Ethical Conflicts over the Management of Transsexual Adolescents-Report of Two Cases

Introduction. The diagnosis and the treatment of transsexualism, particularly during adolescence, generate considerable discussion among specialists. Many health and legal professionals have not yet reached a strong consensus on medical treatment for juvenile transsexuals. Hormonal therapy cannot only represent a medical procedure to adjust the somatic sex to the psychological gender, but can also be a reasonable means of preventing some juvenile transsexuals from engaging in undesirable and risky behavior. Aim. To report the cases of two transsexual adolescents who resorted to prostitution to afford hormonal medications when treatment was denied because of age criteria. Results. Hormonal medications were not recommended by the endocrinology staff because specific laws regulating this medical procedure for juvenile transsexuals in Brazil are lacking. In response, these adolescents chose to use illegally obtained sex hormones to treat themselves. Conclusions. We propose ""harm reduction"" as a means of coping with this dilemma in some cases. Baltieri DA, Cortez FCP, and de Andrade AG. Ethical conflicts over the management of transsexual adolescents-report of two cases. J Sex Med 2009;6:3214-3220.

Professors and the Management of Unavoidable Conflicts of Interest: Don’t Always Need the Heavy Artillery of Policy

Article

Management of Wolf-Livestock Conflicts in Minnesota

In 1975, the gray wolf (Canis lupus) population in Minnesota was protected by the federal Endangered Species Act (USA). At that time, there were 500-750 wolves. By 2004, the population had grown to an estimated 3,020 wolves. Over time, conflicts between wolves and livestock increased. Wolf depredation control programs have been conducted by the U.S. Fish and Wildlife Service (1975-1986) and by the U.S. Department of Agriculture’s Wildlife Services program (1986 to present). In 1978, Minnesota’s wolves were reclassified from endangered to threatened which allowed authorized federal agents to lethally remove wolves that had depredated on livestock or pets. A State funded wolf compensation program was also established in 1978. Wildlife Services’ wolf damage management approach utilizes both nonlethal and lethal methods of control. Currently, wolf depredations are verified at 60-85 farms annually and 125-175 wolves are taken each year. Wolf compensation payments to livestock producers have averaged $67,111 per year during the past five years. Most livestock losses occur during spring and summer. Selective removal of depredating wolves, coupled with improvements in animal husbandry practices, has potential for reducing wolf-livestock conflicts. Minnesota’s wolf population is currently considered to be fully recovered and federal delisting is expected to occur in the near future.

Changes in institutional governance and management of higher education in Laos: National University of Laos

PhD thesis in Educational Sciences (specialization in Politics of Education).

Will climate change drive alien invasive plants into areas of high protection value? An improved model-based regional assessment to prioritise the management of invasions.

Species distribution models (SDMs) studies suggest that, without control measures, the distribution of many alien invasive plant species (AIS) will increase under climate and land-use changes. Due to limited resources and large areas colonised by invaders, management and monitoring resources must be prioritised. Choices depend on the conservation value of the invaded areas and can be guided by SDM predictions. Here, we use a hierarchical SDM framework, complemented by connectivity analysis of AIS distributions, to evaluate current and future conflicts between AIS and high conservation value areas. We illustrate the framework with three Australian wattle (Acacia) species and patterns of conservation value in Northern Portugal. Results show that protected areas will likely suffer higher pressure from all three Acacia species under future climatic conditions. Due to this higher predicted conflict in protected areas, management might be prioritised for Acacia dealbata and Acacia melanoxylon. Connectivity of AIS suitable areas inside protected areas is currently lower than across the full study area, but this would change under future environmental conditions. Coupled SDM and connectivity analysis can support resource prioritisation for anticipation and monitoring of AIS impacts. However, further tests of this framework over a wide range of regions and organisms are still required before wide application.

Participatory approaches in the management of Natura 2000: when EU biodiversity policy gets closer to its citizens. Bruges Political Research Paper No. 26/May 2012

The Habitats Directive has created a European network of protected areas combining environmental protection with social and economic activities. Although not clearly advocated in the Directive, participatory approaches have incrementally emerged in order to ensure an adequate management of the Natura 2000 network. This paper looks at the reasons why the European Commission on one side and the national/local authorities on the other side chose to engage in participatory approaches and assesses the structure, degree and scope of these approaches in the light of input and output legitimacy. Main findings are that participation was mostly implemented as a reaction to conflicts and out of a concern over policy implementation, two elements that continue to drive the philosophy of the Natura 2000 network‘s management. The limits of participation in Brussels are contrasted with the potential for more genuine and effective participation mechanisms on the field.

Management of plant invasions mediated by frugivore interactions

1. Some of the most damaging invasive plants are dispersed by frugivores and this is an area of emerging importance in weed management. It highlights the need for practical information on how frugivores affect weed population dynamics and spread, how frugivore populations are affected by weeds and what management recommendations are available. 2. Fruit traits influence frugivore choice. Fruit size, the presence of an inedible peel, defensive chemistry, crop size and phenology may all be useful traits for consideration in screening and eradication programmes. By considering the effect of these traits on the probability, quality and quantity of seed dispersal, it may be possible to rank invasive species by their desirability to frugivores. Fruit traits can also be manipulated with biocontrol agents. 3. Functional groups of frugivores can be assembled according to broad species groupings, and further refined according to size, gape size, pre- and post-ingestion processing techniques and movement patterns, to predict dispersal and establishment patterns for plant introductions. 4. Landscape fragmentation can increase frugivore dispersal of invasives, as many invasive plants and dispersers readily use disturbed matrix environments and fragment edges. Dispersal to particular landscape features, such as perches and edges, can be manipulated to function as seed sinks if control measures are concentrated in these areas. 5.Where invasive plants comprise part of the diet of native frugivores, there may be a conservation conflict between control of the invasive and maintaining populations of the native frugivore, especially where other threats such as habitat destruction have reduced populations of native fruit species. 6. Synthesis and applications. Development of functional groups of frugivore-dispersed invasive plants and dispersers will enable us to develop predictions for novel dispersal interactions at both population and community scales. Increasingly sophisticated mechanistic seed dispersal models combined with spatially explicit simulations show much promise for providing weed managers with the information they need to develop strategies for surveying, eradicating and managing plant invasions. Possible conservation conflicts mean that understanding the nature of the invasive plant-frugivore interaction is essential for determining appropriate management.

The World Heritage vs. Local Comnuty : identifying the sources of conflicts

The presented work is an essay rather than a scientific dissertation. The author wants to put an impact on the source of conflicts regarding the complex subject of heritage management and conservation in comparison with the local needs and the given context. The paper attempts to show the role of local communities and their cooperation with authorities as well as the effects of such cooperation. The area of research comprises the problems arising in the field of implementing external rules on the local field, challenges appearing regarding the needs of local communities and the efforts of official authorities trying to implement the principles of the conventions. The problems arise when local communities display the lack of understanding and do not share the common idea of heritage conservation. This is caused mainly by the decreasing possibilities of comfortable life. The author tries to identify the main and wrongful approaches as ‘Gone with the Wind’, ‘The Prince and The Pauper’, ‘Heart of Darkness’ or ‘Scarlet letter’. The focus will be put to explain what the areas are where a mutual misunderstanding arise and why all parts to the problem present different points of view. What creates a value? Is it a heritage object or maybe the other values need a stronger protection? When the general duty and the need to protect the heritage is regarded as a controversy and when it is considered as a value within a given community? The international public interest in heritage protection is often regarded as an attempt to diminish the sovereign power of the community and provokes severe controversies and tensions. The major problem envisaged today seems to be the massive and increasing urbanisation and the destruction of the vestiges still existing of traditional cultures, when we consider century urban post-industrial districts of Upper Silesia in Poland, the medieval cities in Western Europe, the traditional nomad Masaya villages in Kenya or the remains of vanished cultures in various regions of Asia. The preferred platform of cooperation between the parts of the conflict includes divergent needs, beliefs and practices of communities and the possible fields of reconciling the abovementioned. Chosen examples of the best practices considering mutual cooperation will be underlined.

Management Of Severe Thoracic Impalement Trauma Against Two-wheeled Horse Carriage: A Case Report And Literature Review.

Thoracic injuries in general are of great importance due to their high incidence and high mortality. Thoracic impalement injuries are rare but severe due to the combination of cause, effect and result. This study's primary objective is to report the case of a young man who was impaled by a two-wheeled horse carriage shaft while crashing his motorcycle in a rural zone. An EMT-B ferry was called at the crash scene and a conscious patient was found, sustaining a severe impalement injury to the left hemithorax, suspended over the floor by the axial skeleton with the carriage shaft coming across his left chest. As a secondary objective, a literature review of thoracic impalement injuries is performed. Cases of thoracic impalement injury require unique and individualized care based on injury severity and affected organs. Reported protocols for managing impalement injuries are entirely anecdotal, with no uniformity on impaled patient's approach and management. In penetrating trauma, it is essential not to remove the impaled object, so that possible vascular lesions remain buffered by the object, avoiding major bleeding and exsanguination haemorrhage. Severed impaled thoracic patients should be transferred to a specialist centre for trauma care, as these lesions typically require complex multidisciplinary treatment. High-energy thoracic impalement injuries are rare and hold a high mortality rate, due to the complexity of trauma and associated injuries such as thoracic wall and lung lesions. Modern medicine still seems limited in cases of such seriousness, not always with satisfactory results.

Comparative analysis of the new guidelines and consensuses for the management of hypothyroidism, thyroid nodules, and differentiated thyroid cancer

233

Management of a complex dentoalveolar trauma: a case report

This paper describes the case of a 12-year-old male patient who presented a severe lateral luxation of the maxillary central incisors due to a bicycle fall. Treatment involved suture of the soft tissues lacerations, and repositioning and splinting of the injured teeth, followed by endodontic treatment and periodontal surgery. After a 2-year follow-up, clinical and radiographic evaluation revealed that the incisors presented satisfactory esthetic and functional demands.

Immediate reconstruction following breast-conserving surgery: management of the positive surgical margins and influence on secondary reconstruction

The efficacy of breast-conserving surgery for the local control of early breast cancer has been repeatedly evidenced. Although immediate reconstruction following breast-conserving surgery has been described, little information is available regarding surgical management in reoperative settings due to positive margins. We studied the influence of intraoperatively assessed and postoperatively controlled surgical margin status on the type of breast-conserving surgery and report our results regarding complications in a reoperative breast reconstruction scenario. All patients were seen by a multidisciplinary team who recommended breast-conserving surgery. According to the breast volume, ptosis and tumor size/location, the patients were also evaluated by a plastic surgeon, who recommended reconstruction with the appropriate technique. Intraoperative assessment of surgical margins was determined by histological examination of frozen sections. The mean follow-up time was 48months. Two hundred and eighteen patients (88.5 per cent ) underwent breast-conserving surgery and immediate reconstruction. Twelve (5.5 per cent ) patients had a positive tumor margin after review of the permanent section. All patients underwent re-exploration. In 1.3 per cent , a second reconstructive technique was indicated and in 2.2 per cent a skin-sparing mastectomy with total reconstruction was performed. Our findings support the important role of the intraoperative assessment of surgical margins and its interference in the selection of reconstruction techniques and negative margins; however, it will not guarantee complete excision of the tumor. Success depends on coordinated planning with the oncologic surgeon and careful intraoperative management

Laparoscopic nephrectomy outside gerota fascia for management of inflammatory kidney

Background and Purpose: A nonfunctioning inflammatory kidney is a challenging surgical condition for urologists. Some investigators recommend open surgery because of the surgical difficulties caused by the inflammatory process, whereas others try to apply the advantages of a ""simple"" non-hand-assisted laparoscopic approach. We report our experience with simple laparoscopic nephrectomy for inflammatory kidney management. Patients and Methods: From July 2002 through December 2006, 50 pure laparoscopic nephrectomies were performed for inflammatory kidney ( 43 because of pyelonephritis, 5 for xanthogranulomatous pyelonephritis (XGP), and 2 for pyonephrosis). Histopathologic analysis was the criterion used for inflammatory kidney diagnosis. Pain or recurrent urinary tract infection associated with a nonfunctioning excluded kidney was the eligibility criterion for the procedure. Preoperatively, all patients underwent complete image and functional renal assessment. Morcellation was used to remove surgical specimens. Conversion index, surgical difficulties, operative time, and postoperative complications were evaluated. Results: Conversion was performed in 14 of 50 (28%) patients, including two with XGP and one with pyonephrosis. Adhesions, vascular (two inferior vena cava) lesions, and intestinal lesions (two colon) were the main causes of conversion. Acute pancreatitis developed in one patient, and one patient had a wound infection. Reoperations were unnecessary, and no deaths occurred. Conclusion: Pure laparoscopic nephrectomy was successful in 72% of patients with inflammatory kidneys. The laparoscopic dissection was useful even in those cases converted to open surgery. This is a high-risk procedure, however, and both surgeon and patient must be aware of that before the decision is made for this approach.