Effects Of Different Management Strategies Research Articles

Subclinical Cushing's Syndrome and Metabolic Disorder.

The concept of subclinical Cushing’s syndrome stands on the presence of adrenocorticotropic hormone-independent subclinical hypercortisolism without a clear Cushingoid phenotype and may be observed in patients with an incidentally found adrenal adenoma [1]. Kim et al. [2] found that the prevalence of subclinical Cushing’s syndrome in Korean patients with adrenal incidentaloma was 7.1% (19 of 268 patients), which suggests that subclinical hypercortisolism is commonly found in patients with this disorder. Moreover, the presence of subclinical hypercortisolism in these patients was also associated with an increased prevalence of cardiovascular disease risk factors such as diabetes and hypertension [2]. As findings shown in Kim’s study, subclinical hypercortisolism is the most common hormonal abnormality in patients with adrenal incidentaloma [3] and even a very low excess of cortisol in patients with subclinical Cushing’s syndrome may contribute to the development of metabolic disorders such as obesity, diabetes, hypertension, and osteoporosis [1,4]. Thus, there has been a recent rise in interest regarding the diagnosis and management of subclinical Cushing’s syndrome. A recent study by Di Dalmazi et al. [5] observed that the incidences of cardiovascular events and mortality were higher in patients with subclinical Cushing’s syndrome compared to those with non-secreting adrenal incidentalomas over a mean followup period of 7.5 years. These authors suggested that this difference might be attributable to the relationship between subclinical cortisol excess and cardiovascular disease risk factors. The finding that subclinical hypercortisolism can harm patients implies that the management of subclinical Cushing’s syndrome would be a beneficial strategy to mitigate the effects of this disease. However, there is insufficient evidence to conclude which management strategy may be most effective [1]. To date, the majority of studies investigating this issue have been conducted using retrospective and cross-sectional designs with small sample sizes and a variety of definitions. Only one prospective study has been published showing that laparoscopic adrenalectomy is more beneficial than conservative management for the improvement of cardiovascular disease risk factors [6]. Thus, it is necessary to conduct a high-quality prospective study of the long-term outcomes of patients with subclinical Cushing’s syndrome, including their natural histories and the impending complications and/or risk factors. Furthermore, prospective studies should evaluate the effects of different management strategies on cardiovascular disease events and mortality in patients with adrenal incidentaloma and subclinical Cushing’s syndrome [1,6]. Currently, a multicenter, randomized, controlled prospective study assessing the long-term metabolic effects of adrenalectomy in Korean patients with adrenal incidentalomas and subclinical Cushing’s syndrome is underway (Clinicaltrial. gov: NCT01383420). The findings of this study will provide further insight into the effects of the management of subclinical Cushing’s syndrome on metabolic disorders.

The optimal age of sown field margins for breeding farmland birds

The Europe‐wide decline in the populations and diversity of farmland birds has not been stopped despite dedicated conservation efforts such as agri‐environment schemes (AES). The main reason for the lack of success of AES is considered to be their low ecological quality and insufficient area. Understanding the effects of different management strategies on the ecological quality of AES is therefore important. Here, we investigate the relationship between breeding bird density and species richness and the age of sown field margins, a widely used type of AES, in southwestern Switzerland. Territories of breeding birds were mapped on 67 field margins between 2004 and 2011. Territory densities (for eight species) and species richness were analysed in relation to age of the field margin. A general negative correlation between size of the field margin and territory density indicated that territory density was higher when the birds could forage in adjacent cultivated land. Territory densities and species richness increased up to an age of 4–6 years after sowing, depending on the species, and declined thereafter. The results suggest that the co‐occurrence of newly sown margins and margins over 3 years old will have a positive effect on breeding bird densities and species diversity.

Estimation of transmission dynamics of the Ceratomyxa shasta actinospore to the salmonid host

Transmission dynamics of the actinospore stage of Ceratomyxa shasta to the salmonid host were investigated under field and laboratory conditions. The number of parasites transmitted and the transmission rate were compared between 2 different exposure durations and also among different water velocities, by means of field exposures. Under laboratory conditions, the number of parasites transmitted and the transmission rates were compared across a broader range of water velocities and also at different water temperatures. Transmission rate was not constant over time as the number of parasites transmitted increased non-linearly between the 2 exposure durations. Transmission was also inversely related to water velocity and there was a threshold to transmission between 0.2-0.3 m s(-1). Lastly, transmission rate increased with water temperature up to 18 °C then decreased at 23 °C. These experiments provide a range of values of transmission that will be incorporated into an epidemiological model to simulate the effectiveness of different management strategies. Additionally, these experiments provided novel information on the effects of environmental conditions (i.e. water velocity and water temperature) on the transmission dynamics between the salmonid host and the actinospore stage.

On the relative influence of climate forcing agents on the saline intrusion in a well-mixed estuary: Medium-term Monte Carlo predictions

Reyes-Merlo, M.Á., Díez-Minguito, M., Ortega-Sánchez, M., Baquerizo A. and Losada, M.Á., 2013. On the relative influence of climate forcing agents on the saline intrusion in a well-mixed estuary: Medium-term Monte Carlo. In: Conley, D.C., Masselink, G., Russell, P.E. and O'Hare, T.J. (eds.), Proceedings 12 International Coastal Symposium (Plymouth, England), Journal of Coastal Research, Special Issue No. 65, pp. 1200–1205, ISSN 0749-0208.-->In this work we analyze the estuarine circulation and the dependence of the salt intrusion on the climate forcing agents in the Guadalquivir river estuary. The salt flux driving mechanisms are discussed. Exchange flow is identified and characterized by means of estimates of the effective vertical turbulent viscosity Nz, which decreases from 1.2·10−3 m2/s near the mouth to 3.3 · 10−4 m2/s in the middle reach of the estuary due to the decrease of the shear stress and to the longitudinal density gradient. Power-law relationships are obtained to assess the relative influence of the tidal current amplitude, river flow, and wind conditions at the inner shelf on the saline intrusion. It is found that the dependence of the salt intrusion on the river flow increases with the flow, and the gravitational circulation is greatly enhanced during the fluvially-dominated regime. The influence of tides increases after high discharges due to the reduction of the boundary shear stresses associated to the mud entrainment. Easterly winds favors the baroclinic circulation, increasing the injection of saltier water, which replaces the superficial, low-salinity water flushed out of the estuary. The obtained relationships are used to predict on a medium-term basis the effect of different management strategies on the saline intrusion, by means of Markov Chain Monte Carlo simulations. Results show that the mean intrusion length would increase about 8% under the expected scenario in which the freshwater discharges decrease by 15% the next 15 years.

Rapid ongoing decline of Baird's tapir in Cusuco National Park, Honduras

During the International Tapir Symposium 16-21 Oct 2011, the conservation of Baird's tapir (Tapirus bairdii) in Honduras received a boost with the signing of a memorandum of understanding between the Minister Director of the Honduran Institute of Conservation and Forestry (ICF) and the Tapir Specialist Group (TSG). Despite this agreement, accelerating levels of hunting and habitat loss continue to pose a threat to Baird's tapir in Honduras. An ongoing study in Cusuco National Park in northwestern Honduras has been monitoring changes in population dynamics of Baird's tapir since 2006 through the collection of occupancy data. The study has identified an increase in hunting pressure, coinciding with a drastic decline in the encounter rate with Baird's tapir spoor. Here, we examine the significance of a range of demographic variables on Baird's tapir occupancy in Cusuco National Park using the software PRESENCE, and simulate the effects of different management strategies on the future dynamics of the population using the stochastic simulation software VORTEX. The predictions of the theoretical population models are compared to observed changes in occupancy levels. We found that non-intervention resulted in the local extinction of Baird's tapir within a very short time frame, but that various intervention models enabled the population to recover to near carrying capacity. Occupancy and extinction probability were shown to respond markedly to the increase in hunting pressure; and occupancy models supported the future population predictions generated by VORTEX. Our study suggests that immediate intervention is required to reduce hunting pressure to near historical levels to prevent the imminent local extinction of the species.

Vegetative growth response of black cherry (Prunus serotina) to different mechanical control methods in a biosphere reserve

We assessed the effectiveness of different management strategies against the non-native invasive tree species black cherry ( Prunus serotina Ehrh.). The species causes substantial management problems in European forest ecosystems, like the Valle del Ticino Biosphere Reserve in Italy, by suppressing the regeneration of native tree species. This can modify ecological key processes and cause biodiversity loss. Since chemical and biological control has mainly been abandoned in European forest ecosystem management, mechanical control measures are presently the preferred option to proceed against the black cherry but have shown very limited results in the reserve. The aim was to control the success of felling the species and to test other mechanical control methods such as girdling and snapping the trees with regard to their efficiency by quantifying the species’ growth reactions. For this purpose, observational studies were conducted in two forest stands of which one was treated in 1996 and the other more recently in 2009. A subsample of resprouting stumps was treated a second time in 2010 to observe the effect of a direct second cutback. An experimental study was implemented in a third forest stand also in 2010 to compare three different mechanical control methods. The results suggest that felling black cherry is ineffective if the objective is to reduce the species’ abundance because resprouts occur on 100% of the treated trees and biomass increment is not reduced in the long term. Girdling proved to be the most effective treatment across the diameter classes considered.

The Prognostic Value of Tubal Patency Test After Medical Treatment of an Ectopic Pregnancy

Background : Ectopic pregnancy (EP) is defined as the abnormal implantation of the blastocyst outside the uterine endometrium. The most common site of implantation is the Fallopian tube. The effect of different management strategies on subsequent fertility following tubal ectopic pregnancy is unknown. Some women who have had ectopic pregnancies will have difficulty becoming pregnant again. The aim of this study is to evaluate the tubal patency after successful medical treatment of an un-ruptured tubal ectopic pregnancy with systemic methotrexate (MTX). M ethods: This is an observational retrospective study carried out on 72 women diagnosed as un-ruptured tubal ectopic pregnancy. Systemic treatment with a single dose methotrexate (50 mg/m 2 intramuscularly) was used for 32 women and 40 cases underwent surgery. Hysterosalpingography (HSG) was performed on 30 patients (successfully managed with methotrexate) and 40 cases that underwent unilateral salpingectomy (as initial treatment). Results: The medical treatment with single dose MTX for EP was effective (93.8%) as a primary treatment. In the MTX group, the HSG findings from the ipsilateral tube showed that 83.3% the diseased tubes were open and 16.7% were obstructed. The contralateral tube was patent in 93.3% and obstructed in 6.7%. In salpingectomy group the contralateral tube was patent in 82.5% and obstructed in 17.5%. Conclusion: For an un-ruptured tubal EP, the medical treatment with MTX is effective. Routine HSG following medical treatment does not seem necessary but might be considered in selected risk cases. doi: http://dx.doi.org/10.4021/jcgo48w

Placenta accreta/increta/percreta: incidence, risk factors, management and outcomes

ObjectiveTo estimate the incidence and describe the risk factors, management and outcomes of placenta accreta/increta/percreta.MethodsA national population-based case-control study was undertaken using the UK Obstetric Surveillance System between May 2010-April...

Extreme Conservation Leads to Recovery of the Virunga Mountain Gorillas

As wildlife populations are declining, conservationists are under increasing pressure to measure the effectiveness of different management strategies. Conventional conservation measures such as law enforcement and community development projects are typically designed to minimize negative human influences upon a species and its ecosystem. In contrast, we define “extreme” conservation as efforts targeted to deliberately increase positive human influences, including veterinary care and close monitoring of individual animals. Here we compare the impact of both conservation approaches upon the population growth rate of the critically endangered Virunga mountain gorillas (Gorilla beringei beringei), which increased by 50% since their nadir in 1981, from approximately 250 to nearly 400 gorillas. Using demographic data from 1967–2008, we show an annual decline of 0.7%±0.059% for unhabituated gorillas that received intensive levels of conventional conservation approaches, versus an increase 4.1%±0.088% for habituated gorillas that also received extreme conservation measures. Each group of habituated gorillas is now continuously guarded by a separate team of field staff during daylight hours and receives veterinary treatment for snares, respiratory disease, and other life-threatening conditions. These results suggest that conventional conservation efforts prevented a severe decline of the overall population, but additional extreme measures were needed to achieve positive growth. Demographic stochasticity and socioecological factors had minimal impact on variability in the growth rates. Veterinary interventions could account for up to 40% of the difference in growth rates between habituated versus unhabituated gorillas, with the remaining difference likely arising from greater protection against poachers. Thus, by increasing protection and facilitating veterinary treatment, the daily monitoring of each habituated group contributed to most of the difference in growth rates. Our results argue for wider consideration of extreme measures and offer a startling view of the enormous resources that may be needed to conserve some endangered species.

Methodological comparison of calibration procedures for durum wheat parameters in the STICS model

Parameter estimation is an important preliminary step before using a crop model to evaluate the effect of different management strategies. This study compared three procedures for estimating parameters of the STICS soil–crop model. Two procedures estimate parameters using information on both dynamic and end-of-season variables. One of those procedures estimates parameters in successive estimation steps, whereas the other estimates many parameters simultaneously in a single step. The third procedure uses only information on end-of-season variables. In all cases, the parameter values were constrained to lie within the same bounds, which represent physiologically reasonable values. Data from 235 and 138 experimental plots were used for parameter estimation and independent model evaluation, respectively. Mean squared error of adjustment and of prediction were analysed to evaluate the performance of the different procedures. An agronomic analysis was conducted to evaluate the capacity of the model to respond to varying fertilisation strategies. The results indicate that using information from dynamic variables is not useful if the only objective is to improve model prediction of end-of season variables. However, to improve model prediction of both dynamic and end-of-season variables, all information should be used. In this case, better results were obtained when all dynamic variables were used in a single estimation step. This study provides some methodological guidelines on running parameter estimation for complex crop models. Our results also indicate that parameter estimation can highlight problems of process representation in a crop model.

Modelling the complex dynamics of vegetation, livestock and rainfall in asemiarid rangeland in South Africa

Predicting the effect of different management strategies on range condition is a challenge for farmers in highly variable environments. A model that explains how the relations between rainfall, livestock and vegetation composition vary over time and interact is needed. Rangeland ecosystems have a hierarchical structure that can be described in terms of vegetation composition, stocking rate and rainfall at the ecosystem level, and the performance of individual animals and plants at the lower level. In this paper, we present mathematical models that incorporate ideas from complex systems theory to integrate several strands of rangeland theory in a hierarchical framework. Compared with observed data from South Africa, the model successfully predicted the relationship between rainfall, vegetation composition and animal numbers over 30 years. Extending model runs over 100 years suggested that initial starting conditions can have a major effect on rangeland dynamics (divergence), and that hysteresis is more likely during a series of low rainfall years. Our model suggests that applying an upper threshold to animal numbers may help to conserve the biodiversity and resilience of grazing systems, whilst maintaining farmers’ ability to respond to changing environmental conditions, a management option here termed controlled disequilibrium.

Intestinal atresia in association with gastroschisis: a 26-year review

We reviewed our experience with gastroschisis (GS) complicated by intestinal atresia over the last 26 years. Our aim was to determine the effect of different management strategies employed and the morbidity associated with this condition in our unit. A retrospective casenote review was carried out. Data regarding the operative management of the GS and atresia was recorded. Primary outcome measures included time to commence and establish full enteral feeds, duration of parenteral nutrition, complications and outcome. Of 179 neonates with GS, 23 also had intestinal atresia. 13 underwent primary closure of the defect, 5 had patch closure and 5 had a silo placed. 4 atresias were 'missed' at first operation. The 19 recognised atresias were managed either by stoma formation, primary anastomosis or deferred management with subsequent primary anastomosis. There was wide variation in the outcomes of patients in each group. Differences in outcome between the management strategies are likely to reflect an inherent variability in patient condition, site of atresia, and bowel suitability for anastomosis at first surgery, rather than the mode of surgical management. Individual management plans should be tailored to the clinical condition of each patient.

Protection vs. commercial management: Spatial and temporal analysis of land cover changes in the tropical forests of Central India

Tropical forests worldwide are undergoing rapid changes due to increasing human populations and varied land use practices. In an effort to protect these forests and their species, the number of protected areas has increased exponentially in recent decades. Clearly protected areas play a crucial role in conservation efforts and this strategy has been found to be successful in several studies. However, protected areas are often embedded within a matrix of other land cover types, including non-protected forests, agricultural fields, or urban areas. It is therefore critical for park management to think beyond the borders of their protected areas and work to maintain ecological integrity of the surrounding matrix and the connectivity between protected areas. This study integrates remote sensing, GIS and field observations to examine the effects of different management strategies on land cover changes. As a case study we examine a tiger reserve in Central India which is surrounded by commercially managed forests, representative of many protected areas throughout India. Findings of this study show that while protected areas play an important role in conservation, alternative approaches including favorable management policies could also be effective to extend conservation over larger areas.

Cost effectiveness of management strategies for urinary tract infections: results from randomised controlled trial

Objective To assess the cost effectiveness of different management strategies for urinary tract infections.Design Cost effectiveness analysis alongside a randomised controlled trial with a one month follow-up.Setting Primary care.Participants 309...

Effect of different management strategies on soil quality of citrus orchards in Southern Italy

AbstractTwenty‐six soil samples were collected from 13 paired orchards (organically vs. conventionally managed) homogeneous for age, rootstock and cultivars, belonging to the Eastern Sicily Organic Citrus farm Network. The soil quality was evaluated by chemical and biochemical indicators. The total organic C, humification parameters and isoelectric focusing of extracted organic matter were measured to quantify the size of relevant soil C pools. In addition, C turnover was evaluated by determining microbial C mineralization, C microbial biomass and by calculating the mineralization and metabolic quotient (qCO2). The results obtained demonstrated that organic citrus soils were characterized by a general increase in all the organic matter pools, which means a greater C supply for soil metabolic processes. This observed trend did not directly influence the organic matter turnover, indicating that the organic approach could act as a soil C‐sink. The soil microflora of organically managed soils showed an improved efficiency in use of energy and organic resources, corresponding to an increased ability of soils under organic management to sustain biological productivity in the long term.

Antiviral therapy for hepatitis B-related liver cancer prevention is more cost-effective than cancer screening

In Australia, Asian-born populations are 6-12 times more likely to develop hepatocellular cancer (HCC) than Australian-born individuals. We therefore, modelled the consequences of different management strategies for chronic hepatitis B (CHB) in Asian-born adults aged > or = 35 years. A Markov model compared (1) enhanced surveillance for HCC alone (HCC surveillance), or (2) enhanced HCC surveillance coupled with CHB treatment (HCC prevention) to the current practice, of low CHB treatment uptake. Patients were stratified and managed according to risk categories, based upon hepatitis B virus (HBV) viral load and alanine aminotransferase (ALT) levels. We measured costs, health outcomes [cases of HCC and deaths averted, quality-adjusted life-years (QALYs) gained] and incremental cost-effectiveness ratios (ICERs). HCC surveillance would cost on average AU$8479 per person, compared to AU$2632 with current clinical practice and result in a gain of 0.014 QALYs (AU$401,516/QALY gained). A HCC prevention strategy would cost on average AU$14,600 per person, result in 0.923 QALYs gained (AU$12,956/QALY gained), reduce cases of cirrhosis by 52%, HCC diagnoses by 47% and CHB-related deaths by 56%, compared to current practice. HCC prevention appears to be a cost-effective public health strategy in at-risk populations in Australia and is preferable to HCC surveillance as a cancer control strategy.

Simulation model for contraceptive management of the Assateague Island feral horse population using individual-based data

The National Park Service (NPS) manages a culturally significant population of feral horses (Equus caballus) inhabiting the Maryland portion of Assateague Island, a barrier island in the eastern United States. Rapid growth of this population over the past few decades from 28 to 166 horses negatively impacts native species and ecological processes on the island. Since 1994, contraception via porcine zona pellucida vaccine has been used to control horse numbers, although herd reduction has been slower than initially expected, leading NPS to consider other management options. An individual-based stochastic simulation model was developed using the Vortex software program to examine the effects of different management strategies on the population. Data from the managed population were used to populate the model parameters. Model projections over the next 50 years using current management practices show an average rate of population decline of 13% per year, suggesting that the population will reach the management target of 80–100 horses in 5–8 years. The effectiveness of contraception to reduce the herd and maintain it at various target sizes of 20–100 horses was also assessed. The accumulation of inbreeding at each target population size was also modelled.

What Would Pediatric Infectious Disease Consultants Recommend for Management of Culture-Negative Acute Hematogenous Osteomyelitis?

To assess the opinion of pediatric infectious disease (PID) specialists regarding the management of culture-negative acute hematogenous osteomyelitis. A questionnaire that included a hypothetical case scenario of a 4-year-old boy with culture-negative osteomyelitis was distributed via a Web-based system to PID specialists across the United States. Of 481 eligible participants surveyed, 147 (31%) responded. For initial therapy of osteomyelitis, 37% of respondents chose a beta-lactam, 24% chose clindamycin, 10% chose vancomycin as the sole therapy, and 29% chose a combination of these. The initial choice of antibiotics was correlated with the reported incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in the institution (P < 0.01). In areas where the prevalence of CA-MRSA was intermediate (between 25% and 50%), the choice of antibiotics was more heterogeneous. For change from intravenous to oral therapy, approximately 70% of respondents would change to oral therapy sooner than 3 weeks depending on clinical, laboratory, and social factors. After significant clinical and laboratory (sedimentation rate and C-reactive protein) improvements, most respondents (69%) chose to treat for a total duration (intravenous and oral) of 3 to 4 weeks. This study illustrates that the empiric choice of antibiotics for treatment of acute hematogenous osteomyelitis was driven by the local prevalence of CA-MRSA. When the prevalence of CA-MRSA was intermediate, the recommendations for management of bone infections were more heterogeneous. Clinical trials are needed to compare the effect of different management strategies on outcome, side effects, and costs. Level V.

Zur Integration heuristischer Managementstrategien in die Dynamische Finanzanalyse

Dynamic financial analysis (DFA) has become an important tool in analyzing the financial situation of insurance companies. Constant development and documentation of DFA tools has occurred during the last years. However, several questions concerning the implementation of DFA systems have not been answered in the DFA literature to date. One such important issue is the consideration of management strategies in the DFA context. The aim of this paper is to study the effects of different management strategies on a non-life insurer’s risk and return profile. Therefore, we extend the results of a recent working paper by Eling / Parnitzke / Schmeiser (2007) with two variants and test these variants numerically within a DFA simulation study.

Management Strategies and Dynamic Financial Analysis

Dynamic financial analysis (DFA) has become an important tool in analyzing the financial situation of insurance companies. Constant development and documentation of DFA tools has occurred during the last years. However, several questions concerning the implementation of DFA systems have not been answered in the DFA literature to date. One such important issue is the consideration of management strategies in the DFA context. The aim of this paper is to study the effects of different management strategies on a non-life insurer's risk and return profile. Therefore, we develop several management strategies and test them numerially within a DFA simulation study.