Pelvic Reconstruction following Abdominoperineal Resection and Pelvic Exenteration: Management Practices among Plastic and Colorectal Surgeons

2021 ◽  
Author(s):  
Michael J. Stein ◽  
Aneesh Karir ◽  
Melissa N. Hanson ◽  
Naveen Cavale ◽  
Alex M. Almoudaris ◽  
...  
Keyword(s):  
Abdominoperineal Resection ◽  
Dead Space ◽  
Management Practices ◽  
Pelvic Exenteration ◽  
Muscle Flap ◽  
The United States ◽  
Pelvic Reconstruction ◽  
Flap Reconstruction ◽  
Colorectal Surgeons ◽  
Perineal Defect

Abstract Background Pelvic reconstruction with a muscle flap significantly improves postoperative outcomes following abdominoperineal resection (APR). Despite it being the gold standard, significant surgeon-selection bias remains with respect to the necessity of pelvic obliteration, flap choice, and ostomy placement. The objective of the study was to characterize management practices among colorectal surgeons (CSs) and plastic surgeons (PSs). Methods Specialty-specific surveys were distributed electronically to CSs and PSs via surgical societies. Surveys were designed to illustrate geographic and specialty-specific differences in management. Results Of 106 (54 CSs and 52 PSs) respondents (58% Canada, 21% Europe, 14% the United States, and 6% Asia/Africa), significant interdisciplinary differences in practices were observed. Most respondents indicated that multidisciplinary meetings were not performed (74% of CSs and 78% of PSs). For a nonradiated pelvic dead space with small perineal defect, 91% of CSs and 56% of PSs indicated that flap reconstruction was not required. For a radiated pelvic dead space with small perineal defect, only 54% of CSs and 6% of PSs indicated that there was no need for flap reconstruction. With respect to ostomy placement, 87% of CSs and 21% of PSs indicated that stoma placement through the rectus was superior. When two ostomies were required, most CSs preferred exteriorizing ostomies through bilateral recti and requesting thigh-based reconstruction. PSs favored the vertical rectus abdominis muscle (VRAM; 52%) over the gracilis (23%) and inferior gluteal artery perforator (IGAP; 23%) flaps. Among PSs, North Americans favor abdominally based flaps (VRAM 60%), while Europeans favor gluteal-based flaps (IGAP 78%). Conclusion A lack of standardization continues to exist with respect to the reconstruction of pelvic defects following APR and pelvic exenteration. Geographic and interdisciplinary biases with respect to ostomy placement, flap choice, and role for pelvic obliteration continues to influence reconstructive practices. These cases should continue to be approached on a case by case basis, driven by pathology, presence of radiation, comorbidities, and the size of the pelvic and perineal defect.

Strategies to improve implementation of adaptive management practices for restoration in coastal Louisiana

Shore & Beach ◽  
2020 ◽  
pp. 83-91
Author(s):  
Tim Carruthers ◽  
Richard Raynie ◽  
Alyssa Dausman ◽  
Syed Khalil
Keyword(s):  
Adaptive Management ◽  
Management Practices ◽  
Numerical Models ◽  
The United States ◽  
State Agency ◽  
Coastal Protection ◽  
Coastal Restoration ◽  
Management Actions ◽  
Coastal Louisiana ◽  
Restoration Effort

Natural resources of coastal Louisiana support the economies of Louisiana and the whole of the United States. However, future conditions of coastal Louisiana are highly uncertain due to the dynamic processes of the Mississippi River delta, unpredictable storm events, subsidence, sea level rise, increasing temperatures, and extensive historic management actions that have altered natural coastal processes. To address these concerns, a centralized state agency was formed to coordinate coastal protection and restoration effort, the Coastal Protection and Restoration Authority (CPRA). This promoted knowledge centralization and supported informal adaptive management for restoration efforts, at that time mostly funded through the Coastal Wetlands Planning, Protection and Restoration Act (CWPPRA). Since the Deepwater Horizon (DWH) oil spill in 2010 and the subsequent settlement, the majority of restoration funding for the next 15 years will come through one of the DWH mechanisms; Natural Resource and Damage Assessment (NRDA), the RESTORE Council, or National Fish and Wildlife Foundation –Gulf Environmental Benefit Fund (NFWF-GEBF). This has greatly increased restoration effort and increased governance complexity associated with project funding, implementation, and reporting. As a result, there is enhanced impetus to formalize and unify adaptive management processes for coastal restoration in Louisiana. Through synthesis of input from local coastal managers, historical and current processes for project and programmatic implementation and adaptive management were summarized. Key gaps and needs to specifically increase implementation of adaptive management within the Louisiana coastal restoration community were identified and developed into eight tangible and specific recommendations. These were to streamline governance through increased coordination amongst implementing entities, develop a discoverable and practical lessons learned and decision database, coordinate ecosystem reporting, identify commonality of restoration goals, develop a common cross-agency adaptive management handbook for all personnel, improve communication (both in-reach and outreach), have a common repository and clearing house for numerical models used for restoration planning and assessment, and expand approaches for two-way stakeholder engagement throughout the restoration process. A common vision and maximizing synergies between entities can improve adaptive management implementation to maximize ecosystem and community benefits of restoration effort in coastal Louisiana. This work adds to current knowledge by providing specific strategies and recommendations, based upon extensive engagement with restoration practitioners from multiple state and federal agencies. Addressing these practitioner-identified gaps and needs will improve engagement in adaptive management in coastal Louisiana, a large geographic area with high restoration implementation within a complex governance framework.

THE NATURE AND ENVIRONMENT OF COST MANAGEMENT AMONG EARLY NINETEENTH CENTURY U.S. TEXITLE MANUFACTURERS

1992 ◽  
Vol 19 (2) ◽  
pp. 1-24 ◽  
Author(s):  
Thomas Tyson
Keyword(s):  
Nineteenth Century ◽  
New England ◽  
Management Practices ◽  
Cost Management ◽  
Cost Accounting ◽  
The United States ◽  
Social Forces ◽  
Cost Information ◽  
Early Nineteenth Century ◽  
Textile Mills

Several authors have suggested that a particular managerial component was needed before cost accounting could be fully used for accountability and disciplinary purposes. They argue that the marriage of managerialism and accounting first occurred in the United States at the Springfield Armory after 1840. They generally downplay the quality and usefulness of cost accounting at the New England textile mills before that time and call for a re-examination of original mill records from a disciplinary perspective. This paper reports the results of such a re-examination. It initially describes the social and economic environment of U.S. textile manufacturing in New England in the early nineteenth century. Selected cost memos and reports are described and analyzed to indicate the nature and scope of costing undertaken at the mills in Lowell, Massachusetts, in the late 1820s and early 1830s. The paper discusses how particular cost information was used and speculates why certain more modern procedures were not adopted. Its major finding is that cost management practices fully measured up to the business complexities, economic pressures, and social forces of the day.

scholarly journals Efficacy and Application Strategies for Propiconazole as a New Postharvest Fungicide for Managing Sour Rot and Green Mold of Citrus Fruit

Plant Disease ◽  
2012 ◽  
Vol 96 (2) ◽  
pp. 235-242 ◽  
Author(s):  
A. H. McKay ◽  
H. Förster ◽  
J. E. Adaskaveg
Keyword(s):  
Management Practices ◽  
Citrus Fruit ◽  
The United States ◽  
Optimal Time ◽  
Inoculum Concentration ◽  
Time Of Application ◽  
Sour Rot ◽  
Green Mold ◽  
Highly Effective ◽  
Moderately Resistant

Few postharvest treatments are available for managing sour rot of citrus caused by Galactomyces citri-aurantii and they are generally not very effective. The demethylation-inhibiting (DMI) triazole fungicides propiconazole and cyproconazole were found to be highly effective and more efficacious than other DMIs evaluated, such as metconazole and tebuconazole, in reducing postharvest sour rot of citrus. Additional studies were conducted with propiconazole as a postharvest treatment because it has favorable toxicological characteristics for food crop registration in the United States and the registrant supports a worldwide registration. Regression and covariance analyses were performed to determine optimal time of application after inoculation and fungicide rate. In laboratory studies, decay incidence increased when propiconazole applications were delayed from 8 to 24 h (lemon) or 18 to 42 h (grapefruit) after inoculation. Effective rates of the fungicide were 64 to 512 μg/ml and were dependent on inoculum concentration of the sour rot pathogen and on the type of citrus fruit. Propiconazole was found to be compatible with sodium hypochlorite at 100 μg/ml and 1 to 3% sodium bicarbonate without loss of efficacy for decay control on lemon. The addition of hydrogen peroxide/peroxyacetic acid at 80 μg/ml slightly decreased the effectiveness of propiconazole. Heated (48°C) solutions of propiconazole did not significantly improve the efficacy compared with solutions at 22°C. In experimental packing-line studies, aqueous in-line drenches applied alone or followed by applications of the fungicide in storage or packing fruit coatings were highly effective, reducing sour rot to between 0 and 1.2% compared with 83.8% decay incidence in the control when treatments were made up to 16 h after inoculation. When the fungicide was applied in either fruit coating, decay was only reduced to 49.1 to 57.1% incidence. Tank mixtures of propiconazole with the citrus postharvest fungicides fludioxonil and azoxystrobin were highly effective in reducing green mold caused by isolates of Penicillium digitatum sensitive or moderately resistant to imazalil and sour rot. Propiconazole will be an important postharvest fungicide for managing sour rot of citrus and potentially can be integrated into current management practices to reduce postharvest crop losses caused by DMI-sensitive isolates of P. digitatum.

Pectoralis Muscle Flap Reconstruction of Pediatric Sternal Wound Infections

2003 ◽  
Vol 14 (4) ◽  
pp. 512-516 ◽  
Author(s):  
David Zabel ◽  
Benjamin D. Eskra ◽  
Dimitri Laddis ◽  
Negin Noorchashm ◽  
Ralph Siewers ◽  
...  
Keyword(s):  
Muscle Flap ◽  
Wound Infections ◽  
Pectoralis Muscle ◽  
Flap Reconstruction ◽  
Sternal Wound Infections

scholarly journals Quinoa’s Potential to Enhance Dietary Management of Obesity and Type-2 Diabetes: A Review of the Current Evidence

Diabetology ◽  
2021 ◽  
Vol 2 (2) ◽  
pp. 77-94
Author(s):  
Alexander Little ◽  
Kevin Murphy ◽  
Patrick Solverson
Keyword(s):  
Type 2 Diabetes ◽  
Best Management Practices ◽  
Management Practices ◽  
The United States ◽  
Lipid Absorption ◽  
Current Evidence ◽  
Future Research ◽  
Dietary Management ◽  
Obesity And Diabetes

The prevalence of diet-induced obesity and type-2 diabetes remains a growing concern in the United States. As best management practices still include improved diet and physical activity, bioactive food components, contained within functional foods, show promise in curbing the cardiometabolic complications associated with excess weight and diabetes. Quinoa is an emerging candidate crop for its versatility in wide-ranging growing conditions as one approach to address food security, but it also contains several components that may serve as a dietary tool for post-industrial countries struggling with the health complications of caloric excess. Preliminary rodent feeding studies demonstrate that components within quinoa, namely, phytosteroids, phenolics, polysaccharides, and peptides, can prevent adiposity, dyslipidemia, and hyperglycemia. Mechanistic activity may involve reduced lipid absorption and adipogenesis, increased energy expenditure and glucose oxidation and corrected gut microbiota. Other intestinal actions may include blocked carbohydrate digestion with enhanced incretin signaling. Evidence in clinical trials is lacking and future research spanning cells to the clinic is needed to further elucidate the interesting preliminary reports reviewed here. Quinoa offers several unique attributes that could be harnessed to improve the dietary management of obesity and diabetes.

scholarly journals Development and scale-up of bioprotectants to keep staple foods safe from aflatoxin contamination in Africa

2021 ◽  
pp. 587-628
Author(s):  
Ranajit Bandyopadhyay ◽  
◽  
Alejandro Ortega-Beltran ◽  
Matieyedou Konlambigue ◽  
Lawrence Kaptoge ◽  
...  
Keyword(s):  
Management Practices ◽  
Scale Up ◽  
The United States ◽  
Aflatoxin Contamination ◽  
Barriers To Adoption ◽  
African Countries ◽  
Factors Affecting ◽  
Significant Public Health ◽  
Private And Public ◽  
Staple Foods

Aflatoxins pose a significant public health risk, decrease productivity and profitability and hamper trade. To minimize aflatoxin contamination a biocontrol technology based on atoxigenic strains of Aspergillus flavus that do not produce aflatoxin is used widely in the United States. The technology, with the generic name Aflasafe, has been improved and adapted for use in Africa. Aflasafe products have been developed or are currently being developed in 20 African countries. Aflatoxin biocontrol is being scaled up for use in several African countries through a mix of public, private, and public-private interventions. Farmers in several countries have commercially treated nearly 400,000 ha of maize and groundnut achieving >90% reduction in aflatoxin contamination. This chapter summarizes the biology of aflatoxin-producing fungi and various factors affecting their occurence, including climate change. Various management practices for aflatoxin mitigation are then discussed. These include biological control, which is increasingly being adopted by farmers in several countries. We discuss biocontrol product development and commercialization in various African countries. Subsequently, we highlight some barriers to adoption and other challenges.

Pelvic reconstruction after abdominoperineal resection of the rectum

2011 ◽  
Vol 89 (2) ◽  
pp. 77-81
Author(s):  
Carlos Moreno-Sanz ◽  
Marina Manzanera-Díaz ◽  
Mikael Clerveus ◽  
F. Javier Cortina-Oliva ◽  
Julián de Pedro-Conal ◽  
...  
Keyword(s):  
Abdominoperineal Resection ◽  
Pelvic Reconstruction
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