosequence in which land-use history ranged from recent conversion from primary forest to 100 years in continuous cropping. Nutrient treatments included a range of N and P fertilizer rates applied separately and in combination. Maize productivity without fertilizer was used as a proxy measure for indigenous soil fertility (ISF). Soil pools of mineral nitrogen, strongly bound P and plant-available P decreased by 82%, 31% and 36%, and P adsorption capacity increased by 51% after 100 years of continuous cultivation. For the long rainy season (LR), grain yield without fertilizer declined rapidly as cultivation age increased from 0 to 25 years and then gradually declined to a yield of 1.6 Mg ha,1, which was maintained as time under cultivation increased from 60 to 100 years. LR grain yield in the old conversions was only 24% of the average young conversion grain yield (6.4 Mg ha,1). Application of either N or P alone significantly increased grain yield in both the LR and short rainy (SR) seasons, but only application of 120 kg N ha,1 on the old conversion increased yield by >1 Mg ha,1. In both SR and LR, there was a greater average yield increment response to N and P when applied together (ranging from 1 to 3.8 Mg ha,1 for the LR), with the greatest responses on the old conversions. The benefit,cost ratio (BCR) for applying 120 kg N ha,1 alone was <1 except on the old conversions, while BCRs were>1 for applying 25 kg P ha,1 alone at all levels of conversion for both seasons. Application of both N (120 kg N ha,1) and P (25 kg P ha,1) on the old conversions resulted in the greatest BCRs. This study clearly indicates that maize productivity responses to N and P fertilizer are significantly affected by the age of cultivation and its influence on ISF, but that loss of productivity can be restored rapidly when these limiting nutrients are applied. Management strategies should consider ISF and economic factors to determine optimal N and P input requirements for achieving and sustaining profitable crop production on degraded soils. [source] The challenges of conservation for declining migrants: are reserve-based initiatives during the breeding season appropriate for the Pied Flycatcher Ficedula hypoleuca?IBIS, Issue 3 2009ANNE E. GOODENOUGH Creating conservation policies for declining migrant species in response to global change presents a considerable challenge. Migrant species are affected by factors at breeding grounds, overwintering areas and during migration. Accordingly, reserve-based management during the breeding season is not always a suitable conservation strategy. Recent Pied Flycatcher population decline typifies the pattern for many migrants. The UK population has declined by 43% in the past decade, but explanations, and possible solutions, remain elusive. We use 15 years of data (1990,2004) from a declining British population to establish possible reasons for decline, considering: (1) breeding performance (including the influences of competition and predation); (2) weather patterns caused by the winter phase (December,March) of the North Atlantic Oscillation (NAO), which modify conditions experienced at wintering grounds and on migration; and (3) possible impacts of climate change on spring temperatures. We conclude that decreasing breeding performance is contributing to decline, but that non-breeding factors are more important. Winter NAO index is a strong predictor of breeding population, probably because it influences food abundance in Africa and at migratory stopover points. Importantly, however, year itself enhances the predictive model, indicating that influences on population remain unaccounted for by current research. Management strategies based on increasing breeding productivity cannot fully address population decline because non-breeding factors appear important. However, as breeding performance is declining, breeding-based strategies remain useful conservation tools. To this end, our research indicates that optimal placement of nestboxes as regards orientation and habitat management to increase larval food supplies could increase productivity significantly. [source] Crohn's is not a 6-week disease.INFLAMMATORY BOWEL DISEASES, Issue 8 2004Lifelong management of mild to moderate Crohn's disease Abstract Crohn's disease is an idiopathic, chronic inflammatory disorder of the digestive tract with heterogeneous clinical presentations. Crohn's is currently not a curable disease, and patients are faced with a lifetime of recurrent disease flare-ups and remissions. Management strategies for Crohn's must therefore be targeted toward lifelong management, taking into consideration not only the short-term but also the long-term aspects of the disease. With this in mind, here we review the classifications and natural history of Crohn's disease and discuss possible predictive factors for the disease evolution in a patient. Here we also evaluate the current preferable treatment practices, based on scientifically valid research and collective clinical experience, for the management of mild to moderate Crohn's disease. [source] Importance of implementation and residual risk analyses in sediment remediationINTEGRATED ENVIRONMENTAL ASSESSMENT AND MANAGEMENT, Issue 1 2006Richard J Wenning Abstract Management strategies for addressing contaminated sediments can include a wide range of actions, ranging from no action, to the use of engineering controls, to the use of more aggressive, intrusive activities related to removing, containing, or treating sediments because of environmental or navigation considerations. Risk assessment provides a useful foundation for understanding the environmental benefits, residual hazards, and engineering limitations of different remedy alternatives and for identifying or ranking management options. This article, part of a series of panel discussion papers on sediment remediation presented at the Third International Conference on Remediation of Contaminated Sediments held 20,25 January 2005 in New Orleans, Louisiana, USA, reviews 2 types of risk that deserve careful consideration when evaluating remedy alternatives. The evaluation of remedy implementation risks addresses predominantly short-term engineering issues, such as worker and community health and safety, equipment failures, and accident rates. The evaluation of residual risks addresses predominantly longer-term biological and environmental issues, such as ecological recovery, bioaccumulation, and relative changes in exposure and effects to humans, aquatic biota, and wildlife. Understanding the important pathways for contaminant exposure, the human and wildlife populations potentially at risk, and the possible hazards associated with the implementation of different engineering options will contribute to informed decision making with regard to short- and long-term effectiveness, implementability, and potential environmental hazards. [source] Management strategies for Barrett's esophagusJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 6 2007Lybus Hillman [source] A new evidence-based model for weight management in primary care: the Counterweight ProgrammeJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 3 2004The Counterweight Project Team Abstract Background/Aims Obesity has become a global epidemic, and a major preventable cause of morbidity and mortality. Management strategies and treatment protocols are however poorly developed and evaluated. The aim of the Counterweight Programme is to develop an evidence-based model for the management of obesity in primary care. Methods The Counterweight Programme is based on the theoretical model of Evidence-Based Quality Assessment aimed at improving the management of obese adults (18,75 years) in primary care. The model consists of four phases: (1) practice audit and needs assessment, (2) practice support and training, (3) practice nurse-led patient intervention, and (4) evaluation. Patient intervention consisted of screening and treatment pathways incorporating evidence-based approaches, including patient-centred goal setting, prescribed eating plans, a group programme, physical activity and behavioural approaches, anti-obesity medication and weight maintenance strategies. Weight Management Advisers who are specialist obesity dietitians facilitated programme implementation. Eighty practices were recruited of which 18 practices were randomized to act as controls and receive deferred intervention 2 years after the initial audit. Results By February 2004, 58 of the 62 (93.5%) intervention practices had been trained to run the intervention programme, 47 (75.8%) practices were active in implementing the model and 1256 patients had been recruited (74% female, 26% male, mean age 50.6 years, SD 14). At baseline, 75% of patients had at one or more co-morbidity, and the mean body mass index (BMI) was 36.9 kg/m2 (SD 5.4). Of the 1256 patients recruited, 91% received one of the core lifestyle interventions in the first 12 months. For all patients followed up at 12 months, 34% achieved a clinical meaningful weight loss of 5% or more. A total of 51% of patients were classed as compliant in that they attended the required level of appointments in 3, 6, and 12 months. For fully compliant patients, weight loss improved with 43% achieving a weight loss of 5% or more at 12 months. Conclusion The Counterweight Programme is an evidence-based weight management model which is feasible to implement in primary care. [source] Nationwide linkage analysis in Scotland implicates age as the critical overall determinant of mortality in ulcerative colitisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 12 2010R. J. NICHOLLS Aliment Pharmacol Ther,31, 1310,1321 Summary Background, Recent data associated higher mortality with medical rather than surgical intervention in patients with ulcerative colitis who require hospitalization. Aim, To examine factors influencing UC-related mortality in Scotland. Method, Using the national record linkage database 1998,2000, 3-year mortality was determined after four admission types: colectomy-elective or emergency; no colectomy-elective or emergency. Results, Of 1078 patients, crude 3-year mortality rates were: colectomy elective 5.6% (n = 177) and emergency 9.0% (100); no colectomy elective 9.8% (244) and emergency 16.0% (557). Using elective colectomy as reference, multivariate analysis [OR (95% CI)] showed that admission age >50 years [OR 5.46 (2.29,11.95)], male gender [OR 1.92 (1.23,3.02)], comorbidity [OR 2.2 (1.38,3.51)], length of stay >15 days [OR 2.04 (1.08,3.84)] and prior IBD admission [OR 1.66 (1.06,2.61)] were independently related to mortality. Age was the strongest determinant. No patient <30 years died. Mortality of patients aged <50 years [10/587 (1.7%)] was significantly lower than mortality of those aged 50,64 years [26/246 (10.6%)] (,2 = 32.91; P < 0.0000001) and >65 [96/245 (39.2%)] (,2 = 218.2; P < 0.0000001). For those patients aged more than 65 years, mortality in the four groups was 29.4%, 33.3%, 28.1% and 44.7%, all greater than expected in the Scottish population on assessment of standardized mortality ratios. Conclusion, Hospital admission in UC patients >65 is associated with high mortality. Management strategies should consider this by treatment in specialist units, early investigation, focused medical treatment and earlier surgical referral. [source] Skin cancer in liver transplant recipientsLIVER TRANSPLANTATION, Issue 3 2000Clark C. Otley Skin cancer is the most common malignancy arising in the posttransplantation setting. Multiple factors contribute to the high risk for cutaneous carcinoma in immunosuppressed organ-transplant recipients. We review the phenomenon of skin cancer in solid-organ transplant recipients and further delineate the problem in the context of liver transplantation. Skin cancer is a significant medical and surgical problem for organ-transplant recipients. With prolonged allograft function and patient survival, the majority of solid-organ transplant recipients will eventually develop skin cancer. Although squamous cell carcinoma is the most common cutaneous malignancy in this population, basal cell carcinoma, melanoma, and Kaposi's sarcoma, as well as uncommon skin malignancies, may occur. Highly susceptible patients may develop hundreds of squamous cell carcinomas, which may be life threatening. Management strategies focus on regular full-skin and nodal examination, aggressive treatment of established malignancies, and prophylactic measures to reduce the risk for additional photodamage and malignant transformation. Skin cancer is a substantial cause of morbidity and even mortality among solid-organ transplant recipients. As a byproduct of immunosuppression, liver transplant recipients experience a high incidence of skin cancer and should be educated and managed accordingly. [source] Management strategies following microsurgical flap failureMICROSURGERY, Issue 1 2010F.A.C.S., William Lineaweaver M.D. Although increasingly rare, failed microsurgical flaps are a complicated clinical problem when they occur. Review of reports of management following microsurgical flap failure offers an outline of options. A substantial number of breast and extremity patients elect abandonment of reconstruction. The majority of head and neck, breast, and extremity patients proceed to nonmicrosurgical reconstructive options. Head and neck patients (38%) and 35% of extremity patients elect to have second microsurgical flaps, and 84% of these procedures were successful.Patient management following microsurgical flap failure includes strategic abandonment of reconstruction in some cases, use of conventional procedures in a majority of cases, and further microsurgical procedures in one-third of cases. The reconstructive surgeon should have this range of possibilities available for these difficult cases. © 2009 Wiley-Liss, Inc. Microsurgery, 2010. [source] Prevention and treatment of cluster headachePROGRESS IN NEUROLOGY AND PSYCHIATRY, Issue 3 2009Anna S Cohen PhD Cluster headache is an excruciatingly painful primary headache syndrome with rapid onset attacks that are relatively short, typically up to three hours. Management strategies involve avoidance of possible triggers to attacks, such as alcohol and naps, and pharmacological treatments aimed at either quickly aborting acute attacks, or preventive therapies to suppress the attacks entirely, or reduce their frequency, severity or duration. Copyright © 2009 Wiley Interface Ltd [source] Management strategies associating batch-graded and size-graded postlarvae can reduce heterogeneous individual growth in Macrobrachium rosenbergii (de Man)AQUACULTURE RESEARCH, Issue 15 2002K Ranjeet Abstract Two sets of adaptive trials were performed to determine the effects of size grading and batch grading on size heterogeneity in cultured Macrobrachium rosenbergii raised in the Coconut Garden channels of Kuttanad, Southern India. In the first set of trials, postlarvae were batch graded on the basis of their hatching order, segregated and grown separately as first-hatched and second-hatched groups. In the second set of trials, postlarvae were size graded as jumpers and laggards and were grown in separate channels. The average weight attained by prawns after 10 months of culture was highest for jumpers (83.11 g) and lowest for the prawns from the first-hatched group (43.76 g). The percentage of males was highest in the population of jumpers (58.23%). Highest production was recorded in the channel stocked with postlarvae from the second-hatched group (103.4 kg ha,1) and lowest production was obtained from the first-hatched group (63.74 kg ha,1). The proportions of undesirable small males were highest among laggards and the first-hatched group: 24.8% and 15.1% respectively. The level of heterozygosity within morphotypes was also high in these groups. Jumpers attained good growth by the end of culture but, because of their low survival rate, this approach was not economically feasible. However, higher production and survival in the second-hatched group improved economic viability. Thus, for better results, stocking with later-hatched groups would be more appropriate than stocking with the first-hatched group. [source] Hematologic complications of anti-CMV therapy in solid organ transplant recipientsCLINICAL TRANSPLANTATION, Issue 3 2009Lara Danziger-Isakov Abstract:, Cytomegalovirus (CMV) infection complicates the post-operative course of patients receiving solid organ transplants. While ganciclovir has significantly reduced the direct effects of CMV infection, some patients cannot tolerate the optimal therapeutic exposure required for CMV prevention and treatment. Few reports directly address the incidence, consequences, and risk factors for hematologic toxicities related to ganciclovir therapy. Nevertheless, leukopenia, thrombocytopenia, and anemia occur in 5,50% of patients. Current strategies, focused on ganciclovir dose reduction, may increase the risk of CMV reactivation and drug-resistant disease. The current article reviews the incidence, risk factors, and consequences of ganciclovir-associated hematologic adverse events in transplant recipients. Management strategies, including ganciclovir dose reduction, and the addition of CMV hyperimmune globulin are discussed. Exposing this relatively frequently occurring, but uncommonly discussed, toxicity should lead to better avoidance and treatment strategies, without placing patients at increased risk of CMV disease. [source] Management strategy and HR in international mergers: choice, constraint and pragmatismHUMAN RESOURCE MANAGEMENT JOURNAL, Issue 1 2009Chris Rees The article combines consideration of the range of contextual factors that impact on management strategy and HR in the post-merger period (such as corporate structures and cultures, pressures from shareholders and regulatory and legal environments at national and international level) with an examination of the interests and power of various groups of actors within the firm. Specifically, we apply a framework which integrates the insights of market-based, institutionalist and micro-political approaches. We locate our analysis within the relevant international HRM literature, most notably recent debates concerning multinational corporation (MNC) merger dynamics. International mergers and acquisitions provide particularly useful scenarios through which to explore the interdependence between choice and constraint, illustrated here by processes of negotiation, compromise and balance across a range of issues in several case study organisations. The key areas highlighted concern: (1) the integration of HR strategies, and (2) processes of post-merger rationalisation. [source] Salmon farming: towards an Integrated Pest Management strategy for sea lice.PEST MANAGEMENT SCIENCE (FORMERLY: PESTICIDE SCIENCE), Issue 6 200219 June 2001., SCI Meeting at Department of Zoology, Scotland, University of Aberdeen First page of article [source] Native saltbush (Rhagodia spp.; Chenopodiaceae) as a potential reservoir for agromyzid leafminer parasitoids on horticultural farmsAUSTRALIAN JOURNAL OF ENTOMOLOGY, Issue 1 2010Glenys Wood Abstract Australia has to date been spared the introduction of highly polyphagous invasive pest agromyzid leafminers; however, their arrival and spread should be considered imminent. To develop a pre-emptive control strategy to deal with exotic leafminer outbreaks the first step is to identify Australian leafmining flies, their plant hosts and their parasitoids to gain an understanding of their population dynamics. Native vegetation may be providing resources for beneficial parasitic wasps plus access to alternative hosts and refuge from disturbance. Here, two Australian endemic saltbushes (Rhagodia candolleana and R. parabolica, Caryophyllales: Chenopodiaceae) have been investigated for their potential to act as reservoirs for endemic agromyzid hosts and their key parasitoids. Mined leaves of the two Rhagodia species were sampled on two commercial horticultural properties in the Virginia horticulture area on the Northern Adelaide Plains between September 2007 and April 2008. Leaf mines on both Rhagodia species were caused by an endemic leafminer species, putatively Phytoliriomyza praecellens Spencer (Diptera: Agromyzidae). Ten species of parasitoids (all Hymenoptera) emerged from R. candolleana mines and seven different species from R. parabolica mines, mainly from the family Eulophidae and with some Pteromalidae and Braconidae. Trigonogastrella Girault sp. (Pteromalidae), Zagrammosoma latilineatum Ubaidillah and Hemiptarsenus varicornis Girault (both Eulophidae) were the most abundant species on R. candolleana, whereas two Opius Wesmael spp. (Braconidae) were the most abundant species on R. parabolica. Findings from this survey suggest an opportunity to plant purpose-designed refuges that could play a role in conservation biological control as part of an Integrated Pest Management strategy developed prior to incursion of pest leafminers such as Liriomyza species. [source] Volume Overload and Cardiorenal SyndromesCONGESTIVE HEART FAILURE, Issue 2010Claudio Ronco MD To include the vast array of interrelated derangements and to stress the bidirectional nature of the heart-kidney interactions, the classification of the cardiorenal syndrome today includes 5 subtypes whose terminology reflects their primary and secondary pathology, time frame, and the presence of concomitant cardiac and renal dysfunction. Cardiorenal syndromes (CRSs) are pathophysiologic disorders of the heart and kidneys whereby acute or chronic dysfunction of one organ may induce acute or chronic dysfunction of the other. Type 1 CRS reflects an abrupt worsening of cardiac function leading to acute kidney injury. Type 2 CRS describes chronic abnormalities in cardiac function causing progressive chronic kidney disease. Type 3 CRS consists in an abrupt worsening of renal function causing acute cardiac disorder. Type 4 CRS describes a state of chronic kidney disease contributing to decreased cardiac function, cardiac hypertrophy, and/or increased risk of adverse cardiovascular events. Type 5 CRS reflects a systemic condition (eg, sepsis) simultaneously causing both cardiac and renal dysfunction. Biomarkers can help characterize the subtypes of CRS as well as suggest the timing of treatment initiation and its likely effectiveness. The identification of patients and the pathophysiologic mechanisms underlying each syndrome subtype, including fluid overload or, in general, altered conditions of fluid status, can help physicians understand clinical derangements, provide the rationale for management strategies, and allow the design of future clinical trials with more accurate selection and stratification of the population under investigation. Congest Heart Fail. 2010;16(4)(suppl 1):Si,Siv. ©2010 Wiley Periodicals, Inc. [source] Role of Genetic Refuges in the Restoration of Native Gene Pools of Brown TroutCONSERVATION BIOLOGY, Issue 4 2009ROSA M. ARAGUAS introgresión de piscifactoría; pautas de manejo; acervos génicas nativas; refugios genéticos; repoblación de peces Abstract:,Captive-bred animals derived from native, alien, or hybrid stocks are often released in large numbers in natural settings with the intention of augmenting harvests. In brown trout (Salmo trutta), stocking with hatchery-reared non-native fish has been the main management strategy used to maintain or improve depleted wild brown trout populations in Iberian and other Mediterranean regions. This measure has become a serious threat to the conservation of native genetic diversity, mainly due to introgressive hybridization. Aware of this risk, the agency responsible for management of brown trout in the eastern Pyrenees (Spain) created "brown trout genetic refuges" to preserve the integrity of brown trout gene pools in this region. Within refuge areas, the prerefuge status with respect to fishing activities has been maintained, but hatchery releases have been banned completely. We evaluated this management strategy through a comparison of the stocking impact on native populations that accounted for stocking histories before and after refuge designations and fishing activities. In particular we examined the relevant scientific, cultural, and political challenges encountered. Despite agency willingness to change fishery policies to balance exploitation and conservation, acceptance of these new policies by anglers and genetic monitoring of refuge populations should also be considered. To improve management supported by genetic refuges, we suggest focusing on areas where the public is more receptive, considering the situation of local native diversity, and monitoring of adjacent introgressed populations. We recommend the use of directional supportive breeding only when a population really needs to be enhanced. In any case, management strategies should be developed to allow for protection within the context of human use. Resumen:,Animales criados en cautiverio derivados de individuos nativos, exóticos o híbridos a menudo son liberados en grandes cantidades en ambientes naturales con la intención de incrementar su explotación. En la trucha común (Salmo trutta), la repoblación con peces no nativos criados en granjas ha sido la principal estrategia de manejo utilizada para mantener o mejorar poblaciones naturales de trucha común en la Peninsula Ibérica y otras regiones Mediterráneas. Esta medida se ha convertido en una seria amenaza para la conservación de la diversidad genética nativa, debido principalmente a la hibridación introgresiva. Consciente de este riesgo, la agencia responsable del manejo de la trucha común en los Pirineos orientales (España) creó"refugios genéticos de trucha común" para preservar la integridad de las acervos genéticos de trucha común en esta región. Dentro de las áreas de refugio, se ha mantenido el estatus previo al refugio con respecto a las actividades pesqueras pero las liberaciones de peces de piscifactoría han sido completamente prohibidas. Evaluamos esta estrategia de manejo mediante la comparación del impacto de la repoblación sobre las poblaciones nativas que registraron historias de repoblación antes y después de la designación de refugios y de actividades pesqueras. En particular, examinamos los significativos retos científicos, culturales y políticos que encontramos. A pesar de la disponibilidad de la agencia para cambiar las políticas de pesca hacia un equilibrio entre la explotación y la conservación, también se debe considerar la aceptación de estas nuevas políticas por los pescadores y el monitoreo genético de las poblaciones en los refugios. Para mejorar el manejo en los refugios genéticos sugerimos centrarse en las áreas donde el público es más receptivo, considerando la situación de la diversidad nativa local y el monitoreo de las poblaciones introgresadas adyacentes. Recomendamos la utilización de la cría de apoyo direccional solo cuando una población realmente requiera ser mejorada. En cualquier caso, se deberían desarrollar estrategias de manejo para permitir la protección en el contexto del uso por el hombre. [source] | ||||||||||||||||||||||||||||||||||||||||||||||