Prevalence and management of familial hypercholesterolaemia in patients with acute coronary syndromes.

AIMS We aimed to assess the prevalence and management of clinical familial hypercholesterolaemia (FH) among patients with acute coronary syndrome (ACS). METHODS AND RESULTS We studied 4778 patients with ACS from a multi-centre cohort study in Switzerland. Based on personal and familial history of premature cardiovascular disease and LDL-cholesterol levels, two validated algorithms for diagnosis of clinical FH were used: the Dutch Lipid Clinic Network algorithm to assess possible (score 3-5 points) or probable/definite FH (>5 points), and the Simon Broome Register algorithm to assess possible FH. At the time of hospitalization for ACS, 1.6% had probable/definite FH [95% confidence interval (CI) 1.3-2.0%, n = 78] and 17.8% possible FH (95% CI 16.8-18.9%, n = 852), respectively, according to the Dutch Lipid Clinic algorithm. The Simon Broome algorithm identified 5.4% (95% CI 4.8-6.1%, n = 259) patients with possible FH. Among 1451 young patients with premature ACS, the Dutch Lipid Clinic algorithm identified 70 (4.8%, 95% CI 3.8-6.1%) patients with probable/definite FH, and 684 (47.1%, 95% CI 44.6-49.7%) patients had possible FH. Excluding patients with secondary causes of dyslipidaemia such as alcohol consumption, acute renal failure, or hyperglycaemia did not change prevalence. One year after ACS, among 69 survivors with probable/definite FH and available follow-up information, 64.7% were using high-dose statins, 69.0% had decreased LDL-cholesterol from at least 50, and 4.6% had LDL-cholesterol ≤1.8 mmol/L. CONCLUSION A phenotypic diagnosis of possible FH is common in patients hospitalized with ACS, particularly among those with premature ACS. Optimizing long-term lipid treatment of patients with FH after ACS is required.

European legislation and implementation measures in the management of construction and demolition waste.

The intense activity in the construction sector during the last decade has generated huge volumes of construction and demolition (C&D) waste. In average, Europe has generated around 890 million tonnes of construction and demolition waste per year. Although now the activity has entered in a phase of decline, due to the change of the economic cycle, we don’t have to forget all the problems caused by such waste, or rather, by their management which is still far from achieving the overall target of 70% for C&D waste --excludes soil and stones not containing dangerous substances-- should be recycled in the EU Countries by 2020 (Waste Framework Directive). But in fact, the reality is that only 50% of the C&D waste generated in EU is recycled and 40% of it corresponds to the recycling of soil and stones not containing dangerous substances. Aware of this situation, the European Countries are implementing national policies as well as different measures to prevent the waste that can be avoidable and to promote measures to increase recycling and recovering. In this aspect, this article gives an overview of the amount of C&D waste generated in European countries, as well as the amount of this waste that is being recycled and the different measures that European countries have applied to solve this situation.

Legal Aspects which Implement Good Practice Measures in the Management of Construction and Demolition Waste

The construction industry, one of the most important ones in the development of a country, generates unavoidable impacts on the environment. The social demand towards greater respect for the environment is a high and general outcry. Therefore, the construction industry needs to reduce the impact it produces. Proper waste management is not enough; we must take a further step in environmental management, where new measures need to be introduced for the prevention at source, such as good practices to promote recycling. Following the amendment of the legal frame applicable to Construction and Demolition Waste (C&D waste), important developments have been incorporated in European and International laws, aiming to promote the culture of reusing and recycling. This change of mindset, that is progressively taking place in society, is allowing for the consideration of C&D waste no longer as an unusable waste, but as a reusable material. The main objective of the work presented in this paper is to enhance C&D waste management systems through the development of preventive measures during the construction process. These measures concern all the agents intervening in the construction process as only the personal implication of all of them can ensure an efficient management of the C&D waste generated. Finally, a model based on preventive measures achieves organizational cohesion between the different stages of the construction process, as well as promoting the conservation of raw materials through the use and waste minimization. All of these in order to achieve a C&D waste management system, whose primary goal is zero waste generation

Analysis, monitoring, and management of quality of experience in video delivery services over IP

Esta tesis estudia la monitorización y gestión de la Calidad de Experiencia (QoE) en los servicios de distribución de vídeo sobre IP. Aborda el problema de cómo prevenir, detectar, medir y reaccionar a las degradaciones de la QoE desde la perspectiva de un proveedor de servicios: la solución debe ser escalable para una red IP extensa que entregue flujos individuales a miles de usuarios simultáneamente. La solución de monitorización propuesta se ha denominado QuEM(Qualitative Experience Monitoring, o Monitorización Cualitativa de la Experiencia). Se basa en la detección de las degradaciones de la calidad de servicio de red (pérdidas de paquetes, disminuciones abruptas del ancho de banda...) e inferir de cada una una descripción cualitativa de su efecto en la Calidad de Experiencia percibida (silencios, defectos en el vídeo...). Este análisis se apoya en la información de transporte y de la capa de abstracción de red de los flujos codificados, y permite caracterizar los defectos más relevantes que se observan en este tipo de servicios: congelaciones, efecto de “cuadros”, silencios, pérdida de calidad del vídeo, retardos e interrupciones en el servicio. Los resultados se han validado mediante pruebas de calidad subjetiva. La metodología usada en esas pruebas se ha desarrollado a su vez para imitar lo más posible las condiciones de visualización de un usuario de este tipo de servicios: los defectos que se evalúan se introducen de forma aleatoria en medio de una secuencia de vídeo continua. Se han propuesto también algunas aplicaciones basadas en la solución de monitorización: un sistema de protección desigual frente a errores que ofrece más protección a las partes del vídeo más sensibles a pérdidas, una solución para minimizar el impacto de la interrupción de la descarga de segmentos de Streaming Adaptativo sobre HTTP, y un sistema de cifrado selectivo que encripta únicamente las partes del vídeo más sensibles. También se ha presentado una solución de cambio rápido de canal, así como el análisis de la aplicabilidad de los resultados anteriores a un escenario de vídeo en 3D. ABSTRACT This thesis proposes a comprehensive approach to the monitoring and management of Quality of Experience (QoE) in multimedia delivery services over IP. It addresses the problem of preventing, detecting, measuring, and reacting to QoE degradations, under the constraints of a service provider: the solution must scale for a wide IP network delivering individual media streams to thousands of users. The solution proposed for the monitoring is called QuEM (Qualitative Experience Monitoring). It is based on the detection of degradations in the network Quality of Service (packet losses, bandwidth drops...) and the mapping of each degradation event to a qualitative description of its effect in the perceived Quality of Experience (audio mutes, video artifacts...). This mapping is based on the analysis of the transport and Network Abstraction Layer information of the coded stream, and allows a good characterization of the most relevant defects that exist in this kind of services: screen freezing, macroblocking, audio mutes, video quality drops, delay issues, and service outages. The results have been validated by subjective quality assessment tests. The methodology used for those test has also been designed to mimic as much as possible the conditions of a real user of those services: the impairments to evaluate are introduced randomly in the middle of a continuous video stream. Based on the monitoring solution, several applications have been proposed as well: an unequal error protection system which provides higher protection to the parts of the stream which are more critical for the QoE, a solution which applies the same principles to minimize the impact of incomplete segment downloads in HTTP Adaptive Streaming, and a selective scrambling algorithm which ciphers only the most sensitive parts of the media stream. A fast channel change application is also presented, as well as a discussion about how to apply the previous results and concepts in a 3D video scenario.

Emotions and the Engineering of Adaptiveness in Complex Systems

A major challenge in the engineering of complex and critical systems is the management of change, both in the system and in its operational environment. Due to the growing of complexity in systems, new approaches on autonomy must be able to detect critical changes and avoid their progress towards undesirable states. We are searching for methods to build systems that can tune the adaptability protocols. New mechanisms that use system-wellness requirements to reduce the influence of the outer domain and transfer the control of uncertainly to the inner one. Under the view of cognitive systems, biological emotions suggests a strategy to configure value-based systems to use semantic self-representations of the state. A method inspired by emotion theories to causally connect to the inner domain of the system and its objectives of wellness, focusing on dynamically adapting the system to avoid the progress of critical states. This method shall endow the system with a transversal mechanism to monitor its inner processes, detecting critical states and managing its adaptivity in order to maintain the wellness goals. The paper describes the current vision produced by this work-in-progress.

Management of irrigation frequency and nitrogen fertilization to mitigate GHG and NO emissions from drip-fertigated crops

Drip irrigation combined with split application of fertilizer nitrogen (N) dissolved in the irrigation water (i.e. drip fertigation) is commonly considered best management practice for water and nutrient efficiency. As a consequence, its use is becoming widespread. Some of the main factors (water-filled pore space, NH4+ and NO3−) regulating the emissions of greenhouse gases (i.e. N2O, CO2 and CH4) and NO from agroecosystems can easily be manipulated by drip fertigation without yield penalties. In this study, we tested management options to reduce these emissions in a field experiment with a melon (Cucumis melo L.) crop. Treatments included drip irrigation frequency (weekly/daily) and type of N fertilizer (urea/calcium nitrate) applied by fertigation. Crop yield, environmental parameters, soil mineral N concentrations and fluxes of N2O, NO, CH4 and CO2 were measured during 85 days. Fertigation with urea instead of calcium nitrate increased N2O and NO emissions by a factor of 2.4 and 2.9, respectively (P < 0.005). Daily irrigation reduced NO emissions by 42% (P < 0.005) but increased CO2 emissions by 21% (P < 0.05) compared with weekly irrigation. We found no relation between irrigation frequency and N2O emissions. Based on yield-scaled Global Warming Potential as well as NO cumulative emissions, we conclude that weekly fertigation with a NO3−-based fertilizer is the best option to combine agronomic productivity with environmental sustainability. Our study shows that adequate management of drip fertigation, while contributing to the attainment of water and food security, may provide an opportunity for climate change mitigation.

Emotions and the Engineering of Adaptiveness in Complex Systems

A major challenge in the engineering of complex and critical systems is the management of change, both in the system and in its operational environment. Due to the growing of complexity in systems, new approaches on autonomy must be able to detect critical changes and avoid their progress towards undesirable states. We are searching for methods to build systems that can tune the adaptability protocols. New mechanisms that use system-wellness requirements to reduce the influence of the outer domain and transfer the control of uncertainly to the inner one. Under the view of cognitive systems, biological emotions suggests a strategy to configure value-based systems to use semantic self-representations of the state. A method inspired by emotion theories to causally connect to the inner domain of the system and its objectives of wellness, focusing on dynamically adapting the system to avoid the progress of critical states. This method shall endow the system with a transversal mechanism to monitor its inner processes, detecting critical states and managing its adaptivity in order to maintain the wellness goals. The paper describes the current vision produced by this work-in-progress.

Great Himalaya: Tourism and the dynamics of change in Nepal

Based on extensive field work and years of personal experience, the authors discuss the development of tourism in the Great Himalaya of Nepal from the early days of mountaineering to present-day trekking. Tourism and its potentials, drawbacks, and risks are illustrated with a focus on the Khumbu/Everest and Annapurna regions, the most popular mountain destinations in the country. The themes addressed include: growth and expansion of mountain tourism; employment and income generation; wealth, poverty, and livelihood as reflected in statistics and personal accounts by local people; the revival of trade with Tibet; tourism and the role of women; the crucial role played by institutions, policies and political stability; and environmental issues such as forest degradation, garbage management, and trail damage. With its numerous illustrations, text boxes and quotes, the book is intended for a broad readership of policy- and decision-makers in tourism and development, scholars, and tourists and mountaineers who take an interest in mountain development in the Great Himalaya and elsewhere.

A longitudinal study of employee adaptation to organizational change: The role of change-related information and change-related self-efficacy

This study examined the role of information, efficacy, and 3 stressors in predicting adjustment to organizational change. Participants were 589 government employees undergoing an 18-month process of regionalization. To examine if the predictor variables had long-term effects on adjustment, the authors assessed psychological well-being, client engagement, and job satisfaction again at a 2-year follow-up. At Time 1, there was evidence to suggest that information was indirectly related to psychological well-being, client engagement, and job satisfaction, via its positive relationship to efficacy. There also was evidence to suggest that efficacy was related to reduced stress appraisals, thereby heightening client engagement. Last, there was consistent support for the stress-buffering role of Time I self-efficacy in the prediction of Time 2 job satisfaction.

A decade of downsizing: Understanding the contours of change in Australia, 1990-99

his paper seeks to map a decade of organizational downsizing in Australia utilizing a comprehensive longitudinal data set of 4153 firms. Aggregate downsizing measures conceal extensive change within organizations. We seek to assess these processes by comparing a conventional downsizing measure with more specific occupational downsizing measures. The results show the contours of change in Australia over the 1990s; indicate that there are distinctive and contrasting trends; and raise significant issues for future theoretical and empirical research.

Water quality monitoring: A combined approach to investigate gradients of change in the Great Barrier Reef, Australia

For the managers of a region as large as the Great Barrier Reef, it is a challenge to develop a cost effective monitoring program, with appropriate temporal and spatial resolution to detect changes in water quality. The current study compares water quality data (phytoplankton abundance and water clarity) from remote sensing with field sampling (continuous underway profiles of water quality and fixed site sampling) at different spatial scales in the Great Barrier Reef north of Mackay (20 degrees S). Five transects (20-30 km long) were conducted from clean oceanic water to the turbid waters adjacent to the mainland. The different data sources demonstrated high correlations when compared on a similar spatial scale (18 fixed sites). However, each data source also contributed unique information that could not be obtained by the other techniques. A combination of remote sensing, underway sampling and fixed stations will deliver the best spatial and temporal monitoring of water quality in the Great Barrier Reef. (c) 2004 Elsevier Ltd. All rights reserved.

Effects of neurosurgical management of Parkinson's disease on speech characteristics and oromotor function

The present study examined the effects of neurosurgical management of Parkinson's disease (PD), including the procedures of pallidotomy, thalamotomy, and deep-brain stimulation (DBS) on perceptual speech characteristics, speech,, intelligibility and oromotor function in a group of 22 participants with PD. The surgical participant group was compared with a group of 25 non-neurologically impaired individuals matched for age and sex. In addition, the study investigated 16 participants with PD who did not undergo neurosurgical management to control for disease progression. Results revealed that neurosurgical intervention did not significantly change the surgical participants' perceptual speech dimensions or oromotor function despite significant postoperative improvements in ratings of general motor function and disease severity. Reasons why neurosurgical intervention resulted in dissimilar outcomes with respect to participants' perceptual speech dimensions and general motor function are proposed.

OHS in the nursing workplace: accountability and the management of stress

There has been growing interest in occupational stress in the nursing context, both in New Zealand and internationally. This article takes a critical approach to the literature on nursing stress by examining the implications of a body of research largely informed by a theoretical approach which highlights the individual. In spite of evidence that the main sources of stress for nurses are related to workplace conditions, the focus is on the individual nurse and his/her personal response to stress. This approach encourages the development of interventions where the objectives are the individual management of stress, and thereby consolidates nurses' perceptions of powerlessness. Alternatives to these palliative measures, such as highlighting the legal obligations for employers to provide a safe workplace or collective industrial action for change, are glaringly absent in the literature. The importance of such an approach is supported by recent findings from the United States on the advantages of hospitals which promote nurses' autonomy and control.

Allozyme electrophoresis still represents a powerful technique in the management of coral reefs

Understanding genetic variability and gene flow between populations of scleractinian corals separated by one to several hundred kilometers is crucially important as we head into a century of climate change in which an understanding of the connectivity of populations is a critically important question in management. Genetic methods that directly use molecular variance in the DNA should offer greater precision in detecting differences among individuals and populations than the more traditional allozyme electrophoresis. However, this paper highlights the point that the limited number of DNA markers that have been identified for scleractinian coral genetic studies do not necessarily offer greater precision than that offered by allozymes. In fact, at present allozyme electrophoresis yields greater information than the eight different DNA markers used in this study. Given the relative ease of use of allozymes and the wealth of comparable data sets from numerous previously published studies, allozyme electrophoresis should not be dismissed for population structure and connectivity studies on coral reefs. While continued effort should be placed into searching for new DNA markers, until a more sensitive DNA marker becomes available for scleractinian corals, allozyme electrophoresis remains a powerful and relevant technique for understanding the connectivity of coral population studies.

A core vocabulary approach for management of inconsistent speech disorder

Developmental speech disorder is accounted for by theories derived from psychology, psycholinguistics, linguistics and medicine, with researchers developing assessment protocols that reflect their theoretical perspective. How theory and data analyses lead to different therapy approaches, however, is sometimes unclear. Here, we present a case management plan for a 7 year old boy with unintelligible speech. Assessment data were analysed to address seven case management questions regarding need for intervention, service delivery, differential diagnosis, intervention goals, generalization of therapeutic gains, discharge criteria and evaluation of efficacy. Jarrod was diagnosed as having inconsistent speech disorder that required intervention. He pronounced 88% of words differently when asked to name each word in the 25 word inconsistency test of the Diagnostic Evaluation of Articulation and Phonology three times, each trial separated by another activity. Other standardized assessments supported the diagnosis of inconsistent speech disorder that, according to previous research, is associated with a deficit in phonological assembly. Core vocabulary intervention was chosen as the most appropriate therapy technique. Its nature and a possible protocol for implementation is described.