Self-management of coronary heart disease in angina patients after percutaneous coronary intervention: A mixed methods study.

After having elective percutaneous coronary intervention (PCI) patients are expected to self-manage their coronary heart disease (CHD) by modifying their risk factors, adhering to medication and effectively managing any recurring angina symptoms but that may be ineffective. Objective: Explore how patients self-manage their coronary heart disease (CHD) after elective PCI and identify any factors that may infl uence that. Design and method: This mixed methods study recruited a convenience sample of patients (n=93) approximately three months after elective PCI. Quantitative data were collected using a survey and were subject to univariate, bivariate and multi-variate analysis. Qualitative data from participant interviews was analysed using thematic analysis. Findings: After PCI, 74% of participants managed their angina symptoms inappropriately. Younger participants and those with threatening perceptions of their CHD were more likely to know how to effectively manage their angina symptoms. Few patients adopted a healthier lifestyle after PCI. Qualitative analysis revealed that intentional non-adherence to some medicines was an issue. Some participants felt unsupported by healthcare providers and social networks in relation to their self-management. Participants reported strong emotional responses to CHD and this had a detrimental effect on their self-management. Few patients accessed cardiac rehabilitation.

Status and management of spring-run chinook salmon

Runs have dwindled in many parts of California and additional protection or management actions are needed to protect the fish from further declines. The following is a report requested by the Fish and Game Commission on the status and current management of spring-run chinook salmon stocks. Fish counts presented in this report were developed by a variety of methods. Some of them are estimates of total run-size or spawning escapement, while others are indices of abundance derived from counts of maturing fish in their holding areas. It is important to note the stock assessment method used. Index area counts will always underestimate the true run size, often by a very large margin.

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.

Development of project management procedures for customer project business

Objective of the thesis is to develop project management procedure for chilled beam projects. In organization is recognized that project management techniques could help in large and complex projects. Information sharing have been challenging in projects, so improvement of information sharing is one key topic of the thesis. Academic researches and literature are used to find suitable project management theories and methods. Main theories are related to phases of the project and project management tools. Practical knowledge of project management is collected from two project business oriented companies. Project management tools are chosen and modified to fulfill needs of the beam projects. Result of the thesis is proposed project management procedure, which includes phases of the chilled beam projects and project milestones. Project management procedure helps to recognize the most critical phases of the project and tools help to manage information of the project. Procedure increases knowledge of the project management techniques and tools. It also forms coherent project management working method among the chilled beam project group.

Influence of climate variability and stocking strategies on greenhouse gas emissions (GHGE), production and profit of a northern Queensland beef cattle herd

Previous studies of greenhouse gas emissions (GHGE) from beef production systems in northern Australia have been based on models of ‘steady-state’ herd structures that do not take into account the considerable inter-annual variation in liveweight gain, reproduction and mortality rates that occurs due to seasonal conditions. Nor do they consider the implications of flexible stocking strategies designed to adapt these production systems to the highly variable climate. The aim of the present study was to quantify the variation in total GHGE (t CO2e) and GHGE intensity (t CO2e/t liveweight sold) for the beef industry in northern Australia when variability in these factors was considered. A combined GRASP–Enterprise modelling platform was used to simulate a breeding–finishing beef cattle property in the Burdekin River region of northern Queensland, using historical climate data from 1982–2011. GHGE was calculated using the method of Australian National Greenhouse Gas Inventory. Five different stocking-rate strategies were simulated with fixed stocking strategies at moderate and high rates, and three flexible stocking strategies where the stocking rate was adjusted annually by up to 5%, 10% or 20%, according to pasture available at the end of the growing season. Variation in total annual GHGE was lowest in the ‘fixed moderate’ (~9.5 ha/adult equivalent (AE)) stocking strategy, ranging from 3799 to 4471 t CO2e, and highest in the ‘fixed high’ strategy (~5.9 ha/AE), which ranged from 3771 to 7636 t CO2e. The ‘fixed moderate’ strategy had the least variation in GHGE intensity (15.7–19.4 t CO2e/t liveweight sold), while the ‘flexible 20’ strategy (up to 20% annual change in AE) had the largest range (10.5–40.8 t CO2e/t liveweight sold). Across the five stocking strategies, the ‘fixed moderate’ stocking-rate strategy had the highest simulated perennial grass percentage and pasture growth, highest average rate of liveweight gain (121 kg/steer), highest average branding percentage (74%) and lowest average breeding-cow mortality rate (3.9%), resulting in the lowest average GHGE intensity (16.9 t CO2e/t liveweight sold). The ‘fixed high’ stocking rate strategy (~5.9 ha/AE) performed the poorest in each of these measures, while the three flexible stocking strategies were intermediate. The ‘fixed moderate’ stocking strategy also yielded the highest average gross margin per AE carried and per hectare. These results highlight the importance of considering the influence of climate variability on stocking-rate management strategies and herd performance when estimating GHGE. The results also support a body of previous work that has recommended the adoption of moderate stocking strategies to enhance the profitability and ecological stability of beef production systems in northern Australia.

Aerial surveys to monitor bluefin tuna abundance and track efficiency of management measures

Conservation and management measures for exploited fish species rely on our ability to monitor variations in population abundance. In the case of the eastern stock of Atlantic bluefin tuna (ABFT), recent changes in management policies have strongly affected the reliability of fishery-dependent indicators due to drastic changes in fishing season/area, fisheries selectivity and strategy. However, fishery-independent indices of abundance are rare for large pelagic fish, and obtaining them is often costly and labor intensive. Here, we show that scientific aerial surveys are an appropriate tool for monitoring juvenile bluefin tuna abundance in the Mediterranean. We present an abundance index based on 62 aerial surveys conducted since 2000, using 2 statistical approaches to deal with the sampling strategy: line and strip transects. Both approaches showed a significant increase in juvenile ABFT abundance in recent years, resulting from the recovery plan established in 2007. Nonetheless, the estimates from the line transect method appear to be more robust and stable. This study provides essential information for fisheries management. Expanding the spatial coverage to other nursery grounds would further increase the reliability and representativeness of this index.

Down scaling to regional assessment of greenhouse gas emissions to enable consistency in accounting for emissions reduction projects and national inventory accounts for northern beef production in Australia

This paper explores the effect of using regional data for livestock attributes on estimation of greenhouse gas (GHG) emissions for the northern beef industry in Australia, compared with using state/territory-wide values, as currently used in Australia’s national GHG inventory report. Regional GHG emissions associated with beef production are reported for 21 defined agricultural statistical regions within state/territory jurisdictions. A management scenario for reduced emissions that could qualify as an Emissions Reduction Fund (ERF) project was used to illustrate the effect of regional level model parameters on estimated abatement levels. Using regional parameters, instead of state level parameters, for liveweight (LW), LW gain and proportion of cows lactating and an expanded number of livestock classes, gives a 5.2% reduction in estimated emissions (range +12% to –34% across regions). Estimated GHG emissions intensity (emissions per kilogram of LW sold) varied across the regions by up to 2.5-fold, ranging from 10.5 kg CO2-e kg–1 LW sold for Darling Downs, Queensland, through to 25.8 kg CO2-e kg–1 LW sold for the Pindan and North Kimberley, Western Australia. This range was driven by differences in production efficiency, reproduction rate, growth rate and survival. This suggests that some regions in northern Australia are likely to have substantial opportunities for GHG abatement and higher livestock income. However, this must be coupled with the availability of management activities that can be implemented to improve production efficiency; wet season phosphorus (P) supplementation being one such practice. An ERF case study comparison showed that P supplementation of a typical-sized herd produced an estimated reduction of 622 t CO2-e year–1, or 7%, compared with a non-P supplemented herd. However, the different model parameters used by the National Inventory Report and ERF project means that there was an anomaly between the herd emissions for project cattle excised from the national accounts (13 479 t CO2-e year–1) and the baseline herd emissions estimated for the ERF project (8 896 t CO2-e year–1) before P supplementation was implemented. Regionalising livestock model parameters in both ERF projects and the national accounts offers the attraction of being able to more easily and accurately reflect emissions savings from this type of emissions reduction project in Australia’s national GHG accounts.

Structured decision making as a tool for facilitating stakeholder engagement in non-renewable resource management: using the case study of hydraulic fracturing in the Green Point Shale formation in western Newfoundland

This thesis examines the importance of effective stakeholder engagement that complies with the doctrines of social justice in non-renewable resources management decision-making. It uses hydraulic fracturing in the Green Point Shale Formation in Western Newfoundland as a case study. The thesis uses as theoretical background John Rawls’ and David Miller’ theory of social justice, and identifies the social justice principles, which are relevant to stakeholder engagement. The thesis compares the method of stakeholder engagement employed by the Newfoundland and Labrador Hydraulic Fracturing Review Panel (NLHFRP), with the stakeholder engagement techniques recommended by the Structured Decision Making (SDM) model, as applied to a simulated case study involving hydraulic fracturing in the Green Point Shale Formation. Using the already identified social justice principles, the thesis then developed a framework to measure the level of compliance of both stakeholder engagement techniques with social justice principles. The main finding of the thesis is that the engagement techniques prescribed by the SDM model comply more closely with the doctrines of social justice than the engagement techniques applied by the NLHFRP. The thesis concludes by recommending that the SDM model be more widely used in non- renewable resource management decision making in order to ensure that all stakeholders’ concerns are effectively heard, understood and transparently incorporated in the nonrenewable resource policies to make them consistent with local priorities and goals, and with the social justice norms and institutions.

Modeling height-diameter relationship in pinus pinaster ait. in the forest intervention zone of Lomba, NE-Portugal

In this work, the relationship between diameter at breast height (d) and total height (h) of individual-tree was modeled with the aim to establish provisory height-diameter (h-d) equations for maritime pine (Pinus pinaster Ait.) stands in the Lomba ZIF, Northeast Portugal. Using data collected locally, several local and generalized h-d equations from the literature were tested and adaptations were also considered. Model fitting was conducted by using usual nonlinear least squares (nls) methods. The best local and generalized models selected, were also tested as mixed models applying a first-order conditional expectation (FOCE) approximation procedure and maximum likelihood methods to estimate fixed and random effects. For the calibration of the mixed models and in order to be consistent with the fitting procedure, the FOCE method was also used to test different sampling designs. The results showed that the local h-d equations with two parameters performed better than the analogous models with three parameters. However a unique set of parameter values for the local model can not be used to all maritime pine stands in Lomba ZIF and thus, a generalized model including covariates from the stand, in addition to d, was necessary to obtain an adequate predictive performance. No evident superiority of the generalized mixed model in comparison to the generalized model with nonlinear least squares parameters estimates was observed. On the other hand, in the case of the local model, the predictive performance greatly improved when random effects were included. The results showed that the mixed model based in the local h-d equation selected is a viable alternative for estimating h if variables from the stand are not available. Moreover, it was observed that it is possible to obtain an adequate calibrated response using only 2 to 5 additional h-d measurements in quantile (or random) trees from the distribution of d in the plot (stand). Balancing sampling effort, accuracy and straightforwardness in practical applications, the generalized model from nls fit is recommended. Examples of applications of the selected generalized equation to the forest management are presented, namely how to use it to complete missing information from forest inventory and also showing how such an equation can be incorporated in a stand-level decision support system that aims to optimize the forest management for the maximization of wood volume production in Lomba ZIF maritime pine stands.

Pressure ulcer management in Oman: nurses’ knowledge and views

Background: Pressure ulcers (PrUs) have a significant impact on health system expenditure and patient’s quality of life. It is a global problem. Many studies were undertaken in regard to PrU prevention and management. In Oman, no studies have been conducted to investigate nurses’ knowledge on prevention and management of PrUs. The purpose of this descriptive sequential explanatory mixed-method study was to explore the nurses’ level of knowledge in relation to prevention and management of PrUs in Oman. Methods: A mixed method design was used and the study was conducted over two Phases. In Phase I, a questionnaire was developed to explore nurses’ knowledge on PrU, policy, and resources. The main section of the questionnaire was the Pieper-Zulkowski Pressure Ulcer knowledge test (PZ-PUKT) which tests the knowledge on PrU. Another two sections were developed including questions about wound policy and resources available for PrU prevention and management in Oman. The questionnaire was distributed to nurses who were working in surgical, medical, orthopaedic, CCU, and ICU wards/units in seven hospitals. In Phase II study, semi-structured qualitative interviews were conducted with 16 of the questionnaire respondents. Interviews took approximately 30 minutes, were recorded and transcribed verbatim. Qualitative data were analysed using the Knowledge, Attitudes and Practice (KAP) model as the a priori framework. Results: In Phase I, 478 questionnaires were analysed. The knowledge test results showed the overall mean percent score for correctly answered questions was 51% suggesting a low level of knowledge. There was a significant relationship between nurses’ knowledge and age (P=0.001) and between knowledge and years of experience (P=0.001) with knowledge increasing with age and years of experience. In Phase II, four themes were identified from the interviews: knowledge, attitude, and practice (framework themes) and perception of role. Findings indicated positive and negative attitudes towards the care of PrUs. Some nurses stated feeling rewarded when they see wounds improving while others said they could not work with patients independently because they lacked the knowledge and the skills needed. There was variation in the management of PrU between hospitals. Both studies indicated that the wound management policy did not include enough information to guide nurses. Conclusion: Overall the nurses’ level of knowledge on PrU was relatively low. Most nurses were not familiar with wound management policy or different PrU prevention and management strategies. Nurses are aware of the risk of PrUs and try their best to manage them with the available resources however more training is required.

Assessing earnings management in european publicly traded firms

We investigate if investors may benefit from using the accruals quality measure to assess the level of earnings management exercised by firms when preparing their accounting statements. More earnings management is expected to be associated with high information asymmetry among stock market participants because it makes earnings information less precise, thus providing an information advantage to informed investors relative to liquidity traders. Our results based on a sample of European publicly traded firms are consistent with a positive association between earnings management and information asymmetry. However, given some previous studies suggesting that accruals based measures may be noisy indicators of earnings management we further develop and test a method to enhance the performance of accruals quality in detecting earnings management.

Assessing Earnings Management in European Publicly Traded Firms

We investigate if investors may benefit from using the accruals quality measure to assess the level of earnings management exercised by firms when preparing their accounting statements. More earnings management is expected to be associated with high information asymmetry among stock market participants because it makes earnings information less precise, thus providing an information advantage to informed investors relative to liquidity traders. Our results based on a sample of European publicly traded firms are consistent with a positive association between earnings management and information asymmetry. However, given some previous studies suggesting that accruals based measures may be noisy indicators of earnings management we further develop and test a method to enhance the performance of accruals quality in detecting earnings management

French good practice guidelines for management of the risk of low back pain among workers exposed to manual material handling: Hierarchical strategy of risk assessment of work situations

International audience