Lite4Life (Tier 2 adult weight management service)

This service Aims: To provide a multi-component weight management service that supports sustainable behaviour change and weight loss in adults 16 years and over with a BMI 28. To enable patients to develop the necessary personal attributes for their own long term weight management and to understand the impact of their weight on their health and co-morbidities. Objectives: To provide an evidence based, multi-component tier 2 weight management service that improves patients knowledge and skills for effective and sustainable weight loss helps patients identify their own facilitators for positive behaviour change and to address underlying barriers to long-term behaviour changeincreases patients self-efficacy and confidence in their ability to address their weight To be an integral part of the tiered approach to weight management services for the population of Stockton. To ensure equitable service provision across Stockton-on-Tees. To provide intensive group based service, one-to-one support and maintenance support. To support the service user to develop and review a personalised goal setting plan phase 2 and at discharge after phase 2. To ensure a smooth transition from the service (tier2) to tier 1 services to ensure continuity of care for service users.Recruit referrals using a variety of and appropriate methods. To establish a single point of contact for referrals into the service.Continually promote the service across a range of mediums and liaise and work in partnership with key interdependencies (refer to 2.4) To establish a robust database and data collection system in line with information governance. To ensure the access criteria, care pathway and referral process is clearly understood by all health care professionals and those who may refer into the service. To establish close links with, and signpost and/or enable service users to access suitable services where patient needs indicate this. This may include access to Tees Time to Talk (IAPT) for psychological therapies; Specialist Weight Management Service; physical activity programmes; Tier 1 services; and primary care. To provide the necessary venues, equipment and assets needed to deliver the programme, ensuring due regard is given to the quality and safety of all materials used. To collect and provide data in quarterly reports to the Commissioner to allow for continued monitoring and evaluation of the service in line with the Standard Evaluation Framework (available at www.noo.org.uk/core/SEF) and as specified by the Commissioner.

Environmental management for the control of Triatoma dimidiata (Latreille, 1811), (Hemiptera: Reduviidae) in Costa Rica: a pilot project

An ecological control method, using environmental management operations, based on biological and behavioral characteristics of Triatoma dimidiata (Latreille, 1811), was implemented as a pilot project in an area of Costa Rica where the bug is prevalent. The sample was represented by 20 houses with peridomestic colonies (two also had indoor infestation), divided in two equivalent groups of 10 each. In one group we intervened the houses, i.e. all objects or materials that were serving as artificial ecotopes for the bugs were removed, and the second group was used as control houses. After a year of periodic follow up, it became evident that in those houses with a modified environment the number of insects had decreased notoriously even after the first visits and this was more evident after a period of 12.5 to 13.5 months in which no insects were detected in eight of the houses. It also became clear that in this group of houses, recolonization by wild bugs from the surrounding areas, became more difficult, probably due to the absence of protection from bug predators. In the control houses, with the exception of three in which the inhabitants decided to intervene on their own, and another house with a peculiar situation, the insect populations remained the same or even showed a tendency to increase, as confirmed at the end of the experiment. We believe that the method is feasible, low costing and non contaminating. It could be used successfully in other places where T. dimidiata is common and also in countries where other species colonize peridomestic areas of homes. Environmental management of this kind should seek the participation of the members of the communities, in order to make it a more permanent control measure.

An analysis of the components of pain, function, and health-related quality of life in patients with failed back surgery syndrome treated with spinal cord stimulation or conventional medical management

Objectives: Failed back surgery syndrome (FBSS) patients experience pain, functional disability, and reduced health-related quality of life (HRQoL) despite anatomically successful surgery. Examining sub-dimensions of health outcomes measures provides insight into patient well-being. Materials and Methods: The international multicenter PROCESS trial collected detailed HRQoL (EuroQol-5D; Short-Form 36) and function (Oswestry Disability Index) information on 100 FBSS patients. Results: At baseline, patients reported moderate-to-severe leg and back pain adversely affecting all dimensions of function and HRQoL. Compared with conventional medical management alone, patients also receiving spinal cord stimulation (SCS) reported superior pain relief, function, and HRQoL at six months on overall and most sub-component scores. The majority of these improvements with SCS were sustained at 24 months. Nonetheless, 36-40% of patients experienced ongoing marked disability (standing, lifting) and HRQoL problems (pain/discomfort). Conclusions: Longer-term patient management and research must focus on these refractory FBSS patients with persisting poor function and HRQoL outcomes.

Anàlisi del flux de materials del sector de la fusta a Catalunya per l’any 2005

Anàlisi del flux de manterials que travessen el sector de la fusta a Catalunya durant l’any 2005 calculant els balanços de matèria i els indicadors derivats, de cara a avaluar la gestió dels boscos a Catalunya

Improving anemia management with less frequently dosed erythropoiesis stimulating agents

Introduction and Aims: The process of delivering erythropoiesis stimulating agents (ESAs) to hemodialysis patients (HD) is complex. Many European countries are requiring centers to document this process. To date, there has not been any comprehensive description of the operational aspects of ESA delivery in Europe. The objective of the Mercurius study was to describe the entire process of ESA delivery in dialysis centers. In addition, we explored the benefits of less frequent dosing. Methods: A conceptual model was developed to classify the sub-processes in the pharmacy, dialysis unit, waste unit, and back office. Within each dialysis unit activities associated with dose determination, ordering procedures, receipt and storage of ESAs, and ESA administration were measured. Within the pharmacy, ordering from supplier, receiving and storing, and delivering ESA to the dialysis unit were measured. The amount of time and materials associated with waste disposal and back office activities were also observed. We also evaluated the impact of less frequent dosing on the resources required to perform anemia management for HD patients. Structured interviews with staff were used to develop a comprehensive list of processes, sub-processes, and activities that are routinely followed to order, register, administer, and dispose of waste associated with ESAs. Each activity was evaluated to determine if less frequent dosing influenced the amount of resources required. A model was developed to estimate the change in resources consumed using less frequent dosing regimens. Results: Eight centers from 5 European countries (Belgium, France, Italy, Sweden, and Switzerland) participated in the study. The number of HD patients in each center ranged from 42 to 707 (mean=175). Across all of the centers, patients received a variety of dosing regimens (eg, TIW, BIW, QW and Q2W). The mean (±SD) time spent for the pharmacy to order an ESA from the supplier was 6.1 (±8.7) minutes; time spent in the dialysis unit and pharmacy for receiving and storing ESPs was 5.3 (±5.3) and 10.0 (±10.9) minutes, respectively; and time spent administering each injection was 6.4 (±6.5) minutes. Switching from current dosing practices to Q2W could decrease the mean number of syringes used from 12,420 to 5,085 per year. We estimate a reduction in the number of disinfective tissues and liquids of 58% and 71%, respectively by switching from current practice to dosing ESAs Q2W. Conclusions: There was significant variation in the time that it takes to perform routine ESA activities. We estimate that a reduction in resources required to manage anemia can be obtained by reducing the frequency of administration from the current mix of ESAs. These resources could be redeployed for patient care.

Aplicatiu de gestió de magatzem amb dispositiu mòbils de Materials Brecor

Disseny d’un projecte que controli la gestió d’ubicacions del magatzem d’una empresa del sector de materials de construcció, concretament de “Materials Brecor”, una empresa líder de la zona compresa entre la costa brava sud i el maresme nord. L’Objectiu principal és concebre un projecte que permeti controlar en temps real tant l’entrada com la sortida de mercaderies, a més a més de poder consultar la ubicació de cadascuna d’elles dins el magatzem. Aconseguint millorar els temps de resposta en el moment de localitzar l’article demanat i la seva posterior expedició al client

Management of corn stalk waste as reinforcement for polypropylene injection moulded composites

The main objective of this study was the management of corn stalk waste as reinforcement for polypropylene (PP) injection moulded composites as an alternative to wood flour and fibers. In the first step, corn stalk waste was subjected to various treatments, and four different corn stalk derivatives (flour and fibers) able to be used as reinforcement of composite materials were prepared and characterized. These derivatives are corn stalk flour, thermo-mechanical, semi-chemical, and chemical fibers. They were characterized in terms of their yield, lignin content, Kappa number, fiber length/diameter ratio, fines, coarseness, viscosity, and the length at the break of a standard sheet of paper. Results showed that the corn stalk derivatives have different physico-chemical properties. In the second step, the prepared flour and fibers were explored as a reinforcing element for PP composites. Coupled and non-coupled PP composites were prepared and tested for tensile properties. For overall trend, with the addition of a coupling agent, tensile properties of composites significantly improved, as compared with non-coupled samples. In addition, a morphological study revealed the positive effect of the coupling agent on the interfacial bonding. The composites prepared with semichemical fiber gave better results in comparison with the rest of the corn stalk derivatives due to its chemical characteristics

Patient dose management in fluoroscopy : the use of DRL : P123

Purpose: To set local dose reference levels (DRL) that allow radiologists to control stochastic and deterministic effects. Methods and materials: Dose indicators for cerebral angiographies and hepatic embolizations were collected during 4 months and analyzed in our hospital. The data were compared when an image amplifier was used instead of a flat panel detector. The Mann and Whitney test was used. Results: For the 40 cerebral angiographies performed the DRL for DAP, fluoroscopy time and number of images were respectively: 166 Gy.cm2, 19 min, 600. The maximum DAP was 490 Gy.cm2 (fluoroscopy time: 84 min). No significant difference for fluoroscopy time and DAP for image amplifier and flat panel detector (p = 0.88) was observed. The number of images was larger for flat panel detector (p = 0.004). The values obtained were slightly over the present proposed DRL: 150 Gy.cm2, 15 min, 400. Concerning the 13 hepatic embolizations the DRL for DAP fluoroscopy time and number of images were: 315 Gy.cm2, 25 min, 370. The maximum DAP delivered was 845 Gy.cm2 (fluoroscopy time of 48 min). No significant difference between image amplifier and flat panel detector was observed (p = 0.005). The values obtained were also slightly over the present proposed DRL: 300 Gy.cm2, 20 min, 200. Conclusion: These results show that the introduction of flat panel detector did not lead to an increase in patient dose. A DRL concerning the cumulative dose (that allow to control the deterministic effect) should be introduced to allow radiologists to have full control on the risks associated with ionizing radiations. Results of this on going study will be presented.

Materials and Mix Optimization Procedures for PCC Pavements, March 2006

Severe environmental conditions, coupled with the routine use of deicing chemicals and increasing traffic volume, tend to place extreme demands on portland cement concrete (PCC) pavements. In most instances, engineers have been able to specify and build PCC pavements that met these challenges. However, there have also been reports of premature deterioration that could not be specifically attributed to a single cause. Modern concrete mixtures have evolved to become very complex chemical systems. The complexity can be attributed to both the number of ingredients used in any given mixture and the various types and sources of the ingredients supplied to any given project. Local environmental conditions can also influence the outcome of paving projects. This research project investigated important variables that impact the homogeneity and rheology of concrete mixtures. The project consisted of a field study and a laboratory study. The field study collected information from six different projects in Iowa. The information that was collected during the field study documented cementitious material properties, plastic concrete properties, and hardened concrete properties. The laboratory study was used to develop baseline mixture variability information for the field study. It also investigated plastic concrete properties using various new devices to evaluate rheology and mixing efficiency. In addition, the lab study evaluated a strategy for the optimization of mortar and concrete mixtures containing supplementary cementitious materials. The results of the field studies indicated that the quality management concrete (QMC) mixtures being placed in the state generally exhibited good uniformity and good to excellent workability. Hardened concrete properties (compressive strength and hardened air content) were also satisfactory. The uniformity of the raw cementitious materials that were used on the projects could not be monitored as closely as was desired by the investigators; however, the information that was gathered indicated that the bulk chemical composition of most materials streams was reasonably uniform. Specific minerals phases in the cementitious materials were less uniform than the bulk chemical composition. The results of the laboratory study indicated that ternary mixtures show significant promise for improving the performance of concrete mixtures. The lab study also verified the results from prior projects that have indicated that bassanite is typically the major sulfate phase that is present in Iowa cements. This causes the cements to exhibit premature stiffening problems (false set) in laboratory testing. Fly ash helps to reduce the impact of premature stiffening because it behaves like a low-range water reducer in most instances. The premature stiffening problem can also be alleviated by increasing the water–cement ratio of the mixture and providing a remix cycle for the mixture.

Combined approach for the management of large vestibular schwannomas: Planned subtotal resection followed by gamma knife surgery in a series of 20 consecutive cases.

INTRODUCTION: The management of large lesions of the skull base, such as vestibular schwannomas (VS) is challenging. Microsurgery remains the main treatment option. Combined approaches (planned subtotal resection followed by gamma knife surgery (GKS) for residual tumor long-term control) are being increasingly considered to reduce the risk of neurological deficits following complete resection. The current study aims to prospectively evaluate the safety-efficacy of combined approach in patients with large VS. MATERIALS AND METHODS: We present our experience with planned subtotal resection followed by gamma knife surgery (GKS) in a consecutive a series of 20 patients with large vestibular schwannomas, treated between 2009 and 2014 in Lausanne University Hospital, Switzerland. Clinical and radiological data and audiograms were prospectively collected for all patients, before and after surgery, before and after GKS, at regular intervals, in dedicated case-report forms. Additionally, for GKS, dose-planning parameters were registered. RESULTS: Twenty patients (6 males and 14 females) with large VS had been treated by this approach. The mean age at the time of surgery was 51.6years (range 34.4-73.4). The mean presurgical diameter was 36.7 (range 26.1-45). The mean presurgical tumor volume was 15.9cm(3) (range 534.9). Three patients (15%) needed a second surgical intervention because of high volume of the tumor remnant considered too large for a safe GKS. The mean follow-up after surgery was 27.2months (range 6-61.3). The timing of GKS was decided on the basis of the residual tumor shape and size following surgery. The mean duration between surgery and GKS was 7.6months (range 413.9, median 6months). The mean tumor volume at the time of GKS was 4.1cm(3) (range 0.5-12.8). The mean prescription isodose volume was 6.3cm(3) (range 0.8-15.5). The mean number of isocenters was 20.4 (range 11-31) and the mean marginal prescription dose was 11.7Gy (range 11-12). We did not have any major complications in our series. Postoperative status showed normal facial nerve function (House-Brackmann grade I) in all patients. Six patients with useful pre-operative hearing (GR class 1) underwent surgery with the aim to preserve cochlear nerve function; of these patients, 5 (83.3%) of them remained in GR class 1 and one (16.7%) lost hearing (GR class 5). Two patients having GR class 3 at baseline remained in the same GR class, but the tonal audiometry improved in one of them during follow-up. Eleven patients (57.8%) were in GR class 5 preoperatively; one patient improved hearing after surgery, passing to GR class 3 postoperatively. Following GKS, there were no new neurological deficits, with facial and hearing function remaining identical to that after surgery. CONCLUSION: Our data suggest that planned subtotal resection followed by GKS has an excellent clinical outcome with respect to retaining facial and cochlear nerve function. This represents a paradigm shift of the treatment goals from a complete tumor excision perspective to that of a surgery designed to preserve neural functions. As long-term results emerge, this approach of a combined treatment (microsurgery and GKS) will most probably become the standard of care in the management of large vestibular schwanomma.

Reconstruction of metal pollution and recent sedimentation processes in Havana Bay (Cuba): A tool for coastal ecosystem management.

Since 1998 the highly polluted Havana Bay ecosystem has been the subject of a mitigation program. In order to determine whether pollution-reduction strategies were effective, we have evaluated the historical trends of pollution recorded in sediments of the Bay. A sediment core was dated radiometrically using natural and artificial fallout radionuclides. An irregularity in the (210)Pb record was caused by an episode of accelerated sedimentation. This episode was dated to occur in 1982, a year coincident with the heaviest rains reported in Havana over the XX century. Peaks of mass accumulation rates (MAR) were associated with hurricanes and intensive rains. In the past 60 years, these maxima are related to strong El Niño periods, which are known to increase rainfall in the north Caribbean region. We observed a steady increase of pollution (mainly Pb, Zn, Sn, and Hg) since the beginning of the century to the mid 90s, with enrichment factors as high as 6. MAR and pollution decreased rapidly after the mid 90s, although some trace metal levels remain high. This reduction was due to the integrated coastal zone management program introduced in the late 90s, which dismissed catchment erosion and pollution.

Fact Sheet: Hazards Materials Accidents, 2009

A hazardous materials accident can occur anywhere. Communities located near chemical manufacturing plants are particularly at risk. However, hazardous materials are transported on our roadways, railways and waterways daily, so any area is considered vulnerable to an accident.

Artificial-Intelligence-Based Optimization of the Management of Snow Removal Assets and Resources Final Report, October 2002

Geographic information systems (GIS) and artificial intelligence (AI) techniques were used to develop an intelligent snow removal asset management system (SRAMS). The system has been evaluated through a case study examining snow removal from the roads in Black Hawk County, Iowa, for which the Iowa Department of Transportation (Iowa DOT) is responsible. The SRAMS is comprised of an expert system that contains the logical rules and expertise of the Iowa DOT’s snow removal experts in Black Hawk County, and a geographic information system to access and manage road data. The system is implemented on a mid-range PC by integrating MapObjects 2.1 (a GIS package), Visual Rule Studio 2.2 (an AI shell), and Visual Basic 6.0 (a programming tool). The system could efficiently be used to generate prioritized snowplowing routes in visual format, to optimize the allocation of assets for plowing, and to track materials (e.g., salt and sand). A test of the system reveals an improvement in snowplowing time by 1.9 percent for moderate snowfall and 9.7 percent for snowstorm conditions over the current manual system.

Laparoscopic surgery for coeliac artery compression syndrome: current management and technical aspects.

Objectives: The study aims to assess the feasibility and midterm outcome of trans-peritoneal laparoscopy for coeliac artery compression syndrome (CACS).Design: Retrospective chart review involving four European vascular surgery departments and two surgical teams.Materials and methods: charts for patients who underwent laparoscopy for symptomatic CACS between December 2003 and November 2009 were reviewed. Preoperative computed tomography (CT) angiography and postoperative duplex scan and/or CT angiography were performed.Results: Eleven consecutive patients (nine women) with a median age of 52 years (interquartile range: 42.5-59 years) underwent trans-peritoneal laparoscopy for CACS. All patients had a history of postprandial abdominal pain; weight loss exceeded 10% of the body mass in eight cases. Preoperative CT angiography revealed coeliac trunk stenosis >70% in all cases. One patient had additional aortitis and inferior mesenteric artery occlusion, while another patient presented with an occluded superior mesenteric artery. Two conversions occurred (one difficult dissection and one aorto-hepatic bypass needed for incomplete release of CACS). The median blood loss was 195 ml (range: 50-900 ml) and median operative time was 80 min (interquartile range: 65-162.5 years). Symptoms improved immediately in 10/11 patients (no residual stenosis) while one remained unchanged despite a residual stenosis treated by a percutaneous angioplasty. Symptoms reappeared in one patient due to coeliac axis occlusion. The mean follow-up period was 35 +/- 23 months (range: 12-78 months).Conclusion: Our study demonstrates that trans-peritoneal laparoscopy for treating median arcuate ligament syndrome is safe and feasible. Additional patients and a longer follow-up are needed for long-term assessment of this laparoscopic technique. (C) 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Access Management Awareness Program Phase II Report, TR-402, 1997

This report presents the results of a number of detailed Iowa access management case studies. Case studies were selected to provide a cross-section of locations and community sizes in Iowa as well as a variety of project types. Generally, access management projects completed during the mid-1990s were chosen as case studies. Projects ranging from driveway consolidation to full raised medians were analyzed on a before and after basis in terms of traffic safety, traffic operations, and adjacent business vitality. Sources of information used for the case study analysis included: road project files; traffic accident records; state sales tax records; and personal interviews of business owners, business customers, and local officials. The case study results from Iowa essentially confirm results of previous access management research from around the nation. Recent access in Iowa had significant, positive impacts in terms of traffic safety. The average reduction of annual accidents and accident rates on improved roadways was approximately 40%. Improvements in access management also led to significantly better roadway operations for most case studies. Although a small number of individual businesses do report sales losses and/or customer complaints once projects have been completed, access management projects in Iowa have not had an adverse impact on the majority of businesses located along them. In fact, some access management projects in Iowa seem to have contributed to an improved business environment along the corridors that have been improved. The results from the Iowa case studies presented in this report will be used to develop access management education materials for Iowa transportation professionals and other audiences interested in the impacts of access management.