The management of systemic hypertension in optometric practice

Aim: Systemic hypertension is a silent killer that may have very few warning signs. This study examines detection and management of patients with cardiovascular disease (CVD) by optometrists in the UK. Method: A survey was sent out to 1402 optometrists who practice in the UK to investigate the nature and knowledge of detection of systemic hypertension. Results: The survey response rate was 37%. Optometrists were neutral to slightly positive towards the use of blood pressure (BP) monitors, but not on a routine basis. The most frequently asked question during history and symptoms concerned the patient's prescribed medication for systemic hypertension, and the least was that of specifying the last BP measurement. The additional test most widely used in the examination of the systemic hypertensive patient was direct ophthalmoscopy with red-free filter. Over one-tenth of optometric practices had a BP monitor, with automated devices being the most popular. Patients most likely to have their BP measured were suspect systemic hypertensives. Retinal haemorrhages are the most important finding in influencing an optometrist's referral criteria for suspected systemic hypertension. Conclusion: Although optometrists monitor the retina for signs of damage from systemic hypertension, further education in this important condition is warranted. © 2005 The College of Optometrists.

Medical management of diabetic retinopathy:fenofibrate and ACCORD eye studies

The approach of all ophthalmologists, diabetologists and general practitioners seeing patients with diabetic retinopathy should be that good control of blood glucose, blood pressure and plasma lipids are all essential components of modern medical management. The more recent data on the use of fenofibrate in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) and The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye studies is reviewed. In FIELD, fenofibrate (200 mg/day) reduced the requirements for laser therapy and prevented disease progression in patients with pre-existing diabetic retinopathy. In ACCORD Eye, fenofibrate (160 mg daily) with simvastatin resulted in a 40% reduction in the odds of retinopathy progressing over 4 years, compared with simvastatin alone. This occurred with an increase in HDL-cholesterol and a decrease in the serum triglyceride level in the fenofibrate group, as compared with the placebo group, and was independent of glycaemic control. We believe fenofibrate is effective in preventing progression of established diabetic retinopathy in type 2 diabetes and should be considered for patients with pre-proliferative diabetic retinopathy and/or diabetic maculopathy, particularly in those with macular oedema requiring laser. © 2011 Macmillan Publishers Limited All rights reserved.

On the new economic philosophy of crisis management in the European Union

This essay attempts to go beyond presenting the bits and pieces of still ongoing crisis management in the EU. Instead it attempts at finding the ‘red thread’ behind a series of politically improvised decisions. Our fundamental research question asks whether basic economic lessons learned in the 1970s are still valid. Namely, that a crises emanating from either structural or regulatory weaknesses cannot and should not be remedied by demand management. Our second research question is the following: Can lacking internal commitment and conviction in any member state be replaced or substituted by external pressure or formalized procedures and sanctions? Under those angles we analyze the project on establishing a fiscal and banking union in the EU, as approved by the Council in December 2012.

Change of composition and diversity of species and grassland management between different grazing intensity in Pannonian dry and wet grasslands

Investigations were carried out in wet and dry pasture. Coenological recordings were taken in three zones. The first zone (“A”) located 0-50 m near the stable, second zone (“B”) located 50-150 m from the stable, while the third zone (“C”) located farther than 150 m. We have carried out analyses of ecological and environmental factors and life form types. Based on our results for both dry and wet grasslands, quadrates of “A” zone were well isolated from the rest of the zones. Overgrazing, which involves considerable trampling, vanishes differences among vegetations, thereby promotes weed and disturbance tolerant rich vegetation. The lowest species number and diversity could be found here. Due to the nitrogen enrichment due to the constant presence of livestock, drier and less heat demanding habitat developed in the “A” zones, according to the environmental indicators. Because of the change in management, conservation and diversity values of “C” zone increased, however, according to nature protection values it underperformed compared to “B” zone. According to the sample area, wet grasslands from the sandy areas of Kiskunság, preserve nature protection values and grass composition better moving away from stables, due to less grazing pressure. Drier backgrounds tolerate stronger grazing pressure.

Evaluation of corporate environmental management approaches: A framework and application

This article proposes a framework to evaluate corporate environmental strategies. In the proposed framework, a company's environmental risks are analyzed on two dimensions, One dimension, the endogenous environmental risks, arises from the internal operations of the company. The other dimension, the exogenous environmental risks, are determined by the company's external world: its location, its ecological setting, and the demographic characteristics of the physical environment in which it operates. Four environmental management approaches are defined as a function of endogenous and exogenous environmental risks: reactive, proactive, strategic, and crisis preventive. The framework was applied in a survey of 141 company representatives in Hungary. A relationship was sought between the a priori defined environmental management approaches based on technology and location and the companies' environmental management characteristics defined by senior managers. Variables that differentiated among the four environmental management approaches were identified and ranked. The study concludes that there is a relatively well-defined relationship between the environmental risks of companies and the nature of their environmental management approaches, Implementing a strategic environmental management approach may not be the best option for all companies - although there is a growing pressure to do so.

Pressure ulcers and nutritional deficits in elderly long-term care patients: Effects of a comprehensive nutritional program on pressure ulcer healing, length of hospital stay and charges to patients

The elderly are at the highest risk of developing pressure ulcers that result in prolonged hospitalization, high health care costs, increased mortality, and decreased quality of life. The burden of pressure ulcers will intensify because of a rapidly increasing elderly population in the United States (US). Poor nutrition is a major predictor of pressure ulcer formation. The purpose of this study was to examine the effects of a comprehensive, interdisciplinary nutritional protocol on: (1) pressure ulcer wound healing (2) length of hospital stays, and (3) charges for pressure ulcer management. Using a pre-intervention/post intervention quasi-experimental design the study sample was composed of 100 patients 60 years or older, admitted with or acquiring a pressure ulcer. A pre-intervention group (n= 50) received routine pressure ulcer care (standard diet, dressing changes, and equipment). A post-intervention group received routine care plus an interdisciplinary nutrition intervention (physical therapy, speech therapy, occupational therapy, added protein and calories to the diet). Research questions were analyzed using descriptive statistics, frequencies, Chi-Square Tests, and T-tests. Findings indicated that the comprehensive, interdisciplinary nutritional protocol had a significant effect on the rate of wound healing in Week3 and Week4, total hospital length of stay (pre-intervention M= 43.2 days, SD=31.70 versus M=31.77, SID-12.02 post-intervention), and pressure ulcer length of stay (pre-intervention 25.28 days, SD5.60 versus 18.40 days, SD 5.27 post-intervention). Although there was no significant difference in total charges for the pre-intervention group ($727,245.00) compared to the post-intervention group ($702,065.00), charges for speech (m=$5885.12, SD=$332.55), pre albumin (m=$808.52,SD= $332.55), and albumin($278 .88, SD=55.00) were higher in the pre-intervention group and charges for PT ($5721.26, SD$3655.24) and OT($2544 .64, SD=1712.863) were higher in the post-intervention group. Study findings indicate that this comprehensive nutritional intervention was effective in improving pressure ulcer wound healing, decreasing both hospital length of stay for treatment of pressure ulcer and total hospital length of stay while showing no significant additional charges for treatment of pressure ulcers.

Process of privatization: Benefits of *reform in management of public housing

The study of the private management of public housing is an important topic to be critically analyzed as the government search for ways to increase efficiency in providing housing for the poor. Public Housing Authorities must address the cost for repairing or replacing the deteriorating housing stock, the increase in the need for affordable housing, and the lack of supply. There is growing pressure on efficient use of public funds that has heightened the need for profound structural reform. An important strategy for carrying out such reform is through privatization. Although privatization does not work in every case, the majority position in the traditional privatization literature is that reliance on private organizations normally, but not always, results in cost savings. ^ The primary purpose of this dissertation is to determine whether a consensus exist among decision-makers on the efficiency of privatizing the management of public housing. A secondary purpose is to review the techniques (best practices) used by the private sector that results in cost-efficiencies in the management of public housing. The study employs the use of a triangulated research design utilizing cross-sectional survey methodology that included use of a survey instrument to solicit responses from the private managers. The study consists of qualitative methods using interviews from key informants of private-sector management firms and public housing agencies, case studies, focus groups, archival records and housing authorities documents. ^ Results indicated that important decision-makers perceive that private managers made a positive contribution to cost-efficiencies in the management of public housing. The performance of private contractors served as a yardstick for comparison of efficiency of services that are produced in-house. The study concluded that private managers made the benefits of their management techniques well known creating a sense of competition between public and private managers. Competition from private contractors spurred municipal worker and management productivity improvements creating better management results for the public housing authorities. The study results are in concert with a review of recent research and studies that also concluded private managers have some distinct advantages to controlling costs in the management of public housing. ^

Pressure ulcers and nutritional deficits in elderly long-term care patients : effects of a comprehensive nutritional program on pressure ulcer healing, length of hospital stay and charges to patients

The elderly are at the highest risk of developing pressure ulcers that result in prolonged hospitalization, high health care costs, increased mortality, and decreased quality of life. The burden of pressure ulcers will intensify because of a rapidly increasing elderly population in the United States (US). Poor nutrition is a major predictor of pressure ulcer formation. The purpose of this study was to examine the effects of a comprehensive, interdisciplinary nutritional protocol on: 1) pressure ulcer wound healing 2) length of hospital stays, and 3) charges for pressure ulcer management. Using a pre-intervention/post intervention quasi-experimental design the study sample was composed of 100 patients 60 years or older, admitted with or acquiring a pressure ulcer. A pre-intervention group (n= 50) received routine pressure ulcer care (standard diet, dressing changes, and equipment). A post-intervention group received routine care plus an interdisciplinary nutrition intervention (physical therapy, speech therapy, occupational therapy, added protein and calories to the diet). Research questions were analyzed using descriptive statistics, frequencies, Chi-Square Tests, and T-tests. Findings indicated that the comprehensive, interdisciplinary nutritional protocol had a significant effect on the rate of wound healing in Week3 and Week4, total hospital length of stay (pre-intervention M= 43.2 days, SD=31.70 versus M=31.77, SD=12.02 post-intervention), and pressure ulcer length of stay (pre-intervention 25.28 days, SD5.60 versus 18.40 days, SD 5.27 post-intervention). Although there was no significant difference in total charges for the pre-intervention group ($727,245.00) compared to the post-intervention group ($702,065.00), charges for speech (m=$5885.12, SD=$332.55), pre albumin (m=$808.52,SD= $332.55), and albumin($278 .88, SD=55.00) were higher in the pre-intervention group and charges for PT ($5721.26, SD$3655.24) and OT($2544 .64, SD=1712.863) were higher in the post-intervention group. Study findings indicate that this comprehensive nutritional intervention was effective in improving pressure ulcer wound healing, decreasing both hospital length of stay for treatment of pressure ulcer and total hospital length of stay while showing no significant additional charges for treatment of pressure ulcers.

Importance of risk factor management in diabetic patients and reduction in Stage B heart failure

BACKGROUND: A number of studies have demonstrated the presence of a diabetic cardiomyopathy, increasing the risk of heart failure development in this population. Improvements in present-day risk factor control may have modified the risk of diabetes-associated cardiomyopathy.

AIM: We sought to determine the contemporary impact of diabetes mellitus (DM) on the prevalence of cardiomyopathy in at-risk patients with and without adjustment for risk factor control.

DESIGN: A cross-sectional study in a population at risk for heart failure.

METHODS: Those with diabetes were compared to those with other cardiovascular risk factors, unmatched, matched for age and gender and then matched for age, gender, body mass index, systolic blood pressure and low density lipoprotein cholesterol.

RESULTS: In total, 1399 patients enrolled in the St Vincent's Screening to Prevent Heart Failure (STOP-HF) cohort were included. About 543 participants had an established history of DM. In the whole sample, Stage B heart failure (asymptomatic cardiomyopathy) was not found more frequently among the diabetic cohort compared to those without diabetes [113 (20.8%) vs. 154 (18.0%), P = 0.22], even when matched for age and gender. When controlling for these risk factors and risk factor control Stage B was found to be more prevalent in those with diabetes [88 (22.2%)] compared to those without diabetes [65 (16.4%), P = 0.048].

CONCLUSION: In this cohort of patients with established risk factors for Stage B heart failure superior risk factor management among the diabetic population appears to dilute the independent diabetic insult to left ventricular structure and function, underlining the importance and benefit of effective risk factor control in this population on cardiovascular outcomes.

Predators on private land: broad-scale socioeconomic interactions influence large predator management

The proliferation of private land conservation areas (PLCAs) is placing increasing pressure on conservation authorities to effectively regulate their ecological management. Many PLCAs depend on tourism for income, and charismatic large mammal species are considered important for attracting international visitors. Broad-scale socioeconomic factors therefore have the potential to drive fine-scale ecological management, creating a systemic scale mismatch that can reduce long-term sustainability in cases where economic and conservation objectives are not perfectly aligned. We assessed the socioeconomic drivers and outcomes of large predator management on 71 PLCAs in South Africa. Owners of PLCAs that are stocking free-roaming large predators identified revenue generation as influencing most or all of their management decisions, and rated profit generation as a more important objective than did the owners of PLCAs that did not stock large predators. Ecotourism revenue increased with increasing lion (Panthera leo) density, which created a potential economic incentive for stocking lion at high densities. Despite this potential mismatch between economic and ecological objectives, lion densities were sustainable relative to available prey. Regional-scale policy guidelines for free-roaming lion management were ecologically sound. By contrast, policy guidelines underestimated the area required to sustain cheetah (Acinonyx jubatus), which occurred at unsustainable densities relative to available prey. Evidence of predator overstocking included predator diet supplementation and frequent reintroduction of game. We conclude that effective facilitation of conservation on private land requires consideration of the strong and not necessarily beneficial multiscale socioeconomic factors that influence private land management.

Capacity Management in Healthcare Services

The level of demand for healthcare services can fluctuate widely and this can place pressure on the capacity of service providers. This article examines some of the approaches used to influence the level of available capacity in the healthcare services sector. A number of strategies designed to flex capacity are discussed, including the development of flexible approaches to human resources; rapid responses to changes in demand; the use of self-service technology and self-care; and the use of temporary additional facilities.

The impact of gillnet mesh sizes on Oreochromis niloticus: a proposed management strategy

Gillnets are popularly used in commercial fishing on both Lake kioga and lake Victoria. On Lake kioga the legal mesh size is from 4½ (114) upwards while on Lake Victoria, a multifishery lake, various mesh sizes are in operation. However, the fishermen on these lakes still use the smaller meshes to be able to harvest certain categories of fish especially Oreochromis species group whose catch rates are already on the decline due to either use of small mesh size nets, high fishing pressure and to L.Kioga in particular, predation by lates niloticus.

An examination of the techniques used to capture mangrove crabs, Ucides cordatus, in the Mamanguape River estuary, Northeastern Brazil, with implications for management.

The present research, undertaken in a mangrove swamp in northeastern Brazil (Mamanguape River Estuary), examined the factors that led to the overwhelming acceptance of the tangle-netting technique by crab harvesters in detriment to the now illegal tamping technique. Both techniques are the only ones currently used at our study site and in many other areas in Brazil, despite being prohibited by law. Data were collected through direct observations to determine capture efficiency, productivity, daily production, selectivity, and harvesting effort, and through interviews with crab harvesters, focusing on their perceptions of the capture techniques, the conditions of crab stocks and the sales price of a dozen crabs. Our results indicated that the two capture techniques did not significantly differ in terms of their efficiency or productivity, but daily production rates differed significantly, being greater using tangle-netting. The tangle-netting permits a greater harvesting effort (6 hours and 34 min) compared to tamping (4 hours and 19 min). Tangle-netting is also less selective than tamping indicated by the larger number of captured smaller specimens, including females. This results in a lower average sales price for a dozen crabs caught by tangle-netting (US$ 0.95) compared to tamping (US$ 1.02). The greater daily production of crab harvesters using the tangle-netting technique nevertheless increased their net gain, explaining their preference for this method, Given that tangle-netting results in greater harvesting pressure but lower selectivity compared to tamping, it may potentially be less sustainable. All of the crab harvesters interviewed having more than 20 years of experience (n = 34) stated they perceived that stocks of U. cordatus had become reduced over the last 20 years, together with average crab sizes. It is now important to examine the structure of the local U. cordatus population and to assess its fishery to allow evaluating whether the illegal, but prominent tangle-netting and tamping mangrove crab capture techniques are sustainable or not. We further suggest improving the dialogue between decision makers and fishermen, which barely exists to date, to initiate a discussion about possible ways of resolving the current situation of illegality of the fishermen. This will be key to achieving effective sustainable co-management of this important natural mangrove forest resource.

Silverleaf whitefly resistance management

Silverleaf whitefly (SLW) is a major late season pest of cotton due to its potential to contaminate cotton lint with honeydew. To prevent this, management is often reliant on the use of insecticides to control SLW populations. With selection pressure SLW develop resistance to insecticides they are exposed to, resulting in spray failures. Our lab tests resistance levels in SLW populations collected from across the cotton industry. In this presentation I will provide an update of emerging SLW resistance issues the cotton industry is facing.

Use of business analysis in beef businesses to direct management practice change for climate adaptation outcomes

Beef businesses in northern Australia are facing increased pressure to be productive and profitable with challenges such as climate variability and poor financial performance over the past decade. Declining terms of trade, limited recent gains in on-farm productivity, low profit margins under current management systems and current climatic conditions will leave little capacity for businesses to absorb climate change-induced losses. In order to generate a whole-of-business focus towards management change, the Climate Clever Beef project in the Maranoa-Balonne region of Queensland trialled the use of business analysis with beef producers to improve financial literacy, provide a greater understanding of current business performance and initiate changes to current management practices. Demonstration properties were engaged and a systematic approach was used to assess current business performance, evaluate impacts of management changes on the business and to trial practices and promote successful outcomes to the wider industry. Focus was concentrated on improving financial literacy skills, understanding the business’ key performance indicators and modifying practices to improve both business productivity and profitability. To best achieve the desired outcomes, several extension models were employed: the ‘group facilitation/empowerment model’, the ‘individual consultant/mentor model’ and the ‘technology development model’. Providing producers with a whole-of-business approach and using business analysis in conjunction with on-farm trials and various extension methods proved to be a successful way to encourage producers in the region to adopt new practices into their business, in the areas of greatest impact. The areas targeted for development within businesses generally led to improvements in animal performance and grazing land management further improving the prospects for climate resilience.