A prospective, randomized, and controlled study of fluid management in children with severe head injury: lactated Ringer's solution versus hypertonic saline.

OBJECTIVES: Resuscitation in severe head injury may be detrimental when given with hypotonic fluids. We evaluated the effects of lactated Ringer's solution (sodium 131 mmol/L, 277 mOsm/L) compared with hypertonic saline (sodium 268 mmol/L, 598 mOsm/L) in severely head-injured children over the first 3 days after injury. DESIGN: An open, randomized, and prospective study. SETTING: A 16-bed pediatric intensive care unit (ICU) (level III) at a university children's hospital. PATIENTS: A total of 35 consecutive children with head injury. INTERVENTIONS: Thirty-two children with Glasgow Coma Scores of <8 were randomly assigned to receive either lactated Ringer's solution (group 1) or hypertonic saline (group 2). Routine care was standardized, and included the following: head positioning at 30 degrees; normothermia (96.8 degrees to 98.6 degrees F [36 degrees to 37 degrees C]); analgesia and sedation with morphine (10 to 30 microg/kg/hr), midazolam (0.2 to 0.3 mg/kg/hr), and phenobarbital; volume-controlled ventilation (PaCO2 of 26.3 to 30 torr [3.5 to 4 kPa]); and optimal oxygenation (PaO2 of 90 to 105 torr [12 to 14 kPa], oxygen saturation of >92%, and hematocrit of >0.30). MEASUREMENTS AND MAIN RESULTS: Mean arterial pressure and intracranial pressure (ICP) were monitored continuously and documented hourly and at every intervention. The means of every 4-hr period were calculated and serum sodium concentrations were measured at the same time. An ICP of 15 mm Hg was treated with a predefined sequence of interventions, and complications were documented. There was no difference with respect to age, male/female ratio, or initial Glasgow Coma Score. In both groups, there was an inverse correlation between serum sodium concentration and ICP (group 1: r = -.13, r2 = .02, p < .03; group 2: r = -.29, r2 = .08, p < .001) that disappeared in group 1 and increased in group 2 (group 1: r = -.08, r2 = .01, NS; group 2: r = -.35, r2 =.12, p < .001). Correlation between serum sodium concentration and cerebral perfusion pressure (CPP) became significant in group 2 after 8 hrs of treatment (r = .2, r2 = .04, p = .002). Over time, ICP and CPP did not significantly differ between the groups. However, to keep ICP at <15 mm Hg, group 2 patients required significantly fewer interventions (p < .02). Group 1 patients received less sodium (8.0 +/- 4.5 vs. 11.5 +/- 5.0 mmol/kg/day, p = .05) and more fluid on day 1 (2850 +/- 1480 vs. 2180 +/- 770 mL/m2, p = .05). They also had a higher frequency of acute respiratory distress syndrome (four vs. 0 patients, p = .1) and more than two complications (six vs. 1 patient, p = .09). Group 2 patients had significantly shorter ICU stay times (11.6 +/- 6.1 vs. 8.0 +/- 2.4 days; p = .04) and shorter mechanical ventilation times (9.5 +/- 6.0 vs. 6.9 +/- 2.2 days; p = .1). The survival rate and duration of hospital stay were similar in both groups. CONCLUSIONS: Treatment of severe head injury with hypertonic saline is superior to that treatment with lactated Ringer's solution. An increase in serum sodium concentrations significantly correlates with lower ICP and higher CPP. Children treated with hypertonic saline require fewer interventions, have fewer complications, and stay a shorter time in the ICU.

A Semantic wiki for quality management in software development projects

Quality management has become a strategic issue for organisations and is very valuable to produce quality software. However, quality management systems (QMS) are not easy to implement and maintain. The authors' experience shows the benefits of developing a QMS by first formalising it using semantic web ontologies and then putting them into practice through a semantic wiki. The QMS ontology that has been developed captures the core concepts of a traditional QMS and combines them with concepts coming from the MPIu'a development process model, which is geared towards obtaining usable and accessible software products. Then, the ontology semantics is directly put into play by a semantics-aware tool, the Semantic MediaWiki. The developed QMS tool is being used for 2 years by the GRIHO research group, where it has manages almost 50 software development projects taking into account the quality management issues. It has also been externally audited by a quality certification organisation. Its users are very satisfied with their daily work with the tool, which manages all the documents created during project development and also allows them to collaborate, thanks to the wiki features.

The Key Features of Knowledge and Knowledge Management in Product Development Process

Tutkimusongelmana oli kuinka tiedon johtamisella voidaan edesauttaa tuotekehitysprosessia. Mitkä ovat ne avaintekijät tietoympäristössä kuin myös itse tiedossa, joilla on merkitystä erityisesti tuotekehitysprosessin arvon muodostumiseen ja prosessien kehittämiseen? Tutkimus on laadullinen Case-tutkimus. Tutkimusongelmat on ensin selvitetty kirjallisuuden avulla, jonka jälkeen teoreettinen viitekehys on rakennettu tutkimaan rajattua ongelma-aluetta case-yrityksestä. Empiirisen tutkimuksen materiaali koostuu pääasiallisesti henkilökohtaisten teemahaastattelujen aineistosta. Tulokset merkittävimmistä tiedon hyväksikäytön haittatekijöistä, kuten myös parannusehdotukset on lajiteltu teoreettisessa viitekehyksessä esitettyjen oletustekijöiden mukaan. Haastatteluissa saadut vastaukset tukevat kirjallisuudesta ja alan ammattilaiselta saatua käsitystä tärkeimmistä vaikuttavista tekijöistä. Tärkeimmät toimenpiteet ja aloitteet joilla parannettaisiin tiedon muodostumista, koskivat ennnen kaikkea työnteon ulkoisia olosuhteita, eikä niinkään tiedon muodostumisen prosessia itseään. Merkittävimpiä haittatekijöitä olivat kultturiin, fyysiseen ja henkiseen tilaan ja henkilöstöresursseihin liittyvät ongelmat. Ratkaisuja ongelmiin odotettiin saatavan lähinnä tietotekniikan, henkilöstöresurssien ja itse tiedon muokkaamisen avulla. Tuotekehitysprosessin ydin tietovirtojen ja –pääomien luokittelu ja tulkitseminen tiedon muodostusta kuvaavan Learning Spiralin avulla antoi lähinnä teoreettisia viitteitä siitä millaisia keinoja on olemassa tiedon lisäämiseen ja jakamiseen eri tietotyypeittäin. Tulosten perusteella caseyrityksessä pitäisi kiinnittää erityistä huomiota tiedon dokumentointiin ja jakamiseen erityisesti sen tiedon osalta, joka on organisaatiossa vain harvalla ja/tai luonteeltaan hyvin tacitia.

Five year trends in dyslipidaemia prevalence and management in Switzerland: The CoLaus study.

BACKGROUND AND AIMS: Data from prospective cohorts describing dyslipidaemia prevalence and treatment trends are lacking. Using data from the prospective CoLaus study, we aimed to examine changes in serum lipid levels, dyslipidaemia prevalence and management in a population-based sample of Swiss adults. METHODS AND RESULTS: Cardiovascular risk was assessed using PROCAM. Dyslipidaemia and low-density lipoprotein cholesterol (LDL-C) target levels were defined according to the Swiss Group for Lipids and Atherosclerosis. Complete baseline and follow up (FU) data were available for n = 4863 subjects during mean FU time of 5.6 years. Overall, 32.1% of participants were dyslipidaemic at baseline vs 46.3% at FU (p < 0.001). During this time, lipid lowering medication (LLM) rates among dyslipidaemic subjects increased from 34.0% to 39.2% (p < 0.001). In secondary prevention, LLM rates were 42.7% at baseline and 53.2% at FU (p = 0.004). In multivariate analysis, LLM use among dyslipidaemic subjects, between baseline and FU, was positively associated with personal history of CVD, older age, hypertension, higher BMI and diabetes, while negatively associated with higher educational level. Among treated subjects, LDL-C target achievement was positively associated with diabetes and negatively associated with personal history of CVD and higher BMI. Among subjects treated at baseline, LLM discontinuation was negatively associated with older age, male sex, smoking, hypertension and parental history of CVD. CONCLUSIONS: In Switzerland, the increase over time in dyslipidaemia prevalence was not paralleled by a similar increase in LLM. In a real-life setting, dyslipidaemia management remains far from optimal, both in primary and secondary prevention.

Urban environments and situated institutions : everyday governance in west Bengal

How do processes of power shape the urban environment in small Indian cities? On a day-to-day basis, who actually controls access to and the use of environmental resources? How is this done? Answering these questions contributes to our ability to develop a nuanced understanding the urban condition. In order to investigate these questions an actor-oriented approach is developed, drawing on the anthropological literatures on everyday governance and the everyday state. This conceptual framework informs an urban political ecology approach oriented towards everyday practices and the micro-politics of the (re)production of urban socio-natures. This thesis employs a mixed methods approach to qualitative research. Three cases are presented to explore: para (neighbourhood) clubs as governance actors, the governance of the urban pondscape, and the urban political ecology of solid waste management. These case studies serve to highlight how power shapes the (re)production of urban socio-natures through the everyday environmental governance practices of a complex network of governance actors. This work further demonstrates how multiple intersectionalities, including class, caste and access to political and social authority, shape these practices and their outcomes. Finally, the manner in which balances of power, place making and the formation of subject positions may both result from and shape everyday environmental governance practices and their outcomes is explored. This empirical investigation makes a number of contributions to the literature. It has explores the hereto-understudied topics of environmental governance in small cities in India, the urban political ecologies of non-piped water and of solid waste, and the role of clubs as governance actors. It further contributes to conversations within the literature on how to deepen and broaden Urban Political Ecology by engaging with everyday practices, and cases of ordinary, not-openly contested socio-natures. -- Comment les processus de pouvoir influencent-ils l'environnement urbain dans les petites villes indiennes ? Au quotidien, qui contrôle l'accès et l'utilisation des ressources environnementales ? Comment ce contrôle s'exerce-t-il ? Répondre à ces questions contribue au développement d'une compréhension nuancée de la condition urbaine. Afin d'explorer ces questions une approche actor-oriented de la gouvernance quotidienne est développée, faisant appel aux littératures anthropologiques de la gouvernance quotidienne et de l'everyday state. Ce cadre conceptuel établit ainsi une approche d'Urban Political Ecology orientée vers les pratiques quotidiennes et la micro- politique de la (re) production des socio-natures urbaines. Cette thèse emploie des méthodes qualitatives mixtes. Trois cas sont présentés afin d'étudier : les clubs para (quartier) comme acteurs de la gouvernance; la gouvernance de la pondscape urbaine; et l'urban political ecology de la gestion des déchets solides. Ces études de cas permettent de mettre en lumière la façon dont le pouvoir influence la (re)production des socio-natures urbaines par le biais des pratiques quotidiennes de gouvernance environnementale d'un réseau complexe d'acteurs. Ce travail démontre également comment plusieurs intersectionnalités, y compris la classe, la caste et l'accès au pouvoir politique et social, façonnent ces pratiques de gouvernance et leurs produits. Finalement, cette recherche explore la manière dont les équilibres de pouvoir, la fabrication de lieux et la formation de la position du sujet peuvent à la fois résulter de et contribuer à façonner les pratiques quotidiennes de gouvernance environnementale et leurs produits. Cette investigation empirique fait ainsi plusieurs contributions à la littérature. Elle explore les questions jusque-là sous-étudiées de la gouvernance environnementale dans les petites villes en Inde, de l'urban political ecology de l'eau non courante et des déchets solides, ainsi que du rôle des clubs comme acteurs de la gouvernance. Celle-ci contribue également à des débats sur la façon d'approfondir et d'élargir l'urban political ecology en travaillant sur les pratiques quotidiennes, et sur des cas de socio-natures ordinaires, pas ouvertement contestées.

A feasability study of the analysis of the economic outcomes of specialized nutrition in obesity and weight management in Switzerland

The increasing prevalence of obesity and its associated complications requires specialized care to improve outcomes and control health care costs. Obesity is associated with numerous serious and costly medical problems requiring specialized care in managing health. The economic burden of obesity includes increased inpatient and outpatient medical expenditures as well as employer-related issues of absenteeism and associate costs. The objectives of this study are: - To describe the health consequences and the economic burden of obesity, - To review the existing treatment - To argue in favor of a specialized nutritional intervention that has shown to improve health and reduce obesity related health care costs. Therefore, expose the possibility of introducing the specialized nutrition in Switzerland and the feasibility of this project considering the medical trends and reimbursement system in Switzerland The benefits and outcomes for the patients will be the significant weight loss which reduces the severity and risk factors for complications and the improved health and quality of life. Weight loss will be a combination of a diet, exercise and behavioral interventions which are the basic recommendations for obesity treatment in addition to the specialized nutritional support. By nutritional support, we mean products that are intended to provide nutritional support in the dietary management of people with specific diseases and conditions when adequate intake of regular foods is compromised. These products are called, Food for special medical purposes FSMP. They are not intended to treat, cure, prevent, mitigate or have a direct impact on disease in a manner similar to drugs or other medical treatments and should be used under medical supervision. They also provide a low cost alternative to surgery. From a health care system perspective, the specialized nutrition will drive its advantage by reducing the utilization of medical services for obesity associated complications like medication, physician's consultations and surgical interventions arriving to a cost effective care for the hospitals, the health care organizations and the third party payers which are the health insurances. [Author, p. 4]

Research Priorities for seabirds: Improving seabird conservation and management in the 21st century

Seabirds are facing a growing number of threats in both terrestrial and marine habitats, and many populations have experienced dramatic changes over past decades. Years of seabird research have improved our understanding of seabird populations and provided a broader understanding of marine ecological processes. In an effort to encourage future research and guide seabird conservation science, seabird researchers from 9 nations identified the 20 highest priority research questions and organized these into 6 general categories: (1) population dynamics, (2) spatial ecology, (3) tropho-dynamics, (4) fisheries interactions, (5) response to global change, and (6) management of anthropogenic impacts (focusing on invasive species, contaminants and protected areas). For each category, we provide an assessment of the current approaches, challenges and future directions. While this is not an exhaustive list of all research needed to address the myriad conservation challenges seabirds face, the results of this effort represent an important synthesis of current expert opinion across sub-disciplines within seabird ecology. As this synthesis highlights, research, in conjunction with direct management, education, and community engagement, can play an important role in facilitating the conservation and management of seabird populations and of the ocean ecosystems on which they and we depend.

Requirement management in nuclear power projects

Diplomityön tarkoituksena oli tutkia vaatimusten hallintaa suunnittelu- ja konsultointiyrityksen kannalta Suomen ydinvoimaprojekteissa keskittyen ydinturvallisuus- ja laatuvaatimuksiin. Ydinvoimaprojekteissa toimiminen on edellyttänyt menettelyohjeiden ja laatujärjestelmän uudelleen organisointia yrityksessä ja esiin on noussut haasteita liittyen muun muassa vaatimusten tunnistamiseen ja todentamiseen erityyppisissä ja erilaajuisissa projekteissa. Työ toteutettiin perehtymällä ydinvoimaan liittyvään lainsäädäntöön Suomessa, ohjeisiin ja standardeihin sekä haastattelemalla yrityksen omia asiantuntijoita. Viimeaikaisista sekä meneillään olevista projekteista kerättiin kokemuksia sekä arvioitiin ydinvoima projekteja varten laaditun projektin toteutusohjeen toimivuutta ja käytettävyyttä esimerkkiprojektin avulla. Suurimmiksi haasteiksi tunnistettiin lainsäädännöllisten vaatimusten, kuten ydinvoima- laitosohjeiden (YVL) muuttuminen ja tulkinnanvaraisuus sekä asiakkaiden perehtymät- tömyys Suomen lainsäädäntöön ja vaatimustasoon liittyen ydinturvallisuuteen. Työn tuloksena tunnistettiin hyviä vaatimusten hallintaan liittyviä projektinhallintaa ja ydin- turvallisuutta edistäviä asioita, kuten vaatimusten täsmentäminen jo sopimustasolla sekä niiden täyttymisen seuranta projektin aikana. Erillisen vaatimustietokannan luomista ydinvoimaprojekteja varten tutkittiin, mutta siitä luovuttiin teknisten vaatimusten osalta kannattamattomana, sillä standardien ja vaatimusten määrä kasvoi niin suureksi, että niiden hallitseminen vaatisi enemmän työtä kuin mitä projektien taso yleensä sallisi.

Irrigation management in pruned coffee tree crop

It was evaluated the effect of irrigation management on the production characteristics of coffee cultivar Acaiá MG-1474, planted in spacing of 3.00 m x 0.60 m, pruned in 2004, and irrigated by drip since the planting, in 1997. The experimental designed used was of randomized blocks with five treatments and four replications. The treatments consisted of irrigation management strategies, applying or not applying controlled moisture deficit in layer of 0 to 0.4m, in dry seasons of the year: A = no irrigation (control), B = irrigation during all year considering the factor of water availability in the soil (f) equal to 0.75, C = irrigation during all year considering f = 0.25, D = irrigation during all year, but in January /February /March /July /October /November /December with f = 0.25 and April /May /June /August /September with f = 0.75, E = irrigation only during April /May /June /August /September with f = 0.25. From July /2005 to June /2007 the applied water depth was defined based on Class A pan evaporation (ECA) and the period from July/2007 to June/2008 based on readings of matric potential of soil obtained from Watermark® sensors. Each plot consisted of three rows with ten plants per row, considering as useful plot five plants of center line. The results indicated that the E irrigation management was the most suitable for technical reasons.

Volunteer RR® corn management in roundup ready® soybean-corn succession system

The present study evaluated the effects of cover crops (Pennisetum glaucum, Crotalaria spectabilis and Urochloa ruziziensis) associated with the application of herbicides {glyphosate; (glyphosate + haloxyfop-R); (glyphosate + fluazifop-p-butyl); (glyphosate + imazethapyr) and (glyphosate + imazaquin)} in soybean desiccation management for volunteer RR® corn control. The experiment was conducted under field conditions at Sinop-MT, during the 2013/2014 crop season, in a randomized complete blocks design with factorial scheme and four replications. The following parameter were evaluated: dry matter of cover crops and ground coverage rate, control of volunteer RR® corn present at the time of desiccation, dry matter, height and intoxication level on soybean plants caused by herbicides at 7, 14 and 28 days after emergence (DAE), control of volunteer RR® corn derived from emergence fluxes subsequent to desiccation management and soybean yield. The joint application of (glyphosate + haloxyfop-R) provided the best level of volunteer RR® corn control present at the time of desiccation. Satisfactory control (80%) of volunteer corn was obtained with the application of (glyphosate + imazethapyr). This treatment displayed an additional residual effect of imazethapyr, which efficiently controled volunteer RR® corn derived from fluxes subsequent to desiccation management, especially in treatments performed under U. ruziziensis straw. None of the herbicides used in desiccation management caused any significant effect on dry matter, height and phytotoxicity of soybean plants at 7, 14 and 28 DAE nor on grain yield.

From KAPTUR to VADS4R: Exploring Research Data Management in the Visual Arts

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

Transition management in action within the context of nutrient economy

Tämä työ tutkii ja tarkastelee transitio-kokeilua ravinnetaloudessa. Transitio-kokeilu on toimintatutkimusprojekti, joka toteutetaan systeemisen muutoksen ajattelun mukaisesti alhaalta ylöspäin. Ravinnetalous määritetään tarkemmin työn kautta sekä analysoidaan monitaso-perspektiivin näkökulmasta. Ravinnetalous on terminä varsin tuntematon ja tarvitsee enemmän tunnettavuutta laajemman yleisön edessä. Transitio-areenan ja transitio-visioiden kehittäminen ovat työn keskipisteessä, koska ne ovat tärkeimpiä vaiheita transition alkuvaiheessa. Joukko sidosryhmätoimijoita osallistuu transitio areenaan sekä visioiden jatkokehittelyyn. Visio(t) luodaan ensisijaisesti backcasting-menetelmällä, jota myös täydennetään tavanomaisella ennustamisella. Backcasting- menetelmä on osin osallistava ja siinä käytetään ravinteiden planeettarajoja kvantitatiivisina pääperiaatteina, minkä tuloksena myös visiot ovat osin kvantitatiivisia. Transitio areenan kokoaminen ja fasilitointi aiheuttavat hankalia kysymyksiä, jotka tarvitsevat jatko-tutkimusta. Alhaalta-ylöspäin organisoitu transitio-arena houkuttelee niche-toimijoita, mutta epäonnistuu sitouttamaan julkisen vallan toimijoita. Toimintamallin voimasuhteet, politiikka ja transition vakiinnuttaminen tulisivat olla jatko-toimenpiteinä niin tutkimuksessa kuin toiminnassakin.

Pediatric pain: prevalence, assessment, and management in a teaching hospital

The goal of this study was to examine the prevalence, assessment and management of pediatric pain in a public teaching hospital. The study sample consisted of 121 inpatients (70 infants, 36 children, and 15 adolescents), their families, 40 physicians, and 43 nurses. All participants were interviewed except infants and children who could not communicate due to their clinical status. The interview included open-ended questions concerning the inpatients’ pain symptoms during the 24 h preceding data collection, as well as pain assessment and pharmacological/non-pharmacological management of pain. The data were obtained from 100% of the eligible inpatients. Thirty-four children/adolescents (28%) answered the questionnaire and for the other 72% (unable to communicate), the family/health professional caregivers reported pain. Among these 34 persons, 20 children/adolescents reported pain, 68% of whom reported that they received pharmacological intervention for pain relief. Eighty-two family caregivers were available on the day of data collection. Of these, 40 family caregivers (49%) had observed their child’s pain response. In addition, 74% reported that the inpatients received pharmacological management. Physicians reported that only 38% of the inpatients exhibited pain signs, which were predominantly acute pain detected during clinical procedures. They reported that 66% of patients received pharmacological intervention. The nurses reported pain signs in 50% of the inpatients, which were detected during clinical procedures. The nurses reported that pain was managed in 78% of inpatients by using pharmacological and/or non-pharmacological interventions. The findings provide evidence of the high prevalence of pain in pediatric inpatients and the under-recognition of pain by health professionals.

The Role of HR Management in the Corporate Matrix System

The successful performance of company in the market relates to the quality management of human capital aiming to improve the company's internal performance and external implementation of the core business strategy. Companies with matrix structure focusing on realization and development of innovation and technologies for the uncertain market need to select thoroughly the approach to HR management system. Human resource management has a significant impact on the organization and use a variety of instruments such as corporate information systems to fulfill their functions and objectives. There are three approaches to strategic control management depending on major impact on the major interference in employee decision-making, development of skills and his integration into the business strategy. The mainstream research has focus only on the framework of strategic planning of HR and general productivity of firm, but not on features of organizational structure and corporate software capabilities for human capital. This study tackles the before mentioned challenges, typical for matrix organization, by using the HR control management tools and corporate information system. The detailed analysis of industry producing and selling electromotor and heating equipment in this master thesis provides the opportunity to improve system for HR control and displays its application in the ERP software. The results emphasize the sustainable role of matrix HR input control for creating of independent project teams for matrix structure who are able to respond to various uncertainties of the market and use their skills for improving performance. Corporate information systems can be integrated into input control system by means of output monitoring to regulate and evaluate the processes of teams, using key performance indicators and reporting systems.

Undergraduate Student Anxiety-Management in Academia: Appraising the Value of Services and Strategies

This study explored strategies that Brock University undergraduate students value the most for managing anxiety in academia. Although previous literature indicates services and techniques such as academic advising, physical activity, and educator engagement help students, few if any have ranked students’ perceived value of anxiety-management strategies. The researcher recruited 54 undergraduate student participants (primarily from the Department of Community Health Sciences) through online invitation. Participants completed an online survey to rate their previous experience with anxiety-management strategies discussed in the literature. Survey findings identified the 4 most valuable resources students used to manage anxiety in academia: (a) educators who post academic material posted online (e.g., on Sakai) early in the term, (b) physical activity, (c) socialization, and (d) breaking large assignments into smaller portions. Conversely, student participants found disability services, counseling, and medication to be the least valuable resources. Results suggest higher-education facilities should ensure that the most valuable services are readily available to students seeking them. The study contributes to the field by identifying a broad set of strategies that students find highly valuable in their management of academic related anxiety.