Diabetes, hyperglycemia and the management of cerebrovascular disease

Purpose of review Hyperglycemia is frequent in patients with cerebrovascular disease. This review article aims to summarize the recent evidence from observational studies that examined the adverse cerebrovascular effects of dysglycemic states as well as interventional studies assessing intensive management strategies for hyperglycemia. Recent findings In recent years, diabetes, prediabetic states and insulin resistance and their association with cerebrovascular disease were an important focus of research. The cerebrovascular consequences of these metabolic abnormalities were found to extend beyond ischemic stroke to covert brain infarcts, other structural brain changes and to cognitive impairment with and without dementia. Interventional studies did not reveal that more intensive management of chronic hyperglycemia and of hyperglycemia in the setting of acute stroke improves outcome. There is clear evidence, however, that the overall management of multiple risk factors and behavior modification in patients with dysglycemia may reduce the burden of cerebrovascular disease. Summary Observational studies reveal the growing burden and adverse cerebrovascular effects of dysglycemic states. Currently available interventional studies assessing more intensive strategies for the management of hyperglycemia did not prove, however, to be effective. We discuss the current evidence, pathophysiological considerations and management implications.

Current Patient Management of Chronic Myeloid Leukemia in Latin America A Study by the Latin American Leukemia Net (LALNET)

BACKGROUND: Treatment recommendations have been developed for management of patients with chronic myeloid leukemia (CML). METHODS: A 30-item multiple-choice questionnaire was administered to 435 hematologists and oncohematologists in 16 Latin American countries. Physicians self-reported their diagnostic, therapeutic, and disease management strategies. RESULTS: Imatinib is available as initial therapy to 92% of physicians, and 42% of physicians have access to both second-generation tyrosine kinase inhibitors. Standard-dose imatinib is the preferred initial therapy for most patients, but 20% would manage a young patient initially with an allogeneic stem cell transplant from a sibling donor, and 10% would only offer hydroxyurea to an elderly patient. Seventy-two percent of responders perform routine cytogenetic analysis for monitoring patients on therapy, and 59% routinely use quantitative polymerase chain reaction. For patients who fail imatinib therapy, 61% would increase the dose of imatinib before considering change to a second-generation tyrosine kinase inhibitor, except for patients aged 60 years, for whom a switch to a second-generation tyrosine kinase inhibitor was the preferred choice. CONCLUSIONS: The answers to this survey provide insight into the management of patients with CML in Latin America. Some deviations from current recommendations were identified. Understanding the treatment patterns of patients with CML in broad population studies is important to identify needs and improve patient care. Cancer 2010;116:4991-5000. (C) 2070 American Cancer Society.

Distributed generation producers' reserve management

Sustainable development concerns are being addressed with increasing attention, in general, and in the scope of power industry, in particular. The use of distributed generation (DG), mainly based on renewable sources, has been seen as an interesting approach to this problem. However, the increasing of DG in power systems raises some complex technical and economic issues. This paper presents ViProd, a simulation tool that allows modeling and simulating DG operation and participation in electricity markets. This paper mainly focuses on the operation of Virtual Power Producers (VPP) which are producers’ aggregations, being these producers mainly of DG type. The paper presents several reserve management strategies implemented in the scope of ViProd and the results of a case study, based on real data.

Educational policies, territories and actors strategies

The purpose of this paper is to analyse how educational policies about school violence are reinterpreted and implemented at school level and if this process contributes to a more pluralistic and democratic school. A research carried out in 3 clusters of schools showed that the diversity of understandings and strategies to face school violence, higher within the territories than between them, was associated to the school board's agendas and the legitimacy of the different actors to interpret and act within the national policies framework. There was a high consistency between violence management strategies and the ways schools faced social and cultural diversity. Those who favour more inclusive strategies to deal with violence tend to provide higher educational opportunities in schools, inversely, those who favour repressive strategies are more likely to support educational and social selective strategies, with less educational offer; less participation of teachers, students and parents in violence regulation.

A model for heterogeneous networks management and Performance evaluation

In general, modern networks are analysed by taking several Key Performance Indicators (KPIs) into account, their proper balance being required in order to guarantee a desired Quality of Service (QoS), particularly, cellular wireless heterogeneous networks. A model to integrate a set of KPIs into a single one is presented, by using a Cost Function that includes these KPIs, providing for each network node a single evaluation parameter as output, and reflecting network conditions and common radio resource management strategies performance. The proposed model enables the implementation of different network management policies, by manipulating KPIs according to users' or operators' perspectives, allowing for a better QoS. Results show that different policies can in fact be established, with a different impact on the network, e.g., with median values ranging by a factor higher than two.

Optimal strategies for marine wildlife tourism in small islands

Tese de Doutoramento, Ciências Económicas e Empresariais (especialidade de Economia), 18 de Junho de 2015, Universidade dos Açores

Knowledge management in multinational companies: the repatriates’ role in the competitive advantage in subsidiaries

This paper addresses the topic of knowledge management in multinational companies (MNCs). Its purpose is to examine the role of expatriates in knowledge acquisition and transfer within MNCs. Specifically it focuses on knowledge acquisition and transfer from one MNC head office located in Germany to two Portuguese subsidiaries as a basis for competitive advantage in their Portuguese subsidiaries. A qualitative research methodology is used, specifically through an exploratory case study approach, which examines how international assignments are important for the role of expatriates In knowledge acquisition and transfer between foreign head offices and their Portuguese subsidiaries. The data were collected through semi structured interviews to 10 Portuguese repatriates from two Portuguese subsidiaries of one foreign MNC. The findings suggest that the reasons that lead to expatriating employees from Portuguese subsidiaries to foreign head offices are connected to (1) knowledge management strategies to development the subsidiary’s performance; (2) new skills and knowledge acquisition by future team leaders and business/product managers in Portuguese subsidiaries; (3) procuring knowledge, from agents in head office, to be disseminated amongst co-workers in Portuguese subsidiaries; (4) acquiring global management skills, impossible to acquire locally and; (5) developing global projects within MNC. Also our results show that knowledge acquisition and transfer from foreign head office, through subsidiaries’ expatriates, contributes directly to the Portuguese subsidiaries’ innovation, improved performance, competitive advantage and growth in the economic sectors in which they operate. Moreover, evidence reveals that expatriation is seen as a strategy to fulfil some of the main organisational objectives through their expatriates (e.g., create new products and business markets, develop and incorporate new organisational techniques and processes, integrate global teams within multinational corporation with a responsibility on the definition of global objectives). The results obtained suggest that expatriates have a central role in acquiring and transferring strategic knowledge from MNC head office to their subsidiaries located in Portugal. Based on the findings, the paper discusses in detail the main theoretical and managerial implications. Suggestions for further research are also presented. The study’s main limitation is the small size of the sample, but its findings and methodology are quite original and significant.

Implementing a site waste management plan: a case study of a medium sized building contractor in Ireland

Construction and demolition waste management is becoming increasingly important on construction sites as landfill space in Ireland is rapidly depleting and waste management costs are rising. Due to these factors waste management plans are seen as a good response to minimising waste on site and this thesis aims to investigate how to implement such a plan on a practical case study as well as investigating the legislation regarding construction and demolition waste along with market availability for the reuse of the waste. Main contractor surveys were also carried out in order to gain a better understanding of current attitudes within the industry and these surveys are analysed in chapter five. A survey was also carried out among sub-contractors but this survey has not been used for this thesis as the study is on-going. The primary aim of this thesis is to examine the waste hierarchy opportunities that are available for construction and demolition waste in Ireland and to examine the effects of management strategies on construction and demolition waste reduction at the project level. A partnership was developed with Carey Developments Ltd in Co. Galway and an analysis of their waste management practices was undertaken. The primary case study will be the ‘Taylors Hill’ project in Co. Galway where work commenced in March, 2012. The secondary aim of the thesis is to develop specific waste minimisation strategies for the company and to develop a training tool kit for use on site.

The management of the type 2 diabetic patient with hypertension - too late and too little: suggested improvements

Patients with comorbid hypertension and type 2 diabetes are common, have a greatly increased risk of premature cardiovascular and renal morbidity and mortality, and are likely to increase substantially in number over the next 10-15 years. We suggest the need for more aggressive management strategies for these patients, regardless of their baseline blood pressure, including the early use of combination therapy with blockers of the renin-angiotensin system.

Hierarchic species-area relationships and the management of forest habitat islands in intensive farmland

Habitat loss and fragmentation due to land use changes are major threats to biodiversity in forest ecosystems, and they are expected to have important impacts on many taxa and at various spatial scales. Species richness and area relationships (SARs) have been used to assess species diversity patterns and drivers, and thereby in the establishment of conservation and management strategies. Here we propose a hierarchical approach to achieve deeper insights on SARs in small forest islets in intensive farmland and to address the impacts of decreasing naturalness on such relationships. In the intensive dairy landscapes of Northwest Portugal, where small forest stands (dominated by pines, eucalypts or both) represent semi-natural habitat islands, 50 small forest stands were selected and surveyed for vascular plant diversity. A hierarchical analytical framework was devised to determine species richness and inter- and intra-patch SARs for the whole set of forest patches (general patterns) and for each type of forest (specific patterns). Differences in SARs for distinct groups were also tested by considering subsets of species (native, alien, woody, and herbaceous). Overall, values for species richness were confirmed to be different between forest patches exhibiting different levels of naturalness. Whereas higher values of plant diversity were found in pine stands, higher values for alien species were observed in eucalypt stands. Total area of forest (inter-patch SAR) was found not to have a significant impact on species richness for any of the targeted groups of species. However, significant intra-patch SARs were obtained for all groups of species and forest types. A hierarchical approach was successfully applied to scrutinise SARs along a gradient of forest naturalness in intensively managed landscapes. Dominant canopy tree and management intensity were found to reflect differently on distinct species groups as well as to compensate for increasing stand area, buffering SARs among patches, but not within patches. Thus, the maintenance of small semi-natural patches dominated by pines, under extensive practices of forest management, will promote native plant diversity while at the same time contributing to limit the expansion of problematic alien invasive species.

"I came from there (but no one warned me!)": reflections on people management policies that target intranational interculturality

The purpose of this article is to analyze how professionals who decided to risk intramobility in their careers and who were hired by organizations from the industrial complex of Camaçari (Bahia) perceive the development of people management strategies that target intranational interculturality within these organizations. To achieve this, besides a review and theoretical analysis of the concepts of mobility, intercultural management and people management in organizations, 13 professionals were interviewed who had moved from different Brazilian states to work in companies in this particular complex. The results indicate that generally organizations ignore intercultural aspects, which is reflected in a gap in people management strategies. One indication of this refers to the lack of initial support, which generates problems for the individuals who arrive with great expectations in their new workplace. Furthermore, there is evidence that the financial help provided is insufficient and it becomes necessary to pay attention also to subjective aspects that involve relocation and the consequent international interculturality. Finally, it is believed that expansion of the focus of studies on intercultural management, with a look at intranational aspects, makes it possible to learn theoretical and practical lessons because of the experiences of the players who underwent the process, since intercultural management and people management can generate comparative advantages for organizations.

Movement, impacts and management of plant distributions in response to climate change: insights from invasions

A major challenge in this era of rapid climate change is to predict changes in species distributions and their impacts on ecosystems, and, if necessary, to recommend management strategies for maintenance of biodiversity or ecosystem services. Biological invasions, studied in most biomes of the world, can provide useful analogs for some of the ecological consequences of species distribution shifts in response to climate change. Invasions illustrate the adaptive and interactive responses that can occur when species are confronted with new environmental conditions. Invasion ecology complements climate change research and provides insights into the following questions: i) how will species distributions respond to climate change? ii) how will species movement affect recipient ecosystems? and iii) should we, and if so how can we, manage species and ecosystems in the face of climate change? Invasion ecology demonstrates that a trait-based approach can help to predict spread speeds and impacts on ecosystems, and has the potential to predict climate change impacts on species ranges and recipient ecosystems. However, there is a need to analyse traits in the context of life-history and demography, the stage in the colonisation process (e.g., spread, establishment or impact), the distribution of suitable habitats in the landscape, and the novel abiotic and biotic conditions under which those traits are expressed. As is the case with climate change, invasion ecology is embedded within complex societal goals. Both disciplines converge on similar questions of "when to intervene?" and "what to do?" which call for a better understanding of the ecological processes and social values associated with changing ecosystems.

Perioperative thirst: an analysis from the perspective of the Symptom Management Theory

A theoretical study aimed to analyze the existing knowledge in the literature on the perioperative thirst symptom from the perspective of Symptom Management Theory, and supplemented with the experience of the study group and thirst research. Thirst is described as a very intense symptom occurring in the perioperative period, and for this reason it cannot be ignored. The Symptom Management Theory is adequate for understanding the thirst symptom and is a deductive theory, focused on the domains of the Person, Environment and Health / Illness Status, as well as on the dimensions of Experience, Management Strategies and Symptom Outcomes. Using the theory leads us to consider perioperative thirst in its multifactorial aspects, analyzing the interrelation of its domains and dimensions in order to draw attention to this symptom that has been insufficiently valued, recorded and treated in clinical practice.

Effects of different management systems on porosity of oxisols in Paraná, Brazil

Soils play a fundamental role in the production of human foods. The Oxisols in the state of Paraná are among the richest and most productive soils in Brazil, but degradation and low porosity are frequently documented, due to intensive farming involving various management strategies and the application of high-tech solutions. This study aims to investigate changes in the porosity of two Red Oxisols (Latossolos Vermelhos), denoted LVef (eutroferric) and LVdf (dystroferric) under conventional and no-tillage soil management, with a succession of annual crops of soybean, maize and wheat over a continuous period of more than 20 years. After describing the soil profiles under native forest, no-tillage management and conventional tillage using the crop profile method, deformed and non-deformed soil samples were collected from the volumes most compacted by human intervention and the physical, chemical and mineralogical properties analyzed. The various porosity classes (total pore volume, inter-aggregate porosity between channels and biological cavities) and intra-aggregate porosity (determined in 10 cm³ saturated clods subjected to a pressure of -10 kPa to obtain a pore volume with a radius (r eq), > 15 μm and < 15 μm). The results showed that the effects of no-tillage farming on porosity are more pronounced in both soil types. Porosity of the LVdf was higher than pf the LVef soil, whatever the management type. In the LVdf soil, only pores with a radius of > 15 μm were affected by farming whereas in the LVef soil, pores with a radius of < 15 μm were affected as well.

European expert opinion on the management of invasive candidiasis in adults.

This report discusses the present status of antifungal therapy and treatment options for candidaemia, considered by experts in the field in Europe. A conference of 26 experts from 13 European countries was held to discuss strategies for the treatment and prevention of invasive candidiasis, with the aim of providing a review on optimal management strategies. Published and unpublished comparative trials on antifungal therapy were analysed and discussed. Commonly asked questions about the management of candidaemia were selected, and possible responses to these questions were discussed. Panellists were then asked to respond to each question by using a touchpad answering system. After the initial conference, the viewpoint document has been reviewed and edited to include new insights and developments since the initial meeting. For many situations, consensus on treatment could not be reached, and the responses indicate that treatment is likely to be modified on a patient-to-patient basis, depending on factors such as degree of illness, prior exposure to azole antifungals, and the presence of potentially antifungal drug-resistant Candida species.