A comparison of treatment options for management of end stage kidney disease in elderly patients : a systematic review

Background Chronic kidney disease is a global public health problem of increasing prevalence. There are five stages of kidney disease, with Stage 5 indicating end stage kidney disease (ESKD) requiring dialysis or death will eventually occur. Over the last two decades there have been increasing numbers of people commencing dialysis. A majority of this increase has occurred in the population of people who are 65 years and over. With the older population it is difficult to determine at times whether dialysis will provide any benefit over non-dialysis management. The poor prognosis for the population over 65 years raises issues around management of ESKD in this population. It is therefore important to review any research that has been undertaken in this area which compares outcomes of the older ESKD population who have commenced dialysis with those who have received non-dialysis management. Objective The primary objective was to assess the effect of dialysis compared with non-dialysis management for the population of 65 years and over with ESKD. Inclusion criteria Types of participants This review considered studies that included participants who were 65 years and older. These participants needed to have been diagnosed with ESKD for greater than three months and also be either receiving renal replacement therapy (RRT) (hemodialysis [HD] or peritoneal dialysis [PD]) or non-dialysis management. The settings for the studies included the home, self-care centre, satellite centre, hospital, hospice or nursing home. Types of intervention(s)/phenomena of interest This review considered studies where the intervention was RRT (HD or PD) for the participants with ESKD. There was no restriction on frequency of RRT or length of time the participant received RRT. The comparator was participants who were not undergoing RRT. Types of studies This review considered both experimental and epidemiological study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case control studies and analytical cross sectional studies. This review also considered descriptive epidemiological study designs including case series, individual case reports and descriptive cross sectional studies for inclusion. This review included any of the following primary and secondary outcome measures: •Primary outcome – survival measures •Secondary outcomes – functional performance score (e.g. Karnofsky Performance score) •Symptoms and severity of end stage kidney disease •Hospital admissions •Health related quality of life (e.g. KDQOL, SF36 and HRQOL) •Comorbidities (e.g. Charlson Comorbidity index).

Approaches and frameworks for management and research in small-scale fisheries in the developing world

Commonly adopted approaches to managing small-scale fisheries (SSFs) in developing countries do not ensure sustainability. Progress is impeded by a gap between innovative SSF research and slower-moving SSF management. The paper aims to bridge the gap by showing that the three primary bases of SSF management--ecosystem, stakeholders’ rights and resilience--are mutually consistent and complementary. It nominates the ecosystem approach as an appropriate starting point because it is established in national and international law and policy. Within this approach, the emerging resilience perspective and associated concepts of adaptive management and institutional learning can move management beyond traditional control and resource-use optimization, which largely ignore the different expectations of stakeholders; the complexity of ecosystem dynamics; and how ecological, social, political and economic subsystems are linked. Integrating a rights-based perspective helps balance the ecological bias of ecosystem-based and resilience approaches. The paper introduces three management implementation frameworks that can lend structure and order to research and management regardless of the management approach chosen. Finally, it outlines possible research approaches to overcome the heretofore limited capacity of fishery research to integrate across ecological, social and economic dimensions and so better serve the management objective of avoiding fishery failure by nurturing and preserving the ecological, social and institutional attributes that enable it to renew and reorganize itself. (PDF contains 29 pages)

Fisheries management in the social domain: perspectives from Tanzania's Lake Victoria fishery

For a long time, the Tanzanian Fisheries Department has managed Tanzanian fisheries without incorporating other stakeholders within its management framework. On lake Victoria, the persistent use of illegal fishing gear and declining catches have led the government to realize that this system of fisheries management may no longer be viable, and have sought to incorporate fishing communities into the management structure. Through the creation of beach management units (BMUs), the Fisheries Departments have sought to persuade fishing communities to implement and enforce Tanzania's fishing regulations and to monitor the fishery. In this paper we explore a recently gathered data set that yields information on, amongst others, how Tanzanian fishing communities perceive the state of their resource base, how they view their relationship with the Fisheries Department, the efficacy of fishing regulations and other variables. We draw on a series of criteria developed by Ostron (1990) for institutional 'robustness' to explore various areas of institutional development on Lake Victoria, and to try and anticipate how the BMUs will fare. We argue there are many socio-political and economic factors that will determine how communities will receive and perceive their responsibilities towards government-imposed administrative structures at the local level, these will become 'socialized' such that they will vary from place to place. While this may bode well for problems of heterogeneity, it does not necessarily mean that fisheries management objective on Lake Victoria will be met

Identifying functional stakeholder clusters to maximise communication for the ecosystem approach to fisheries management

Interaction with ecological models can improve stakeholder participation in fisheries management. Problems exist in efficiently communicating outputs to stakeholders and an objective method of structuring stakeholder differences is lacking. This paper aims to inform the design of a multi-user communication interface for fisheries management by identifying functional stakeholder groups. Intuitive categorisation of stakeholders, derived from survey responses, is contrasted with an Evidence-Based method derived from analysis of stakeholder literature. Intuitive categorisation relies on interpretation and professional judgement when categorising stakeholders among conventional stakeholder groups. Evidence-Based categorisation quantitatively characterises each stakeholder with a vector of four management objective interest-strength values (Yield, Employment, Profit and Ecosystem Preservation). Survey respondents agreed little in forming intuitive groups and the groups were poorly defined and heterogeneous in interests. In contrast the Evidence-Based clusters were well defined and largely homogeneous, so more useful for identifying functional relations with model outputs. The categorisations lead to two different clusterings of stakeholders and suggest unhelpful stereotyping of stakeholders may occur with the Intuitive categorisation method. Stakeholder clusters based on literature-evidence show a high degree of common interests among clusters and is encouraging for those seeking to maximise dialogue and consensus forming. © 2013 Elsevier Ltd.

Identifying marine pelagic ecosystem management objectives and indicators

International policy frameworks such as the Common Fisheries Policy and the European Marine Strategy Framework Directive define high-level strategic goals for marine ecosystems. Strategic goals are addressed via general and operational management objectives. To add credibility and legitimacy to the development of objectives, for this study stakeholders explored intermediate level ecological, economic and social management objectives for Northeast Atlantic pelagic ecosystems. Stakeholder workshops were undertaken with participants being free to identify objectives based on their own insights and needs. Overall 26 objectives were proposed, with 58% agreement in proposed objectives between two workshops. Based on published evidence for pressure-state links, examples of operational objectives and suitable indicators for each of the 26 objectives were then selected. It is argued that given the strong species-specific links of pelagic species with the environment and the large geographic scale of their life cycles, which contrast to demersal systems, pelagic indicators are needed at the level of species (or stocks) independent of legislative region. Pelagic community indicators may be set at regional scale in some cases. In the evidence-based approach used in this study, the selection of species or region specific operational objectives and indicators was based on demonstrated pressure-state links. Hence observed changes in indicators can reliably inform on appropriate management measures

Towards an organisational disaster risk management culture and practice for banks

The disaster risk management culture and practice that is evident within banks will significantly impact upon the capability and preparedness of institutions and their personnel to plan for, and respond to, an occurrence that may affect the continuity of critical business functions. The principal outcome of this paper is the development of a structured education and training framework that will support the achievement of banks' disaster risk management objective. The education and training framework comprises three specific programs: 1. an induction/awareness program targeted to all personnel; 2. a contingency planning program - a specialist program for disaster risk management personnel; and 3. an executive program designed for senior management, directors and strategic decision makers.

Population monitoring for kangaroo management

In wildlife management, the program of monitoring will depend on the management objective. If the objective is damage mitigation, then ideally it is damage that should be monitored. Alternatively, population size (N) can be used as a surrogate for damage, but the relationship between N and damage obviously needs to be known. If the management objective is a sustainable harvest, then the system of monitoring will depend on the harvesting strategy. In general, the harvest strategy in all states has been to offer a quota that is a constant proportion of population size. This strategy has a number of advantages over alternative strategies, including a low risk of over- or underharvest in a stochastic environment, simplicity, robustness to bias in population estimates and allowing harvest policy to be proactive rather than reactive. However, the strategy requires an estimate of absolute population size that needs to be made regularly for a fluctuating population. Trends in population size and in various harvest statistics, while of interest, are secondary. This explains the large research effort in further developing accurate estimation methods for kangaroo populations. Direct monitoring on a large scale is costly. Aerial surveys are conducted annually at best, and precision of population estimates declines with the area over which estimates are made. Management at a fine scale (temporal or spatial) therefore requires other monitoring tools. Indirect monitoring through harvest statistics and habitat models, that include rainfall or a greenness index from satellite imagery, may prove useful.

Simple rules to contain an invasive species with a complex life cycle and high dispersal capacity

Designing practical rules for controlling invasive species is a challenging task for managers, particularly when species are long-lived, have complex life cycles and high dispersal capacities. Previous findings derived from plant matrix population analyses suggest that effective control of long-lived invaders may be achieved by focusing on killing adult plants. However, the cost-effectiveness of managing different life stages has not been evaluated. We illustrate the benefits of integrating matrix population models with decision theory to undertake this evaluation, using empirical data from the largest infestation of mesquite (Leguminosae: Prosopis spp) within Australia. We include in our model the mesquite life cycle, different dispersal rates and control actions that target individuals at different life stages with varying costs, depending on the intensity of control effort. We then use stochastic dynamic programming to derive cost-effective control strategies that minimize the cost of controlling the core infestation locally below a density threshold and the future cost of control arising from infestation of adjacent areas via seed dispersal. Through sensitivity analysis, we show that four robust management rules guide the allocation of resources between mesquite life stages for this infestation: (i) When there is no seed dispersal, no action is required until density of adults exceeds the control threshold and then only control of adults is needed; (ii) when there is seed dispersal, control strategy is dependent on knowledge of the density of adults and large juveniles (LJ) and broad categories of dispersal rates only; (iii) if density of adults is higher than density of LJ, controlling adults is most cost-effective; (iv) alternatively, if density of LJ is equal or higher than density of adults, management efforts should be spread between adults, large and to a lesser extent small juveniles, but never saplings. Synthesis and applications.In this study, we show that simple rules can be found for managing invasive plants with complex life cycles and high dispersal rates when population models are combined with decision theory. In the case of our mesquite population, focussing effort on controlling adults is not always the most cost-effective way to meet our management objective.

Managing and learning with multiple models: Objectives and optimization algorithms

The quality of environmental decisions should be gauged according to managers' objectives. Management objectives generally seek to maximize quantifiable measures of system benefit, for instance population growth rate. Reaching these goals often requires a certain degree of learning about the system. Learning can occur by using management action in combination with a monitoring system. Furthermore, actions can be chosen strategically to obtain specific kinds of information. Formal decision making tools can choose actions to favor such learning in two ways: implicitly via the optimization algorithm that is used when there is a management objective (for instance, when using adaptive management), or explicitly by quantifying knowledge and using it as the fundamental project objective, an approach new to conservation.This paper outlines three conservation project objectives - a pure management objective, a pure learning objective, and an objective that is a weighted mixture of these two. We use eight optimization algorithms to choose actions that meet project objectives and illustrate them in a simulated conservation project. The algorithms provide a taxonomy of decision making tools in conservation management when there is uncertainty surrounding competing models of system function. The algorithms build upon each other such that their differences are highlighted and practitioners may see where their decision making tools can be improved. © 2010 Elsevier Ltd.

A retrospective evaluation of sustainable yields for Australia's Northern Prawn Fishery

The fundamental aim in fisheries management is to determine an optimal fishing effort for sustainably harvesting from a replenishable resource. The current management objective of Australia's Northern Prawn Fishery is to maximize the long-term net economic return following Australian government policy, resulting in an average recent catch of tiger prawn species of about 1,250 tons only. However, the maximum sustainable catch stated from different studies is around 3,000-4,700 tons. We also evaluated the net profit assuming that there was no buyback scheme in 2005 and the fishing fleet was kept at 89 vessels since 2005 and concluded that 40% more catch on average (2006-2009) and an additional total profit of A$ 17 million ( excluding crew cost) could have been gained in addition to the many millions of dollars of savings in the buyback scheme. These findings have great implications for future management in Australia and elsewhere because there is a grave concern of overfishing worldwide.

Beyond fecundity control: which weeds are most containable?

1. Eradication is often the preferred strategy in the management of new weed invasions, but recent research has shown that the circumstances under which eradication can be achieved are highly constrained. Containment is a component of an eradication strategy and also a management objective in its own right. Just as for eradication, containment of a weed invasion should be attempted only if it is considered feasible. However, very little guidance exists for the assessment of containment feasibility for weeds. 2. Numerous factors have been proposed as influencing feasibility of containment, but those that relate to the potential for management of dispersal pathways and timely detection of new foci of infestation appear to be critical. Theory suggests that the rate of spread is largely driven by long-distance dispersal (LDD). However, LDD is generally unpredictable and often occurs for species that do not appear to be adapted for it. Furthermore, many (if not most) LDD events fail to give rise to new infestations. 3. As the probability of colonisation is related to the numbers of propagules immigrating ('propagule pressure') at a point in the landscape, dispersal pathways that move relatively large numbers of propagules simultaneously and/or repeatedly should most enhance weed spread. It is these pathways whose potential for management has the greatest bearing upon containment feasibility. A key impediment to containment is undetected spread; this need not occur through LDD and is more likely to occur through dispersal to lesser distances. 4. Synthesis and applications. Feasibility of containment should be viewed in terms of the effort required to reduce weed spread rate, as well as the effectiveness of relevant management actions. Where dispersal vectors are not readily manageable and the probability of detection via structured and/or unstructured surveillance is low, a much greater reliance upon fecundity control will be needed to contain a weed. A combination of empirical and theoretical approaches should be used to develop and refine estimates of containment feasibility. Such estimates will aid decision-making with regard to whether to attempt to reduce weed spread and assist in prioritisation of different weeds for containment.

High-Throughput Sequencing of microRNAs in Peripheral Blood Mononuclear Cells: Identification of Potential Weight Loss Biomarkers

INTRODUCTION: MicroRNAs (miRNAs) are being increasingly studied in relation to energy metabolism and body composition homeostasis. Indeed, the quantitative analysis of miRNAs expression in different adiposity conditions may contribute to understand the intimate mechanisms participating in body weight control and to find new biomarkers with diagnostic or prognostic value in obesity management. OBJECTIVE: The aim of this study was the search for miRNAs in blood cells whose expression could be used as prognostic biomarkers of weight loss. METHODS: Ten Caucasian obese women were selected among the participants in a weight-loss trial that consisted in following an energy-restricted treatment. Weight loss was considered unsuccessful when <5% of initial body weight (non-responders) and successful when >5% (responders). At baseline, total miRNA isolated from peripheral blood mononuclear cells (PBMC) was sequenced with SOLiD v4. The miRNA sequencing data were validated by RT-PCR. RESULTS: Differential baseline expression of several miRNAs was found between responders and non-responders. Two miRNAs were up-regulated in the non-responder group (mir-935 and mir-4772) and three others were down-regulated (mir-223, mir-224 and mir-376b). Both mir-935 and mir-4772 showed relevant associations with the magnitude of weight loss, although the expression of other transcripts (mir-874, mir-199b, mir-766, mir-589 and mir-148b) also correlated with weight loss. CONCLUSIONS: This research addresses the use of high-throughput sequencing technologies in the search for miRNA expression biomarkers in obesity, by determining the miRNA transcriptome of PBMC. Basal expression of different miRNAs, particularly mir-935 and mir-4772, could be prognostic biomarkers and may forecast the response to a hypocaloric diet.

Classification of handwriting patterns in patients with Parkinson´s disease, using a biometric sensor

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Impacts of changing climate and land use on vegetation dynamics in a Mediterranean ecosystem: insights from paleoecology and dynamic modeling

Forests near the Mediterranean coast have been shaped by millennia of human disturbance. Consequently, ecological studies relying on modern observations or historical records may have difficulty assessing natural vegetation dynamics under current and future climate. We combined a sedimentary pollen record from Lago di Massacciucoli, Tuscany, Italy with simulations from the LandClim dynamic vegetation model to determine what vegetation preceded intense human disturbance, how past changes in vegetation relate to fire and browsing, and the potential of an extinct vegetation type under present climate. We simulated vegetation dynamics near Lago di Massaciucoli for the last 7,000 years using a local chironomid-inferred temperature reconstruction with combinations of three fire regimes (small infrequent, large infrequent, small frequent) and three browsing intensities (no browsing, light browsing, and moderate browsing), and compared model output to pollen data. Simulations with low disturbance support pollen-inferred evidence for a mixed forest dominated by Quercus ilex (a Mediterranean species) and Abies alba (a montane species). Whereas pollen data record the collapse of A. alba after 6000 cal yr bp, simulated populations expanded with declining summer temperatures during the late Holocene. Simulations with increased fire and browsing are consistent with evidence for expansion by deciduous species after A. alba collapsed. According to our combined paleo-environmental and modeling evidence, mixed Q. ilex and A. alba forests remain possible with current climate and limited disturbance, and provide a viable management objective for ecosystems near the Mediterranean coast and in regions that are expected to experience a mediterranean-type climate in the future.

An Autonomous Engine for Services Configuration and Deployment.

The runtime management of the infrastructure providing service-based systems is a complex task, up to the point where manual operation struggles to be cost effective. As the functionality is provided by a set of dynamically composed distributed services, in order to achieve a management objective multiple operations have to be applied over the distributed elements of the managed infrastructure. Moreover, the manager must cope with the highly heterogeneous characteristics and management interfaces of the runtime resources. With this in mind, this paper proposes to support the configuration and deployment of services with an automated closed control loop. The automation is enabled by the definition of a generic information model, which captures all the information relevant to the management of the services with the same abstractions, describing the runtime elements, service dependencies, and business objectives. On top of that, a technique based on satisfiability is described which automatically diagnoses the state of the managed environment and obtains the required changes for correcting it (e.g., installation, service binding, update, or configuration). The results from a set of case studies extracted from the banking domain are provided to validate the feasibility of this proposa