Aortic mural thrombus in a nonaneurysmal minimally atherosclerotic or normal aorta is a rare clinical entity and an uncommon cause of peripheral arterial embolization. Both anticoagulation therapy and aortic surgery are commonly used as primary treatment, but there are no consensuses or clinical guidelines to outline the best management strategy for this unusual problem. This systematic review compares the outcomes of these different strategies for the treatment of aortic mural thrombus.
Two large cardiovascular outcome trials of canagliflozin, the CANVAS Program, will complete in early 2017: the CANagliflozin cardioVascular Assessment Study (CANVAS) and the CANagliflozin cardioVascular Assessment Study - Renal (CANVAS-R). Accruing data for the sodium-glucose co-transporter 2 inhibitor (SGLT2i) class has identified questions and opportunities that were not apparent when the trials were designed. Accordingly, a series of modifications have been made to the planned analyses. These updates will ensure that the data from the CANVAS Program will maximise advances in scientific knowledge and patient care. The specification of the analysis strategy prior to knowledge of the trial results, their design by the independent scientific trial Steering Committee, the detailed a priori definition of the analysis plans and the external review provided by the US Food and Drug Administration, all provide for a maximally efficient and robust utilisation of the data. The CANVAS Program should significantly advance our understanding of the effects of canagliflozin, and the broader SGLT2i class, on a range of important efficacy and safety outcomes.
Proper management of fecal sludge has significant positive health and environmental externalities. Most research on managing onsite sanitation so far either simulates the costs of, or the welfare effects from, managing sludge in situ in pit latrines. Thus, designing management strategies for onsite rural sanitation is challenging, because the actual costs of transporting sludge for treatment, and sources for financing these transport costs, are not well understood.
Acute mesenteric ischemia (AMI) is an emergency with a high mortality rate; survivors have high rates of intestinal failure. We performed a prospective study to assess a multidisciplinary and multimodal management approach, focused on intestinal viability.
Successful watershed planning can be enhanced by stakeholder involvement in developing and implementing plans that reflect community goals and resource limitations. Community DECISIONS (Community Decision Support for Integrated, On-the-ground Nutrient Reduction Strategies) is a structured decision process to help stakeholders evaluate strategies that reduce watershed nutrient imbalances. A nutrient accounting algorithm and nutrient treatment database provide information on nutrient loadings and costs of alternative strategies to reduce loadings. Stakeholders were asked to formulate goals for the North Fork Shenandoah River Watershed in Virginia and select among strategies to achieve those goals. The Vector Analytic Hierarchy Process was used to rank strategies. Stakeholders preferred a Maximum strategy that included point source upgrades, riparian buffers, no-till corn silage, wheat cover, and bioretention filters in developed areas. Participants generally agreed that the process helped improve communication among stakeholders, was helpful for watershed planning, and should be used for TMDL (Total Maximum Daily Load) planning. Participants suggested more attention be paid to ensuring that all relevant issues are addressed and all information needed to make decisions is available. Watershed planning should provide stakeholders with clear scientific information about physical and socioeconomic processes. However, planning processes must give stakeholders adequate time to consider issues that may not have been addressed by existing scientific models and datasets.
This paper proposes a two-stage group decision making approach to urban landscape management and planning supported by the analytic hierarchy process. The proposed approach combines an application of the consensus convergence model and the weighted geometric mean method. The application of the proposed approach is shown on a real urban landscape planning problem with a park-forest in Belgrade, Serbia. Decision makers were policy makers, i.e., representatives of several key national and municipal institutions, and experts coming from different scientific fields. As a result, the most suitable management plan from the set of plans is recognized. It includes both native vegetation renewal in degraded areas of park-forest and continued maintenance of its dominant tourism function. Decision makers included in this research consider the approach to be transparent and useful for addressing landscape management tasks. The central idea of this paper can be understood in a broader sense and easily applied to other decision making problems in various scientific fields.
This department highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools, and resources that mobilize and sustain organizational change initiatives. In this article, the author explores personal resilience as an important individual characteristic that affects team functioning and thus organizational adaptability to change. The important role of resilience in strategic leadership for change is presented along with suggestions for evaluating and developing resilience.
This review considers the management of motion in photon radiation therapy. An overview is given of magnitudes and variability of motion of various structures and organs, and how the motion affects images by producing artifacts and blurring. Imaging of motion is described, including 4DCT and 4DPET. Techniques for monitoring motion in real time by use of surrogates are reviewed. Treatment planning for various motion-management treatment delivery strategies is discussed, including choice of planning image, treatment field margins and dose calculation. Imaging techniques displaying motion in the treatment room for pre-treatment as well as real-time imaging for localization and verification are covered, and their use for various motion-management treatment delivery techniques is discussed. Use of motion management for different treatment sites-breast, lung and other sites-is elaborated, and gating, breath-hold and beam tracking strategies are described. Suggestions are given for breast and lung for practicable protocols for routine clinical use of motion management, including decision strategies. Finally, a perspective of the future of motion management in photon radiation therapy is given.
This department highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools, and resources that mobilize and sustain organizational change initiatives. In this article, the author introduces the book Lean In and presents applicable lessons for nursing leadership career development.
Objectives: The aim of this investigation was to present and evaluate an original method of mini-invasive oral surgery and orthodontics based on 3D images from a computed tomography software (3DNEO(®), 3DNEOVISION). Materials and methods: Three patients with impacted teeth were examined and their data were analyzed with this software based on the “region growing” method. Results: Several clinical interests emerge : locate and visualize precisely the relationships of the impacted tooth with the adjacent anatomical elements under the desired angle, associate/dissociate the different elements of the 3D scene, measure the distances, calculate the axes of traction, materialize the way of traction and the optimal point for bonding, prepare virtually the surgical exposure and orthodontic treatment plan. Conclusion: This 3D method might provide information for improved diagnosis and treatment plans in order to ultimately result in more successful treatment outcomes and better care for patients.