Management of persistent pain in the older people

Persistent pain is a commonly experienced symptom. It affects 25% of community-dwelling older adults and up to 80% of nursing home residents, and can have a major impact on quality of life and functional capacity. Unfortunately pain in older patients is often undertreated and misunderstood. Assessment of pain type and severity is important. Most older people, even with moderately impaired cognition, are able to self-report pain. Validated assessment tools using non-verbal pain cues are available for people with more advanced cognitive impairment. Management of pain in older people can be challenging. Physiological changes may impact on pain perception and the pharmacodynamics and pharmacokinetics of medications. Older people are often more sensitive to the adverse effects of analgesic medications and are at risk of drug–drug interactions due to the presence of co-morbidities and polypharmacy. In general, analgesic medications should be commenced at low doses, titrated based on effect and tolerability, and regularly reviewed. Contemporary pain management often utilises multiple analgesics in lower doses to optimise efficacy and avoid dose-related toxicity. A bio-psycho-social approach to the management of persistent pain, utilising a multidisciplinary team and including non-drug strategies, may produce the best results. The goal of pain management is not always to eliminate pain, since this may not be attainable, but rather to enhance function and improve quality of life. This article discusses persistent non-cancer pain in older people, its assessment and management, and the risks and benefits of pharmacological treatment in this population.

Managing Project Business Development: an Inter-Organizational and Intra-Organizational Perspective (summary section only)

The driving force behind this study is the gap between the reality of the firms engaged in project business and the available studies covering project management and business process development. Previous studies show that project-based organizations were ‘immature’ in terms of the project-management ‘maturity model’, as few firms were found to be optimizing processes. Even within those, very little attention was paid to combine inter-organizational and intra-organizational perspectives. In this study an effort is made to elaborate some thoughts and views on project management, which interrelate firms’ external and internal activities. In line with the integration, the dissertation uses an approach to the management of project-business interdependencies in the networks of actors, activities and resources. Firstly, the study develops an understanding for inter-organizational perspectives by exploring the complementarities of process activities in the basic development of project business. It presents a framework that is elaborated on the basis of the reciprocal interactions of activities within and outside the organization—thus providing a coherent basis for continuous business-process improvement. In addition, the study presents new tools that can be used to develop project-business processes in each of its functional areas. The research demonstrates how project-business activities can be optimized using the right resources at the right time with the right actors and the right actions. The selected five articles included in this dissertation explain the basic framework for the development of project business. Each paper covers various aspects of inter-organizational and intra-organizational perspectives for project management. The study develops a valuable and procedural model for business-process improvement using the Delphi method that can be used not only in academia but also as a guide for practitioners that takes them through a series of well-defined steps when making informed, consistent and efficient changes to their business processes.

Management of Routine in Two Chinese Kindergartens - An Ethnographic Study

Based on a one-month long ethnographic study conducted in two Chinese kindergartens, this study aims to understand the issue of discipline in the Chinese preschool setting through an examination of practices teachers use to manage everyday routines in the kindergarten. It also seeks to understand teachers’ values behind their choices of practices. Data of this study are comprised of three parts - notes of participant observation in eight classrooms with a focus on teacher-child interaction; interviews with nine teachers and directors of the two kindergartens; and written accounts of four teachers collected after the fieldwork in order to understand the particular practices of teachers’ praising and criticizing children. A grounded theory approach is applied to code and analyze data. Results of analysis are structured as followed. First the concept of routine is clarified based on teachers’ definition of it and observation notes on its main components, namely the timetable of everyday activities; general behavioral rules in the kindergarten; and detailed rules and procedures for various activities in the kindergarten. Then practices for managing routines are examined – how teachers organize children in activities, enforce routines, and restore routines when they are not followed well. After that, the matter of self-control is examined in relation with external control. Then teachers’ perception of their roles as the manager, director and executor of routines is presented in a discourse of control in which the values behind practices are found to be embedded. The next section of analysis examines the role of routine in relation with other activities in the kindergarten. Results indicate that routine which is supposed to be the foundation of other activities is in conflict with other activities. The last section of analysis provides some reflections on the rational of routine management in Chinese kindergartens in relation with the overall goals of Chinese preschool education. It also provides some reflections on the effect current mode of teacher-child interactions may have on children's self construction and their understanding of self in relation with the society. As a conclusion, this study suggests that the current mode of routine management in Chinese kindergartens relies heavily on teachers' control, leaving great room for better acknowledging children's agency.

Management of bushland vegetation using rainwater harvesting in eastern Kenya.

Microcatchment water harvesting (MCWH) improved the survival and growth of planted trees on heavy soils in eastern Kenya five to six years after planting. In the best method, the cross-tied furrow microcatchments, the mean annual increments (MAI; based on the average biomass of living trees multiplied by tree density and survival) of the total and usable biomass in Prosopis juliflora were 2787 and 1610 kg ha-1 a-1 respectively, when the initial tree density was 500 to 1667 trees per hectare. Based on survival, the indigenous Acacia horrida, A. mellifera and A. zanzibarica were the most suitable species for planting using MCWH. When both survival and yield were considered, a local seed source of the introduced P. juliflora was superior to all other species. The MAI in MCWH was at best distinctly higher than that in the natural vegetation (163­307 and 66­111 kg ha-1 a-1 for total and usable biomass respectively); this cannot satisfy the fuelwood demand of concentrated populations, such as towns or irrigation schemes. The density of seeds of woody species in the topsoil was 40.1 seeds m-2 in the Acacia-Commiphora bushland and 12.6 seeds m-2 in the zone between the bushland and the Tana riverine forest. Rehabilitation of woody vegetation using the soil seed bank alone proved difficult due to the lack of seeds of desirable species. The regeneration and dynamics of woody vegetation were also studied both in cleared and undisturbed bushland. A sub-type of Acacia-Commiphora bushland was identified as Acacia reficiens bushland, in which the dominant Commiphora species is C. campestris. Most of the woody species did not have even-aged populations but cohort structures that were skewed towards young individuals. The woody vegetation and the status of soil nutrients were estimated to recover in 15­20 years on Vertic Natrargid soils after total removal of above-ground vegetation.

The management of large mammals in relation to male strategies and conflict with people

Many large mammals such as elephant, rhino and tiger often come into conflict with people by destroying agricultural crops and even killing people, thus providing a deterrent to conservation efforts. The males of these polygynous species have a greater variance in reproductive success than females, leading to selection pressures favouring a ‘high risk-high gain’ strategy for promoting reproductive success. This brings them into greater conflict with people. For instance, adult male elephants are far more prone than a member of a female-led family herd to raid agricultural crops and to kill people. In polygynous species, the removal of a certain proportion of ‘surplus’ adult males is not likely to affect the fertility and growth rate of the population. Hence, this could be a management tool which would effectively reduce animal-human conflict, and at the same time maintain the viability of the population. Selective removal of males would result in a skewed sex ratio. This would reduce the ‘effective population size’ (as opposed to the total population or census number), increase the rate of genetic drift and, in small populations, lead to inbreeding depression. Plans for managing destructive mammals through the culling of males will have to ensure that the appropriate minimum size in the populations is being maintained.

The potential of microbial ecological indicators to guide ecosophisticated management of hydrocarbon-contaminated soils

Soil is an unrenewable natural resource under increasing anthropogenic pressure. One of the main threats to soils, compromising their ability to provide us with the goods and ecosystem services we expect, is pollution. Oil hydrocarbons are the most common soil contaminants, and they disturb not just the biota but also the physicochemical properties of soils. Indigenous soil micro-organisms respond rapidly to changes in the soil ecosystem, and are chronically in direct contact with the hydrophobic pollutants on the soil surfaces. Soil microbial variables could thus serve as an intrinsically relevant indicator of soil quality, to be used in the ecological risk assessment of contaminated and remediated soils. Two contrasting studies were designed to investigate soil microbial ecological responses to hydrocarbons, together with parallel changes in soil physicochemical and ecotoxicological properties. The aim was to identify quantitative or qualitative microbiological variables that would be practicable and broadly applicable for the assessment of the quality and restoration of oil-polluted soil. Soil bacteria commonly react on hydrocarbons as a beneficial substrate, which lead to a positive response in the classical microbiological soil quality indicators; negative impacts were accurately reflected only after severe contamination. Hydrocarbon contaminants become less bioavailable due to weathering processes, and their potentially toxic effects decrease faster than the total concentration. Indigenous hydrocarbon degrader bacteria, naturally present in any terrestrial environment, use specific mechanisms to improve access to the hydrocarbon molecules adsorbed on soil surfaces. Thus when contaminants are unavailable even to the specialised degraders, they should pose no hazard to other biota either. Change in the ratio of hydrocarbon degrader numbers to total microbes was detected to predictably indicate pollutant effects and bioavailability. Also bacterial diversity, a qualitative community characteristic, decreased as a response to hydrocarbons. Stabilisation of community evenness, and community structure that reflected clean reference soil, indicated community recovery. If long-term temporal monitoring is difficult and appropriate clean reference soil unavailable, such comparison could possibly be based on DNA-based community analysis, reflecting past+present, and RNA-based community analysis, showing exclusively present conditions. Microbial ecological indicators cannot replace chemical oil analyses, but they are theoretically relevant and operationally practicable additional tools for ecological risk assessment. As such, they can guide ecologically informed and sustainable ecosophisticated management of oil-contaminated lands.

Optimal management of beaver population using a reduced-order distributed parameter model and single network adaptive critics

Beavers are often found to be in conflict with human interests by creating nuisances like building dams on flowing water (leading to flooding), blocking irrigation canals, cutting down timbers, etc. At the same time they contribute to raising water tables, increased vegetation, etc. Consequently, maintaining an optimal beaver population is beneficial. Because of their diffusion externality (due to migratory nature), strategies based on lumped parameter models are often ineffective. Using a distributed parameter model for beaver population that accounts for their spatial and temporal behavior, an optimal control (trapping) strategy is presented in this paper that leads to a desired distribution of the animal density in a region in the long run. The optimal control solution presented, imbeds the solution for a large number of initial conditions (i.e., it has a feedback form), which is otherwise nontrivial to obtain. The solution obtained can be used in real-time by a nonexpert in control theory since it involves only using the neural networks trained offline. Proper orthogonal decomposition-based basis function design followed by their use in a Galerkin projection has been incorporated in the solution process as a model reduction technique. Optimal solutions are obtained through a "single network adaptive critic" (SNAC) neural-network architecture.

Experimental results of an activated carbon-HFC 134a adsorption cooling system for thermal management of electronics

Results of performance measurement of a small cooling capacity laboratory model of an adsorption refrigeration system for thermal management of electronics are compiled. This adsorption cooler was built with activated carbon as the adsorbent and HFC 134a as the refrigerant to produce a cooling capacity under 5 W using waste heat up to 90 degrees C. The thermal compression process is obtained from an ensemble of four solid sorption compressors. Parametric study was conducted with cycle times of 16 and 20 min, heat source temperatures from 73 to 87 degrees C and cooling loads from 3 to 4.9W. Overall system performance is analyzed using two indicators, namely, cooling effectiveness and normalized exergetic efficiency. (C) 2011 Elsevier Ltd. All rights reserved.

Queuing strategies for qos management of traffic between lans interconnected by low-speed wan links

We provide a comparative performance evaluation of packet queuing and link admission strategies for low-speed wide area network Links (e.g. 9600 bps, 64 kbps) that interconnect relatively highspeed, connectionless local area networks (e.g. 10 Mbps). In particular, we are concerned with the problem of providing differential quality of service to interLAN remote terminal and file transfer sessions, and throughput fairness between interLAN file transfer sessions. We use analytical and simulation models to study a variety of strategies. Our work also serves to address the performance comparison of connectionless vs. connection-oriented interconnection of CLNS LANS. When provision of priority at the physical transmission level is not feasible, we show, for low-speed WAN links (e.g. 9600 bps), the superiority of connection-oriented interconnection of connectionless LANs, with segregation of traffic streams with different QoS requirements into different window flow controlled connections. Such an implementation can easily be obtained by transporting IP packets over an X.25 WAN. For 64 kbps WAN links, there is a drop in file transfer throughputs, owing to connection overheads, but the other advantages are retained, The same solution also helps to provide throughput fairness between interLAN file transfer sessions. We also provide a corroboration of some of our modelling results with results from an experimental test-bed.

Management of the rhesus monkey Macaca mulatta and hanuman langur Presbytis entellus in Himachal Pradesh, India

The rhesus monkey Macaca mulatta and Hanuman langur Presbytis entellus are distributed all over the State of Himachal Pradesh, India. Although both species inhabit forested areas, only rhesus monkeys seem also to have become urbanized. There are about 200,000 rhesus monkeys and 120,000 Hanuman langurs. A three-year survey at Shimla showed an increasing trend in their populations. Potential threats to survival of these primates differ in the 12 districts. The two species differ in feeding and habitat preferences. People's feelings, perceptions and attitudes reward them point to an incipient man-monkey conflict and erosion of conservation ethics. A comprehensive management plan for these primates should be formulated, and involve local people. Copyright (C) 1996 Elsevier Science Limited

Management of Municipal Solid Waste

Solid material thrown away as unused from various sectors such as agricultural, commercial, domestic, industrial and institutional constitutes solid wastes. This places an enormous strain on natural resources and seriously undermines efficient and sustainable development. Management of Municipal Solid Waste discusses the ways to salvage the situation through efficient management of solid wastes from waste generation to final disposal. The various processes such as waste generation, collection, storage, processing, recovery, transport, and disposal, are explained with the support of case studies. The book discusses reduction of waste at the source and to foster implementation of integrated solid waste management systems that are cost-effective and protect human health and the environment.