Science.gov

Sample records for initial work-up management

  1. Classical Hodgkin’s lymphoma in adults: guidelines of the Italian Society of Hematology, the Italian Society of Experimental Hematology, and the Italian Group for Bone Marrow Transplantation on initial work-up, management, and follow-up

    PubMed Central

    Brusamolino, Ercole; Bacigalupo, Andrea; Barosi, Giovanni; Biti, Giampaolo; Gobbi, Paolo G.; Levis, Alessandro; Marchetti, Monia; Santoro, Armando; Zinzani, Pier Luigi; Tura, Sante

    2009-01-01

    The Italian Society of Hematology (SIE), the Italian Society of Experimental Haematology (SIES) and the Italian Group for Bone Marrow Transplantation (GITMO) commissioned a project to develop practice guidelines for the initial work-up, therapy and follow-up of classical Hodgkin’s lymphoma. Key questions to the clinical evaluation and treatment of this disease were formulated by an Advisory Committee, discussed and approved by an Expert Panel (EP) composed of senior hematologists and one radiotherapist. After a comprehensive and systematic literature review, the EP recommendations were graded according to their supporting evidence. An explicit approach to consensus methodologies was used for evidence interpretation and for producing recommendations in the absence of a strong evidence. The EP decided that the target domain of the guidelines should include only classical Hodgkin’s lymphoma, as defined by the WHO classification, and exclude lymphocyte predominant histology. Distinct recommendations were produced for initial work-up, first-line therapy of early and advanced stage disease, monitoring procedures and salvage therapy, including hemopoietic stem cell transplant. Separate recommendations were formulated for elderly patients. Pre-treatment volumetric CT scan of the neck, thorax, abdomen, and pelvis is mandatory, while FDG-PET is recommended. As to the therapy of early stage disease, a combined modality approach is still recommended with ABVD followed by involved-field radiotherapy; the number of courses of ABVD will depend on the patient risk category (favorable or unfavorable). Full-term chemotherapy with ABVD is recommended in advanced stage disease; adjuvant radiotherapy in patients without initial bulk who achieved a complete remission is not recommended. In the elderly, chemotherapy regimens more intensive than ABVD are not recommended. Early evaluation of response with FDG-PET scan is suggested. Relapsed or refractory patients should receive high

  2. Work-up and management of lone atrial fibrillation: results of the European Heart Rhythm Association Survey.

    PubMed

    Pison, Laurent; Hocini, Mélèze; Potpara, Tatjana S; Todd, Derick; Chen, Jian; Blomström-Lundqvist, Carina

    2014-10-01

    The purpose of this European Heart Rhythm Association (EHRA) survey was to explore the work-up and management of lone atrial fibrillation (AF) among the European centres. Thirty-two European centres, all members of the EHRA electrophysiology (EP) research network, responded to this survey and completed the list of questions. The prevalence of lone AF has been reported to be ≤10% by 19 (60%) of the participating centres. The presence of isolated left atrial enlargement and left ventricular diastolic dysfunction represent heart disease according to 50 and 84% of the centres, respectively, and exclude the diagnosis of lone AF. Fifty-nine per cent of responders do not routinely consider genetic testing in lone AF patients. The initial therapeutic approach in symptomatic paroxysmal lone AF is antiarrhythmic drug therapy as reported by 31 (97%) of the centres. Pulmonary vein isolation only is the first ablation strategy for patients with symptomatic persistent lone AF at 27 (84%) of the responding centres. Assessment for sleep apnoea, obesity, and intensive sports activity in lone AF is performed at 27 (84%) centres. In conclusion, this EP Wire survey confirms that the term 'lone AF' is still used in daily practice. The work-up typically includes screening for known risk factors but not genetic testing. The preferred management of paroxysmal lone AF is rhythm control with antiarrhythmic drugs, whereas pulmonary vein isolation is the first ablation strategy for the majority of patients with symptomatic persistent lone AF. PMID:25267359

  3. Practical Work-up and Management of Recurrent Pregnancy Loss for the Front-Line Clinician.

    PubMed

    Branch, D Ware; Silver, Robert M

    2016-09-01

    Only a few so-called etiologies of recurrent pregnancy loss recurrent pregnancy loss in otherwise healthy women are adequately supported by well-designed investigations of association. The majority of proposed "treatments" have not been subjected to rigorous trials. The American Board of Internal Medicine Choosing Wisely initiative urges providers and patients to have constructive dialog aimed at choosing health care that is supported by evidence, not duplicative of other tests or procedures already received, free from harm, and truly necessary. We support the refreshing, objective frankness promoted by this campaign. A version of the Choosing Wisely "Do" and "Don't" format for recurrent pregnancy loss is presented. PMID:27403584

  4. Osteoblastoma of the lateral skull base: work-up, surgical management, and a review of the literature".

    PubMed

    Miller, Craig; Khan, Rihan; Lemole, G Michael; Jacob, Abraham

    2013-06-01

    Objectives To describe the work-up and surgical management of an osteoblastoma involving the lateral skull base. Typically occurring in the spine or long bones, osteoblastomas of the craniofacial skeleton are exceedingly rare and infrequently reported. A review of the current literature regarding temporal bone osteoblastoma, diagnosis, and treatment is described. Methods This case report describes the clinical presentation, radiographic studies, surgical management, histology, and postoperative follow-up of a young man presenting to a tertiary care neurotology practice with osteoblastoma involving the lateral skull base. A review of the current literature regarding osteoblastoma of the skull base, work-up, and treatment is described. Results A 15-year-old adolescent boy with a greater than 1-year history of right-sided retroauricular pain, a palpable postauricular mass, and chronic headaches presented for evaluation/management. Microscope examination of the ears, hearing, and cranial nerve function were normal. High-resolution temporal bone computed tomography and magnetic resonance imaging scans were obtained, which revealed an expansile mass involving the junction of the temporal and occipital bones. The patient underwent a combined retrosigmoid/retrolabyrinthine resection of this extradural tumor. Histology revealed a benign bone neoplasm consistent with osteoblastoma. Complete surgical resection was achieved, and the patient's symptoms fully resolved. Follow-up imaging studies found no evidence of recurrence. The scientific literature relevant to work-up and management of osteoblastoma is reviewed. Discussion Osteoblastomas of the lateral skull base are rare, histologically benign tumors that can present with radiographic features suggestive of malignancy. An en bloc resection is important for both diagnosis and definitive treatment of these neoplasms. The differential diagnosis on imaging and histology is discussed. PMID:23943719

  5. Initial management of temporomandibular disorders.

    PubMed

    Syrop, Steven B

    2002-08-01

    The existing dental literature does not support the superiority of any one type of treatment to manage TMD. Few studies meet rigorous scientific standards of the randomized clinical trial. This has led to enormous controversy. The initial management of TMD does not have to be controversial. Noninvasive, reversible modalities can be employed that carry very little risk and a high degree of success (Table 4). The success rate of this approach has been studied and determined to be 75% to 90%. Of course, not every patient will get better with this approach. For those who do not improve more advanced techniques must be used, and referral to specialists in TMD, neurology, and rehabilitation medicine may be required. A few patients will need surgery. Initial treatment of TMD requires relatively simple modalities, such as patient education, adherence to a soft diet, reducing oral habits, self-directed home physical therapy, muscle relaxation, the use of medication, and the proper use of bite plates. The majority of TMD patients will respond successfully to these basic treatments. PMID:12221818

  6. Diagnostic work-up of GERD.

    PubMed

    Vela, Marcelo F

    2014-10-01

    Gastroesophageal reflux disease (GERD) is frequently diagnosed by symptoms and good response to acid suppression with proton pump inhibitors. Further work up is required when the diagnosis of GERD is uncertain, for alarm symptoms, PPI-refractoriness, and often for extraesophageal presentations. Useful tools include endoscopy for mucosal assessment and reflux monitoring (pH or impedance-pH) to quantify reflux burden. Objective documentation of pathological reflux is mandatory prior to anti-reflux surgery. In some patients, symptoms that can be attributed to GERD may have other causes; in these patients, testing that excludes GERD helps direct the diagnostic and treatment efforts to other causes. PMID:25216910

  7. Managing Dualities in Planned Change Initiatives

    ERIC Educational Resources Information Center

    Barge, J. Kevin; Lee, Michael; Maddux, Kristy; Nabring, Richard; Townsend, Bryan

    2008-01-01

    Dualities play an important role in creating the conditions for change and managing planned change initiatives. Building on Seo, Putnam, and Bartunek's (2003) work, this study focuses on the dualities associated with managing change processes. A case study of a planned change process called the Circle of Prosperity Initiative, a multi-stakeholder…

  8. Current Initiatives and Issues in Collection Management.

    ERIC Educational Resources Information Center

    Bennett, Scott

    1984-01-01

    Reports on initiatives being taken by the Association of Research Libraries, University of Pittsburgh, Research Libraries Group, and Center for Research Libraries in response to development of collection management in academic librarianship, and comments on issues emerging from these initiatives--use documentation, cooperation, and paperless…

  9. Initial management strategies for follicular lymphoma

    PubMed Central

    Chen, Qiushi; Ayer, Turgay; Nastoupil, Loretta J; Seward, Miray; Zhang, Hongzheng; Sinha, Rajni; Flowers, Christopher R

    2013-01-01

    SUMMARY Follicular lymphoma (FL) can vary markedly in its initial presentation, and no single standard approach for its initial management has been adopted. Available options for the initial management of FL include watchful waiting, radiation, single-agent rituximab and combination of rituximab and chemotherapy with strategies segregated for patients who have low and high tumor burden disease based on established criteria. However, marked debate occurs regarding the role of watchful waiting in the modern era for low tumor burden, asymptomatic patients, the optimal timing of rituximab, the selection of chemotherapy regimen to partner with rituximab in high tumor burden patients, and strategies for the management of relapsed disease. We provide an evidence-based discussion on these and other issues regarding the management of FL, and propose a mathematical modeling approach for addressing some of these questions. PMID:23476737

  10. Recent Initiatives in Labor-Management Cooperation.

    ERIC Educational Resources Information Center

    National Center for Productivity and Quality of Working Life, Washington, DC.

    This report draws on a series of conferences held to develop guides for labor-management cooperation at the plant level. These included six recent initiatives conferences held in cooperation with State University Institutes of Industrial Relations and the Federal Mediation and Conciliation Service (FMCS) and a seventh sponsored by the Commission…

  11. Diagnosis and initial management of kidney stones.

    PubMed

    Portis, A J; Sundaram, C P

    2001-04-01

    The diagnosis and initial management of urolithiasis have undergone considerable evolution in recent years. The application of noncontrast helical computed tomography (CT) in patients with suspected renal colic is one major advance. The superior sensitivity and specificity of helical CT allow urolithiasis to be diagnosed or excluded definitively and expeditiously without the potential harmful effects of contrast media. Initial management is based on three key concepts: (1) the recognition of urgent and emergency requirements for urologic consultation, (2) the provision of effective pain control using a combination of narcotics and nonsteroidal anti-inflammatory drugs in appropriate patients and (3) an understanding of the impact of stone location and size on natural history and definitive urologic management. These concepts are discussed with reference to contemporary literature, with the goal of providing tools that family physicians can use in the emergency department or clinic. PMID:11310648

  12. Update on Washington initiatives on ecosystem management

    SciTech Connect

    Kostka, D.

    1995-12-01

    A biological {open_quotes}revolution{close_quotes} is in progress. Due to initiatives of the Clinton-Gore administration, biologists across the nation are trying to define and use a new concept called ecosystem management. {open_quotes}Ecosystem management{close_quotes} was born in the frustration of trying to deal with the spotted owl controversy in the Northwest. Biologists could not agree on what should be done. And the biologists and economists rarely got together to try to solve problems. Some astute individuals realized that to achieve a sustainable development, ecosystems would have to be managed on a much larger scale than merely small plots of lands. And people from many different backgrounds and disciplines would need to come together to find solutions. This paper will present the views of a Washington insider who has been a player (although too frequently a minor league player!) in administration initiatives to infuse ecosystem management principles and practices in our national conscience. Today, federal agency staff talk to those in other offices within their own agency. Federal agency staff also work on joint projects across federal agencies. In addition, state government, nonprofits, universities, interested individuals, and tribal governments are becoming involved. This is the biological {open_quotes}revolution{close_quotes} that is in progress. The emphasis is shifting from looking at the life history and problems of single species to a much broader approach of examining many species, including humans. The author will present a report on results of the ecosystem management initiative in the last year and point out some of the hurdles still ahead.

  13. The AGU Data Management Maturity Model Initiative

    NASA Astrophysics Data System (ADS)

    Bates, J. J.

    2015-12-01

    In September 2014, the AGU Board of Directors approved two initiatives to help the Earth and space sciences community address the growing challenges accompanying the increasing size and complexity of data. These initiatives are: 1) Data Science Credentialing: development of a continuing education and professional certification program to help scientists in their careers and to meet growing responsibilities and requirements around data science; and 2) Data Management Maturity (DMM) Model: development and implementation of a data management maturity model to assess process maturity against best practices, and to identify opportunities in organizational data management processes. Each of these has been organized within AGU as an Editorial Board and both Boards have held kick off meetings. The DMM model Editorial Board will recommend strategies for adapting and deploying a DMM model to the Earth and space sciences create guidance documents to assist in its implementation, and provide input on a pilot appraisal process. This presentation will provide an overview of progress to date in the DMM model Editorial Board and plans for work to be done over the upcoming year.

  14. Risk management for the Space Exploration Initiative

    NASA Technical Reports Server (NTRS)

    Buchbinder, Ben

    1993-01-01

    Probabilistic Risk Assessment (PRA) is a quantitative engineering process that provides the analytic structure and decision-making framework for total programmatic risk management. Ideally, it is initiated in the conceptual design phase and used throughout the program life cycle. Although PRA was developed for assessment of safety, reliability, and availability risk, it has far greater application. Throughout the design phase, PRA can guide trade-off studies among system performance, safety, reliability, cost, and schedule. These studies are based on the assessment of the risk of meeting each parameter goal, with full consideration of the uncertainties. Quantitative trade-off studies are essential, but without full identification, propagation, and display of uncertainties, poor decisions may result. PRA also can focus attention on risk drivers in situations where risk is too high. For example, if safety risk is unacceptable, the PRA prioritizes the risk contributors to guide the use of resources for risk mitigation. PRA is used in the Space Exploration Initiative (SEI) Program. To meet the stringent requirements of the SEI mission, within strict budgetary constraints, the PRA structure supports informed and traceable decision-making. This paper briefly describes the SEI PRA process.

  15. Native American Initiative Short Course Management Plan

    SciTech Connect

    Carroll, H.B.

    1999-04-27

    A training program is outlined for members of Native American tribes having an interest in working in the oil and gas industry. Also, the program will assist tribes whose lands have oil and gas resources to become more familiar with the industry and technology necessary to develop their resources. The proposed program will contribute to meeting the goals of the U.S. Department of Energy's (DOE) Domestic Oil and Gas Initiative to help Native American tribes become more self-sufficient in developing and managing their resources through training in cost-effective, improved technologies for hydrocarbon production that will meet environmental regulations. The training program outlined is for adult tribal representatives who are responsible for managing tribal mineral holdings or setting policy, or who work in the oil and gas industry. The course content is in response to a survey that was developed by BDM-Oklahoma and sent in the spring of 1995 to 26 tribes or tribal agencies which were identified through previous contact with DOE. Tribes were asked to indicate course content needs, levels, preferred time of year, and location. Six tribes responded with specific recommendations and needs. These tribes include the Osage, Creek, Pueblo, Cherokee, St. Regis Mohawk, Northern Arapaho, and Ute Mountain Ute. The results of the survey are included in a table.The training will be conducted at various locations by BDM-Oklahoma technical staff, which , includes geologists, exploration and drilling specialists, oil and gas production specialists, environmental policy specialists, and contract specialists. The proposed training schedule offers three workshops per year and includes those courses identified in the survey by the tribes. The schedule initially proposed in April 1995 has been modified in order to offer training identified by the tribes in the most cost-effective manner. Participants will be able to take two courses, and travel costs will be minimized. A schedule is

  16. 28 CFR 549.63 - Initial medical evaluation and management.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Initial medical evaluation and management... MANAGEMENT MEDICAL SERVICES Hunger Strikes, Inmate § 549.63 Initial medical evaluation and management. (a... Bureau institution considered medically appropriate, or to a community hospital....

  17. 28 CFR 549.63 - Initial medical evaluation and management.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Initial medical evaluation and management... MANAGEMENT MEDICAL SERVICES Hunger Strikes, Inmate § 549.63 Initial medical evaluation and management. (a... hunger strike: (1) Measure and record height and weight; (2) Take and record vital signs; (3)...

  18. 28 CFR 549.63 - Initial medical evaluation and management.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Initial medical evaluation and management... MANAGEMENT MEDICAL SERVICES Hunger Strikes, Inmate § 549.63 Initial medical evaluation and management. (a... hunger strike: (1) Measure and record height and weight; (2) Take and record vital signs; (3)...

  19. 28 CFR 549.63 - Initial medical evaluation and management.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Initial medical evaluation and management... MANAGEMENT MEDICAL SERVICES Hunger Strikes, Inmate § 549.63 Initial medical evaluation and management. (a... hunger strike: (1) Measure and record height and weight; (2) Take and record vital signs; (3)...

  20. 28 CFR 549.63 - Initial medical evaluation and management.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Initial medical evaluation and management... MANAGEMENT MEDICAL SERVICES Hunger Strikes, Inmate § 549.63 Initial medical evaluation and management. (a... hunger strike: (1) Measure and record height and weight; (2) Take and record vital signs; (3)...

  1. Continuous Risk Management: A NASA Program Initiative

    NASA Technical Reports Server (NTRS)

    Hammer, Theodore F.; Rosenberg, Linda

    1999-01-01

    NPG 7120.5A, "NASA Program and Project Management Processes and Requirements" enacted in April, 1998, requires that "The program or project manager shall apply risk management principles..." The Software Assurance Technology Center (SATC) at NASA GSFC has been tasked with the responsibility for developing and teaching a systems level course for risk management that provides information on how to comply with this edict. The course was developed in conjunction with the Software Engineering Institute at Carnegie Mellon University, then tailored to the NASA systems community. This presentation will briefly discuss the six functions for risk management: (1) Identify the risks in a specific format; (2) Analyze the risk probability, impact/severity, and timeframe; (3) Plan the approach; (4) Track the risk through data compilation and analysis; (5) Control and monitor the risk; (6) Communicate and document the process and decisions.

  2. 10 CFR 473.22 - Initial review by manager.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Initial review by manager. 473.22 Section 473.22 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION AUTOMOTIVE PROPULSION RESEARCH AND DEVELOPMENT Review and Certification of Grants, Cooperative Agreements, Contracts, and Projects § 473.22 Initial review by manager....

  3. 10 CFR 473.22 - Initial review by manager.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 3 2012-01-01 2012-01-01 false Initial review by manager. 473.22 Section 473.22 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION AUTOMOTIVE PROPULSION RESEARCH AND DEVELOPMENT Review and Certification of Grants, Cooperative Agreements, Contracts, and Projects § 473.22 Initial review by manager....

  4. 10 CFR 473.22 - Initial review by manager.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 3 2013-01-01 2013-01-01 false Initial review by manager. 473.22 Section 473.22 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION AUTOMOTIVE PROPULSION RESEARCH AND DEVELOPMENT Review and Certification of Grants, Cooperative Agreements, Contracts, and Projects § 473.22 Initial review by manager....

  5. 10 CFR 473.22 - Initial review by manager.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 3 2014-01-01 2014-01-01 false Initial review by manager. 473.22 Section 473.22 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION AUTOMOTIVE PROPULSION RESEARCH AND DEVELOPMENT Review and Certification of Grants, Cooperative Agreements, Contracts, and Projects § 473.22 Initial review by manager....

  6. Knowledge Management Initiatives at a Small University

    ERIC Educational Resources Information Center

    Gill, Avninder

    2009-01-01

    Purpose: The purpose of this paper is to address the knowledge management (KM) challenges faced by the administration of a small university which does not have a mature research culture. Design/methodology/approach: The paper follows both technocratic as well as ecological approaches to develop a sustainable KM. Strengths, weaknesses,…

  7. Hanford Tanks Initiative requirements and document management process guide

    SciTech Connect

    Schaus, P.S.

    1998-05-22

    This revision of the guide provides updated references to project management level Program Management and Assessment Configuration Management activities, and provides working level directions for submitting requirements and project documentation related to the Hanford Tanks Initiative (HTI) project. This includes documents and information created by HTI, as well as non-HTI generated materials submitted to the project.

  8. Paradise nearly Gained. Volume 1: Developing the Frontline Management Initiative.

    ERIC Educational Resources Information Center

    Barratt-Pugh, Llandis; Soutar, Geoffrey N.

    The Frontline Management Initiative (FMI) provides a framework for competency-based development of frontline managers in Australian enterprises. The FMI's impact on businesses was examined in a national study that included the following activities: focus groups; a national survey of management development and targeted national survey of FMI users;…

  9. Langerhans Cell Histiocytosis (LCH): Guidelines for Diagnosis, Clinical Work-Up, and Treatment for Patients Till the Age of 18 Years

    PubMed Central

    Haupt, Riccardo; Minkov, Milen; Astigarraga, Itziar; Schäfer, Eva; Nanduri, Vasanta; Jubran, Rima; Egeler, R Maarten; Janka, Gritta; Micic, Dragan; Rodriguez-Galindo, Carlos; Van Gool, Stefaan; Visser, Johannes; Weitzman, Sheila; Donadieu, Jean

    2013-01-01

    These guidelines for the management of patients up to 18 years with Langerhans cell histiocytosis (LCH) have been set up by a group of experts involved in the Euro Histio Net project who participated in national or international studies and in peer reviewed publications. Existing guidelines were reviewed and changed where new evidence was available in the literature up to 2012. Data and publications have been ranked according to evidence based medicine and when there was a lack of published data, consensus between experts was sought. Guidelines for diagnosis, initial clinical work-up, and treatment and long-term follow-up of LCH patients are presented. PMID:23109216

  10. The DSN Asset Management/Maintenance Improvement Initiative

    NASA Astrophysics Data System (ADS)

    Wackley, J.; Dundics, D.

    2011-11-01

    This article describes the Asset Management/Maintenance Improvement (AMMI) initiative: the first focused Deep Space Network (DSN) initiative intended to improve the efficiency and efficacy of maintenance, support improvement in equipment reliability, and provide metrics for use in understanding equipment reliability and the use of maintenance resources. The initiative has resulted in the introduction of many new processes and procedures including the global use of a computerized maintenance management system (CMMS) and Reliability-Centered Maintenance (RCM) concepts. The work performed as part of the AMMI initiative represents significant changes to the DSN maintenance culture that has been in place for over 40 years.

  11. Management Control System Support of Initiatives for Disruptive Students

    ERIC Educational Resources Information Center

    Scott, Colin

    2011-01-01

    Purpose: The purpose of the paper is to investigate the management control system (MCS) support of school initiatives to develop the school climate and to re-engage disruptive students. Design/methodology/approach: The paper adopts an approach of critical action research interviews with management and document reviews informed by Habermasian…

  12. Attitudes toward Anger Management Scale: Development and Initial Validation

    ERIC Educational Resources Information Center

    Boudreaux, David J.; Dahlen, Eric R.; Madson, Michael B.; Bullock-Yowell, Emily

    2014-01-01

    This article describes the development and preliminary validation of the Attitudes Toward Anger Management Scale (ATAMS), a self-report measure of attitudes toward anger management services. Undergraduate volunteers ("N" = 415) completed an initial version of the instrument. Principal components analysis yielded a two-factor solution.…

  13. PLANS FOR THE LAND MANAGEMENT SYSTEM (LMS) INITIATIVE

    EPA Science Inventory

    The Land Management System (LMS) is an initiative of the U.S. Army Engineer Research and Development Center (ERDC) to address technology requirements related to land and water resource management in both military and Civil Works mission areas. The purpose of LMS is to provide rel...

  14. 7 CFR 4290.140 - Approval of initial Management Expenses.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Approval of initial Management Expenses. 4290.140 Section 4290.140 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE RURAL BUSINESS INVESTMENT...

  15. 7 CFR 4290.140 - Approval of initial Management Expenses.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 15 2014-01-01 2014-01-01 false Approval of initial Management Expenses. 4290.140 Section 4290.140 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE RURAL BUSINESS INVESTMENT...

  16. 7 CFR 4290.140 - Approval of initial Management Expenses.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 15 2011-01-01 2011-01-01 false Approval of initial Management Expenses. 4290.140 Section 4290.140 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE RURAL BUSINESS INVESTMENT...

  17. 7 CFR 4290.140 - Approval of initial Management Expenses.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 15 2013-01-01 2013-01-01 false Approval of initial Management Expenses. 4290.140 Section 4290.140 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE RURAL BUSINESS INVESTMENT...

  18. 7 CFR 4290.140 - Approval of initial Management Expenses.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 15 2012-01-01 2012-01-01 false Approval of initial Management Expenses. 4290.140 Section 4290.140 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE RURAL BUSINESS INVESTMENT...

  19. 10 CFR 473.22 - Initial review by manager.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...) Review the proposed research and development to be performed under grant, under cooperative agreement... 10 Energy 3 2011-01-01 2011-01-01 false Initial review by manager. 473.22 Section 473.22 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION AUTOMOTIVE PROPULSION RESEARCH AND DEVELOPMENT Review...

  20. Initial resuscitation and management of pediatric septic shock

    PubMed Central

    Martin, Kelly; Weiss, Scott L.

    2015-01-01

    The pediatric sepsis syndrome remains a common cause of morbidity, mortality, and health care utilization costs worldwide. The initial resuscitation and management of pediatric sepsis is focused on 1) rapid recognition of abnormal tissue perfusion and restoration of adequate cardiovascular function, 2) eradication of the inciting invasive infection, including prompt administration of empiric broad-spectrum antimicrobial medications, and 3) supportive care of organ system dysfunction. Efforts to improve early and aggressive initial resuscitation and ongoing management strategies have improved outcomes in pediatric severe sepsis and septic shock, though many questions still remain as to the optimal therapeutic strategies for many patients. In this article, we will briefly review the definitions, epidemiology, clinical manifestations, and pathophysiology of sepsis and provide an extensive overview of both current and novel therapeutic strategies used to resuscitate and manage pediatric patients with severe sepsis and septic shock. PMID:25604591

  1. Diagnostic challenges in the work up of hypereosinophilia: pitfalls in bone marrow core biopsy interpretation.

    PubMed

    Schwaab, Juliana; Jawhar, Mohamad; Naumann, Nicole; Schmitt-Graeff, Annette; Fabarius, Alice; Horny, Hans-Peter; Cross, Nicholas C P; Hofmann, Wolf-Karsten; Reiter, Andreas; Metzgeroth, Georgia

    2016-03-01

    The FIP1L1-PDGFRA (FP) fusion gene is identified in a substantial proportion of patients with eosinophilia-associated myeloproliferative neoplasms (MPN-eo) who subsequently achieve rapid and durable remissions on imatinib. In the initial diagnostic work-up of hypereosinophilia (HE), histologic and immunohistochemical evaluation of a bone marrow (BM) core biopsy is considered essential for the differentiation between reactive hypereosinophilia (HER), MPN-eo and hypereosinophilic syndrome (HES). We therefore retrospectively analysed the initial reports of BM core biopsies from 116 patients who were subsequently identified as FP positive (FP+, n = 56) or FP negative/corticosteroid-responsive HER or HES (n = 60). Compared to HER or HES, detection of FP was more frequently associated with increased numbers of blasts (11/56 vs. 2/60, p = 0.007) and mast cells (23/33 vs. 7/23, p = 0.006; with expression of CD25 [11/18 vs. 2/13, p = 0.025]), and/or fibrosis (25/35 vs. 1/23, p < 0.0001). In FP+ patients, HE was correctly associated with an underlying clonal haematologic disorder in only 36/56 (64 %) of cases, but final BM diagnoses included a variety of diagnoses such as MPN-eo (n = 15), acute myeloid leukaemia (n = 8), systemic mastocytosis (n = 6), chronic myeloid leukaemia (n = 5) or unclassified MPN (n = 2). We conclude that the final evaluation of BM core biopsies in the diagnostic work-up of HE should include comprehensive morphologic (stains for myeloid blast cells, mast cells and fibres) and genetic analyses before a final diagnosis is established. PMID:26797429

  2. [Initial evaluation and management of paroxysmal supraventricular tachycardia].

    PubMed

    Rujic, Dragana; Sundbøll, Jens; Tofig, Bawer Jalal; Nielsen, Jens Cosedis; Pareek, Manan

    2016-01-18

    The paroxysmal supraventricular tachycardias (SVT) are commonly encountered arrhythmias and include atrioventricular nodal re-entrant tachycardia, atrioventricular reciprocating tachycardia, and focal atrial tachycardia. These tachycardias share several clinical features as well as similar management strategies. The probable mechanism of paroxysmal SVT can often be diagnosed from the clinical findings and a 12-lead ECG. This review describes the initial evaluation and treatment of patients with paroxysmal SVT, including distinctive features from the most important differential diagnoses. PMID:26815585

  3. Wyoming Landscape Conservation Initiative data management and integration

    USGS Publications Warehouse

    Latysh, Natalie; Bristol, R. Sky

    2011-01-01

    Six Federal agencies, two State agencies, and two local entities formally support the Wyoming Landscape Conservation Initiative (WLCI) and work together on a landscape scale to manage fragile habitats and wildlife resources amidst growing energy development in southwest Wyoming. The U.S. Geological Survey (USGS) was tasked with implementing targeted research and providing scientific information about southwest Wyoming to inform the development of WLCI habitat enhancement and restoration projects conducted by land management agencies. Many WLCI researchers and decisionmakers representing the Bureau of Land Management, U.S. Fish and Wildlife Service, the State of Wyoming, and others have overwhelmingly expressed the need for a stable, robust infrastructure to promote sharing of data resources produced by multiple entities, including metadata adequately describing the datasets. Descriptive metadata facilitates use of the datasets by users unfamiliar with the data. Agency representatives advocate development of common data handling and distribution practices among WLCI partners to enhance availability of comprehensive and diverse data resources for use in scientific analyses and resource management. The USGS Core Science Informatics (CSI) team is developing and promoting data integration tools and techniques across USGS and partner entity endeavors, including a data management infrastructure to aid WLCI researchers and decisionmakers.

  4. Southern Appalachian Mountains initiative: Regional partnership for air quality management

    SciTech Connect

    Brewer, P.F.

    1999-07-01

    The Southern Appalachian Mountains Initiative (SAMI) is a voluntary partnership of state and federal agencies, industry, environmental groups, academia, and interested public. SAMI was established to identify and recommend air emissions management strategies to remedy existing and prevent future adverse air quality impacts to natural resources in Southern Appalachia, with particular focus on Class I national park and wilderness areas. SAMI's integrated assessment is focusing simultaneously on ozone, visibility impairment, and acid deposition. Computer models are linking emissions, atmospheric transport, exposures, and environmental and socioeconomic effects. The assessment is considering the impacts of existing and newly enacted federal air regulatory requirements and alternative emissions management strategies that SAMI might recommend for regional, state, or community-based actions.

  5. Portfolio management for off-line revenue initiatives.

    PubMed

    Edgett, S J

    1996-01-01

    During the past decade, the health services sector has experienced a period of rapid change that has resulted in the creation of a large number of new services. This article advocates the use of a service development matrix as a planning aid for senior managers seeking to attract additional revenue through the development of new services. By strategically selecting and developing new services, rather than simple imitating other health care providers, marketers will be better able to focus limited corporate resources on new service initiatives that generate positive returns. PMID:10162425

  6. Breckinridge Project, initial effort. Report VI. Project Management Plan

    SciTech Connect

    1982-01-01

    Report VI presents a comprehensive plan for the management of the Breckinridge Project. For the purpose of this report, the project work is divided into five major project phases: Development, Engineering, Procurement, Construction, and Operations. The results of the Development Phase (Initial Effort) of the project are discussed in Section 1.0. This phase of the project was performed under a Cooperative Agreement with US Department of Energy and has produced 43 volumes of documentation. Fifteen volumes contain information of proprietary nature for patented processes and are therefore classified as Limited Access; however, twenty-eight volumes are not classified and are suitable for public dissemination. This Project Management Plan is a volume of the unclassified documentation. The other twenty-seven volumes contain comprehensive data on technical, financial, and environmental aspects of the project. Each of the four remaining project phases is presented starting with the extensive planning that will be performed and continuing through to the execution and completion of each phase. The major roles of the Operator, Ashland Synthetic Fuels, Inc. (ASFI), and the Managing Contractor are defined. Although a contract has not yet been executed with a Managing Contractor, the procedures, controls, organization and management philosophy of Bechtel Petroleum, Inc., are presented in this report as being representative of those used by contractors in the business of performing the engineering, procurement, and construction of projects of this size and complexity. The organizational structures of the Operator and the Managing Contractor are described, with designation of key project team personnel by job description and organization charts. Provisions for cost, schedule, and material control are described.

  7. [Initial surgical management of squamous carcinoma of the vulva].

    PubMed

    Salazar-Báez, Israel; Salazar-Campos, Jessica E; López-Arias, Alhely; Villavicencio-Valencia, Verónica; Coronel-Martínez, Jaime; Candelaria-Hernández, Myrna; Pérez-Montiel, Delia; Pérez-Plasencia, Carlos; Rojas-García, Aurora Elizabeth; Cantú de León, David

    2016-01-01

    Vulvar cancer accounts for approximately 4% of gynecological malignancies. At the Instituto Nacional de Cancerologia in Mexico it occupies the fourth place. The purpose of this study is to assess the management of squamous carcinoma of the vulva with initial surgical treatment. It is a descriptive retrospective, observational study, from January 1, 2002 to December 31, 2012. Twenty-seven patients, clinical stages I, II, or III, initial surgical management, with at least one year of follow-up were included. In 51.85% a partial vulvectomy was performed and in 40.74% a wide excision; 66.66% underwent inguinofemoral dissection. Recurrence occurred in 25.91% of cases and the overall survival at 10 years was 63%. It is concluded that with invasion of up to 1 mm of lymph node, affection is 0%; with invasion of 1 mm and up to 5 mm this increases to 25%; an invasion of more than 5 mm implies up to 45%. Recurrence in our study was primarily distant, necessitating long-term monitoring with emphasis on symptoms to request imaging studies when suspected. Adjuvant therapy should be offered to patients with positive nodes, close or positive margins, and tumors larger than 4 cm. PMID:27335183

  8. The key role of color Doppler ultrasound in the work-up of hemodialysis vascular access.

    PubMed

    Lomonte, Carlo; Meola, Mario; Petrucci, Ilaria; Casucci, Francesco; Basile, Carlo

    2015-01-01

    Vascular access (VA) is the lifeline for the hemodialysis patient and the native arterio-venous fistula (AVF) is the first-choice access. Among the different tests used in the VA domain, color Doppler ultrasound (CD-US) plays a key role in the clinical work-up. At the present time, three are the main fields of CD-US application: (i) evaluation of forearm arteries and veins in surgical planning; (ii) testing of AVF maturation; (iii) VA complications. Specifically, during the AVF maturation, CD-US allows to measure the diameter and flow volume in the brachial artery and calculate the peak systolic velocity (PSV) of the arterial axis, anastomosis and efferent vein, to detect critical stenosis. The borderline stenosis, revealed by the discrepancies between access flow rate and PSV, should be followed up with subsequent tests to detect progression of stenosis; the cases with significant changes in brachial flow should be referred to angiography. In conclusion, clinical monitoring remains the backbone of any VA program. CD-US is of utmost importance in a patient-centered VA evaluation, because it allows the appropriate management of all aspects of VA care. These are the main reasons why we strongly advocate the adoption of a VA surveillance program based on CD-US. PMID:25264303

  9. Management of patients with Graves' orbitopathy: initial assessment, management outside specialised centres and referral pathways.

    PubMed

    Perros, Petros; Dayan, Colin M; Dickinson, A Jane; Ezra, Daniel; Estcourt, Stephanie; Foley, Peter; Hickey, Janis; Lazarus, John H; MacEwen, Caroline J; McLaren, Julie; Rose, Geoffrey E; Uddin, Jimmy; Vaidya, Bijay

    2015-04-01

    Graves' orbitopathy (GO) is uncommon, but responsible for considerable morbidity. A coordinated approach between healthcare professionals is required in order to meet the needs of patients. Early diagnosis can be achieved by a simple clinical assessment. Low-cost effective interventions can be initiated by generalists, which may improve outcomes. Moderate-to-severe GO should be referred to specialised centres. Recommendations for clinical diagnosis, initial management and referral pathways are highlighted. PMID:25824071

  10. Initial management of adults with idiopathic (immune) thrombocytopenic purpura.

    PubMed

    George, J N

    2002-03-01

    Since idiopathic (immune) thrombocytopenic purpura (ITP) in adults is usually a chronic condition with few spontaneous remissions, the goal of treatment is not cure, but to maintain a hemostatically safe platelet level. The indication for treatment should be based not merely on platelet counts, but also clinical indices of bleeding. Although most patients show good initial response to prednisone, the side effects of steroids limit this treatment. Currently, long-term management usually involves splenectomy. Since splenectomy has surgical risks and may also predispose the patient to sepsis, a clinical trial using anti-D (WinRho-SDR) has been performed to determine whether this treatment can safely delay or avoid the need for surgery. The use of WinRho may also reveal the occurrence of spontaneous remissions, a previously unrecognized subgroup of adults with chronic ITP. PMID:11913992

  11. Diabetes management: optimizing roles for nurses in insulin initiation.

    PubMed

    Levich, Bridget R

    2011-01-01

    Type 2 diabetes is a major public health concern. Screening and early diagnosis followed by prompt and aggressive treatment interventions can help control progression of diabetes and its complications. Nurses are often the first healthcare team members to interact with patients and are being called on to apply their specialized knowledge, training, and skills to educate and motivate patients with diabetes about insulin use and practical ways to achieve treatment goals. Clinical nurse specialists possess specific training and skills to provide this level of care, while staff or office-based nurses may be trained by physicians to fulfill a task-specific role. This manuscript reviews the benefits of intensive glycemic control in type 2 diabetes, therapeutic goals and guidelines, advances in insulin therapy, and contribution of nurses in overcoming barriers to insulin initiation and related aspects of diabetes care. Nurses are particularly well positioned to fill the gap and improve efficiency in diabetes-related healthcare by assisting patients with insulin initiation and other aspects of glycemic self-management. PMID:21468244

  12. 94-A13 Native American Initiative Short Course Management Plan

    SciTech Connect

    Carroll, Herbert B.; Johnson, William I.; Kokesh, Judith H.

    1999-04-27

    A training program conducted in Bartlesville by BDM-Oklahoma technical staff, which included geologists, geophysicists, exploration and drilling specialists, and environmental policy experts. The proposed training schedule offered four courses per year and included those coursed identified by the tribes in the survey. The training program was outlined for members of Native American Tribes whose lands have oil and gas resources. The proposed program contributed to meeting the goals of the U.S. Department of Energy's (DOE) Domestic Oil and Gas Initiative to help Native American tribes become more self-sufficient in developing and managing their resources through training in cost-effective, improved technologies for hydrocarbon production that will meet environmental regulations. The training program outlined was for adult tribal representatives who are responsible for managing tribal mineral holdings or setting policy, or who work in the oil and gas industry. The course content is in response to a survey that was developed by BDM-Oklahoma and sent in the Spring of 1995 to 26 tribal agencies identified through previous contact with DOE. Tribes were asked to indicate course content needs, levels, preferred time of year, and location. Six tribes responded with specific recommendations and needs. These tribes, were the Creek, Pueblo, Cherokee, St. Regis Mohawk, Northern Arapho, and Ute Mountain Ute.

  13. Initial assessment and management of pediatric trauma patients

    PubMed Central

    McFadyen, J Grant; Ramaiah, Ramesh; Bhananker, Sanjay M

    2012-01-01

    Injury is the leading cause of death and disability in children. Each year, almost one in six children in the United States require emergency department (ED) care for the treatment of injuries, and more than 10,000 children die from injuries. Severely injured children need to be transported to a facility that is staffed 24/7 by personnel experienced in the management of children, and that has all the appropriate equipment to diagnose and manage injuries in children. Anatomical, physiological, and emotional differences between adults and children mean that children are not just scaled-down adults. Facilities receiving injured children need to be child and family friendly, in order to minimize the psychological impact of injury on the child and their family/carers. Early recognition and treatment of life-threatening airway obstruction, inadequate breathing, and intra-abdominal and intra-cranial hemorrhage significantly increases survival rate after major trauma. The initial assessment and management of the injured child follows the same ATLS® sequence as adults: primary survey and resuscitation, followed by secondary survey. A well-organized trauma team has a leader who designates roles to team members and facilitates clear, unambiguous communication between team members. The team leader stands where he/she can observe the entire team and monitor the “bigger picture.” Working together as a cohesive team, the members perform the primary survey in just a few minutes. Life-threatening conditions are dealt with as soon as they are identified. Necessary imaging studies are obtained early. Constant reassessment ensures that any deterioration in the child's condition is picked up immediately. The secondary survey identifies other injuries, such as intra-abdominal injuries and long-bone fractures, which can result in significant hemorrhage. The relief of pain is an important part of the treatment of an injured child. PMID:23181205

  14. The NOAH Initiative: Disaster Management Using WebGIS

    NASA Astrophysics Data System (ADS)

    Alconis, J. A.; Eco, R. C.; Lagmay, A.; Aracan, K.; Seveses, L.

    2013-12-01

    The Philippines is beset by many natural hazards that result in disasters costing huge amount of lives and millions worth of economic damages. In response to these perennial problems, the Philippine government, through the Department of Science and Technology, launched the Nationwide Operational Assessment of Hazards (NOAH) in July 2012 to integrate government resources and various initiatives, and develop technologies aimed at mitigating disasters. Among the current activities are high-resolution mapping of critical watersheds using LiDAR to serve as base maps for geohazard models, deployment of automated rain gauges and water level sensors across the country, and use of Doppler radar data and satellite imagery to quantify and downscale weather forecasts among others. A critical component of this initiative is the development of a near real-time web-based spatial data infrastructure which integrates all disaster-related datasets from different agencies from both government and non-government institutions. The program is designed to utilize the latest communication technologies to process, analyze, and disseminate both spatial and non-spatial information with temporal components and their associated metadata to come up with a centralized hazards decision support system for disaster management. It is now being utilized by end-users such as government agencies, local government units, academic institutions, and non-government organizations. More importantly, since its launch, thousands of lives have been saved from severe floods brought by the August 2012 Southwest Monsoon rains and the onslaught of Supertyphoon Bopha in December 2012. Though much work still remains, this is a needed step in the right direction.

  15. Initial respiratory management in preterm infants and bronchopulmonary dysplasia

    PubMed Central

    López, Ester Sanz; Rodríguez, Elena Maderuelo; Navarro, Cristina Ramos; Sánchez-Luna, Manuel

    2011-01-01

    BACKGROUND: Ventilator injury has been implicated in the pathogenesis of bronchopulmonary dysplasia. Avoiding invasive ventilation could reduce lung injury, and early respiratory management may affect pulmonary outcomes. OBJECTIVE: To analyze the effect of initial respiratory support on survival without bronchopulmonary dysplasia at a gestational age of 36 weeks. DESIGN/METHODS: A prospective 3-year observational study. Preterm infants of <32 weeks gestational age were classified into 4 groups according to the support needed during the first 2 hours of life: room air, nasal continuous positive airway pressure, intubation/surfactant/extubation and prolonged mechanical ventilation (defined as needing mechanical ventilation for more than 2 hours). RESULTS: Of the 329 eligible patients, a total of 49% did not need intubation, and 68.4% did not require prolonged mechanical ventilation. At a gestational age of 26 weeks, there was a significant correlation between survival without bronchopulmonary dysplasia and initial respiratory support. Preterm infants requiring mechanical ventilation showed a higher risk of death and bronchopulmonary dysplasia. After controlling for gestational age, antenatal corticosteroid use, maternal preeclampsia and chorioamnionitis, the survival rate without bronchopulmonary dysplasia remained significantly lower in the mechanically ventilated group. CONCLUSIONS: In our population, the need for more than 2 hours of mechanical ventilation predicted the development of bronchopulmonary dysplasia in preterm infants with a gestational age >26 weeks (sensitivity = 89.5% and specificity = 67%). The need for prolonged mechanical ventilation could be an early marker for the development of bronchopulmonary dysplasia. This finding could help identify a target population with a high risk of chronic lung disease. Future research is needed to determine other strategies to prevent bronchopulmonary dysplasia in this high-risk group of patients. PMID

  16. Management initiatives to waste management decisions and environmental compliance in Oak Ridge, Tennessee

    SciTech Connect

    Jones, C.G.

    1988-01-01

    Martin Marietta Energy Systems, Inc. (MMES) has been the operating contractor for the nuclear production and research facilities at Oak Ridge, Tennessee and Paducah, Kentucky for about four and one-half years. Environmental compliance, regulatory interaction, and public confidence have been very significant issues during this time. This presentation will review the environmental situation in Oak Ridge in 1984 and will discuss management initiatives and experience in the development and implementation of effective environmental and waste management and health and safety programs committed to the protection of the environment, our workers and the public with an overall goal of full compliance with all current and anticipated regulations.

  17. Results of comprehensive diagnostic work-up in ‘idiopathic’ dilated cardiomyopathy

    PubMed Central

    Broch, Kaspar; Andreassen, Arne K; Hopp, Einar; Leren, Trond P; Scott, Helge; Müller, Fredrik; Aakhus, Svend; Gullestad, Lars

    2015-01-01

    Objective Dilated cardiomyopathy (DCM) is characterised by left ventricular dilation and dysfunction not caused by coronary disease, valvular disease or hypertension. Owing to the considerable aetiological and prognostic heterogeneity in DCM, an extensive diagnostic work-up is recommended. We aimed to assess the value of diagnostic testing beyond careful physical examination, blood tests, echocardiography and coronary angiography. Methods From October 2008 to November 2012, we prospectively recruited 102 patients referred to our tertiary care hospital with a diagnosis of ‘idiopathic’ DCM based on patient history, physical examination, routine blood tests, echocardiography and coronary angiography. Extended work-up included cardiac MRI, exercise testing, right-sided catheterisation with biopsies, 24 h ECG and genetic testing. Results In 15 patients (15%), a diagnosis other than ‘idiopathic’ DCM was made based on additional tests. In 10 patients (10%), a possibly disease-causing mutation was detected. 2 patients were found to have non-compaction cardiomyopathy based on MRI findings; 2 patients had systemic inflammatory disease with cardiac involvement; and in 1 patient, cardiac amyloidosis was diagnosed by endomyocardial biopsy. Only in 5 cases did the results of the extended work-up have direct therapeutic consequences. Conclusions In patients with DCM, in whom patient history and routine work-up carry no clues to the aetiology, the diagnostic and therapeutic yield of extensive additional testing is modest. PMID:26468400

  18. 13 CFR 108.140 - SBA approval of initial Management Expenses.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false SBA approval of initial Management Expenses. 108.140 Section 108.140 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS... SBA approval of initial Management Expenses. A NMVC Company must have its Management Expenses...

  19. 13 CFR 108.140 - SBA approval of initial Management Expenses.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 13 Business Credit and Assistance 1 2013-01-01 2013-01-01 false SBA approval of initial Management Expenses. 108.140 Section 108.140 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS... SBA approval of initial Management Expenses. A NMVC Company must have its Management Expenses...

  20. 13 CFR 108.140 - SBA approval of initial Management Expenses.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 13 Business Credit and Assistance 1 2012-01-01 2012-01-01 false SBA approval of initial Management Expenses. 108.140 Section 108.140 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS... SBA approval of initial Management Expenses. A NMVC Company must have its Management Expenses...

  1. 13 CFR 108.140 - SBA approval of initial Management Expenses.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false SBA approval of initial Management Expenses. 108.140 Section 108.140 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS... SBA approval of initial Management Expenses. A NMVC Company must have its Management Expenses...

  2. Initial Validation of the Children's Worry Management Scale

    ERIC Educational Resources Information Center

    Zeman, Janice Lillian; Cassano, Michael; Suveg, Cynthia; Shipman, Kimberly

    2010-01-01

    We investigated the psychometric properties of a new instrument, the Children's Worry Management Scale (CWMS). The CWMS has three subscales that specify methods of regulating worry: inhibition (the suppression of worry), dysregulation (exaggerated displays of worry), and coping (constructive ways of managing worry). Using a Caucasian, middle-class…

  3. The Experience of Initial Management Training in ELT

    ERIC Educational Resources Information Center

    Rimmer, Wayne

    2016-01-01

    Management training in ELT organizations is often inadequate. New managers are in severe need of training, especially for tasks which are non-pedagogical, yet they operate in a milieu where there are few opportunities for support compared with colleagues in mainstream education. The purpose of this case study, a rare evidence-based contribution to…

  4. The Appropriate Use of Neuroimaging in the Diagnostic Work-Up of Dementia

    PubMed Central

    2014-01-01

    Background Diagnosis of dementia is challenging and requires both ruling out potentially treatable underlying causes and ruling in a diagnosis of dementia subtype to manage patients and suitably plan for the future. Objectives This analysis sought to determine the appropriate use of neuroimaging during the diagnostic work-up of dementia, including indications for neuroimaging and comparative accuracy of alternative technologies. Data Sources A literature search was performed using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database, for studies published between 2000 and 2013. Review Methods Data on diagnostic accuracy and impact on clinical decision making were abstracted from included studies. Quality of evidence was assessed using GRADE. Results The search yielded 5,374 citations and 15 studies were included. Approximately 10% of dementia cases are potentially treatable, though less than 1% reverse partially or fully. Neither prediction rules nor clinical indications reliably select the subset of patients who will likely benefit from neuroimaging. Clinical utility is highest in ambiguous cases or where dementia may be mixed, and lowest for clinically diagnosed Alzheimer disease or clinically excluded vascular dementia. There is a lack of evidence that MRI is superior to CT in detecting a vascular component to dementia. Accuracy of structural imaging is moderate to high for discriminating different types of dementia. Limitations There was significant heterogeneity in estimates of diagnostic accuracy, which often prohibited a statistical summary of findings. The quality of data reported by studies prohibited calculation of likelihood ratios in the present analysis. No studies from primary care were found; thus, generalizability beyond tertiary care settings may be limited. Conclusions A diagnosis of reversible dementia is rare. Imaging has the most

  5. "Deja Vu All over Again" Initiatives in Academic Management.

    ERIC Educational Resources Information Center

    Bilik, Laurie J.; Blum, Mark C.

    1989-01-01

    While colleges and universities are increasingly retreating to management models already considered counterproductive in industry, corporations are beginning to appreciate the principles of shared authority and are developing collegial-style cultures. (MSE)

  6. Searching for Extended Identity: The Problematised Role of Managing People Development, as Illuminated by the Frontline Management Initiative.

    ERIC Educational Resources Information Center

    Barratt-Pugh, Llandis

    Australia's Frontline Management Initiative (FMI) marks a political move toward workplace learning and provides evidence concerning development of managing identities and management of such workplace learning. The FMI was examined as a technology of identity within the discourse of enterprise and an instrument of textualization of the workplace.…

  7. Management PhD Candidates' Job Search: The Initial Interview.

    ERIC Educational Resources Information Center

    Hunt, Steven C.; Sawhney, Rajeev

    2003-01-01

    A survey of 200 doctoral students who interviewed with business schools at the Academy of Management conference received 74 responses. On average, they interviewed with 15.74 schools and did considerable preconference information gathering. Many complained of the physical conditions and lack of interviewer preparation. (Contains 20 references.)…

  8. Business, Marketing and Management Teacher Education Initiative. Final Report.

    ERIC Educational Resources Information Center

    Haynes, Thomas S.; And Others

    Three objectives of an Illinois project were as follows: (1) develop models for business, marketing, and management teacher education; (2) develop linkages between business and educational agency personnel; and (3) develop Tech Prep programs that lead to associate degrees and further education. During the project, staff at Illinois State…

  9. Initial evaluation and management of the critical burn patient.

    PubMed

    Vivó, C; Galeiras, R; del Caz, Ma D P

    2016-01-01

    The major improvement in burn therapy is likely to focus on the early management of hemodynamic and respiratory failures in combination with an aggressive and early surgical excision and skin grafting for full-thickness burns. Immediate burn care by first care providers is important and can vastly alter outcomes, and it can significantly limit burn progression and depth. The goal of prehospital care should be to cease the burning process as well as prevent future complications and secondary injuries for burn shock. Identifying burn patients appropriate for immediate or subacute transfer is an important step in reducing morbidity and mortality. Delays in transport to Burn Unit should be minimized. The emergency management follows the principles of the Advanced Trauma Life Support Guidelines for assessment and stabilization of airway, breathing, circulation, disability, exposure and environment control. All patients with suspected inhalation injury must be removed from the enclosure as soon as possible, and immediately administer high-flow oxygen. Any patient with stridor, shortness of breath, facial burns, singed nasal hairs, cough, soot in the oral cavity, and history of being in a fire in an enclosed space should be strongly considered for early intubation. Fibroscopy may also be useful if airway damage is suspected and to assess known lung damage. Secondary evaluation following admission to the Burn Unit of a burned patient suffering a severe thermal injury includes continuation of respiratory support and management and treatment of inhalation injury, fluid resuscitation and cardiovascular stabilization, pain control and management of burn wound. PMID:26724246

  10. A Cost Management Control Procedure for Initial Training in Surface Ship Acquisition Programs. Final Report.

    ERIC Educational Resources Information Center

    Nutter, Roger V.; And Others

    A study was conducted to develop a cost management control procedure to assist Navy managers in making decisions about initial training development and implementation in surface ship acquisition programs. Objectives were (1) develop and illustrate a cost management control procedure for centralized collection, storage, and control of cost data for…

  11. 15 CFR 930.38 - Consistency determinations for activities initiated prior to management program approval.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ..., DEPARTMENT OF COMMERCE OCEAN AND COASTAL RESOURCE MANAGEMENT FEDERAL CONSISTENCY WITH APPROVED COASTAL MANAGEMENT PROGRAMS Consistency for Federal Agency Activities § 930.38 Consistency determinations for... activities initiated prior to management program approval. 930.38 Section 930.38 Commerce and Foreign...

  12. Value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules.

    PubMed

    Schwarz, Carsten; Schönfeld, Nicolas; Bittner, Roland C; Mairinger, Thomas; Rüssmann, Holger; Bauer, Torsten T; Kaiser, Dirk; Loddenkemper, Robert

    2013-01-01

    The diagnostic value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules (SPN) is still under debate among pneumologists, radiologists and thoracic surgeons. In a prospective observational manner, flexible bronchoscopy was routinely performed in 225 patients with SPN of unknown origin. Of the 225 patients, 80.5% had lung cancer, 7.6% had metastasis of an extrapulmonary primary tumour and 12% had benign aetiology. Unsuspected endobronchial involvement was found in 4.4% of all 225 patients (or in 5.5% of patients with lung cancer). In addition, flexible bronchoscopy clarified the underlying aetiology in 41% of the cases. The bronchoscopic biopsy results from the SPN were positive in 84 (46.5%) patients with lung cancer. Surgery was cancelled due to the results of flexible bronchoscopy in four cases (involvement of the right main bronchus (impaired pulmonary function did not allow pneumonectomy) n=1, small cell lung cancer n=1, bacterial pneumonia n=2), and the surgical strategy had to be modified to bilobectomy in one patient. Flexible bronchoscopy changed the planned surgical approach in five cases substantially. These results suggest that routine flexible bronchoscopy should be included in the regular pre-operative work-up of patients with SPN. PMID:22496316

  13. Technology Integration Initiative In Support of Outage Management

    SciTech Connect

    Gregory Weatherby; David Gertman

    2012-07-01

    Plant outage management is a high priority concern for the nuclear industry from cost and safety perspectives. Often, command and control during outages is maintained in the outage control center where many of the underlying technologies supporting outage control are the same as those used in the 1980’s. This research reports on the use of advanced integrating software technologies and hand held mobile devices as a means by which to reduce cycle time, improve accuracy, and enhance transparency among outage team members. This paper reports on the first phase of research supported by the DOE Light Water Reactor Sustainability (LWRS) Program that is performed in close collaboration with industry to examine the introduction of newly available technology allowing for safe and efficient outage performance. It is thought that this research will result in: improved resource management among various plant stakeholder groups, reduced paper work, and enhanced overall situation awareness for the outage control center management team. A description of field data collection methods, including personnel interview data, success factors, end-user evaluation and integration of hand held devices in achieving an integrated design are also evaluated. Finally, the necessity of obtaining operations cooperation support in field studies and technology evaluation is acknowledged.

  14. [A guide to initial management of minor head injury].

    PubMed

    Shiomi, Naoto; Echigo, Tadashi

    2004-05-01

    We reviewed the records of 1,335 minor head injury patients with initial Glasgow Coma Scale (GCS) scores of 15 treated by our neurosurgery service between January 1998 and December 2000. Skull X-ray was performed in 945 patients (71%), and Computed tomography (CT) was performed in 590 patients (44%). Skull fracture was shown radiographically in 24 patients (2.5%), and abnormalities on the initial CT were seen in 29 patients (4.9%). The most frequent intracranial lesion on CT was acute epidural hematoma with skull fracture. Significantly more intracranial lesions were found in those with a fracture than in those without by chi2 analysis. Post-traumatic vomiting was significantly associated with radiographical abnormalities, but headache and nausea did not increase the risk of skull fracture and intracranial lesions on the CT. Patients required neurosurgical intervention in 4 cases, and all of those were acute epidural hematoma with skull fracture. In this study, the first thing we should do for asymptomatic minor head injury patients with a GCS score of 15 is to investigate the presence of a skull fracture by skull X-ray. Head trauma patients with a skull fracture and post-traumatic vomiting should undergo CT to facilitate detection of intracranial lesions, even when there are no abnormal neurological signs. PMID:15287484

  15. External compression as initial management of giant omphaloceles.

    PubMed

    DeLuca, F G; Gilchrist, B F; Paquette, E; Wesselhoeft, C W; Luks, F I

    1996-07-01

    The authors describe a noninvasive technique for the management of giant omphaloceles. Two patients with giant omphaloceles were managed with external compression. Dry sterile dressings were used, buttressed by an Ace bandage in the first case and by a handcrafted Velcro abdominal binder in the second. The binder was tightened every 2 or 3 days. Renal, cardiovascular, respiratory, and gastrointestinal parameters were measured regularly to determine whether the binder was too tight. The first patient had only occasional emesis, and the defect was repaired after 40 days of compression. The second patient experienced intermittent hypertension, occasional emesis, and mild oxygen desaturation, which resolved when the binder was loosened slightly. The fascia muscle and skin were closed after 30 days of external compression. Both patients are currently living at home and doing well. This form of external compression is an effective, inexpensive, and low-risk method for the gradual reduction of giant omphaloceles, and should be considered for patients born with this problem. PMID:8811569

  16. Informing the Design and Evaluation of Superuser Care Management Initiatives

    PubMed Central

    Cantor, Joel C.

    2016-01-01

    Background: Health care spending is concentrated among a small number of high-cost patients, and the popularity of initiatives to improve care and reduce cost among such “superusers” (SUs) is growing. However, SU costs decline naturally over time, even without intervention, a statistical phenomenon known as regression-to-the-mean (RTM). Objectives: We assess the magnitude of RTM in hospital costs for cohorts of hospital SUs identified on the basis of high inpatient (IP) or emergency department (ED) utilization. We further examine how cost and RTM are associated with patient characteristics including behavioral health (BH) problems, multiple chronic conditions, and indicators of vulnerability. Study Design: Using longitudinally linked all-payer hospital billing data, we selected patient cohorts with ≥2 IP stays (IP SUs) or ≥6 ED visits (ED SUs) during a 6-month baseline period, and additional subgroups defined by combinations of IP and ED superuse. Population Studied: A total of 289,060 NJ hospital IP and treat-and-release ED patients over 2009–2011. Results: Hospital costs among IP and ED SUs declined 70% and 38%, respectively, over 8 quarters following the baseline period. The decrease occurs more quickly for IP SUs compared with ED SUs. Presence of BH problems was positively associated with costs among patients overall, but the relationship varied by SU cohort. Conclusions: Understanding patterns of RTM among SU populations is important for designing intervention strategies, as there is greater potential for savings among patients with more persistent costs (less RTM). Further, as many SU initiatives lack resources for rigorous evaluation, quantifying the extent of RTM is vital for interpreting program outcomes. PMID:27219632

  17. Quantified diagnostic work-up casts: applications for interdisciplinary treatment planning.

    PubMed

    Solow, Roger A

    2016-01-01

    Diagnostic casts that accurately replicate a patient's occlusion are essential for planning comprehensive care and interdisciplinary treatment. These casts can reveal the actual problem in the spatial relationship between the maxilla and the mandible, which may not be apparent on intraoral examination. Duplicate casts can be altered and measured to quantify the extent of the correction necessary for a predictable result. Treatment planning for interdisciplinary cases requires thorough evaluation of the entire problem and solution set as well as coordination of all procedures. Severe problems and invasive treatments require precise treatment planning. This case report illustrates these principles through multiple applications of quantified diagnostic work-up casts for a patient requiring orthognathic surgery, orthodontics, and occlusal adjustment after a mandibular subcondylar fracture. PMID:27148655

  18. Developing Organisational Knowledge Management Initiatives: A Collaborative Research Approach

    NASA Astrophysics Data System (ADS)

    Linger, Henry

    The articulation of the knowledge management (KM) concept has occurred in the context of a radical shift away from goods and services to an information- based economy (Porter and Millar, 1985; Drucker, 1993 Boisot 1995; Boisot 1998) The organisational response to this shift has been a move towards global enterprises with very flat structures that, in principle, enable enterprises to react rapidly to changes in their operating environments (Drucker, 1988; Scott Morton, 1991; Galliers and Baets, 1998). Organisations that operate in the information economy require an ability to generate, access and utilise the volumes of information that are now readily available without the constraint of media, geography or time (Boisot, 1995). A critical factor is the speed at which they are able to productively process such information.

  19. INTEGRATED SAFETY MANAGEMENT SYSTEM SAFETY CULTURE IMPROVEMENT INITIATIVE

    SciTech Connect

    MCDONALD JA JR

    2009-01-16

    In 2007, the Department of Energy (DOE) identified safety culture as one of their top Integrated Safety Management System (ISMS) related priorities. A team was formed to address this issue. The team identified a consensus set of safety culture principles, along with implementation practices that could be used by DOE, NNSA, and their contractors. Documented improvement tools were identified and communicated to contractors participating in a year long pilot project. After a year, lessons learned will be collected and a path forward determined. The goal of this effort was to achieve improved safety and mission performance through ISMS continuous improvement. The focus of ISMS improvement was safety culture improvement building on operating experience from similar industries such as the domestic and international commercial nuclear and chemical industry.

  20. IBFAN Africa training initiatives: code implementation and lactation management.

    PubMed

    Mbuli, A

    1994-01-01

    As part of an ongoing effort to halt the decline of breast feeding rates in Africa, 35 representatives of 12 different African countries met in Mangochi, Malawi, in February 1994. The Code of Marketing of Breastmilk Substitutes was scrutinized. National codes were drafted based on the "Model Law" of the IBFAN Code Documentation Centre (ICDC), Penang. Mechanisms of implementation, specific to each country, were developed. Strategies for the promotion, protection, and support of breast feeding, which is very important to child survival in Africa, were discussed. The training course was organized by ICDC, in conjunction with IBFAN Africa, and with the support of the United Nations Children's Fund (UNICEF) and the World Health Organization (WHO). Countries in eastern, central, and southern Africa were invited to send participants, who included professors, pediatricians, nutritionists, MCH personnel, nurses, and lawyers. IBFAN Africa has also been conducting lactation management workshops for a number of years in African countries. 26 health personnel (pediatricians, nutritionists, senior nursing personnel, and MCH workers), representing 7 countries in the southern African region, attended a training of trainers lactation management workshop in Swaziland in August, 1993 with the support of their UNICEF country offices. The workshop included lectures, working sessions, discussions, and slide and video presentations. Topics covered included national nutrition statuses, the importance of breast feeding, the anatomy and physiology of breast feeding, breast feeding problems, the International Code of Marketing, counseling skills, and training methods. The field trip to a training course covering primary health care that was run by the Traditional Healers Organization (THO) in Swaziland was of particular interest because of the strong traditional medicine sector in many African countries. IBFAN Africa encourages use of community workers (traditional healers, Rural Health

  1. Incidental prostate cancer prevalence at radical cystoprostatectomy--importance of the histopathological work-up.

    PubMed

    Wetterauer, C; Weibel, M; Gsponer, J R; Vlajnic, T; Zellweger, T; Bütikofer, S; Müller, G; Püschel, H; Bachmann, A; Gasser, T C; Bubendorf, L; Rentsch, C A

    2014-12-01

    The reported incidental prostate cancer prevalence rates at radical cystoprostatectomy cover a range from 4 to 60 %. We investigated the influence of the histopathological work-up on prostate cancer prevalence rates. We identified 114 patients who had undergone cystoprostatectomy for bladder cancer between 2000 and 2012. Complete histopathological assessment was defined as follows: (i) complete embedding of the prostate gland, (ii) sectioning of 15 or more prostate sections, and (iii) processing as whole mount slides. Prostate cancer prevalence rates derived from complete and incomplete histopathological assessments were compared. The overall prostate cancer prevalence rate was 59.6 %. A mean of 14.4 macroscopic tissue sections (thickness 3-5 mm) were sectioned. Sectioning ≥15 sections resulted in a prostate cancer detection rate of 75 %, compared to 42.6 % when sectioning <15 sections (p < 0.001). Complete embedding yielded a prostate cancer detection rate of 72.3 and of 23.1 % for partly embedded prostates (p < 0.0001). Prostate cancer was detected in 68.8 % of the whole mounted samples and in 38.2 % of the samples sectioned as standard slides (p < 0.01); according to the criteria described by Epstein and Ohori, 44.1 % of the detected prostate cancers were clinically significant. The quality of the histopathological work-up significantly influences prostate cancer detection rates and might at least partially explain the highly variable reported incidental prostate cancer prevalence rates at cystoprostatectomy (CP). The high proportion of significant prostate cancer found in our series calls for a careful surgical approach to the prostate during CP. PMID:25269630

  2. Assessment of erythroid dysplasia by "difference from normal" in routine clinical flow cytometry work-up.

    PubMed

    Eidenschink Brodersen, Lisa; Menssen, Andrew J; Wangen, Jamie R; Stephenson, Christine F; de Baca, Monica E; Zehentner, Barbara K; Wells, Denise A; Loken, Michael R

    2014-10-21

    Introduction: While multidimensional flow cytometry (MDF) has great utility in diagnostic work-ups of patients with suspected myelodysplastic syndromes (MDS), only the myeloid lineage has demonstrated reproducible abnormalities from multiple laboratories. With the effects of ammonium chloride (NH4 Cl) lysis on erythroid progenitors previously described, we applied this protocol to a patient cohort with diagnosed MDS to investigate phenotypic abnormalities that indicate erythroid dysplasia. Method: Bone marrow specimens [39 MDS, 9 acute myeloid leukemia (AML), 7 JAK2(V617F) positive myeloproliferative neoplasms (MPN), 5 nutritional deficiencies] were processed by NH4 Cl lysis and Ficoll preparation and evaluated by MDF using a difference from normal algorithm. Results: For the MDS cohort, phenotypic abnormalities on the mature erythroid progenitors were frequent for CD71 and CD36 (36% for each antigen); abnormalities for CD235a (8%) were observed. Among immature erythroid progenitors, abnormal maturation patterns (≤5%) and increased CD105 intensity (9%) were seen. Increased frequency of CD105 bright cells was observed (18%). While antigenic abnormalities correlated between NH4 Cl lysis and Ficoll preparation, the lysis method demonstrated the most consistent quantitative antigen intensities. Mean erythroid phenotypic abnormalities and prognostic cytogenetic subgroups correlated strongly. Morphologic and erythroid phenotypic abnormalities correlated, as did increasing FCSS and number of erythroid abnormalities, albeit without further increase for AML patients. Discussion: These data expand the understanding of erythropoiesis and define immunophenotypic abnormalities that indicate dyserythropoiesis in MDS utilizing a lysis protocol practical for routine implementation in clinical flow cytometric work-up. Preliminary studies also indicate strong correlation between phenotypic erythroid dysplasia and poor prognosis, as classified cytogenetically. © 2014 Clinical

  3. Implementing a Case Management Initiative in High-Need Schools

    PubMed Central

    Gifford, Elizabeth J.

    2013-01-01

    States continue to experiment with ways of improving health and human service use by people with complex needs. Such efforts have often sought to increase individual and family control over services as well as to enhance coordination among providers. Paths to achieving these goals are not well understood. This study draws on two previously distinct conceptual frameworks to examine how 71 public schools implemented a team approach to increasing family and agency engagement for children at risk. Results from longitudinal data fit the core components expected to affect implementation and also indicated sustainability, but in ways distinctive to the initiative's public school settings. Accountability to the state appeared to be a major catalyst, yet in some respects also constrained local agencies from participating as intended. School inertia may have both undermined the program through some evaluation practices and gaps in administrative support, and supported integration into organizational routines and successful experimentation over time in increasing caregiver involvement. Family hesitation about sharing information with multiple agencies may also help explain why the goal of seamless coordination remains elusive. PMID:23976809

  4. 7 CFR 4290.360 - Initial review of Applicant's management team's qualifications.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... INVESTMENT COMPANY (âRBICâ) PROGRAM Evaluation and Selection of RBICs § 4290.360 Initial review of Applicant... Applicant concerning the qualifications of the Applicant's management team to determine in his or her...

  5. 7 CFR 4290.360 - Initial review of Applicant's management team's qualifications.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... INVESTMENT COMPANY (âRBICâ) PROGRAM Evaluation and Selection of RBICs § 4290.360 Initial review of Applicant... Applicant concerning the qualifications of the Applicant's management team to determine in his or her...

  6. 7 CFR 4290.360 - Initial review of Applicant's management team's qualifications.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... INVESTMENT COMPANY (âRBICâ) PROGRAM Evaluation and Selection of RBICs § 4290.360 Initial review of Applicant... Applicant concerning the qualifications of the Applicant's management team to determine in his or her...

  7. 7 CFR 4290.360 - Initial review of Applicant's management team's qualifications.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... INVESTMENT COMPANY (âRBICâ) PROGRAM Evaluation and Selection of RBICs § 4290.360 Initial review of Applicant... Applicant concerning the qualifications of the Applicant's management team to determine in his or her...

  8. 7 CFR 4290.360 - Initial review of Applicant's management team's qualifications.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... INVESTMENT COMPANY (âRBICâ) PROGRAM Evaluation and Selection of RBICs § 4290.360 Initial review of Applicant... Applicant concerning the qualifications of the Applicant's management team to determine in his or her...

  9. 43 CFR 2920.3 - Bureau of Land Management initiated land use proposals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... initiated land use proposals. Where, as a result of the land use planning process, the desirability of... lands is demonstrated, the authorized officer may identify a use for the public land and notify the... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Bureau of Land Management initiated...

  10. 43 CFR 2920.3 - Bureau of Land Management initiated land use proposals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... initiated land use proposals. Where, as a result of the land use planning process, the desirability of... lands is demonstrated, the authorized officer may identify a use for the public land and notify the... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Bureau of Land Management initiated...

  11. 43 CFR 2920.3 - Bureau of Land Management initiated land use proposals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... initiated land use proposals. Where, as a result of the land use planning process, the desirability of... lands is demonstrated, the authorized officer may identify a use for the public land and notify the... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Bureau of Land Management initiated...

  12. 43 CFR 2920.3 - Bureau of Land Management initiated land use proposals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... initiated land use proposals. Where, as a result of the land use planning process, the desirability of... lands is demonstrated, the authorized officer may identify a use for the public land and notify the... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Bureau of Land Management initiated...

  13. Implementation guide for Hanford Tanks Initiative C-106 heel retrieval contract management HNF-2511

    SciTech Connect

    McDaniel, L.B.

    1998-04-17

    This report is an Implementation Guide for Hanford Tanks Initiative C-106 heel retrieval contract management HNF-2511 to provide a set of uniform instructions for managing the two contractors selected. The primary objective is to produce the necessary deliverables and services for the HTI project within schedule and budget.

  14. Paradise nearly Gained. Volume 2: Case Studies of Impact and Diversity for Frontline Management Initiative Practice.

    ERIC Educational Resources Information Center

    Barratt-Pugh, Llandis; Soutar, Geoffrey N.

    This document presents the case studies from a multi-phase study of the impact of Australia's Frontline Management Initiative (FMI), which provides a framework for competency-based development of frontline managers in Australian enterprises. Nineteen organizational case studies and one individual case study of the FMI's impacts are included. The…

  15. Clinical utility of BOLD fMRI in preoperative work-up of epilepsy

    PubMed Central

    Ganesan, Karthik; Ursekar, Meher

    2014-01-01

    Surgical techniques have emerged as a viable therapeutic option in patients with drug refractory epilepsy. Pre-surgical evaluation of epilepsy requires a comprehensive, multiparametric, and multimodal approach for precise localization of the epileptogenic focus. Various non-invasive techniques are available at the disposal of the treating physician to detect the epileptogenic focus, which include electroencephalography (EEG), video-EEG, magnetic resonance imaging (MRI), functional MRI including blood oxygen level dependent (BOLD) techniques, single photon emission tomography (SPECT), and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET). Currently, non-invasive high-resolution MR imaging techniques play pivotal roles in the preoperative detection of the seizure focus, and represent the foundation for successful epilepsy surgery. BOLD functional magnetic resonance imaging (fMRI) maps allow for precise localization of the eloquent cortex in relation to the seizure focus. This review article focuses on the clinical utility of BOLD (fMRI) in the pre-surgical work-up of epilepsy patients. PMID:24851002

  16. Optimising the Pre-Operative Investigative Work Up for Elective Surgical Patients

    PubMed Central

    Hack-Adams, Nadine; king, natalie; Ahuja, Manisha; M Higgs, Simon

    2015-01-01

    Effective pre-operative assessment of patients awaiting elective surgery should entail appropriate use of scarce NHS resources, as well as underpin patient safety. The pre-operative admissions service in district general hospitals is often junior doctor led, with a new cohort of clinicians taking over its running every four months. Lack of familiarity on the part of these clinicians with the investigative work up required for certain surgical procedures often results in over investigation of patients in the pre-admission setting, wasting time and NHS resources. A retrospective audit of 53 patients who underwent laparoscopic cholecystectomy over a representative two month period demonstrated that 33% of patients received unnecessary pre-admission blood tests, including clotting screen and ‘group and save’. Design and implementation of a “Pre-Admission Handbook”, for use by junior doctors and nurse practitioners in the pre-operative setting, reduced the rate of over investigation to 12% in a subsequent, prospective audit cycle of 50 patients, and has improved patient care by standardising the pre-admissions process for elective surgery at Gloucester Royal Hospital. PMID:26734393

  17. Prerequisite work-up of the couple before in-vitro fertilization.

    PubMed

    Ron-El, R; Bracha, Y; Herman, A; Golan, A; Soffer, Y; Bukovsky, I; Caspi, E

    1992-04-01

    Prerequisite examinations, including immune status for rubella and hepatitis B antigens, cultures for Chlamydia trachomatis and mycoplasmas, Pap smear and hystersalpingogram were performed in 227 couples before their enrollment into an in-vitro fertilization (IVF) programme. The examinations were completed in 187 couples. Immune status for rubella had already been documented in 45% of the women: of the remainder, 11 patients were not immune (6%). A screening test for hepatitis B antigens had already been documented in only 10% of the patients; eight of the remaining women (5%) were carriers of hepatitis B antigen. C. trachomatis and Mycoplasma hominis were each isolated from 14% of the patients and Ureaplasma urealiticum from 16%. Pap smears had been previously performed in only 35% of the enrolled women. Six (5%) of the 122 newly referred cases had cervical intra-epithelial dysplasia. In 21 (11%) cases some pathology in the uterine cavity was demonstrated. One patient conceived after diagnostic hysteroscopy; another two patients conceived following lysis of adhesions and before IVF treatment. The results of this study show the importance of the preparatory examinations before the IVF and embryo transfer procedure, and raise the medical and medico-legal aspects of this prerequisite work-up. PMID:1522189

  18. Managing Systemic Curriculum Change: A Critical Analysis of Hong Kong's Target-Oriented Curriculum Initiative.

    ERIC Educational Resources Information Center

    Carless, David

    1997-01-01

    Describes Hong Kong's Target-Oriented Curriculum (TOC), a major curriculum renewal initiative designed to improve the quality of learning in local primary schools. Discusses the context in which it was introduced and factors that proved problematic in managing change. Focuses on five elements in the change process: practicality, ownership, teacher…

  19. Self-Management of Social Initiations by Kindergarten Students with Disabilities in the General Education Classroom

    ERIC Educational Resources Information Center

    Reynolds, Brooke M.; Gast, David L.; Luscre, Deanna

    2014-01-01

    The effectiveness of a self-management intervention on social interaction behaviors was evaluated for students with disabilities and social deficits. Four students enrolled in a general education kindergarten classroom were taught to self-monitor social initiations during nonstructured social time via a digital wrist counter. The number of social…

  20. Statewide Adoption and Initial Implementation of Contingency Management for Substance-Abusing Adolescents

    ERIC Educational Resources Information Center

    Henggeler, Scott W.; Chapman, Jason E.; Rowland, Melisa D.; Halliday-Boykins, Colleen A.; Randall, Jeff; Shackelford, Jennifer; Schoenwald, Sonja K.

    2008-01-01

    Four hundred thirty-two public sector therapists attended a workshop in contingency management (CM) and were interviewed monthly for the following 6 months to assess their adoption and initial implementation of CM to treat substance-abusing adolescent clients. Results showed that 58% (n = 131) of the practitioners with at least one…

  1. 77 FR 11798 - Federal Housing Administration (FHA) Risk Management Initiatives: Revised Seller Concessions...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-28

    ... URBAN DEVELOPMENT 24 CFR Chapter II Federal Housing Administration (FHA) Risk Management Initiatives... Counsel, HUD. ACTION: Correction. SUMMARY: On February 23, 2012 (77 FR 10695), HUD published a request for... methods for submitting public comments. All submissions must refer to the docket number (FR-5572-N-01)...

  2. Technology Transfer and Innovation Initiatives in Strategic Management: Generating an Alternative Perspective

    ERIC Educational Resources Information Center

    Major, E.

    2003-01-01

    This paper taps the strategic management discipline to inform our understanding of technology transfer and innovation (TTI) initiatives. With special focus on the UK Foresight programme it considers the impacts that the resource-based and core competence approaches to strategy can have on understanding the nature and effectiveness of TTI…

  3. 13 CFR 107.140 - SBA approval of initial Management Expenses.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false SBA approval of initial Management Expenses. 107.140 Section 107.140 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION SMALL BUSINESS INVESTMENT COMPANIES Qualifying for an SBIC License Organizing An Sbic § 107.140 SBA approval...

  4. 13 CFR 107.140 - SBA approval of initial Management Expenses.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 13 Business Credit and Assistance 1 2013-01-01 2013-01-01 false SBA approval of initial Management Expenses. 107.140 Section 107.140 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION SMALL BUSINESS INVESTMENT COMPANIES Qualifying for an SBIC License Organizing An Sbic § 107.140 SBA approval...

  5. 13 CFR 107.140 - SBA approval of initial Management Expenses.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false SBA approval of initial Management Expenses. 107.140 Section 107.140 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION SMALL BUSINESS INVESTMENT COMPANIES Qualifying for an SBIC License Organizing An Sbic § 107.140 SBA approval...

  6. 13 CFR 107.140 - SBA approval of initial Management Expenses.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 13 Business Credit and Assistance 1 2014-01-01 2014-01-01 false SBA approval of initial Management Expenses. 107.140 Section 107.140 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION SMALL BUSINESS INVESTMENT COMPANIES Qualifying for an SBIC License Organizing An Sbic § 107.140 SBA approval...

  7. 13 CFR 107.140 - SBA approval of initial Management Expenses.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 13 Business Credit and Assistance 1 2012-01-01 2012-01-01 false SBA approval of initial Management Expenses. 107.140 Section 107.140 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION SMALL BUSINESS INVESTMENT COMPANIES Qualifying for an SBIC License Organizing An Sbic § 107.140 SBA approval...

  8. 40 CFR 63.11584 - What are my initial and continuous compliance management practice requirements?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 14 2010-07-01 2010-07-01 false What are my initial and continuous compliance management practice requirements? 63.11584 Section 63.11584 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES...

  9. New mechanism under International Flood Initiative toward robustness for flood management in the Asia Pacific region

    NASA Astrophysics Data System (ADS)

    Murase, M.; Yoshitani, J.; Takeuchi, K.; Koike, T.

    2015-12-01

    Climate change is likely to result in increases in the frequency or intensity of extreme weather events. It is imperative that a good understanding is developed of how climate change affects the events that are reflected in hydrological extremes such as floods and how practitioners in water resources management deal with them. Since there is still major uncertainty as to how the impact of climate change affect actual water resources management, it is important to build robustness into management schemes and communities. Flood management under such variety of uncertainty favors the flexible and adaptive implementation both in top-down and bottom-up approaches. The former uses projections of global or spatially downscaled models to drive resource models and project resource impacts. The latter utilizes policy or planning tools to identify what changes in climate would be most threatening to their long-range operations. Especially for the bottom-up approaches, it is essential to identify the gap between what should be done and what has not been achieved for disaster risks. Indicators or index are appropriate tools to measure such gaps, but they are still in progress to cover the whole world. The International Flood Initiative (IFI), initiated in January 2005 by UNESCO and WMO in close cooperation with UNU and ISDR, IAHS and IAHR, has promoted an integrated approach to flood management to take advantage of floods and use of flood plains while reducing the social, environmental and economic risks. Its secretariat is located in ICHARM. The initiative objective is to support national platforms to practice evidence-based disaster risk reduction through mobilizing scientific and research networks at national, regional and international levels. The initiative is now preparing for a new mechanism to facilitate the integrated approach for flood management on the ground regionally in the Asia Pacific (IFI-AP) through monitoring, assessment and capacity building.

  10. Waste Management Improvement Initiatives at Atomic Energy of Canada Limited - 13091

    SciTech Connect

    Chan, Nicholas; Adams, Lynne; Wong, Pierre

    2013-07-01

    Atomic Energy of Canada Limited's (AECL) Chalk River Laboratories (CRL) has been in operation for over 60 years. Radioactive, mixed, hazardous and non-hazardous wastes have been and continue to be generated at CRL as a result of research and development, radioisotope production, reactor operation and facility decommissioning activities. AECL has implemented several improvement initiatives at CRL to simplify the interface between waste generators and waste receivers: - Introduction of trained Waste Officers representing their facilities or activities at CRL; - Establishment of a Waste Management Customer Support Service as a Single-Point of Contact to provide guidance to waste generators for all waste management processes; and - Implementation of a streamlined approach for waste identification with emphasis on early identification of waste types and potential disposition paths. As a result of implementing these improvement initiatives, improvements in waste management and waste transfer efficiencies have been realized at CRL. These included: 1) waste generators contacting the Customer Support Service for information or guidance instead of various waste receivers; 2) more clear and consistent guidance provided to waste generators for waste management through the Customer Support Service; 3) more consistent and correct waste information provided to waste receivers through Waste Officers, resulting in reduced time and resources required for waste management (i.e., overall cost); 4) improved waste minimization and segregation approaches, as identified by in-house Waste Officers; and 5) enhanced communication between waste generators and waste management groups. (authors)

  11. Shared Care: A Quality Improvement Initiative to Optimize Primary Care Management of Constipation

    PubMed Central

    Vernacchio, Louis; Trudell, Emily; Antonelli, Richard; Nurko, Samuel; Leichtner, Alan M.; Lightdale, Jenifer R.

    2015-01-01

    BACKGROUND: Pediatric constipation is commonly managed in the primary care setting, where there is much variability in management and specialty referral use. Shared Care is a collaborative quality improvement initiative between Boston Children’s Hospital and the Pediatric Physician’s Organization at Children’s (PPOC), through which subspecialists provide primary care providers with education, decision-support tools, pre-referral management recommendations, and access to advice. We investigated whether Shared Care reduces referrals and improves adherence to established clinical guidelines. METHODS: We reviewed the primary care management of patients 1 to 18 years old seen by a Boston Children’s Hospital gastroenterologist and diagnosed with constipation who were referred from PPOC practices in the 6 months before and after implementation of Shared Care. Charts were assessed for patient factors and key components of management. We also tracked referral rates for all PPOC patients for 29 months before implementation and 19 months after implementation. RESULTS: Fewer active patients in the sample were referred after implementation (61/27 365 [0.22%] vs 90/27 792 [0.36%], P = .003). The duration of pre-referral management increased, and the rate of fecal impaction decreased after implementation. No differences were observed in documentation of key management recommendations. Analysis of medical claims showed no statistically significant change in referrals. CONCLUSIONS: A multifaceted initiative to support primary care management of constipation can alter clinical care, but changes in referral behavior and pre-referral management may be difficult to detect and sustain. Future efforts may benefit from novel approaches to provider engagement and systems integration. PMID:25896837

  12. Coagulation disorders and their cutaneous presentations: Diagnostic work-up and treatment.

    PubMed

    Dabiri, Ganary; Damstetter, Elizabeth; Chang, Yunyoung; Baiyee Ebot, Emily; Powers, Jennifer Gloeckner; Phillips, Tania

    2016-05-01

    Both inherited and acquired hypercoagulable states can present with nonspecific clinical manifestations, such as petechiae, purpura, livedo reticularis, and ulcerations. A good history and physical examination are crucial to diagnoses of these conditions. Inherited conditions tend to present either in neonatal period or later in life, while acquired conditions typically occur later in life. Diagnostic studies are performed to identify the coagulation cascade deficiency or defect. Treatment primarily hinges on anticoagulation and wound care. In this article, we provide an in-depth analysis of the clinical manifestations, diagnostic considerations, and management options of patients in hypercoagulable states. PMID:27085226

  13. A Performance Management Initiative for Local Health Department Vector Control Programs

    PubMed Central

    Gerding, Justin; Kirshy, Micaela; Moran, John W.; Bialek, Ron; Lamers, Vanessa; Sarisky, John

    2016-01-01

    Local health department (LHD) vector control programs have experienced reductions in funding and capacity. Acknowledging this situation and its potential effect on the ability to respond to vector-borne diseases, the U.S. Centers for Disease Control and Prevention and the Public Health Foundation partnered on a performance management initiative for LHD vector control programs. The initiative involved 14 programs that conducted a performance assessment using the Environmental Public Health Performance Standards. The programs, assisted by quality improvement (QI) experts, used the assessment results to prioritize improvement areas that were addressed with QI projects intended to increase effectiveness and efficiency in the delivery of services such as responding to mosquito complaints and educating the public about vector-borne disease prevention. This article describes the initiative as a process LHD vector control programs may adapt to meet their performance management needs. This study also reviews aggregate performance assessment results and QI projects, which may reveal common aspects of LHD vector control program performance and priority improvement areas. LHD vector control programs interested in performance assessment and improvement may benefit from engaging in an approach similar to this performance management initiative. PMID:27429555

  14. Pain Management in Long-Term Care Communities: A Quality Improvement Initiative

    PubMed Central

    Reid, Cary; O’Neil, Kevin W.; Dancy, JaNeen; Berry, Carolyn A.; Stowell, Stephanie A.

    2015-01-01

    Pain is underrecognized and undertreated in the long-term care (LTC) setting. To improve the management of pain for LTC residents, the authors implemented a quality improvement (QI) initiative at one LTC facility. They conducted a needs assessment to identify areas for improvement and designed a 2-hour educational workshop for facility staff and local clinicians. Participants were asked to complete a survey before and after the workshop, which showed significant improvement in their knowledge of pain management and confidence in their ability to recognize and manage residents’ pain. To measure the effectiveness of the QI initiative, the authors performed a chart review at baseline and at 3 and 8 months after the workshop and evaluated relevant indicators of adequate pain assessment and management. The post-workshop chart reviews showed significant improvement in how consistently employees documented pain characteristics (ie, location, intensity, duration) in resident charts and in their use of targeted pain assessments for residents with cognitive dysfunction. The proportion of charts that included a documented plan for pain assessment was high at baseline and remained stable throughout the study. Overall, the findings suggest a QI initiative is an effective way to improve pain care practices in the LTC setting. PMID:25949232

  15. Children with Developmental Language Delay at 24 Months of Age: Results of a Diagnostic Work-Up

    ERIC Educational Resources Information Center

    Buschmann, Anke; Jooss, Bettina; Rupp, Andre; Dockter, Sonja; Blaschtikowitz, Heike; Heggen, Iris; Pietz, Joachim

    2008-01-01

    The aim of this study was to evaluate if a diagnostic work-up should be recommended for 2-year-old children with developmental language delay (LD), or if the widely chosen "wait and see" strategy is adequate. Children with LD were identified in paediatric practices during routine developmental check-ups using a German parent-report screening…

  16. The National Oncology Working Group (NOW) initiative: payer and provider collaborations in oncology benefits management.

    PubMed

    Soper, Aileen M; Reeder, C E; Brown, Loreen M; Stojanovska, Ana; Lennert, Barbara J

    2010-04-01

    Payers recognize the need to expand benefits management for oncology but struggle to find effective solutions amid the complexity of available therapies and skepticism from oncologists, who are facing their own set of economic pressures. An effort called the National Oncology Working Group (NOW) Initiative is trying to change the sometimes adversarial relationship between payers and oncologists through a collaborative model. The group, which is supported by pharmaceutical manufacturer sanofi-aventis, is developing patient-centered strategies for successful and sustainable oncology benefits management. The focus includes finding consensus between payers and providers and devising solutions for oncology management such as decreasing variability of cancer care and improving end-of-life care for patients with terminal illness. NOW is designing tools that will be tested in small-scale regional demonstration projects, which NOW participants anticipate will set an example for successful oncology benefits management that can be replicated and expanded. PMID:20370311

  17. Transjugular Intrahepatic Portosystemic Shunt: Indications, Contraindications, and Patient Work-Up

    PubMed Central

    Copelan, Alexander; Kapoor, Baljendra; Sands, Mark

    2014-01-01

    The transjugular intrahepatic portosystemic shunt (TIPS) procedure is effective in achieving portal decompression and in managing some of the major complications of portal hypertension. While many clinicians are familiar with the two most common indications for TIPS placement, secondary prophylaxis of esophageal variceal hemorrhage and treatment of refractory ascites, evidence for its usefulness is growing in other entities, where it has been less extensively studied but demonstrates promising results. Newer indications include early utilization in the treatment of esophageal variceal hemorrhage, Budd–Chiari syndrome, ectopic varices, and portal vein thrombosis. The referring clinician and interventionist must remain cognizant of the contraindications to the procedure to avoid complications and potential harm to the patient. This review is designed to provide an in-depth analysis of the most common as well as less typical indications for TIPS placement, and to discuss the contraindications and appropriate patient evaluation for this procedure. PMID:25177083

  18. Initial development of a practical safety audit tool to assess fleet safety management practices.

    PubMed

    Mitchell, Rebecca; Friswell, Rena; Mooren, Lori

    2012-07-01

    Work-related vehicle crashes are a common cause of occupational injury. Yet, there are few studies that investigate management practices used for light vehicle fleets (i.e. vehicles less than 4.5 tonnes). One of the impediments to obtaining and sharing information on effective fleet safety management is the lack of an evidence-based, standardised measurement tool. This article describes the initial development of an audit tool to assess fleet safety management practices in light vehicle fleets. The audit tool was developed by triangulating information from a review of the literature on fleet safety management practices and from semi-structured interviews with 15 fleet managers and 21 fleet drivers. A preliminary useability assessment was conducted with 5 organisations. The audit tool assesses the management of fleet safety against five core categories: (1) management, systems and processes; (2) monitoring and assessment; (3) employee recruitment, training and education; (4) vehicle technology, selection and maintenance; and (5) vehicle journeys. Each of these core categories has between 1 and 3 sub-categories. Organisations are rated at one of 4 levels on each sub-category. The fleet safety management audit tool is designed to identify the extent to which fleet safety is managed in an organisation against best practice. It is intended that the audit tool be used to conduct audits within an organisation to provide an indicator of progress in managing fleet safety and to consistently benchmark performance against other organisations. Application of the tool by fleet safety researchers is now needed to inform its further development and refinement and to permit psychometric evaluation. PMID:22342958

  19. [Key messages for the initial management of the elderly patient with acute heart failure].

    PubMed

    Martín-Sánchez, F Javier; Rodríguez-Adrada, Esther; Llorens, Pere; Formiga, Francesc

    2015-01-01

    Acute heart failure is a high prevalence geriatric syndrome that has become one of the most frequent causes of visits to emergency departments, as well as hospital admission, and is associated with high morbidity, mortality and functional impairment. There has been an increasing amount of information published in recent years on the initial management of acute heart failure and the results of the short-term outcomes, as well as the natural history of the disease. The objective of this study is to provide several recommendations that should be taken into account in the initial management of the elderly patient with acute heart failure in the emergency departments, and to review the most interesting currently on-going clinical trials. PMID:25959134

  20. Setting the Stage: Measure Selection, Coordination, and Data Collection for a National Self-Management Initiative

    PubMed Central

    Kulinski, Kristie P.; Boutaugh, Michele; Smith, Matthew Lee; Ory, Marcia G.; Lorig, Kate

    2015-01-01

    This paper describes the history and rationale behind the development of a centralized data collection system for the national rollout of the Chronic Disease Self-Management Program (CDSMP) through the American Recovery and Reinvestment Act of 2009 Communities Putting Prevention to Work: CDSMP initiative. In addition to justifying the need for solutions to the burgeoning burden of chronic disease in the United States, this paper provides details about CDSMP and related self-management education programs, including their structure, facilitator training, and effectiveness. These topics set the stage for the processes and procedures to create and manage the database for use at the national, state, and local levels. Furthermore, this paper describes the processes related to selecting variables, coordinating data collection, and utilizing data to inform research and policy. PMID:25964919

  1. Data initiatives: building a managed care network utilizing clinical performance data.

    PubMed

    Tilley, S; Bomberger, D; Ackroyd, T; Smith, A; Hamory, B

    1996-01-01

    Responding to the rising health care costs of its traditional indemnity health care plan, Hershey Foods Corporation developed its own managed care plan as part of the company strategy to better control its health care costs. In developing a provider network for its managed care plan, Hershey Foods utilized data from the Pennsylvania Health Care Cost Containment Council and the expertise of many different groups, health care data consultants (Healthcare Research Affiliates), the insurance provider (Capital Blue Cross/Pennsylvania Blue Shield), health care providers, as well as the employees and their union representatives. Selection of providers for the network necessitated a data initiative that analyzed indicators of quality and cost efficiency. This article explores the roles of these different groups in building the managed care network for Hershey and examines the organizational changes within these different groups to accommodate the Hershey Foods project. PMID:8763228

  2. Initial Management and Evaluation of the Multisystem Injured Patient, Part 1

    PubMed Central

    Jacobs, Lenworth M.

    1987-01-01

    Trauma is the fourth leading cause of death for all Americans, with a mortality rate of 61 deaths per 100,000 people. Although the definitive place for the management of major abdominal or thoracic hemorrhage, as well as neurological or orthopedic problems, is the operating room in a tertiary care hospital, trauma is a time-related disease, and the more quickly hemorrhage is controlled and appropriate management initiated, the better the outcome. The author outlines a systematic approach to prehospital management of the trauma patient that includes a primary survey and a secondary survey. The primary survey (Part 1) focuses on life-threatening conditions that affect the airway and methods to clear the airway immediately. Once the airway is cleared, any anatomical or physiologic compromise that limits ventilation is identified and corrected, hemorrhage is controlled, and the cervical spine, if injury is suspected, is protected. The secondary survey (Part 2) is a comprehensive examination. PMID:3586032

  3. The Family Medicine Residency Training Initiative in Miscarriage Management: Impact on Practice in Washington State

    PubMed Central

    Darney, Blair G.; Weaver, Marcia R.; Stevens, Nancy; Kimball, Jeana; Prager, Sarah W.

    2013-01-01

    BACKGROUND AND OBJECTIVES Non-complicated spontaneous abortion cases should be counseled about the full range of management approaches, including uterine evacuation using manual vacuum aspiration (MVA). The Residency Training Initiative in Miscarriage Management (RTI-MM) is an intensive, multidimensional intervention designed to facilitate implementation of office-based management of spontaneous abortion using MVA in family medicine residency settings. The purpose of this study was to test the impact of the RTI-MM on self-reported use of MVA for management of spontaneous abortion. METHODS We used a pretest/posttest one group study design and a web-based, anonymous survey to collect data on knowledge, attitudes, perceived barriers, and practice of office-based management of spontaneous abortion. We used multivariable models to estimate incident relative risks and accounted for data clustering at the residency site level. RESULTS Our sample included 441 residents and faculty from 10 family medicine residency sites. Our findings show a positive association between the RTI-MM and self-reported use of MVA for management of spontaneous abortion (adjusted RR=9.11 [CI=4.20-19.78]) and were robust to model specification. Male gender, doing any type of management of spontaneous abortion (eg, expectant, medication), other on-site reproductive health training interventions, and support staff knowledge scores were also significant correlates of physician practice of MVA. CONCLUSIONS Our findings suggest that the RTI-MM was successful in influencing the practice of management of spontaneous abortion using MVA in this population and that support staff knowledge may impact physician practice. Integrating MVA into family medicine settings would potentially improve access to evidence-based, comprehensive care for women. PMID:23378077

  4. Nurse and manager perceptions of nurse initiated and managed antiretroviral therapy (NIMART) implementation in South Africa: a qualitative study

    PubMed Central

    Davies, Natasha Elaine Claire Garai; Homfray, Mike; Venables, Emilie Charlotte

    2013-01-01

    Objective To explore nurse and facility and programme manager perceptions of nurse initiated and managed antiretroviral therapy (NIMART) implementation in Gauteng, South Africa. Design In this qualitative study, in-depth interviews and focus group discussions were conducted to gain insight into participants’ experiences of NIMART implementation. Setting Participants came from urban, peri-urban and rural primary healthcare clinics in two Gauteng Province municipalities. Participants 25 nurses and 18 managers who were actively involved in NIMART implementation were purposively sampled. Results The findings from this study reveal that, despite encountering numerous challenges including human resources, training and clinical mentoring and health systems issues, NIMART nurses and managers remained optimistic about their work. Study participants felt empowered by their expanded roles. Increased responsibilities associated with NIMART implementation encouraged better use of creative problem-solving and teamwork to facilitate integration of NIMART into existing clinic services. NIMART nurses perceived antiretroviral therapy (ART) patients to be more insightful about their illness, engaged in their HIV treatment and aware of the importance of adherence which enhanced nurse–patient relationships and increased their sense of job satisfaction. Conclusions Although the implementation of NIMART is complex, when NIMART is implemented well, ART access is increased and patient outcomes are improved. Supportive interventions which address the specific challenges faced by nurses providing NIMART now need to be implemented. Attempts should be made to replicate the positive aspects of NIMART implementation identified by participants as this may improve healthcare providers’ experiences of task-shifting. PMID:24240142

  5. Wyoming Landscape Conservation Initiative Science and Management Workshop Proceedings, May 12-14, 2009, Laramie, Wyoming

    USGS Publications Warehouse

    2010-01-01

    The U.S. Geological Survey (USGS) hosted the second Wyoming Landscape Conservation Initiative (WLCI) Science and Management Workshop at the University of Wyoming Conference Center and Hilton Garden Inn on May 12, 13, and 14, 2009, in Laramie, Wyo. The workshop focused on six topics seen as relevant to ongoing WLCI science and management activities: mapping and modeling resources for decisionmaking; data information and management; fish and wildlife research; changing landscapes; monitoring; and reclamation and offsite mitigation. Panelists gave presentations on ongoing research in these six areas during plenary sessions followed by audience discussions. Three breakout groups focused on discussing wildlife, reclamation, and monitoring. Throughout the plenary sessions, audience discussions, and breakout groups, several needs were repeatedly emphasized by panelists and workshop participants: developing a conservation plan and identifying priority areas and species for conservation actions; gaining a deeper understanding of sagebrush ecology; identifying thresholds for wildlife that can be used to create an 'early warning system' for managers; continuing to collect basic data across the landscape; facilitating even greater communication and partnership across agencies and between scientists and land managers; and engaging proactively in understanding new changes on the landscape such as wind energy development and climate change. Detailed proceedings from the workshop are captured and summarized in this report.

  6. An assessment of technology alternatives for telecommunications and information management for the space exploration initiative

    NASA Technical Reports Server (NTRS)

    Ponchak, Denise S.; Zuzek, John E.

    1991-01-01

    On the 20th anniversary of the Apollo 11 lunar landing, President Bush set forth ambitious goals for expanding human presence in the solar system. The Space Exploration Initiative (SEI) addresses these goals beginning with Space Station Freedom, followed by a permanent return to the Moon, and a manned mission to Mars. A well designed, adaptive Telecommunications, Navigation, and Information Management (TNIM) infrastructure is vital to the success of these missions. Utilizing initial projections of user requirements, a team under the direction of NASA's Office of Space Operations developed overall architectures and point designs to implement the TNIM functions for the Lunar and Mars mission scenarios. Based on these designs, an assessment of technology alternatives for the telecommunications and information management functions was performed. This technology assessment identifies technology developments necessary to meet the telecommunications and information management system requirements for SEI. Technology requirements, technology needs and alternatives, the present level of technology readiness in each area, and a schedule for development are presented.

  7. Ultrasound techniques in the evaluation of the mediastinum, part 2: mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques, clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography

    PubMed Central

    Jenssen, Christian; Annema, Jouke Tabe; Clementsen, Paul; Cui, Xin-Wu; Borst, Mathias Maximilian

    2015-01-01

    Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node (MLN) staging affects the management of patients with both operable and inoperable lung cancer (e.g., surgery vs. combined chemoradiation therapy). Tissue sampling is often indicated for accurate nodal staging. Recent international lung cancer staging guidelines clearly state that endosonography should be the initial tissue sampling test over surgical staging. Mediastinal nodes can be sampled from the airways [endobronchial ultrasound combined with transbronchial needle aspiration (EBUS-TBNA)] or the esophagus [endoscopic ultrasound fine needle aspiration (EUS-FNA)]. EBUS and EUS have a complementary diagnostic yield and in combination virtually all MLNs can be biopsied. Additionally endosonography has an excellent yield in assessing granulomas in patients suspected of sarcoidosis. The aim of this review in two integrative parts is to discuss the current role and future perspectives of all ultrasound techniques available for the evaluation of mediastinal lymphadenopathy and mediastinal staging of lung cancer. A specific emphasis will be on learning mediastinal endosonography. Part 1 deals with an introduction into ultrasound techniques, MLN anatomy and diagnostic reach of ultrasound techniques and part 2 with the clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography. PMID:26623120

  8. Initiatives and outcomes of green supply chain management implementation by Chinese manufacturers.

    PubMed

    Zhu, Qinghua; Sarkis, Joseph; Lai, Kee-hung

    2007-10-01

    This paper aims to explore the green supply chain management (GSCM) initiatives (implementation) of various manufacturing industrial sectors in China and examine the links between GSCM initiatives and performance outcomes. We conducted a survey to collect data from four typical manufacturing industrial sectors in China, namely, power generating, chemical/petroleum, electrical/electronic and automobile, and received 171 valid organizational responses for data analysis. Analysis of variance (ANOVA) was used to analyze the data. The results are consistent with our prediction that the different manufacturing industry types display different levels of GSCM implementation and outcomes. We specifically found that the electrical/electronic industry has relatively higher levels of GSCM implementation and achieves better performance outcomes than the other three manufacturer types. Implications of the results are discussed and suggestions for further research on the implementation of GSCM are offered. PMID:17084502

  9. Herbal Medicine Offered as an Initiative Therapeutic Option for the Management of Hepatocellular Carcinoma.

    PubMed

    Chen, Shao-Ru; Qiu, Hong-Cong; Hu, Yang; Wang, Ying; Wang, Yi-Tao

    2016-06-01

    Hepatocellular carcinoma (HCC) is a common malignant cancer and is the third leading cause of death worldwide. Effective treatment of this disease is limited by the complicated molecular mechanism underlying HCC pathogenesis. Thus, therapeutic options for HCC management are urgently needed. Targeting the Wnt/β-catenin, Hedgehog, Notch, and Hippo-YAP signaling pathways in cancer stem cell development has been extensively investigated as an alternative treatment. Herbal medicine has emerged as an initiative therapeutic option for HCC management because of its multi-level, multi-target, and coordinated intervention effects. In this article, we summarized the recent progress and clinical benefits of targeting the above mentioned signaling pathways and using natural products such as herbal medicine formulas to treat HCC. Proving the clinical success of herbal medicine is expected to deepen the knowledge on herbal medicine efficiency and hasten the adoption of new therapies. Copyright © 2016 John Wiley & Sons, Ltd. PMID:26879574

  10. Evaluation of leadership skills during the simulation education course for the initial management of blunt trauma.

    PubMed

    Schott, Eric; Brautigam, Robert T; Smola, Jacqueline; Burns, Karyl J

    2012-04-01

    Leadership skills of senior residents, trauma fellows, and a nurse practitioner were assessed during simulation training for the initial management of blunt trauma. This was a pilot, observational study, that in addition to skill development and assessment also sought to determine the need for a dedicated leadership training course for surgical residents. The study evaluated the leadership skills and adherence to Advance Trauma Life Support (ATLS) guidelines of the team leaders during simulation training. The team leaders' performances on criteria regarding prearrival planning, critical actions based on ATLS, injury identification, patient management, and communication were evaluated for each of five blunt-trauma scenarios. Although there was a statistically significant increase in leadership skills for performing ATLS critical actions, P < 0.05, there were 10 adverse events. A structured simulation program dedicated to developing skills for team leadership willbe a worthwhile endeavor at our institution. PMID:22611722

  11. Treatment Modalities and Antimicrobial Stewardship Initiatives in the Management of Intra-Abdominal Infections

    PubMed Central

    Hoffmann, Charles; Zak, Matthew; Avery, Lisa; Brown, Jack

    2016-01-01

    Antimicrobial stewardship programs (ASPs) focus on improving the utilization of broad spectrum antibiotics to decrease the incidence of multidrug-resistant Gram positive and Gram negative pathogens. Hospital admission for both medical and surgical intra-abdominal infections (IAIs) commonly results in the empiric use of broad spectrum antibiotics such as fluoroquinolones, beta-lactam beta-lactamase inhibitors, and carbapenems that can select for resistant organisms. This review will discuss the management of uncomplicated and complicated IAIs as well as highlight stewardship initiatives focusing on the proper use of broad spectrum antibiotics. PMID:27025526

  12. A science and technology initiative within the office of civilian radioactive waste management

    USGS Publications Warehouse

    Budnitz, R.J.; Kiess, T.E.; Peters, M.; Duncan, D.

    2003-01-01

    In 2002, by following a national decision-making process that had been specified in the 1982 Nuclear Waste Policy Act, Yucca Mountain (YM) was designated as the site for the nation's geologic repository for commercial spent nuclear fuel (SNF). The U.S. Department of Energy's (DOE's) Office of Civilian Radioactive Waste Management (OCRWM) must now obtain regulatory approval to construct and operate a repository there, and to develop transportation and infrastructure needed to support operations. The OCRWM has also recently begun a separate Science and Technology (S&T) initiative, whose purposes, beginnings, current projects, and future plans are described here.

  13. Diagnostic Work-up and Follow-up in Children with Tall Stature: A Simplified Algorithm for Clinical Practice

    PubMed Central

    Stalman, Susanne E.; Pons, Anke; Wit, Jan M.; Kamp, Gerdine A.; Plötz, Frans B.

    2015-01-01

    Objective: No evidence-based guideline has been published about optimal referral criteria and diagnostic work-up for tall stature in children. The aim of our study was to describe auxological and clinical characteristics of a cohort of children referred for tall stature, to identify potential candidates for adult height reduction, and to use these observations for developing a simple algorithm for diagnostic work-up and follow-up in clinical practice. Methods: Data regarding family and medical history, auxological measurements, bone age development, physical examination, additional diagnostic work-up, and final diagnosis were collected from all children referred for tall stature, irrespective of their actual height standard deviation score (HSDS). Predicted adult height (PAH) was calculated in children above 10 years. Characteristics of patients with an indication for adult height reduction were determined. Results: Hundred thirty-two children (43 boys) with a mean ± SD age of 10.9±3.2 (range 0.5-16.9) years were included in the study. Fifty percent of the referred children had an HSDS ≤2.0 (n=66). Two pathological cases (1.5%) were found (HSDS 2.3 and 0.9). Tall children without pathology were diagnosed as idiopathic tall, further classified as familial tall stature (80%), constitutional advancement of growth (5%), or unexplained non-familial tall stature (15%). Of the 74 children in whom PAH was calculated, epiphysiodesis was considered in six (8%) and performed in four (5%) patients. Conclusion: The incidence of pathology was very low in children referred for tall stature, and few children were potential candidates for adult height reduction. We propose a simple diagnostic algorithm for clinical practice. PMID:26777036

  14. Engaging and empowering patients to manage their type 2 diabetes, Part II: Initiatives for success.

    PubMed

    Jacob, Stephan; Serrano-Gil, Manuel

    2010-10-01

    Type 2 diabetes (T2D) has reached pandemic proportions. The impact of it and its long-term sequelae represent a significant burden for many healthcare systems around the world, and a significant number of patients struggle to achieve the internationally recommended targets for the modifiable risk factors that optimize healthy outcomes. In the first part of this two-part review, the scene was set showing that there seems to be a knowledge, attitude, and practice (KAP) gap hindering successful management of T2D. Although theoretical knowledge about how T2D should be managed exists, the attitude of patients and healthcare professionals seems to influence the practicalities of implementing life-enhancing changes for patients living with diabetes. Following the chronic care model, macro-level initiatives such as Finland's national diabetes program, "The Development Programme for the Prevention and Care of Diabetes" (DEHKO), encourage a coordinated, supportive policy and financial environment for healthcare system change, and are advocated by the International Diabetes Federation. Over a 10-year period, the DEHKO program aims to demonstrate that a top-down population approach to prevention, focusing on reducing obesity, increasing physical activity, and encouraging healthier eating habits, may improve the overall health of the nation. However, the patient is the focus of day-to-day management of T2D, and innovative strategies that use a community (meso-level) approach to encourage self-management, or that embrace new technologies to access diabetes self-management education or support networks, are likely to be the way forward. Such measures may close the apparent KAP gap and bring about real and measurable benefits in quality of life and life expectancy. The second part of this review describes some of the many and varied initiatives designed to engage and empower patients to self-manage their T2D, with the aim of increasing the proportion of patients reaching health

  15. Direct cost for initial management of prostate cancer: a systematic review

    PubMed Central

    Sanyal, C.; Aprikian, A.G.; Chevalier, S.; Cury, F.L.; Dragomir, A.

    2013-01-01

    Background Prostate cancer (pca) is the most common non-skin cancer among men in Canada and other Western countries. Increased prevalence and higher cost of newer treatments have led to a significant rise in the economic burden of pca. The objectives of the present study were to systematically review the literature on direct costs for the initial management of pca, and to examine the methodologic considerations across studies. Methods Bibliographic databases were systematically searched for peer-reviewed articles in English. Studies were reviewed for methodologic considerations and mean direct cost of active surveillance or watchful waiting (as/ww) and initial treatments. Direct cost was standardized to 2011 Canadian dollars. Results After a review of abstracts and full-text papers, seventeen articles met the eligibility criteria and were included in the review. Studies were published during 1992–2010. The studies reported on health care systems in the United States, France, the United Kingdom, German, Italy, and Spain. Our review identified a lack of methodologic consensus, leading to variation in direct costs between studies. Nevertheless, results indicate a significant direct cost of pca treatments. Conclusions The existing literature lacks methodologically rigorous studies on the direct costs of pca treatments specific to publicly funded health care systems. Additional studies are required to appreciate the direct costs of newer treatments and the impact of their adoption on the growing economic burden of pca management. PMID:24311952

  16. CIOMS and ICH initiatives in pharmacovigilance and risk management: overview and implications.

    PubMed

    Tsintis, Panos; La Mache, Edith

    2004-01-01

    In this article we review the current initiatives by the Council for International Organizations of Medical Sciences (CIOMS) and the International Conference on Harmonisation (ICH) on pharmacovigilance planning that are due for general release during 2004. These initiatives could form the basis for applying concepts of risk management to medicines throughout their life cycle, from preclinical and clinical development to marketed use. The CIOMS VI Working Group (with 28 senior scientists worldwide from drug regulatory authorities and pharmaceutical companies) is currently developing scientific guidance that relates to clinical trials for medicines during development. It recommends a developmental pharmacovigilance concept - a 'living' concept that would start early in drug development supporting the science and ethics of research leading up to licensing (marketing authorisation) and continuing to post-authorisation (postmarketing) pharmacovigilance. This approach is seen as complementary to current ICH initiatives called 'Pharmacovigilance Planning'. ICH will introduce two concepts in pharmacovigilance management of medicinal products: the 'Pharmacovigilance Specification' and the 'Pharmacovigilance Plan'. The 'Pharmacovigilance Specification' will summarise important knowns and unknowns about the medicine. It will include safety risks identified at the licensing stage, potential risks and any key missing information. These elements will be essential to the formulation of pharmacovigilance plans. Dialogue and common understanding between regulators and the pharmaceutical industry will be a key factor for developing pharmacovigilance plans during the life cycle of medicines. Appropriate interaction with health professionals and patients should also be planned for the future as regulatory systems become more transparent. Where no significant issues are apparent at the licensing (marketing authorisation) stage, routine pharmacovigilance practices will be followed

  17. The Data Management System for the Shipboard Automated Meteorological and Oceanographic System (SAMOS) Initiative

    NASA Astrophysics Data System (ADS)

    Smith, S. R.; Arko, R. A.; Bourassa, M. A.; Hu, J.; McDonald, M.; Rettig, J.; Rolph, J.

    2009-12-01

    The data assembly center (DAC) for the SAMOS initiative has developed and implemented an automated data management system that collects, formats, quality controls, distributes, and archives near real-time surface marine data from research vessels. A SAMOS is a computerized data logging system that continuously records navigational (ship’s position, course, speed, and heading), meteorological (winds, air temperature, pressure, moisture, rainfall, and radiation), and near-surface oceanographic (sea temperature, salinity, conductivity, florescence) parameters while the vessel is at sea. The SAMOS initiative relies on the high-quality instrumentation purchased and deployed by the research vessel operators and does not provide instrumentation to the vessels. Currently, the SAMOS initiative receives measurements recorded at 1-min intervals and derived from higher frequency samples (on the order of 1 Hz). As of 2009, 21 research vessels provide routine SAMOS observations to the DAC. The data management system automatically tracks progress of the daily data acquisition and quality processing, stores metadata on instrumentation and ships, and provides data monitoring capability via a user-friendly web interface. An SQL database stores essential parameters to support tracking, data quality control, and version control for each file throughout the process. Presently, SAMOS data are acquired directly from research vessels at sea via a daily email transfer protocol. The steps of this NOAA funded protocol will be described along with lessons learned through the development process. A new DAC initiative, funded by NSF, to develop a 2nd SAMOS data acquisition protocol, via collaboration with the Rolling deck to Repository (R2R) project, will be outlined. The new protocol is envisioned to include transmission of the higher frequency meteorological and surface oceanic samples from participating vessels to real-time servers at R2R. The SAMOS DAC will access these samples for data

  18. Diagnostic work up for language testing in patients undergoing awake craniotomy for brain lesions in language areas.

    PubMed

    Bilotta, Federico; Stazi, Elisabetta; Titi, Luca; Lalli, Diana; Delfini, Roberto; Santoro, Antonio; Rosa, Giovanni

    2014-06-01

    Awake craniotomy is the technique of choice in patients with brain tumours adjacent to primary and accessory language areas (Broca's and Wernicke's areas). Language testing should be aimed to detect preoperative deficits, to promptly identify the occurrence of new intraoperative impairments and to establish the course of postoperative language status. Aim of this case series is to describe our experience with a dedicated language testing work up to evaluate patients with or at risk for language disturbances undergoing awake craniotomy for brain tumour resection. Pre- and intra operative testing was accomplished with 8 tests. Intraoperative evaluation was accomplished when patients were fully cooperative (Ramsey < 3). Postoperative evaluation was scheduled at early (within 21 days) and long-term follow-up (3-6 months). Twenty consecutive patients were prospectively recruited. Preoperative language testings were normal in 9 patients (45%), showed mild to moderate language deficit in 8 (40%) and severe language deficit or aphasic disorders in 3 (15%). Broca's area was identified in 15 patients, in all cases by counting arrest during stimulation and in 12 cases by naming arrest. In this article we describe our experience using a language testing work up to evaluate - pre, intra and postoperatively - patients undergoing awake craniotomy for brain tumour resection with preoperative language disturbances or at risk for postoperative language deficits. This approach allows a systematic evaluation and recording of language function status and can be accomplished even when a neuropsychologist or speech therapist are not involved in the operation crew. PMID:24195669

  19. Marshall Space Flight Center Propulsion Systems Department (PSD) Knowledge Management (KM) Initiative

    NASA Technical Reports Server (NTRS)

    Caraccioli, Paul; Varnedoe, Tom; Smith, Randy; McCarter, Mike; Wilson, Barry; Porter, Richard

    2006-01-01

    NASA Marshall Space Flight Center's Propulsion Systems Department (PSD) is four months into a fifteen month Knowledge Management (KM) initiative to support enhanced engineering decision making and analyses, faster resolution of anomalies (near-term) and effective, efficient knowledge infused engineering processes, reduced knowledge attrition, and reduced anomaly occurrences (long-term). The near-term objective of this initiative is developing a KM Pilot project, within the context of a 3-5 year KM strategy, to introduce and evaluate the use of KM within PSD. An internal NASA/MSFC PSD KM team was established early in project formulation to maintain a practitioner, user-centric focus throughout the conceptual development, planning and deployment of KM technologies and capabilities within the PSD. The PSD internal team is supported by the University of Alabama's Aging Infrastructure Systems Center of Excellence (AISCE), lntergraph Corporation, and The Knowledge Institute. The principle product of the initial four month effort has been strategic planning of PSD KNI implementation by first determining the "as is" state of KM capabilities and developing, planning and documenting the roadmap to achieve the desired "to be" state. Activities undertaken to suppoth e planning phase have included data gathering; cultural surveys, group work-sessions, interviews, documentation review, and independent research. Assessments and analyses have beon pedormed including industry benchmarking, related local and Agency initiatives, specific tools and techniques used and strategies for leveraging existing resources, people and technology to achieve common KM goals. Key findings captured in the PSD KM Strategic Plan include the system vision, purpose, stakeholders, prioritized strategic objectives mapped to the top ten practitioner needs and analysis of current resource usage. Opportunities identified from research, analyses, cultural1KM surveys and practitioner interviews include

  20. New perspectives on sea use management: initial findings from European experience with marine spatial planning.

    PubMed

    Douvere, Fanny; Ehler, Charles N

    2009-01-01

    Increased development pressures on the marine environment and the potential for multiple use conflicts, arising as a result of the current expansion of offshore wind energy, fishing and aquaculture, dredging, mineral extraction, shipping, and the need to meet international and national commitments to biodiversity conservation, have led to increased interest in sea use planning with particular emphasis on marine spatial planning. Several European countries, on their own initiative or driven by the European Union's Marine Strategy and Maritime Policy, the Bergen Declaration of the North Sea Conference, and the EU Recommendation on Integrated Coastal Zone Management, have taken global leadership in implementing marine spatial planning. Belgium, The Netherlands, and Germany in the North Sea, and the United Kingdom in the Irish Sea, have already completed preliminary sea use plans and zoning proposals for marine areas within their national jurisdictions. This paper discusses the nature and context of marine spatial planning, the international legal and policy framework, and the increasing need for marine spatial planning in Europe. In addition, the authors review briefly three marine spatial planning initiatives in the North Sea and conclude with some initial lessons learned from these experiences. PMID:18786758

  1. NORTH AMERICA'S SOUND MANAGEMENT OF CHEMICALS INITIATIVE: APPLICATION OF SELECTION CRITERIA TO DIOXINS/FURANS, HEXACHLOROBENZENE, AND HEXACHLOROCYCLOHEXANES

    EPA Science Inventory

    In October 1997, the North American Commission for Environmental Cooperation finalized its process for identifying candidate substances for regional action under the Sound Management of Chemicals Initiative. Regional action plans will be prepared if substantive risk to human he...

  2. Health Sector Initiatives for Disaster Risk Management in Ethiopia: A Narrative Review

    PubMed Central

    Tadesse, Luche; Ardalan, Ali

    2014-01-01

    Background: Natural and man-made disasters are prevailing in Ethiopia mainly due to drought, floods, landslides, earthquake, volcanic eruptions, and disease epidemics. Few studies so far have critically reviewed about medical responses to disasters and little information exists pertaining to the initiatives being undertaken by health sector from the perspective of basic disaster management cycle. This article aimed to review emergency health responses to disasters and other related interventions which have been undertaken in the health sector. Methods: Relevant documents were identified by searches in the websites of different sectors in Ethiopian and international non-governmental organizations and United Nations agencies. Using selected keywords, articles were also searched in the data bases of Medline, CINAHL, Scopus, and Google Scholar. In addition, pertinent articles from non-indexed journals were referred to. Results: Disaster management system in Ethiopia focused on response, recovery, and rehabilitation from 1974 to 1988; while the period between 1988 and 1993 marked the transition phase towards a more comprehensive approach. Theoretically, from 1993 onwards, the disaster management system has fully integrated the mitigation, prevention, and preparedness phases into already existing response and recovery approach, particularly for drought. This policy has changed the emergency response practices and the health sector has taken some initiatives in the area of emergency health care. Hence, drought early warning system, therapeutic feeding program in hospitals, health centers and posts in drought prone areas to manage promptly acute malnutrition cases have all been put in place. In addition, public health disease emergencies have been responded to at all levels of health care system. Conclusions: Emergency health responses to drought and its ramifications such as acute malnutrition and epidemics have become more comprehensive in the context of basic disaster

  3. Research Initiatives and Preliminary Results In Automation Design In Airspace Management in Free Flight

    NASA Technical Reports Server (NTRS)

    Corker, Kevin; Lebacqz, J. Victor (Technical Monitor)

    1997-01-01

    The NASA and the FAA have entered into a joint venture to explore, define, design and implement a new airspace management operating concept. The fundamental premise of that concept is that technologies and procedures need to be developed for flight deck and ground operations to improve the efficiency, the predictability, the flexibility and the safety of airspace management and operations. To that end NASA Ames has undertaken an initial development and exploration of "key concepts" in the free flight airspace management technology development. Human Factors issues in automation aiding design, coupled aiding systems between air and ground, communication protocols in distributed decision making, and analytic techniques for definition of concepts of airspace density and operator cognitive load have been undertaken. This paper reports the progress of these efforts, which are not intended to definitively solve the many evolving issues of design for future ATM systems, but to provide preliminary results to chart the parameters of performance and the topology of the analytic effort required. The preliminary research in provision of cockpit display of traffic information, dynamic density definition, distributed decision making, situation awareness models and human performance models is discussed as they focus on the theme of "design requirements".

  4. Deep space telecommunications, navigation, and information management. Support of the space exploration initiative

    NASA Astrophysics Data System (ADS)

    Hall, Justin R.; Hastrup, Rolf C.

    The United States Space Exploration Initiative (SEI) calls for the charting of a new and evolving manned course to the Moon, Mars, and beyond. This paper discusses key challenges in providing effective deep space telecommunications, navigation, and information management (TNIM) architectures and designs for Mars exploration support. The fundamental objectives are to provide the mission with means to monitor and control mission elements, acquire engineering, science, and navigation data, compute state vectors and navigate, and move these data efficiently and automatically between mission nodes for timely analysis and decision-making. Although these objectives do not depart, fundamentally, from those evolved over the past 30 years in supporting deep space robotic exploration, there are several new issues. This paper focuses on summarizing new requirements, identifying related issues and challenges, responding with concepts and strategies which are enabling, and, finally, describing candidate architectures, and driving technologies. The design challenges include the attainment of: 1) manageable interfaces in a large distributed system, 2) highly unattended operations for in-situ Mars telecommunications and navigation functions, 3) robust connectivity for manned and robotic links, 4) information management for efficient and reliable interchange of data between mission nodes, and 5) an adequate Mars-Earth data rate.

  5. Laboratory information management system for membrane protein structure initiative--from gene to crystal.

    PubMed

    Troshin, Petr V; Morris, Chris; Prince, Stephen M; Papiz, Miroslav Z

    2008-12-01

    Membrane Protein Structure Initiative (MPSI) exploits laboratory competencies to work collaboratively and distribute work among the different sites. This is possible as protein structure determination requires a series of steps, starting with target selection, through cloning, expression, purification, crystallization and finally structure determination. Distributed sites create a unique set of challenges for integrating and passing on information on the progress of targets. This role is played by the Protein Information Management System (PIMS), which is a laboratory information management system (LIMS), serving as a hub for MPSI, allowing collaborative structural proteomics to be carried out in a distributed fashion. It holds key information on the progress of cloning, expression, purification and crystallization of proteins. PIMS is employed to track the status of protein targets and to manage constructs, primers, experiments, protocols, sample locations and their detailed histories: thus playing a key role in MPSI data exchange. It also serves as the centre of a federation of interoperable information resources such as local laboratory information systems and international archival resources, like PDB or NCBI. During the challenging task of PIMS integration, within the MPSI, we discovered a number of prerequisites for successful PIMS integration. In this article we share our experiences and provide invaluable insights into the process of LIMS adaptation. This information should be of interest to partners who are thinking about using LIMS as a data centre for their collaborative efforts. PMID:18991141

  6. Improving outcome in severe trauma: trauma systems and initial management: intubation, ventilation and resuscitation.

    PubMed

    Harris, Tim; Davenport, Ross; Hurst, Tom; Jones, Jonathan

    2012-10-01

    Severe trauma is an increasing global problem mainly affecting fit and healthy younger adults. Improvements in the entire pathway of trauma care have led to improvements in outcome. Development of a regional trauma system based around a trauma centre is associated with a 15-50% reduction in mortality. Trauma teams led by senior doctors provide better care. Although intuitively advantageous, the involvement of doctors in the pre-hospital care of trauma patients currently lacks clear evidence of benefit. Poor airway management is consistently identified as a cause of avoidable morbidity and mortality. Rapid sequence induction/intubation is frequently indicated but the ideal drugs have yet to be identified. The benefits of cricoid pressure are not clear cut. Dogmas in the management of pneumothoraces have been challenged: chest x-ray has a role in the diagnosis of tension pneumothoraces, needle aspiration may be ineffective, and small pneumothoraces can be managed conservatively. Identification of significant haemorrhage can be difficult and specific early resuscitation goals are not easily definable. A hypotensive approach may limit further bleeding but could worsen significant brain injury. The ideal initial resuscitation fluid remains controversial. In appropriately selected patients early aggressive blood product resuscitation is beneficial. Hypothermia can exacerbate bleeding and the benefit in traumatic brain injury is not adequately studied for firm recommendations. PMID:23014941

  7. Structural health and prognostics management for offshore wind turbines : an initial roadmap.

    SciTech Connect

    Griffith, Daniel Todd; Resor, Brian Ray; White, Jonathan Randall; Paquette, Joshua A.; Yoder, Nathanael C.

    2012-12-01

    Operations and maintenance costs for offshore wind plants are expected to be significantly higher than the current costs for onshore plants. One way in which these costs may be able to be reduced is through the use of a structural health and prognostic management system as part of a condition based maintenance paradigm with smart load management. To facilitate the creation of such a system a multiscale modeling approach has been developed to identify how the underlying physics of the system are affected by the presence of damage and how these changes manifest themselves in the operational response of a full turbine. The developed methodology was used to investigate the effects of a candidate blade damage feature, a trailing edge disbond, on a 5-MW offshore wind turbine and the measurements that demonstrated the highest sensitivity to the damage were the local pitching moments around the disbond. The multiscale method demonstrated that these changes were caused by a local decrease in the blade's torsional stiffness due to the disbond, which also resulted in changes in the blade's local strain field. Full turbine simulations were also used to demonstrate that derating the turbine power by as little as 5% could extend the fatigue life of a blade by as much as a factor of 3. The integration of the health monitoring information, conceptual repair cost versus damage size information, and this load management methodology provides an initial roadmap for reducing operations and maintenance costs for offshore wind farms while increasing turbine availability and overall profit.

  8. Tangible Results and Progress in Flood Risks Management with the PACTES Initiative

    NASA Astrophysics Data System (ADS)

    Costes, Murielle; Abadie, Jean-Paul; Ducuing, Jean-Louis; Denier, Jean-Paul; Stéphane

    The PACTES project (Prévention et Anticipation des Crues au moyen des Techniques Spatiales), initiated by CNES and the French Ministry of Research, aims at improving flood risk management, over the following three main phases : - Prevention : support and facilitate the analysis of flood risks and socio-economic impacts (risk - Forecasting and alert : improve the capability to predict and anticipate the flooding event - Crisis management : allow better situation awareness, communication and sharing of In order to achieve its ambitious objectives, PACTES: - integrates state-of-the-art techniques and systems (integration of the overall processing chains, - takes advantage of integrating recent model developments in wheather forecasting, rainfall, In this approach, space technology is thus used in three main ways : - radar and optical earth observation data are used to produce Digital Elevation Maps, land use - earth observation data are also an input to wheather forecasting, together with ground sensors; - satellite-based telecommunication and mobile positioning. Started in December 2000, the approach taken in PACTES is to work closely with users such as civil security and civil protection organisms, fire fighter brigades and city councils for requirements gathering and during the validation phase. It has lead to the development and experimentation of an integrated pre-operational demonstrator, delivered to different types of operational users. Experimentation has taken place in three watersheds representative of different types of floods (flash and plain floods). After a breaf reminder of what the PACTES project organization and aims are, the PACTES integrated pre-operational demonstrator is presented. The main scientific inputs to flood risk management are summarized. Validation studies for the three watersheds covered by PACTES (Moselle, Hérault and Thoré) are detailed. Feedback on the PACTES tangible results on flood risk management from an user point of view

  9. Current trends in initial management of laryngeal cancer: the declining use of open surgery.

    PubMed

    Silver, Carl E; Beitler, Jonathan J; Shaha, Ashok R; Rinaldo, Alessandra; Ferlito, Alfio

    2009-09-01

    The role of open surgery for management of laryngeal cancer has been greatly diminished during the past decade. The development of transoral endoscopic laser microsurgery (TLS), improvements in delivery of radiation therapy (RT) and the advent of multimodality protocols, particularly concomitant chemoradiotherapy (CCRT) have supplanted the previously standard techniques of open partial laryngectomy for early cancer and total laryngectomy followed by adjuvant RT for advanced cancer. A review of the recent literature revealed virtually no new reports of conventional conservation surgery as initial treatment for early stage glottic and supraglottic cancer. TLS and RT, with or without laser surgery or CCRT, have become the standard initial treatments for T1, T2 and selected T3 laryngeal cancer. Photodynamic therapy (PDT) may have an emerging role in the treatment of early laryngeal cancer. Anterior commissure involvement presents particular difficulties in application of TLS, although no definitive conclusions have been reached with regard to optimal treatment of these lesions. Results of TLS are equivalent to those obtained by conventional conservation surgery, with considerably less morbidity, less hospital time and better postoperative function. Oncologic results of TLS and RT are equivalent for glottic cancer, but with better voice results for RT in patients who require more extensive cordectomy. The preferred treatment for early supraglottic cancer, particularly for bulkier or T3 lesions is TLS, with or without postoperative RT. The Veterans Administration Study published in 1991 established the fact that the response to neoadjuvant CT predicts the response of a tumor to RT. Patients with advanced tumors that responded either partially or completely to CT were treated with RT, and total laryngectomy was reserved for non-responders. This resulted in the ability to preserve the larynx in a significant number of patients with locally advanced laryngeal cancer, while

  10. Associations of race and ethnicity with anemia management among patients initiating renal replacement therapy.

    PubMed Central

    Weisbord, Steven D.; Fried, Linda F.; Mor, Maria K.; Resnick, Abby L.; Kimmel, Paul L.; Palevsky, Paul M.; Fine, Michael J.

    2007-01-01

    BACKGROUND: Many patients initiate renal replacement therapy with suboptimal anemia management. The factors contributing to this remain largely unknown. The aim of this study was to assess the associations of race and ethnicity with anemia care prior to the initiation of renal replacement therapy. METHODS: Using data from the medical evidence form filed for patients who initiated renal replacement therapy between 1995-2003, we assessed racial and ethnic differences in pre-end-stage renal disease hematocrit levels, the use of erythropoiesis stimulation agents (ESAs), the proportion of patients with hematocrit levels > or = 33% and the proportion of patients with hematocrit levels < 33% that did not receive ESA. We also examined secular trends in racial and ethnic differences in these parameters. RESULTS: In multivariable analyses, non-Hispanic blacks had lower hematocrit levels (delta hematocrit = -0.97%, 95% CI: -1.00-0.94%), and were less likely to receive ESA (OR = 0.82, 95% CI: 0.81-0.84), to initiate renal replacement therapy with hematocrit > or = 33% (OR = 0.78, 95% CI: 0.77-0.79) or to receive ESA if the hematocrit was < 33% (OR = 0.79, 95% CI: 0.77-0.80) than non-Hispanic whites. White Hispanics also had lower hematocrit levels (delta hematocrit = -0.42%, 95% CI:-0.47% to -0.37%), and were less likely to receive ESA (OR = 0.86, 95% CI: 0.85-0.88), to have hematocrit levels > or = 33% (OR = 0.91, 95% CI: 0.89-0.93) or to receive ESA if the hematocrit was < 33% (OR = 0.85, 95% CI: 0.83-0.87) than non-Hispanic whites. These disparities persisted over the eight-year study period. CONCLUSIONS: African-American race and Hispanic ethnicity are associated with suboptimal pre-end-stage renal disease anemia management. Efforts to improve anemia care should incorporate targeted interventions to decrease these disparities. PMID:18020096

  11. 75 FR 74038 - Twin Eagle Resource Management, LLC; Supplemental Notice That Initial Market-Based Rate Filing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-30

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF ENERGY Federal Energy Regulatory Commission Twin Eagle Resource Management, LLC; Supplemental Notice That Initial Market... supplemental notice in the above-referenced proceeding, of Twin Eagle Resource Management, LLC's ]...

  12. Bit by Bit: A Series of Trends, Tools, and Initiatives Are Aimed at Improving Electronic Resource Management

    ERIC Educational Resources Information Center

    Webster, Peter

    2006-01-01

    Electronic resources are more prominent than ever in library collections, yet they resist easy management. A range of tools and cooperative efforts are emerging to improve the management and evaluation of electronic resources. Initiatives are underway to standardize and automate the harvesting of usage statistics and e-journal title and holdings…

  13. The African Capacity Building Initiative: Toward Improved Policy Analysis and Development Management in Sub-Saharan Africa.

    ERIC Educational Resources Information Center

    World Bank, Washington, DC.

    The objective of the African Capacity Building Initiative is to build and strengthen local capabilities for policy analysis and development management in Sub-Saharan Africa. This report examines the nature and magnitude of the problem, which basically consists of a shortage of development management skills combined with weakness in the area of…

  14. Post-game analysis: An initial experiment for heuristic-based resource management in concurrent systems

    NASA Technical Reports Server (NTRS)

    Yan, Jerry C.

    1987-01-01

    In concurrent systems, a major responsibility of the resource management system is to decide how the application program is to be mapped onto the multi-processor. Instead of using abstract program and machine models, a generate-and-test framework known as 'post-game analysis' that is based on data gathered during program execution is proposed. Each iteration consists of (1) (a simulation of) an execution of the program; (2) analysis of the data gathered; and (3) the proposal of a new mapping that would have a smaller execution time. These heuristics are applied to predict execution time changes in response to small perturbations applied to the current mapping. An initial experiment was carried out using simple strategies on 'pipeline-like' applications. The results obtained from four simple strategies demonstrated that for this kind of application, even simple strategies can produce acceptable speed-up with a small number of iterations.

  15. Environmental Management Technology Leveraging Initiative. Topical report, October 1, 1995--September 30, 1996

    SciTech Connect

    1996-12-31

    The ``Environmental Management Technology Leveraging Initiative,`` a cooperative agreement between the Global Environment and Technology Foundation and the Department of Energy-Morgantown Energy Technology Center, has completed its second year. This program, referred to as the Global Environmental Technology Enterprise (GETE) is an experiment to bring together the public and private sectors to identify, formulate, promote and refine methods to develop more cost-effective clean-up treatments. Working closely with Department of Energy officials, National Laboratory representatives, business people, academia, community groups, and other stakeholders, this program attempts to commercialize innovative, DOE-developed technologies. The methodology to do so incorporates three elements: business assistance, information, and outreach. A key advance this year was the development of a commercialization guidance document which can be used to diagnose the commercialization level and needs for innovative technologies.

  16. Managing Systemic Curriculum Change: A Critical Analysis of Hong Kong's Target-Oriented Curriculum Initiative

    NASA Astrophysics Data System (ADS)

    Carless, David R.

    1997-07-01

    Educational innovations have rarely lived up to the expectations of their proponents and have often been reshaped, adopted half-heartedly, ignored or rejected. The difficulty of successfully implementing innovations and the complexity of the change process are now widely acknowledged. Curriculum renewal attempts in the Hong Kong context have also been problematic, with classroom practitioners often not implementing reforms disseminated by centralised government agencies. This paper focuses on Hong Kong's Target-Oriented Curriculum (TOC), a major curriculum renewal initiative designed to improve the quality of learning in local primary schools. The paper describes the innovation, the context into which it is being introduced, and a number of factors that proved problematic in the management of change. The discussion focuses on five elements in the change process, namely practicality, ownership, teacher attitudes, teacher training and resources. From this analysis, some of the implications for curriculum implementation, both in Hong Kong and elsewhere, are identified and discussed.

  17. Integrating risk management data in quality improvement initiatives within an academic neurosurgery department.

    PubMed

    McLaughlin, Nancy; Garrett, Matthew C; Emami, Leila; Foss, Sarah K; Klohn, Johanna L; Martin, Neil A

    2016-01-01

    OBJECT While malpractice litigation has had many negative impacts on health care delivery systems, information extracted from lawsuits could potentially guide toward venues to improve care. The authors present a comprehensive review of lawsuits within a tertiary academic neurosurgical department and report institutional and departmental strategies to mitigate liability by integrating risk management data with quality improvement initiatives. METHODS The Comprehensive Risk Intelligence Tool database was interrogated to extract claims/suits abstracts concerning neurosurgical cases that were closed from January 2008 to December 2012. Variables included demographics of the claimant, type of procedure performed (if any), claim description, insured information, case outcome, clinical summary, contributing factors and subfactors, amount incurred for indemnity and expenses, and independent expert opinion in regard to whether the standard of care was met. RESULTS During the study period, the Department of Neurosurgery received the most lawsuits of all surgical specialties (30 of 172), leading to a total incurred payment of $4,949,867. Of these lawsuits, 21 involved spinal pathologies and 9 cranial pathologies. The largest group of suits was from patients with challenging medical conditions who underwent uneventful surgeries and postoperative courses but filed lawsuits when they did not see the benefits for which they were hoping; 85% of these claims were withdrawn by the plaintiffs. The most commonly cited contributing factors included clinical judgment (20 of 30), technical skill (19 of 30), and communication (6 of 30). CONCLUSIONS While all medical and surgical subspecialties must deal with the issue of malpractice and liability, neurosurgery is most affected both in terms of the number of suits filed as well as monetary amounts awarded. To use the suits as learning tools for the faculty and residents and minimize the associated costs, quality initiatives addressing the

  18. Initial Abstinence Status and Contingency Management Treatment Outcomes: Does Race Matter?

    PubMed Central

    Montgomery, LaTrice; Carroll, Kathleen M.; Petry, Nancy M.

    2015-01-01

    Objective Limited research has evaluated African American substance users’ response to evidence-based treatments. This study examined the efficacy of contingency management (CM) in African American and White cocaine users. Method A secondary analysis evaluated effects of race, treatment condition, and baseline cocaine urine sample results on treatment outcomes of African American (n = 444) and White (n = 403) cocaine abusers participating in one of six randomized clinical trials comparing CM to standard care. Results African American and White patients who initiated treatment with a cocaine-negative urine sample remained in treatment for similar durations and submitted a comparable proportion of negative samples during treatment regardless of treatment type; CM was efficacious in both races in terms of engendering longer durations of abstinence in patients who began treatment abstinent. Whites who began treatment with a cocaine positive sample remained in treatment longer and submitted a higher proportion of negative samples when assigned to CM than standard care. African Americans who initiated treatment with a cocaine positive sample, however, did not remain in treatment longer with CM compared with standard care, and gains in terms of drug use outcomes were muted in nature relative to Whites. This interaction effect persisted through the 9-month follow-up period. Conclusions CM is not equally effective in reducing drug use among all subgroups, specifically African American patients who are using cocaine upon treatment entry. Future research on improving treatment outcomes in this population is needed. PMID:25798729

  19. Project W-211, initial tank retrieval systems, retrieval control system software configuration management plan

    SciTech Connect

    RIECK, C.A.

    1999-02-23

    This Software Configuration Management Plan (SCMP) provides the instructions for change control of the W-211 Project, Retrieval Control System (RCS) software after initial approval/release but prior to the transfer of custody to the waste tank operations contractor. This plan applies to the W-211 system software developed by the project, consisting of the computer human-machine interface (HMI) and programmable logic controller (PLC) software source and executable code, for production use by the waste tank operations contractor. The plan encompasses that portion of the W-211 RCS software represented on project-specific AUTOCAD drawings that are released as part of the C1 definitive design package (these drawings are identified on the drawing list associated with each C-1 package), and the associated software code. Implementation of the plan is required for formal acceptance testing and production release. The software configuration management plan does not apply to reports and data generated by the software except where specifically identified. Control of information produced by the software once it has been transferred for operation is the responsibility of the receiving organization.

  20. Common Ground: An Investigation of Environmental Management Alcohol Prevention Initiatives in a College Community*

    PubMed Central

    Wood, Mark D.; DeJong, William; Fairlie, Anne M.; Lawson, Doreen; Lavigne, Andrea M.; Cohen, Fran

    2009-01-01

    Objective: This article presents an evaluation of Common Ground, a media campaign-supported prevention program featuring increased enforcement, decreased alcohol access, and other environmental management initiatives targeting college student drinking. Method: Phase 1 of the media campaign addressed student resistance to environmentally focused prevention by reporting majority student support for alcohol policy and enforcement initiatives. Phase 2 informed students about state laws, university policies, and environmental initiatives. We conducted student telephone surveys, with samples stratified by gender and year in school, for 4 consecutive years at the intervention campus and 3 years at a comparison campus. We did a series of one-way between-subjects analyses of variance and analyses of covariance, followed by tests of linear trend and planned comparisons. Targeted outcomes included perceptions of enforcement and alcohol availability, alcohol use, and alcohol-impaired driving. We examined archived police reports for student incidents, primarily those resulting from loud parties. Results: There were increases at the intervention campus in students' awareness of formal alcohol-control efforts and perceptions of the alcohol environment, likelihood of apprehension for underage drinking, consequences for alcohol-impaired driving, and responsible alcohol service practices. There were decreases in the perceived likelihood of other students' negative behavior at off-campus parties. Police-reported incidents decreased over time; however, perceived consequences for off-campus parties decreased. No changes were observed for difficulty finding an off-campus party, self-reported alcohol use, or alcohol-impaired driving. Conclusions: The intervention successfully altered perceptions of alcohol enforcement, alcohol access, and the local alcohol environment. This study provides important preliminary information to researchers and practitioners engaged in collaborative

  1. Knowledge Management Initiatives Used to Maintain Regulatory Expertise in Transportation and Storage of Radioactive Materials - 12177

    SciTech Connect

    Lindsay, Haile; Garcia-Santos, Norma; Saverot, Pierre; Day, Neil; Gambone Rodriguez, Kimberly; Cruz, Luis; Sotomayor-Rivera, Alexis; Vechioli, Lucieann; Vera, John; Pstrak, David

    2012-07-01

    The U.S. Nuclear Regulatory Commission (NRC) was established in 1974 with the mission to license and regulate the civilian use of nuclear materials for commercial, industrial, academic, and medical uses in order to protect public health and safety, and the environment, and promote the common defense and security. Currently, approximately half (∼49%) of the workforce at the NRC has been with the Agency for less than six years. As part of the Agency's mission, the NRC has partial responsibility for the oversight of the transportation and storage of radioactive materials. The NRC has experienced a significant level of expertise leaving the Agency due to staff attrition. Factors that contribute to this attrition include retirement of the experienced nuclear workforce and mobility of staff within or outside the Agency. Several knowledge management (KM) initiatives have been implemented within the Agency, with one of them including the formation of a Division of Spent Fuel Storage and Transportation (SFST) KM team. The team, which was formed in the fall of 2008, facilitates capturing, transferring, and documenting regulatory knowledge for staff to effectively perform their safety oversight of transportation and storage of radioactive materials, regulated under Title 10 of the Code of Federal Regulations (10 CFR) Part 71 and Part 72. In terms of KM, the SFST goal is to share critical information among the staff to reduce the impact from staff's mobility and attrition. KM strategies in place to achieve this goal are: (1) development of communities of practice (CoP) (SFST Qualification Journal and the Packaging and Storing Radioactive Material) in the on-line NRC Knowledge Center (NKC); (2) implementation of a SFST seminar program where the seminars are recorded and placed in the Agency's repository, Agency-wide Documents Access and Management System (ADAMS); (3) meeting of technical discipline group programs to share knowledge within specialty areas; (4) development of

  2. The Gulf of Mexico Research Initiative: Managing a Multidisciplinary Data Explosion

    NASA Astrophysics Data System (ADS)

    Howard, M. K.; Gibeaut, J. C.; Reed, D.

    2011-12-01

    On April 20, 2010 the Deepwater Horizon drilling unit located in the northeastern Gulf of Mexico, experienced a catastrophic wellhead blowout. Roughly 5 billion barrels of oil and 1 million U.S. gallons of dispersant were released near the wellhead over the next three months. Within weeks of the blowout, BP announced the Gulf of Mexico Research Initiative (GRI) and pledged 50M/yr over 10 years for independent scientific research on the spill's impact on the ecosystem. Two months after the blowout three institutions were awarded a total of 25M in fast-track grants (Louisiana State University, Northern Gulf Institute, and Florida Institute of Oceanography). Soon after the Alabama Marine Environmental Sciences Consortium and the National Institutes of Health were awarded 5M and 10M, respectively. These five institutions began to generate data almost immediately. First year grants funded 100's of researchers from nearly 100 research units. Their activities included numerical modeling, field data collection, and laboratory experiments. Measured parameters included those associated with chemical analyses of oil, gas, and dispersants, studies of bacteria, plants and animals -from phytoplankton to marsh grasses, from zooplankton to cetaceans. Studies were conducted from estuaries to the deep Gulf, from atmosphere to sediments. Parameters from physical oceanography, marine meteorology, and biogeochemistry were measured in abundance. Additionally, impact studies on human mental, physical health and businesses were made. Proposals for years 2-4 of the program were to be awarded in August 2011 supporting 4-8 research consortia. Consortia may have up to 20 named researchers. In aggregate, these studies yielded a multidisciplinary data explosion. Following the fast-track awards the GRI Administrative Unit (AU) was established and a data management activity initiated. That activity became the GRI Information and Data Cooperative (GRIIDC). "Cooperative" emphasizes the

  3. The Western Energy Corridor Initiative: Unconventional Fuel Development Issues, Impacts, and Management Assessment

    NASA Astrophysics Data System (ADS)

    Wolfsberg, A.; Hagood, M.; Pasqualini, D.; Wood, T.; Wilson, C.; Witkowski, M.; Levitt, D.; Pawar, R.; Keating, G.; Ziock, H.

    2008-12-01

    The United States is increasingly dependent on imported oil and gas; commodities for which other nations are competing and for which future supply may be inadequate to support our transportation fuel needs. Therefore, a renewed interest in 'harder-to-get' unconventional fuels has emerged in both industry and government with directed focus on world class hydrocarbon resources within a corridor extending from Canada southward through the Rocky Mountain States. Within this Western Energy Corridor, co-located with significant conventional hydrocarbon and renewable energy resources, lie some of the world's richest unconventional hydrocarbon resources in oil shales, oil sands and coal for coal-to-liquid conversion. However, development of these resources poses substantial environmental concerns as well as increasing competition for limited resources of water and habitat. With large-scale energy development in the predominantly rural region, local communities, infrastructures, and economies will face increasing demands for roads, electricity, law enforcement, labor, and other support services. The Western Energy Corridor Initiative (WECI) seeks to develop an integrated assessment of the impacts of unconventional fuel development, the interrelationships of planned energy developments in different basins, and the resultant demands placed on the region. This initial WECI study focuses on two of the most important current issues for industry, regulators, and stakeholders -- the assessment of carbon and water resources issues, impacts, and management strategies. Through scenario analyses using coupled systems and process level models, this study investigates the viability of integrated development of multiple energy resources in a carbon neutral and environmentally acceptable manner, and the interrelationships of various energy resource development plans. The modeling framework is designed to extend to include infrastructure, employment, training, fiscal and economic demands

  4. The initial management of trauma patients is an especially relevant setting to evaluate professional practice patterns.

    PubMed

    Harrois, A; Mertes, P-M; Tazarourte, K; Atchabahian, A; Duranteau, J; Langeron, O; Vigué, B

    2013-01-01

    The initial management of trauma patients in a dedicated location is a crucial step in the treatment of these patients. The characteristics of this phase are such that they meet all the criteria for a professional practice patterns evaluation (PPPE or PPE): formalized protocols, clear-cut timeframes, specific roles of different stakeholders, and multidisciplinary medical and paramedical team. In addition, the expected result of the PPE approach, improved care, will have a direct impact on patient outcomes. This PPE modeled on an audit aims at evaluating the care process based on representative criteria. These criteria should include: the planned structure and organization; the protocols; the strategy and time frames for procedure implementation; the relationships between stakeholders; the results. For each criterion, differences between the expected characteristics and the observed reality are analyzed. The prospective (independent observer or video) and/or retrospective (records, register) collection of data during 20 consecutive encounters should be sufficient to identify dysfunctions and provide guidance on the changes that need to be implemented. The proposed data collection form includes 15 items representative of the five defined criteria. These items often describe departmental choice. The pursuit of quality is defined first in terms of medical and paramedical results, but also in administrative and financial terms. Following the analysis produced by a representative group of actors, a multidisciplinary discussion of the results should be followed by proposals for simple changes approved by everyone. After a few months of implementation, the impact of the proposed improvement measures will be assessed by a new survey. This approach, in addition to improving the quality of care, allows better team stress management and greater work enjoyment. PMID:23916520

  5. Current trends in initial management of oropharyngeal cancer: the declining use of open surgery.

    PubMed

    Haigentz, Missak; Silver, Carl E; Corry, June; Genden, Eric M; Takes, Robert P; Rinaldo, Alessandra; Ferlito, Alfio

    2009-12-01

    The widespread availability of novel primary treatment approaches against oropharyngeal cancers has provided several potentially curative surgical and nonsurgical treatment options for patients, generating both hope and controversy. As treatment is usually curative in intent, management considerations must include consideration of primary tumor and nodal disease control as well as long-term toxicities and functional outcomes. Anatomical and functional organ preservation (speech and deglutition) remains of paramount importance to patients with oropharyngeal cancer and the physicians involved in their care, accounting for the growing popularity of chemoradiotherapy and transoral surgical techniques for this indication. These novel approaches have greatly diminished the role of open surgery as initial therapy for oropharyngeal cancers. Open surgery which is often reserved for salvage on relapse, may still be an appropriate therapy for certain early stage primary lesions. The growing treatment armamentarium requires careful consideration for optimal individualized care. The identification of oncogenic human papillomavirus as a predictive and prognostic marker in patients with oropharyngeal cancer has great potential to further optimize the choice of treatment. In this review, novel primary therapies against oropharyngeal squamous cell carcinoma are presented in the context of anatomical, quality of life, and emerging biological considerations. PMID:19866522

  6. Global Threat Reduction Initiative Fuel Thermo-Physical Characterization Project: Sample Management Plan

    SciTech Connect

    Casella, Amanda J.; Pereira, Mario M.; Steen, Franciska H.

    2013-01-01

    This sample management plan provides guidelines for sectioning, preparation, acceptance criteria, analytical path, and end-of-life disposal for the fuel element segments utilized in the Global Threat Reduction Initiative (GTRI), Fuel Thermo-Physical Characterization Project. The Fuel Thermo-Physical Characterization Project is tasked with analysis of irradiated Low Enriched Uranium (LEU) Molybdenum (U-Mo) fuel element samples to support the GTRI conversion program. Sample analysis may include optical microscopy (OM), scanning electron microscopy (SEM) fuel-surface interface analysis, gas pycnometry (density) measurements, laser flash analysis (LFA), differential scanning calorimetry (DSC), thermogravimetry and differential thermal analysis with mass spectroscopy (TG /DTA-MS), Inductively Coupled Plasma Spectrophotometry (ICP), alpha spectroscopy, and Thermal Ionization Mass Spectroscopy (TIMS). The project will utilize existing Radiochemical Processing Laboratory (RPL) operating, technical, and administrative procedures for sample receipt, processing, and analyses. Test instructions (TIs), which are documents used to provide specific details regarding the implementation of an existing RPL approved technical or operational procedure, will also be used to communicate to staff project specific parameters requested by the Principal Investigator (PI). TIs will be developed, reviewed, and issued in accordance with the latest revision of the RPL-PLN-700, RPL Operations Plan. Additionally, the PI must approve all project test instructions and red-line changes to test instructions.

  7. Five-year evolution of a telangiectatic osteosarcoma initially managed as an aneurysmal bone cyst.

    PubMed

    Saito, Tsuyoshi; Oda, Yoshinao; Kawaguchi, Ken-Ichi; Tanaka, Kazuhiro; Matsuda, Shuichi; Sakamoto, Akio; Iwamoto, Yukihide; Tsuneyoshi, Masazumi

    2005-05-01

    We present the clinical, radiographic, and pathologic features of a telangiectatic osteosarcoma (TOS) of the right femoral neck in a 20-year-old man which was initially diagnosed and managed as an aneurysmal bone cyst (ABC). The lesion recurred twice. At the second recurrence TOS was diagnosed. The first local recurrence was recognized 4 years 8 months after the first operation. The clinical diagnosis for the recurrent lesion was recurrent ABC, and curettage and bone graft with internal fixation were performed. The second local recurrence was observed 8 months after the second surgery. The right lesser trochanter appeared destroyed on the radiograph, and a large medial soft tissue mass was demonstrated by computed tomography. The patient underwent wide resection of the tumor with prosthetic replacement of the right proximal femur. The histologic section for this lesion showed a blood-filled cystic lesion, and its wall contained sarcomatous cells with atypical mitoses and tumor osteoid. The histologic diagnosis for the second recurrent lesion was high-grade TOS. The retrospective review of the histologic section for the primary lesion showed similar features to ABC except for a few bizarre cells without mitosis in the tissue of cystic wall. The patient demonstrates no evidence of disease 13 months after the last surgery without adjuvant therapy (he declined chemotherapy). PMID:15570421

  8. Why don’t families initiate treatment? A qualitative multicentre study investigating parents’ reasons for declining paediatric weight management

    PubMed Central

    Perez, Arnaldo; Holt, Nicholas; Gokiert, Rebecca; Chanoine, Jean-Pierre; Legault, Laurent; Morrison, Katherine; Sharma, Arya; Ball, Geoff

    2015-01-01

    BACKGROUND: Many families referred to specialized health services for managing paediatric obesity do not initiate treatment; however, reasons for noninitiation are poorly understood. OBJECTIVE: To understand parents’ reasons for declining tertiary-level health services for paediatric weight management. METHOD: Interviews were conducted with 18 parents of children (10 to 17 years of age; body mass index ≥85th percentile) who were referred for weight management, but did not initiate treatment at one of three Canadian multidisciplinary weight management clinics. A semi-structured interview guide was used to elicit parents’ responses about reasons for noninitiation. Interviews were audio-recorded and transcribed verbatim. Data were managed using NVivo 9 (QSR International, Australia) and analyzed thematically. RESULTS: Most parents (mean age 44.1 years; range 34 to 55 years) were female (n=16 [89%]), obese (n=12 [66%]) and had a university degree (n=13 [71%]). Parents’ reasons for not initiating health services were grouped into five themes: no perceived need for paediatric weight management (eg, perceived children did not have a weight or health problem); no perceived need for further actions (eg, perceived children already had a healthy lifestyle); no intention to initiate recommended care (eg, perceived clinical program was not efficacious); participation barriers (eg, children’s lack of motivation); and situational factors (eg, weather). CONCLUSION: Physicians should not only discuss the need for and value of specialized care for managing paediatric obesity, but also explore parents’ intention to initiate treatment and address reasons for noninitiation that are within their control. PMID:26038633

  9. Extending stakeholder theory to promote resource management initiatives to key stakeholders: a case study of water transfers in Alberta, Canada.

    PubMed

    Lafreniere, Katherine C; Deshpande, Sameer; Bjornlund, Henning; Hunter, M Gordon

    2013-11-15

    Many attempts to implement resource management initiatives in Canadian and international communities have been resisted by stakeholders despite inclusion of their representatives in the decision-making process. Managers' failure to understand stakeholders' perspectives when proposing initiatives is a potential cause of this resistance. Our study uses marketing thought to enhance stakeholder theory by bringing in an audience-centric perspective. We attempt to understand how stakeholders perceive their interests in an organization and consequently decide how to influence that organization. By doing so, we investigate whether a disconnect exists between the perceptions of managers and those of stakeholders. Natural resource managers can utilize this knowledge to garner stakeholder support for the organization and its activities. We support this claim with findings from a water transfer plebiscite held in the Canadian province of Alberta. Sixteen personal interviews employing narrative inquiry were conducted to document voters' (i.e., irrigators') interpretations. PMID:23895936

  10. No Value for Routine Chest Radiography in the Work-Up of Early Stage Cervical Cancer Patients

    PubMed Central

    Hoogendam, Jacob P.; Zweemer, Ronald P.; Verkooijen, Helena M.; de Jong, Pim A.; van den Bosch, Maurice A. A. J.; Verheijen, René H. M.; Veldhuis, Wouter B.

    2015-01-01

    Aim Evidence supporting the recommendation to include chest radiography in the work-up of all cervical cancer patients is limited. We investigated the diagnostic value of routine chest radiography in cervical cancer staging. Methods All consecutive cervical cancer patients who presented at our tertiary referral center in the Netherlands (January 2006 – September 2013), and for whom ≥6 months follow-up was available, were included. As part of the staging procedure, patients underwent a routine two-directional digital chest radiograph. Findings were compared to a composite reference standard consisting of all imaging studies and histology obtained during the 6 months following radiography. Results Of the 402 women who presented with cervical cancer, 288 (71.6%) underwent chest radiography and had ≥6 months follow-up. Early clinical stage (I/II) cervical cancer was present in 244/288 (84.7%) women, while 44 (15.3%) presented with advanced disease (stage III/IV). The chest radiograph of 1 woman – with advanced pre-radiograph stage (IVA) disease – showed findings consistent with pulmonary metastases. Radiographs of 7 other women – 4 early, 3 advanced stage disease – were suspicious for pulmonary metastases which was confirmed by additional imaging in only 1 woman (with pre-radiograph advanced stage (IIIB) disease) and excluded in 6 cases, including all women with early stage disease. In none of the 288 women were thoracic skeletal metastases identified on imaging or during 6 months follow up. Radiography was unremarkable in 76.4% of the study population, and showed findings unrelated to the cervical carcinoma in 21.2%. Conclusion Routine chest radiography was of no value for any of the early stage cervical cancer patients presenting at our tertiary center over a period of 7.7 years. PMID:26135733

  11. Hydrologic modification to improve habitat in riverine lakes: Management objectives, experimental approach, and initial conditions

    USGS Publications Warehouse

    Johnson, Barry L.; Barko, John W.; Gerasimov, Yuri; James, William F.; Litvinov, Alexander; Naimo, Teresa J.; Wiener, James G.; Gaugush, Robert F.; Rogala, James T.; Rogers, Sara J.

    1996-01-01

    The Finger Lakes habitat-rehabilitation project is intended to improve physical and chemical conditions for fish in six connected back water lakes in Navigation Pool 5 of the upper Missouri River. The primary management objective is to improve water temperature, dissolved oxygen concentration and current velocity during winter for bluegills, Lepomis macrochirus, and black crappies, Pomoxis nigromaculatus, two of the primary sport fishes in the lakes. The lakes will be hydrologically altered by Installing culverts to Introduce controlled flows of oxygenated water into four lakes, and an existing unregulated culvert on a fifth lake will be equipped with a control gate to regulate inflow. These habitat modifications constitute a manipulative field experiment that will compare pre-project (1991 to summer 1993) and post-project (fall 1993 to 1996) conditions in the lakes, including hydrology, chemistry, rooted vegetation, and fish and macroinvertebrate communities. Initial data indicate that the Finger Lakes differ in water chemistry, hydrology, and macrophyte abundance. Macroinvertebrate communities also differed among lakes: species diversity was highest in lakes with dense aquatic macrophytes. The system seems to support a single fish community, although some species concentrated in individual lakes at different times. The introduction of similar flows into five of the lakes will probably reduce the existing physical and chemical differences among lakes. However, our ability to predict the effects of hydrologic modification on fish populations is limited by uncertainties concerning both the interactions of temperature, oxygen and current in winter and the biological responses of primary and secondary producers. Results from this study should provide guidance for similar habitat-rehabilitation projects in large rivers.

  12. A Randomized Trial Adapting Contingency Management Targets Based on Initial Abstinence Status of Cocaine-Dependent Patients

    ERIC Educational Resources Information Center

    Petry, Nancy M.; Barry, Danielle; Alessi, Sheila M.; Rounsaville, Bruce J.; Carroll, Kathleen M.

    2012-01-01

    Objective: Contingency management (CM) reduces drug use, but questions remain regarding optimal targets and magnitudes of reinforcement. We evaluated the efficacy of CM reinforcing attendance in patients who initiated treatment with cocaine-negative samples, and of higher magnitude abstinence-based CM in patients who began treatment positive.…

  13. "Life Could Be a Dream": What US-Based Management PhD Students Desire in an Initial Academic Appointment

    ERIC Educational Resources Information Center

    Flynn, C. Brian; Feild, Hubert S.; Bedeian, Arthur G.

    2011-01-01

    Purpose: The purpose of this paper is to first identify the work- and non-work-related criteria US-based management doctoral students consider important in selecting an initial academic appointment, and second, to explore whether gender and race/ethnicity are associated with the importance attached to these criteria. Design/methodology/approach:…

  14. Evaluation of the Pilot Program of the Truancy Case Management Partnership Initiative in the District of Columbia, 2011-12

    ERIC Educational Resources Information Center

    Liberman, Akiva; Cahill, Meagan

    2012-01-01

    This evaluation of the Case Management Partnership Initiative (CPMI) found that the program successfully linked high-need families with services designed to prevent truancy. The truancy prevention program, implemented at Anacostia and Ballou High Schools in 2011-2012, links chronically truant ninth graders and their families to social services and…

  15. Prospects for Learning in River Management: Exploring the Initial Implementation of the Water Framework Directive in a Swedish River Basin

    ERIC Educational Resources Information Center

    Lundmark, Carina; Jonsson, Gunnar

    2014-01-01

    This case study explores the initial implementation of the EU Water Framework Directive (WFD) in the Lule River basin, Sweden, examining how and to what extent administrative procedures enable learning through dialogue and stakeholder collaboration. Theorising on adaptive co-management and social learning is used to structure what is to be learnt,…

  16. Modeling the effects of irrigation frequencies, initial water and nitrogen on corn yield responses for best management

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Competing demands for fresh water resources necessitate adaptation of limited water irrigations in agriculture. In this context, the Crop Water Production Functions (CWPF) used in limited water irrigation management need to integrate the effects of climate, initial soil water content at planting, an...

  17. Managing Curriculum: Rapid Implementation and Sustainability of a Districtwide Data Initiative

    ERIC Educational Resources Information Center

    Wayman, Jeffrey C.; Conoly, Katherine

    2006-01-01

    In March 2003, the Corpus Christi Independent School District (CCISD) received a Curriculum Management Audit report from the Texas Curriculum Management Audit Center of the Texas Association of School Administrators. One of the findings of this audit was that CCISD lacked a clear comprehensive management plan to define and guide the design,…

  18. Stridor and apnea as the initial presentation of primary hypoparathyroidism.

    PubMed

    Chou, Courtney T; Siegel, Bianca; Mehta, Deepak

    2016-01-01

    We present a previously undescribed case of stridor and apnea as the initial presentation of primary hypoparathyroidism. A neonate presenting with these symptoms was initially diagnosed with laryngopharyngeal reflux and laryngomalacia. After failing medical management, she underwent supraglottoplasty with improvement of stridor, but persistent apneic events. Further work-up showed severe hypocalcemia due to hypoparathyroidism. Subsequent genetic testing revealed a diagnosis of Bartter Syndrome Type V, a rare cause of primary hypoparathyroidism. Although uncommon, hypocalcemic tetany can present as apneic episodes in the setting of unrecognized primary hypoparathyroidism. Electrolyte abnormalities should be explored in neonates with recurrent apnea of unknown etiology. PMID:26746608

  19. Pain Management in the Elderly: An FDA Safe Use Initiative Expert Panel's View on Preventable Harm Associated with NSAID Therapy

    PubMed Central

    Taylor, Robert; Lemtouni, Salma; Weiss, Karen; Pergolizzi, Joseph V.

    2012-01-01

    Optimization of current pain management strategies is necessary in order to reduce medication risks. Promoting patient and healthcare provider education on pain and pain medications is an essential step in reducing inadequate prescribing behaviors and adverse events. In an effort to raise awareness on medication safety, the FDA has launched the Safe Use Initiative program. The program seeks to identify areas with the greatest amount of preventable harm and help promote new methods and practices to reduce medication risks. Since the establishment of the program, FDA's Safe Use initiative staff convened a panel of key opinion leaders throughout the medical community to address pain management in older adults (≥65 years of age). The aim of the expert panel was to focus on areas where significant risk occurs and where potential interventions will be feasible, implementable, and lead to substantial impact. The panel suggested one focus could be the use of NSAIDs for pain management in the elderly. PMID:22400024

  20. The Gulf of Mexico Research Initiative Information and Data Cooperative: Multidisciplinary data management from the ground up

    NASA Astrophysics Data System (ADS)

    Showalter, L. M.; Gibeaut, J. C.

    2015-12-01

    As more journals and funding organizations require data to be made available, more and more scientists are being exposed to the world of data science, metadata development, and data standards so they can ensure future funding and publishing success. The Gulf of Mexico Research Initiative Information and Data Cooperative (GRIIDC) is the vehicle by which the Gulf of Mexico Research Initiative (GOMRI) is making all data collected in this program publically available. This varied group of researchers all have different levels of experience with data management standards and protocols, thus GRIIDC has evolved to embrace the cooperative nature of our work and develop a number of tools and training materials to help ensure data managers and researchers in the GoMRI program are submitting high quality data and metadata that will be useful for years to come. GRIIDC began with a group of 8 data managers many of which had only ever managed their own data, who were then expected to manage the data of a large group of geographically distant researchers. As the program continued to evolve these data managers worked with the GRIIDC team to help identify and develop much needed resources for training and communication for themselves and the scientists they represented. This essential cooperation has developed a team of highly motivated scientists, computer programmers and data scientists who are working to ensure a data and information legacy that promotes continual scientific discovery and public awareness of the Gulf of Mexico Ecosystem and beyond.

  1. 78 FR 21155 - Presence Sensing Device Initiation (PSDI) Standard; Extension of the Office of Management and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-09

    ... 1995 (44 U.S.C. 3506 et seq.) and Secretary of Labor's Order No. 1-2012 (77 FR 3912). Signed at... Occupational Safety and Health Administration Presence Sensing Device Initiation (PSDI) Standard; Extension of... Sensing Device Initiation (PSDI) Standard (29 CFR 1910.217(h)). DATES: Comments must be...

  2. 75 FR 12570 - Presence Sensing Device Initiation (PSDI); Extension of the Office of Management and Budget's...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-16

    ... Act of 1995 (44 U.S.C. 3506 et seq.) and Secretary of Labor's Order No. 5-2007 (72 FR 31159). Signed... Occupational Safety and Health Administration Presence Sensing Device Initiation (PSDI); Extension of the... Sensing Device Initiation (29 CFR 1910.217(h)). DATES: Comments must be submitted (postmarked, sent,...

  3. Managing and Creating an Image in the Interview: The Role of Interviewee Initial Impressions

    ERIC Educational Resources Information Center

    Swider, Brian W.; Barrick, Murray R.; Harris, T. Brad; Stoverink, Adam C.

    2011-01-01

    In employment interviews, individuals use impression management tactics to present themselves as suitable candidates to interviewers. However, not all impression management tactics, or the interviewees who employ them, are effective at positively influencing interview scores. Results of this study indicate that the relationship between impression…

  4. 76 FR 81487 - Application of the Energy Planning and Management Program Power Marketing Initiative to the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-28

    ... Area Power Administration Application of the Energy Planning and Management Program Power Marketing...-2017 marketing efforts, the Energy Management and Planning Program (Program), and the Conformed General...) published in the Federal Register on December 28, ] 1984 (49 FR 50582), are available at...

  5. Initial single shell tank retrieval system project system engineering management plan

    SciTech Connect

    Krieg, S.A., Westinghouse Hanford

    1996-07-31

    This System Engineering Management Plan (SEMP) describes the Systems Engineering approach that will be used to manage the retrieval of waste from the first single shell tank farm using past practice sluicing techniques. This Project SEMP is used to supplement the requirements of the TWRS SEMP, WHC-SD-WM-SEMP-002.

  6. Misfit and Match: The Frontline Management Initiative in the Community Services and Health Industry.

    ERIC Educational Resources Information Center

    Roos, Ian; Smith, Chris Selby; Wright, Liz

    The application of frontline management training in the community and health services (CS&H) industry in Victoria, Australia, was examined through interviews with managers of 11 user and 11 provider organizations in the public and private sectors. The study focused on the following topics: (1) the appropriateness of the Frontline Management…

  7. White-nose Syndrome management: Report on structured decision making initiative

    USGS Publications Warehouse

    Szymanski, Jennifer A.; Runge, Michael C.; Parkin, Mary J.; Armstrong, Mike

    2009-01-01

    This report describes an analysis undertaken to assist state and federal natural resources managers in addressing the following question: What management measures should be taken this year within a given area to control the spread and minimize the effects of white-nose syndrome (WNS) on hibernating bats at the individual and population levels? The answer depends upon specific characteristics of the bat species, the hibernacula, and the syndrome itself, all of which could vary across the geographic extent of WNS and change over time. It also depends on a large number of agency and societal judgments concerning how to balance disease management against other objectives.

  8. System Engineering Management and Implementation Plan for Project W-211 Initial Tank Retrieval Systems (ITRS)

    SciTech Connect

    VAN BEEK, J.E.

    2000-05-05

    This systems Engineering Management and Implementation Plan (SEMIP) describes the Project W-211 implementation of the Tank Farm Contractor Systems Engineering Management Plan (TFC SEMP). The SEMIP defines the systems engineering products and processes used by the project to comply with the TFC SEMP, and provides the basis for tailoring systems engineering processes by applying a graded approach to identify appropriate systems engineering requirements for W-211.

  9. The Saudi Initiative for Asthma - 2016 update: Guidelines for the diagnosis and management of asthma in adults and children

    PubMed Central

    Al-Moamary, Mohamed S.; Alhaider, Sami A.; Idrees, Majdy M.; Al Ghobain, Mohammed O.; Zeitouni, Mohammed O.; Al-Harbi, Adel S.; Yousef, Abdullah A.; Al-Matar, Hussain; Alorainy, Hassan S.; Al-Hajjaj, Mohamed S.

    2016-01-01

    This is an updated guideline for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have guidelines that are up to date, simple to understand and easy to use by nonasthma specialists, including primary care and general practice physicians. SINA approach is mainly based on symptom control and assessment of risk as it is the ultimate goal of treatment. The new SINA guidelines include updates of acute and chronic asthma management, with more emphasis on the use of asthma control in the management of asthma in adults and children, inclusion of a new medication appendix, and keeping consistency on the management at different age groups. The section on asthma in children is rewritten and expanded where the approach is stratified based on the age. The guidelines are constructed based on the available evidence, local literature, and the current situation in Saudi Arabia. There is also an emphasis on patient–doctor partnership in the management that also includes a self-management plan. PMID:26933455

  10. 30 CFR 250.521 - How do I manage the thermal effects caused by initial production on a newly completed or...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... initial production on a newly completed or recompleted well? 250.521 Section 250.521 Mineral Resources... AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Well-Completion Operations Casing Pressure Management § 250.521 How do I manage the thermal effects caused by initial production...

  11. 30 CFR 250.521 - How do I manage the thermal effects caused by initial production on a newly completed or...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... initial production on a newly completed or recompleted well? 250.521 Section 250.521 Mineral Resources... SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Well-Completion Operations Casing Pressure Management § 250.521 How do I manage the thermal effects caused by initial production on a newly completed...

  12. 30 CFR 250.522 - How do I manage the thermal effects caused by initial production on a newly completed or...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... initial production on a newly completed or recompleted well? 250.522 Section 250.522 Mineral Resources... SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Well-Completion Operations Casing Pressure Management § 250.522 How do I manage the thermal effects caused by initial production on a newly completed...

  13. 30 CFR 250.521 - How do I manage the thermal effects caused by initial production on a newly completed or...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... initial production on a newly completed or recompleted well? 250.521 Section 250.521 Mineral Resources... OUTER CONTINENTAL SHELF Oil and Gas Well-Completion Operations Casing Pressure Management § 250.521 How do I manage the thermal effects caused by initial production on a newly completed or recompleted...

  14. Supporting 'Baby Friendly': a quality improvement initiative for the management of transitional neonatal hypoglycaemia.

    PubMed

    Stewart, Claire Elizabeth; Sage, Emma Louise Maitland; Reynolds, Peter

    2016-07-01

    We describe a quality improvement initiative conducted in a medium-sized district general hospital with a neonatal intensive care unit, which involved working with the multidisciplinary team to create a 'Baby Friendly' neonatal hypoglycaemia pathway with implementation of dextrose gel as a first-line treatment. As a result of the project, formula supplementation rates and admissions for transitional hypoglycaemia were reduced and breastfeeding rates at 3 months improved. This initiative demonstrates that evidence-based guidelines with multidisciplinary team input can improve standards of care. PMID:26644391

  15. Initial evaluation and management of infertility by the primary care physician.

    PubMed

    Frey, Keith A; Patel, Ketan S

    2004-11-01

    Infertility is a common condition seen in primary care practices. Infertility is defined as 1 year of unprotected intercourse during which a pregnancy is not achieved. in the United States, 15% to 20% of all couples are infertile, with higher rates seen in older couples. The causes of infertility include abnormalities of any portion of the male or female reproductive system. The female partner usually presents initially for an infertilty problem, often in the context of an annual well-women examination. The primary care physician who provides such preventive care can initiate the diagnostic evaluation and can treat some causes of infertility. PMID:15544024

  16. Variations in thematic mapper spectra of soil related to tillage and crop residue management - Initial evaluation

    NASA Technical Reports Server (NTRS)

    Seeley, M. W.; Ruschy, D. L.; Linden, D. R.

    1983-01-01

    A cooperative research project was initiated in 1982 to study differences in thematic mapper spectral characteristics caused by variable tillage and crop residue practices. Initial evaluations of radiometric data suggest that spectral separability of variably tilled soils can be confounded by moisture and weathering effects. Separability of bare tilled soils from those with significant amounts of corn residue is enhanced by wet conditions, but still possible under dry conditions when recent tillage operations have occurred. In addition, thematic mapper data may provide an alternative method to study the radiant energy balance at the soil surface in conjunction with variable tillage systems.

  17. Radioactive Waste Management in the European Union: Initiatives for New Legislation

    SciTech Connect

    Taylor, D.

    2003-02-25

    Improving the management of radioactive waste in the European Union is a major theme of the ''nuclear package'' recently adopted by the European Commission. Included in the package are proposals for new legislation that would bring about the development of common safety standards in Europe covering the full nuclear sector, segregated funds to cover all nuclear liabilities that remain after the operating lifetime of an installation and clearly defined waste programs for radioactive waste management in each of the Member States of the Union. Included in these programs must be firm dates for a number decision points leading to disposal of all forms of radioactive waste. The package also puts significant emphasis on more, and better coordinated, research on radioactive waste management as the present levels are thought to be inadequate.

  18. The impact of initial and recurrent cockpit resource management training on attitudes

    NASA Technical Reports Server (NTRS)

    Irwin, Cheryl M.

    1991-01-01

    It is noted that previous analyses of the boomerang effect (attitude change as a result of training in the direction opposite of that intended) in aviation training environments were limited in that each subscale of the cockpit management attitudes questionnaire (CMAQ) was examined independently. This study develops and utilizes a new algorithm for grouping subjects such that a global attitude change score is derived from the attitude change scores on each CMAQ subscale. By evaluating global attitude change in addition to the more specific attitude change on each subscale, it might be possible to better comprehend the effects of crew resource management training on pilot attitudes.

  19. Getting Results: Outcomes Management and the Annie E. Casey Foundations Jobs Initiative.

    ERIC Educational Resources Information Center

    Giloth, Robert; Phillips, William

    The Anne E. Casey Foundation (AECF) funded replications of effective jobs projects to achieve better job placement and retention for low-income, young adults. The six projects funded, collectively called the Jobs Initiative (JI), in Denver, Milwaukee, New Orleans, Philadelphia, Seattle, and St. Louis, used an outcomes framework developed by The…

  20. 40 CFR 63.11584 - What are my initial and continuous compliance management practice requirements?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS... to, monitoring results, review of operation and maintenance procedures, review of operation and... 40 Protection of Environment 14 2011-07-01 2011-07-01 false What are my initial and...

  1. NSF/DARPA/NASA Digital Libraries Initiative: A Program Manager's Perspective.

    ERIC Educational Resources Information Center

    Griffin, Stephen M.

    1998-01-01

    Discusses the National Science Foundation (NSF)/United States Defense Advanced Research Projects Agency (DARPA)/National Aeronautics and Space Agency (NASA) Research in Digital Libraries Initiative (DLI). Highlights include benefits of digital libraries; the Federal High Performance Computing and Communications Program (HPCC); and program…

  2. The Implementation of Quality Management Initiatives in the Context of Organisational Learning.

    ERIC Educational Resources Information Center

    Roche, Evelyn

    2002-01-01

    An Irish company embarked on implementing a business excellence model and continuous improvement initiatives. Some employees' reluctance to participate impeded organizational learning, but the creation of a culture that encouraged, facilitated, and rewarded learning enabled movement toward excellence. (Contains 64 references.) (SK)

  3. Teaching Costs in Seven French Universities. Initial Evaluations. Program on Institutional Management in Higher Education.

    ERIC Educational Resources Information Center

    Abraham-Frois, Gilbert

    Methods of evaluating unit operating costs and the development of the services and departments of French universities are examined. After an initial phase devoted to working out a common methodology, it was decided that the latter should be put directly to the test and that devices would have to be found to bridge the gaps in existing data, as,…

  4. From Restaurants to Board Rooms: How Initiating Negotiations Teaches Management Principles and Theory

    ERIC Educational Resources Information Center

    Volkema, Roger J.; Kapoutsis, Ilias

    2016-01-01

    Negotiation is an interpersonal process common to everyday personal and professional success. Yet individuals often fail to recognize opportunities for initiating negotiations and the immediate and long-term implications of these oversights for themselves and others. This article describes a simple yet rich negotiation exercise that learners can…

  5. Initiation of a USDA, ARS Area-Wide Methyl Bromide Alternatives Pest Management Project

    Technology Transfer Automated Retrieval System (TEKTRAN)

    In March, 2006 USDA, ARS decided to establish a 5-year AW Pest Management Project on alternatives to MB. The work will focus on pre-plant alternatives to MB for soil fumigation and occur in the most severely impacted agricultural production systems in South Atlantic and Pacific regions of the U.S.,...

  6. Exchanging Ideas on Evaluation: Evaluating an Initial Management Skills Course: A Case Study.

    ERIC Educational Resources Information Center

    Lyman, Pat

    1979-01-01

    Describes an evaluation study of an interpersonal effectiveness management course for first-level supervisors. The evaluator collected information using graduate appraisal of course content, skill retention, measures, significant incident techniques, analysis of work products/records, appraisal of instructor, observation checklists, and…

  7. 75 FR 41217 - Federal Housing Administration Risk Management Initiatives: Reduction of Seller Concessions and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-15

    ... nationwide housing standards, provide employment and stimulate industry, to improve conditions with respect... conditions and concerns, FHA, in managing the MMIF, must be especially vigilant in monitoring the performance..., the poor performance of seller- financed gift letter mortgage loans, and worsening...

  8. Culturally Competent Diabetes Self-Management Education for Mexican Americans: The Starr County Border Health Initiative.

    ERIC Educational Resources Information Center

    Brown, Sharon A.; Garcia, Alexandra A.; Kouzekanani, Kamiar; Hanis, Craig L.

    2002-01-01

    In a culturally competent diabetes self-management intervention in Starr County, Texas, bilingual Mexican American nurses, dieticians, and community workers provided weekly instruction on nutrition, self-monitoring, exercise and other self-care topics. A biweekly support group promoted behavior change. Interviews and examinations with 256 Mexican…

  9. Policy initiatives for electric-utility load management in AID-assisted countries

    SciTech Connect

    Not Available

    1990-08-01

    The demand for electricity has been growing at a rate of over 7 percent per year, on average, for developing countries (in contrast, demand has been rising by less than 3% annually in the United States). While developing nations have traditionally relied on building new power plants to satisfy their increasing needs for electricity, the strategy has proven to be expensive, consuming over one-quarter of their development budgets and over a quarter of their foreign borrowings. Load management, whereby an electric utility modifies its customers' demand characteristics, offers developing countries an alternative for reducing the need to construct new generating capacity and for better utilizing their existing supply facilities. To mitigate the problems associated with high energy growth rates, especially in the power sector, the lack of investment capital for the electricity sector, and the growing concern for environmental hazards including global climate change, the Office of Energy promotes energy efficiency, the role of private power and other supply options to ensure sustainable development. In view of these objectives, the report examines the rationale for load management in the electricity sector and summarizes the positive U.S. experience with these techniques. Additionally, it recommends a strategy for achieving energy efficiency via load management. Lastly, it recommends to A.I.D. a method for identifying priority Agency-assisted countries as candidates for load management assistance.

  10. Standards in Action. Using National Standards for Human Resource Management and Development in Further Education. 5. Standards-based Initial Teacher Training.

    ERIC Educational Resources Information Center

    Further Education Unit, London (England).

    This booklet explores the use of national standards to structure work-based initial teacher training for teachers working within British further education colleges. Section 1 examines the following aspects of the use of Training and Development Lead Body (TDLB) and Management Charter Initiative (MCI) standards for initial teacher training: reasons…

  11. The Saudi initiative for asthma – 2012 update: Guidelines for the diagnosis and management of asthma in adults and children

    PubMed Central

    Al-Moamary, Mohamed S.; Alhaider, Sami A.; Al-Hajjaj, Mohamed S.; Al-Ghobain, Mohammed O.; Idrees, Majdy M.; Zeitouni, Mohammed O.; Al-Harbi, Adel S.; Al Dabbagh, Maha M.; Al-Matar, Hussain; Alorainy, Hassan S.

    2012-01-01

    This an updated guidelines for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have updated guidelines, which are simple to understand and easy to use by non-asthma specialists, including primary care and general practice physicians. This new version includes updates of acute and chronic asthma management, with more emphasis on the use of Asthma Control Test in the management of asthma, and a new section on “difficult-to-treat asthma.” Further, the section on asthma in children was re-written to cover different aspects in this age group. The SINA panel is a group of Saudi experts with well-respected academic backgrounds and experience in the field of asthma. The guidelines are formatted based on the available evidence, local literature, and the current situation in Saudi Arabia. There was an emphasis on patient–doctor partnership in the management that also includes a self-management plan. The approach adopted by the SINA group is mainly based on disease control as it is the ultimate goal of treatment. PMID:23189095

  12. The Saudi initiative for asthma - 2012 update: Guidelines for the diagnosis and management of asthma in adults and children.

    PubMed

    Al-Moamary, Mohamed S; Alhaider, Sami A; Al-Hajjaj, Mohamed S; Al-Ghobain, Mohammed O; Idrees, Majdy M; Zeitouni, Mohammed O; Al-Harbi, Adel S; Al Dabbagh, Maha M; Al-Matar, Hussain; Alorainy, Hassan S

    2012-10-01

    This an updated guidelines for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have updated guidelines, which are simple to understand and easy to use by non-asthma specialists, including primary care and general practice physicians. This new version includes updates of acute and chronic asthma management, with more emphasis on the use of Asthma Control Test in the management of asthma, and a new section on "difficult-to-treat asthma." Further, the section on asthma in children was re-written to cover different aspects in this age group. The SINA panel is a group of Saudi experts with well-respected academic backgrounds and experience in the field of asthma. The guidelines are formatted based on the available evidence, local literature, and the current situation in Saudi Arabia. There was an emphasis on patient-doctor partnership in the management that also includes a self-management plan. The approach adopted by the SINA group is mainly based on disease control as it is the ultimate goal of treatment. PMID:23189095

  13. Management of recurrence after initial surgery for malignant pleural mesothelioma: a mini-review.

    PubMed

    Halezeroğlu, Semih; Migliore, Marcello

    2015-01-01

    Recurrence after surgery in the multimodality therapy for malignant pleural mesothelioma is a common problem. As the majority of patients experience not only local but also distant metastases, a systemic treatment strategy in addition to local control measures remains necessary. Nevertheless, none of the chemotherapy regimens have achieved clinical success. Local management modalities such as stereotaxic treatments, cryoablation and redo surgery on the other hand have promising results, but provide palliative outcomes. PMID:26638919

  14. Controlled tissue expansion in the initial management of the short bowel state.

    PubMed

    Murphy, F; Khalil, B A; Gozzini, S; King, B; Bianchi, A; Morabito, A

    2011-05-01

    The treatment of short gut syndrome has evolved dramatically during the past decade. The combination of surgical techniques and medical management in the context of a multidisciplinary approach has improved the outcomes of these children. The authors describe in detail their technique of controlled tissue expansion of the bowel before lengthening procedures. Monitoring of the child and troubleshooting actions during the controlled tissue expansion program also are discussed. PMID:21318429

  15. An Ontology of Quality Initiatives and a Model for Decentralized, Collaborative Quality Management on the (Semantic) World Wide Web

    PubMed Central

    2001-01-01

    This editorial provides a model of how quality initiatives concerned with health information on the World Wide Web may in the future interact with each other. This vision fits into the evolving "Semantic Web" architecture - ie, the prospective that the World Wide Web may evolve from a mess of unstructured, human-readable information sources into a global knowledge base with an additional layer providing richer and more meaningful relationships between resources. One first prerequisite for forming such a "Semantic Web" or "web of trust" among the players active in quality management of health information is that these initiatives make statements about themselves and about each other in a machine-processable language. I present a concrete model on how this collaboration could look, and provide some recommendations on what the role of the World Health Organization (WHO) and other policy makers in this framework could be. PMID:11772549

  16. Towards reframing health service delivery in Uganda: the Uganda Initiative for Integrated Management of Non-Communicable Diseases

    PubMed Central

    Schwartz, Jeremy I.; Dunkle, Ashley; Akiteng, Ann R.; Birabwa-Male, Doreen; Kagimu, Richard; Mondo, Charles K.; Mutungi, Gerald; Rabin, Tracy L.; Skonieczny, Michael; Sykes, Jamila; Mayanja-Kizza, Harriet

    2015-01-01

    Background The burden of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) is accelerating. Given that the capacity of health systems in LMICs is already strained by the weight of communicable diseases, these countries find themselves facing a double burden of disease. NCDs contribute significantly to morbidity and mortality, thereby playing a major role in the cycle of poverty, and impeding development. Methods Integrated approaches to health service delivery and healthcare worker (HCW) training will be necessary in order to successfully combat the great challenge posed by NCDs. Results In 2013, we formed the Uganda Initiative for Integrated Management of NCDs (UINCD), a multidisciplinary research collaboration that aims to present a systems approach to integrated management of chronic disease prevention, care, and the training of HCWs. Discussion Through broad-based stakeholder engagement, catalytic partnerships, and a collective vision, UINCD is working to reframe integrated health service delivery in Uganda. PMID:25563451

  17. Has dialysis payment reform led to initial racial disparities in anemia and mineral metabolism management?

    PubMed

    Turenne, Marc N; Cope, Elizabeth L; Porenta, Shannon; Mukhopadhyay, Purna; Fuller, Douglas S; Pearson, Jeffrey M; Dahlerus, Claudia; Lantz, Brett; Tentori, Francesca; Robinson, Bruce M

    2015-03-01

    Implementation of the Medicare ESRD prospective payment system (PPS) and changes to dosing guidelines for erythropoiesis-stimulating agents (ESAs) in 2011 appear to have influenced use of injectable medications among dialysis patients. Given historically higher ESA and vitamin D use among black patients, we assessed the effect of these policy changes on racial disparities in the management of anemia and mineral metabolism. Analyses used cross-sectional monthly cohorts for a period-prevalent sample of 7384 maintenance hemodialysis patients at 132 facilities from the Dialysis Outcomes and Practice Patterns Study (DOPPS) Practice Monitor. Linear splines with knots at each policy change were used in survey-weighted regressions to estimate time trends in hemoglobin (Hgb), erythropoietin (EPO) dose, intravenous (IV) iron dose, ferritin, transferrin saturation (TSAT) concentration, parathyroid hormone (PTH), IV vitamin D dose, cinacalcet use, and phosphate binder use. From August 2010 to December 2011, mean Hgb declined from 11.5 to 11.0 g/dl (P<0.001), mean EPO dose declined from 20,506 to 14,777 U/wk (P<0.001), and mean serum PTH increased from 340 to 435 pg/ml (P<0.001). No meaningful differences by race were observed regarding the rates of change of management practices or laboratory measures (all P>0.21). Mean EPO and vitamin D dose and serum PTH levels remained higher in blacks. Despite evidence that anemia and mineral metabolism management practices have changed significantly over time, there was no immediate indication of racial disparities resulting from implementation of the PPS or ESA label change. Further studies are needed to examine effects among patient and facility subgroups. PMID:25300289

  18. Has Dialysis Payment Reform Led to Initial Racial Disparities in Anemia and Mineral Metabolism Management?

    PubMed Central

    Cope, Elizabeth L.; Porenta, Shannon; Mukhopadhyay, Purna; Fuller, Douglas S.; Pearson, Jeffrey M.; Dahlerus, Claudia; Lantz, Brett; Tentori, Francesca; Robinson, Bruce M.

    2015-01-01

    Implementation of the Medicare ESRD prospective payment system (PPS) and changes to dosing guidelines for erythropoiesis-stimulating agents (ESAs) in 2011 appear to have influenced use of injectable medications among dialysis patients. Given historically higher ESA and vitamin D use among black patients, we assessed the effect of these policy changes on racial disparities in the management of anemia and mineral metabolism. Analyses used cross-sectional monthly cohorts for a period-prevalent sample of 7384 maintenance hemodialysis patients at 132 facilities from the Dialysis Outcomes and Practice Patterns Study (DOPPS) Practice Monitor. Linear splines with knots at each policy change were used in survey-weighted regressions to estimate time trends in hemoglobin (Hgb), erythropoietin (EPO) dose, intravenous (IV) iron dose, ferritin, transferrin saturation (TSAT) concentration, parathyroid hormone (PTH), IV vitamin D dose, cinacalcet use, and phosphate binder use. From August 2010 to December 2011, mean Hgb declined from 11.5 to 11.0 g/dl (P<0.001), mean EPO dose declined from 20,506 to 14,777 U/wk (P<0.001), and mean serum PTH increased from 340 to 435 pg/ml (P<0.001). No meaningful differences by race were observed regarding the rates of change of management practices or laboratory measures (all P>0.21). Mean EPO and vitamin D dose and serum PTH levels remained higher in blacks. Despite evidence that anemia and mineral metabolism management practices have changed significantly over time, there was no immediate indication of racial disparities resulting from implementation of the PPS or ESA label change. Further studies are needed to examine effects among patient and facility subgroups. PMID:25300289

  19. Deep space telecommunications, navigation, and information management - Support of the Space Exploration Initiative

    NASA Technical Reports Server (NTRS)

    Hall, Justin R.; Hastrup, Rolf C.

    1990-01-01

    The principal challenges in providing effective deep space navigation, telecommunications, and information management architectures and designs for Mars exploration support are presented. The fundamental objectives are to provide the mission with the means to monitor and control mission elements, obtain science, navigation, and engineering data, compute state vectors and navigate, and to move these data efficiently and automatically between mission nodes for timely analysis and decision making. New requirements are summarized, and related issues and challenges including the robust connectivity for manned and robotic links, are identified. Enabling strategies are discussed, and candidate architectures and driving technologies are described.

  20. Public involvement in the priority setting activities of a wait time management initiative: a qualitative case study

    PubMed Central

    Bruni, Rebecca A; Laupacis, Andreas; Levinson, Wendy; Martin, Douglas K

    2007-01-01

    Background As no health system can afford to provide all possible services and treatments for the people it serves, each system must set priorities. Priority setting decision makers are increasingly involving the public in policy making. This study focuses on public engagement in a key priority setting context that plagues every health system around the world: wait list management. The purpose of this study is to describe and evaluate priority setting for the Ontario Wait Time Strategy, with special attention to public engagement. Methods This study was conducted at the Ontario Wait Time Strategy in Ontario, Canada which is part of a Federal-Territorial-Provincial initiative to improve access and reduce wait times in five areas: cancer, cardiac, sight restoration, joint replacements, and diagnostic imaging. There were two sources of data: (1) over 25 documents (e.g. strategic planning reports, public updates), and (2) 28 one-on-one interviews with informants (e.g. OWTS participants, MOHLTC representatives, clinicians, patient advocates). Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. Results The Ontario Wait Time Strategy partially meets the four conditions of 'accountability for reasonableness'. The public was not directly involved in the priority setting activities of the Ontario Wait Time Strategy. Study participants identified both benefits (supporting the initiative, experts of the lived experience, a publicly funded system and sustainability of the healthcare system) and concerns (personal biases, lack of interest to be involved, time constraints, and level of technicality) for public involvement in the Ontario Wait Time Strategy. Additionally, the participants identified concern for the consequences (sustainability, cannibalism, and a class system) resulting from the Ontario Wait Times Strategy. Conclusion We described and evaluated a wait time management initiative (the Ontario Wait Time Strategy

  1. Criteria for CT and Initial Management of Head Injured Infants: A Review

    PubMed Central

    SHIOMI, Naoto; ECHIGO, Tadashi; HINO, Akihiko; HASHIMOTO, Naoya; YAMAKI, Tarumi

    2016-01-01

    Criteria for computed tomography (CT) to head injured infants have not been established. Since the identification of neurological findings is difficult in infants, examination by CT may be necessary in some cases, but it may be difficult to perform CT because of problems with radiation exposure and body movement. Moreover, even though no intracranial abnormality was found immediately after injury, abnormal findings may appear after several hours. From this viewpoint, course observation after injury may be more important than CT in the initial treatment of head trauma in infants. The complaints and neurological manifestations of infants, particularly those aged 2 or younger, are frequently unclear; therefore, there is an opinion that CT is recommended for all pediatric patients. However, the appropriateness of its use should be determined after confirming the mechanism of injury, consciousness level, neurological findings, and presence/absence of a history of abuse. Among the currently available rules specifying criteria for CT of infants with head trauma, the Pediatric Emergency Care Applied Research Network (PECARN) study may be regarded as reliable at present. In Japan, where the majority of emergency hospitals are using CT, it may be necessary to develop criteria for CT in consideration of the actual situation. CT diagnosis for pediatric head trauma is not always necessary. When no imaging is performed, this should be fully explained at the initial treatment before selecting course observation at home. Checking on a state of the patients by telephone is useful for both patients and physicians. PMID:27194179

  2. Criteria for CT and Initial Management of Head Injured Infants: A Review.

    PubMed

    Shiomi, Naoto; Echigo, Tadashi; Hino, Akihiko; Hashimoto, Naoya; Yamaki, Tarumi

    2016-07-15

    Criteria for computed tomography (CT) to head injured infants have not been established. Since the identification of neurological findings is difficult in infants, examination by CT may be necessary in some cases, but it may be difficult to perform CT because of problems with radiation exposure and body movement. Moreover, even though no intracranial abnormality was found immediately after injury, abnormal findings may appear after several hours. From this viewpoint, course observation after injury may be more important than CT in the initial treatment of head trauma in infants. The complaints and neurological manifestations of infants, particularly those aged 2 or younger, are frequently unclear; therefore, there is an opinion that CT is recommended for all pediatric patients. However, the appropriateness of its use should be determined after confirming the mechanism of injury, consciousness level, neurological findings, and presence/absence of a history of abuse. Among the currently available rules specifying criteria for CT of infants with head trauma, the Pediatric Emergency Care Applied Research Network (PECARN) study may be regarded as reliable at present. In Japan, where the majority of emergency hospitals are using CT, it may be necessary to develop criteria for CT in consideration of the actual situation. CT diagnosis for pediatric head trauma is not always necessary. When no imaging is performed, this should be fully explained at the initial treatment before selecting course observation at home. Checking on a state of the patients by telephone is useful for both patients and physicians. PMID:27194179

  3. Depression Screening in Chronic Disease Management: A Worksite Health Promotion Initiative.

    PubMed

    Jensen, Elizabeth; Dumas, Bonnie P; Edlund, Barbara J

    2016-03-01

    This pilot project aimed to improve depression symptoms and quality-of-life measures for individuals in a worksite disease management program. Two hundred forty-three individuals were invited to participate, out of which 69 enrolled. The participants had a history of diabetes, hypertension, or hyperlipidemia, and demonstrated depression using the Patient Health Questionnaire-9 (PHQ-9). The project consisted of counseling sessions provided every 2 to 4 weeks by a family nurse practitioner. PHQ-9 scores and those of an instrument that measures quality of life, the Veteran's Rand-12 (VR-12), were compared pre-intervention and post-intervention to evaluate the effectiveness of the project. PHQ-9 and VR-12 Mental Health Component (MHC) scores improved significantly after 3 months of nurse practitioner-led individual counseling sessions. This project demonstrated that depression screening and therapeutic management, facilitated by a nurse practitioner, can improve depression and perceived quality of life in individuals with hypertension, hyperlipidemia, or type 2 diabetes. PMID:26458410

  4. Telecommunications, navigation and information management concept overview for the Space Exploration Initiative program

    NASA Technical Reports Server (NTRS)

    Bell, Jerome A.; Stephens, Elaine; Barton, Gregg

    1991-01-01

    An overview is provided of the Space Exploration Initiative (SEI) concepts for telecommunications, information systems, and navigation (TISN), and engineering and architecture issues are discussed. The SEI program data system is reviewed to identify mission TISN interfaces, and reference TISN concepts are described for nominal, degraded, and mission-critical data services. The infrastructures reviewed include telecommunications for robotics support, autonomous navigation without earth-based support, and information networks for tracking and data acquisition. Four options for TISN support architectures are examined which relate to unique SEI exploration strategies. Detailed support estimates are given for: (1) a manned stay on Mars; (2) permanent lunar and Martian settlements; short-duration missions; and (4) systematic exploration of the moon and Mars.

  5. Early initiation of low-dose corticosteroid therapy in the management of septic shock: a retrospective observational study

    PubMed Central

    2012-01-01

    Introduction The use of low-dose steroid therapy in the management of septic shock has been extensively studied. However, the association between the timing of low-dose steroid therapy and the outcome has not been evaluated. Therefore, we evaluated whether early initiation of low-dose steroid therapy is associated with mortality in patients with septic shock. Methods We retrospectively analyzed the clinical data of 178 patients who received low-dose corticosteroid therapy for septic shock between January 2008 and December 2009. Time-dependent Cox regression models were used to adjust for potential confounding factors in the association between the time to initiation of low-dose corticosteroid therapy and in-hospital mortality. Results The study population consisted of 107 men and 71 women with a median age of 66 (interquartile range, 54 to 71) years. The 28-day mortality was 44% and low-dose corticosteroid therapy was initiated within a median of 8.5 (3.8 to 19.1) hours after onset of septic shock-related hypotension. Median time to initiation of low-dose corticosteroid therapy was significantly shorter in survivors than in non-survivors (6.5 hours versus 10.4 hours; P = 0.0135). The mortality rates increased significantly with increasing quintiles of time to initiation of low-dose corticosteroid therapy (P = 0.0107 for trend). Other factors associated with 28-day mortality were higher Simplified Acute Physiology Score (SAPS) 3 (P < 0.0001) and Sequential Organ Failure Assessment (SOFA) scores (P = 0.0007), dose of vasopressor at the time of initiation of low-dose corticosteroid therapy (P < 0.0001), need for mechanical ventilation (P = 0.0001) and renal replacement therapy (P < 0.0001), while the impaired adrenal reserve did not affect 28-day mortality (81% versus 82%; P = 0.8679). After adjusting for potential confounding factors, the time to initiation of low-dose corticosteroid therapy was still significantly associated with 28-day mortality (adjusted odds

  6. Strategies for selecting optimal sampling and work-up procedures for analysing alkylphenol polyethoxylates in effluents from non-activated sludge biofilm reactors.

    PubMed

    Stenholm, Ake; Holmström, Sara; Hjärthag, Sandra; Lind, Ola

    2012-01-01

    Trace-level analysis of alkylphenol polyethoxylates (APEOs) in wastewater containing sludge requires the prior removal of contaminants and preconcentration. In this study, the effects on optimal work-up procedures of the types of alkylphenols present, their degree of ethoxylation, the biofilm wastewater treatment and the sample matrix were investigated for these purposes. The sampling spot for APEO-containing specimens from an industrial wastewater treatment plant was optimized, including a box that surrounded the tubing outlet carrying the wastewater, to prevent sedimented sludge contaminating the collected samples. Following these changes, the sampling precision (in terms of dry matter content) at a point just under the tubing leading from the biofilm reactors was 0.7% RSD. The findings were applied to develop a work-up procedure for use prior to a high-performance liquid chromatography-fluorescence detection analysis method capable of quantifying nonylphenol polyethoxylates (NPEOs) and poorly investigated dinonylphenol polyethoxylates (DNPEOs) at low microg L(-1) concentrations in effluents from non-activated sludge biofilm reactors. The selected multi-step work-up procedure includes lyophilization and pressurized fluid extraction (PFE) followed by strong ion exchange solid phase extraction (SPE). The yields of the combined procedure, according to tests with NP10EO-spiked effluent from a wastewater treatment plant, were in the 62-78% range. PMID:22519096

  7. Community health workers as drivers of a successful community-based disease management initiative.

    PubMed

    Peretz, Patricia J; Matiz, Luz Adriana; Findley, Sally; Lizardo, Maria; Evans, David; McCord, Mary

    2012-08-01

    In 2005, local leaders in New York City developed the Washington Heights/Inwood Network for Asthma Program to address the burden of asthma in their community. Bilingual community health workers based in community organizations and the local hospital provided culturally appropriate education and support to families who needed help managing asthma. Families participating in the yearlong care coordination program received comprehensive asthma education, home environmental assessments, trigger reduction strategies, and clinical and social referrals. Since 2006, 472 families have enrolled in the yearlong program. After 12 months, hospitalizations and emergency department visits decreased by more than 50%, and caregiver confidence in controlling the child's asthma increased to nearly 100%. Key to the program's success was the commitment and involvement of community partners from program inception to date. PMID:22515859

  8. Healthy sand : a farmers initiative on soil protection and ecosystem service management

    NASA Astrophysics Data System (ADS)

    Smit, Annemieke; Verzandvoort, Simone; Kuikman, Peter; Stuka, Jason; Morari, Francesco; Rienks, Willem; Stokkers, Jan; Hesselink, Bertus; Lever, Henk

    2015-04-01

    In a small region in the Netherlands a group of dairy farmers (cooperated in a foundation HOE Duurzaam) cooperates with the drinking water company and together aim for a more healthy soil. They farm a sandy soil, which is in most of the parcels low in organic matter. The local farmers perceive loss of soil fertility and blame loss of soil organic matter for that. All farmers expect that increasing the soil organic matter content will retain more nitrates in the soil, leading to a reduction in nitrate leaching and a higher nutrient availability for the crops, forage and grass and probably low urgency for grassland renewal. The drinking water company in the area also has high expectations that a higher SOM content does relate to higher quality of the (drinking) water and lower costs to clean and filter the water to meet drinking water quality requirements. Most farmers in the area face suboptimal moisture conditions and thrive for increasing the soil organic matter content and improving the soil structure as key factors to relieve, soil moisture problems both in dry (drought) and wet (flooding) periods. A better water holding capacity of the soil provides benefits for the regional water board as this reduces leaching and run-off. The case study, which is part of the Recare-project, at first glance deals with soil management and technology to improve soil quality. However, the casus in fact deals with social innovation. The real challenge to this group of neighbours, farmers within a small region, and to science is how to combine knowledge and experience on soil management for increasing the content of soil organic matter and how to recognize the ecosystem services that are provided by the adapted and more 'healthy' soils. And also how to formalize relations between costs and benefits of measures taken in the field and how these could be financially rewarded from an agreed and acceptable financial awarding scheme based on payments for securing soil carbon stocks and

  9. Choice of Fluid Therapy in the Initial Management of Sepsis, Severe Sepsis, and Septic Shock.

    PubMed

    Chang, Ronald; Holcomb, John B

    2016-07-01

    Sepsis results in disruption of the endothelial glycocalyx layer and damage to the microvasculature, resulting in interstitial accumulation of fluid and subsequently edema. Fluid resuscitation is a mainstay in the initial treatment of sepsis, but the choice of fluid is unclear. The ideal resuscitative fluid is one that restores intravascular volume while minimizing edema; unfortunately, edema and edema-related complications are common consequences of current resuscitation strategies. Crystalloids are recommended as first-line therapy, but the type of crystalloid is not specified. There is increasing evidence that normal saline is associated with increased mortality and kidney injury; balanced crystalloids may be a safer alternative. Albumin is similar to crystalloids in terms of outcomes in the septic population but is costlier. Hydroxyethyl starches appear to increase mortality and kidney injury in the critically ill and are no longer indicated in these patients. In the trauma population, the shift to plasma-based resuscitation with decreased use of crystalloid and colloid in the treatment of hemorrhagic shock has led to decreased inflammatory and edema-mediated complications. Studies are needed to determine if these benefits also occur with a similar resuscitation strategy in the setting of sepsis. PMID:26844975

  10. Initial Validation of a Knowledge-Based Measure of Social Information Processing and Anger Management

    PubMed Central

    Cassano, Michael; MacEvoy, Julie Paquette; Costigan, Tracy

    2010-01-01

    Over the past fifteen years many schools have utilized aggression prevention programs. Despite these apparent advances, many programs are not examined systematically to determine the areas in which they are most effective. One reason for this is that many programs, especially those in urban under-resourced areas, do not utilize outcome measures that are sensitive to the needs of ethnic minority students. The current study illustrates how a new knowledge-based measure of social information processing and anger management techniques was designed through a partnership-based process to ensure that it would be sensitive to the needs of urban, predominately African American youngsters, while also having broad potential applicability for use as an outcome assessment tool for aggression prevention programs focusing upon social information processing. The new measure was found to have strong psychometric properties within a sample of urban predominately African American youth, as item analyses suggested that almost all items discriminate well between more and less knowledgeable individuals, that the test-retest reliability of the measure is strong, and that the measure appears to be sensitive to treatment changes over time. In addition, the overall score of this new measure is moderately associated with attributions of hostility on two measures (negative correlations) and demonstrates a low to moderate negative association with peer and teacher report measures of overt and relational aggression. More research is needed to determine the measure's utility outside of the urban school context. PMID:20449645

  11. Role of intraoral distractors in management of cranial synostosis: An initial experience

    PubMed Central

    Sahoo, Nandakishor; Roy, Indranil Deb; Gupta, Vishal; Desai, Ajay Premanand

    2014-01-01

    Objective: The objective of the following study is to evaluate the results of strip craniectomy with distraction osteogenesis, using the intraoral distractor devices, as a modality of treatment for craniosynostosis. Materials and Methods: Two cases of cranial synostosis were selected for this study. The cases were operated for strip craniectomy with distraction osteogenesis using a pair of miniaturized intraoral distractor devices. Distraction was carried out after a latency period of 4 days at a rate of 0.5 mm twice a day. Total separation of osteotomized segments achieved was in the range of 25-28 mm. Results: Both patients were evaluated clinico-radiologically at 3, 6 and 12 months postoperatively. There was an increase in the occipital frontal circumference with improvement in the contour of the skull. Both the cases showed marked improvement of bowel habits, bladder control and cognitive behavior. Radiologically copper-beaten appearance reduced considerably suggesting improved intracranial pressure. Conclusion: Combination of distraction osteogenesis with strip craniectomy for the management of craniosynostosis is an effective treatment modality with promising results. PMID:24987594

  12. Initial validation of a knowledge-based measure of social information processing and anger management.

    PubMed

    Leff, Stephen S; Cassano, Michael; MacEvoy, Julie Paquette; Costigan, Tracy

    2010-10-01

    Over the past fifteen years many schools have utilized aggression prevention programs. Despite these apparent advances, many programs are not examined systematically to determine the areas in which they are most effective. One reason for this is that many programs, especially those in urban under-resourced areas, do not utilize outcome measures that are sensitive to the needs of ethnic minority students. The current study illustrates how a new knowledge-based measure of social information processing and anger management techniques was designed through a partnership-based process to ensure that it would be sensitive to the needs of urban, predominately African American youngsters, while also having broad potential applicability for use as an outcome assessment tool for aggression prevention programs focusing upon social information processing. The new measure was found to have strong psychometric properties within a sample of urban predominately African American youth, as item analyses suggested that almost all items discriminate well between more and less knowledgeable individuals, that the test-retest reliability of the measure is strong, and that the measure appears to be sensitive to treatment changes over time. In addition, the overall score of this new measure is moderately associated with attributions of hostility on two measures (negative correlations) and demonstrates a low to moderate negative association with peer and teacher report measures of overt and relational aggression. More research is needed to determine the measure's utility outside of the urban school context. PMID:20449645

  13. Vulvar cancer: initial management and systematic review of literature on currently applied treatment approaches.

    PubMed

    Sznurkowski, Jacek Jan

    2016-07-01

    This review provides guidelines and aims to estimate utilisation rates of treatment modalities applied in vulvar cancer. Current standards of treatment are as follows: wide local excision instead of radical vulvectomy in the case of small tumour (T < 2 cm), no lymph node dissection in the case of a micro-invasive tumour (invasion <1 mm), unilateral lymph node dissection in the case of a lateral tumour and inguinal-femoral lymphadenectomy by separate incisions instead of en bloc inguinal-femoral lymph node excision. Implementation of sentinel lymph node biopsy in patients with tumours not exceeding 4 cm is safe and efficiently eliminates redundant groin dissections. Pre-operative treatment with chemoradiotherapy reduces tumour size and improves surgical excision of inoperable primary tumours or fixed lymph nodes, but side effects are considerable. Literature search performed using PubMed database (from: 1 June 2005 to 1 June 2015) with the terms 'consecutive', 'vulvar cancer', 'treatment' identified seven full-text manuscripts, including data on 1114 patients. Utilisation rates of neoadjuvant radiochemotherapy, chemotherapy alone, surgery, adjuvant radiotherapy and adjuvant radiochemotherapy were 5.9%, 0.3%, 89.3%, 22.6% and 0.2% respectively. An evidence-based estimation of appropriate rates of surgery, radiotherapy and chemotherapy for vulvar cancer is needed to compare management reflecting guidelines with presented here real frequency of applied modalities. PMID:26880231

  14. Peroral endoscopic myotomy—initial experience with anesthetic management of 24 procedures and systematic review

    PubMed Central

    Goudra, Basavana; Singh, Preet Mohinder; Gouda, Gowri; Sinha, Ashish C.

    2016-01-01

    Background: Peroral endoscopic myotomy (POEM) is a novel method of treating achalasia of the esophagus. Very little data are available to guide the anesthesia providers caring for these patients. The anesthetic challenges are primarily related to the risk of pulmonary aspiration. There is also a potential risk of pneumomediastinum, pneumoperitoneum, subcutaneous, or submucosal emphysema, as a result of carbon dioxide tracking into the soft tissues surrounding the esophagus and lower esophageal sphincter. Methods: In this retrospective study, electronic charts of 24 patients who underwent POEM over 18 months were reviewed. Demographic data, fasting status, relevant aspiration risks, anesthetic technique, and postoperative care measures were extracted. Results: Fasting times for both solids and liquids were variable. None of the patients underwent preprocedural esophageal emptying. Standard induction and intubation were performed in 16, rapid sequence induction (RSI) with cricoid pressure in seven, and modified rapid sequence without application of cricoid pressure in one of the patients. One of the patients aspirated at induction, and the procedure was aborted. However, the procedure was performed successfully after a few weeks, this time a RSI with cricoid pressure was chosen. Conclusion: As there are no guidelines for the perioperative management of patients presenting for POEM presently, certain recommendations can be made. Preprocedural esophageal emptying should be considered in patients considered as high-risk, although cultural factors might preclude such an approach. Induction and intubation in a semi-reclining position might be useful. Although debatable, use of RSI with cricoid pressure should be strongly considered. PMID:27212764

  15. Novel Oral Anticoagulants: Recommendations for Patient Evaluation, Treatment Initiation, Follow-up and Perioperative Management.

    PubMed

    Baumann, Stefan; Huseynov, Aydin; El-Battrawy, Ibrahim; Renker, Matthias; Akin, Ibrahim

    2015-01-01

    New oral anticoagulants (NOACs) are becoming available as alternatives to vitamin K antagonists (VKAs) to prevent systemic embolism in patients with non-valvular atrial fibrillation for the prevention and treatment of venous thromboembolism and pulmonary embolism. A comprehensive understanding of the basic concepts of hemostaseology, the underlying pharmacology, drug interactions and management of potential complications is essential for the selection of suitable patients to receive NOACs, for correct prescription and for optimal patient treatment. Furthermore, the use of NOACs in a perioperative setting is crucial, as it requires knowledge of time and dose of last intake of drug, current renal function and the planned procedure in order to assess the overall risk of bleeding. Although no antidote exists to reverse the effects of these novel drugs, selective substitution of coagulation factors and dialysis may be necessary. Therefore, choosing the most beneficial alternative to VKAs on an individual basis can be challenging for physicians. In conclusion, the recent introduction of NOACs represents an opportunity for anticoagulative treatment regimes, while the benefits, risks and limitations should be reflected carefully. The purpose of this systematic review is to highlight features and to provide practical guidance of NOACs in comparison with VKAs that should be considered in a multifaceted decision making process to improve efficacy and safety. PMID:26666330

  16. Possible land management uses of common cypress to reduce wildfire initiation risk: a laboratory study.

    PubMed

    Della Rocca, G; Hernando, C; Madrigal, J; Danti, R; Moya, J; Guijarro, M; Pecchioli, A; Moya, B

    2015-08-15

    Accurate determination of flammability is required in order to improve knowledge about vegetation fire risk. Study of the flammability of different plant species is essential for the Mediterranean area, where most ecosystems are adapted to natural fire but vulnerable to recurrent human-induced fires, which are the main cause of forest degradation. However, the methods used to evaluate vegetation flammability have not yet been standardized. Cupressus sempervirens is a native or naturalized forest tree species in the Mediterranean area that is able to tolerate prolonged drought and high temperatures. The aim of this study was to characterize the flammability of C. sempervirens var. horizontalis at particle level by using different bench-scale calorimetry techniques (mass loss calorimeter, epiradiator and oxygen bomb) to determine the main flammability descriptors (ignitability, sustainability, combustibility and consumability) in live crown and litter samples. Our findings indicate that this variety of cypress is relatively resistant to ignition because of the high ash content, the high critical heat flux, the high time to ignition displayed by both crown and litter samples and the ability of the leaves to maintain a high water content during the summer. We also discuss the possibility of exploiting some morphological, functional and ecological traits of the species to construct a barrier system (with selected varieties of cypress) as a promising complementary land management tool to reduce the fire spread and intensity in a Mediterranean context. PMID:26046989

  17. Clinical policy: Critical issues in the initial evaluation and management of patients presenting to the emergency department in early pregnancy.

    PubMed

    Hahn, Sigrid A; Lavonas, Eric J; Mace, Sharon E; Napoli, Anthony M; Fesmire, Francis M

    2012-09-01

    This clinical policy from the American College of Emergency Physicians is the revision of the 2003 Clinical Policy: Critical Issues in the Initial Evaluation and Management of Patients Presenting to the Emergency Department in Early Pregnancy.(1) A writing subcommittee reviewed the literature to derive evidence-based recommendations to help clinicians answer the following critical questions: (1) Should the emergency physician obtain a pelvic ultrasound in a clinically stable pregnant patient who presents to the emergency department (ED) with abdominal pain and/or vaginal bleeding and a beta human chorionic gonadotropin (β-hCG) level below a discriminatory threshold? (2) In patients who have an indeterminate transvaginal ultrasound, what is the diagnostic utility of β-hCG for predicting possible ectopic pregnancy? (3) In patients receiving methotrexate for confirmed or suspected ectopic pregnancy, what are the implications for ED management? Evidence was graded and recommendations were developed based on the strength of the available data in the medical literature. A literature search was also performed for a critical question from the 2003 clinical policy.(1) Is the administration of anti-D immunoglobulin indicated among Rh-negative women during the first trimester of pregnancy with threatened abortion, complete abortion, ectopic pregnancy, or minor abdominal trauma? Because no new, high-quality articles were found, the management recommendations from the previous policy are discussed in the introduction. PMID:22921048

  18. Initial Management of Childhood Acute Immune Thrombocytopenia: Single-Center Experience of 32 Years.

    PubMed

    Yildiz, Inci; Ozdemir, Nihal; Celkan, Tiraje; Soylu, Selen; Karaman, Serap; Canbolat, Aylin; Dogru, Omer; Erginoz, Ethem; Apak, Hilmi

    2015-01-01

    Immune thrombocytopenia (ITP) is an acute self-limited disease of childhood, mostly resolving within 6 months irrespective of whether therapy is given or not. Treatment options when indicated include corticosteroids, intravenous immune globulin (IVIG), and anti-RhD immunoglobulin. We reviewed our 32 years' experience for first-line therapy of acute ITP. Five hundred forty-one children (mean age: 5.3 years) diagnosed and treated for ITP were evaluated retrospectively. Among 491 acute ITP patients, IVIG was used in 27%, high-dose steroids in 27%, low-dose steroids in 20%, anti-D immunoglobulin G (IgG) in 2%, and no therapy in 22%. When the initial response (platelets >50 × 10(9)/L) to first-line treatment modalities were compared, 89%, 84%, and 78% patients treated by low-dose steroids, high-dose steroids, and IVIG responded to treatment, respectively (P > .05). Mean time to recovery of platelets was 16.8, 3.8, and 3.0 days in patients treated with low-dose steroids, high-dose steroids, and IVIG, respectively (P < .0001). Thrombocytopenia recurred in 23% of low-dose steroid, 39% of high-dose steroid, and in 36% of IVIG (P < .0001) treatment groups. Of 108 patients who were observed alone, 4 (3%) had a recurrence on follow-up and only 2 of these required treatment subsequently. Recurrence was significantly less in no therapy group compared with children treated with 1 of the 3 options of pharmacotherapy (P < .0001). Response rates were similar between patients treated by IVIG and low- and high-dose steroids; however, time to response was slower in patients treated with low-dose steroids compared with IVIG and high-dose steroids. PMID:26154620

  19. Usefulness of low iodine diet in managing patients with differentiated thyroid cancer - initial results

    PubMed Central

    Dobrenic, Margareta; Huic, Drazen; Zuvic, Marijan; Grosev, Darko; Petrovic, Ratimir; Samardzic, Tatjana

    2011-01-01

    Background Low iodine diet (LID) is recommended in patients with differentiated thyroid cancer before radioiodine administration. Patients with increased thyroglobulin (Tg) level, but negative 131I whole body scan present diagnostic and therapeutic dilemma. This study was designed to evaluate the benefit of a two-week LID in patients with elevated serum Tg levels and negative 131I whole body scans. Patients and methods. For the impact assessment of two-week LID on radioiodine tissue avidity, radioiodine scans before and after LID were compared. Sixteen patients with serum Tg > 2 μg/L, negative Tg-antibodies, and negative radioiodine scans underwent two-week LID before the 131I administration. Fourteen patients underwent diagnostic scanning and two patients received radioiodine therapy. Iodine concentration in the morning urine specimens were measured in each patient, a day before and 15th day after starting LID. Results Following self-managed LID, patients were able to significantly reduce their iodine body content by 50% (range 28–65%, p<0,001). 13 patients (82%) accomplished mild iodine deficiency (50-99 μg/L) and one patient (6%) achieved targeted moderate iodine deficient state (<50 μg/L). All diagnostic post-LID scans were negative. Both post-therapy 131I scans showed radioiodine accumulation outside of normal 131I distribution (neck region and diffuse hepatic uptake). This study demonstrated that two-week LID is effective way to decrease total body iodine content, although without a visible effect on post-LID diagnostic 131I scans. Conclusions A more stringent dietary protocol and longer iodine restriction period are probably needed to achieve targeted moderate iodine deficiency in patients preparing for 131I administration. This might result in higher radioiodine avidity of thyroid remnant/metastases. PMID:22933955

  20. A Postpartum Community-Based Weight Management Intervention Designed for Low-Income Women: Feasibility and Initial Efficacy Testing.

    PubMed

    Berry, Diane; Verbiest, Sarah; Hall, Emily Gail; Dawson, Ida; Norton, Deborah; Willis, Shaderika; McDonald, Kimberly; Stuebe, Alison

    2015-07-01

    Postpartum weight retention increases a woman's risk of entering subsequent pregnancies overweight or obese, and women who are overweight or obese in pregnancy face higher rates of complications for themselves and their infants. This study assessed the feasibility, acceptability, and initial efficacy of an intervention to prevent postpartum weight retention in predominantly low-income African-American women. A randomized control pilot study was conducted to test the effects of the intervention on weight, adiposity, health behaviors, and eating and exercise self-efficacy from baseline (Time 1) to study completion (Time 2). The women in the experimental group had significantly greater decreases in triceps skinfolds (p = 0.01) and subscapular skinfolds (p = 0.04) and had significantly greater nutrition knowledge (p =0.04) than the control group. The results indicate that women randomized to a postpartum weight management program significantly decreased adiposity, increased nutrition knowledge and action, and, in addition, the women found the intervention acceptable. PMID:26371358

  1. Together - a couples' program to improve communication, coping, and financial management skills: development and initial pilot-testing.

    PubMed

    Falconier, Mariana K

    2015-04-01

    The accumulated knowledge about the negative impact of financial strain on couple's relationship functioning and the magnitude of the latest economic downturn have brought together the fields of financial counseling and couples' therapy. This article describes the development of a new interdisciplinary program that aims at helping couples under financial strain improve their financial management, communication, and dyadic coping skills. The article also reports the results from its initial pilot-testing with data collected from 18 financially distressed couples before and after participation in the program and 3 months later. Results from repeated measures ANOVAs suggest that the program may help reduce both partners' financial strain and the male negative communication and improve both partners' financial management skills and strategies to cope together with financial strain, and the male relationship satisfaction. These findings together with the high satisfaction reported by participants regarding the structure and content of the sessions and homework suggest that this program may be a promising approach to help couples experiencing financial strain. Gender differences, clinical implications, and possibilities for further research are also discussed. PMID:24910157

  2. 2015 recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative.

    PubMed

    Dejaco, Christian; Singh, Yogesh P; Perel, Pablo; Hutchings, Andrew; Camellino, Dario; Mackie, Sarah; Abril, Andy; Bachta, Artur; Balint, Peter; Barraclough, Kevin; Bianconi, Lina; Buttgereit, Frank; Carsons, Steven; Ching, Daniel; Cid, Maria; Cimmino, Marco; Diamantopoulos, Andreas; Docken, William; Duftner, Christina; Fashanu, Billy; Gilbert, Kate; Hildreth, Pamela; Hollywood, Jane; Jayne, David; Lima, Manuella; Maharaj, Ajesh; Mallen, Christian; Martinez-Taboada, Victor; Maz, Mehrdad; Merry, Steven; Miller, Jean; Mori, Shunsuke; Neill, Lorna; Nordborg, Elisabeth; Nott, Jennifer; Padbury, Hannah; Pease, Colin; Salvarani, Carlo; Schirmer, Michael; Schmidt, Wolfgang; Spiera, Robert; Tronnier, David; Wagner, Alexandre; Whitlock, Madeline; Matteson, Eric L; Dasgupta, Bhaskar

    2015-10-01

    Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR. PMID:26352874

  3. 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative.

    PubMed

    Dejaco, Christian; Singh, Yogesh P; Perel, Pablo; Hutchings, Andrew; Camellino, Dario; Mackie, Sarah; Abril, Andy; Bachta, Artur; Balint, Peter; Barraclough, Kevin; Bianconi, Lina; Buttgereit, Frank; Carsons, Steven; Ching, Daniel; Cid, Maria; Cimmino, Marco; Diamantopoulos, Andreas; Docken, William; Duftner, Christina; Fashanu, Billy; Gilbert, Kate; Hildreth, Pamela; Hollywood, Jane; Jayne, David; Lima, Manuella; Maharaj, Ajesh; Mallen, Christian; Martinez-Taboada, Victor; Maz, Mehrdad; Merry, Steven; Miller, Jean; Mori, Shunsuke; Neill, Lorna; Nordborg, Elisabeth; Nott, Jennifer; Padbury, Hannah; Pease, Colin; Salvarani, Carlo; Schirmer, Michael; Schmidt, Wolfgang; Spiera, Robert; Tronnier, David; Wagner, Alexandre; Whitlock, Madeline; Matteson, Eric L; Dasgupta, Bhaskar

    2015-10-01

    Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR. PMID:26359488

  4. Advanced Air Traffic Management Research (Human Factors and Automation): NASA Research Initiatives in Human-Centered Automation Design in Airspace Management

    NASA Technical Reports Server (NTRS)

    Corker, Kevin M.; Condon, Gregory W. (Technical Monitor)

    1996-01-01

    NASA has initiated a significant thrust of research and development focused on providing the flight crew and air traffic managers automation aids to increase capacity in en route and terminal area operations through the use of flexible, more fuel-efficient routing, while improving the level of safety in commercial carrier operations. In that system development, definition of cognitive requirements for integrated multi-operator dynamic aiding systems is fundamental. The core processes of control and the distribution of decision making in that control are undergoing extensive analysis. From our perspective, the human operators and the procedures by which they interact are the fundamental determinants of the safe, efficient, and flexible operation of the system. In that perspective, we have begun to explore what our experience has taught will be the most challenging aspects of designing and integrating human-centered automation in the advanced system. We have performed a full mission simulation looking at the role shift to self-separation on board the aircraft with the rules of the air guiding behavior and the provision of a cockpit display of traffic information and an on-board traffic alert system that seamlessly integrates into the TCAS operations. We have performed and initial investigation of the operational impact of "Dynamic Density" metrics on controller relinquishing and reestablishing full separation authority. (We follow the assumption that responsibility at all times resides with the controller.) This presentation will describe those efforts as well as describe the process by which we will guide the development of error tolerant systems that are sensitive to shifts in operator work load levels and dynamic shifts in the operating point of air traffic management.

  5. Cobalamin and homocysteine in older adults: do we need to test for serum levels in the work-up of dementia?

    PubMed

    Garcia, Angeles

    2007-10-01

    This article reviews available information on the relationship between cobalamin (Cbl), homocysteine (tHcy) and cognitive decline and dementia in older adults with the aim to propose recommendations as to the need to perform such determinations in the work-up for dementia. The article includes brief reviews of the magnitude of the problem, effects of the Canadian folic acid fortification program on the Cbl and tHcy status in older adults, relation between Cbl and tHcy and cognition and cognitive changes, and available data on treatment trials up to March 2007. Recommendations and levels of evidence were assigned and approved by consensus following the directives of the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia. The review concludes that determination of Cbl (vit B12) levels are recommended in the work-up for dementia and cognitive decline because of the high prevalence of Cbl deficits in this population, independently of the possible effects of normalization of Cbl levels on cognitive function. Even though elevated tHcy is a risk factor for dementia, there is no proo of that normalization of tHcy levels changes the course of the disease. Clinical trials on that regard are on going. PMID:19595952

  6. Identify-Isolate-Inform: A Tool for Initial Detection and Management of Zika Virus Patients in the Emergency Department.

    PubMed

    Koenig, Kristi L; Almadhyan, Abdulmajeed; Burns, Michael J

    2016-05-01

    First isolated in 1947 from a monkey in the Zika forest in Uganda, and from mosquitoes in the same forest the following year, Zika virus has gained international attention due to concerns for infection in pregnant women potentially causing fetal microcephaly. More than one million people have been infected since the appearance of the virus in Brazil in 2015. Approximately 80% of infected patients are asymptomatic. An association with microcephaly and other birth defects as well as Guillain-Barre Syndrome has led to a World Health Organization declaration of Zika virus as a Public Health Emergency of International Concern in February 2016. Zika virus is a vector-borne disease transmitted primarily by the Aedes aegypti mosquito. Male to female sexual transmission has been reported and there is potential for transmission via blood transfusions. After an incubation period of 2-7 days, symptomatic patients develop rapid onset fever, maculopapular rash, arthralgia, and conjunctivitis, often associated with headache and myalgias. Emergency department (ED) personnel must be prepared to address concerns from patients presenting with symptoms consistent with acute Zika virus infection, especially those who are pregnant or planning travel to Zika-endemic regions, as well as those women planning to become pregnant and their partners. The identify-isolate-inform (3I) tool, originally conceived for initial detection and management of Ebola virus disease patients in the ED, and later adjusted for measles and Middle East Respiratory Syndrome, can be adapted for real-time use for any emerging infectious disease. This paper reports a modification of the 3I tool for initial detection and management of patients under investigation for Zika virus. Following an assessment of epidemiologic risk, including travel to countries with mosquitoes that transmit Zika virus, patients are further investigated if clinically indicated. If after a rapid evaluation, Zika or other arthropod

  7. Identify-Isolate-Inform: A Tool for Initial Detection and Management of Zika Virus Patients in the Emergency Department

    PubMed Central

    Koenig, Kristi L.; Almadhyan, Abdulmajeed; Burns, Michael J.

    2016-01-01

    First isolated in 1947 from a monkey in the Zika forest in Uganda, and from mosquitoes in the same forest the following year, Zika virus has gained international attention due to concerns for infection in pregnant women potentially causing fetal microcephaly. More than one million people have been infected since the appearance of the virus in Brazil in 2015. Approximately 80% of infected patients are asymptomatic. An association with microcephaly and other birth defects as well as Guillain-Barre Syndrome has led to a World Health Organization declaration of Zika virus as a Public Health Emergency of International Concern in February 2016. Zika virus is a vector-borne disease transmitted primarily by the Aedes aegypti mosquito. Male to female sexual transmission has been reported and there is potential for transmission via blood transfusions. After an incubation period of 2–7 days, symptomatic patients develop rapid onset fever, maculopapular rash, arthralgia, and conjunctivitis, often associated with headache and myalgias. Emergency department (ED) personnel must be prepared to address concerns from patients presenting with symptoms consistent with acute Zika virus infection, especially those who are pregnant or planning travel to Zika-endemic regions, as well as those women planning to become pregnant and their partners. The identify-isolate-inform (3I) tool, originally conceived for initial detection and management of Ebola virus disease patients in the ED, and later adjusted for measles and Middle East Respiratory Syndrome, can be adapted for real-time use for any emerging infectious disease. This paper reports a modification of the 3I tool for initial detection and management of patients under investigation for Zika virus. Following an assessment of epidemiologic risk, including travel to countries with mosquitoes that transmit Zika virus, patients are further investigated if clinically indicated. If after a rapid evaluation, Zika or other arthropod

  8. [Pathological diagnosis, work-up and reporting of breast cancer. Recommendations of the 3rd Hungarian Consensus Conference on Breast Cancer].

    PubMed

    Cserni, Gábor; Kulka, Janina; Francz, Monika; Járay, Balázs; Kálmán, Endre; Kovács, Ilona; Krenács, Tibor; Udvarhelyi, Nóra; Vass, László

    2016-09-01

    There have been relevant changes in the diagnosis and treatment of breast cancer to implement the updating of the 2010 recommendations made during the 2nd national consensus conference on the disease. Following a wide interdisciplinary consultation, the present recommendations have been finalized after their public discussion at the 3rd Hungarian Consensus Conference on Breast Cancer. The recommendations cover non-operative and intraoperative diagnostics, the work-up of operative specimens, the determination of prognostic and predictive markers and the content of the cytology and histology reports. Furthermore, it touches some special issues such as the current status of multigene molecular markers, the role of pathologists in clinical trials and prerequisites for their involvement, some relevant points about the future. PMID:27579721

  9. The Challenge of Prenatal Diagnostic Work-Up of Maternally Inherited X-Linked Opitz G/BBB: Case Report and Literature Review

    PubMed Central

    Spinelli, Marialuigia; Sica, Carmine; Novelli, Antonio; Di Meglio, Letizia; Martinelli, Pasquale

    2015-01-01

    Background. Prenatal diagnosis of Optiz G/BBB syndrome (OS) is challenging because the characteristic clinical features, such as facial and genitourinary anomalies, may be subtle at sonography and rather unspecific. Furthermore, molecular testing of the disease gene is not routinely performed, unless a specific diagnosis is suggested. Method. Both familial and ultrasound data were used to achieve the diagnosis of X-linked OS (XLOS), which was confirmed by molecular testing of MID1 gene (Xp22.3) at birth. Results. Sequencing of MID1 gene disclosed the nucleotide change c.1285 +1 G>T, previously associated with XLOS. Conclusions. This case illustrates current challenges of the prenatal diagnostic work-up of XLOS and exemplifies how clinical investigation, including family history, and accurate US foetal investigations can lead to the correct diagnosis. PMID:26064728

  10. Evaluation of a practice guideline for the management of respiratory distress syndrome in preterm infants: A quality improvement initiative

    PubMed Central

    Read, Brooke; Lee, David SC; Fraser, Debbie

    2016-01-01

    BACKGROUND: The use of mechanical ventilation to treat respiratory distress syndrome in preterm infants has been associated with the development of bronchopulmonary dysplasia. As part of a quality improvement initiative to reduce the incidence of bronchopulmonary dysplasia in preterm infants, a new practice guideline for the management of respiratory distress syndrome was developed and adopted into practice in a neonatal intensive care unit in February 2012. OBJECTIVE: To evaluate the effects of implementing the new guideline in regard to the use of mechanical ventilation and surfactant, and the incidence of bronchopulmonary dypslasia. METHODS: An historical cohort of very preterm infants (gestational age 260 to 326 weeks) born one year before guideline implementation was compared with a similar cohort of infants born one year following guideline implementation. Data were collected retrospectively from the local neonatal intensive care unit database. RESULTS: A total of 272 preterm infants were included in the study: 129 in the preguideline cohort and 143 in the postguideline cohort. Following the implementation of the guideline, the proportion of infants treated with ongoing mechanical ventilation was reduced from 49% to 26% (P<0.001) and there was a trend toward a reduction in bronchopulmonary dysplasia (27% versus 18%; P=0.07). There was no difference in the proportion of infants treated with surfactant (54% versus 50%). CONCLUSION: The implementation of the practice guideline helped to minimize the use of ongoing mechanical ventilation in preterm infants. PMID:26941562

  11. Characterizing the Assessment and Management of Vitamin D Levels in Patients with Osteoporosis in Clinical Practice: A Chart Review Initiative

    PubMed Central

    Adachi, Jonathan D.; Brown, Jacques P.; Ioannidis, George

    2015-01-01

    Though vitamin D is important for bone health, little is known about the monitoring and management of vitamin D levels in patients with osteoporosis in clinical practice—a deficit this chart review initiative aimed to remedy. A total of 52 physicians completed profiles for 983 patients being treated for osteoporosis between November 2008 and April 2009. Information collected included demographics; fracture risk factors; availability and level of serum vitamin D measurements; and information on osteoporosis medications and calcium and vitamin D supplementation. Physicians also evaluated patients' current regimens and detailed proposed changes, if applicable. Nearly 85% of patients were prescribed calcium and vitamin D supplements. Serum 25-hydroxy vitamin D levels were available for 73% of patients. Of these patients, approximately 50% had levels less than 80 nmol/L, which contrasts with the 37% thought to have “unsatisfactory” vitamin D levels based on physician perceptions. Physicians felt 26% of patients would benefit from additional vitamin D supplementation. However, no changes to the osteoporosis regimen were suggested for 48% of patients perceived to have “unsatisfactory” vitamin D levels. The results underscore the importance of considering vitamin D status when looking to optimize bone health. PMID:25709852

  12. Full Life-Cycle Defect Management Assessment: Initial Inspection Data Collection Results and Research Questions for Further Study

    NASA Technical Reports Server (NTRS)

    Shull, Forrest; Feldmann, Raimund; Haingaertner, Ralf; Regardie, Myrna; Seaman, Carolyn

    2007-01-01

    It is often the case in software projects that when schedule and budget resources are limited, the Verification and Validation (V&V) activities suffer. Fewer V&V activities can be afforded and moreover, short-term challenges can result in V&V activities being scaled back or dropped altogether. As a result, too often the default solution is to save activities for improving software quality until too late in the life-cycle, relying on late-term code inspections followed by thorough testing activities to reduce defect counts to acceptable levels. As many project managers realize, however, this is a resource-intensive way of achieving the required quality for software. The Full Life-cycle Defect Management Assessment Initiative, funded by NASA s Office of Safety and Mission Assurance under the Software Assurance Research Program, aims to address these problems by: Improving the effectiveness of early life-cycle V&V activities to make their benefits more attractive to team leads. Specifically, we focus on software inspection, a proven method that can be applied to any software work product, long before executable code has been developed; Better communicating this effectiveness to software development teams, along with suggestions for parameters to improve in the future to increase effectiveness; Analyzing the impact of early life-cycle V&V on the effectiveness and cost required for late life-cycle V&V activities, such as testing, in order to make the tradeoffs more apparent. This white paper reports on an initial milestone in this work, the development of a preliminary model of inspection effectiveness across multiple NASA Centers. This model contributes toward reaching our project goals by: Allowing an examination of inspection parameters, across different types of projects and different work products, for an analysis of factors that impact defect detection effectiveness. Allowing a comparison of this NASA-specific model to existing recommendations in the literature

  13. Preliminary results on the role of PET/CT in initial staging, restaging, and management of lung cancer

    NASA Astrophysics Data System (ADS)

    Malamitsi, J.; Valotassiou, B.; Iliadis, K.; Kosmidis, P.; Laspas, F.; Vasilaki, M.; Pipini, E.; Petounis, A.; Gogou, L.; Pagou, M.; Dalianis, K.; Efthimiadou, R.; Andreou, J.

    2006-12-01

    AimTo determine true-positive and true-negative rates of PET/CT studies in the staging of lung cancer as compared with conventional imaging (CT and bone scan and occasionally MRI) and the impact of PET/CT on the treatment strategy in patients with lung cancer. Materials and methodTwenty patients (21 studies) with known or suspected lung cancer (14 patients with non-small-cell lung cancer (NSCLC), three patients with small-cell lung cancer (SCLC), three patients with solitary pulmonary nodule underwent initial staging (seven studies) or restaging (14 studies) with combined FDG PET and CT scans on a PET/CT tomograph. PET/CT images were evaluated separately by two nuclear medicine physicians and two radiologists specialized on PET, CT, and MRI. Histology results and a more than 6 months follow-up served as the reference standards. ResultsAccurate diagnosis was achieved on 16 studies. Site-by-site analysis gave the following results: 16 true-positive sites (seven on histology, nine on >6 months follow-up), six true-negative sites (two on histology, four on >6 months follow-up). On PET/CT, six patients were correctly down-staged, three patients were correctly upstaged and seven patients were diagnosed correctly as being on the same stage (2/7 with increase of extent of disease, 5/7 with the same extent of disease). One patient was falsely upstaged and three patients were falsely down-staged. On the basis of PET/CT results, change of management was induced in six patients, while in 14 patients there was no change induced. In five cases PET/CT was partially accurate: on site-by-site analysis, four sites proved true positive (on histology), one site false positive (on histology), and four sites false negative (one on histology, three on >6 months follow-up). ConclusionIn our early experience, PET/CT contributed significantly to correct staging and management of patients with lung cancer.

  14. The Breast Health Global Initiative: clinical practice guidelines for management of breast cancer in low- and middle-income countries.

    PubMed

    Yip, Cheng Har; Anderson, Benjamin O

    2007-08-01

    Breast cancer is an increasingly urgent problem in low- and mid-level resource countries of the world. Despite knowing the optimal management strategy based on guidelines developed in wealthy countries, clinicians are forced to provide less-than-optimal care to patients when diagnostic and/or treatment resources are lacking. For this reason, it is important to identify which resources commonly applied in resource-abundant countries most effectively fill the healthcare needs in limited-resource regions, where patients commonly present with more advanced disease at diagnosis, and to provide guidance on how new resource allocations should be made in order to maximize improvement in outcome. Established in 2002, the Breast Health Global Initiative (BHGI) created an international health alliance to develop evidence-based guidelines for countries with limited resources (low- and middle-income countries) to improve breast health outcomes. The BHGI serves as a program for international guideline development and as a hub for linkage among clinicians, governmental health agencies and advocacy groups to translate guidelines into policy and practice. The BHGI collaborated with 12 national and international health organizations, cancer societies and nongovernmental organizations to host two BHGI international summits. The evidence-based BHGI Guidelines, developed at the 2002 Global Summit, were published in 2003 as a theoretical treatise on international breast healthcare. These guidelines were then updated and expanded at the 2005 Global Summit into a fully comprehensive and flexible framework to permit incremental improvements in healthcare delivery, based upon outcomes, cost, cost-effectiveness and use of healthcare services. PMID:18028018

  15. Recommendations for the management of intracranial haemorrhage - part I: spontaneous intracerebral haemorrhage. The European Stroke Initiative Writing Committee and the Writing Committee for the EUSI Executive Committee.

    PubMed

    Steiner, Thorsten; Kaste, Markku; Katse, Markku; Forsting, Michael; Mendelow, David; Kwiecinski, Hubert; Szikora, Istvan; Juvela, Seppo; Marchel, Andrzej; Chapot, René; Cognard, Christophe; Unterberg, Andreas; Hacke, Werner

    2006-01-01

    This article represents the recommendations for the management of spontaneous intracerebral haemorrhage of the European Stroke Initiative (EUSI). These recommendations are endorsed by the 3 European societies which are represented in the EUSI: the European Stroke Council, the European Neurological Society and the European Federation of Neurological Societies. PMID:16926557

  16. 30 CFR 250.522 - How do I manage the thermal effects caused by initial production on a newly completed or...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 2 2013-07-01 2013-07-01 false How do I manage the thermal effects caused by initial production on a newly completed or recompleted well? 250.522 Section 250.522 Mineral Resources BUREAU OF SAFETY AND ENVIRONMENTAL ENFORCEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER...

  17. Public health incident management: Logistical and operational aspects of the 2009 initial outbreak of H1N1 influenza in Mexico.

    PubMed

    Cruz, Miguel A; Hawk, Nicole M; Poulet, Christopher; Rovira, Jose; Rouse, Edward N

    2015-01-01

    Hosting an international outbreak response team can pose a challenge to jurisdictions not familiar with incident management frameworks. Basic principles of team forming, organizing, and executing mission critical activities require simple and flexible communication that can be easily understood by the host country's public health leadership and international support agencies. Familiarity with incident command system principles before a public health emergency could save time and effort during the initial phases of the response and aid in operationalizing and sustaining complex field activities throughout the response. The 2009 initial outbreak of H1N1 in Mexico highlighted the importance of adequately organizing and managing limited resources and expertise using incident management principles. This case study describes logistical and operational aspects of the response and highlights challenges faced during this response that may be relevant to the organization of public health responses and incidents requiring international assistance and cooperation. PMID:27149316

  18. Public health incident management: logistical and operational aspects of the 2009 initial outbreak of H1N1 influenza in Mexico.

    PubMed

    Cruz, Miguel A; Hawk, Nicole M; Poulet, Christopher; Rovira, Jose; Rouse, Edward N

    2015-01-01

    Hosting an international outbreak response team can pose a challenge to jurisdictions not familiar with incident management frameworks. Basic principles of team forming, organizing, and executing mission critical activities require simple and flexible communication that can be easily understood by the host country's public health leadership and international support agencies. Familiarity with incident command system principles before a public health emergency could save time and effort during the initial phases of the response and aid in operationalizing and sustaining complex field activities throughout the response. The 2009 initial outbreak of H1N1 in Mexico highlighted the importance of adequately organizing and managing limited resources and expertise using incident management principles. This case study describes logistical and operational aspects of the response and highlights challenges faced during this response that may be relevant to the organization of public health responses and incidents requiring international assistance and cooperation. PMID:25779901

  19. A generic, flexible protocol for preimplantation human leukocyte antigen typing alone or in combination with a monogenic disease, for rapid case work-up and application.

    PubMed

    Kakourou, Georgia; Destouni, Aspasia; Vrettou, Christina; Traeger-Synodinos, Jan; Kanavakis, Emmanuel

    2014-01-01

    Human leukocyte antigen (HLA) typing of in vitro fertilization (IVF) embryos, aims to establish a pregnancy that is HLA compatible with an affected sibling who requires hematopoietic stem cell transplantation (HSCT). It can be performed with or without preimplantation genetic diagnosis (PGD) for exclusion of a single-gene disorder (SGD) and it is a multistep, technically challenging procedure at every stage. Our purpose was to address the difficulties of genetic analysis by developing a fast, reliable and accurate PGD-HLA protocol, to simplify patient work-up and PGD application, while providing high flexibility for combination with any SGD. Requests included PGD-HLA for β-thalassemia (β-thal)/sickle cell disease (most common request), Diamond-Blackfan anemia (DBA), chronic granulomatous disease (CGD) and preimplantation-HLA typing only. For HLA haplotyping, we selected a panel of 26 short tandem repeats (STRs) distributed across the entire HLA locus, following PGD guidelines. When required, mutation detection was performed by both a direct and indirect approach. To support concurrent SGD exclusion and HLA typing, a one-step, single-tube, multiplex fluorescent touchdown-polymerase chain reaction (PCR) was optimized. The described touchdown-PCR was successfully applied for all PGD-HLA protocols. Eight clinical cycles were performed with a diagnosis achieved for 94.7% of amplified biopsied blastomeres. Embryo transfer took place in six cycles, with two pregnancies achieved and two healthy female infants (from a twin pregnancy) born so far. Our protocol enables HLA typing in a single PCR, reducing the risk of contamination and the cost, and providing faster results. It requires minimum optimization before clinical application, irrespective of the SGD involved, decreasing the waiting time from referral to treatment for all PGD-HLA cases. PMID:24131134

  20. Adolescents with co-occurring substance use and mental conditions in a private managed care health plan: prevalence, patient characteristics, and treatment initiation and engagement.

    PubMed

    Chi, Felicia W; Sterling, Stacy; Weisner, Constance

    2006-01-01

    This study examined the prevalence, patient characteristics, and treatment initiation and engagement of adolescents with co-occurring substance use (SU) and serious mental health (MH) diagnoses in a private, managed care health plan. We identified 2,005 adolescents aged 12-17, who received both SU and MH diagnoses within a 1-year window between 1/1/2000 and 12/31/2002; 57% were girls. Gender variations were found in diagnoses received and point of identification. Being dually diagnosed in specialty departments (rather than Primary Care and Emergency) and receiving both diagnoses within a shorter time period were associated with treatment initiation and engagement. PMID:17182422

  1. Opportunities and Challenges in Training Elementary School Teachers in Classroom Management: Initial Results from Classroom Management in Action, an Online Professional Development Program

    ERIC Educational Resources Information Center

    Marquez, Brion; Vincent, Claudia; Marquez, Jessie; Pennefather, Jordan; Smolkowski, Keith; Sprague, Jeffrey

    2016-01-01

    Classroom management remains a challenge for many teachers. The approach and delivery of professional development (PD) in classroom management may determine how well teachers are able to apply evidence-based approaches in their classrooms. We use existing literature to identify the key features that make in-service PD effective and present them as…

  2. Added value of semi-quantitative breast-specific gamma imaging in the work-up of suspicious breast lesions compared to mammography, ultrasound and 3-T MRI

    PubMed Central

    Seymer, A; Keinrath, P; Holzmannhofer, J; Pirich, C; Hergan, K; Meissnitzer, M W

    2015-01-01

    Objective: To prospectively analyse the diagnostic value of semi-quantitative breast-specific gamma imaging (BSGI) in the work-up of suspicious breast lesions compared with that of mammography (MG), breast ultrasound and MRI of the breast. Methods: Within a 15-month period, 67 patients with 92 breast lesions rated as Category IV or V according to the breast imaging reporting and data system detected with MG and/or ultrasound were included into the study. After the injection of 740–1110 MBq of Technetium-99m (99mTc) SestaMIBI intravenously, scintigrams were obtained in two projections comparable to MG. The BSGI was analysed visually and semi-quantitatively by calculating a relative uptake factor (X). With the exception of two patients with cardiac pacemakers, all patients underwent 3-T breast MRI. Biopsy results were obtained as the reference standard in all patients. Sensitivity, specificity, positive- and negative-predictive values, accuracy and area under the curve were calculated for each modality. Results: Among the 92 lesions, 67 (72.8%) were malignant. 60 of the 67 cancers of any size were detected by BSGI with an overall sensitivity of 90%, only exceeded by ultrasound with a sensitivity of 99%. The sensitivity of BSGI for lesions <1 cm declined significantly to 60%. Overall specificity of ultrasound was only 20%. Specificity, accuracy and positive-predictive value were the highest for BSGI (56%, 80% and 85%, respectively). X was significantly higher for malignant lesions (mean, 4.27) and differed significantly between ductal types (mean, 4.53) and the other histopathological entities (mean, 3.12). Conclusion: Semi-quantitative BSGI with calculation of the relative uptake factor (X) can help to characterize breast lesions. BSGI negativity may obviate the need for biopsy of breast lesions >1 cm with low or intermediate prevalence for malignancy. Advances in knowledge: Compared with morphological imaging modalities, specificity, positive

  3. Initial Management of Low-Risk Pediatric Fever and Neutropenia: Efficacy and Safety, Costs, Quality-of-Life Considerations, and Preferences.

    PubMed

    Sung, Lillian

    2012-01-01

    Initial management options for pediatric low-risk fever and neutropenia (FN) include outpatient compared with inpatient management and oral compared with intravenous therapy. Single-arm and randomized trials have been conducted in children. Meta-analyses provide support for the equivalence of outpatient and inpatient approaches. Outpatient oral management may be associated with a higher risk of readmission compared with outpatient intravenous management in children with FN, although other outcomes such as treatment failure and discontinuation of the regimen because of adverse effects were similar. Importantly, there have been no reported deaths among low-risk children treated as outpatients or with oral antibiotics. Costs, whether derived directly or through cost-effectiveness analysis, are consistently reduced when an outpatient approach is used. Quality of life (QoL) and preferences should be considered in order to evaluate different strategies, plan programs, and anticipate uptake of outpatient programs. Using parent-proxy report, child QoL is consistently higher with outpatient approaches, although research evaluating child self-report is limited. Preferences incorporate estimated QoL, but, in addition, factor in issues such as costs, fear, anxiety, and logistical issues. Only approximately 50% of parents prefer outpatient management. Future research should develop tools to facilitate outpatient care and to measure caregiver burden associated with this strategy. Additional work should also focus on eliciting child preferences for outpatient management. Finally, studies of effectiveness of an ambulatory approach in the real-world setting outside of clinical trials are important. PMID:24451798

  4. HealthTWITTER Initiative: Design of a Social Networking Service Based Tailored Application for Diabetes Self-Management

    PubMed Central

    Kim, Hye Hyeon

    2014-01-01

    Objectives Diabetes is a chronic disease of continuously increasing prevalence. It is a disease with risks of serious complications, thus warranting its long-term management. However, current health management and education programs for diabetes mainly consist of one-way communication, and systematic social support backup to solve diabetics' emotional problems is insufficient. Methods According to individual behavioral changes based on the Transtheoretical Model, we designed a non-drug intervention, including exercise, and applied it to a mobile based application. For effective data sharing between patients and physicians, we adopted an SNS function for our application in order to offer a social support environment. Results To induce continual and comprehensive care for diabetes, rigorous self-management is essential during the diabetic's life; this is possible through a collaborative patient-physician healthcare model. We designed and developed an SNS-based diabetes self-management mobile application that supports the use of social groups, which are present in three social GYM types. With simple testing of patients in their 20s and 30s, we were able to validate the usefulness of our application. Conclusions Mobile gadget-based chronic disease symptom management and intervention has the merit that health management can be conducted anywhere and anytime in order to cope with increases in the demand for health and medical services that are occurring due to the aging of the population and to cope with the surge of national medical service costs. This patient-driven and SNS-based intervention program is expected to contribute to promoting the health management habits of diabetics, who need to constantly receive health guidance. PMID:25152836

  5. Perioperative Management of a Jehovah's Witness Presenting for Skull Base Surgery

    PubMed Central

    Chaney, Mark A.; Jellish, W. Scott; Leonetti, John P.

    1996-01-01

    A 22-year-old, otherwise healthy, female Jehovah's Witness underwent resection of a midline skull base chondrosarcoma which had been detected after a work-up for headache and diplopia. After bilateral maxillectomies, ethmoidectomies, and a sphenoidectomy, the patient's chondrosarcoma was resected. Despite proper anesthetic management and meticulous hemostasis, significant intraoperative blood loss occurred. The initial postoperative hemoglobin level was 2.3 gm/dL. The clinical concerns pertaining to the perioperative management of the Jehovah's Witness are discussed along with the patient's course and management. PMID:17170989

  6. Perioperative Management of a Jehovah's Witness Presenting for Skull Base Surgery.

    PubMed

    Chaney, M A; Jellish, W S; Leonetti, J P

    1996-01-01

    A 22-year-old, otherwise healthy, female Jehovah's Witness underwent resection of a midline skull base chondrosarcoma which had been detected after a work-up for headache and diplopia. After bilateral maxillectomies, ethmoidectomies, and a sphenoidectomy, the patient's chondrosarcoma was resected. Despite proper anesthetic management and meticulous hemostasis, significant intraoperative blood loss occurred. The initial postoperative hemoglobin level was 2.3 gm/dL. The clinical concerns pertaining to the perioperative management of the Jehovah's Witness are discussed along with the patient's course and management. PMID:17170989

  7. Feasibility and Satisfaction with a Tailored Web-based Audit Intervention for Recalibrating Radiologists’ Thresholds for Conducting Additional Work-up

    PubMed Central

    Carney, Patricia A.; Geller, Berta M.; Sickles, Edward A.; Miglioretti, Diana L.; Aiello Bowles, Erin J.; Abraham, Linn; Feig, Stephen A.; Brown, David; Cook, Andrea J.; Yankaskas, Bonnie C.; Elmore, Joann G.

    2010-01-01

    Purpose To examine the feasibility of and satisfaction with a tailored web-based intervention designed to decrease radiologists' recommendation of inappropriate additional work-up following a screening mammogram. Methods We developed a web-based educational intervention designed to reduce inappropriate recall. Radiologists were randomly assigned to participate in an early intervention group or a late (control) intervention group, the latter of which served as a control for a nine-month follow-up period, after which they were invited to participate in the intervention. Intervention content was derived from our prior research and included three modules: 1) an introduction to audit statistics for mammography performance; 2) a review of data showing radiologists' inflated perceptions of medical malpractice risks related to breast imaging, and 3) a review of data on breast cancer risk among women seen in their practices. Embedded within the intervention were individualized audit data for each participating radiologists obtained from the national Breast Cancer Surveillance Consortium. Results Seventy-four radiologists (37.8%; 74/196) consented to the intervention, which was completed by 67.5% (27/40) of those randomized to the early intervention group and 41.2% (14/34) of those randomized to the late (control) group. Thus, a total of 41 (55%) completed the intervention. On average, three log-ins were used to complete the program (range 1–14), which took approximately 1 hour. Ninety-five percent found the program moderately to very helpful in understanding how to calculate basic performance measures. Ninety-three percent found viewing their own performance measures moderately to very helpful, and 83% reported it being moderately to very important to learn that the breast cancer risk in their screening population program was lower than perceived. The percentage of radiologists who reported that the risk of medical malpractice influences their recall rates dropped from 36

  8. Initial Impressions of Community-Dwelling Older Adults and Case Managers about Community-Based Telehealth Kiosks

    PubMed Central

    Courtney, Karen L.; Lingler, Jennifer H.; Mecca, Laurel Person; Garlock, Laurie A.; Schulz, Richard; Dick, Andrew W.; Olshansky, Ellen

    2010-01-01

    Community-based (multi-user) telehealth interventions may be beneficial for older adults, but there is little research regarding community-based telehealth. We used a qualitative descriptive approach to examine the acceptability and perceived value of community-based telehealth kiosks with regard to current health self-management practices of community-dwelling older adults as a first step in feasibility assessment. Participants included residents (n=6) and community agency case managers (n=3) of a HUD-subsidized senior apartment building. Both positive impressions and concerns of each group are presented. Findings helped guide the plans for future telehealth kiosk implementation and training. PMID:20509594

  9. 75 FR 40759 - Initiation of Review of Management Plan/Regulations of the Hawaiian Islands Humpback Whale...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-14

    ... regulations that became effective December 29, 1999 (64 FR 63262). NOAA anticipates completion of the revised.../Regulations of the Hawaiian Islands Humpback Whale National Marine Sanctuary; Intent To Prepare Draft...) has initiated a review of the Hawaiian Islands Humpback Whale National Marine Sanctuary (HIHWNMS...

  10. Incorporating Video Feedback into Self-Management Training to Promote Generalization of Social Initiations by Children with Autism

    ERIC Educational Resources Information Center

    Deitchman, Carole; Reeve, Sharon A.; Reeve, Kenneth F.; Progar, Patrick R.

    2010-01-01

    Self-monitoring is a well-studied and widely used self-management skill in which a person observes and records his or her own behavior. Video feedback (VFB) occurs when an instructor videotapes a child's performances and reviews the footage with the child and potentially allows the child to score or evaluate their own behavior. A multiple-probe…

  11. Determinants of "Community Participation": The Tradition of Local Initiatives and the Institutionalisation of School Management Committees in Oromia Region, Ethiopia

    ERIC Educational Resources Information Center

    Yamada, Shoko

    2014-01-01

    A School Management Committee (SMC) is an administrative tool adopted in many developing countries to decentralise administrative and financial responsibilities at school level, while involving local people in decision-making and making education more responsive to demands. I question the assumption linking administrative decentralisation and…

  12. Student-Initiated Use of Multilingual Resources in English-Language Classroom Interaction: Next-Turn Management

    ERIC Educational Resources Information Center

    Ziegler, Gudrun; Sert, Olcay; Durus, Natalia

    2012-01-01

    This paper investigates the use of multilingual resources by plurilingual participants in two English language classrooms in Luxembourg. Using Conversation Analysis and drawing on transcriptions of video-recordings, we present three examples of student use of multilingual resources and their respective teacher next turn management (through…

  13. On the development and implementation of ecosystem management plans for water resources in the Great Lakes: A case study of the RAP initiative

    SciTech Connect

    MacKenzie, S.H.

    1991-01-01

    The ecosystem approach to water resource management is deceptively simple: one must recognize the interrelationships among water, land, air, and all living things and undertake resource planning in such a way that the integrity of the natural system is preserved. Significant features of the ecosystem approach include its watershed boundaries, its holistic orientation, and its assumption that humans should be viewed as part of, rather than apart from, the natural system. A theme of environmental ethics and education underlies the approach. Although it seems straightforward, the ecosystem approach has important implications for water management. In 1985, the International Joint Commission challenged government agencies to utilize the ecosystem approach to develop Remedial Action Plans to rehabilitate forty-two hotspots across the Great Lakes Basin. This initiative represented a first effort to implement the ecosystem approach in the Great Lakes. The research questions were: what does ecosystem management mean in the context of the RAP process, and how can one increase the likelihood of successful implementation of ecosystem management plans The research proposition suggests that there are three preconditions to ecosystem management: participation; decision making; and legitimacy. Comparative case studies of Green Bay, Wisconsin; Saginaw Bay, Michigan; and Hamilton Harbor, Ontario were undertaken. Thirty-five RAP participants were chosen for on-site indepth interviews. Data were arrayed by respondent, question, and case, and were analyzed for content.

  14. An examination of the Total Quality Management (TQM) concept given current Federal/DoD competition initiatives

    NASA Astrophysics Data System (ADS)

    Stabile, Michael E.

    1992-06-01

    Quality is vital to our defense and quality improvement is key to increasing productivity. The Department of Defense (DoD) Total Quality Management (TQM) effort has been given top priority by the Secretary of Defense. Many questions exist concerning the problems encountered when implementing TQM throughout DoD. This thesis looks at the compatibility of the TQM philosophy with current Federal Acquisition Regulation competition requirements. The writer concludes that the TQM philosophy implementation is compatible with existing competition policy.

  15. An analysis of the effect of STEM initiatives on socially responsible diversity management in the US aerospace and defense industry

    NASA Astrophysics Data System (ADS)

    Johnson-Oliver, Patrick

    Workforce diversity is a growing concern at a global level and enlightened economic self-interest and corporate image compels industries to leverage it as a competitive advantage. The US aerospace and defense industry (US ADI) addresses workforce diversity through socially responsible diversity management. Prior research into the topic of approaching workforce diversity as a business rationale and a moral imperative has been limited. Scharmer and Kaufer's (2013) Theory U guided this longitudinal explanatory quantitative study, leading from the future as it emerged relative to socially responsible diversity management to compel industry to remove blind spots and co-create an economy that benefits all by promoting workforce diversity as a dual agenda. This study filled a research gap investigating the business case for diversity as a dual agenda in aerospace industry science, technology, engineering, and mathematics (STEM) disciplines. The study also investigated the America COMPETES Act as a moderator of the relationship between historically black colleges and universities (HBCUs) and industry. Data was retrieved for secondary data analysis from the National Science Foundation (NSF) and other public government services and agency websites. Two hypotheses were tested using quantitative analysis including descriptive statistics, linear regression, ANOVA, and two factor analysis. The statistical results were analyzed and deductive logic employed to develop conclusions for the study. There was a significant relationship found between both predictors and socially responsible diversity management. The results reinforce the necessity for the aerospace defense industry to promote the dual agenda of the business case for diversity as complementary; not as competing mandates.

  16. Initial Usability and Feasibility Evaluation of a Personal Health Record-Based Self-Management System for Older Adults

    PubMed Central

    Sheehan, Barbara; Lucero, Robert J.

    2015-01-01

    Introduction: Electronic personal health record-based (ePHR-based) self-management systems can improve patient engagement and have an impact on health outcomes. In order to realize the benefits of these systems, there is a need to develop and evaluate heath information technology from the same theoretical underpinnings. Methods: Using an innovative usability approach based in human-centered distributed information design (HCDID), we tested an ePHR-based falls-prevention self-management system—Self-Assessment via a Personal Health Record (i.e., SAPHeR)—designed using HCDID principles in a laboratory. And we later evaluated SAPHeR’s use by community-dwelling older adults at home. Results: The innovative approach used in this study supported the analysis of four components: tasks, users, representations, and functions. Tasks were easily learned and features such as text-associated images facilitated task completion. Task performance times were slow, however user satisfaction was high. Nearly seven out of every ten features desired by design participants were evaluated in our usability testing of the SAPHeR system. The in vivo evaluation suggests that older adults could improve their confidence in performing indoor and outdoor activities after using the SAPHeR system. Discussion/Conclusion: We have applied an innovative consumer-usability evaluation. Our approach addresses the limitations of other usability testing methods that do not utilize consistent theoretically based methods for designing and testing technology. We have successfully demonstrated the utility of testing consumer technology use across multiple components (i.e., task, user, representational, functional) to evaluate the usefulness, usability, and satisfaction of an ePHR-based self-management system. PMID:26290889

  17. Minimal intervention dentistry II: part 3. Management of non-cavitated (initial) occlusal caries lesions--non-invasive approaches through remineralisation and therapeutic sealants.

    PubMed

    Holmgren, C; Gaucher, C; Decerle, N; Doméjean, S

    2014-03-01

    Epidemiological data on dental caries show that prevention and treatment needs have evolved significantly over the past two decades. In younger patients the distribution of caries lesions is mainly found on the occlusal surfaces. The treatment approaches utilised by dentists must evolve to integrate preventive and treatment solutions tailored to the care needs, which are straightforward to implement in the dental office and whose effectiveness is underpinned by scientific evidence. This article aims to describe the principles of non-invasive management of non-cavitated (initial) occlusal caries lesions, based on evidence from recent studies published in the international literature. PMID:24603245

  18. Municipal initiatives for managing dunes in coastal residential areas: a case study of Avalon, New Jersey, USA

    NASA Astrophysics Data System (ADS)

    Nordstrom, Karl F.; Jackson, Nancy L.; Bruno, Michael S.; de Butts, Harry A.

    2002-10-01

    The characteristics of foredunes created in a municipal management program on a developed barrier island are evaluated to identify how landforms used as protection structures can be natural in appearance and function yet compatible with human values. Shoreline management zones include a naturally evolving, undeveloped segment; a noneroding, developed segment; eroding and noneroding segments of an "improved beach" where dunes have been built by artificial nourishment; and a privately built, artificially nourished dune on the shoreline of an inlet. A disastrous storm in 1962 resulted in an aggressive program for building dunes using sand fences, vegetation plantings, purchase of undeveloped lots, and sediment backpassing to maintain beach widths and dune elevations. The present nourished and shaped foredune in the improved beach is higher, wider, and closer to the berm crest than the natural dune. Restricted inputs of aeolian sand keep the surface flat and poorly vegetated. A stable section of this engineered shore has a wider beach, and sand fences have created a higher foredune with greater topographic diversity. The cross shore zonation of vegetation here is more typical of natural dunes, but the environmental gradient is much narrower. The privately built dune is low, narrow, and located where it could not be created naturally. Foreshore and aeolian sediments in the undeveloped segment and the improved beach are similar in mean grain size (0.16-0.21 mm) and sorting (0.31-0.39 φ), but sediment on the surface of the nourished dune is coarser (28.1% gravel) with a more poorly sorted sand fraction (1.30 φ) representing lag elements on the deflation surface. Willingness to enhance beaches and dunes for protection has reduced insurance premiums and allowed the municipality to qualify for funds from the Federal Emergency Management Agency (FEMA) to replace lost sediment, thus placing an economic value on dunes. Success of the management program is attributed to: (i

  19. Public policy and risk financing strategies for global catastrophe risk management - the role of global risk initiatives

    NASA Astrophysics Data System (ADS)

    McSharry, Patrick; Mitchell, Andrew; Anderson, Rebecca

    2010-05-01

    Decision-makers in both public and private organisations depend on accurate data and scientific understanding to adequately address climate change and the impact of extreme events. The financial impacts of catastrophes on populations and infrastructure can be offset through effective risk transfer mechanisms, structured to reflect the specific perils and levels of exposure to be covered. Optimal strategies depend on the likely socio-econonomic impact, the institutional framework, the overall objectives of the covers placed and the level of both the frequency and severity of loss potential expected. The diversity of approaches across different countries has been documented by the Spanish "Consorcio de Compensación de Seguros". We discuss why international public/private partnerships are necessary for addressing the risk of natural catastrophes. International initiatives such as the Global Earthquake Model (GEM) and the World Forum of Catastrophe Programmes (WFCP) can provide effective guidelines for constructing natural catastrophe schemes. The World Bank has been instrumental in the creation of many of the existing schemes such as the Turkish Catastrophe Insurance Pool, the Caribbean Catastrophe Risk Insurance Facility and the Mongolian Index-Based Livestock Insurance Program. We review existing schemes and report on best practice in relation to providing protection against natural catastrophe perils. The suitability of catastrophe modelling approaches to support schemes across the world are discussed and we identify opportunities to improve risk assessment for such schemes through transparent frameworks for quantifying, pricing, sharing and financing catastrophe risk on a local and global basis.

  20. Initial assessment of the benefits of implementing pharmacogenetics into the medical management of patients in a long-term care facility

    PubMed Central

    Saldivar, Juan-Sebastian; Taylor, David; Sugarman, Elaine A; Cullors, Ali; Garces, Jorge A; Oades, Kahuku; Centeno, Joel

    2016-01-01

    The health care costs associated with prescription drugs are enormous, particularly in patients with polypharmacy (taking more than five prescription medications), and they continue to grow annually. The evolution of pharmacogenetics has provided clinicians with a valuable tool that allows for a smarter, more fine-tuned approach to treating patients for a number of clinical conditions. Applying a pharmacogenetics approach to the medical management of patients can provide a significant improvement to their care, result in cost savings by reducing the use of ineffective drugs, and decrease overall health care utilization. AltheaDx has begun a study to look at the benefits associated with incorporating pharmacogenetics into the medical management of patients who are on five or more medications. Applying pharmacogenetic guided PharmD recommendations across this patient population resulted in the elimination and/or replacement of one to three drugs, for 50% of the polypharmacy patient population tested, and an estimated US$621 in annual savings per patient. The initial assessment of this study shows that there is a clear opportunity for concrete health care savings solely from prescription drug management when incorporating pharmacogenetic testing. PMID:26855597

  1. Assistance to Oil and Gas State Agencies and Industry through Continuation of Environmental and Production Data Management and a Water Regulatory Initiative

    SciTech Connect

    Grunewald, Ben; Arthur, Dan; Langhus, Bruce; Gillespie, Tom; Binder, Ben; Warner, Don; Roberts, Jim; Cox, D.O.

    2002-05-31

    This grant project was a major step toward completion of the Risk Based Data Management System (RBDMS) project. Additionally the project addresses the needs identified during the projects initial phases. By implementing this project, the following outcomes were sought: (1) State regulatory agencies implemented more formalized environmental risk management practices as they pertain to the production of oil and gas, and injection via Class II wells. (2) Enhancement of oil and gas production by implementing a management system supporting the saving of abandoned or idle wells located in areas with a relatively low environmental risk of endangering underground sources of drinking water (USDWs) in a particular state. (3) Verification that protection of USDWs is adequate and additional restrictions of requirements are not necessary in areas with a relatively low environmental risk. (4) Standardization of data and information maintained by state regulatory agencies and decrease the regulatory cost burden on producers operating in multiple states, and (5) Development of a system for electronic data transfer among operators and state regulatory agencies and reduction of overall operator reporting burdens.

  2. A degree-day model initiated by pheromone trap captures for managing pecan nut casebearer (Lepidoptera: Pyralidae) in pecans.

    PubMed

    Knutson, Allen E; Muegge, Mark A

    2010-06-01

    Field observations from pecan, Carya illinoinensis (Wangenh.) Koch, orchards in Texas were used to develop and validate a degree-day model of cumulative proportional adult flight and oviposition and date of first observed nut entry by larvae of the first summer generation of the pecan nut casebearer, Acrobasis nuxvorella Nuenzig (Lepidoptera: Pyralidae). The model was initiated on the date of first sustained capture of adults in pheromone traps. Mean daily maximum and minimum temperatures were used to determine the sum of degree-days from onset to 99% moth flight and oviposition and the date on which first summer generation larvae were first observed penetrating pecan nuts. Cumulative proportional oviposition (y) was described by a modified Gompertz equation, y = 106.05 x exp(-(exp(3.11 - 0.00669 x (x - 1), with x = cumulative degree-days at a base temperature of 3.33 degrees C. Cumulative proportional moth flight (y) was modeled as y = 102.62 x exp(- (exp(1.49 - 0.00571 x (x - 1). Model prediction error for dates of 10, 25, 50, 75, and 90% cumulative oviposition was 1.3 d and 83% of the predicted dates were within +/- 2 d of the observed event. Prediction error for date of first observed nut entry was 2.2 d and 77% of model predictions were within +/- 2 d of the observed event. The model provides ample lead time for producers to implement orchard scouting to assess pecan nut casebearer infestations and to apply an insecticide if needed to prevent economic loss. PMID:20568619

  3. Seventh Joint Meeting of K-J-CaP and CaPSURE: extending the global initiative to improve prostate cancer management

    PubMed Central

    Akaza, Hideyuki; Kim, Choung Soo; Carroll, Peter; Choi, In Young; Chung, Byung Ha; Cooperberg, Matthew R.; Hirao, Yoshihiko; Hinotsu, Shiro; Horie, Shigeo; Lee, Ji Youl; Namiki, Mikio; Ng, Chi-Fai; Onozawa, Mizuki; Ozono, Seiichiro; Ueno, Satoru; Umbas, Rainy; Ye, Dingwei; Zhu, Gang

    2014-01-01

    This report summarizes the presentations and discussions that took place at the Seventh Joint Meeting of the Korea–Japan Study Group of Prostate Cancer (K-J-CaP) and the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) held in Seoul, Korea, in September 2013. The original J-CaP and CaPSURE Joint Initiative has now been established since 2007 and since the initial collaboration between research teams in the United States (US) and Japan, the project has expanded to include several other Asian countries. The objective of the initiative is to analyze and compare data for prostate cancer patients in the participating countries, looking at similarities and differences in patient management and outcomes. Until now the focus has been primarily on data generated within J-CaP and CaPSURE, both large-scale, longitudinal, observational databases of prostate cancer patients in Japan and the US, respectively. This year’s meeting was hosted for the first time in Korea which has recently established its own national database–K-CaP–to add to the wealth of data generated by J-CaP and CaPSURE. As a newly-developed database, K-CaP has also provided a valuable ‘template’ for other countries, such as China and Indonesia, planning to establish their own national databases and this will ultimately allow greater opportunities for international data comparisons. A range of topics was discussed at this Seventh Joint Meeting including comparison of outcomes following androgen deprivation therapy or radical prostatectomy in patients with localized prostate cancer, the use of active surveillance as a treatment option and the triggers for intervention when employing this regimen, patient quality of life during treatment, the impact of comorbidities on outcomes, and a comparison of recent outcomes data between J-CaP and CaPSURE. The participants recognized that prostate cancer was now a global disease and therefore major insights into understanding and improving

  4. A review of initial investigations to utilize ERTS-1 data in determining the availability and distribution of living marine resources. [fish harvesting and management in Gulf of Mexico

    NASA Technical Reports Server (NTRS)

    Stevenson, W. H.; Kemmerer, A. J.; Atwell, B. H.; Maughan, P. M.

    1974-01-01

    This study was initiated in July 1972 to determine the reliability of satellite and high altitude sensors to provide data about oceanographic parameters in coastal waters; demonstrate the use of remotely sensed oceanographic information to predict the distribution and abundance of adult menhaden; and, demonstrate the potential of using satellite acquired information for improving the harvest and management of a fishery resource. The study focused on coastal are as in the north central portion of the Gulf of Mexico including parts of Alabama, Mississippi and Louisiana. The area used in the final analysis was limited to the Mississippi Sound, which is approximately 145 kilometers (90 miles) long and 16 kilometers (10 miles) wide, has an average water depth of about 3.7 meters (12 feet), and in general characterizes an estuarine environment.

  5. Identify-Isolate-Inform: A Modified Tool for Initial Detection and Management of Middle East Respiratory Syndrome Patients in the Emergency Department

    PubMed Central

    Koenig, Kristi L.

    2015-01-01

    Middle East respiratory syndrome (MERS) is a novel infectious disease caused by a coronavirus (MERS-CoV) first reported in Saudi Arabia in September 2012. MERS later spread to other countries in the Arabian Peninsula, followed by an outbreak in South Korea in 2015. At least 26 countries have reported MERS cases, and these numbers may increase over time. Due to international travel opportunities, all countries are at risk of imported cases of MERS, even if outbreaks do not spread globally. Therefore, it is essential for emergency department (ED) personnel to be able to rapidly assess MERS risk and take immediate actions if indicated. The Identify-Isolate-Inform (3I) tool, originally conceived for initial detection and management of Ebola virus disease patients in the ED and later adjusted for measles, can be adapted for real-time use for any emerging infectious disease. This paper reports a modification of the 3I tool for use in initial detection and management of patients under investigation for MERS. Following an assessment of epidemiologic risk factors, including travel to countries with current MERS transmission and contact with patients with confirmed MERS within 14 days, patients are risk stratified by type of exposure coupled with symptoms of fever and respiratory illness. If criteria are met, patients must be immediately placed into airborne infection isolation (or a private room until this type of isolation is available) and the emergency practitioner must alert the hospital infection prevention and control team and the local public health department. The 3I tool will facilitate rapid categorization and triggering of appropriate time-sensitive actions for patients presenting to the ED at risk for MERS. PMID:26587081

  6. A critical assessment of marine aquarist biodiversity data and commercial aquaculture: identifying gaps in culture initiatives to inform local fisheries managers.

    PubMed

    Murray, Joanna M; Watson, Gordon J

    2014-01-01

    It is widely accepted that if well managed, the marine aquarium trade could provide socio-economic stability to local communities while incentivising the maintenance of coral reefs. However, the trade has also been implicated as having potentially widespread environmental impacts that has in part driven developments in aquaculture to relieve wild collection pressures. This study investigates the biodiversity in hobbyist aquaria (using an online survey) and those species currently available from an aquaculture source (commercial data and hobbyist initiatives) in the context of a traffic light system to highlight gaps in aquaculture effort and identify groups that require fisheries assessments. Two hundred and sixty nine species including clown fish, damsels, dotty backs, angelfish, gobies, sea horses and blennies, have reported breeding successes by hobbyists, a pattern mirrored by the European and US commercial organisations. However, there is a mismatch (high demand and low/non-existent aquaculture) for a number of groups including tangs, starfish, anemones and hermit crabs, which we recommend are priority candidates for local stock assessments. Hobbyist perception towards the concept of a sustainable aquarium trade is also explored with results demonstrating that only 40% of respondents were in agreement with industry and scientists who believe the trade could be an exemplar of a sustainable use of coral reefs. We believe that a more transparent evidence base, including the publication of the species collected and cultured, will go some way to align the concept of a sustainable trade across industry stakeholders and better inform the hobbyist when purchasing their aquaria stock. We conclude by proposing that a certification scheme established with government support is the most effective way to move towards a self-regulating industry. It would prevent industry "greenwashing" from multiple certification schemes, alleviate conservation concerns, and, ultimately

  7. Structural health and prognostics management for offshore wind turbines : case studies of rotor fault and blade damage with initial O&M cost modeling.

    SciTech Connect

    Myrent, Noah J.; Kusnick, Joshua F.; Barrett, Natalie C.; Adams, Douglas E.; Griffith, Daniel Todd

    2013-04-01

    Operations and maintenance costs for offshore wind plants are significantly higher than the current costs for land-based (onshore) wind plants. One way to reduce these costs would be to implement a structural health and prognostic management (SHPM) system as part of a condition based maintenance paradigm with smart load management and utilize a state-based cost model to assess the economics associated with use of the SHPM system. To facilitate the development of such a system a multi-scale modeling approach developed in prior work is used to identify how the underlying physics of the system are affected by the presence of damage and faults, and how these changes manifest themselves in the operational response of a full turbine. This methodology was used to investigate two case studies: (1) the effects of rotor imbalance due to pitch error (aerodynamic imbalance) and mass imbalance and (2) disbond of the shear web; both on a 5-MW offshore wind turbine in the present report. Based on simulations of damage in the turbine model, the operational measurements that demonstrated the highest sensitivity to the damage/faults were the blade tip accelerations and local pitching moments for both imbalance and shear web disbond. The initial cost model provided a great deal of insight into the estimated savings in operations and maintenance costs due to the implementation of an effective SHPM system. The integration of the health monitoring information and O&M cost versus damage/fault severity information provides the initial steps to identify processes to reduce operations and maintenance costs for an offshore wind farm while increasing turbine availability, revenue, and overall profit.

  8. A Critical Assessment of Marine Aquarist Biodiversity Data and Commercial Aquaculture: Identifying Gaps in Culture Initiatives to Inform Local Fisheries Managers

    PubMed Central

    Murray, Joanna M.; Watson, Gordon J.

    2014-01-01

    It is widely accepted that if well managed, the marine aquarium trade could provide socio-economic stability to local communities while incentivising the maintenance of coral reefs. However, the trade has also been implicated as having potentially widespread environmental impacts that has in part driven developments in aquaculture to relieve wild collection pressures. This study investigates the biodiversity in hobbyist aquaria (using an online survey) and those species currently available from an aquaculture source (commercial data and hobbyist initiatives) in the context of a traffic light system to highlight gaps in aquaculture effort and identify groups that require fisheries assessments. Two hundred and sixty nine species including clown fish, damsels, dotty backs, angelfish, gobies, sea horses and blennies, have reported breeding successes by hobbyists, a pattern mirrored by the European and US commercial organisations. However, there is a mismatch (high demand and low/non-existent aquaculture) for a number of groups including tangs, starfish, anemones and hermit crabs, which we recommend are priority candidates for local stock assessments. Hobbyist perception towards the concept of a sustainable aquarium trade is also explored with results demonstrating that only 40% of respondents were in agreement with industry and scientists who believe the trade could be an exemplar of a sustainable use of coral reefs. We believe that a more transparent evidence base, including the publication of the species collected and cultured, will go some way to align the concept of a sustainable trade across industry stakeholders and better inform the hobbyist when purchasing their aquaria stock. We conclude by proposing that a certification scheme established with government support is the most effective way to move towards a self-regulating industry. It would prevent industry “greenwashing” from multiple certification schemes, alleviate conservation concerns, and, ultimately

  9. Nurses' perceptions of using an evidence-based care bundle for initial emergency nursing management of patients with severe traumatic brain injury: A qualitative study.

    PubMed

    Damkliang, Jintana; Considine, Julie; Kent, Bridie; Street, Maryann

    2015-10-01

    Evidence to guide initial emergency nursing care of patients with severe traumatic brain injury (TBI) in Thailand is currently not available in a useable form. A care bundle was used to summarise an evidence-based approach to the initial emergency nursing management of patients with severe TBI and was implemented in one Thai emergency department. The aim of this study was to describe Thai emergency nurses' perceptions of care bundle use. A descriptive qualitative study was used to describe emergency nurses' perceptions of care bundle use during the implementation phase (Phase-One) and then post-implementation (Phase-Two). Ten emergency nurses participated in Phase-One, while 12 nurses participated in Phase-Two. In Phase-One, there were five important factors identified in relation to use of the care bundle including quality of care, competing priorities, inadequate equipment, agitated patients, and teamwork. In Phase Two, participants perceived that using the care bundle helped them to improve quality of care, increased nurses' knowledge, skills, and confidence. Care bundles are one strategy to increase integration of research evidence into clinical practice and facilitate healthcare providers to deliver optimal patient care in busy environments with limited resources. PMID:26049810

  10. Engaging faith-based resources to initiate and support diabetes self-management among African Americans: a collaboration of informal and formal systems of care.

    PubMed

    Johnson, Patria; Thorman Hartig, Margaret; Frazier, Renee; Clayton, Mae; Oliver, Georgia; Nelson, Belinda W; Williams-Cleaves, Beverly J

    2014-11-01

    Diabetes for Life (DFL), a project of Memphis Healthy Churches (MHC) and Common Table Health Alliance (CTHA; formerly Healthy Memphis Common Table [HMCT]), is a self-management program aimed at reducing health disparities among African Americans with type 2 Diabetes Mellitus in Memphis and Shelby County, Tennessee. This program is one of five national projects that constitute The Alliance to Reduce Disparities in Diabetes, a 5-year grant-funded initiative of The Merck Foundation. Our purpose is to describe the faith-based strategies supporting DFL made possible by linking with an established informal health system, MHC, created by Baptist Memorial Health Care. The MHC network engaged volunteer Church Health Representatives as educators and recruiters for DFL. The components of the DFL project and the effect on chronic disease management for the participants will be described. The stages of DFL recruitment and implementation from an open-access to a closed model involving six primary care practices created a formal health system. The involvement of CTHA, a regional health collaborative, created the opportunity for DFL to expand the pool of health care providers and then recognize the core of providers most engaged with DFL patients. This collaboration between MHC and HMCT led to the organization of the formal health network. PMID:25359253

  11. The spectral database Specchio: Data management, data sharing and initial processing of field spectrometer data within the Dimensions of Biodiversity project

    NASA Astrophysics Data System (ADS)

    Hueni, A.; Schweiger, A. K.

    2015-12-01

    Field spectrometry has substantially gained importance in vegetation ecology due to the increasing knowledge about causal ties between vegetation spectra and biochemical and structural plant traits. Additionally, worldwide databases enable the exchange of spectral and plant trait data and promote global research cooperation. This can be expected to further enhance the use of field spectrometers in ecological studies. However, the large amount of data collected during spectral field campaigns poses major challenges regarding data management, archiving and processing. The spectral database Specchio is designed to organize, manage, process and share spectral data and metadata. We provide an example for using Specchio based on leaf level spectra of prairie plant species collected during the 2015 field campaign of the Dimensions of Biodiversity research project, conducted at the Cedar Creek Long-Term Ecological Research site, in central Minnesota. We show how spectral data collections can be efficiently administered, organized and shared between distinct research groups and explore the capabilities of Specchio for data quality checks and initial processing steps.

  12. The Need for International Terminology and Definitions for Texture-Modified Foods and Thickened Liquids Used in Dysphagia Management: Foundations of a Global Initiative.

    PubMed

    Cichero, Julie A Y; Steele, Catriona; Duivestein, Janice; Clavé, Pere; Chen, Jianshe; Kayashita, Jun; Dantas, Roberto; Lecko, Caroline; Speyer, Renee; Lam, Peter; Murray, Joseph

    2013-01-01

    Conservative estimates suggest that dysphagia (difficulty swallowing) affects approximately 8 % of the world's population. Dysphagia is associated with malnutrition, dehydration, chest infection and potentially death. While promising treatments are being developed to improve function, the modification of food texture and liquid thickness has become a cornerstone of dysphagia management. Foods are chopped, mashed or puréed to compensate for chewing difficulties or fatigue, improve swallowing safety and avoid asphyxiation. Liquids are typically thickened to slow their speed of transit through the oral and pharyngeal phases of swallowing, to avoid aspiration of material into the airway and improve transit to the esophagus. Food texture and liquid modification for dysphagia management occurs throughout the world. However, the names, the number of levels of modification and characteristics vary within and across countries. Multiple labels increase the risk to patient safety. National standardization of terminology and definitions has been promoted as a means to improve patient safety and inter-professional communication. This article documents the need for international standardized terminology and definitions for texture-modified foods and liquids for individuals with dysphagia. Furthermore, it documents the research plan and foundations of a global initiative dedicated to this purpose. PMID:24392282

  13. Acute poisoning following ingestion of medicines: initial management. How to treat life-threatening complications and to evaluate the risk of delayed effects and psychological distress.

    PubMed

    2010-12-01

    Acute poisoning following ingestion of medications, both intentional and unintentional, is frequent and more or less severe. It is often unclear whether a toxic dose has been ingested. This review examines the initial management of patients with suspected acute poisoning, based on a review of the literature using the standard Prescrire methodology. We examined clinical practice guidelines, which are mostly based on observational, pharmacological and toxicological data, as well as empirical data. Few comparative trials are available. In life-threatening situations, the first priority is to call an emergency response mobile unit and to implement life-support techniques, i.e., resuscitation for cardiorespiratory arrest; respiratory support if necessary; and the left lateral head-down position and glucose injection if the patient is unconscious. Prompt, initial measures may also include: anticonvulsant injection for status epilepticus (diazepam, for example); a sedative for extreme agitation (diazepam or clorazepate if there is no risk of respiratory depression; otherwise haloperidol); atropine for severe bradycardia; elevating the legs for hypotension; and naloxone in case of respiratory depression due to opioids. Drug poisoning can be life-threatening.The extent of the risk should be assessed by questioning the patient and close contacts, examining the immediate environment, and carrying out a clinical examination to identify a major toxic condition. The severity of poisoning is assessed by gathering all information about the patient, the drug(s) ingested, the circumstances of ingestion, and any other substances ingested at the same time. A poison control centre may be called to assist with diagnosis, to predict the clinical consequences, and to guide patient management. Activated charcoal can reduce the gastrointestinal absorption of some drugs. It should be given as soon as possible, preferably within 2 hours after ingestion of a drug known to be adsorbed by

  14. FSGS: Diagnosis and Diagnostic Work-Up

    PubMed Central

    Sprangers, Ben; Meijers, Björn; Appel, Gerald

    2016-01-01

    Focal segmental glomerulosclerosis is a histologic lesion, rather than a clinical disease. FSGS is common cause of nephrotic syndrome in both adults and children worldwide. In the United States it is the most common primary glomerular disease resulting in end-stage renal disease and recent reports have suggested that its incidence might be on the rise. Currently the incidence is estimated to be 7 per million. The podocyte is the cellular target cell in FSGS and in recent years substantial insight in the pathogenesis and genetics of FSGS have accumulated. Furthermore the discovery of potential novel biomarkers to diagnose FSGS and monitor disease activity has renewed interest in this disease. In this review article we will focus on the clinical presentation and diagnosis of FSGS. PMID:27314022

  15. Frostbite: prevention and initial management.

    PubMed

    Zafren, Ken

    2013-03-01

    Frostbite is a local freezing injury that can cause tissue loss. Historically, it has been a disease of wars, but it is a hazard for anyone who ventures outdoors in cold weather. Frozen tissue is damaged both during freezing and rewarming. Frozen tissue is numb. Rewarming causes hyperemia and is often painful. Blisters and edema develop after rewarming. Hard eschar may form with healthy tissue deep to the eschar. Frostbite can be classified as superficial, without permanent tissue loss, or deep, with varying degrees of permanent tissue loss, often less than appearances suggest. It can be difficult to predict the amount of tissue loss at the time of presentation and early in the subsequent course. Prevention is better than treatment. It may be advisable not to rewarm frozen extremities in the field, but spontaneous thawing is often unavoidable. Extremities that have thawed should be protected from refreezing at all costs. Once in a protected environment, extremities that are still frozen should be rapidly thawed in warm water. Therapy with aspirin or ibuprofen may be helpful, but evidence is limited. Thrombolytic treatment within the first 24 hours after rewarming seems to be beneficial in some cases of severe frostbite. Prostacyclin therapy is very promising. PMID:23537254

  16. Effecting change in primary care management of respiratory conditions: a global scoping exercise and literature review of educational interventions to inform the IPCRG's E-Quality initiative.

    PubMed

    McDonnell, Juliet; Williams, Siân; Chavannes, Niels H; Correia de Sousa, Jaime; Fardy, H John; Fletcher, Monica; Stout, James; Tomlins, Ron; Yusuf, Osman M; Pinnock, Hilary

    2012-12-01

    This discussion paper describes a scoping exercise and literature review commissioned by the International Primary Care Respiratory Group (IPCRG) to inform their E-Quality programme which seeks to support small-scale educational projects to improve respiratory management in primary care. Our narrative review synthesises information from three sources: publications concerning the global context and health systems development; a literature search of Medline, CINAHL and Cochrane databases; and a series of eight interviews conducted with members of the IPCRG faculty. Educational interventions sit within complex healthcare, economic, and policy contexts. It is essential that any development project considers the local circumstances in terms of economic resources, political circumstances, organisation and administrative capacities, as well as the specific quality issue to be addressed. There is limited evidence (in terms of changed clinician behaviour and/or improved health outcomes) regarding the merits of different educational and quality improvement approaches. Features of educational interventions that were most likely to show some evidence of effectiveness included being carefully designed, multifaceted, engaged health professionals in their learning, provided ongoing support, were sensitive to local circumstances, and delivered in combination with other quality improvement strategies. To be effective, educational interventions must consider the complex healthcare systems within which they operate. The criteria for the IPCRG E-Quality awards thus require applicants not only to describe their proposed educational initiative but also to consider the practical and local barriers to successful implementation, and to propose a robust evaluation in terms of changed clinician behaviour or improved health outcomes. PMID:22875141

  17. Setting global research priorities for integrated community case management (iCCM): Results from a CHNRI (Child Health and Nutrition Research Initiative) exercise

    PubMed Central

    Wazny, Kerri; Sadruddin, Salim; Zipursky, Alvin; Hamer, Davidson H.; Jacobs, Troy; Kallander, Karin; Pagnoni, Franco; Peterson, Stefan; Qazi, Shamim; Raharison, Serge; Ross, Kerry; Young, Mark; Marsh, David R.

    2014-01-01

    Aims To systematically identify global research gaps and resource priorities for integrated community case management (iCCM). Methods An iCCM Child Health and Nutrition Research Initiative (CHNRI) Advisory Group, in collaboration with the Community Case Management Operational Research Group (CCM ORG) identified experts to participate in a CHNRI research priority setting exercise. These experts generated and systematically ranked research questions for iCCM. Research questions were ranked using a “Research Priority Score” (RPS) and the “Average Expert Agreement” (AEA) was calculated for every question. Our groups of experts were comprised of both individuals working in Ministries of Health or Non Governmental Organizations (NGOs) in low– and middle–income countries (LMICs) and individuals working in high–income countries (HICs) in academia or NGO headquarters. A Spearman’s Rho was calculated to determine the correlation between the two groups’ research questions’ ranks. Results The overall RPS ranged from 64.58 to 89.31, with a median score of 81.43. AEA scores ranged from 0.54 to 0.86. Research questions involving increasing the uptake of iCCM services, research questions concerning the motivation, retention, training and supervision of Community Health Workers (CHWs) and concerning adding additional responsibilities including counselling for infant and young child feeding (IYCF) and treatment of severe acute malnutrition (SAM) ranked highly. There was weak to moderate, statistically significant, correlation between scores by representatives of high–income countries and those working in–country or regionally (Spearman’s ρ = 0.35034, P < 0.01). Conclusions Operational research to determine optimal training, supervision and modes of motivation and retention for the CHW is vital for improving iCCM, globally, as is research to motivate caregivers to take advantage of iCCM services. Experts working in–country or regionally in LMICs

  18. Research Initiatives

    Cancer.gov

    This page provides detailed information about currently funded RFA initiatives both led by DCCPS, and those led by other NIH Institutes and Centers (I/Cs) that include DCCPS as a partner. Each initiative includes a table of funded grants and a map that shows the location of funded institutions.

  19. Development of an Assessment Tool for Agricultural Best Management Practice Implementation in the Great Lakes Restoration Initiative Priority Watersheds—Upper East River, Tributary to Green Bay, Wisconsin

    USGS Publications Warehouse

    Merriman, Katherine R.

    2015-01-01

    The Great Lakes face a number of serious challenges that cause damage to water quality, habitat, ecology, and coastal health. Excess nutrients from point and nonpoint sources have a history of causing harmful algal blooms (HABs); since the late 1990s, a resurgence of HABs have forced beach closures and resulted in water quality impairments across the Great Lakes. Studies increasingly point to phosphorus (P) runoff from agricultural lands as the cause of these HABs. In 2010, the Great Lakes Restoration Initiative (GLRI) was launched to revitalize the Great Lakes. The GLRI aims to address the challenges facing the Great Lakes and provide a framework for restoration and protection. As part of this effort, the Priority Watersheds Work Group (PWWG), cochaired by the U.S. Environmental Protection Agency (EPA) and the U.S. Department of Agriculture-Natural Resources Conservation Service (USDA–NRCS), is targeting Priority Watersheds (PWs) to reduce the amount of P reaching the Great Lakes. Within the PWs, USDA–NRCS identifies small-scale subbasins with high concentrations of agriculture for coordinated nutrient reduction efforts and enhanced monitoring and modeling. The USDA–NRCS supplies financial and/or technical assistance to producers to install or implement best management practices (BMPs) to lessen the negative effects of agriculture to water quality; additional funding is provided by the GLRI through USDA–NRCS to saturate the small-scale subbasins with BMPs. The watershed modeling component, introduced in this fact sheet, assesses the effectiveness of USDA–NRCS funded BMPs, and nutrient reductions because of GLRI or other funding programs are differentiated. Modeling scenarios consider BMPs that have already been applied and those planned to be implemented across the small-scale subbasins.

  20. Development of an Assessment Tool for Agricultural Best Management Practice Iimplementation in the Great Lakes Restoration Initiative Priority Watersheds—Alger Creek, Tributary to Saginaw River, Michigan

    USGS Publications Warehouse

    Merriman, Katherine R.

    2015-01-01

    The Great Lakes face a number of serious challenges that cause damage to water quality, habitat, ecology, and coastal health. Excess nutrients from point and nonpoint sources have a history of causing harmful algal blooms (HABs); since the late 1990s, a resurgence of HABs have forced beach closures and resulted in water quality impairments across the Great Lakes. Studies increasingly point to phosphorus (P) runoff from agricultural lands as the cause of these HABs. In 2010, the Great Lakes Restoration Initiative (GLRI) was launched to revitalize the Great Lakes. The GLRI aims to address the challenges facing the Great Lakes and provide a framework for restoration and protection. As part of this effort, the Priority Watersheds Work Group (PWWG), cochaired by the U.S. Environmental Protection Agency (EPA) and the U.S. Department of Agriculture-Natural Resources Conservation Service (USDA–NRCS), is targeting Priority Watersheds (PWs) to reduce the amount of P reaching the Great Lakes. Within the PWs, USDA–NRCS identifies small-scale subbasins with high concentrations of agriculture for coordinated nutrient reduction efforts and enhanced monitoring and modeling. The USDA–NRCS supplies financial and/or technical assistance to producers to install or implement best management practices (BMPs) to lessen the negative effects of agriculture to water quality; additional funding is provided by the GLRI through USDA–NRCS to saturate the small-scale subbasins with BMPs. The watershed modeling component, introduced in this fact sheet, assesses the effectiveness of USDA–NRCS funded BMPs, and nutrient reductions because of GLRI or other funding programs are differentiated. Modeling scenarios consider BMPs that have already been applied and those planned to be implemented across the small-scale subbasins.

  1. Utilization of a Cloud-Based Diabetes Management Program for Insulin Initiation and Titration Enables Collaborative Decision Making Between Healthcare Providers and Patients

    PubMed Central

    Lau, Ka Hei Karen; Huang, Ruyi; Ghiloni, Suzanne; Le, Hung; Gilroy, Scott; Abrahamson, Martin; Moore, John

    2016-01-01

    Abstract Background: Overseeing proper insulin initiation and titration remains a challenging task in diabetes care. Recent advances in mobile technology have enabled new models of collaborative care between patients and healthcare providers (HCPs). We hypothesized that the adoption of such technology could help individuals starting basal insulin achieve better glycemic control compared with standard clinical practice. Materials and Methods: This was a 12 ± 2-week randomized controlled study with 40 individuals with type 2 diabetes who were starting basal insulin due to poor glycemic control. The control group (n = 20) received standard face-to-face care and phone follow-up as needed in a tertiary center, whereas the intervention group (n = 20) received care through the cloud-based diabetes management program where regular communications about glycemic control and insulin doses were conducted via patient self-tracking tools, shared decision-making interfaces, secure text messages, and virtual visits (audio, video, and shared screen control) instead of office visits. Results: By intention-to-treat analysis, the intervention group achieved a greater hemoglobin A1c decline compared with the control group (3.2 ± 1.5% vs. 2.0% ± 2.0%; P = 0.048). The Diabetes Treatment Satisfaction Questionnaire showed a significant improvement in the intervention group compared with the control group (an increase of 10.1 ± 11.7 vs. 2.1 ± 6.5 points; P = 0.01). HCPs spent less time with patients in the intervention group compared with those in the control group (65.9 min per subject vs. 81.6 min per subject). However, the intervention group required additional training time to use the mobile device. Conclusions: Mobile health technology could be an effective tool in sharing data, enhancing communication, and improving glycemic control while enabling collaborative decision making in diabetes care. PMID:26645932

  2. SCB initiator

    DOEpatents

    Bickes, Jr., Robert W.; Renlund, Anita M.; Stanton, Philip L.

    1994-01-01

    A detonator for high explosives initiated by mechanical impact includes a cylindrical barrel, a layer of flyer material mechanically covering the barrel at one end, and a semiconductor bridge ignitor including a pair of electrically conductive pads connected by a semiconductor bridge. The bridge is in operational contact with the layer, whereby ignition of said bridge forces a portion of the layer through the barrel to detonate the explosive. Input means are provided for igniting the semiconductor bridge ignitor.

  3. SCB initiator

    DOEpatents

    Bickes Jr., Robert W.; Renlund, Anita M.; Stanton, Philip L.

    1994-11-01

    A detonator for high explosives initiated by mechanical impact includes a cylindrical barrel, a layer of flyer material mechanically covering the barrel at one end, and a semiconductor bridge ignitor including a pair of electrically conductive pads connected by a semiconductor bridge. The bridge is in operational contact with the layer, whereby ignition of said bridge forces a portion of the layer through the barrel to detonate the explosive. Input means are provided for igniting the semiconductor bridge ignitor.

  4. Integrated Research on the Development of Global Climate Risk Management Strategies - Framework and Initial Results of the Research Project ICA-RUS

    NASA Astrophysics Data System (ADS)

    Emori, Seita; Takahashi, Kiyoshi; Yamagata, Yoshiki; Oki, Taikan; Mori, Shunsuke; Fujigaki, Yuko

    2013-04-01

    With the aim of proposing strategies of global climate risk management, we have launched a five-year research project called ICA-RUS (Integrated Climate Assessment - Risks, Uncertainties and Society). In this project with the phrase "risk management" in its title, we aspire for a comprehensive assessment of climate change risks, explicit consideration of uncertainties, utilization of best available information, and consideration of every possible conditions and options. We also regard the problem as one of decision-making at the human level, which involves social value judgments and adapts to future changes in circumstances. The ICA-RUS project consists of the following five themes: 1) Synthesis of global climate risk management strategies, 2) Optimization of land, water and ecosystem uses for climate risk management, 3) Identification and analysis of critical climate risks, 4) Evaluation of climate risk management options under technological, social and economic uncertainties and 5) Interactions between scientific and social rationalities in climate risk management (see also: http://www.nies.go.jp/ica-rus/en/). For the integration of quantitative knowledge of climate change risks and responses, we apply a tool named AIM/Impact [Policy], which consists of an energy-economic model, a simplified climate model and impact projection modules. At the same time, in order to make use of qualitative knowledge as well, we hold monthly project meetings for the discussion of risk management strategies and publish annual reports based on the quantitative and qualitative information. To enhance the comprehensiveness of the analyses, we maintain an inventory of risks and risk management options. The inventory is revised iteratively through interactive meetings with stakeholders such as policymakers, government officials and industrial representatives.

  5. Analysis of California Condor (Gymnogyps californianus) use of six management units using location data from global positioning system transmitters, southern California, 2004-09-Initial report

    USGS Publications Warehouse

    Johnson, Matthew; Kern, Jeffrey; Haig, Susan M.

    2010-01-01

    This report provides an analysis of California Condor (Gymnogyps californianus) space use of six management units in southern California (Hopper Mountain and Bitter Creek National Wildlife Refuges, Wildlands Conservancy-Wind Wolves Preserve, Tejon Mountain Village Specific Plan, California Condor Study Area, and the Tejon Ranch excluding Tejon Mountain Village Specific Plan and California Condor Study Area). Space use was analyzed to address urgent management needs using location data from Global Positioning System transmitters. The U.S. Fish and Wildlife Service provided the U.S. Geological Survey with location data (2004-09) for California Condors from Global Positioning System transmitters and Geographic Information System data for the six management units in southern California. We calculated relative concentration of use estimates for each management unit for each California Condor (n = 21) on an annual basis (n = 39 annual home ranges) and evaluated resource selection for the population each year using the individual as our sampling unit. The most striking result from our analysis was the recolonization of the Tejon Mountain Village Specific Plan, California Condor Study Area, and Tejon Ranch management units during 2008. During 2004-07, the home range estimate for two (25 percent) California Condors overlapped the Tejon Mountain Village Specific Plan, California Condor Study Area, and Tejon Ranch management units (n = 8), and use within the annual home range generally was bimodal and was concentrated on the Bitter Creek and Hopper Mountain National Wildlife Refuges. However, 10 (77 percent) California Condor home ranges overlapped the Tejon Mountain Village Specific Plan, California Condor Study Area, and Tejon Ranch management units during 2008 (n = 13), and by 2009, the home range of every condor carrying a Global Positioning System transmitter (n = 14) overlapped these management units. Space use was multimodal within the home range during 2008-09 and was

  6. Initial Investigations of Controller Tools and Procedures for Schedule-Based Arrival Operations with Mixed Flight-Deck Interval Management Equipage

    NASA Technical Reports Server (NTRS)

    Callantine, Todd J.; Cabrall, Christopher; Kupfer, Michael; Omar, Faisal G.; Prevot, Thomas

    2012-01-01

    NASA?s Air Traffic Management Demonstration-1 (ATD-1) is a multi-year effort to demonstrate high-throughput, fuel-efficient arrivals at a major U.S. airport using NASA-developed scheduling automation, controller decision-support tools, and ADS-B-enabled Flight-Deck Interval Management (FIM) avionics. First-year accomplishments include the development of a concept of operations for managing scheduled arrivals flying Optimized Profile Descents with equipped aircraft conducting FIM operations, and the integration of laboratory prototypes of the core ATD-1 technologies. Following each integration phase, a human-in-the-loop simulation was conducted to evaluate and refine controller tools, procedures, and clearance phraseology. From a ground-side perspective, the results indicate the concept is viable and the operations are safe and acceptable. Additional training is required for smooth operations that yield notable benefits, particularly in the areas of FIM operations and clearance phraseology.

  7. Acquisition Management: Agencies Can Improve Training on New Initiatives. Report to the Chairman, Subcommittee on Technology and Procurement Policy, Committee on Government Reform, House of Representatives.

    ERIC Educational Resources Information Center

    General Accounting Office, Washington, DC.

    A study assessed strategies agencies use to ensure that their workforces are receiving the training necessary to implement acquisition initiatives. Focus was on the General Services Administration (GSA), National Aeronautics and Space Administration (NASA), and Department of Defense (DOD). Findings indicated that the critical elements important to…

  8. The Examination and Analysis of the Effects of Elementary Principals' Specific Management Practices on Teacher Morale and Willingness to Embrace Initiative

    ERIC Educational Resources Information Center

    Reardon, Thomas B.

    2012-01-01

    The purpose of this study was to determine if there was a relationship between specific principal management practices (as defined in this study as: informal visits to the classroom, face-to-face communication, written communication, visibility throughout the school campus, and a presence at extracurricular activities) and teacher morale. The…

  9. SRS Public Involvement in Waste Management Has Resulted in Effective Decisions Supported by the Public Including Disposal Changes and Top-to-Bottom Review Initiative Consensus

    SciTech Connect

    Goldston, W. T.; Villasor, H. P.

    2003-02-27

    In the Savannah River Site's (SRS') Solid Waste Management Program, a key to success is the Public Involvement Program. The Solid Waste Division at SRS manages the site's transuranic, low-level, mixed, and hazardous wastes. All decisions associated with management of this waste are of interest to the public and successful program implementation would be impossible without a vigorous public involvement program. The SRS Solid Waste Division (SWD) and its Department of Energy (DOE) customer developed, implemented, and maintain a comprehensive public participation and communications program. It is staffed by public participation and technical specialists to ensure information is presented in a manner that is technically accurate while being tailored for understanding by people without a technical background. The program provides the public with accurate, complete, timely information and early meaningful participation opportunities. It also fulfills the public participation activities required by laws, regulations, DOE Orders, and negotiated agreements. The primary goal of the SWD Public Participation Program is to fulfill the objectives of the SWD and SRS Strategic Plans to ''build trust and communicate openly, honestly, and responsibly with employees, customers, stakeholders, and regulators,'' and to ''work to extend the support of external stakeholders for the pursuit of SRS and DOE Complex business goals.'' This paper focuses on the public participation program goals, the implementation through formal plans and objectives, targeted waste management programs and specific audiences, and specific effects of the program on waste management activities. A discussion of the DOE and contractor teaming along with how plans are carried out is also included.

  10. Role of biomarkers in the management of antibiotic therapy: an expert panel review II: clinical use of biomarkers for initiation or discontinuation of antibiotic therapy

    PubMed Central

    2013-01-01

    Biomarker-guided initiation of antibiotic therapy has been studied in four conditions: acute pancreatitis, lower respiratory tract infection (LRTI), meningitis, and sepsis in the ICU. In pancreatitis with suspected infected necrosis, initiating antibiotics best relies on fine-needle aspiration and demonstration of infected material. We suggest that PCT be measured to help predict infection; however, available data are insufficient to decide on initiating antibiotics based on PCT levels. In adult patients suspected of community-acquired LRTI, we suggest withholding antibiotic therapy when the serum PCT level is low (<0.25 ng/mL); in patients having nosocomial LRTI, data are insufficient to recommend initiating therapy based on a single PCT level or even repeated measurements. For children with suspected bacterial meningitis, we recommend using a decision rule as an aid to therapeutic decisions, such as the Bacterial Meningitis Score or the Meningitest®; a single PCT level ≥0.5 ng/mL also may be used, but false-negatives may occur. In adults with suspected bacterial meningitis, we suggest integrating serum PCT measurements in a clinical decision rule to help distinguish between viral and bacterial meningitis, using a 0.5 ng/mL threshold. For ICU patients suspected of community-acquired infection, we do not recommend using a threshold serum PCT value to help the decision to initiate antibiotic therapy; data are insufficient to recommend using PCT serum kinetics for the decision to initiate antibiotic therapy in patients suspected of ICU-acquired infection. In children, CRP can probably be used to help discontinue therapy, although the evidence is limited. In adults, antibiotic discontinuation can be based on an algorithm using repeated PCT measurements. In non-immunocompromised out- or in- patients treated for RTI, antibiotics can be discontinued if the PCT level at day 3 is < 0.25 ng/mL or has decreased by >80-90%, whether or not microbiological documentation has

  11. Towards Developing an Initial Programme Theory: Programme Designers and Managers Assumptions on the Antiretroviral Treatment Adherence Club Programme in Primary Health Care Facilities in the Metropolitan Area of Western Cape Province, South Africa

    PubMed Central

    Mukumbang, Ferdinand C.; van Belle, Sara; Marchal, Bruno; van Wyk, Brian

    2016-01-01

    Background The antiretroviral adherence club intervention was rolled out in primary health care facilities in the Western Cape province of South Africa to relieve clinic congestion, and improve retention in care, and treatment adherence in the face of growing patient loads. We adopted the realist evaluation approach to evaluate what aspects of antiretroviral club intervention works, for what sections of the patient population, and under which community and health systems contexts, to inform guidelines for scaling up of the intervention. In this article, we report on a step towards the development of a programme theory—the assumptions of programme designers and health service managers with regard to how and why the adherence club intervention is expected to achieve its goals and perceptions on how it has done so (or not). Methods We adopted an exploratory qualitative research design. We conducted a document review of 12 documents on the design and implementation of the adherence club intervention, and key informant interviews with 12 purposively selected programme designers and managers. Thematic content analysis was used to identify themes attributed to the programme actors, context, mechanisms, and outcomes. Using the context-mechanism-outcome configurational tool, we provided an explanatory focus of how the adherence club intervention is roll-out and works guided by the realist perspective. Results We classified the assumptions of the adherence club designers and managers into the rollout, implementation, and utilisation of the adherence club programme, constructed around the providers, management/operational staff, and patients, respectively. Two rival theories were identified at the patient-perspective level. We used these perspectives to develop an initial programme theory of the adherence club intervention, which will be tested in a later phase. Conclusion The perspectives of the programme designers and managers provided an important step towards developing

  12. Openness initiative

    SciTech Connect

    Duncan, S.S.

    1995-12-31

    Although antinuclear campaigns seem to be effective, public communication and education efforts on low-level radioactive waste have mixed results. Attempts at public information programs on low-level radioactive waste still focus on influencing public opinion. A question then is: {open_quotes}Is it preferable to have a program focus on public education that will empower individuals to make informed decisions rather than trying to influence them in their decisions?{close_quotes} To address this question, a case study with both quantitative and qualitative data will be used. The Ohio Low-Level Radioactive Waste Education Program has a goal to provide people with information they want/need to make their own decisions. The program initiated its efforts by conducting a statewide survey to determine information needed by people and where they turned for that information. This presentation reports data from the survey and then explores the program development process in which programs were designed and presented using the information. Pre and post data from the programs reveal attitude and knowledge shifts.

  13. 21 CFR 12.120 - Initial decision.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... the Division of Dockets Management and served upon all participants. Once the initial decision is... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Initial decision. 12.120 Section 12.120 Food and... PUBLIC HEARING Initial and Final Decisions § 12.120 Initial decision. (a) The presiding officer...

  14. The child with immune thrombocytopenic purpura: is pharmacotherapy or watchful waiting the best initial management? A panel discussion from the 2002 meeting of the American Society of Pediatric Hematology/Oncology.

    PubMed

    Bolton-Maggs, Paula; Tarantino, Michael D; Buchanan, George R; Bussel, James B; George, James N

    2004-02-01

    The initial management of immune thrombocytopenic purpura is a topic of debate among pediatric hematologists. The decision whether to start a patient on pharmacotherapy or to employ an approach of watchful waiting and patient education is problematic for this group of physicians. A wide variety of research studies and review articles have been published on either side of this debate. Here, the proceedings from a panel discussion, held at the 2002 American Society of Pediatric Hematology/Oncology meeting, are presented. The panel, composed of experts on both sides of the debate, presented the rationale, benefits, and risks of both pharmacotherapy and the watchful waiting strategy. PMID:14767210

  15. Compatibility of technologies with regulations in the waste management of H-3, I-129, C-14, and Kr-85. Part I. Initial information base

    SciTech Connect

    Trevorrow, L.E.; Vandegrift, G.F.; Kolba, V.M.; Steindler, M.J.

    1983-08-01

    This report summarizes the information base that was collected and reviewed in preparation for carrying out an analysis of the compatibility with regulations of waste management technologies for disposal of H-3, I-129, C-14, and Kr-85. Based on the review of this literature, summaries are presented here of waste-form characteristics, packaging, transportation, and disposal methods. Also discussed are regulations that might apply to all operations involved in disposal of the four nuclides, including the processing of irradiated fuel in a fuel reprocessing plant, packaging, storage, transport, and final disposal. The compliance assessment derived from this information is reported in a separate document. 309 references.

  16. Siting and Transportation for Consolidated Used Nuclear Fuel Management Facilities: A Proposed Approach for a Regional Initiative to Begin the Dialogue - 13562

    SciTech Connect

    Thrower, Alex W.; Janairo, Lisa

    2013-07-01

    The Blue Ribbon Commission on America's Nuclear Future (BRC) was formed in January 2010 to conduct a comprehensive review of policies for managing the back end of the nuclear fuel cycle, and to develop a new national strategy. Over two years, the BRC held dozens of meetings and heard from hundreds of Federal, State, Tribal, and local officials, as well as representatives of trade and labor organizations, technical groups, non-governmental organizations, and other stakeholders. The Commission's final report (issued January 26, 2012) offers a strategy to resolve longstanding challenges to responsible management of the United States' nuclear waste legacy. The Commission recommended Congressional action to rewrite parts of the Nuclear Waste Policy Act (NWPA); however, a comprehensive legislative overhaul will likely take years to fully implement. The nature and characteristics of nuclear waste, the activities that generated it, and the past history of federal efforts to manage the waste make it virtually certain that finding workable solutions will be controversial and difficult. As the BRC report suggests, this difficulty can be made insurmountable if top-down, federally-mandated efforts are forced upon unwilling States, Tribes, and local communities. Decades of effort and billions of ratepayer and taxpayer dollars have been spent attempting to site and operate spent fuel storage and disposal facilities in this manner. The experience thus far indicates that voluntary consent and active partnership of States, Tribes, and local governments in siting, designing, and operating such facilities are critical. Some States, Tribes, and local communities have indicated that, given adequate scientific and technical information, along with appropriate incentives, assurances, and authority, they might be willing to consider hosting facilities for consolidated storage and disposal of spent nuclear fuel. The authors propose a new regional approach to identifying and resolving issues

  17. EUROANDRILL Initiative

    NASA Astrophysics Data System (ADS)

    Florindo, Fabio; Steering Committee, Euroandrill

    2010-05-01

    EuroANDRILL is a new initiative to create a European network with the goal to increase future involvement of European countries in the ANDRILL [ANtarctic geological DRILLing] Programme. Antarctica has been heavily glaciated for approximately 34 million years, but its ice sheets have fluctuated considerably and are one of the major driving forces for changes in climate throughout the Cenozoic Era. The spatial scale and temporal pattern of these fluctuations is subject to considerable debate. Understanding the response of large ice masses to climatic forcing is of vital importance because ice volume variations drive global sea level changes and also alter the capacity of ice sheets and sea-ice to act as major heat sinks/insulators. It is particularly important to assess the stability of the cryosphere in the face of rising CO2 levels, as modelling of the climate shift from a warm, vegetated Antarctica to a cold, ice-covered state 34 million years ago suggests a powerful greenhouse gas influence. As Antarctica is the major driver of Earth's climate and sea level, much effort has been expended in deriving models of its behaviour. Some of these models have been successfully validated against modern conditions. EuroANDRILL will provide a coherent, integrated platform for European leadership and involvement in the international ANDRILL programme. The coordination and networking provided by EuroANDRILL will seek to expand participation by European nations, institutions, and individual scientists in the study of the geologic history of the polar regions and their paleoclimatic significance. During the IPY, ANDRILL has been a highly visible and successful programme. This programme seeks to expand on this legacy beyond the IPY and make these contributions sustainable in the European Research Area through networking of research projects and future planning efforts, which establish Europe as a key player in future polar sediment and rock drilling. EuroANDRILL is set up under

  18. Microdrill Initiative - Initial Market Evaluation

    SciTech Connect

    Spears & Associates, Inc

    2003-07-01

    The U.S. Department of Energy (DOE) is launching a major research and development initiative to create a small, fast, inexpensive and environmentally friendly rig for drilling 5000 feet boreholes to investigate potential oil and gas reservoirs. DOE wishes to get input from petroleum industry operators, service companies and equipment suppliers on the operation and application of this coiled-tubing-based drilling unit. To that end, DOE has asked Spears & Associates, Inc. (SAI) to prepare a special state-of-the-market report and assist during a DOE-sponsored project-scoping workshop in Albuquerque near the end of April 2003. The scope of the project is four-fold: (1) Evaluate the history, status and future of demand for very small bore-hole drilling; (2) Measure the market for coiled tubing drilling and describe the state-of-the-art; (3) Identify companies and individuals who should have an interest in micro drilling and invite them to the DOE workshop; and (4) Participate in 3 concurrent workshop sessions, record and evaluate participant comments and report workshop conclusions.

  19. [New tools for the management of renal function in the elderly: Berlin Initiative Study equation and hematocrit, urea and gender formulae].

    PubMed

    Heras, Manuel; Fernández-Reyes, María José

    2016-05-20

    In the last few years a debate has emerged on the range of normal renal function in the elderly, and if every elderly person with a glomerular filtration rate estimated using formulas (Cockroft-Gault, MDRD, CKD-EPI) of less than 60ml/min/1.73m(2) has kidney disease. In this review we analysed, based on the results of the study Elderly people with chronic kidney disease of the Hospital de Segovia, the new equations to measure kidney function in the elderly: the Berlin Initiative Study equation designed to estimate the glomerular filtration rate in people aged 70 or more, and the hematocrit, urea and gender formula to establish whether an elderly person with a glomerular filtration rate lower than 60mL/min/1.73m(2) has kidney disease. PMID:26971975

  20. Status of Environmental Management Initiatives to Accelerate the Reduction of Environmental Risks and Challenges Posed by the Legacy of the Cold War

    SciTech Connect

    2009-01-01

    Fifty years of nuclear weapons production and energy research in the United States during the Cold War generated large amounts of radioactive wastes, spent nuclear fuel (SNF), excess plutonium and uranium, thousands of contaminated facilities, and contaminated soil and groundwater. During most of that half century, the Nation did not have the environmental regulatory structure or nuclear waste cleanup technologies that exist today. The result was a legacy of nuclear waste that was stored and disposed of in ways now considered unacceptable. Cleaning up and ultimately disposing of these wastes is the responsibility of the U.S. Department of Energy (DOE). In 1989, DOE established the Office of Environmental Management (EM) to solve the large scale and technically challenging risks posed by the world's largest nuclear cleanup. This required EM to build a new nuclear cleanup infrastructure, assemble and train a technically specialized workforce, and develop the technologies and tools required to safely decontaminate, disassemble, stabilize, disposition, and remediate unique radiation hazards. The sites where nuclear activities produced legacy waste and contamination include the original Manhattan Project sites--Los Alamos, New Mexico; Hanford, Washington; and Oak Ridge, Tennessee--as well as major Cold War sites, such as Savannah River Site, South Carolina; the Idaho National Laboratory, Idaho; Rocky Flats Plant, Colorado; and Fernald, Ohio. Today EM has responsibility for nuclear cleanup activities at 21 sites covering more than two million acres in 13 states, and employs more than 30,000 Federal and contractor employees, including scientists, engineers and hazardous waste technicians. This cleanup poses unique, technically complex problems, which must be solved under the most hazardous of conditions, and which will require billions of dollars a year for several more decades. The EM program focus during its first 10 years was on managing the most urgent risks and

  1. A national strategy for identification, prioritisation and management of pollution from abandoned non-coal mine sites in England and Wales. I. Methodology development and initial results.

    PubMed

    Mayes, W M; Johnston, D; Potter, H A B; Jarvis, A P

    2009-10-15

    In regions affected by historic non-coal (principally metal) mining activity, government agencies are often faced with the challenge of deploying limited remedial resources at abandoned mine sites to achieve maximum improvements in the chemical and ecological quality of impacted ground and surface waters. As such, strategies for the defensible allocation of public funds require comprehensive and systematic frameworks by which to identify and prioritise polluting sites for remediation. This paper describes the development and initial findings of such a national initiative in England and Wales which allies catchment-scale environmental impact assessments using existing public archive data, with recognition of the uncertainty in impact appraisals arising from disparities in data availability between sites and regions. The methodology identifies polluting sites and takes account not only of the chemical and ecological impacts of mine water discharges on receiving watercourses, but also of socio-economic factors such as conservation and heritage concerns, which can both impede or complement efforts to remediate mine sites. Using a Geographic Information System database and a suite of spatial analyses employing Boolean operators, both the extent of the pollution problem from abandoned non-coal mines in England and Wales (6% of 7815 surface water bodies are affected nationally) and the insight that can be gleaned from systematic analyses of existing archive data are highlighted. The results of the nationwide survey can be used as a dynamic database to inform future remedial planning, in terms of prioritising impacted river basins and abandoned non-coal mine sites themselves for either remediation or future monitoring efforts. As the assessment framework is built upon existing water quality and ecological data and mine site/geological data, there is considerable scope for the approach to be applied elsewhere where the legacy of historic mining persists through the

  2. Hanford tanks initiative plan

    SciTech Connect

    McKinney, K.E.

    1997-07-01

    Abstract: The Hanford Tanks Initiative (HTI) is a five-year project resulting from the technical and financial partnership of the U.S. Department of Energy`s Office of Waste Management (EM-30) and Office of Science and Technology Development (EM-50). The HTI project accelerates activities to gain key technical, cost performance, and regulatory information on two high-level waste tanks. The HTI will provide a basis for design and regulatory decisions affecting the remainder of the Tank Waste Remediation System`s tank waste retrieval Program.

  3. Comparison of characteristics and outcomes by initial study contact (website versus staff) for participants enrolled in a weight-management study

    PubMed Central

    Funk, Kristine L; Elder, Charles R.; Lindberg, Nangel M.; Gullion, Christina M.; DeBar, Lynn L.; Meltesen, Gayle; Stevens, Victor J.

    2012-01-01

    Background Traditional recruitment methods for clinical trials, such as telephone, mail, and print-media, are often inefficient, costly and use large amounts of staff time and resources. Purpose This analysis was conducted to determine whether retention, demographics, and outcomes differed between enrolled participants who responded to recruitment outreach using an Internet-based information and registration system and enrollees whose first contact was with study staff via telephone. Methods We identified potentially eligible participants from Kaiser Permanente Northwest databases and mailed brochures inviting them to participate in the Life weight-loss maintenance study. We also used employee newsletters, a member-directed website, and messages to employee email distribution lists to publicize the study. All outreach methods contained both a website address and a telephone number through which respondents could register for an information session. The website contained the same information as was provided by staff over the telephone. Results Out of 2122 potential participants who expressed interest in the study, 70% did so through the website. There was no difference in retention rates between enrollees who initiated contact through the website (WEB = 308) and enrollees who contacted the study by telephone (Staff = 161). The WEB group was younger (p = 0.01), had higher income (p = 0.01) and education (p < 0.01) levels, and lower body mass index (p < 0.01). There was a trend toward greater weight loss in the WEB group (p = 0.06). Limitations We did not conduct a formal cost analysis of the two methods. Also, the population for this analysis was mostly Caucasian and middle income; thus, we cannot draw conclusions about the generalizability of our findings to more racially and economically diverse populations. Conclusion Enrolled participants who used a website to register for an initial study information session had similar study retention and outcome performance as

  4. French Society of ENT (SFORL) guidelines for care pathway organization in head and neck oncology (short version). Early management of head and neck cancer.

    PubMed

    Cuny, F; Babin, E; Lacau-Saint-Guily, J; Baujat, B; Bensadoun, R; Bozec, A; Chevalier, D; Choussy, O; Deneuve, S; Fakhry, N; Guigay, J; Makeieff, M; Merol, J-C; Mouawad, F; Pavillet, J; Rebiere, C; Righini, C; Sostras, M-C; Tournaille, M; Vergez, S

    2015-09-01

    Early management in oncology is based on coordination and high-quality exchange between the various health-care partners. The present guidelines are based on a literature search with levels of evidence. Treatment waiting time can be optimized by performing assessment as early as possible (Expert opinion), to limit the interval (ideally, less than 4 weeks) between first consultation and data collection. In the first specialist consultation, diagnostic work-up should be scheduled and the data required for management should be determined (Grade B). Work-up may be conducted on a day-care basis or with conventional admission (Expert opinion). The patient's medico-social context should be taken into account from the outset, with social work involvement whenever necessary (Expert opinion). Pain and nutritional management should be planned for (Grade A) and realistic therapeutic education be provided (Expert opinion). Community-hospital teamwork for supportive care should be optimized (Expert opinion). Management should be early and multidisciplinary, to shorten delay between diagnosis and treatment initiation. PMID:26183548

  5. Long-Term Clinical Outcomes according to Initial Management and Thrombolysis In Myocardial Infarction Risk Score in Patients with Acute Non-ST-Segment Elevation Myocardial Infarction

    PubMed Central

    Jeong, Hae Chang; Jeong, Myung Ho; Chae, Shung Chull; Hur, Seung Ho; Hong, Taek Jong; Kim, Young Jo; Seong, In Whan; Chae, Jei Keon; Rhew, Jay Young; Chae, In Ho; Cho, Myeong Chan; Bae, Jang Ho; Rha, Seung Woon; Kim, Chong Jin; Choi, Donghoon; Jang, Yang Soo; Yoon, Junghan; Chung, Wook Sung; Cho, Jeong Gwan; Seung, Ki Bae; Park, Seung Jung

    2010-01-01

    Purpose There is still debate about the timing of revascularization in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI). We analyzed the long-term clinical outcomes of the timing of revascularization in patients with acute NSTEMI obtained from the Korea Acute Myocardial Infarction Registry (KAMIR). Materials and Methods 2,845 patients with acute NSTEMI (65.6 ± 12.5 years, 1,836 males) who were enrolled in KAMIR were included in the present study. The therapeutic strategy of NSTEMI was categorized into early invasive (within 48 hours, 65.8 ± 12.6 years, 856 males) and late invasive treatment (65.3 ± 12.1 years, 979 males). The initial- and long-term clinical outcomes were compared between two groups according to the level of Thrombolysis In Myocardial Infarction (TIMI) risk score. Results There were significant differences in-hospital mortality and the incidence of major adverse cardiac events during one-year clinical follow-up between two groups (2.1% vs. 4.8%, p < 0.001, 10.0% vs. 13.5%, p = 0.004, respectively). According to the TIMI risk score, there was no significant difference of long-term clinical outcomes in patients with low to moderate TIMI risk score, but significant difference in patients with high TIMI risk score (≥ 5 points). Conclusions The old age, high Killip class, low ejection fraction, high TIMI risk score, and late invasive treatment strategy are the independent predictors for the long-term clinical outcomes in patients with NSTEMI. PMID:20046515

  6. Endoscopic Gold Fiducial Marker Placement into the Bladder Wall to Optimize Radiotherapy Targeting for Bladder-Preserving Management of Muscle-Invasive Bladder Cancer: Feasibility and Initial Outcomes

    PubMed Central

    Garcia, Maurice M.; Gottschalk, Alexander R.; Brajtbord, Jonathan; Konety, Badrinath R.; Meng, Maxwell V.; Roach, Mack; Carroll, Peter R.

    2014-01-01

    Background and Purpose Bladder radiotherapy is a management option for carefully selected patients with muscle-invasive bladder cancer. However, the inability to visualize the tumor site during treatment and normal bladder movement limits targeting accuracy and increases collateral radiation. A means to accurately and reliably target the bladder during radiotherapy is needed. Materials and Methods Eighteen consecutive patients with muscle-invasive bladder cancer (T1–T4) elected bladder-preserving treatment with maximal transurethral resection (TUR), radiation and concurrent chemotherapy. All underwent endoscopic placement of 24-K gold fiducial markers modified with micro-tines (70 [2.9×0.9 mm.]; 19 [2.1×0.7 mm.) into healthy submucosa 5-10 mm. from the resection margin, using custom-made coaxial needles. Marker migration was assessed for with intra-op bladder-filling cystogram and measurement of distance between markers. Set-up error and marker retention through completion of radiotherapy was confirmed by on-table portal imaging. Results Between 1/2007 and 7/2012, a total of 89 markers (3–5 per tumor site) were placed into 18 patients of mean age 73.6 years. Two patients elected cystectomy before starting treatment; 16/18 completed chemo-radiotherapy. All (100%) markers were visible with all on-table (portal, cone-beam CT), fluoroscopy, plain-film, and CT-scan imaging. In two patients, 1 of 4 markers placed at the tumor site fell-out (voided) during the second half of radiotherapy. All other markers (80/82, 98%) were present through the end of radio-therapy. No intraoperative (e.g. uncontrolled bleeding, collateral injury) or post-operative complications (e.g. stone formation, urinary tract infection, post-TUR hematuria >48 hours) occurred. Use of micro-tined fiducial tumor-site markers afforded a 2 to 6-fold reduction in bladder-area targeted with high-dose radiation. Discussion Placement of the micro-tined fiducial markers into the bladder was feasible and

  7. Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis: integrating systematic literature research and expert opinion of a broad panel of rheumatologists in the 3e Initiative

    PubMed Central

    Colebatch, Alexandra N.; Buchbinder, Rachelle; Edwards, Christopher J.; Adams, Karen; Englbrecht, Matthias; Hazlewood, Glen; Marks, Jonathan L.; Radner, Helga; Ramiro, Sofia; Richards, Bethan L.; Tarner, Ingo H.; Aletaha, Daniel; Bombardier, Claire; Landewé, Robert B.; Müller-Ladner, Ulf; Bijlsma, Johannes W. J.; Branco, Jaime C.; Bykerk, Vivian P.; da Rocha Castelar Pinheiro, Geraldo; Catrina, Anca I.; Hannonen, Pekka; Kiely, Patrick; Leeb, Burkhard; Lie, Elisabeth; Martinez-Osuna, Píndaro; Montecucco, Carlomaurizio; Østergaard, Mikkel; Westhovens, Rene; Zochling, Jane; van der Heijde, Désirée

    2012-01-01

    Objective. To develop evidence-based recommendations for pain management by pharmacotherapy in patients with inflammatory arthritis (IA). Methods. A total of 453 rheumatologists from 17 countries participated in the 2010 3e (Evidence, Expertise, Exchange) Initiative. Using a formal voting process, 89 rheumatologists representing all 17 countries selected 10 clinical questions regarding the use of pain medications in IA. Bibliographic fellows undertook a systematic literature review for each question, using MEDLINE, EMBASE, Cochrane CENTRAL and 2008–09 European League Against Rheumatism (EULAR)/ACR abstracts. Relevant studies were retrieved for data extraction and quality assessment. Rheumatologists from each country used this evidence to develop a set of national recommendations. Multinational recommendations were then formulated and assessed for agreement and the potential impact on clinical practice. Results. A total of 49 242 references were identified, from which 167 studies were included in the systematic reviews. One clinical question regarding different comorbidities was divided into two separate reviews, resulting in 11 recommendations in total. Oxford levels of evidence were applied to each recommendation. The recommendations related to the efficacy and safety of various analgesic medications, pain measurement scales and pain management in the pre-conception period, pregnancy and lactation. Finally, an algorithm for the pharmacological management of pain in IA was developed. Twenty per cent of rheumatologists reported that the algorithm would change their practice, and 75% felt the algorithm was in accordance with their current practice. Conclusions. Eleven evidence-based recommendations on the management of pain by pharmacotherapy in IA were developed. They are supported by a large panel of rheumatologists from 17 countries, thus enhancing their utility in clinical practice. PMID:22447886

  8. Framework for Evaluating Educational Systemic Initiatives.

    ERIC Educational Resources Information Center

    Ikegulu, T. Nelson

    This paper describes the implementation of the Holistic Systemic Evaluation (HSE), a component of an Education Systemic Initiative's strategic management. The HSE provides general guidance for the implementation and continual improvement of an Education Systemic Initiative Reform (ESIR). The implementation of the education system initiative plan:…

  9. 5 CFR 185.137 - Initial decision.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Initial decision. 185.137 Section 185.137 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PROGRAM FRAUD CIVIL REMEDIES § 185.137 Initial decision. (a) The ALJ shall issue an initial decision based only on the record,...

  10. The Knowledge Stealing Initiative?

    NASA Technical Reports Server (NTRS)

    Goshorn, Larry

    2005-01-01

    I have the honor of being on the Academy of Program and Project Leadership (APPL) Knowledge Sharing Feedback and Assessment Team (FAA), and as such, I am privileged to receive the feedback written by many of you as attendees of the Project Management (PM) Master s Forums. It is the intent of the FAA Team and APPL leadership to use this feedback as a tool for continuous program improvement. As a retired (sort of) PM in the payload contracting industry, I'm a big supporter of NASA s Knowledge Sharing Initiative (KSI), especially the Master's Forums. I really enjoy participating in them. Unfortunately I had to miss the 8th forum in Pasadena this past Spring, but I did get the feedback package for the Assessment Team work. So here I was, reviewing twelve pages of comments, reflections, learning notes and critiques from attendees of the 8th forum.

  11. New Directions in Campus Management: Personnel Initiatives

    ERIC Educational Resources Information Center

    McCormick, James H.

    1976-01-01

    In a speech to CUPA's 1976 convention, a college president examines the personnel function of an institution. He calls for a human resources planning system that includes (1) a manpower forecast, (2) a succession plan, (3) a development plan, and (4) a staffing plan. (LBH)

  12. Potential and Challenges of Low-Cost and High-Tech Crowd-sensing Approaches in Hydrometeorology for Better Water Resources Management - Insights and Learnings from the Global iMoMo Initiative

    NASA Astrophysics Data System (ADS)

    Siegfried, Tobias

    2016-04-01

    In developing and transition countries and despite significant global investments in hydrometeorology, data on water remain scarce/fragmented. One key reason is that traditional sensing in hydrology, hydro- and agro-meteorology does not scale because of high investment costs and difficult maintenance of traditional technology, esp. in remote and/or poor regions. Even where there are data, these are often difficult to access and interpret for local stakeholders due outdated data transmission and the lack of access to modern tools for data management/analysis/synthesis and exchange. In recent years, there have been substantial technology developments in environmental sensing and mobile communication technology that enable the application and deployment of affordable and scalable high-tech solutions for better water monitoring at different scales (local to transboundary levels). The WMO is acknowledging and promoting the potential for application of these technologies. One key aspect is to anchor these technologies in local communities that perform crowd-sensing tasks on a regular basis. The merits as well as challenges (including introduction of human factor, less accuracy as compared to traditional sensing, intermittency of data, …) of such approaches will be discussed in the context of the WMO-led Global iMoMo Initiative and its numerous activities on the ground in Eastern and Southern Africa as well as in Central Asia.

  13. WORK-UP OF STILLBIRTH: A REVIEW OF THE EVIDENCE

    PubMed Central

    SILVER, Robert M.; VARNER, Michael W.; REDDY, Uma; GOLDENBERG, Robert; PINAR, Halit; CONWAY, Deborah; BUKOWSKI, Radek; CARPENTER, Marshall; HOGUE, Carol; WILLINGER, Marian; DUDLEY, Donald; SAADE, George; STOLL, Barbara

    2009-01-01

    Despite improvements in antenatal and intrapartum care, stillbirth, defined as in utero fetal death at 20 weeks of gestation or greater, remains an important, largely unstudied, and poignant problem in obstetrics. Over 26,000 stillbirths were reported in the US in 2001. Although several conditions have been linked to stillbirth, it is difficult to define the precise etiology in many cases. This paper reviews known and suspected causes of stillbirth including genetic abnormalities, infection, fetal-maternal hemorrhage, and a variety of medical conditions in the mother. The proportion of stillbirths that have a diagnostic explanation is higher in centers that conduct a defined and systematic evaluation. Recommended diagnostic tests for stillbirth are discussed. The on-going work of the NICHD Stillbirth Collaborative Research Network, a consortium of 5 academic centers in the United States that are studying the scope and causes of stillbirth, is presented. PMID:17466694

  14. Vital Signs building work-up: The Museum of Anthropology

    SciTech Connect

    Millet, M.S.; Erwine, B.

    1997-12-31

    The paper will present the structure and the results of an in depth study of the Museum of Anthropology, designed by Arthur Erickson Architects for the University of British Columbia in Vancouver and completed in 1976. Part of the Vital Signs Curriculum Project created by Cris Benton and administered through the University of California at Berkeley, this analytic project was designed and carried out by a faculty/student team in the Department of Architecture at the University of Washington. The significance of this study is the simultaneous presentation of qualitative and quantitative information about the thermal and luminous environment of this building.

  15. Work-up of Pediatric Urinary Tract Infection.

    PubMed

    Schmidt, Bogdana; Copp, Hillary L

    2015-11-01

    Pediatric urinary tract infection (UTI) costs the health care system more than $180 million annually, and accounts for more than 1.5 million clinician visits per year. Accurate and timely diagnosis of these infections is important for determining appropriate treatment and preventing long-term complications such as renal scarring, hypertension, and end-stage renal disease. After the first 12 months, girls are more likely to be diagnosed with a UTI. About half of boys with UTI are diagnosed within the first 12 months of life. Diagnosis of UTI is made based on history and examination findings and confirmed by urine testing. PMID:26475948

  16. Pathophysiology and Clinical Work-Up of Acute Kidney Injury.

    PubMed

    Meola, Mario; Nalesso, Federico; Petrucci, Ilaria; Samoni, Sara; Ronco, Claudio

    2016-01-01

    Acute kidney injury (AKI), also known in the past as acute renal failure, is a syndrome characterized by the rapid loss of kidney excretory function. It is usually diagnosed by the accumulation of end products of nitrogen metabolism (urea and creatinine) or decreased urine output or both. AKI is the clinical consequence of several disorders that acutely affect the kidney, causing electrolytes and acid-base imbalance, hyperhydration and loss of depurative function. AKI is common in critical care patients in whom it is often secondary to extrarenal events. No specific therapies can attenuate AKI or accelerate renal function recovery; thus, the only treatment is supportive. New diagnostic techniques such as renal biomarkers might improve early diagnosis. Also ultrasonography helps nephrologists in AKI diagnosis, in order to describe and follow kidney alterations and find possible causes of AKI. Renal replacement therapy is a life-saving treatment if AKI is severe. If patients survive to AKI, and did not have previous chronic kidney disease (CKD), they typically recover to dialysis independence. However, evidence suggests that patients who have had AKI are at increased risk of subsequent CKD. PMID:27169469

  17. [Differential diagnosis and work up of chronic leg ulcers].

    PubMed

    Spoljar, Sanja

    2014-10-01

    Many factors contribute to the pathogenesis of leg ulcers. The main causes are chronic venous insufficiency, peripheral arterial occlusive disease (PAOD) and diabetes. Some leg ulcers are caused by combinations of these well-known etiologic factors. The most common cause of PAOD is arteriosclerosis. In diabetic patients, distal symmetric neuropathy and peripheral vascular disease are probably the most important etiologic factors in the development of leg ulcers. Less frequent causes of chronic leg ulcers are hematologic diseases, autoimmune diseases, genetic defects, infections, primary skin disease, cutaneous malignant diseases, use of some medications and therapeutic procedures, and numerous exogenous factors. Diagnosis of leg ulcer is made upon medical history, clinical picture, palpation of arteries, functional testing and serologic testing. Device-based diagnostic testing should be performed for additional clarification. Also, lesion biopsy should be taken for histopathology, direct immunofluorescence, bacteriology and mycology. The knowledge of differential diagnosis is essential for ensuring treatment success in a patient with leg ulcer. PMID:25326987

  18. The Plus 50 Initiative Evaluation: Initiative Impact

    ERIC Educational Resources Information Center

    American Association of Community Colleges (NJ1), 2012

    2012-01-01

    The American Association of Community Colleges (AACC), with funding from The Atlantic Philanthropies, created the Plus 50 Initiative (2008-2012). This initiative was designed to build the capacity of community colleges nationwide to develop programming that engages the plus 50 learner. This report contains: (1) An overview of the Plus 50…

  19. 41 CFR 105-70.037 - Initial decision.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Initial decision. 105-70.037 Section 105-70.037 Public Contracts and Property Management Federal Property Management... Administration 70-IMPLEMENTATION OF THE PROGRAM FRAUD CIVIL REMEDIES ACT OF 1986 § 105-70.037 Initial...

  20. 5 CFR 831.1110 - Initial decision.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Initial decision. 831.1110 Section 831.1110 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) RETIREMENT Prohibition on Payments of Annuities § 831.1110 Initial decision. (a) Upon...

  1. Initialized Fractional Calculus

    NASA Technical Reports Server (NTRS)

    Lorenzo, Carl F.; Hartley, Tom T.

    2000-01-01

    This paper demonstrates the need for a nonconstant initialization for the fractional calculus and establishes a basic definition set for the initialized fractional differintegral. This definition set allows the formalization of an initialized fractional calculus. Two basis calculi are considered; the Riemann-Liouville and the Grunwald fractional calculi. Two forms of initialization, terminal and side are developed.

  2. Randomised controlled trial and cost consequences study comparing initial physiotherapy assessment and management with routine practice for selected patients in an accident and emergency department of an acute hospital

    PubMed Central

    Richardson, B; Shepstone, L; Poland, F; Mugford, M; Finlayson, B; Clemence, N

    2005-01-01

    Objective: The Department of Health is reviewing the effectiveness of accident and emergency (A&E) departments. This study aimed to compare health and economic effects of physiotherapy initial assessment and management with routine practice in an A&E department. Methods: Randomised controlled trial and cost and consequences study. Patients presenting at A&E were eligible if suspected at triage to have soft tissue injury without fracture. The efficacy end point was "days to return to usual activities". Secondary end points included patient satisfaction with their care and further health outcomes and cost data. Results: 766 of 844 (915) patients were randomised. The median days before return to usual activities (available for 73% of those randomised) was greater in the physiotherapist group (41 days compared with 28.5 days; hazard ratio 0.85 p = 0.071). The physiotherapy group expressed greater satisfaction with their A&E care (on a scale of 1 to 5, median was 4.2 compared with 4.0, p<0.001), were more likely to be given advice and reassurance, and more likely to be provided with aids and appliances. Costs were the same between the two arms. Conclusion: There is evidence that physiotherapy leads to a prolonged time before patients return to usual activities. This study shows no clear danger from physiotherapy intervention and long term outcomes may be different but given these findings, a best estimate is that introducing physiotherapist assessment will increase costs to the health service and society. Routine care should continue be provided unless there is some reason why it is not feasible to do so and an alternative must be found. PMID:15662054

  3. APEC Smart Grid Initiative

    SciTech Connect

    Bloyd, Cary N.

    2012-03-01

    This brief paper describes the activities of the Asia Pacific Economic Cooperation (APEC) Smart Grid Initiative (ASGI) which is being led by the U.S. and developed by the APEC Energy Working Group. In the paper, I describe the origin of the initiative and briefly mention the four major elements of the initiative along with existing APEC projects which support it.

  4. Sustainable Forest Bioenergy Initiative

    SciTech Connect

    Breger, Dwayne; Rizzo, Rob

    2011-09-20

    associated with biomass usage, an understanding of forest management trends including harvesting and fuel processing methods, and the carbon profile of utilizing forest based woody biomass for the emerging biomass markets. Each of the tasks and subtasks have provided an increased level of understanding to support new directives, policies and adaptation of existing regulations within Massachusetts. The project has provided the essential information to allow state policymakers and regulators to address emerging markets, while ensuring forest sustainability and understanding the complex science on CO2 accounting and impacts as a result of biomass harvesting for power generation. The public at large and electricity ratepayers in Massachusetts will all benefit from the information garnered through this project. This is a result of the state’s interest to provide financial incentives to only biomass projects that demonstrate an acceptable carbon profile, an efficient use of the constrained supply of fuel, and the harvest of biomass to ensure forest sustainability. The goals of the Massachusetts Sustainable Forest Bioenergy Initiative as proposed in 2006 were identified as: increase the diversity of the Massachusetts energy mix through biomass; promote economic development in the rural economy through forest industry job creation; help fulfill the state’s energy and climate commitments under the Renewable Energy Portfolio Standard and Climate Protection Plan; assist the development of a biomass fuel supply infrastructure to support energy project demands; provide education and outreach to the public on the benefits and impacts of bioenergy; improve the theory and practice of sustainable forestry in the Commonwealth. Completed project activities summarized below will demonstrate the effectiveness of the project in meeting the above goals. In addition, as discussed above, Massachusetts DOER needed to make some modifications to its work plan and objectives during the term of this

  5. Initial Events in Bacterial Transcription Initiation

    PubMed Central

    Ruff, Emily F.; Record, M. Thomas; Artsimovitch, Irina

    2015-01-01

    Transcription initiation is a highly regulated step of gene expression. Here, we discuss the series of large conformational changes set in motion by initial specific binding of bacterial RNA polymerase (RNAP) to promoter DNA and their relevance for regulation. Bending and wrapping of the upstream duplex facilitates bending of the downstream duplex into the active site cleft, nucleating opening of 13 bp in the cleft. The rate-determining opening step, driven by binding free energy, forms an unstable open complex, probably with the template strand in the active site. At some promoters, this initial open complex is greatly stabilized by rearrangements of the discriminator region between the −10 element and +1 base of the nontemplate strand and of mobile in-cleft and downstream elements of RNAP. The rate of open complex formation is regulated by effects on the rapidly-reversible steps preceding DNA opening, while open complex lifetime is regulated by effects on the stabilization of the initial open complex. Intrinsic DNA opening-closing appears less regulated. This noncovalent mechanism and its regulation exhibit many analogies to mechanisms of enzyme catalysis. PMID:26023916

  6. Hospitality Management.

    ERIC Educational Resources Information Center

    College of the Canyons, Valencia, CA.

    A project was conducted at College of the Canyons (Valencia, California) to initiate a new 2-year hospitality program with career options in hotel or restaurant management. A mail and telephone survey of area employers in the restaurant and hotel field demonstrated a need for, interest in, and willingness to provide internships for such a program.…

  7. Progress in Initiator Modeling

    SciTech Connect

    Hrousis, C A; Christensen, J S

    2009-05-04

    There is great interest in applying magnetohydrodynamic (MHD) simulation techniques to the designs of electrical high explosive (HE) initiators, for the purpose of better understanding a design's sensitivities, optimizing its performance, and/or predicting its useful lifetime. Two MHD-capable LLNL codes, CALE and ALE3D, are being used to simulate the process of ohmic heating, vaporization, and plasma formation in the bridge of an initiator, be it an exploding bridgewire (EBW), exploding bridgefoil (EBF) or slapper type initiator. The initiation of the HE is simulated using Tarver Ignition & Growth reactive flow models. 1-D, 2-D and 3-D models have been constructed and studied. The models provide some intuitive explanation of the initiation process and are useful for evaluating the potential impact of identified aging mechanisms (such as the growth of intermetallic compounds or powder sintering). The end product of this work is a simulation capability for evaluating margin in proposed, modified or aged initiation system designs.

  8. 5 CFR 831.109 - Initial decision and reconsideration.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Office of Personnel Management (OPM) may request OPM to review its initial decision. (b) Actions covered... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Initial decision and reconsideration. 831.109 Section 831.109 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL...

  9. Prioritizing Scientific Initiatives.

    ERIC Educational Resources Information Center

    Bahcall, John N.

    1991-01-01

    Discussed is the way in which a limited number of astronomy research initiatives were chosen and prioritized based on a consensus of members from the Astronomy and Astrophysics Survey Committee. A list of recommended equipment initiatives and estimated costs is provided. (KR)

  10. Illinois: Prevention Initiative

    ERIC Educational Resources Information Center

    Center for Law and Social Policy, Inc. (CLASP), 2012

    2012-01-01

    The Illinois Prevention Initiative provides grants to home-based and center-based programs to expand access to the Early Head Start (EHS) model as well as other birth to 3 models. The goal is to serve additional children birth to age 3 and help grantees increase program quality. The initiative to expand access to EHS and other models was…

  11. An Urban Initiative.

    ERIC Educational Resources Information Center

    New Jersey State Dept. of Education, Trenton.

    New Jersey's urban initiative has two components. The first is a broad-based program that addresses critical issues common to most urban districts Statewide. The second is a comprehensive program (Operation School Renewal) that concentrates the State's resources in three urban districts. The concentrated initiative, Operation School Renewal, will…

  12. Community Marriage Initiatives

    ERIC Educational Resources Information Center

    Doherty, William J.; Anderson, Jared R.

    2004-01-01

    This article reviews the development of community marriage initiatives and their relationship with family professionals, with particular emphasis on sociohistorical context. We describe five leading community marriage initiatives, discuss the state of the evaluation research, and propose new directions for this promising area of work.

  13. The Saudi Initiative for Asthma

    PubMed Central

    Al-Moamary, Mohamed S.; Al-Hajjaj, Mohamed S.; Idrees, Majdy M.; Zeitouni, Mohamed O.; Alanezi, Mohammed O.; Al-Jahdal, Hamdan H.; Al Dabbagh, Maha

    2009-01-01

    The Saudi Initiative for Asthma (SINA) provides up-to-date guidelines for healthcare workers managing patients with asthma. SINA was developed by a panel of Saudi experts with respectable academic backgrounds and long-standing experience in the field. SINA is founded on the latest available evidence, local literature, and knowledge of the current setting in Saudi Arabia. Emphasis is placed on understanding the epidemiology, pathophysiology, medications, and clinical presentation. SINA elaborates on the development of patient-doctor partnership, self-management, and control of precipitating factors. Approaches to asthma treatment in SINA are based on disease control by the utilization of Asthma Control Test for the initiation and adjustment of asthma treatment. This guideline is established for the treatment of asthma in both children and adults, with special attention to children 5 years and younger. It is expected that the implementation of these guidelines for treating asthma will lead to better asthma control and decrease patient utilization of the health care system. PMID:19881170

  14. [Clinical management. Clinical management units. Management agreements].

    PubMed

    Ortega Moreno, A

    2003-12-01

    Clinical management (CM) as a concept includes different innovating experiences in health care services management among developed countries, which were initiated during the late eighties and the first nineties. They were mostly due to the concern that political leaders had about their financial viability. CM, as far as it is understood in Spain, is an organizing model which considers the patient as the centre of the health system. It is guided towards disease, looking for continuous assistance and facilitates an autonomous management together with decentralization at the time of taking decisions. It involves professionals whose clinical practice, based on guides, medical records and care planning, incorporate the knowledge and methodology of "evidence based medicine". Clinical management units (CMU) are organizational types of CM, which implantation is spreading rapidly in the different national health care systems. They include a person who assumes responsibility for them, who act as the hospital directorship interlocutor and are autonomous at the time of managing the allocated resources related to their medical programmes and services. They have an information system adapted to their own needs and an outcome evaluation system which allows them "process" re-engineering. CMU's strengths and weaknesses are highly dependent on the professionals that integrate them. The CMU responsible carries out a management contract with the hospital directorship in which CMU competences, directorship's obligations, essential aspects to meet agreed goals, an outcome evaluation system and an incentives scheme are included. PMID:15206333

  15. 49 CFR 40.367 - Who initiates a PIE proceeding?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false Who initiates a PIE proceeding? 40.367 Section 40... DRUG AND ALCOHOL TESTING PROGRAMS Public Interest Exclusions § 40.367 Who initiates a PIE proceeding? The following DOT officials may initiate a PIE proceeding: (a) The drug and alcohol program manager...

  16. 34 CFR 300.182 - Initial decision; final decision.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Panel that the initial decision is being further reviewed. (Approved by the Office of Management and... 34 Education 2 2010-07-01 2010-07-01 false Initial decision; final decision. 300.182 Section 300... CHILDREN WITH DISABILITIES State Eligibility Department Procedures § 300.182 Initial decision;...

  17. Autonomous aircraft initiative study

    NASA Technical Reports Server (NTRS)

    Hewett, Marle D.

    1991-01-01

    The results of a consulting effort to aid NASA Ames-Dryden in defining a new initiative in aircraft automation are described. The initiative described is a multi-year, multi-center technology development and flight demonstration program. The initiative features the further development of technologies in aircraft automation already being pursued at multiple NASA centers and Department of Defense (DoD) research and Development (R and D) facilities. The proposed initiative involves the development of technologies in intelligent systems, guidance, control, software development, airborne computing, navigation, communications, sensors, unmanned vehicles, and air traffic control. It involves the integration and implementation of these technologies to the extent necessary to conduct selected and incremental flight demonstrations.

  18. Advanced Concepts Research Initiative

    EPA Science Inventory

    This initiative is investigating various approaches to controlling and treating wet-weather flow (WWF) discharges in the urban watershed. WWF, including combined sewer overflow (CSO), sanitary sewer overflow (SSO) and stormwater discharges are leading causes of receiving water q...

  19. The RAS Initiative

    Cancer.gov

    NCI established the RAS Initiative to explore innovative approaches for attacking the proteins encoded by mutant forms of RAS genes and to ultimately create effective, new therapies for RAS-related cancers.

  20. Piezoelectrically Initiated Pyrotechnic Igniter

    NASA Technical Reports Server (NTRS)

    Quince, Asia; Dutton, Maureen; Hicks, Robert; Burnham, Karen

    2013-01-01

    This innovation consists of a pyrotechnic initiator and piezoelectric initiation system. The device will be capable of being initiated mechanically; resisting initiation by EMF, RF, and EMI (electromagnetic field, radio frequency, and electromagnetic interference, respectively); and initiating in water environments and space environments. Current devices of this nature are initiated by the mechanical action of a firing pin against a primer. Primers historically are prone to failure. These failures are commonly known as misfires or hang-fires. In many cases, the primer shows the dent where the firing pin struck the primer, but the primer failed to fire. In devices such as "T" handles, which are commonly used to initiate the blowout of canopies, loss of function of the device may result in loss of crew. In devices such as flares or smoke generators, failure can result in failure to spot a downed pilot. The piezoelectrically initiated ignition system consists of a pyrotechnic device that plugs into a mechanical system (activator), which on activation, generates a high-voltage spark. The activator, when released, will strike a stack of electrically linked piezo crystals, generating a high-voltage, low-amperage current that is then conducted to the pyro-initiator. Within the initiator, an electrode releases a spark that passes through a pyrotechnic first-fire mixture, causing it to combust. The combustion of the first-fire initiates a primary pyrotechnic or explosive powder. If used in a "T" handle, the primary would ramp the speed of burn up to the speed of sound, generating a shock wave that would cause a high explosive to go "high order." In a flare or smoke generator, the secondary would produce the heat necessary to ignite the pyrotechnic mixture. The piezo activator subsystem is redundant in that a second stack of crystals would be struck at the same time with the same activation force, doubling the probability of a first strike spark generation. If the first

  1. 41 CFR 105-70.038 - Reconsideration of initial decision.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Reconsideration of initial decision. 105-70.038 Section 105-70.038 Public Contracts and Property Management Federal Property Management Regulations System (Continued) GENERAL SERVICES ADMINISTRATION Regional Offices-General...

  2. Current Status of Diversity Initiatives in Selected Multinational Corporations.

    ERIC Educational Resources Information Center

    Wentling, Rose Mary; Palma-Rivas, Nilda

    2000-01-01

    Interviews with eight diversity managers in multinational corporations revealed a variety of domestic and international diversity initiatives, especially in leadership and management. Formal and informal methods were used to plan them. Business unit managers were responsible for implementation. Evaluation was difficult and time consuming. (SK)

  3. 28 CFR 541.15 - Initial hearing.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Initial hearing. 541.15 Section 541.15 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT INMATE DISCIPLINE... was last confined. (d) The inmate is entitled to make a statement and to present documentary...

  4. Understanding the Early Years (UEY) Initiative

    ERIC Educational Resources Information Center

    Human Resources and Social Development Canada, 2007

    2007-01-01

    Internal Audit Services conducted an Early Implementation Review of the Understanding the Early Years (UEY) Initiative in 2006-07. This review is intended to provide assurance to senior management that program delivery has been established appropriately in order to meet its objectives and highlight any areas that require focused management…

  5. LIFE CYCLE INITIATIVES IN USEPA: JOURNAL ARTICLE

    EPA Science Inventory

    NRMRL-CIN-1501 Curran*, M.A. "Life Cycle Initiatives in USEPA." Paper published in: 1st International Conference on Life Cycle Management (LCM2001), Copenhagen, Denmark, 8/27-29/2001, S. Christiansen, M. Horup, A.A. Jensen (Ed.), 2001, p. 201-204. 06/21/2001 There is a growing...

  6. Evaluation of the 1996-99 HEFCE/DENI Disability Special Initiative. A Report by the Higher Education Consulting Group (THECG) and the Commonwealth Higher Education Management Service (CHEMS).

    ERIC Educational Resources Information Center

    Higher Education Funding Council for England, Bristol.

    The report evaluates a special initiative of the Higher Education Funding Council for England (HEFCE) and the Department of Education of Northern Ireland (DENI) in 1996-1997 and 1998-1999 to encourage institutions to develop high quality provisions for students with disabilities and to increase the participation in higher education of students…

  7. CONSULTATION ON WAYS OF CONSIDERING THE RESULTS OF EPA'S NATIONAL SURVEY ON ENVIRONMENTAL MANAGEMENT OF ASTHMA AND CHILDRENS EXPOSURE TO ETS [NSEMA/CEE] FOR THE INDOOR ENVIRONMENTS DIVISIONS ASTHMA INITIATIVE.

    EPA Science Inventory

    EPA has completed the field phase and is engaged in the analysis phase of its National Survey on Environmental Management of Asthma and Children's Exposure to ETS [NSEMA/CEE]. This is a nation-wide survey on awareness of and existing attitudes toward asthma and its environmental ...

  8. Total Quality Management in Academic Libraries: Initial Implementation Efforts. Proceedings from the International Conference on TQM and Academic Libraries (1st, Washington, D.C., April 20-22, 1994).

    ERIC Educational Resources Information Center

    Rounds, Laura, Ed.; Matthews, Michael, Ed.

    This document contains conference papers, other speeches, and supplementary material from the first International Conference on Total Quality Management (TQM) and Academic Libraries, held in 1994. The conference was comprised of four sessions, and the introductory remarks of each are included, along with transcriptions of each session's…

  9. Research on diabatic initialization

    NASA Technical Reports Server (NTRS)

    Kasahara, Akira

    1990-01-01

    The objective of this research project is to contribute to improvement in the synoptic analyses in the tropics for numerical weather prediction and climate research. In addition to a prediction model, four dimensional data assimilation systems have two principal components. One is objective analysis and the other is initialization. Various methods of objective analysis are designed primarily to analyze the mass and rotational wind fields. Methods of initialization are developed to obtain the irrotational wind and its associated vertical velocity field which are balanced with the mass field and free from meteorological noise. There are essentially three approaches to the problem of initialization: quasi-geostrophic theory, bounded derivative method and nonlinear normal mode method. In the midlatitudes, these approaches generally produce satisfactory results even without diabatic effects for large-scale motions. In the tropics, the situation is quite different from that in the midlatitudes. Because of a small magnitude of the Coriolis parameter and a weak horizontal temperature gradient in the tropics, any method of initialization must incorporate diabatic effects. In fact, it can be said that understanding the problem of diabatic initialization is the key to improving the analysis and weather forecasting in the tropics.

  10. Worldwide Alzheimer's disease neuroimaging initiative.

    PubMed

    Carrillo, Maria C; Bain, Lisa J; Frisoni, Giovanni B; Weiner, Michael W

    2012-07-01

    The Alzheimer's Disease Neuroimaging Initiative (ADNI) was launched in 2003 to speed drug development by validating imaging and blood/cerebrospinal fluid biomarkers for Alzheimer's disease clinical treatment trials. ADNI is a naturalistic (nontreatment) multisite longitudinal study. A true public-private partnership, the first phase of ADNI (ADNI 1) set a new standard for data sharing without embargo. In addition, it has been extended to 2017 by additional funding (North American-ADNI Grand Opportunities and ADNI 2) as well as multiple projects around the world, collectively known as Worldwide ADNI (WW-ADNI). The goal of WW-ADNI is to harmonize projects and results across different geographical sites and to encourage and harmonize data management and availability to investigators around the world. WW-ADNI projects are currently underway in North America, Europe, Japan, Australia, Korea, Taiwan, and Argentina, with a nascent program in China and a possible future program in Brazil. PMID:22748939

  11. Science initiative for international development

    NASA Astrophysics Data System (ADS)

    Showstack, Randy

    2011-07-01

    A new initiative to use science to address global development challenges was launched by the U.S. National Science Foundation (NSF) and the U.S. Agency for International Development (USAID) on 7 July. Partnerships for Enhanced Engagement in Research (PEER) will capitalize on competitively awarded investments to support and build scientific and technical capacity in the developing world, according to the agencies. USAID has allocated $7 million for PEER, which the agencies indicate could leverage an additional $25-50 million in NSFfunded research at U.S. institutions to focus on issues including climate change, disaster mitigation, water, renewable energy, and food security. The program is beginning with six pilot programs in Asia and Africa, including fostering a Bangladeshi seismological community, studying the impacts of land use on biodiversity dynamics in Burkina Faso, and examining climate change and integrated resource management around Agougou Natural Pond in Mali.

  12. Research on diabatic initialization

    NASA Technical Reports Server (NTRS)

    Kashara, Akira

    1993-01-01

    The objective of this research is to contribute to the improvement of the analyses of irrotational wind and moisture fields in the tropics through advancement in the technique of initialization, incorporating diabatic effects and use of satellite-derived, radiometric imagery data that are not used currently by operational centers. Significant accomplishments during the period of May 1991 - April 1992 in research involving the following are presented: impact of tropical initialization upon the spin-up of precipitation forecasts; and a unified approach to diabatic initialization for improvement in the analysis of divergence and water vapor fields in the tropics. Focus of current research and plans for next year are discussed with respect to the topics of controlling the precipitation over shoot during the early part of a numerical forecast and the use of satellite imagery data for improvement of the tropical analysis.

  13. STI Program Multimedia Initiative

    NASA Technical Reports Server (NTRS)

    Cotter, Gladys A.; Kaye, Karen

    1993-01-01

    This paper relates the experience of the NASA Scientific and Technical Information Program in introducing multimedia within the STI Program framework. A discussion of multimedia technology is included to provide context for the STI Program effort. The STI Program's Multimedia Initiative is discussed in detail. Parallels and differences between multimedia and traditional information systems project development are highlighted. Challenges faced by the program in initiating its multimedia project are summarized along with lessons learned. The paper concludes with a synopsis of the benefits the program hopes to provide its users through the introduction of multimedia illustrated by examples of successful multimedia projects.

  14. A review of initial investigations to utilize ERTS-1 data in determining the availability and distribution of living marine resources. [harvest and management of fisheries resources in Mississippi Sound and Gulf waters

    NASA Technical Reports Server (NTRS)

    Stevenson, W. H.; Kemmerer, A. J.; Atwell, B. H.; Maughan, P. M.

    1974-01-01

    The National Marine Fisheries Service has been studying the application of aerospace remote sensing to fisheries management and utilization for many years. The 15-month ERTS study began in July 1972 to: (1) determine the reliability of satellite and high altitude sensors to provide oceanographic parameters in coastal waters; (2) demonstrate the use of remotely-sensed oceanographic information to predict the distribution and abundance of adult menhaden; and (3) demonstrate the potential use of satellites for acquiring information for improving the harvest and management of fisheries resources. The study focused on a coastal area in the north-central portion of the Gulf of Mexico, including parts of Alabama, Mississippi, and Louisiana. The test area used in the final analysis was the Mississippi Sound and the area outside the barrier islands to approximately the 18-meter (10-fathom) curve.

  15. Project Management Plan (PMP) for Work Management Implementation

    SciTech Connect

    SHIPLER, C.E.

    2000-01-13

    The purpose of this document is to provide a project plan for Work Management Implementation by the River Protection Project (RPP). Work Management is an information initiative to implement industry best practices by replacing some Tank Farm legacy system

  16. Phillips Laboratory small satellite initiatives

    NASA Astrophysics Data System (ADS)

    Lutey, Mark K.; Imler, Thomas A.; Davis, Robert J.

    1993-09-01

    The Phillips Laboratory Space Experiments Directorate in conjunction with the Air Force Space Test Program (AF STP), Defense Advanced Research and Projects Agency (DARPA) and Strategic Defense Initiative Organization (SDIO), are managing five small satellite program initiatives: Lightweight Exo-Atmospheric Projectile (LEAP) sponsored by SDIO, Miniature Sensor Technology Integration (MSTI) sponsored by SDIO, Technology for Autonomous Operational Survivability (TAOS) sponsored by Phillips Laboratory, TechSat sponsored by SDIO, and the Advanced Technology Standard Satellite Bus (ATSSB) sponsored by DARPA. Each of these spacecraft fulfills a unique set of program requirements. These program requirements range from a short-lived `one-of-a-kind' mission to the robust multi- mission role. Because of these diverging requirements, each program is driven to use a different design philosophy. But regardless of their design, there is the underlying fact that small satellites do not always equate to small missions. These spacecraft with their use of or ability to insert new technologies provide more capabilities and services for their respective payloads which allows the expansion of their mission role. These varying program efforts culminate in an ATSSB spacecraft bus approach that will support moderate size payloads, up to 500 pounds, in a large set of orbits while satisfying the `cheaper, faster, better' method of doing business. This technical paper provides an overview of each of the five spacecraft, focusing on the objectives, payoffs, technologies demonstrated, and program status.

  17. Clean Energy Manufacturing Initiative

    SciTech Connect

    2013-04-01

    The initiative will strategically focus and rally EERE’s clean energy technology offices and Advanced Manufacturing Office around the urgent competitive opportunity for the United States to be the leader in the clean energy manufacturing industries and jobs of today and tomorrow.

  18. Best Practices & Outstanding Initiatives

    ERIC Educational Resources Information Center

    Training, 2011

    2011-01-01

    In this article, "Training" editors recognize innovative and successful learning and development programs and practices. They share best practices from Automatic Data Processing, Inc., Farmers Insurance Group, FedEx Express, InterContinental Hotels Group, and Oakwood Temporary Housing. They also present the outstanding initiatives of EMD Serono,…

  19. Monolithic exploding foil initiator

    DOEpatents

    Welle, Eric J; Vianco, Paul T; Headley, Paul S; Jarrell, Jason A; Garrity, J. Emmett; Shelton, Keegan P; Marley, Stephen K

    2012-10-23

    A monolithic exploding foil initiator (EFI) or slapper detonator and the method for making the monolithic EFI wherein the exploding bridge and the dielectric from which the flyer will be generated are integrated directly onto the header. In some embodiments, the barrel is directly integrated directly onto the header.

  20. Funds Fuel Graduation Initiatives

    ERIC Educational Resources Information Center

    Gewertz, Catherine

    2010-01-01

    In the first wave of funding under a revitalized high school graduation initiative, the U.S. Department of Education is betting nearly $50 million that it can help states and school districts find better ways to hang onto students who might drop out and bring back those who have disappeared without diplomas. Twenty-nine states and districts won…

  1. The Core Skills Initiative.

    ERIC Educational Resources Information Center

    Further Education Unit, London (England).

    A British initiative that aims to identify, develop, and assess core skills in post-16 courses and qualifications is summarized in this bulletin. The first section discusses expectations regarding what core skills can achieve. The following section focuses on other purposes to which core skills could contribute, such as broadening the post-16…

  2. DIOXIN EXPOSURE INITIATIVE PUBLICATIONS

    EPA Science Inventory

    Following is a listing of published articles that have come out of EPA's Dioxin Exposure Initiative

    SOURCES:

      <...

    1. The SEED Initiative

      ERIC Educational Resources Information Center

      Teich, Carolyn R.

      2011-01-01

      Committed to fulfilling the promise of the green economy, the American Association of Community Colleges (AACC) launched the Sustainability Education and Economic Development (SEED) initiative (www.theseedcenter.org) in October 2010. The project advances sustainability and clean energy workforce development practices at community colleges by…

    2. Mixed-Initiative Clustering

      ERIC Educational Resources Information Center

      Huang, Yifen

      2010-01-01

      Mixed-initiative clustering is a task where a user and a machine work collaboratively to analyze a large set of documents. We hypothesize that a user and a machine can both learn better clustering models through enriched communication and interactive learning from each other. The first contribution or this thesis is providing a framework of…

    3. Department-Initiated Change

      ERIC Educational Resources Information Center

      Watson, Anne; De Geest, Els

      2014-01-01

      This paper reports the activity of three secondary school mathematics departments in England in self-initiated states of change that led to overall improvements in students' achievements when compared to previous cohorts. This took place without intervention and without their participation in external projects. They provide examples of…

    4. Sourcebook of Restructuring Initiatives.

      ERIC Educational Resources Information Center

      Stefkovich, Jacqueline A., Ed.

      This three-part sourcebook identifies school restructuring initiatives with a national scope and presents comprehensive information about them. Part 1 identifies and describes national restructuring programs (e.g., Coalition of Essential Schools, Learning Tomorrow, Success for All). Each program description provides an overview of the program as…

    5. Focusing educational initiatives

      NASA Technical Reports Server (NTRS)

      Parks, George K.

      1990-01-01

      The United States will soon be facing a critical shortage of aerospace scientists and engineers. To address this problem, Space Grant Colleges can assist in focusing interest in existing educational initiatives and in creating new educational opportunities, particularly for women and underrepresented minorities.

    6. Transformative Change Initiative

      ERIC Educational Resources Information Center

      Bragg, D. D.; Kirby, C.; Witt, M. A.; Richie, D.; Mix, S.; Feldbaum, M.; Liu, S.; Mason, M.

      2014-01-01

      The Transformative Change Initiative (TCI) is dedicated to assisting community colleges to scale up innovation in the form of guided pathways, programs of study, and evidence-based strategies to improve student outcomes and program, organization, and system performance. The impetus for TCI is the Trade Adjustment Assistance Community College and…

    7. New worldwide hydrological initiative needed

      NASA Astrophysics Data System (ADS)

      Shuttleworth, W. James

      This essay argues for a new, decade-long worldwide hydrological initiative to permit change in the paradigm that underlies hydrological design and management. It is stimulated by the fact that over the last 20 years there has been a distinct change in our understanding of the nature and origin of the statistics of hydrological variables as measured in an individual watershed or region. The assumption was that these statistics are entirely haphazard in nature and indeterminate in origin, and do not change with time.Thus the most important hydrological variables (such as precipitation, runoff, and potential evaporation) are sampled over a calibration period (of perhaps only a few decades), and the statistics observed within that calibration period are used as the basis for hydrological design and water resource management. Now, however, there is increasing realization that the nature of the locally observed statistics of hydrological variables may be significantly determined by global-scale phenomena and might be prone to long-term change.

    8. Frontotemporal Disorders: Treatment and Management

      MedlinePlus

      ... Initiatives alzheimers.gov National Alzheimer’s Plan National Alzheimer's Project Act (NAPA) About ADEAR Frontotemporal Disorders: Information for Patients, Families, and Caregivers Treatment and Management Managing the symptoms of frontotemporal disorders may involve ...

    9. Best Practices & Outstanding Initiatives

      ERIC Educational Resources Information Center

      Training, 2012

      2012-01-01

      In this article, "Training" editors recognize innovative and successful learning and development programs and practices submitted in the 2012 Training Top 125 application. Best practices: (1) Edward Jones: Practice Makes Perfect (sales training); (2) Grant Thornton LLP: Senior Manager Development Program (SMDP); (3) MetLife, Inc.: Top Advisor…

    10. Successful integration of ergonomics into continuous improvement initiatives.

      PubMed

      Monroe, Kimberly; Fick, Faye; Joshi, Madina

      2012-01-01

      Process improvement initiatives are receiving renewed attention by large corporations as they attempt to reduce manufacturing costs and stay competitive in the global marketplace. These initiatives include 5S, Six Sigma, and Lean. These programs often take up a large amount of available time and budget resources. More often than not, existing ergonomics processes are considered separate initiatives by upper management and struggle to gain a seat at the table. To effectively maintain their programs, ergonomics program managers need to overcome those obstacles and demonstrate how ergonomics initiatives are a natural fit with continuous improvement philosophies. PMID:22316947

    11. NASA's Climate Data Services Initiative

      NASA Astrophysics Data System (ADS)

      McInerney, M.; Duffy, D.; Schnase, J. L.; Webster, W. P.

      2013-12-01

      Our understanding of the Earth's processes is based on a combination of observational data records and mathematical models. The size of NASA's space-based observational data sets is growing dramatically as new missions come online. However a potentially bigger data challenge is posed by the work of climate scientists, whose models are regularly producing data sets of hundreds of terabytes or more. It is important to understand that the 'Big Data' challenge of climate science cannot be solved with a single technological approach or an ad hoc assemblage of technologies. It will require a multi-faceted, well-integrated suite of capabilities that include cloud computing, large-scale compute-storage systems, high-performance analytics, scalable data management, and advanced deployment mechanisms in addition to the existing, well-established array of mature information technologies. It will also require a coherent organizational effort that is able to focus on the specific and sometimes unique requirements of climate science. Given that it is the knowledge that is gained from data that is of ultimate benefit to society, data publication and data analytics will play a particularly important role. In an effort to accelerate scientific discovery and innovation through broader use of climate data, NASA Goddard Space Flight Center's Office of Computational and Information Sciences and Technology has embarked on a determined effort to build a comprehensive, integrated data publication and analysis capability for climate science. The Climate Data Services (CDS) Initiative integrates people, expertise, and technology into a highly-focused, next-generation, one-stop climate science information service. The CDS Initiative is providing the organizational framework, processes, and protocols needed to deploy existing information technologies quickly using a combination of enterprise-level services and an expanding array of cloud services. Crucial to its effectiveness, the CDS

    12. Gravity wave initiated convection

      NASA Technical Reports Server (NTRS)

      Hung, R. J.

      1990-01-01

      The vertical velocity of convection initiated by gravity waves was investigated. In one particular case, the convective motion-initiated and supported by the gravity wave-induced activity (excluding contributions made by other mechanisms) reached its maximum value about one hour before the production of the funnel clouds. In another case, both rawinsonde and geosynchronous satellite imagery were used to study the life cycles of severe convective storms. Cloud modelling with input sounding data and rapid-scan imagery from GOES were used to investigate storm cloud formation, development and dissipation in terms of growth and collapse of cloud tops, as well as, the life cycles of the penetration of overshooting turrets above the tropopause. The results based on these two approaches are presented and discussed.

    13. The space exploration initiative

      NASA Technical Reports Server (NTRS)

      Priest, Pete

      1991-01-01

      A number of view graph charts are presented which outline the presentation. Outlined are reasons for going to Mars, why it is necessary to go to the Moon first, and the presidential decision on the space exploration initiative. Other representative charts are entitled: Lunar transportation system requirement drivers; Mars transportation system requirement drivers; National space policy goals; Exploration hardware needed; Mars mission profile; Science on the Moon and Mars; and Two independent reviews.

    14. Chinese biobanking initiatives.

      PubMed

      Gan, Rongxing; Wang, Huiyuan; Song, Yutong; Fan, Jinli; Xiong, Yan

      2015-02-01

      Due to the requirement for comprehensive clinical research efforts in China, the importance of biobanking in modern clinical research is outlined in this overview. Hospitals, universities, and research institutes have been well organized as fundamental resources for Chinese biobanking initiatives and the resulting bio-sample collections. Here, a brief history and time line of development of biobanking in China will be introduced, as well as strategic designs for future biobanking development. PMID:25686040

    15. Laser Initiated Actuator study

      SciTech Connect

      Watson, B.

      1991-06-27

      The program task was to design and study a laser initiated actuator. The design of the actuator is described, it being comprised of the fiber and body subassemblies. The energy source for all experiments was a Spectra Diode 2200-H2 laser diode. The diode is directly coupled to a 100 micron core, 0.3 numerical aperture fiber optic terminated with an SMA connector. The successful testing results are described and recommendations are made.

    16. Initiation Train Experiments

      NASA Astrophysics Data System (ADS)

      Francois, Elizabeth; Johnson, Carl; Liechty, Gary; Whitley, Von

      2015-06-01

      In an effort to evaluate and qualify a new detonator diagnostic, booster selection and main charge configuration, a variety of small-scale tests have been conducted. This paper will describe the needs, testing approach and model validation. Because of the limited size available some novel approaches were made to understand the observed phenomenon. Function time and time of arrival at various locations in the initiation train are desirable data points. Knowing when each segment initiates the next segment and the time to run up to detonation is critical. Results of our experiments were modeled for timing accuracy, wave shape and pressure. Agreement between the experiments and models will be discussed. The testing that will be discussed is time of arrival wires, PDV, and fiber optic arrays. The time of arrival wire measures the detonator cup breakout time. When correlated to bridge burst, an absolute time is collected. This data point also gives time zero for the booster initiation. Many models actually start at the booster, rather than the detonator, so the inclusion of this data point will improve modeling efforts.

    17. Primary progressive aphasia as the initial manifestation of corticobasal degeneration. A "three in one " syndrome?

      PubMed

      Ioannides, Panos; Karacostas, Dimitris; Hatzipantazi, Maria; Ioannis, Milonas

      2005-01-01

      In 1994, the term "Pick complex" was proposed to indicate significant clinical and pathological overlapping between primary progressive aphasia, frontal lobe dementia and corticobasal degeneration. We report the case of a 60-year-old man, who initially presented progressive non-fluent aphasia with orofacial apraxia, and subsequently, over a period of 3 years, developed mutism, pathological laughter, extrapyramidal rigidity, dystonia, alien hand syndrome and bulbar signs. An extensive haematological, immunological and biochemical work up was normal. The results of neuroimaging studies and neuropsychological tests, along with the clinical evolution, finally led us to the ?three in one? diagnosis, supporting the concept of Pick complex. PMID:16324238

    18. Initial treatment of Parkinson's disease.

      PubMed

      Tarsy, Daniel

      2006-05-01

      Initial treatment of early idiopathic Parkinson's disease (PD) begins with diagnosis based on clinical evaluation supplemented by laboratory studies and brain imaging to exclude causes of secondary parkinsonism. In most cases, testing is normal and the diagnosis of PD rests on clinical criteria. In patients with mild symptoms and signs, the diagnosis of PD may not initially be apparent, and follow-up evaluation is needed to arrive at a diagnosis. Once the diagnosis is made, pharmacologic treatment may not be the first step. First, patient education is essential, especially because PD is a high-profile disease for which information and misinformation are readily available to patients and families. Counseling concerning prognosis, future symptoms, future disability, and treatment must be provided. Questions from patients concerning diet, lifestyle, and exercise are especially common at this point. The decision of when to initiate treatment is the next major consideration. Much controversy but relatively little light has been brought to bear on this issue. L-dopa was the first major antiparkinson medication to be introduced and remains the "gold standard" of treatment. Next in efficacy are the dopamine agonists (DAs). A debate has raged concerning whether initial dopaminergic treatment should be with L-dopa or DAs. Physicians have been concerned about forestalling the appearance of dyskinesias and motor fluctuations, whereas patients have incorrectly understood that L-dopa and possibly other antiparkinson drugs have a finite duration of usefulness, making it important to defer treatment for as long as possible. This has created "L-dopa phobia," which may stand in the way of useful treatment. In spite of this controversy, there is uniform agreement that the appropriate time to treat is when the patient is beginning to be disabled. This varies from patient to patient and depends on age, employment status, nature of job, level of physical activity, concern about

  1. The Epidemiologic, Microbiologic and Clinical Picture of Bacteremia among Febrile Infants and Young Children Managed as Outpatients at the Emergency Room, before and after Initiation of the Routine Anti-Pneumococcal Immunization

    PubMed Central

    Leibovitz, Eugene; David, Nuphar; Ribitzky-Eisner, Haya; Abo Madegam, Mouner; Abuabed, Said; Chodick, Gabriel; Maimon, Michal; Fruchtman, Yariv

    2016-01-01

    We described the occult bacteremia (OB) and bacteremia with diagnosed focus (BwF) picture among children managed as outpatients at the pediatric emergency room (PER) in southern Israel, before and after the introduction of pneumococcal conjugate vaccines (PCVs) introduction in a retrospective study enrolling all three- to 36-month-old patients with fever >38.0 °C during 2005–2014. Of 511 (0.82% of all febrile patients) true bacteremias, 230 (45%) were managed as outpatients; 96 of 230 (41.7%) had OB and 134 (3.59%) had BwF. OB and BwF rates were 0.22% and 3.02%, respectively. A significant decrease was noted in OB and BwF rates (p = 0.0008 and p = 0.02, respectively). S. pneumoniae (SP, 37.5%), K. kingae (11.4%) and Brucella spp. (8.7%) were the most common OB pathogens and SP (29.8%), S. viridans (13.4%), and Brucella spp. (12.7%) were the most common in BwF patients. PCV13 serotypes were not found among the serotypes isolated post-PCV13 introduction. During 2010–2014 there was an increase in non-PCV13 serotype isolation (p = 0.005). SP was the main pathogen isolated among patients with pneumonia, acute otitis media (AOM) and periorbital cellulitis (62.5%, 33.3% and 60%, respectively). OB and BwF decreased following the introduction of PCVs and SP was the main pathogen in both conditions. Vaccine-SP serotypes were not isolated in OB after PCV13 introduction and non-vaccine serotypes increased significantly. PMID:27447651

  2. The Epidemiologic, Microbiologic and Clinical Picture of Bacteremia among Febrile Infants and Young Children Managed as Outpatients at the Emergency Room, before and after Initiation of the Routine Anti-Pneumococcal Immunization.

    PubMed

    Leibovitz, Eugene; David, Nuphar; Ribitzky-Eisner, Haya; Abo Madegam, Mouner; Abuabed, Said; Chodick, Gabriel; Maimon, Michal; Fruchtman, Yariv

    2016-01-01

    We described the occult bacteremia (OB) and bacteremia with diagnosed focus (BwF) picture among children managed as outpatients at the pediatric emergency room (PER) in southern Israel, before and after the introduction of pneumococcal conjugate vaccines (PCVs) introduction in a retrospective study enrolling all three- to 36-month-old patients with fever >38.0 °C during 2005-2014. Of 511 (0.82% of all febrile patients) true bacteremias, 230 (45%) were managed as outpatients; 96 of 230 (41.7%) had OB and 134 (3.59%) had BwF. OB and BwF rates were 0.22% and 3.02%, respectively. A significant decrease was noted in OB and BwF rates (p = 0.0008 and p = 0.02, respectively). S. pneumoniae (SP, 37.5%), K. kingae (11.4%) and Brucella spp. (8.7%) were the most common OB pathogens and SP (29.8%), S. viridans (13.4%), and Brucella spp. (12.7%) were the most common in BwF patients. PCV13 serotypes were not found among the serotypes isolated post-PCV13 introduction. During 2010-2014 there was an increase in non-PCV13 serotype isolation (p = 0.005). SP was the main pathogen isolated among patients with pneumonia, acute otitis media (AOM) and periorbital cellulitis (62.5%, 33.3% and 60%, respectively). OB and BwF decreased following the introduction of PCVs and SP was the main pathogen in both conditions. Vaccine-SP serotypes were not isolated in OB after PCV13 introduction and non-vaccine serotypes increased significantly. PMID:27447651

  3. Initial blood storage experiment

    NASA Technical Reports Server (NTRS)

    Surgenor, Douglas MACN.

    1988-01-01

    The design of the Initial Blood Storage Experiment (IBSE) was based upon a carefully controlled comparison between identical sets of human blood cell suspensions - red cells, white cell, and platelets - one set of which was transported aboard the Columbia on a 6 day 11 hour mission, and the other held on the ground. Both sets were carried inside stainless steel dewars within specially fabricated flight hardware. Individual bags of cell suspensions were randomly assigned with respect to ground vs orbit status, dewar chamber, and specific location within the dewar. To foster optimal preservation, each cell type was held under specific optimal conditions of pH, ionic strength, solute concentration, gas tension, and temperature. An added variable in this initial experiment was provided by the use of three different polymer/plasticizer formulations for the sealed bags which held the blood cells. At termination of the experiment, aliquots of the suspensions, identified only by code, were distributed to be assayed. Assays were selected to constitute a broad survey of cellular properties and thereby maximize the chances of detection of gravitational effects. A total of 74 different outcome measurements were reported for statistical analysis. When the measurements were completed, the results were entered into the IBSE data base, at which time the data were matched with the original blood bag numbers to determine their status with respect to polymer/plasticizer type, orbit status (orbit or ground), and storage position within the experimental hardware. The data were studied by analysis of variance. Initially, type of bag and orbital status were main factors; later more detailed analyses were made on specific issues such as position in the hardware and specific plastic. If the analysis of variance indicated a statistical significance at the 5 percent level the corresponding p-value was reported.

  4. Through bulkhead initiator studies

    SciTech Connect

    Begeal, D.R.

    1997-03-01

    This report describes recent work done to demonstrate feasibility of a fail-safe Through Bulkhead Initiator with minimum dimensions and suitable for use in cyclical thermal environments. Much of the ground work for a fail-safe TBI was previously done by A.C. Schwartz. This study is an expansion of Schwartz`s work to evaluate devices with bulkheads of 304 stainless steel and Inconel 718; explosive donors of PETN, BNCP, and a 0.005 inch thick steel flying plate donor traveling at 2.6 mm/{micro}s; and explosive acceptors of PETN and BNCP. Bulkhead thickness were evaluated in the range of 0.040 to 0.180 inch. The explosive acceptors initiated a small HMX pellet to drive a 0.005 inch thick steel flying plate, and VISAR histories of the HMX-driven flying plates were the measure of acceptable performance. A companion set of samples used a PMMA acceptor to measure the particle velocities at the bulkhead/PMMA interface with VISAR. These data were used to compute the input pressure to the acceptor explosives in an attempt to measure initiation threshold. Unfortunately, the range of bulkhead thicknesses tested did not give any failures, thus the threshold was not determined. It was found that either explosive or the flying plate would perform as a TBI in the bulkhead thickness range tested. The optimum TBI is about 0.060 inches thick, and steel bulkheads seem to be more structurally sound than those made of Inconel. That is, cross section views of the Inconel bulkheads showed it to be more prone to stress cracking than was the 304 stainless steel. Both PETN and BNCP showed good performance when tested at {minus}65 F following thermal cycling of {minus}65 F to +165 F. Analysis of the TBI function times showed that BNCP acceptor explosives were undergoing the classical deflagration to detonation process. The PETN acceptors were undergoing prompt detonation.

  5. Feedback stabilization initiative

    SciTech Connect

    1997-06-01

    Much progress has been made in attaining high confinement regimes in magnetic confinement devices. These operating modes tend to be transient, however, due to the onset of MHD instabilities, and their stabilization is critical for improved performance at steady state. This report describes the Feedback Stabilization Initiative (FSI), a broad-based, multi-institutional effort to develop and implement methods for raising the achievable plasma betas through active MHD feedback stabilization. A key element in this proposed effort is the Feedback Stabilization Experiment (FSX), a medium-sized, national facility that would be specifically dedicated to demonstrating beta improvement in reactor relevant plasmas by using a variety of MHD feedback stabilization schemes.

  6. Human Research Initiative (HRI)

    NASA Technical Reports Server (NTRS)

    Motil, Brian

    2003-01-01

    A code U initiative starting in the FY04 budget includes specific funding for 'Phase Change' and 'Multiphase Flow Research' on the ISS. NASA GRC developed a concept for two facilities based on funding/schedule constraints: 1) Two Phase Flow Facility (TphiFFy) which assumes integrating into FIR; 2) Contact Line Dynamics Experiment Facility (CLiDE) which assumes integration into MSG. Each facility will accommodate multiple experiments conducted by NRA selected PIs with an overall goal of enabling specific NASA strategic objectives. There may also be a significant ground-based component.

  7. Stirling to Flight Initiative

    NASA Technical Reports Server (NTRS)

    Hibbard, Kenneth E.; Mason, Lee S.; Ndu, Obi; Smith, Clayton; Withrow, James P.

    2016-01-01

    Flight (S2F) initiative with the objective of developing a 100-500 We Stirling generator system. Additionally, a different approach is being devised for this initiative to avoid pitfalls of the past, and apply lessons learned from the recent ASRG experience. Two key aspects of this initiative are a Stirling System Technology Maturation Effort, and a Surrogate Mission Team (SMT) intended to provide clear mission pull and requirements context. The S2F project seeks to lead directly into a DOE flight system development of a new SRG. This paper will detail the proposed S2F initiative, and provide specifics on the key efforts designed to pave a forward path for bringing Stirling technology to flight.

  8. Initiation of slug flow

    SciTech Connect

    Hanratty, T.J.; Woods, B.D.

    1995-12-31

    The initiation of slug flow in a horizontal pipe can be predicted either by considering the stability of a slug or by considering the stability of a stratified flow. Measurements of the shedding rate of slugs are used to define necessary conditions for the existence of a slug. Recent results show that slugs develop from an unstable stratified flow through the evolution of small wavelength waves into large wavelength waves that have the possibility of growing to form a slug. The mechanism appears to be quite different for fluids with viscosities close to water than for fluids with large viscosities (20 centipoise).

  9. UNLV Nuclear Hydrogen Initiative

    SciTech Connect

    Hechanova, Anthony E.; Johnson, Allen; O'Toole, Brendan; Trabia, Mohamed; Peterson, Per

    2012-10-25

    Evaluation of the Crack growth rate (CGR) of Alloy 617 and Alloy 276 under constant K at ambient temperature has been completed. Creep deformation of Alloy 230 at different temperature range and load level has been completed and heat to heat variation has been noticed. Creep deformation study of Alloy 276 has been completed under an applied initial stress level of 10% of yield stress at 950ºC. The grain size evaluation of the tested creep specimens of Alloy 276 has been completed.

  10. Advanced Monitoring systems initiative

    SciTech Connect

    R.J. Venedam; E.O. Hohman; C.F. Lohrstorfer; S.J. Weeks; J.B. Jones; W.J. Haas

    2004-09-30

    The Advanced Monitoring Systems Initiative (AMSI) actively searches for promising technologies and aggressively moves them from the research bench into DOE/NNSA end-user applications. There is a large unfulfilled need for an active element that reaches out to identify and recruit emerging sensor technologies into the test and evaluation function. Sensor research is ubiquitous, with the seeds of many novel concepts originating in the university systems, but at present these novel concepts do not move quickly and efficiently into real test environments. AMSI is a widely recognized, self-sustaining ''business'' accelerating the selection, development, testing, evaluation, and deployment of advanced monitoring systems and components.

  11. Knowledge management: an innovative risk management strategy.

    PubMed

    Zipperer, Lorri; Amori, Geri

    2011-01-01

    Knowledge management effectively lends itself to the enterprise risk process. The authors introduce the concept of knowledge management as a strategy to drive innovation and support risk management. They align this work with organizational efforts to improve patient safety and quality through the effective sharing of experience and lessons learned. The article closes with suggestions on how to develop a knowledge management initiative at an organization, who should be on the team, and how to sustain this effort and build the culture it requires to drive success. PMID:21506198

  12. 75 FR 79017 - Notice of Public Meeting, North Slope Science Initiative-Science Technical Advisory Panel

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-17

    ... Bureau of Land Management Notice of Public Meeting, North Slope Science Initiative--Science Technical Advisory Panel AGENCY: Bureau of Land Management, Alaska State Office, North Slope Science Initiative... Interior, North Slope Science Initiative (NSSI)-- Science Technical Advisory Panel (STAP) will meet...

  13. 75 FR 17433 - Notice of Public Meeting, North Slope Science Initiative-Science Technical Advisory Panel

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-06

    ... Bureau of Land Management Notice of Public Meeting, North Slope Science Initiative--Science Technical Advisory Panel AGENCY: Bureau of Land Management, Alaska State Office, North Slope Science Initiative... Interior, North Slope Science Initiative (NSSI)-- Science Technical Advisory Panel (STAP) will meet...

  14. Precision flyer initiator

    DOEpatents

    Frank, Alan M.; Lee, Ronald S.

    1998-01-01

    A precision flyer initiator forms a substantially spherical detonation wave in a high explosive (HE) pellet. An explosive driver, such as a detonating cord, a wire bridge circuit or a small explosive, is detonated. A flyer material is sandwiched between the explosive driver and an end of a barrel that contains an inner channel. A projectile or "flyer" is sheared from the flyer material by the force of the explosive driver and projected through the inner channel. The flyer than strikes the HE pellet, which is supported above a second end of the barrel by a spacer ring. A gap or shock decoupling material delays the shock wave in the barrel from predetonating the HE pellet before the flyer. A spherical detonation wave is formed in the HE pellet. Thus, a shock wave traveling through the barrel fails to reach the HE pellet before the flyer strikes the HE pellet. The precision flyer initiator can be used in mining devices, well-drilling devices and anti-tank devices.

  15. Initiatives for proliferation prevention

    SciTech Connect

    1997-04-01

    Preventing the proliferation of weapons of mass destruction is a central part of US national security policy. A principal instrument of the Department of Energy`s (DOE`s) program for securing weapons of mass destruction technology and expertise and removing incentives for scientists, engineers and technicians in the newly independent states (NIS) of the former Soviet Union to go to rogue countries or assist terrorist groups is the Initiatives for Proliferation Prevention (IPP). IPP was initiated pursuant to the 1994 Foreign Operations Appropriations Act. IPP is a nonproliferation program with a commercialization strategy. IPP seeks to enhance US national security and to achieve nonproliferation objectives by engaging scientists, engineers and technicians from former NIS weapons institutes; redirecting their activities in cooperatively-developed, commercially viable non-weapons related projects. These projects lead to commercial and economic benefits for both the NIS and the US IPP projects are funded in Russian, Ukraine, Kazakhstan and Belarus. This booklet offers an overview of the IPP program as well as a sampling of some of the projects which are currently underway.

  16. Precision flyer initiator

    DOEpatents

    Frank, A.M.; Lee, R.S.

    1998-05-26

    A precision flyer initiator forms a substantially spherical detonation wave in a high explosive (HE) pellet. An explosive driver, such as a detonating cord, a wire bridge circuit or a small explosive, is detonated. A flyer material is sandwiched between the explosive driver and an end of a barrel that contains an inner channel. A projectile or ``flyer`` is sheared from the flyer material by the force of the explosive driver and projected through the inner channel. The flyer than strikes the HE pellet, which is supported above a second end of the barrel by a spacer ring. A gap or shock decoupling material delays the shock wave in the barrel from predetonating the HE pellet before the flyer. A spherical detonation wave is formed in the HE pellet. Thus, a shock wave traveling through the barrel fails to reach the HE pellet before the flyer strikes the HE pellet. The precision flyer initiator can be used in mining devices, well-drilling devices and anti-tank devices. 10 figs.

  17. Brazilian Nanotechnology Initiative

    NASA Astrophysics Data System (ADS)

    Fazzio, Adalberto

    2015-03-01

    In Brazil there is intense research activity in nanotechnology, most of these developed in universities and research institutes. The Brazilian Nanotechnology Initiative (BNI) aims to integrate government actions to promote the competitiveness of the Brazilian industry. This initiative is founded on support for research and development in the laboratories of the National Laboratories for Nanotechnology (SisNANO), starting from an improvement in infrastructure and opening of laboratories for users of academia and business, promoting interaction and transfer knowledge between academia and business. Country currently has 26 thematic networks of nanotechnology, 16 -Virtual-National Institutes of Technology, seven National- Laboratories and 18 Associate Laboratories, which comprise the SisNANO. Seeking to expand and share governance with other government actors, the Interministries Committee for Nanotechnology was set up, composed of 10 ministries, and has the task of coordinating the entire program of the Federal Government Nanotechnology.Cooperation activities are an important part of BNI. Currently Brazil has cooperation programs with U.S., China, Canada and European Union among others. Recently, Brazil decided to join the European NanoReg program where 60 research groups are joining efforts to provide protocols and standards that can help regulatory agencies and governments.

  18. NASA Gulf of Mexico Initiative Hypoxia Research

    NASA Technical Reports Server (NTRS)

    Armstrong, Curtis D.

    2012-01-01

    The Applied Science & Technology Project Office at Stennis Space Center (SSC) manages NASA's Gulf of Mexico Initiative (GOMI). Addressing short-term crises and long-term issues, GOMI participants seek to understand the environment using remote sensing, in-situ observations, laboratory analyses, field observations and computational models. New capabilities are transferred to end-users to help them make informed decisions. Some GOMI activities of interest to the hypoxia research community are highlighted.

  19. Initiation of the Madden-Julian Oscillation

    SciTech Connect

    2015-12-14

    Many storms around the world have roots in the Indian Ocean, where they are churned up by the atmospheric process called the Madden-Julian Oscillation (MJO). PNNL is working to unlock the secrets of the MJO, particularly how it initiates in the Indian Ocean every 30-60 days. Better prediction of the MJO will help resource managers, weather forecasters and people worldwide better prepare for its effects.

  20. Development and Initial Evaluation of the Web-Based Self-Management Program “Partner in Balance” for Family Caregivers of People With Early Stage Dementia: An Exploratory Mixed-Methods Study

    PubMed Central

    de Vugt, Marjolein E; Withagen, Hanneke EJ; Kempen, Gertrudis IJM; Verhey, Frans RJ

    2016-01-01

    Background People with dementia increasingly depend on informal caregivers. Internet-based self-management interventions hold considerable promise for meeting the educational and support needs of early stage dementia caregivers (EDCs) at a reduced cost. Objective This study aimed to (1) develop an online self-management program for EDC to increase self-efficacy and goal attainment, and (2) evaluate the program’s feasibility and report preliminary data on effectiveness. Methods Based on the Medical Research Council (MRC) framework for the development and evaluation of complex interventions, a stepwise approach was adopted to explore potential user needs and develop and validate the content by means of (1) focus group discussions with dementia caregivers (N=28), (2) interviews with dementia care professionals (N=11), and (3) individual think-aloud usability tests with EDC (N=2) and experts (N=2). A pilot evaluation was conducted with EDC (N=17) to test the feasibility and establish preliminary effects. Self-report measures of feasibility were completed after the completion of intervention. Self-efficacy and goal attainment were evaluated before and after the intervention. Results The different steps provided useful information about the needs of potential users regarding the content and delivery of the program. This resulted in the newly developed “Partner in Balance” program. At the start, system failures resulted in a high noncompleter rate (7/17, 41%), but at the end, an acceptable feasibility score of 209 (range 54-234) was found. The convenience of completing the program at home, the tailored content, and the guidance (face-to-face and online) were appraised positively. Preliminary effects on caregiver self-efficacy (P<.05) and goal attainment (T>50) were promising. Conclusions Adaptations were made to the program to limit the amount of system failures and prevent high noncompleter rates. As recommended by the MRC framework, confirming the feasibility and

  1. Contemporary management of cancer of the oral cavity

    PubMed Central

    Genden, Eric M.; Silver, Carl E.; Takes, Robert P.; Suárez, Carlos; Owen, Randall P.; Haigentz, Missak; Stoeckli, Sandro J.; Shaha, Ashok R.; Rapidis, Alexander D.; Rodrigo, Juan Pablo; Rinaldo, Alessandra

    2010-01-01

    Oral cancer represents a common entity comprising a third of all head and neck malignant tumors. The options for curative treatment of oral cavity cancer have not changed significantly in the last three decades; however, the work up, the approach to surveillance, and the options for reconstruction have evolved significantly. Because of the profound functional and cosmetic importance of the oral cavity, management of oral cavity cancers requires a thorough understanding of disease progression, approaches to management and options for reconstruction. The purpose of this review is to discuss the most current management options for oral cavity cancers. PMID:20155361

  2. Contemporary management of cancer of the oral cavity.

    PubMed

    Genden, Eric M; Ferlito, Alfio; Silver, Carl E; Takes, Robert P; Suárez, Carlos; Owen, Randall P; Haigentz, Missak; Stoeckli, Sandro J; Shaha, Ashok R; Rapidis, Alexander D; Rodrigo, Juan Pablo; Rinaldo, Alessandra

    2010-07-01

    Oral cancer represents a common entity comprising a third of all head and neck malignant tumors. The options for curative treatment of oral cavity cancer have not changed significantly in the last three decades; however, the work up, the approach to surveillance, and the options for reconstruction have evolved significantly. Because of the profound functional and cosmetic importance of the oral cavity, management of oral cavity cancers requires a thorough understanding of disease progression, approaches to management and options for reconstruction. The purpose of this review is to discuss the most current management options for oral cavity cancers. PMID:20155361

  3. Clinical profile, etiology, and management of hydropneumothorax: An Indian experience

    PubMed Central

    Kasargod, Vasunethra; Awad, Nilkanth Tukaram

    2016-01-01

    Introduction: Hydropneumothorax is an abnormal presence of air and fluid in the pleural space. Even though the knowledge of hydro-pneumothorax dates back to the days of ancient Greece, not many national or international literatures are documented. Aim: To study clinical presentation, etiological diagnosis, and management of the patients of hydropneumothorax. Materials and Methods: Patients admitted in a tertiary care hospital with diagnosis of hydropneumothorax between 2012 and 2014 were prospectively studied. Detailed history and clinical examination were recorded. Blood, pleural fluid, sputum investigations, and computed tomography (CT) thorax (if necessary) were done. Intercostal drainage (ICD) tube was inserted and patients were followed up till 3 months. Results: Fifty-seven patients were studied. Breathlessness, anorexia, weight loss, and cough were the most common symptoms. Tachypnea was present in 68.4% patients. Mean PaO2 was 71.7 mm of Hg (standard deviation ±12.4). Hypoxemia was present in 35 patients (61.4%). All patients had exudative effusion. Etiological diagnosis was possible in 35 patients by initial work-up and 22 required CT thorax for arriving at a diagnosis. Tuberculosis (TB) was etiology in 80.7% patients, acute bacterial infection in 14%, malignancy in 3.5%, and obstructive airway disease in 1.8%. All patients required ICD tube insertion. ICD was required for 24.8 days (±13.1). Conclusion: Most patients presented with symptoms and signs of cardiorespiratory distress along with cough, anorexia, and weight loss. Extensive pleural fluid analysis is essential in establishing etiological diagnosis. TB is the most common etiology. ICD for long duration with antimicrobial chemotherapy is the management. PMID:27185991

  4. Breckinridge Project, initial effort

    SciTech Connect

    1982-01-01

    Report V, Volume 4 provides descriptions, data, and drawings pertaining to Instrument and Plant Air Systems (Plant 36), Telecommunication Systems (Plant 37), Inert Gas Systems (Plant 38), Purge and Flush Oil Systems (Plant 39), Site Development and Roads (Plant 40), Buildings (Plant 41), Solid Waste Management (Plant 42), and Landfill (Plant 44). Instrument and Plant Air Systems (Plant 36) includes all equipment and piping necessary to supply instrument and utility air to the process plants and offsite facilities. Telecommunication Systems (Plant 37) includes the equipment and wiring for: communication throughout the facility; communication between plant data processing systems and offsite computing facilities; and communication with transportation carriers. Inert Gas Systems (Plant 38) provides high purity and low purity nitrogen streams for plant startup and normal operation. Purge and Flush Oil Systems (Plant 39) provides purge and flush oils to various plants. Site Development and Roads (Plant 40) provides site leveling, the addition of roads, fencing, and drainage, and the placement of fills, pilings, footings, and foundations for plants. Buildings (Plant 41) provides buildings for equipment and for personnel, including utilities, lighting, sanitary facilities, heating, air conditioning, and ventilation. Solid Waste Management (Plant 42) identifies, characterizes, segregates, and transports the various types of solid wastes to either Landfill (Plant 44) or outside disposal sites. Landfill (Plant 44) provides disposal of both nonhazardous and hazardous solid wastes. Information is included (as applicable) for each of the eight plants described.

  5. Benthic habitat map of the U.S. Coral Reef Task Force Watershed Partnership Initiative Kā'anapali priority study area and the State of Hawai'i Kahekili Herbivore Fisheries Management Area, west-central Maui, Hawai'i

    USGS Publications Warehouse

    Cochran, Susan A.; Gibbs, Ann E.; White, Darla J.

    2014-01-01

    Nearshore areas off of west-central Maui, Hawai‘i, once dominated by abundant coral coverage, now are characterized by an increased abundance of turf algae and macroalgae. In an effort to improve the health and resilience of the coral reef system, the Kahekili Herbivore Fisheries Management Area was established by the State of Hawai‘i, and the U.S. Coral Reef Task Force selected the Kā‘anapali region as a priority study area. To support these efforts, the U.S. Geological survey mapped nearly 5 km2 of sea floor from the shoreline to water depths of about 30 m. Unconsolidated sediment (predominantly sand) constitutes 65 percent of the sea floor in the mapped area. Reef and other hardbottom potentially available for coral recruitments constitutes 35 percent of the mapped area. Of this potentially available hardbottom, only 51 percent is covered with a minimum of 10 percent coral, and most is found between 5 and 10 m water depth.

  6. 5 CFR 470.205 - Initiation of research programs.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Initiation of research programs. 470.205... PERSONNEL MANAGEMENT RESEARCH PROGRAMS AND DEMONSTRATIONS PROJECTS Regulatory Requirements Pertaining to Research Programs § 470.205 Initiation of research programs. OPM will announce opportunities for...

  7. Provincially and Locally Initiated Curriculum Program Assessment, Final Report.

    ERIC Educational Resources Information Center

    1999

    This report is an independent assessment of the Provincially Initiated Curriculum (PIC) and Locally Initiated Curriculum (LIC) for British Columbia's Centre for Curriculum, Transfer and Technology (C2T2), which manages both PIC and LIC projects. The report makes four recommendations for C2T2's consideration: (1) a renewed emphasis on communication…

  8. Big Earth Data Initiative: Metadata Improvement: Case Studies

    NASA Technical Reports Server (NTRS)

    Kozimor, John; Habermann, Ted; Farley, John

    2016-01-01

    Big Earth Data Initiative (BEDI) The Big Earth Data Initiative (BEDI) invests in standardizing and optimizing the collection, management and delivery of U.S. Government's civil Earth observation data to improve discovery, access use, and understanding of Earth observations by the broader user community. Complete and consistent standard metadata helps address all three goals.

  9. 5 CFR 470.205 - Initiation of research programs.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Initiation of research programs. 470.205... PERSONNEL MANAGEMENT RESEARCH PROGRAMS AND DEMONSTRATIONS PROJECTS Regulatory Requirements Pertaining to Research Programs § 470.205 Initiation of research programs. OPM will announce opportunities for...

  10. 5 CFR 185.138 - Reconsideration of initial decision.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Reconsideration of initial decision. 185.138 Section 185.138 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PROGRAM FRAUD CIVIL REMEDIES § 185.138 Reconsideration of initial decision. (a) Except as provided...

  11. Managing Mandated Educational Change

    ERIC Educational Resources Information Center

    Clement, Jennifer

    2014-01-01

    This paper explores teachers' perspectives on the management of mandated educational change in order to understand how it may be managed more effectively. A case study of teachers' responses to the introduction of a quality teaching initiative in two New South Wales schools found that while some teachers described the strong negative…

  12. Managing customer service.

    PubMed

    Paget, Zoe

    2015-02-28

    Zoe Paget is the customer services manager at YourVets. Her role includes managing the company's call centre, social media marketing, working with the marketing department to develop customer care initiatives and reporting service levels to the company's directors. PMID:25722341

  13. Instrumented Pipeline Initiative

    SciTech Connect

    Thomas Piro; Michael Ream

    2010-07-31

    This report summarizes technical progress achieved during the cooperative agreement between Concurrent Technologies Corporation (CTC) and U.S. Department of Energy to address the need for a for low-cost monitoring and inspection sensor system as identified in the Department of Energy (DOE) National Gas Infrastructure Research & Development (R&D) Delivery Reliability Program Roadmap.. The Instrumented Pipeline Initiative (IPI) achieved the objective by researching technologies for the monitoring of pipeline delivery integrity, through a ubiquitous network of sensors and controllers to detect and diagnose incipient defects, leaks, and failures. This report is organized by tasks as detailed in the Statement of Project Objectives (SOPO). The sections all state the objective and approach before detailing results of work.

  14. Breckinridge Project, initial effort

    SciTech Connect

    None, None

    1982-09-01

    Report III, Volume 1 contains those specifications numbered A through J, as follows: General Specifications (A); Specifications for Pressure Vessels (C); Specifications for Tanks (D); Specifications for Exchangers (E); Specifications for Fired Heaters (F); Specifications for Pumps and Drivers (G); and Specifications for Instrumentation (J). The standard specifications of Bechtel Petroleum Incorporated have been amended as necessary to reflect the specific requirements of the Breckinridge Project, and the more stringent specifications of Ashland Synthetic Fuels, Inc. These standard specifications are available to the Initial Effort (Phase Zero) work performed by all contractors and subcontractors. Report III, Volume 1 also contains the unique specifications prepared for Plants 8, 15, and 27. These specifications will be substantially reviewed during Phase I of the project, and modified as necessary for use during the engineering, procurement, and construction of this project.

  15. The Advanced Energy Initiative

    NASA Astrophysics Data System (ADS)

    Milliken, JoAnn; Joseck, Fred; Wang, Michael; Yuzugullu, Elvin

    The President's Advanced Energy Initiative (AEI), launched in 2006, addresses the challenges of energy supply and demand facing our Nation by supporting research and development of advanced technologies for transportation and stationary power generation. The AEI portfolio includes clean coal, nuclear and renewable energy technologies (solar and wind) for stationary power generation and advanced battery technologies, cellulosic ethanol as a fuel and hydrogen fuel cells for transportation. These research and development programs are underpinned by comprehensive life-cycle analysis efforts using models such as Hydrogen Analysis (H2A) and Greenhouse Gases, Regulated Emissions and Energy Use in Transportation (GREET) to enable a better understanding of the characteristics and trade-offs associated with advanced energy options and to help decision makers choose viable pathways for clean, reliable and affordable energy.

  16. The Gossamer Initiative

    NASA Technical Reports Server (NTRS)

    Chmielewski, Artur B.; Moore, Chris; Howard, Rick

    2000-01-01

    The Gossamer Spacecraft Initiative is a new NASA program to begin long-range development of enabling technologies for very large, ultra-lightweight structures and apertures. Large apertures include optical, infrared and submillimeter telescopes, "photon buckets" for optical communications and "non-coherent" imaging, solar concentrators, and radio frequency antennas. Developments in the very large ultra-light structures will be forces on one of their most challenging applications-solar sails. The sail structures will include both 3-axis stabilizing and spinning. Gossamer spacecraft technology will eventually allow NASA to undertake bold new missions of discovery, such as searching for the signs of life on planets orbiting nearby stars and sailing through space on beams of light of places beyond our solar system.

  17. [Advanced Composites Technology Initiatives

    NASA Technical Reports Server (NTRS)

    Julian, Mark R.

    2002-01-01

    This final report closes out the W02 NASA Grant #NCC5-646. The FY02 grant for advanced technology initiatives through the Advanced Composites Technology Institute in Bridgeport, WV, at the Robert C. Byrd Institute (RCBI) Bridgeport Manufacturing Technology Center, is complete; all funding has been expended. RCBI continued to expand access to technology; develop and implement a workforce-training curriculum; improve material development; and provide prototyping and demonstrations of new and advanced composites technologies for West Virginia composites firms. The FY 02 efforts supported workforce development, technical training and the HST development effort of a super-lightweight composite carrier prototype and expanded the existing technical capabilities of the growing aerospace industry across West Virginia to provide additional support for NASA missions. Additionally, the Composites Technology and Training Center was awarded IS0 9001 - 2000 certification and Cleanroom Class 1000 certification during this report period.

  18. 5 CFR 9701.372 - Creating initial pay ranges.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 3 2012-01-01 2012-01-01 false Creating initial pay ranges. 9701.372 Section 9701.372 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT... HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Transitional Provisions § 9701.372...

  19. 5 CFR 470.205 - Initiation of research programs.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Initiation of research programs. 470.205 Section 470.205 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERSONNEL MANAGEMENT RESEARCH PROGRAMS AND DEMONSTRATIONS PROJECTS Regulatory Requirements Pertaining...

  20. 5 CFR 470.205 - Initiation of research programs.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Initiation of research programs. 470.205 Section 470.205 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERSONNEL MANAGEMENT RESEARCH PROGRAMS AND DEMONSTRATIONS PROJECTS Regulatory Requirements Pertaining...

  1. 5 CFR 470.205 - Initiation of research programs.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Initiation of research programs. 470.205 Section 470.205 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERSONNEL MANAGEMENT RESEARCH PROGRAMS AND DEMONSTRATIONS PROJECTS Regulatory Requirements Pertaining...

  2. 41 CFR 50-203.15 - Initiation of proceeding.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 41 Public Contracts and Property Management 1 2013-07-01 2013-07-01 false Initiation of proceeding. 50-203.15 Section 50-203.15 Public Contracts and Property Management Other Provisions Relating to Public Contracts PUBLIC CONTRACTS, DEPARTMENT OF LABOR 203-RULES OF PRACTICE Minimum Wage Determinations Under the Walsh-Healey Public Contracts Act...

  3. 5 CFR 9701.372 - Creating initial pay ranges.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Creating initial pay ranges. 9701.372 Section 9701.372 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND...

  4. 41 CFR 50-203.15 - Initiation of proceeding.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 41 Public Contracts and Property Management 1 2011-07-01 2009-07-01 true Initiation of proceeding. 50-203.15 Section 50-203.15 Public Contracts and Property Management Other Provisions Relating to Public Contracts PUBLIC CONTRACTS, DEPARTMENT OF LABOR 203-RULES OF PRACTICE Minimum Wage Determinations Under the Walsh-Healey Public Contracts Act...

  5. 29 CFR 417.16 - Initiation of proceedings.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 2 2010-07-01 2010-07-01 false Initiation of proceedings. 417.16 Section 417.16 Labor Regulations Relating to Labor OFFICE OF LABOR-MANAGEMENT STANDARDS, DEPARTMENT OF LABOR LABOR-MANAGEMENT STANDARDS PROCEDURE FOR REMOVAL OF LOCAL LABOR ORGANIZATION OFFICERS Procedures Upon Failure of Union...

  6. 29 CFR 417.16 - Initiation of proceedings.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 2 2014-07-01 2014-07-01 false Initiation of proceedings. 417.16 Section 417.16 Labor Regulations Relating to Labor OFFICE OF LABOR-MANAGEMENT STANDARDS, DEPARTMENT OF LABOR LABOR-MANAGEMENT STANDARDS PROCEDURE FOR REMOVAL OF LOCAL LABOR ORGANIZATION OFFICERS Procedures Upon Failure of Union To Take Appropriate Remedial Action...

  7. 29 CFR 417.16 - Initiation of proceedings.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 2 2011-07-01 2011-07-01 false Initiation of proceedings. 417.16 Section 417.16 Labor Regulations Relating to Labor OFFICE OF LABOR-MANAGEMENT STANDARDS, DEPARTMENT OF LABOR LABOR-MANAGEMENT STANDARDS PROCEDURE FOR REMOVAL OF LOCAL LABOR ORGANIZATION OFFICERS Procedures Upon Failure of Union...

  8. MONTANA PALLADIUM RESEARCH INITIATIVE

    SciTech Connect

    Peters, John; McCloskey, Jay; Douglas, Trevor; Young, Mark; Snyder, Stuart; Gurney, Brian

    2012-05-09

    Project Objective: The overarching objective of the Montana Palladium Research Initiative is to perform scientific research on the properties and uses of palladium in the context of the U.S. Department of Energy's Hydrogen, Fuel Cells and Infrastructure Technologies Program. The purpose of the research will be to explore possible palladium as an alternative to platinum in hydrogen-economy applications. To achieve this objective, the Initiatives activities will focus on several cutting-edge research approaches across a range of disciplines, including metallurgy, biomimetics, instrumentation development, and systems analysis. Background: Platinum-group elements (PGEs) play significant roles in processing hydrogen, an element that shows high potential to address this need in the U.S. and the world for inexpensive, reliable, clean energy. Platinum, however, is a very expensive component of current and planned systems, so less-expensive alternatives that have similar physical properties are being sought. To this end, several tasks have been defined under the rubric of the Montana Palladium Research Iniative. This broad swath of activities will allow progress on several fronts. The membrane-related activities of Task 1 employs state-of-the-art and leading-edge technologies to develop new, ceramic-substrate metallic membranes for the production of high-purity hydrogen, and develop techniques for the production of thin, defect-free platinum group element catalytic membranes for energy production and pollution control. The biomimetic work in Task 2 explores the use of substrate-attached hydrogen-producing enzymes and the encapsulation of palladium in virion-based protein coats to determine their utility for distributed hydrogen production. Task 3 work involves developing laser-induced breakdown spectroscopy (LIBS) as a real-time, in situ diagnostic technique to characterize PGEs nanoparticles for process monitoring and control. The systems engineering work in task 4 will

  9. Process Engineering Technology Center Initiative

    NASA Technical Reports Server (NTRS)

    Centeno, Martha A.

    2001-01-01

    NASA's Kennedy Space Center (KSC) is developing as a world-class Spaceport Technology Center (STC). From a process engineering (PE) perspective, the facilities used for flight hardware processing at KSC are NASA's premier factories. The products of these factories are safe, successful shuttle and expendable vehicle launches carrying state-of-the-art payloads. PE is devoted to process design, process management, and process improvement, rather than product design. PE also emphasizes the relationships of workers with systems and processes. Thus, it is difficult to speak of having a laboratory for PE at KSC because the entire facility is practically a laboratory when observed from a macro level perspective. However, it becomes necessary, at times, to show and display how KSC has benefited from PE and how KSC has contributed to the development of PE; hence, it has been proposed that a Process Engineering Technology Center (PETC) be developed to offer a place with a centralized focus on PE projects, and a place where KSC's PE capabilities can be showcased, and a venue where new Process Engineering technologies can be investigated and tested. Graphics for showcasing PE capabilities have been designed, and two initial test beds for PE technology research have been identified. Specifically, one test bed will look into the use of wearable computers with head mounted displays to deliver work instructions; the other test bed will look into developing simulation models that can be assembled into one to create a hierarchical model.

  10. Simulation of Initiation in Hexanitrostilbene

    NASA Astrophysics Data System (ADS)

    Thompson, Aidan; Shan, Tzu-Ray; Yarrington, Cole; Wixom, Ryan

    We report on the effect of isolated voids and pairs of nearby voids on hot spot formation, growth and chemical reaction initiation in hexanitrostilbene (HNS) crystals subjected to shock loading. Large-scale, reactive molecular dynamics simulations are performed using the reactive force field (ReaxFF) as implemented in the LAMMPS software. The ReaxFF force field description for HNS has been validated previously by comparing the isothermal equation of state to available diamond anvil cell (DAC) measurements and density function theory (DFT) calculations. Micron-scale molecular dynamics simulations of a supported shockwave propagating in HNS crystal along the [010] orientation are performed (up = 1.25 km/s, Us =4.0 km/s, P = 11GPa.) We compare the effect on hot spot formation and growth rate of isolated cylindrical voids up to 0.1 µm in size with that of two 50nm voids set 100nm apart. Results from the micron-scale atomistic simulations are compared with hydrodynamics simulations. Sandia National Laboratories is a multi-program laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of Lock- heed Martin Corporation, for the U.S. DOE National Nuclear Security Administration under Contract DE-AC04-94AL85000.

  11. [Dementia: management and prevention].

    PubMed

    Daher, Oscar; Nguyen, Sylvain; Smith, Cindi; Büla, Christophe; Démonet, Jean-François

    2016-04-20

    Dementia represents a great challenge for health care providers. Detection of cognitive impairment is critical for early diagnosis of dementia. Early diagnosis allows to initiate individualized management that focuses on maintaining patient's autonomy and supporting their caregivers. Proposed multimodal interventions include physical activity, cognitive training, mediterranean diet, and management of cardiovascular risk factors. Before the initiation of pro-cognitive therapy, medication review is essential to evaluate current treament and determine specific therapeutic objectives, based on patient's overall health and preferences. Overall risk reduction for dementia revolves around similar measures that target physical activity, cognition, diet and management of cardiovascular risk factors. PMID:27276724

  12. Space Climate Initiative

    NASA Astrophysics Data System (ADS)

    Gibson, S. E.; Dikpati, M.; Miesch, M. S.

    2013-12-01

    Solar variability drives our space environment and upper atmosphere, both on short-term "space-weather" time scales and longer "space-climate" time scales. The goal of the proposed initiative is to understand how extremes of solar variability affect space and terrestrial climate by modeling the system from the Sun's interior to the Earth's atmosphere. We have developed a fully 3D Babcock-Leighton solar dynamo model that incorporates the new "BASH" code and "spot-maker" flux emergence technique. This enables us to run dynamo-driven, physically self-consistent experiments that vary flux emergence to examine extreme scenarios of long-term solar variability. For example, motivated by the recent extended solar minimum and possible long-term changes in sunspots, we can address the question "What happens to the solar dynamo and the surface magnetic flux distribution if flux emergence occurs only on scales too small to form sunspots?" From another extreme, we might ask, "What sort of time-evolving flux emergence is likely to foster superstorms such as the 1859 "Carrington flare"? The photospheric magnetic fields arising from such dynamo experiments then provide a boundary condition that may be used for solar irradiance and heliospheric magnetic field models. These models in turn enable studies probing the effects of solar variability extremes on terrestrial climate, geospace environment, and galactic cosmic rays throughout the heliosphere.

  13. Urban Environment Initiative

    NASA Technical Reports Server (NTRS)

    1998-01-01

    The Urban Environment Initiative (UEI), has been established as part of a Cooperative Agreement with the National Aeronautics and Space Administration (NASA). The UEI is part of NASA's overall High Performance Computing and Communications (HPCC) and the Information Infrastructure Technology Applications (IITA) programs. The goal of the UEI is to provide public access to Earth Science information and promote its use with a focus on the environment of urban areas. This goal will be accomplished through collaborative efforts of the UEI team with both community-based and local/regional governmental organizations. The UEI team is comprised of four organizations representing private industry, NASA, and universities: Prime Technologies Service Corporation, NASA's Minority University Space Interdisciplinary Network (MU-SPIN) California State University, at Los Angeles, and Central State University (Wilberforce, OH). "Urban Environment" refers to the web of environmental, economic, and social factors that combine to create the urban world in which we live. Examples of these factors are population distribution, neighborhood demographic profiles, economic resources, business activities, location and concentration of environmental hazards and various pollutants, proximity and level of urban services, which form the basis of the urban environment and ultimately affect our lives and experiences. The use of Geographic Information Systems (GIS) and remote sensing allows data to be visualized in the forms of maps and spatial images. The use of these tools allow analysis of information about urban environments. Also included are descriptions of the four query types which will assist in understanding the maps.

  14. Scientific Component Technology Initiative

    SciTech Connect

    Kohn, S; Bosl, B; Dahlgren, T; Kumfert, G; Smith, S

    2003-02-07

    The laboratory has invested a significant amount of resources towards the development of high-performance scientific simulation software, including numerical libraries, visualization, steering, software frameworks, and physics packages. Unfortunately, because this software was not designed for interoperability and re-use, it is often difficult to share these sophisticated software packages among applications due to differences in implementation language, programming style, or calling interfaces. This LDRD Strategic Initiative investigated and developed software component technology for high-performance parallel scientific computing to address problems of complexity, re-use, and interoperability for laboratory software. Component technology is an extension of scripting and object-oriented software development techniques that specifically focuses on the needs of software interoperability. Component approaches based on CORBA, COM, and Java technologies are widely used in industry; however, they do not support massively parallel applications in science and engineering. Our research focused on the unique requirements of scientific computing on ASCI-class machines, such as fast in-process connections among components, language interoperability for scientific languages, and data distribution support for massively parallel SPMD components.

  15. TFTR initial operations

    SciTech Connect

    Young, K.M.; Bell, M.; Blanchard, W.R.; Bretz, N.; Cecchi, J.; Coonrod, J.; Davis, S.; Dylla, H.F.; Efthimion, P.C.; Fonck, R.

    1983-11-01

    The Tokamak Fusion Test Reactor (TFTR) has operated since December 1982 with ohmically heated plasmas. Routine operation with feedback control of plasma current, position, and density has been obtained for plasmas with I/sub p/ approx. = 800 kA, a = 68 cm, R = 250 cm, and B/sub t/ = 27 kG. A maximum plasma current of 1 MA was achieved with q approx. = 2.5. Energy confinement times of approx. 150 msec were measured for hydrogen and deuterium plasmas with anti n/sub e/ approx. = 2 x 10/sup 13/ cm/sup -3/, T/sub e/ (0) approx. = 1.5 keV, T/sub i/ (0) approx. = 1.5 keV, and Z/sub eff/ approx. = 3. The preliminary results suggest a size-cubed scaling from PLT and are consistent with Alcator C scaling where tau approx. nR/sup 2/a. Initial measurements of plasma disruption characteristics indicate current decay rates of approx. 800 kA in 8 ms which is within the TFTR design requirement of 3 MA in 3 ms.

  16. ALOS-2 initial results

    NASA Astrophysics Data System (ADS)

    Kankaku, Yukihiro; Suzuki, Shinichi; Shimada, Masanobu

    2015-10-01

    The Advanced Land Observing Satellite-2 (ALOS-2) was launched from Tanegashima Space Center by H-IIA rocket successfully on 24th May 2014. ALOS-2 carries the Phased Array type L-band Synthetic Aperture Radar-2 (PALSAR-2) as the state-of-the-art L-band SAR system which succeeds to PALSAR onboard ALOS. PALSAR-2 uses almost whole bandwidth allocated for L-band active sensor of Earth Exploration Satellites Service specified by the Radio Regulation in order to realize the high resolution observation, and also, it transmits more than 6 kW power for lower Noise Equivalent Sigma Zero using 180 TRMs driven by Gallium Nitride (GaN) amplifier which is the first use in space. Furthermore, because ALOS-2 carries the SAR system only, PALSAR-2 antenna can be mounted under the satellite body. It enables to observe right-/left-looking observation by satellite maneuvering. And the high accuracy orbit control to maintain the satellite within 500 m radius tube against the reference orbit enables high coherence for the InSAR processing. Using these new technologies, ALOS-2 has been operating to fulfill the mission requirements such as disaster monitoring and so on. This document introduces the initial result of ALOS-2 from the first year operation.

  17. Moon-Mars Initiative

    NASA Astrophysics Data System (ADS)

    2005-06-01

    On 27 May, the AGU Council unanimously adopted a position statement on NASA's strategic plan released in February 2005:: "A New Age of Exploration: NASA's Direction for 2005 and Beyond". This strategy incorporates U.S. President Bush's vision for manned space flight to Moon and Mars as described in "A Renewed Spirit of Discovery: The President's Vision for U.S. Space Exploration" announced in January 2004. The statement was drafted by a panel chaired by Eric Barron of Penn State University. AGU calls for the U.S. Administration, Congress, and NASA to continue their commitment to innovative Earth and space science programs. This commitment has placed the U.S. in an international leadership position. It enables environmental stewardship, promotes economic vitality, engages the next generation of scientists and engineers, protects life and property, and fosters exploration. It is, however, threatened by new financial demands placed on NASA by the return to human space flight using the space shuttle, finishing the space station, and launching the Moon-Mars initiative.

  18. 78 FR 27366 - North Pacific Fishery Management Council; Public Meetings

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-10

    ... Alaska Fishery Science Center report; Discussion paper on fishing activities and management. 9... fisheries. 6. GOA Trawl Bycatch: Discussion paper on GOA Trawl Bycatch management/ roadmap; Initial...

  19. Gauging without initial symmetry

    NASA Astrophysics Data System (ADS)

    Kotov, Alexei; Strobl, Thomas

    2016-01-01

    The gauge principle is at the heart of a good part of fundamental physics: Starting with a group G of so-called rigid symmetries of a functional defined over space-time Σ, the original functional is extended appropriately by additional Lie(G) -valued 1-form gauge fields so as to lift the symmetry to Maps(Σ , G) . Physically relevant quantities are then to be obtained as the quotient of the solutions to the Euler-Lagrange equations by these gauge symmetries. In this article we show that one can construct a gauge theory for a standard sigma model in arbitrary space-time dimensions where the target metric is not invariant with respect to any rigid symmetry group, but satisfies a much weaker condition: It is sufficient to find a collection of vector fields va on the target M satisfying the extended Killing equationv a(i ; j) = 0 for some connection acting on the index a. For regular foliations this is equivalent to requiring the conormal bundle to the leaves with its induced metric to be invariant under leaf-preserving diffeomorphisms of M, which in turn generalizes Riemannian submersions to which the notion reduces for smooth leaf spaces M / ∼. The resulting gauge theory has the usual quotient effect with respect to the original ungauged theory: in this way, much more general orbits can be factored out than usually considered. In some cases these are orbits that do not correspond to an initial symmetry, but still can be generated by a finite-dimensional Lie group G. Then the presented gauging procedure leads to an ordinary gauge theory with Lie algebra valued 1-form gauge fields, but showing an unconventional transformation law. In general, however, one finds that the notion of an ordinary structural Lie group is too restrictive and should be replaced by the much more general notion of a structural Lie groupoid.

  20. Initial Cladding Condition

    SciTech Connect

    E. Siegmann

    2000-08-22

    The purpose of this analysis is to describe the condition of commercial Zircaloy clad fuel as it is received at the Yucca Mountain Project (YMP) site. Most commercial nuclear fuel is encased in Zircaloy cladding. This analysis is developed to describe cladding degradation from the expected failure modes. This includes reactor operation impacts including incipient failures, potential degradation after reactor operation during spent fuel storage in pool and dry storage and impacts due to transportation. Degradation modes include cladding creep, and delayed hydride cracking during dry storage and transportation. Mechanical stresses from fuel handling and transportation vibrations are also included. This Analysis and Model Report (AMR) does not address any potential damage to assemblies that might occur at the YMP surface facilities. Ranges and uncertainties have been defined. This analysis will be the initial boundary condition for the analysis of cladding degradation inside the repository. In accordance with AP-2.13Q, ''Technical Product Development Planning'', a work plan (CRWMS M&O 2000c) was developed, issued, and utilized in the preparation of this document. There are constraints, caveats and limitations to this analysis. This cladding degradation analysis is based on commercial Pressurized Water Reactor (PWR) fuel with Zircaloy cladding but is applicable to Boiling Water Reactor (BWR) fuel. Reactor operating experience for both PWRs and BWRs is used to establish fuel reliability from reactor operation. It is limited to fuel exposed to normal operation and anticipated operational occurrences (i.e. events which are anticipated to occur within a reactor lifetime), and not to fuel that has been exposed to severe accidents. Fuel burnup projections have been limited to the current commercial reactor licensing environment with restrictions on fuel enrichment, oxide coating thickness and rod plenum pressures. The information provided in this analysis will be used in

  1. Glennan Microsystems Initiative

    NASA Technical Reports Server (NTRS)

    Brillson, Leonard J.

    2002-01-01

    During the 2001-2002 award period, we performed research on Pt/Ti/bare 6H-SiC and bare 4H-SiC interfaces in order to identify their electronic properties as a function of surface preparation. The overall aim of this work is to optimize the electronic properties of metal contacts to SiC as well as the active SiC material itself as a function of surface preparation and subsequent processing. Initially, this work has involved identifying bare surface, subsurface, and metal induced gap states at the metal-SiC contact and correlating energies and densities of deep levels with Schottky barrier heights. We used low energy electron-excited nanoluminescence (LEEN) spectroscopy, X-ray photoemission spectroscopy (XPS), and Secondary Ion Mass Spectrometry (SIMS) in order to correlate electronic states and energy bands with chemical composition, bonding, and crystal structure. A major development has been the discovery of polytype transformations that occur in 4H-SiC under standard microelectronic process conditions used to fabricate SiC devices. Our results are consistent with the stacking fault generation, defect formation, and consequent degradation of SiC recently reported for state-of-the-art ABB commercial diodes under localized electrical stress. Our results highlight the importance of -optimizing process conditions and material properties - anneal times, temperatures and doping to control such structural changes within epitaxial SiC layers. Thus far, we have established threshold times and temperatures beyond which 4H-SiC exhibits 3C-SiC transformation bands for a subset of dopant concentrations and process conditions. On the basis of this temperature time behavior, we have been able to establish an activation energy of approximately 2.5 eV for polytype transformation and dislocation motion. Work continues to establish the fundamental mechanisms underlying the polytype changes and its dependence on material parameters.

  2. Initial Radionuclide Inventories

    SciTech Connect

    Miller, H

    2005-07-12

    The purpose of this analysis is to provide an initial radionuclide inventory (in grams per waste package) and associated uncertainty distributions for use in the Total System Performance Assessment for the License Application (TSPA-LA) in support of the license application for the repository at Yucca Mountain, Nevada. This document is intended for use in postclosure analysis only. Bounding waste stream information and data were collected that capture probable limits. For commercially generated waste, this analysis considers alternative waste stream projections to bound the characteristics of wastes likely to be encountered using arrival scenarios that potentially impact the commercial spent nuclear fuel (CSNF) waste stream. For TSPA-LA, this radionuclide inventory analysis considers U.S. Department of Energy (DOE) high-level radioactive waste (DHLW) glass and two types of spent nuclear fuel (SNF): CSNF and DOE-owned (DSNF). These wastes are placed in two groups of waste packages: the CSNF waste package and the codisposal waste package (CDSP), which are designated to contain DHLW glass and DSNF, or DHLW glass only. The radionuclide inventory for naval SNF is provided separately in the classified ''Naval Nuclear Propulsion Program Technical Support Document'' for the License Application. As noted previously, the radionuclide inventory data presented here is intended only for TSPA-LA postclosure calculations. It is not applicable to preclosure safety calculations. Safe storage, transportation, and ultimate disposal of these wastes require safety analyses to support the design and licensing of repository equipment and facilities. These analyses will require radionuclide inventories to represent the radioactive source term that must be accommodated during handling, storage and disposition of these wastes. This analysis uses the best available information to identify the radionuclide inventory that is expected at the last year of last emplacement, currently identified as

  3. Initial Radionuclide Inventories

    SciTech Connect

    H. Miller

    2004-09-19

    The purpose of this analysis is to provide an initial radionuclide inventory (in grams per waste package) and associated uncertainty distributions for use in the Total System Performance Assessment for the License Application (TSPA-LA) in support of the license application for the repository at Yucca Mountain, Nevada. This document is intended for use in postclosure analysis only. Bounding waste stream information and data were collected that capture probable limits. For commercially generated waste, this analysis considers alternative waste stream projections to bound the characteristics of wastes likely to be encountered using arrival scenarios that potentially impact the commercial spent nuclear fuel (CSNF) waste stream. For TSPA-LA, this radionuclide inventory analysis considers U.S. Department of Energy (DOE) high-level radioactive waste (DHLW) glass and two types of spent nuclear fuel (SNF): CSNF and DOE-owned (DSNF). These wastes are placed in two groups of waste packages: the CSNF waste package and the codisposal waste package (CDSP), which are designated to contain DHLW glass and DSNF, or DHLW glass only. The radionuclide inventory for naval SNF is provided separately in the classified ''Naval Nuclear Propulsion Program Technical Support Document'' for the License Application. As noted previously, the radionuclide inventory data presented here is intended only for TSPA-LA postclosure calculations. It is not applicable to preclosure safety calculations. Safe storage, transportation, and ultimate disposal of these wastes require safety analyses to support the design and licensing of repository equipment and facilities. These analyses will require radionuclide inventories to represent the radioactive source term that must be accommodated during handling, storage and disposition of these wastes. This analysis uses the best available information to identify the radionuclide inventory that is expected at the last year of last emplacement, currently identified as

  4. INITIATE: An Intelligent Adaptive Alert Environment.

    PubMed

    Jafarpour, Borna; Abidi, Samina Raza; Ahmad, Ahmad Marwan; Abidi, Syed Sibte Raza

    2015-01-01

    Exposure to a large volume of alerts generated by medical Alert Generating Systems (AGS) such as drug-drug interaction softwares or clinical decision support systems over-whelms users and causes alert fatigue in them. Some of alert fatigue effects are ignoring crucial alerts and longer response times. A common approach to avoid alert fatigue is to devise mechanisms in AGS to stop them from generating alerts that are deemed irrelevant. In this paper, we present a novel framework called INITIATE: an INtellIgent adapTIve AlerT Environment to avoid alert fatigue by managing alerts generated by one or more AGS. We have identified and categories the lifecycle of different alerts and have developed alert management logic as per the alerts' lifecycle. Our framework incorporates an ontology that represents the alert management strategy and an alert management engine that executes this strategy. Our alert management framework offers the following features: (1) Adaptability based on users' feedback; (2) Personalization and aggregation of messages; and (3) Connection to Electronic Medical Records by implementing a HL7 Clinical Document Architecture parser. PMID:26262056

  5. National Take-Back Initiative

    MedlinePlus

    ... Physicians Drug Disposal Information Drug and Chemical Information E-commerce Initiatives Federal Agencies & Related Links Federal Register Notices ... Physicians Drug Disposal Information Drug and Chemical Information E-commerce Initiatives Federal Agencies & Related Links Federal Register Notices ...

  6. Information resource management concepts for records managers

    SciTech Connect

    Seesing, P.R.

    1992-10-01

    Information Resource Management (ERM) is the label given to the various approaches used to foster greater accountability for the use of computing resources. It is a corporate philosophy that treats information as it would its other resources. There is a reorientation from simply expenditures to considering the value of the data stored on that hardware. Accountability for computing resources is expanding beyond just the data processing (DP) or management information systems (MIS) manager to include senior organization management and user management. Management`s goal for office automation is being refocused from saving money to improving productivity. A model developed by Richard Nolan (1982) illustrates the basic evolution of computer use in organizations. Computer Era: (1) Initiation (computer acquisition), (2) Contagion (intense system development), (3) Control (proliferation of management controls). Data Resource Era: (4) Integration (user service orientation), (5) Data Administration (corporate value of information), (6) Maturity (strategic approach to information technology). The first three stages mark the growth of traditional data processing and management information systems departments. The development of the IRM philosophy in an organization involves the restructuring of the DP organization and new management techniques. The three stages of the Data Resource Era represent the evolution of IRM. This paper examines each of them in greater detail.

  7. The national geomagnetic initiative

    NASA Technical Reports Server (NTRS)

    1993-01-01

    The Earth's magnetic field, through its variability over a spectrum of spatial and temporal scales, contains fundamental information on the solid Earth and geospace environment (the latter comprising the atmosphere, ionosphere, and magnetosphere). Integrated studies of the geomagnetic field have the potential to address a wide range of important processes in the deep mantle and core, asthenosphere, lithosphere, oceans, and the solar-terrestrial environment. These studies have direct applications to important societal problems, including resource assessment and exploration, natural hazard mitigation, safe navigation, and the maintenance and survivability of communications and power systems on the ground and in space. Studies of the Earth's magnetic field are supported by a variety of federal and state agencies as well as by private industry. Both basic and applied research is presently supported by several federal agencies, including the National Science Foundation (NSF), U.S. Geological Survey (USGS), U.S. Department of Energy (DOE), National Oceanic and Atmospheric Administration (NOAA), National Aeronautics and Space Administration (NASA), and U.S. Department of Defense (DOD) (through the Navy, Air Force, and Defense Mapping Agency). Although each agency has a unique, well-defined mission in geomagnetic studies, many areas of interest overlap. For example, NASA, the Navy, and USGS collaborate closely in the development of main field reference models. NASA, NSF, and the Air Force collaborate in space physics. These interagency linkages need to be strengthened. Over the past decade, new opportunities for fundamental advances in geomagnetic research have emerged as a result of three factors: well-posed, first-order scientific questions; increased interrelation of research activities dealing with geomagnetic phenomena; and recent developments in technology. These new opportunities can be exploited through a national geomagnetic initiative to define objectives and

  8. Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative

    PubMed Central

    Visser, K; Katchamart, W; Loza, E; Martinez-Lopez, J A; Salliot, C; Trudeau, J; Bombardier, C; Carmona, L; van der Heijde, D; Bijlsma, J W J; Boumpas, D T; Canhao, H; Edwards, C J; Hamuryudan, V; Kvien, T K; Leeb, B F; Martín-Mola, E M; Mielants, H; Müller-Ladner, U; Murphy, G; Østergaard, M; Pereira, I A; Ramos-Remus, C; Valentini, G; Zochling, J; Dougados, M

    2009-01-01

    Objectives: To develop evidence-based recommendations for the use of methotrexate in daily clinical practice in rheumatic disorders. Methods: 751 rheumatologists from 17 countries participated in the 3E (Evidence, Expertise, Exchange) Initiative of 2007–8 consisting of three separate rounds of discussions and Delphi votes. Ten clinical questions concerning the use of methotrexate in rheumatic disorders were formulated. A systematic literature search in Medline, Embase, Cochrane Library and 2005–7 American College of Rheumatology/European League Against Rheumatism meeting abstracts was conducted. Selected articles were systematically reviewed and the evidence was appraised according to the Oxford levels of evidence. Each country elaborated a set of national recommendations. Finally, multinational recommendations were formulated and agreement among the participants and the potential impact on their clinical practice was assessed. Results: A total of 16 979 references was identified, of which 304 articles were included in the systematic reviews. Ten multinational key recommendations on the use of methotrexate were formulated. Nine recommendations were specific for rheumatoid arthritis (RA), including the work-up before initiating methotrexate, optimal dosage and route, use of folic acid, monitoring, management of hepatotoxicity, long-term safety, mono versus combination therapy and management in the perioperative period and before/during pregnancy. One recommendation concerned methotrexate as a steroid-sparing agent in other rheumatic diseases. Conclusions: Ten recommendations for the use of methotrexate in daily clinical practice focussed on RA were developed, which are evidence based and supported by a large panel of rheumatologists, enhancing their validity and practical use. PMID:19033291

  9. Process Engineering Technology Center Initiative

    NASA Technical Reports Server (NTRS)

    Centeno, Martha A.

    2002-01-01

    NASA's Kennedy Space Center (KSC) is developing as a world-class Spaceport Technology Center (STC). From a process engineering (PE) perspective, the facilities used for flight hardware processing at KSC are NASA's premier factories. The products of these factories are safe, successful shuttle and expendable vehicle launches carrying state-of-the-art payloads. PE is devoted to process design, process management, and process improvement, rather than product design. PE also emphasizes the relationships of workers with systems and processes. Thus, it is difficult to speak of having a laboratory for PE at K.S.C. because the entire facility is practically a laboratory when observed from a macro level perspective. However, it becomes necessary, at times, to show and display how K.S.C. has benefited from PE and how K.S.C. has contributed to the development of PE; hence, it has been proposed that a Process Engineering Technology Center (PETC) be developed to offer a place with a centralized focus on PE projects, and a place where K.S.C.'s PE capabilities can be showcased, and a venue where new Process Engineering technologies can be investigated and tested. Graphics for showcasing PE capabilities have been designed, and two initial test beds for PE technology research have been identified. Specifically, one test bed will look into the use of wearable computers with head mounted displays to deliver work instructions; the other test bed will look into developing simulation models that can be assembled into one to create a hierarchical model.

  10. A Coordinated Initialization Process for the Distributed Space Exploration Simulation

    NASA Technical Reports Server (NTRS)

    Crues, Edwin Z.; Phillips, Robert G.; Dexter, Dan; Hasan, David

    2007-01-01

    A viewgraph presentation on the federate initialization process for the Distributed Space Exploration Simulation (DSES) is described. The topics include: 1) Background: DSES; 2) Simulation requirements; 3) Nine Step Initialization; 4) Step 1: Create the Federation; 5) Step 2: Publish and Subscribe; 6) Step 3: Create Object Instances; 7) Step 4: Confirm All Federates Have Joined; 8) Step 5: Achieve initialize Synchronization Point; 9) Step 6: Update Object Instances With Initial Data; 10) Step 7: Wait for Object Reflections; 11) Step 8: Set Up Time Management; 12) Step 9: Achieve startup Synchronization Point; and 13) Conclusions

  11. Weed Management

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Adaptive management can complement integrated programs to manage weeds in forage production systems. This approach requires establishing management goals, developing and implementing management programs based on the goals, monitoring and assessing impacts of management efforts, and modifying goals a...

  12. Clean Energy Infrastructure Educational Initiative

    SciTech Connect

    Hallinan, Kevin; Menart, James; Gilbert, Robert

    2012-08-31

    The Clean Energy Infrastructure Educational Initiative represents a collaborative effort by the University of Dayton, Wright State University and Sinclair Community College. This effort above all aimed to establish energy related programs at each of the universities while also providing outreach to the local, state-wide, and national communities. At the University of Dayton, the grant has aimed at: solidfying a newly created Master's program in Renewable and Clean Energy; helping to establish and staff a regional sustainability organization for SW Ohio. As well, as the prime grantee, the University of Dayton was responsible for insuring curricular sharing between WSU and the University of Dayton. Finally, the grant, through its support of graduate students, and through cooperation with the largest utilities in SW Ohio enabled a region-wide evaluation of over 10,000 commercial building buildings in order to identify the priority buildings in the region for energy reduction. In each, the grant has achieved success. The main focus of Wright State was to continue the development of graduate education in renewable and clean energy. Wright State has done this in a number of ways. First and foremost this was done by continuing the development of the new Renewable and Clean Energy Master's Degree program at Wright State . Development tasks included: continuing development of courses for the Renewable and Clean Energy Master's Degree, increasing the student enrollment, and increasing renewable and clean energy research work. The grant has enabled development and/or improvement of 7 courses. Collectively, the University of Dayton and WSU offer perhaps the most comprehensive list of courses in the renewable and clean energy area in the country. Because of this development, enrollment at WSU has increased from 4 students to 23. Secondly, the grant has helped to support student research aimed in the renewable and clean energy program. The grant helped to solidify new research

  13. State and federal regulatory initiatives: Pending or underway

    SciTech Connect

    Nosenchuck, N.H.

    1994-12-31

    The author discusses some of the present and future hazardous waste management regulatory initiatives and also presents some of his personal views on hazardous waste management. The primary federal statute governing the regulation of solid and hazardous wastes is the Resource Conservation and Recovery Act (RCRA). Subtitle C of RCRA, relating to hazardous waste management, has evolved into a command and control approach for hazardous waste generators and waste management facilities. The EPA, under RCRA, may authorize a state to administer and enforce a state hazardous waste program in lieu of the federal Subtitle C program.

  14. Riparian-wetland initiative for the 1990`s

    SciTech Connect

    1990-09-01

    This Riparian-Wetland Initiative for the 1990`s provides a blueprint for management and restoration of those areas encompassing 23.7 million acres of BLM lands. This strategy complements other plans such as Waterfowl Habitat Management on Public Lands, A Strategy for the Future and other interdisciplinary, multi-program, cooeprative efforts. Four goals have been established: to restore and maintain riparian-wetland areas so that 75% or more are in proper functioning condition by 1997, to protect areas through proper land management to avoid or mitigate negative impacts, to ensure an aggressive information program, and to improve partnerships and cooperative restorative and management processes.

  15. Florida Hydrogen Initiative

    SciTech Connect

    Block, David L

    2013-06-30

    The Florida Hydrogen Initiative (FHI) was a research, development and demonstration hydrogen and fuel cell program. The FHI program objectives were to develop Florida?s hydrogen and fuel cell infrastructure and to assist DOE in its hydrogen and fuel cell activities The FHI program funded 12 RD&D projects as follows: Hydrogen Refueling Infrastructure and Rental Car Strategies -- L. Lines, Rollins College This project analyzes strategies for Florida's early stage adaptation of hydrogen-powered public transportation. In particular, the report investigates urban and statewide network of refueling stations and the feasibility of establishing a hydrogen rental-car fleet based in Orlando. Methanol Fuel Cell Vehicle Charging Station at Florida Atlantic University ? M. Fuchs, EnerFuel, Inc. The project objectives were to design, and demonstrate a 10 kWnet proton exchange membrane fuel cell stationary power plant operating on methanol, to achieve an electrical energy efficiency of 32% and to demonstrate transient response time of less than 3 milliseconds. Assessment of Public Understanding of the Hydrogen Economy Through Science Center Exhibits, J. Newman, Orlando Science Center The project objective was to design and build an interactive Science Center exhibit called: ?H2Now: the Great Hydrogen Xchange?. On-site Reformation of Diesel Fuel for Hydrogen Fueling Station Applications ? A. Raissi, Florida Solar Energy Center This project developed an on-demand forecourt hydrogen production technology by catalytically converting high-sulfur hydrocarbon fuels to an essentially sulfur-free gas. The removal of sulfur from reformate is critical since most catalysts used for the steam reformation have limited sulfur tolerance. Chemochromic Hydrogen Leak Detectors for Safety Monitoring ? N. Mohajeri and N. Muradov, Florida Solar Energy Center This project developed and demonstrated a cost-effective and highly selective chemochromic (visual) hydrogen leak detector for safety monitoring

  16. Star wars: A question of initiative

    SciTech Connect

    Ennals, R.

    1987-01-01

    This book discusses U.K. and European participation in the Strategic Defense Initiative. The author, a cofounder of The Strategic Research Initiative, participated in research and research management concerned with developing tools for analyzing the complexity of nuclear diplomacy and how international politics are affected by the new technology. It covers research and varying national strategies for applying advanced information technology, intelligent machinery, logic programming in both education and training, and artificial intelligence issues. It introduces the field of computational politics, examining the political importance of computer systems and computational concepts that can help analyze complex political phenomena. It also gives special attention to the American SDI, ''Star Wars,'' which has necessitated the development and deployment of new techniques of political analysis. A section on constructive alternatives to SDI is also included.

  17. Information resource management concepts for records managers

    SciTech Connect

    Seesing, P.R.

    1992-10-01

    Information Resource Management (ERM) is the label given to the various approaches used to foster greater accountability for the use of computing resources. It is a corporate philosophy that treats information as it would its other resources. There is a reorientation from simply expenditures to considering the value of the data stored on that hardware. Accountability for computing resources is expanding beyond just the data processing (DP) or management information systems (MIS) manager to include senior organization management and user management. Management's goal for office automation is being refocused from saving money to improving productivity. A model developed by Richard Nolan (1982) illustrates the basic evolution of computer use in organizations. Computer Era: (1) Initiation (computer acquisition), (2) Contagion (intense system development), (3) Control (proliferation of management controls). Data Resource Era: (4) Integration (user service orientation), (5) Data Administration (corporate value of information), (6) Maturity (strategic approach to information technology). The first three stages mark the growth of traditional data processing and management information systems departments. The development of the IRM philosophy in an organization involves the restructuring of the DP organization and new management techniques. The three stages of the Data Resource Era represent the evolution of IRM. This paper examines each of them in greater detail.

  18. Management of Brain Metastases in ALK-Positive Non-Small-Cell Lung Cancer.

    PubMed

    Rusthoven, Chad G; Doebele, Robert C

    2016-08-20

    The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.A 54-year-old man with a former 15-pack-year smoking history presents with cough and dyspnea. Initial work-up with imaging demonstrates a right suprahilar mass measuring 4.7 cm as well as several enlarged hilar and ipsilateral mediastinal lymph nodes. Bronchoscopy with biopsy reveals adenocarcinoma consistent with a lung primary. Staging with positron emission tomography/computed tomography (PET/CT) reidentifies the primary mass and lymph nodes and shows several PET-avid bone metastases. Brain magnetic resonance imaging (MRI) demonstrates a 1.6-cm right parietal mass with mild vasogenic edema and four additional brain metastases measuring 4 to 9 mm in size. Molecular testing is positive for an anaplastic lymphoma kinase (ALK) gene rearrangement using fluorescence in situ hybridization and negative for EGFR, ROS1, RET, BRAF, KRAS, and other oncogenes. The patient denies any neurologic symptoms and has no significant findings on neurologic exam. He is referred to you for management options for newly diagnosed stage IV (T2aN2M1b) lung adenocarcinoma. PMID:27298405

  19. Acute Psychosis after Recent Isoniazid Initiation.

    PubMed

    Arya, Sidharth; Sukhija, Gagandeep; Singh, Harpreet

    2015-06-01

    Isoniazid as part of Directly Observed Treatment-Short course (DOTS) regimen is universally used. Although, associated psychosis in certain cases is documented earlier, type of symptoms and onset of symptoms remains highly variable. We describe a case of 54-year-old female on anti-tubercular therapy with onset of psychosis within three days of Isoniazid initiation characterised by agitation, loosening of association, echolalia with spontaneous remission after drug stoppage. This case highlights the importance of remaining vigilant and considering isoniazid as possible causative agent for psychosis even within days of its intiation and avoiding delay in management. PMID:26266198

  20. Neurologic Itch Management.

    PubMed

    Şavk, Ekin

    2016-01-01

    Neurologic itch is defined as pruritus resulting from any dysfunction of the nervous system. Itch arising due to a neuroanatomic pathology is seen to be neuropathic. Causes of neuropathic itch range from localized entrapment of a peripheral nerve to generalized degeneration of small nerve fibers. Antipruritic medications commonly used for other types of itch such as antihistamines and corticosteroids lack efficacy in neuropathic itch. Currently there are no therapeutic options that offer relief in all types of neuropathic pruritus, and treatment strategies vary according to etiology. It is best to decide on the appropriate tests and procedures in collaboration with a neurologist during the initial work-up. Treatment of neuropathic itch includes general antipruritic measures, local or systemic pharmacotherapy, various physical modalities, and surgery. Surgical intervention is the obvious choice of therapy in cases of spinal or cerebral mass, abscess, or hemorrhagic stroke, and may provide decompression in entrapment neuropathies. Symptomatic treatment is needed in the vast majority of patients. General antipruritic measures should be encouraged. Local treatment agents with at least some antipruritic effect include capsaicin, local anesthetics, doxepin, tacrolimus, and botulinum toxin A. Current systemic therapy relies on anticonvulsants such as gabapentin and pregabalin. Phototherapy, transcutaneous electrical nerve stimulation, and physical therapy have also been of value in selected cases. Among the avenues to be explored are transcranial magnetic stimulation of the brain, new topical cannabinoid receptor agonists, various modes of acupuncture, a holistic approach with healing touch, and cell transplantation to the spinal cord. PMID:27578080

  1. Initiation into Adolescent Marijuana Use.

    ERIC Educational Resources Information Center

    Brook, Judith S.; And Others

    1980-01-01

    This longitudinal study examined the relationship of three domains (personality/attitudinal orientations, peer relationships, and family socialization factors) with initiation into adolescent marihuana use. (Author/DB)

  2. Multimedia environmental management

    SciTech Connect

    Soesilo, J.A.; Wiley, W.D.

    1999-09-01

    This book explores and supports the argument that effective environmental management must be based on a multimedia approach, which focuses simultaneously on air, water, and waste and enables managers to assess the resulting financial, operation, and management benefits. The multimedia approach, which can be used to design an effective compliance program, includes proper waste and material handling management, systematic monitoring, and record keeping requirements. This approach integrates a wide array of environmental requirements and decision processes, which the authors examine in sixteen chapters, organized into four parts: the role of environmental management; environmental aspects of business operation, environmental processes; and environmental management trends. Within these parts, the authors highlight the development of modern environmental management and provide an overview of federal laws pertinent to multimedia environmental management. They examine such issues as chemical storage and transportation, tank system operations and requirements, waste determination, spill response procedures, and employee training. Environmental processes addressed in the book include the management of solid and hazardous waste, wastewater treatment systems, stormwater management, air emission control, and site remediation. The authors also briefly discuss significant initiatives in US environmental management and look toward corporate sustainable development.

  3. Managing Fault Management Development

    NASA Technical Reports Server (NTRS)

    McDougal, John M.

    2010-01-01

    As the complexity of space missions grows, development of Fault Management (FM) capabilities is an increasingly common driver for significant cost overruns late in the development cycle. FM issues and the resulting cost overruns are rarely caused by a lack of technology, but rather by a lack of planning and emphasis by project management. A recent NASA FM Workshop brought together FM practitioners from a broad spectrum of institutions, mission types, and functional roles to identify the drivers underlying FM overruns and recommend solutions. They identified a number of areas in which increased program and project management focus can be used to control FM development cost growth. These include up-front planning for FM as a distinct engineering discipline; managing different, conflicting, and changing institutional goals and risk postures; ensuring the necessary resources for a disciplined, coordinated approach to end-to-end fault management engineering; and monitoring FM coordination across all mission systems.

  4. 41 CFR 102-5.60 - How long are initial determinations effective?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 41 Public Contracts and Property Management 3 2013-07-01 2013-07-01 false How long are initial determinations effective? 102-5.60 Section 102-5.60 Public Contracts and Property Management Federal Property... Authorizing Home-to-Work Transportation § 102-5.60 How long are initial determinations effective?...

  5. 41 CFR 102-5.60 - How long are initial determinations effective?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false How long are initial determinations effective? 102-5.60 Section 102-5.60 Public Contracts and Property Management Federal Property... Authorizing Home-to-Work Transportation § 102-5.60 How long are initial determinations effective?...

  6. 41 CFR 102-5.60 - How long are initial determinations effective?

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 41 Public Contracts and Property Management 3 2014-01-01 2014-01-01 false How long are initial determinations effective? 102-5.60 Section 102-5.60 Public Contracts and Property Management Federal Property... Authorizing Home-to-Work Transportation § 102-5.60 How long are initial determinations effective?...

  7. 41 CFR 102-5.60 - How long are initial determinations effective?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false How long are initial determinations effective? 102-5.60 Section 102-5.60 Public Contracts and Property Management Federal Property... Authorizing Home-to-Work Transportation § 102-5.60 How long are initial determinations effective?...

  8. 41 CFR 102-5.60 - How long are initial determinations effective?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 41 Public Contracts and Property Management 3 2012-01-01 2012-01-01 false How long are initial determinations effective? 102-5.60 Section 102-5.60 Public Contracts and Property Management Federal Property... Authorizing Home-to-Work Transportation § 102-5.60 How long are initial determinations effective?...

  9. 43 CFR 2920.2 - Procedures for public-initiated land use proposals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Procedures for public-initiated land use...) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) LEASES, PERMITS AND EASEMENTS Leases, Permits and Easements: General Provisions § 2920.2 Procedures for public-initiated...

  10. 43 CFR 2920.2 - Procedures for public-initiated land use proposals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Procedures for public-initiated land use...) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) LEASES, PERMITS AND EASEMENTS Leases, Permits and Easements: General Provisions § 2920.2 Procedures for public-initiated...

  11. 43 CFR 2920.2 - Procedures for public-initiated land use proposals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Procedures for public-initiated land use...) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) LEASES, PERMITS AND EASEMENTS Leases, Permits and Easements: General Provisions § 2920.2 Procedures for public-initiated...

  12. 43 CFR 2920.2 - Procedures for public-initiated land use proposals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Procedures for public-initiated land use...) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) LEASES, PERMITS AND EASEMENTS Leases, Permits and Easements: General Provisions § 2920.2 Procedures for public-initiated...

  13. 78 FR 4870 - Notice of Public Meeting, North Slope Science Initiative-Science Technical Advisory Panel

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-23

    ... Technical Advisory Panel through the Executive Director, North Slope Science Initiative. Each formal meeting... Bureau of Land Management Notice of Public Meeting, North Slope Science Initiative--Science Technical Advisory Panel AGENCY: Bureau of Land Management, Alaska State Office, North Slope Science...

  14. 76 FR 79211 - Notice of Public Meeting, North Slope Science Initiative-Science Technical Advisory Panel

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-21

    ... Panel through the Executive Director, North Slope Science Initiative. Each formal meeting will also have... Bureau of Land Management Notice of Public Meeting, North Slope Science Initiative--Science Technical Advisory Panel AGENCY: Bureau of Land Management, Alaska State Office, North Slope Science...

  15. 77 FR 21806 - Notice of Public Meeting, North Slope Science Initiative-Science Technical Advisory Panel

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-11

    ..., North Slope Science Initiative. Each formal meeting will also have time allotted for hearing public... Bureau of Land Management Notice of Public Meeting, North Slope Science Initiative--Science Technical Advisory Panel AGENCY: Bureau of Land Management, Alaska State Office, North Slope Science...

  16. 76 FR 55943 - Notice of Public Meeting, North Slope Science Initiative-Science Technical Advisory Panel

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-09

    ... Executive Director, North Slope Science Initiative. Each formal meeting will also have time allotted for... Bureau of Land Management Notice of Public Meeting, North Slope Science Initiative--Science Technical Advisory Panel AGENCY: Bureau of Land Management, Alaska State Office, North Slope Science...

  17. 75 FR 159 - Notice of Public Meeting, North Slope Science Initiative, Science Technical Advisory Panel, Alaska

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-04

    ... Bureau of Land Management Notice of Public Meeting, North Slope Science Initiative, Science Technical Advisory Panel, Alaska AGENCY: Bureau of Land Management, Alaska State Office, North Slope Science... of the Interior, North Slope Science Initiative (NSSI)-- Science Technical Advisory Panel (STAP)...

  18. Career Technical Education Pathways Initiative

    ERIC Educational Resources Information Center

    California Community Colleges, Chancellor's Office, 2013

    2013-01-01

    California's education system--the largest in the United States--is an essential resource for ensuring strong economic growth in the state. The Career Technical Education Pathways Initiative (referred to as the Initiative in this report), which became law in 2005, brings together community colleges, K-12 school districts, employers, organized…

  19. Washington State's Student Achievement Initiative

    ERIC Educational Resources Information Center

    Pettitt, Maureen; Prince, David

    2010-01-01

    This article describes Washington State's Student Achievement Initiative, an accountability system implemented in 2005-06 that measures students' gains in college readiness, college credits earned, and degree or certificate completion. The goal of the initiative is to increase educational attainment by focusing on the critical momentum points…

  20. Nebraska: Early Head Start Initiative

    ERIC Educational Resources Information Center

    Center for Law and Social Policy, Inc. (CLASP), 2012

    2012-01-01

    Since 1999, Nebraska's Early Head Start Infant/Toddler Quality Initiative has supported Early Head Start (EHS) and community child care partnerships to improve the quality and professionalism of infant and toddler care. EHS programs apply to receive funding to establish partnerships with center-based or home-based child care.The initiative has…