941 resultados para cuff pressure management
Resumo:
This article provides an example of weak linkages between research and fisheries management despite the pressure of many "actors" and institutions on both sides. Managers must learn to listen to scientists; the latter need to become entrepreneural; and appropriate fora are required to bring the actors together.
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Cobia (Rachycentron canadum) is a pelagic, migratory species with a transoceanic distribution in tropical and subtropical waters. Recreational fishing pressure on Cobia in the United States has increased substantially during the last decade, especially in areas of its annual inshore aggregations, making this species potentially susceptible to overfishing. Although Cobia along the Atlantic and Gulf coasts of the southeastern United States are currently managed as a single fishery, the genetic composition of Cobias in these areas is unclear. On the basis of a robust microsatellite data set from collections along the U.S. Atlantic coast (2008–09), offshore groups were genetically homogenous. However, the 2 sampled inshore aggregations (South Carolina and Virginia) were genetically distinct from each other, as well as from the offshore group. The recapture of stocked fish within their release estuary 2 years after release indicates that some degree of estuarine fidelity occurs within these inshore aggregations and supports the detection of their unique genetic structure at the population level. These results complement the observed high site fidelity of Cobias in South Carolina and support a recent study that confirms that Cobia spawn in the inshore aggregations. Our increased understanding of Cobia life history will be beneficial for determining the appropriate scale of fishery management for Cobia.
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Samples of the commercially and recreationally important West Australian dhufish (Glaucosoma hebraicum) were obtained from the lower west coast of Australia by a variety of methods. Fish <300 mm TL were caught over flat, hard substrata and low-lying limestone reefs, whereas larger fish were caught over larger limestone and coral reef formations. Maximum total lengths, weights, and ages were 981 mm, 15.3 kg, and 39 years, respectively, for females and 1120 mm, 23.2 kg, and 41 years, respectively, for males. The von Bertalanffy growth curves for females and males were significantly different. The values for L∞, k, and t0 in the von Bertalanffy growth equations were 929 mm, 0.111/year, and –0.141 years, respectively, for females, and 1025 mm, 0.111/year, and –0.052 years, respectively, for males. Preliminary estimates of total mortality indicated that G. hebraicum is now subjected to a level of fishing pressure that must be of concern to fishery managers. Glaucosoma hebraicum, which spawns between November and April and predominantly between December and March, breeds at a wide range of depths and is a multiple spawner. The L50’s for females and males at first maturity, i.e. 301 and 320 mm, respectively, were attained by about the end of the third year of life and are well below the minimum legal length (MLL) of 500 mm. Because females and males did not reach the MLL until the end of their seventh and sixth years of life, respectively, they would have had, on average, the opportunity of spawning during four and three spawning seasons, respectively, before they reached the MLL. However, because G. hebraicum caught in water depths >40 m typically die upon release, a MLL is of limited use for conserving this species. Alternative approaches, such as restricting fishing activity in highly fished areas, reducing daily bag limits for recreational fishermen, introducing quotas or revising specific details of certain commercial hand-line licences (or doing both) are more likely to provide effective conservation measures.
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The fish stocks of Lake Albert face immense exploitation pressure which has led to “fishingdown” of their fisheries, with some larger species having been driven to near-extinction, while others such as Citharinus citharus have almost disappeared. Both A. baremose (Angara) and H. forskahlii (Ngassia) historically formed the most important commercial species in Lake Albert until the early 2000s but recent Catch Assessment Surveys (2007-2013) revealed a sweeping decline in their contribution to the commercial catch from 72.7% in 1971 to less than 6% in 2013. The catch per unit effort also registered a two-fold decline from 45.6 and 36.1 kg/boat/day to 22.6 and 18.1 kg/boat/day for A. baremose and H. forskahlii respective between 1971 and 2007. Over 50% of illegal gillnets, below the legal minimum limit of four inches (101.6 mm) used on Lake Albert target the two species. Gillnet experiments found the three inch (76.2 mm) gill net mesh size suitable for sustained harvest of the two species. The study concludes that optimal utilization of the two species and probably other non target fish species is achievable through species specific management strategies, coupling species specific licensing, and controlling harvest of juvenile individuals, overall fishing effort and fish catch on Lake Albert and protecting the vulnerable fish habitats.
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The Uganda sector of Lake Victoria occupies 29,580 km2 (43%). The lake used to boast of a multi-species fishery but presently relies on three major species Lates niloticus, Oreochromis niloticus and Rastrineobola argentea. During the past decade the total fish production on the Ugandan sector increased drastically from 17,000 tonnes in 1981 to about 13,000 tonnes 1991, indicating a healthy state of the fishery. This was contributed by a combination of factors including the explosive establishment of the introduced L. niloticus which contributed 60.8% in 1991 and the increase in the number of fishing canoes from 3470 in 1988 to 8000 in 1990. Isolated fishery resources studies carried out in different areas of the lake since 1971 seem, however, to indicate contrary trends in the available stocks and, therefore, the status of the fishery. In the experimental fishery, continued decline in catch rates have been recorded. Similarly, in the commercial fishery catch per unit of effort has been considerably poor (33 kg per canoe during January - March 1992) and the average size of individual fish laRded continued to decline, obviously pointing at possible over-fishing. This, therefore, calls for further urgent research on the available stocks for proper management strategies to be formulated.
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Established literature on new product development (NPD) management recognizes top management involvement (TMI) as one of the most critical success factors. With increasing pressure to sustain competitive advantage and growth, NPD activities remain the focus of close interest from top management in many organizations. TMI in the NPD domain is receiving increasing academic attention. Despite its criticality, there is no systematic review of the existing literature to inform and stimulate researchers in the field for further investigation. This paper introduces the current state of literature on TMI in NPD, synthesizes important findings, and identifies the gaps and deficiencies in this research stream. The contents of the selected articles, which investigated TMI in NPD, are analyzed based on the type of the study, level of analysis, research methodology, operationalization of TMI, and main findings. Additionally, other studies, which did not directly investigate TMI and support in NPD, but were sufficiently related, are briefly summarized. As a result of this detailed literature review, it can be stated that both exploratory and relational studies provide rich evidence on the critical role of top management in NPD. However, the identified gaps and deficiencies in this research stream call for a better theoretical understanding and well-defined constructs of TMI in the NPD domain for different levels of analysis for future studies.
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The information provided by the in-cylinder pressure signal is of great importance for modern engine management systems. The obtained information is implemented to improve the control and diagnostics of the combustion process in order to meet the stringent emission regulations and to improve vehicle reliability and drivability. The work presented in this paper covers the experimental study and proposes a comprehensive and practical solution for the estimation of the in-cylinder pressure from the crankshaft speed fluctuation. Also, the paper emphasizes the feasibility and practicality aspects of the estimation techniques, for the real-time online application. In this study an engine dynamics model based estimation method is proposed. A discrete-time transformed form of a rigid-body crankshaft dynamics model is constructed based on the kinetic energy theorem, as the basis expression for total torque estimation. The major difficulties, including load torque estimation and separation of pressure profile from adjacent-firing cylinders, are addressed in this work and solutions to each problem are given respectively. The experimental results conducted on a multi-cylinder diesel engine have shown that the proposed method successfully estimate a more accurate cylinder pressure over a wider range of crankshaft angles. Copyright © 2012 SAE International.
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Cryptococcosis is a global invasive mycosis associated with significant morbidity and mortality. These guidelines for its management have been built on the previous Infectious Diseases Society of America guidelines from 2000 and include new sections. There is a discussion of the management of cryptococcal meningoencephalitis in 3 risk groups: (1) human immunodeficiency virus (HIV)-infected individuals, (2) organ transplant recipients, and (3) non-HIV-infected and nontransplant hosts. There are specific recommendations for other unique risk populations, such as children, pregnant women, persons in resource-limited environments, and those with Cryptococcus gattii infection. Recommendations for management also include other sites of infection, including strategies for pulmonary cryptococcosis. Emphasis has been placed on potential complications in management of cryptococcal infection, including increased intracranial pressure, immune reconstitution inflammatory syndrome (IRIS), drug resistance, and cryptococcomas. Three key management principles have been articulated: (1) induction therapy for meningoencephalitis using fungicidal regimens, such as a polyene and flucytosine, followed by suppressive regimens using fluconazole; (2) importance of early recognition and treatment of increased intracranial pressure and/or IRIS; and (3) the use of lipid formulations of amphotericin B regimens in patients with renal impairment. Cryptococcosis remains a challenging management issue, with little new drug development or recent definitive studies. However, if the diagnosis is made early, if clinicians adhere to the basic principles of these guidelines, and if the underlying disease is controlled, then cryptococcosis can be managed successfully in the vast majority of patients.
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BACKGROUND: Despite the impact of hypertension and widely accepted target values for blood pressure (BP), interventions to improve BP control have had limited success. OBJECTIVES: We describe the design of a 'translational' study that examines the implementation, impact, sustainability, and cost of an evidence-based nurse-delivered tailored behavioral self-management intervention to improve BP control as it moves from a research context to healthcare delivery. The study addresses four specific aims: assess the implementation of an evidence-based behavioral self-management intervention to improve BP levels; evaluate the clinical impact of the intervention as it is implemented; assess organizational factors associated with the sustainability of the intervention; and assess the cost of implementing and sustaining the intervention. METHODS: The project involves three geographically diverse VA intervention facilities and nine control sites. We first conduct an evaluation of barriers and facilitators for implementing the intervention at intervention sites. We examine the impact of the intervention by comparing 12-month pre/post changes in BP control between patients in intervention sites versus patients in the matched control sites. Next, we examine the sustainability of the intervention and organizational factors facilitating or hindering the sustained implementation. Finally, we examine the costs of intervention implementation. Key outcomes are acceptability and costs of the program, as well as changes in BP. Outcomes will be assessed using mixed methods (e.g., qualitative analyses--pattern matching; quantitative methods--linear mixed models). DISCUSSION: The study results will provide information about the challenges and costs to implement and sustain the intervention, and what clinical impact can be expected.
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BACKGROUND: Several observational studies have evaluated the effect of a single exposure window with blood pressure (BP) medications on outcomes in incident dialysis patients, but whether BP medication prescription patterns remain stable or a single exposure window design is adequate to evaluate effect on outcomes is unclear. METHODS: We described patterns of BP medication prescription over 6 months after dialysis initiation in hemodialysis and peritoneal dialysis patients, stratified by cardiovascular comorbidity, diabetes, and other patient characteristics. The cohort included 13,072 adult patients (12,159 hemodialysis, 913 peritoneal dialysis) who initiated dialysis in Dialysis Clinic, Inc., facilities January 1, 2003-June 30, 2008, and remained on the original modality for at least 6 months. We evaluated monthly patterns in BP medication prescription over 6 months and at 12 and 24 months after initiation. RESULTS: Prescription patterns varied by dialysis modality over the first 6 months; substantial proportions of patients with prescriptions for beta-blockers, renin angiotensin system agents, and dihydropyridine calcium channel blockers in month 6 no longer had prescriptions for these medications by month 24. Prescription of specific medication classes varied by comorbidity, race/ethnicity, and age, but little by sex. The mean number of medications was 2.5 at month 6 in hemodialysis and peritoneal dialysis cohorts. CONCLUSIONS: This study evaluates BP medication patterns in both hemodialysis and peritoneal dialysis patients over the first 6 months of dialysis. Our findings highlight the challenges of assessing comparative effectiveness of a single BP medication class in dialysis patients. Longitudinal designs should be used to account for changes in BP medication management over time, and designs that incorporate common combinations should be considered.
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BACKGROUND: Several trials have demonstrated the efficacy of nurse telephone case management for diabetes (DM) and hypertension (HTN) in academic or vertically integrated systems. Little is known about the real-world potency of these interventions. OBJECTIVE: To assess the effectiveness of nurse behavioral management of DM and HTN in community practices among patients with both diseases. DESIGN: The study was designed as a patient-level randomized controlled trial. PARTICIPANTS: Participants included adult patients with both type 2 DM and HTN who were receiving care at one of nine community fee-for-service practices. Subjects were required to have inadequately controlled DM (hemoglobin A1c [A1c] ≥ 7.5%) but could have well-controlled HTN. INTERVENTIONS: All patients received a call from a nurse experienced in DM and HTN management once every two months over a period of two years, for a total of 12 calls. Intervention patients received tailored DM- and HTN- focused behavioral content; control patients received non-tailored, non-interactive information regarding health issues unrelated to DM and HTN (e.g., skin cancer prevention). MAIN OUTCOMES AND MEASURES: Systolic blood pressure (SBP) and A1c were co-primary outcomes, measured at 6, 12, and 24 months; 24 months was the primary time point. RESULTS: Three hundred seventy-seven subjects were enrolled; 193 were randomized to intervention, 184 to control. Subjects were 55% female and 50% white; the mean baseline A1c was 9.1% (SD = 1%) and mean SBP was 142 mmHg (SD = 20). Eighty-two percent of scheduled interviews were conducted; 69% of intervention patients and 70% of control patients reached the 24-month time point. Expressing model estimated differences as (intervention--control), at 24 months, intervention patients had similar A1c [diff = 0.1 %, 95 % CI (-0.3, 0.5), p = 0.51] and SBP [diff = -0.9 mmHg, 95% CI (-5.4, 3.5), p = 0.68] values compared to control patients. Likewise, DBP (diff = 0.4 mmHg, p = 0.76), weight (diff = 0.3 kg, p = 0.80), and physical activity levels (diff = 153 MET-min/week, p = 0.41) were similar between control and intervention patients. Results were also similar at the 6- and 12-month time points. CONCLUSIONS: In nine community fee-for-service practices, telephonic nurse case management did not lead to improvement in A1c or SBP. Gains seen in telephonic behavioral self-management interventions in optimal settings may not translate to the wider range of primary care settings.
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Purpose: The purpose of this paper is to examine the extent and nature of greening the supply chain (SC) in the UK manufacturing sector; and the factors that influence the breadth and depth of this activity.
Design/methodology/approach: Based on the findings from a sample of manufacturing organisations drawn from the membership of The Chartered Institute for Purchasing and Supply. Data are collected using a questionnaire, piloted and pre-tested before distribution with responses from 60 manufacturing companies.
Findings: On average manufacturers perceive the greatest pressure to improve environmental performance through legislation and internal drivers (IDs). The least influential pressures are related to societal drivers and SC pressures from individual customers. Green supply chain management (GSCM) practices amongst this “average” group of UK manufacturing organisations are focusing on internal, higher risk, descriptive activities, rather than proactive, external engagement processes. Environmental attitude (EA) is a key predictor of GSCM activity and those organisations that have a progressive attitude are also operationally very active. EA shows some relationship to legislative drivers but other factors are also influential. Operational activity may also be moderated by organisational contingencies such as risk, size, and nationality.
Research limitations/implications: The main limitation to this paper is the relatively small manufacturing sample.
Practical implications: This paper presents a series of constructs that identify GSCM operational activities companies to benchmark themselves against. It suggests which factors are driving these operational changes and how industry contingencies may be influential.
Originality/value: This paper explores what is driving environmental behaviour amongst an “average” sample of manufacturers, what specific management practices take place and the relationships between them.
Keywords: Manufacturing industries, Environmental management, Supply chain management, Sustainable development, United Kingdom
Paper type: Research paper
Resumo:
We assessed ten trophodynamic indicators of ecosystem status for their sensitivity and specificity to fishing management using a size-resolved multispecies fish community model. The responses of indicators to fishing depended on effort and the size selectivity (sigmoid or Gaussian) of fishing mortality. The highest specificity against sigmoid (trawl-like) size selection was seen from inverse fishing pressure and the large fish indicator, but for Gaussian size selection, the large species indicator was most specific. Biomass, mean trophic level of the community and of the catch, and fishing in balance had the lowest specificity against both size selectivities. Length-based indicators weighted by biomass, rather than abundance, were more sensitive and specific to fishing pressure. Most indicators showed a greater response to sigmoid than Gaussian size selection. Indicators were generally more sensitive at low levels of effort because of nonlinear sensitivity in trophic cascades to fishing mortality. No single indicator emerged as superior in all respects, so given available data, multiple complementary indicators are recommended for community monitoring in the ecosystem approach to fisheries management.
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Purpose: To describe a new surgical approach in the management of pseudophakic malignant glaucoma. Design: Noncomparative case series. Participants: Five consecutive patients with pseudophakic malignant glaucoma. Methods: All patients underwent zonulo-hyaloido-vitrectomy. The procedure involves the performance of zonulectomy, hyaloidectomy, and anterior vitrectomy (zonulo-hyaloido-vitrectomy) through a peripheral iridectomy or iridotomy via the anterior chamber. Main Outcome Measures: Medications, visual acuity, intraocular pressure, and anterior and posterior segment findings were recorded before and after surgery. Results: Resolution of the malignant glaucoma was achieved in all cases. No recurrences were observed after a median follow-up of 5.5 months (range, 1-9 months). In one patient with extensive anterior synechiae, bleb failure occurred after the resolution of the malignant glaucoma. This patient was treated successfully with a guarded filtration procedure supplemented with 5-fluorouracil. No other complications were observed. Conclusions: Zonulo-hyaloido-vitrectomy via the anterior segment appears to be an alternative option in the treatment of patients with pseudophakic malignant glaucoma. © 2001 by the American Academy of Ophthalmology.