Knowledge Management Orientation: An Innovative Perspective to Hospital Management.

PubMed

Ghasemi, Matina; Ghadiri Nejad, Mazyar; Bagzibagli, Kemal

2017-12-01

By considering innovation as a new project in hospitals, all the project management's standard steps should be followed in execution. This study investigated the validation of a new set of measures in terms of providing a procedure for knowledge management-oriented innovation that enriches the hospital management system. The relation between innovation and all the knowledge management areas, as the main constructs of project management, was illustrated by referring to project management standard steps and previous studies. Through consultations and meetings with a committee of professional project managers, a questionnaire was developed to measure ten knowledge management areas in hospital's innovation process. Additionally, a group of experts from hospital managers were invited to comment on the applicability of the questionnaires by considering if the items are measurable in hospitals practically. A close-ended, Likert-type scale items, consisted of ten sections, were developed based on project management body of knowledge thorough Delphi technique. It enables the managers to evaluate hospitals' situation to be aware whether the organization follows the knowledge management standards in innovation process or not. By pilot study, confirmatory factor analysis and exploratory factor analysis were conducted to ensure the validity and reliability of the measurement items. The developed items seem to have a potential to help hospital managers and subsequently delivering new products/services successfully based on the standard procedures in their organization. In all innovation processes, the knowledge management areas and their standard steps help hospital managers by a new tool as questionnaire format.

49 CFR 192.935 - What additional preventive and mitigative measures must an operator take?

Code of Federal Regulations, 2010 CFR

2010-10-01

... Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY TRANSPORTATION OF NATURAL AND OTHER GAS BY PIPELINE: MINIMUM FEDERAL SAFETY STANDARDS Gas Transmission Pipeline Integrity Management § 192.935 What additional preventive and mitigative...

Identification of Microbial Gene Biomarkers for in situ RDX Biodegradation

DTIC Science & Technology

2012-12-01

Additional research is required to determine reliable guidelines to inform site managers of specific field concentrations of ammonium and nitrate...Mrs. Cynthia L. Price, Research Biologist, EPED, EL, ERDC; Dr. Rick Arnseth, Project Manager / Geochemist, Tetra Tech Inc., Oak Ridge, TN; and...a biomarker of RDX degradation, as it will also be necessary for bioremediation site managers to measure soil and groundwater concentra- tions for

Development and implementation of a business continuity management risk index.

PubMed

Kadar, Michael

This paper will present the building blocks for developing and implementing the BCM risk index; whether it is used as a comprehensive metric for risk or preparedness. This paper introduces the concept of a business continuity management (BCM) risk index--a comprehensive metric that measures and reports the status of the primary 'intended outcome' of the BCM programme to top management. In addition to measuring the primary programme output,;the BCM risk index can be used to demonstrate the overall value of the BCM programme to executive management. This is accomplished because the BCM risk index allows quantitative measurement of current risk levels and their comparison with established risk tolerances. The BCM Risk Index can provide executive management with reports on the risk level of individual business units, departments, subsidiaries or the enterprise in a way that drives both risk management and BCM initiatives. The name 'risk index' can be misleading, however. The BCM risk index concept can also be used to measure preparedness levels. In fact, implementation at DTE Energy has resulted in calling it the 'preparedness index', which is used to measure and report preparedness levels rather than risk levels.

Measuring outcomes of type 2 diabetes disease management program in an HMO setting.

PubMed

Ibrahim, Ibrahim Awad; Beich, Jeff; Sidorov, Jaan; Gabbay, Robert; Yu, Lucy

2002-01-01

There is a need to evaluate empirical disease management programs used in managing chronic diseases such as diabetes mellitus in managed care settings. We analyzed data from 252 patients with type 2 diabetes before and 1 year after enrollment in a disease management program. We examined clinical indicators such as HbA1C, HDL, LDL, total cholesterol, diastolic blood pressure, and BMI in addition to self-reported health status measured by SF-36 instrument. All clinical indicators showed statistically and clinically significant improvements. Only vitality and mental health showed statistically significant improvements in health status. Weak to moderate significant correlation between clinical indicators and health status was observed. Disease management can be effective at making significant clinical improvements for participants in a mixed-model HMO setting. No strong relationship between clinical indicators and health status was found. Future research is needed using a more specific health status measuring instrument and a randomized clinical trial design.

Assessment of long-term knowledge retention following single-day simulation training for uncommon but critical obstetrical events

PubMed Central

Vadnais, Mary A.; Dodge, Laura E.; Awtrey, Christopher S.; Ricciotti, Hope A.; Golen, Toni H.; Hacker, Michele R.

2013-01-01

Objective The objectives were to determine (i) whether simulation training results in short-term and long-term improvement in the management of uncommon but critical obstetrical events and (ii) to determine whether there was additional benefit from annual exposure to the workshop. Methods Physicians completed a pretest to measure knowledge and confidence in the management of eclampsia, shoulder dystocia, postpartum hemorrhage and vacuum-assisted vaginal delivery. They then attended a simulation workshop and immediately completed a posttest. Residents completed the same posttests 4 and 12 months later, and attending physicians completed the posttest at 12 months. Physicians participated in the same simulation workshop 1 year later and then completed a final posttest. Scores were compared using paired t-tests. Results Physicians demonstrated improved knowledge and comfort immediately after simulation. Residents maintained this improvement at 1 year. Attending physicians remained more comfortable managing these scenarios up to 1 year later; however, knowledge retention diminished with time. Repeating the simulation after 1 year brought additional improvement to physicians. Conclusion Simulation training can result in short-term and contribute to long-term improvement in objective measures of knowledge and comfort level in managing uncommon but critical obstetrical events. Repeat exposure to simulation training after 1 year can yield additional benefits. PMID:22191668

Everyday Functioning in Huntington's Disease: A Laboratory-Based Study of Financial Management Capacity.

PubMed

Sheppard, David P; Pirogovsky-Turk, Eva; Woods, Steven Paul; Holden, Heather M; Nicoll, Diane R; Filoteo, J Vincent; Corey-Bloom, Jody; Gilbert, Paul E

2017-01-01

One important limitation of prior studies examining functional decline in Huntington's disease (HD) has been the reliance on self-reported measures of ability. Since report-based methods can be biased by lack of insight, depression, and cognitive impairment, contrasting self-reported ability with measures that assess capacity may lead to a more comprehensive estimation of real-world functioning. The present study examined self-reported ability to perform instrumental activities of daily living (iADLs) and performance-based financial management capacity in 20 patients diagnosed with mild-moderate Huntington's disease (HD) and 20 demographically similar healthy adults. HD patients reported significantly greater declines in their ability to manage finances. On the capacity measure of financial management, HD patients performed significantly below healthy adults. Additionally, in the HD group there were no significant correlations between self-reported ability and capacity measures of financial management. HD patients endorsed declines in global iADL ability and exhibited deficits in functional capacity when performing a financial management task. Capacity measures may aid in assessing the extent to which HD patients accurately estimate real-world iADL performance, and the present findings suggest that such measures of capacity may be related to the cognitive, but not motor or affective, symptoms of HD.

78 FR 52123 - Atlantic Highly Migratory Species; 2006 Consolidated Highly Migratory Species Fishery Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-22

... quota. As described in the proposed rule, the proposed measures include Allocation measures, Area-Based... logistics for 10 public hearings to provide additional opportunities for members of the public to comment on... among the quota categories; (2) area-based measures that would implement restrictions on the use of...

Carcass addition does not enhance juvenile salmonid biomass, growth, or retention in six Northwestern California streams.

Treesearch

Bret Harvey; Margaret A. Wilzbach

2010-01-01

Fisheries managers commonly consider the addition of salmon carcasses when seeking to enhance salmonid populations. However, the range of environmental conditions under which the technique is effective remains poorly defined. We addressed this issue by measuring the effects of wintertime addition of salmon carcasses on the biomass, growth, and retention of juvenile...

An Analysis of the Navy Regional Data Automation Center (NARDAC) chargeback System

DTIC Science & Technology

1986-09-01

addition, operational control is concerned with performing predefined activities whereas management control relates to the organiza- tion’s goals and...In effect, the management control system monitors the progress of operations and alerts the "appropriate management level" when performance as measured...architecture, the financial control processes, and the audit function ( Brandon , 1978; Anderson, 1983). In an operating DP environment, however, non-financial

77 FR 42688 - Snapper-Grouper Fishery Off the Southern Atlantic States; Snapper-Grouper Management Measures

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-20

... proposed rule to implement a regulatory amendment (Regulatory Amendment 12) to the Fishery Management Plan... can also attach additional files (up to 10MB) in Microsoft Word, Excel, WordPerfect, or Adobe PDF file... benefit to the nation, particularly with respect to providing food production and recreational...

40 CFR 60.2901 - What should I include in my waste management plan?

Code of Federal Regulations, 2010 CFR

2010-07-01

... management plan must include consideration of the reduction or separation of waste-stream elements such as paper, cardboard, plastics, glass, batteries, or metals; or the use of recyclable materials. The plan... place, the costs of additional measures, the emissions reductions expected to be achieved, and any other...

Knowledge Management Orientation: An Innovative Perspective to Hospital Management

PubMed Central

GHASEMI, Matina; GHADIRI NEJAD, Mazyar; BAGZIBAGLI, Kemal

2017-01-01

Background: By considering innovation as a new project in hospitals, all the project management’s standard steps should be followed in execution. This study investigated the validation of a new set of measures in terms of providing a procedure for knowledge management-oriented innovation that enriches the hospital management system. Methods: The relation between innovation and all the knowledge management areas, as the main constructs of project management, was illustrated by referring to project management standard steps and previous studies. Through consultations and meetings with a committee of professional project managers, a questionnaire was developed to measure ten knowledge management areas in hospital’s innovation process. Additionally, a group of experts from hospital managers were invited to comment on the applicability of the questionnaires by considering if the items are measurable in hospitals practically. Results: A close-ended, Likert-type scale items, consisted of ten sections, were developed based on project management body of knowledge thorough Delphi technique. It enables the managers to evaluate hospitals’ situation to be aware whether the organization follows the knowledge management standards in innovation process or not. By pilot study, confirmatory factor analysis and exploratory factor analysis were conducted to ensure the validity and reliability of the measurement items. Conclusion: The developed items seem to have a potential to help hospital managers and subsequently delivering new products/services successfully based on the standard procedures in their organization. In all innovation processes, the knowledge management areas and their standard steps help hospital managers by a new tool as questionnaire format. PMID:29259938

Measuring healthcare productivity - from unit to system level.

PubMed

Kämäräinen, Vesa Johannes; Peltokorpi, Antti; Torkki, Paulus; Tallbacka, Kaj

2016-04-18

Purpose - Healthcare productivity is a growing issue in most Western countries where healthcare expenditure is rapidly increasing. Therefore, accurate productivity metrics are essential to avoid sub-optimization within a healthcare system. The purpose of this paper is to focus on healthcare production system productivity measurement. Design/methodology/approach - Traditionally, healthcare productivity has been studied and measured independently at the unit, organization and system level. Suggesting that productivity measurement should be done in different levels, while simultaneously linking productivity measurement to incentives, this study presents the challenges of productivity measurement at the different levels. The study introduces different methods to measure productivity in healthcare. In addition, it provides background information on the methods used to measure productivity and the parameters used in these methods. A pilot investigation of productivity measurement is used to illustrate the challenges of measurement, to test the developed measures and to prove the practical information for managers. Findings - The study introduces different approaches and methods to measure productivity in healthcare. Practical implications - A pilot investigation of productivity measurement is used to illustrate the challenges of measurement, to test the developed measures and to prove the practical benefits for managers. Originality/value - The authors focus on the measurement of the whole healthcare production system and try to avoid sub-optimization. Additionally considering an individual patient approach, productivity measurement is examined at the unit level, the organizational level and the system level.

Disease management and medication compliance.

PubMed

Cohen, Joshua; Christensen, Kathyrn; Feldman, Lanna

2012-02-01

Lack of medication compliance is harmful to health care systems from both a clinical and economic perspective. This study examines the methods that disease management organizations employ to identify nonadherent patients and to measure effectiveness of compliance programs for patients with diabetes, hyperlipidemia, and cystic fibrosis. In addition, this study investigates the degree to which disease managers assume risk in their contracts, and whether compliance strategies are being coordinated with payers' use of value-based insurance design, in which patient cost sharing is a function of the relative value of pharmaceuticals. This study's findings suggest that disease management may be falling short in terms of: (a) comprehensive commitment to expert-recommended at-home devices used to self-diagnose and measure health indicators; (b) early adoption of expert-recommended new technologies to measure and improve compliance; (c) intensity of use of standard tests in outpatient clinics; (d) coordination of compliance strategies with payers' use of value-based insurance design; and (e) the proportion of risk assumed in disease management contracts.

An Analysis of Test And Evaluation in Rapid Acquisition Programs

DTIC Science & Technology

2015-12-01

program manager is assigned the requirement and allocated resources to carry out with an acquisition plan. 2. Role of Test and Evaluation Test and...Manual, verify the Maintenance Allocation Chart, and ensure the completeness of the System Support Package. The Maintainability Demonstration measured...additional outside personnel that require additional logistics support, such as security, facilitates, and berthing placing additional strain on units. CLS

Final A Street Pond Expansion Environmental Assessment at Beale Air Force Base, California

DTIC Science & Technology

2008-09-01

Beale AFB Habitat Conservation and Management Plan and the environmental protection measures listed in Table 2-3 in the Environmental Assessment (EA...drainage systems that are of sufficient capacity. With adherence to best management practices (Table 2-3 in the EA), adverse effects from erosion...impacts would be minimized by using best management practices (Table 2-3). In addition, the Proposed Action would be designed to allow adequate storm

Cost-effectiveness of a disease management programme for secondary prevention of coronary heart disease and heart failure in primary care.

PubMed

Turner, D A; Paul, S; Stone, M A; Juarez-Garcia, A; Squire, I; Khunti, K

2008-12-01

To determine if a disease management programme for patients with coronary heart disease and heart failure represents an efficient use of health services resources. We carried out an economic evaluation alongside a cluster randomised control trial of 1163 patients with coronary heart disease and chronic heart failure in 20 primary care practices in the United Kingdom. Practices were randomised to either a control group, where patients received standard general practice care, or an intervention group where patients had access to a specialist nurse-led disease management programme. We estimated costs in both groups for coronary heart disease-related resource use. The main outcome measure used in the economic evaluation was quality adjusted life years (QALY) measured using the EuroQol. The disease management programme was associated with an increase in the QALY measured of 0.03 per year and an increase in the total NHS costs of 425 pounds (540 euros), of this only 83 pounds was directly associated with the provision of the nurse clinics. The clinics generated additional QALY at an incremental cost of 13 pounds 158 per QALY compared to the control group. The use of a nurse-led disease management programme is associated with increased costs in other coronary heart disease-related services as well as for the costs of the clinics. They are also associated with improvements in health. Even in the short term these disease management programmes may represent a cost-effective service, as additional QALY are generated at an acceptable extra cost.

A new measure of the impact of managed care on healthcare markets.

PubMed

Pawlson, L G; Moy, E M; Kim, J I; Griner, P F

2001-11-01

Most studies of managed care impact have used health maintenance organization (HMO) penetration or index of competition as the marker of managed care impact. However, little empirical evidence has been found to support the validity of these or other measures in current use. In addition, as managed care evolves to forms other than HMOs and managed care penetration in large metropolitan areas approaches 100% of commercially insured patients, the utility of the most commonly used measure, HMO penetration, will decrease still further. To provide a preliminary analysis of the use of premiums as a measure of market impact of managed care. Retrospective analysis (quartile, correlation, multiple-variable linear regression) of publicly available datasets. Labor market-adjusted HMO premiums from 3 publicly available sources, for the 56 largest metropolitan areas in the United States, were compared with penetration and index of competition as predictors of the dependent market variable, hospital bed-days per 1000 population. Health maintenance organization premiums in the Federal Employees Health Benefits Program emerged as the best predictor of HMO market impact. Average HMO premiums reported in the Interstudy database and for the Medicare+Choice program also outperformed penetration or index of competition in relating to several commonly available markers of competition such as bed-days per 1000. Premiums charged by HMOs are a useful measure of the impact of managed care on healthcare markets in large metropolitan areas.

Performance measurement for supply chain management and evaluation criteria determination for reverse supply chain management

NASA Astrophysics Data System (ADS)

Kongar, N. Elif

2004-12-01

Today, since customers are able to obtain similar-quality products for similar prices, the lead time has become the only preference criterion for most of the consumers. Therefore, it is crucial that the lead time, i.e., the time spent from the raw material phase till the manufactured good reaches the customer, is minimized. This issue can be investigated under the title of Supply Chain Management (SCM). An efficiently managed supply chain can lead to reduced response time for customers. To achieve this, continuous observation of supply chain efficiency, i.e., a constant performance evaluation of the current SCM is required. Widely used conventional performance measurement methods lack the ability to evaluate a SCM since the supply chain is a dynamic system that requires a more thorough and flexible performance measurement technique. Balanced Scorecard (BS) is an efficient tool for measuring the performance of dynamic systems and has a proven capability of providing the decision makers with the appropriate feedback data. In addition to SCM, a relatively new management field, namely reverse supply chain management (RSCM), also necessitates an appropriate evaluation approach. RSCM differs from SCM in many aspects, i.e., the criteria used for evaluation, the high level of uncertainty involved etc., not allowing the usage of identical evaluation techniques used for SCM. This study proposes a generic Balanced Scorecard to measure the performance of supply chain management while defining the appropriate performance measures for SCM. A scorecard prototype, ESCAPE, is presented to demonstrate the evaluation process.

Wilderness solitude: Beyond the social-spatial perspective

Treesearch

Steven J. Hollenhorst; Christopher D. Jones

2001-01-01

The current scholarly and management approach to wilderness solitude has relied on substitute measures such as crowding and privacy to measure solitude. Lackluster findings have been only partially explained by additional social-spatial factors such as encounter norms, displacement, product shift, and rationalization. Missing from the discussion has been an exploration...

Mobilization and Defense Management Technical Reports Series. The Use of Reactivation Networks to Improve Mobilization Preparedness of the Ammunition Industry

DTIC Science & Technology

1983-05-01

additional measures that if implemented • .could make the technique more effective . •j• . SECURITY CLASSIFICATION OF THIS PAGE t•’/en Data Ente red) qqp...preparedness, and recommends additional measures that if implemented could make the technique more effective . Accession For NTIS GRA&I DTIC .TAB...related to mobilization preparedness. I decided to limit this report to the effects of the application of VERM on the prepiredness of the ammunition

Service Discovery Oriented Management System Construction Method

NASA Astrophysics Data System (ADS)

Li, Huawei; Ren, Ying

2017-10-01

In order to solve the problem that there is no uniform method for design service quality management system in large-scale complex service environment, this paper proposes a distributed service-oriented discovery management system construction method. Three measurement functions are proposed to compute nearest neighbor user similarity at different levels. At present in view of the low efficiency of service quality management systems, three solutions are proposed to improve the efficiency of the system. Finally, the key technologies of distributed service quality management system based on service discovery are summarized through the factor addition and subtraction of quantitative experiment.

Nonprice competition and quality of care in managed care: the New York SCHIP market.

PubMed

Liu, Hangsheng; Phelps, Charles E

2008-06-01

To examine the effect of nonprice competition among managed care plans on the quality of care in the New York SCHIP market. U.S. Census 2000; 2002 New York State Managed Care Plan Performance Report; and 2001 New York State Managed Care Annual Enrollment Report. Each market is defined as a county, and competition is measured as the number of plans in a market. Quality of care is measured in percentages using three Consumer Assessment of Health Plans Survey and three Health Plan Employer Data and Information Set scores. Two-stage least squares is applied to address the endogeneity between competition and the quality of care, using population as an instrument. We find a negative association between competition and quality of care. An additional managed care plan is significantly associated with a decrease of 0.40-2.31 percentage points in four out of six quality measures. After adjusting for production cost, a positive correlation is observed between price and quality measures across different pricing regions. It seems likely that pricing policy is a constraint on quality production, although it may not be interpreted as a causal relationship and further study is needed.

Agricultural management and labile carbon additions affect soil microbial community structure and interact with carbon and nitrogen cycling.

PubMed

Berthrong, Sean T; Buckley, Daniel H; Drinkwater, Laurie E

2013-07-01

We investigated how conversion from conventional agriculture to organic management affected the structure and biogeochemical function of soil microbial communities. We hypothesized the following. (1) Changing agricultural management practices will alter soil microbial community structure driven by increasing microbial diversity in organic management. (2) Organically managed soil microbial communities will mineralize more N and will also mineralize more N in response to substrate addition than conventionally managed soil communities. (3) Microbial communities under organic management will be more efficient and respire less added C. Soils from organically and conventionally managed agroecosystems were incubated with and without glucose ((13)C) additions at constant soil moisture. We extracted soil genomic DNA before and after incubation for TRFLP community fingerprinting of soil bacteria and fungi. We measured soil C and N pools before and after incubation, and we tracked total C respired and N mineralized at several points during the incubation. Twenty years of organic management altered soil bacterial and fungal community structure compared to continuous conventional management with the bacterial differences caused primarily by a large increase in diversity. Organically managed soils mineralized twice as much NO3 (-) as conventionally managed ones (44 vs. 23 μg N/g soil, respectively) and increased mineralization when labile C was added. There was no difference in respiration, but organically managed soils had larger pools of C suggesting greater efficiency in terms of respiration per unit soil C. These results indicate that the organic management induced a change in community composition resulting in a more diverse community with enhanced activity towards labile substrates and greater capacity to mineralize N.

Measuring workplace social support for workers with disability.

PubMed

Lysaght, Rosemary; Fabrigar, Leandre; Larmour-Trode, Sherrey; Stewart, Jeremy; Friesen, Margaret

2012-09-01

Social support in the workplace has been has been demonstrated to serve as a contributor to a worker's ability to manage work demands and to manage stress. Research in the area of disability management indicates that interpersonal factors play an important role in the success of return-to-work interventions. The role of workplace support has received limited attention in rehabilitation, despite the salience of support to the disability management process. Prior to this study, there existed no validated quantitative measure of social support for workers who re-enter the workplace following injury or disability. A support measure prototype, the Support for Workers with Disability Scale, was tested with 152 workers in accommodated work situations. Four validation tools were used to assess criterion validity. Factor analysis was used to validate the content structure and reduce the total number of response items. Additional analysis was conducted to determine the ability of the measure to discriminate between groups, and to provide insight into how social support operates in workplaces. Based on analysis, a reduced measure consisting of 41 items and measuring supervisor, co-worker, and non-work supports was created. Secondary analysis disclosed information concerning the nature of supports in the workplace. Higher levels of support were identified for workers with fewer work role limitations and for those with one versus multiple injury claims. This tool provides a validated outcome measure for research examining the social aspects of workplace disability. It can also serve as a quality management tool for human resource professionals engaged in continuous improvement of disability management programs.

50 CFR 660.131 - Pacific whiting fishery management measures.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., surimi (fish paste with additives), fillets (meat from the side of the fish, behind the head and in front... measures. (a) Sectors. In order for a vessel to fish in a particular whiting fishery sector after May 11... considered to be a catcher/processor nor is it considered to be processing fish. Such a vessel is considered...

The Effect of Curanderismo on Chronic Non-malignant Pain: A Case Report.

PubMed

Kennedy, Laura; Gonzales, Erin; Corbin, Lisa

2016-01-01

This case study describes the effects of the use of curanderismo, an indigenous healing modality combining techniques in massage, sound, and aromatherapy, on a patient with chronic pain. Despite being a commonly used health practice in certain populations, little is reported in the medical literature about the use of curanderismo. Case report as part of a larger randomized trial of curanderismo for chronic pain. Setting was a community-based hospital affiliated primary care clinic. An adult patient with chronic, opioid dependent back pain following an injury, and subsequent spinal fusion was treated. Intervention was the patient received 33 curanderismo treatment sessions over 10 months in addition to ongoing conventional treatment at a community-based chronic pain management clinic. Main outcomes measures were self-reported assessments of pain, functional ability, mood, insomnia, and narcotic usage. Secondary outcome measure was qualitative interview. Although there was no change in quantitative self-reported pain measures, the patient reported improved function, mood, and sleep as well as decreased narcotic usage. Curanderismo, in addition to conventional pain management, improved patient reported symptoms and functional ability, led to healthy lifestyle changes, and decreased narcotic usage. Controlled studies are needed to confirm the benefit of curanderismo as safe, non-interventional, and cost-effective adjunct for chronic pain management. Copyright © 2016 Elsevier Inc. All rights reserved.

Client satisfaction with reproductive health-care quality: integrating business approaches to modeling and measurement.

PubMed

Alden, Dana L; Do, Mai Hoa; Bhawuk, Dharm

2004-12-01

Health-care managers are increasingly interested in client perceptions of clinic service quality and satisfaction. While tremendous progress has occurred, additional perspectives on the conceptualization, modeling and measurement of these constructs may further assist health-care managers seeking to provide high-quality care. To that end, this study draws on theories from business and health to develop an integrated model featuring antecedents to and consequences of reproductive health-care client satisfaction. In addition to developing a new model, this study contributes by testing how well Western-based theories of client satisfaction hold in a developing, Asian country. Applied to urban, reproductive health clinic users in Hanoi, Vietnam, test results suggest that hypothesized antecedents such as pre-visit expectations, perceived clinic performance and how much performance exceeds expectations impact client satisfaction. However, the relative importance of these predictors appears to vary depending on a client's level of service-related experience. Finally, higher levels of client satisfaction are positively related to future clinic use intentions. This study demonstrates the value of: (1) incorporating theoretical perspectives from multiple disciplines to model processes underlying health-care satisfaction and (2) field testing those models before implementation. It also furthers research designed to provide health-care managers with actionable measures of the complex processes related to their clients' satisfaction.

Ride-sharing activities of Virginia industries.

DOT National Transportation Integrated Search

1977-01-01

This study sought to measure the extent of existing ridesharing programs among Virginia industries, the potential for additional ride sharing, as presently perceived by management, and the type of information thought to be most useful to firms consid...

Power management system

DOEpatents

Algrain, Marcelo C.; Johnson, Kris W.; Akasam, Sivaprasad; Hoff, Brian D.

2007-10-02

A method of managing power resources for an electrical system of a vehicle may include identifying enabled power sources from among a plurality of power sources in electrical communication with the electrical system and calculating a threshold power value for the enabled power sources. A total power load placed on the electrical system by one or more power consumers may be measured. If the total power load exceeds the threshold power value, then a determination may be made as to whether one or more additional power sources is available from among the plurality of power sources. At least one of the one or more additional power sources may be enabled, if available.

Interactive Query Processing in Big Data Systems: A Cross Industry Study of MapReduce Workloads

DTIC Science & Technology

2012-04-02

invite cluster operators and the broader data management commu- nity to share additional knowledge about their MapReduce workloads. 9. ACKNOWLEDGMENTS...against real- life production MapReduce workloads. Knowledge of such workloads is currently limited to a handful of technology companies [19, 8, 48, 41...database management insights would benefit from checking workload assumptions against empirical measurements. The broad spectrum of workloads analyzed allows

Measuring recreational visitation at U.S. National Parks with crowd-sourced photographs.

PubMed

Sessions, Carrie; Wood, Spencer A; Rabotyagov, Sergey; Fisher, David M

2016-12-01

Land managers rely on visitation data to inform policy and management decisions. However, visitation data is often costly and burdensome to obtain, and provides a limited depth of information. In this paper, we assess the validity of using crowd-sourced, online photographs to infer information about the habits and preferences of recreational visitors by comparing empirical data from the National Park Service to photograph data from the online platform Flickr for 38 National Parks in the western United States. Using multiple regression analysis, we find that the number of photos posted monthly in a park can reliably indicate the number of visitors to a park in a given month. Through additional statistical testing we also find that the home locations of photo-takers, provided voluntarily on an online profile, accurately show the home origins of park visitors. Together, these findings validate a new method for measuring recreational visitation, opening an opportunity for land managers worldwide to track and understand visitation by augmenting current data collection methods with crowd-sourced, online data that is easy and inexpensive to obtain. In addition, it enables future research on how visitation rates change with changes in access, management or infrastructure, weather events, or ecosystem health, and facilitates valuation research, such as travel cost studies. Copyright © 2016 Elsevier Ltd. All rights reserved.

Nonprice Competition and Quality of Care in Managed Care: The New York SCHIP Market

PubMed Central

Liu, Hangsheng; Phelps, Charles E

2008-01-01

Objective To examine the effect of nonprice competition among managed care plans on the quality of care in the New York SCHIP market. Data Sources U.S. Census 2000; 2002 New York State Managed Care Plan Performance Report; and 2001 New York State Managed Care Annual Enrollment Report. Study Design Each market is defined as a county, and competition is measured as the number of plans in a market. Quality of care is measured in percentages using three Consumer Assessment of Health Plans Survey and three Health Plan Employer Data and Information Set scores. Two-stage least squares is applied to address the endogeneity between competition and the quality of care, using population as an instrument. Principle Findings We find a negative association between competition and quality of care. An additional managed care plan is significantly associated with a decrease of 0.40–2.31 percentage points in four out of six quality measures. After adjusting for production cost, a positive correlation is observed between price and quality measures across different pricing regions. Conclusions It seems likely that pricing policy is a constraint on quality production, although it may not be interpreted as a causal relationship and further study is needed. PMID:18454776

Factor analyses of an Adult Epilepsy Self-Management Measurement Instrument (AESMMI).

PubMed

Escoffery, Cam; Bamps, Yvan; LaFrance, W Curt; Stoll, Shelley; Shegog, Ross; Buelow, Janice; Shafer, Patricia; Thompson, Nancy J; McGee, Robin E; Hatfield, Katherine

2015-09-01

The purpose of this study was to test the psychometric properties of an enhanced Adult Epilepsy Self-Management Measurement Instrument (AESMMI). An instrument of 113 items, covering 10 a priori self-management domains, was generated through a multiphase process, based on a review of the literature, validated epilepsy and other chronic condition self-management scales and expert input. Reliability and exploratory factor analyses were conducted on data collected from 422 adults with epilepsy. The instrument was reduced to 65 items, converging on 11 factors: Health-care Communication, Coping, Treatment Management, Seizure Tracking, Social Support, Seizure Response, Wellness, Medication Adherence, Safety, Stress Management, and Proactivity. Exploratory factors supported the construct validity for 6 a priori domains, albeit with significant changes in the retained items or in their scope and 3 new factors. One a priori domain was split in 2 subscales pertaining to treatment. The configuration of the 11 factors provides additional insight into epilepsy self-management behaviors. Internal consistency reliability of the 65-item instrument was high (α=.935). Correlations with independent measures of health status, quality of life, depression, seizure severity, and life impact of epilepsy further validated the instrument. This instrument shows potential for use in research and clinical settings and for assessing intervention outcomes and self-management behaviors in adults with epilepsy. Copyright © 2015 Elsevier Inc. All rights reserved.

Alcohol management in community sports clubs: impact on viability and participation.

PubMed

Crundall, Ian

2012-08-01

Whether improved alcohol management delivers additional benefits to clubs in the form of financial viability, expanded membership, increased spectators and greater capacity for competition. Measures were derived from 657 Australian community sporting clubs enrolled in the Good Sports program. The program assists clubs to manage alcohol through an accreditation process that sets minimum standards for regulatory compliance, club practices and policies. Measures were taken from survey information collected prior to Level 1 accreditation and at the third and final level of club accreditation. Income was found to increase and reliance on alcohol as a funding source was found to diminish over time. Membership increased and was accelerated among females, young people and non-players. No changes in the number of junior and senior teams or players were found. Improved alcohol management can produce a range of benefits beyond responsible drinking patterns that add to club sustainability.

75 FR 38030 - Magnuson-Stevens Act Provisions; Fisheries Off West Coast States; Pacific Coast Groundfish...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-01

... disruption to summer fisheries, as no additional restrictions to fishery management measures are necessary at... impacts within the lowered yelloweye rockfish OY in accordance with the court's order; makes routine in...

A systematic review of risk factors associated with accidental falls, outcome measures and interventions to manage fall risk in non-ambulatory adults.

PubMed

Rice, Laura A; Ousley, Cherita; Sosnoff, Jacob J

2015-01-01

To systematically review peer-reviewed literature pertaining to risk factors, outcome measures and interventions managing fall risk in non-ambulatory adults. Twenty-one papers were selected for inclusion from databases including PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Scopus, Consumer Health Complete and Web of Science. Selected studies involved a description of fall related risk factors, outcomes to assess fall risk and intervention studies describing protocols to manage fall risk in non-ambulatory adults. Studies were selected by two reviewers and consultation provided by a third reviewer. The most frequently cited risk factors/characteristics associated with falls included: wheelchair related characteristics, transfer activities, impaired seated balance and environmental factors. The majority of the outcomes were found to evaluate seated postural control. One intervention study was identified describing a protocol targeting specific problems of individual participants. A global fall prevention program was not identified. Several risk factors associated with falls were identified and must be understood by clinicians to better serve their clients. To improve objective assessment, a comprehensive outcome assessment specific to non-ambulatory adults is needed. Finally, additional research is needed to examine the impact of structured protocols to manage fall risk in non-ambulatory adults. Falls are a common health concern for non-ambulatory adults. Risk factors commonly associated with falls include wheelchair related characteristics, transfer activities, impaired seated balance and environmental factors. Limited outcome measures are available to assess fall risk in non-ambulatory adults. Clinicians must be aware of the known risk factors and provide comprehensive education to their clients on the potential for falls. Additional research is needed to develop and evaluate protocols to clinically manage fall risk.

New knowledge network evaluation method for design rationale management

NASA Astrophysics Data System (ADS)

Jing, Shikai; Zhan, Hongfei; Liu, Jihong; Wang, Kuan; Jiang, Hao; Zhou, Jingtao

2015-01-01

Current design rationale (DR) systems have not demonstrated the value of the approach in practice since little attention is put to the evaluation method of DR knowledge. To systematize knowledge management process for future computer-aided DR applications, a prerequisite is to provide the measure for the DR knowledge. In this paper, a new knowledge network evaluation method for DR management is presented. The method characterizes the DR knowledge value from four perspectives, namely, the design rationale structure scale, association knowledge and reasoning ability, degree of design justification support and degree of knowledge representation conciseness. The DR knowledge comprehensive value is also measured by the proposed method. To validate the proposed method, different style of DR knowledge network and the performance of the proposed measure are discussed. The evaluation method has been applied in two realistic design cases and compared with the structural measures. The research proposes the DR knowledge evaluation method which can provide object metric and selection basis for the DR knowledge reuse during the product design process. In addition, the method is proved to be more effective guidance and support for the application and management of DR knowledge.

Disease management as a performance improvement strategy.

PubMed

McClatchey, S

2001-11-01

Disease management is a strategy of organizing care and services for a patient population across the continuum. It is characterized by a population database, interdisciplinary and interagency collaboration, and evidence-based clinical information. The effectiveness of a disease management program has been measured by a combination of clinical, financial, and quality of life outcomes. In early 1997, driven by a strategic planning process that established three Centers of Excellence (COE), we implemented disease management as the foundation for a new approach to performance improvement utilizing five key strategies. The five implementation strategies are outlined, in addition to a review of the key elements in outcome achievement.

Doctor, my child is bullied: food allergy management in schools.

PubMed

Egan, Maureen; Sicherer, Scott

2016-06-01

Studies suggest that food allergies have increased in prevalence, resulting in most school classrooms having more than one child affected. Children with food allergies are vulnerable for experiencing potentially life-threatening allergic reactions, as well as social consequences such as bullying. Management recommendations for food allergies in schools should incorporate knowledge of both issues. Current recommendations for food allergy management in schools focus on appropriate avoidance measures and prompt recognition and treatment of allergic reactions. Guidelines focus upon a school-wide approach, with comprehensive involvement of many stakeholders, but individual students require specific emergency action plans. Special risk groups include young children who need additional supervision and adolescents who may take risks. Based on the observation that anaphylaxis can occur in persons without a prior diagnosis, having epinephrine available for prompt first-aid management of any student in need is now recommended. To promote socialization, avoidance measures should minimize separation of children with food allergies from their peers. Parents and schools need to be aware of bullying and implement intervention and prevention measures. Management recommendations for food allergies in schools should ensure the safety of the child, address bullying, and avoid unnecessary isolation.

[Greenhouse gas emissions, carbon leakage and net carbon sequestration from afforestation and forest management: A review.

PubMed

Liu, Bo Jie; Lu, Fei; Wang, Xiao Ke; Liu, Wei Wei

2017-02-01

Forests play an important role in climate change mitigation and concentration of CO 2 reduction in the atmosphere. Forest management, especially afforestation and forest protection, could increase carbon stock of forests significantly. Carbon sequestration rate of afforestation ranges from 0.04 to 7.52 t C·hm -2 ·a -1 , while that of forest protection is 0.33-5.20 t C·hm -2 ·a -1 . At the same time, greenhouse gas (GHG) is generated within management boundary due to the production and transportation of the materials consumed in relevant activities of afforestation and forest management. In addition, carbon leakage is also generated outside boundary from activity shifting, market effects and change of environments induced by forest management. In this review, we summarized the definition of emission sources of GHG, monitoring methods, quantity and rate of greenhouse gas emissions within boundary of afforestation and forest management. In addition, types, monitoring methods and quantity of carbon leakage outside boundary of forest management were also analyzed. Based on the reviewed results of carbon sequestration, we introduced greenhouse gas emissions within boundary and carbon leakage, net carbon sequestration as well as the countervailing effects of greenhouse gas emissions and carbon leakage to carbon sequestration. Greenhouse gas emissions within management boundary counteract 0.01%-19.3% of carbon sequestration, and such counteraction could increase to as high as 95% considering carbon leakage. Afforestation and forest management have substantial net carbon sequestration benefits, when only taking direct greenhouse gas emissions within boundary and measurable carbon leakage from activity shifting into consideration. Compared with soil carbon sequestration measures in croplands, afforestation and forest management is more advantageous in net carbon sequestration and has better prospects for application in terms of net mitigation potential. Along with the implementation of the new stage of key ecological stewardship projects in China as well as the concern on carbon benefits brought by projects, it is necessary to make efforts to increase net carbon sequestration via reducing greenhouse gas emissions and carbon leakage. Rational planning before start-up of the projects should be promoted to avoid carbon emissions due to unnecessary consumption of materials and energy. Additionally, strengthening the control and monitoring on greenhouse gas emissions and carbon leakage during the implementation of projects are also advocated.

76 FR 19977 - Fisheries of the South Atlantic; South Atlantic Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-11

... Doubletree Guest Suites Hotel, 181 Church St., Charleston, SC 29401; telephone: (843) 408-8733 or (843) 577... discuss: Fiscal Year (FY) 2011 and FY2012 budgets and additional grant funds; performance measures status...

Basic principles of stability.

PubMed

Egan, William; Schofield, Timothy

2009-11-01

An understanding of the principles of degradation, as well as the statistical tools for measuring product stability, is essential to management of product quality. Key to this is management of vaccine potency. Vaccine shelf life is best managed through determination of a minimum potency release requirement, which helps assure adequate potency throughout expiry. Use of statistical tools such a least squares regression analysis should be employed to model potency decay. The use of such tools provides incentive to properly design vaccine stability studies, while holding stability measurements to specification presents a disincentive for collecting valuable data. The laws of kinetics such as Arrhenius behavior help practitioners design effective accelerated stability programs, which can be utilized to manage stability after a process change. Design of stability studies should be carefully considered, with an eye to minimizing the variability of the stability parameter. In the case of measuring the degradation rate, testing at the beginning and the end of the study improves the precision of this estimate. Additional design considerations such as bracketing and matrixing improve the efficiency of stability evaluation of vaccines.

Effectiveness of Telebehavioral Health Program Nurse Case Managers (NCM): Data Collection Tools and the Process for NCM-Sensitive Outcome Measures.

PubMed

Carlson, Judy; Cohen, Roslyn; Bice-Stephens, Wynona

2014-01-01

As a part of our nation's pursuit of improvements in patient care outcomes, continuity of care, and cost containment, the case manager has become a vital member on interdisciplinary teams and in health care agencies. Telebehavioral health programs, as a relatively new method of delivering behavioral health care, have recently begun to incorporate case management into their multidisciplinary teams. To determine the efficacy and efficiency of healthcare programs, program managers are charged with the determination of the outcomes of the care rendered to patient populations. However, programs that use telehealth methods to deliver care have unique structures in place that impact ability to collect outcome data. A military medical center that serves the Pacific region developed surveys and processes to distribute, administer, and collect information about a telehealth environment to obtain outcome data for the nurse case manager. This report describes the survey development and the processes created to capture nurse case manager outcomes. Additionally, the surveys and processes developed in this project for measuring outcomes may be useful in other settings and disciplines.

The relative effectiveness of self-management programs for type 2 diabetes.

PubMed

McGowan, Patrick

2015-10-01

The objectives of the study were to investigate the effectiveness of 2 types of peer-led self-management programs in bringing about improvements in subjects with type 2 diabetes mellitus and to determine whether there were differences in effectiveness between the 2 programs. The study used a 3-arm randomized controlled trial design with clinical measures taken at baseline and at 6 and 12 months post-program. In total, 405 persons completed baseline questionnaires and were randomly allocated to a diabetes self-management program (n=130), to a general self-management program (n=109) or to a control group (n=122). A 2-way factorial analyses of variance was employed as the primary statistical analysis. The findings showed that the self-management programs had affected 5 of the 30 measures: fatigue, cognitive symptom management, self-efficacy with regard to the disease in general, communication with physician, and the score on the Diabetes Empowerment Scale. In addition, 3 variables-social role limitations, total hospital nights and glycated hemoglobin levels-showed marginally significant interaction effects. The second analysis found similar results, with 4 of the 5 measures remaining statistically significant: fatigue, cognitive symptom management, communication with physician and diabetes empowerment, with neither program being more effective than the other. The major findings are that although both programs were effective in bringing about positive changes in the outcome measures, there was little difference in effectiveness between the Diabetes Self-Management Program and the Chronic Disease Self-Management Program. This finding is consistent with the principle that behaviour-change strategies using self-efficacy are key components in health education programs. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

Hospital-Based Clinical Pharmacy Services to Improve Ambulatory Management of Chronic Obstructive Pulmonary Disease

PubMed Central

Smith, Amber Lanae; Palmer, Valerie; Farhat, Nada; Kalus, James S.; Thavarajah, Krishna; DiGiovine, Bruno; MacDonald, Nancy C.

2016-01-01

Background: No systematic evaluations of a comprehensive clinical pharmacy process measures currently exist to determine an optimal ambulatory care collaboration model for chronic obstructive pulmonary disease (COPD) patients. Objective: Describe the impact of a pharmacist-provided clinical COPD bundle on the management of COPD in a hospital-based ambulatory care clinic. Methods: This retrospective cohort analysis evaluated patients with COPD managed in an outpatient pulmonary clinic. The primary objective of this study was to assess the completion of 4 metrics known to improve the management of COPD: (1) medication therapy management, (2) quality measures including smoking cessation and vaccines, (3) patient adherence, and (4) patient education. The secondary objective was to evaluate the impact of the clinical COPD bundle on clinical and economic outcomes at 30 and 90 days post–initial visit. Results: A total of 138 patients were included in the study; 70 patients served as controls and 68 patients received the COPD bundle from the clinical pharmacist. No patients from the control group had all 4 metrics completed as documented, compared to 66 of the COPD bundle group (P < .0001). Additionally, a statistically significant difference was found in all 4 metrics when evaluated individually. Clinical pharmacy services reduced the number of phone call consults at 90 days (P = .04) but did not have a statistically significant impact on any additional pre-identified clinical outcomes. Conclusion: A pharmacist-driven clinical COPD bundle was associated with significant increases in the completion and documentation of 4 metrics known to improve the outpatient management of COPD.

Use of Chemical Inventory Accuracy Measurements as Leading Indicators

DOE Office of Scientific and Technical Information (OSTI.GOV)

Quigley, David; Freshwater, David; Alnajjar, Mikhail S.

2012-05-15

Chemical safety and lifecycle management (CSLM) is a process that involves managing chemicals and chemical information from the moment someone begins to order a chemical and lasts through final disposition(1). Central to CSLM is tracking data associated with chemicals which, for the purposes of this paper, is termed the chemical inventory. Examples of data that could be tracked include chemical identity, location, quantity, date procured, container type, and physical state. The reason why so much data is tracked is that the chemical inventory supports many functions. These functions include emergency management, which depends upon the data to more effectively planmore » for, and respond to, chemical accidents; environmental management that uses inventory information to aid in the generation of various federally-mandated and other regulatory reports; and chemical management that uses the information to increase the efficiency and safety with which chemicals are stored and utilized. All of the benefits of having an inventory are predicated upon having an inventory that is reasonably accurate. Because of the importance of ensuring one's chemical inventory is accurate, many have become concerned about measuring inventory accuracy. But beyond providing a measure of confidence in information gleaned from the inventory, does the inventory accuracy measurement provide any additional function? The answer is 'Yes'. It provides valuable information that can be used as a leading indicator to gauge the health of a chemical management system. In this paper, we will discuss: (1) what properties make leading indicators effective, (2) how chemical inventories can be used as a leading indicator, (3) how chemical inventory accuracy can be measured, what levels of accuracies should realistically be expected in a healthy system, and (4) what a subpar inventory accuracy measurement portends.« less

Multi-channel temperature measurement system for automotive battery stack

NASA Astrophysics Data System (ADS)

Lewczuk, Radoslaw; Wojtkowski, Wojciech

2017-08-01

A multi-channel temperature measurement system for monitoring of automotive battery stack is presented in the paper. The presented system is a complete battery temperature measuring system for hybrid / electric vehicles that incorporates multi-channel temperature measurements with digital temperature sensors communicating through 1-Wire buses, individual 1-Wire bus for each sensor for parallel computing (parallel measurements instead of sequential), FPGA device which collects data from sensors and translates it for CAN bus frames. CAN bus is incorporated for communication with car Battery Management System and uses additional CAN bus controller which communicates with FPGA device through SPI bus. The described system can parallel measure up to 12 temperatures but can be easily extended in the future in case of additional needs. The structure of the system as well as particular devices are described in the paper. Selected results of experimental investigations which show proper operation of the system are presented as well.

A critical review of the literature on fear of hypoglycemia in diabetes: Implications for diabetes management and patient education.

PubMed

Wild, Diane; von Maltzahn, Robyn; Brohan, Elaine; Christensen, Torsten; Clauson, Per; Gonder-Frederick, Linda

2007-09-01

In many individuals with diabetes, the unpleasant symptoms and negative consequences associated with hypoglycemia may result in significant anxiety or even a fear of hypoglycemia (FoH). This fear may have significant clinical implications for diabetes management. The aim of this review is to integrate existing research on FoH (its measurement, predictors, correlates, impact and treatment) and discuss its implications for diabetes management and patient education. A literature search was conducted using Medline and Embase. The search was limited to journal articles published in English from 1985 to 2007 inclusive. Three hundred and one abstracts were reviewed and 273 were rejected on the basis of non-relevance. In addition to the 28 papers included, six additional papers were identified by further searches and were added to this review. FoH appears to be a widespread phenomenon. It is measured primarily through the use of a specific scale, the Hypoglycemic Fear Survey (HFS). There are a number of factors that relate to whether an individual is likely to develop FoH including whether there is a history of hypoglycemia in an individual, length of time since first insulin treatment, and a higher level of variability in blood glucose level. FoH has been linked to both state and trait anxiety although the relationship is complex. There is evidence that FoH may have a significant negative impact on diabetes management, metabolic control and subsequent health outcomes. There is evidence that blood glucose (BG) awareness training and CBT can reduce levels of fear and improve disease management. More research is needed on how FoH arises and the individual variables which predict its development. In addition, well designed research is required to better understand the behavioral and medical impact of FoH, and interventions to reduce it. There is some evidence to suggest that interventions including BG awareness training and cognitive behavioral therapy can reduce levels of fear and improve disease management. While many aspects of FoH require further well-designed research, it is evident that this phenomenon can have a major impact on diabetes management and needs to be specifically addressed in patient education programs.

Confirmatory Factor Analysis of the Bases of Leader Power: First-Order Factor Model and Its Invariance Across Groups.

PubMed

Rahim, M A; Magner, N R

1996-10-01

Confirmatory factor analyses of data (from five samples: N = 308 accountants and finance professionals, N = 578 management and non-management employees, and N = 588 employed management students in the U.S.; N = 728 management and non-management employees in S. Korea, N = 250 management and non-management bank employees in Bangladesh) on the 29 items of the Rahim Leader Power Inventory were performed with LISREL 7. The results provided support for the convergent and discriminant validities of the subscales measuring the five bases of leader power (coercive, reward, legitimate, expert, and referent), and the invariance of factor pattern and factor loadings across organizational levels and the three American samples. Additional analysis indicated that leader power profiles differed across the three national cultures represented in the study.

A systematic review of instruments that assess the implementation of hospital quality management systems.

PubMed

Groene, Oliver; Botje, Daan; Suñol, Rosa; Lopez, Maria Andrée; Wagner, Cordula

2013-10-01

Health-care providers invest substantial resources to establish and implement hospital quality management systems. Nevertheless, few tools are available to assess implementation efforts and their effect on quality and safety outcomes. This review aims to (i) identify instruments to assess the implementation of hospital quality management systems, (ii) describe their measurement properties and (iii) assess the effects of quality management on quality improvement and quality of care outcomes. We performed a systematic literature search from 1990 to 2011 in PubMed, CINAHL, EMBASE, Cochrane Library and Web of Science. In addition, we used snowball strategies, screened the reference lists of eligible papers, reviewed grey literature and contacted experts in the field. and data extraction Two reviewers screened eligible papers based on pre-defined inclusion and exclusion criteria and all authors extracted data. Eligible papers are described in terms of general characteristics (settings, type and level of respondents, mode of data collection), methodological properties (sampling strategy, item derivation, conceptualization of quality management, assessment of reliability and validity, scoring) and application/implementation (accounting for context, organizational adaptations, sensitivity to change, deployment and effect size). Eighteen papers were deemed eligible for inclusion. While some common domains emerged in measurement conceptualization, substantial differences in scope persist. The instruments' measurement properties were insufficiently described and only few instruments assessed links between the implementation of quality management systems (QMS) and improvement strategies or outcomes. There is currently no well-established measure to assess the implementation and effectiveness of quality management systems. Future research should address this gap.

Methods for understanding super-efficient data envelopment analysis results with an application to hospital inpatient surgery.

PubMed

O'Neill, Liam; Dexter, Franklin

2005-11-01

We compare two techniques for increasing the transparency and face validity of Data Envelopment Analysis (DEA) results for managers at a single decision-making unit: multifactor efficiency (MFE) and non-radial super-efficiency (NRSE). Both methods incorporate the slack values from the super-efficient DEA model to provide a more robust performance measure than radial super-efficiency scores. MFE and NRSE are equivalent for unique optimal solutions and a single output. MFE incorporates the slack values from multiple output variables, whereas NRSE does not. MFE can be more transparent to managers since it involves no additional optimization steps beyond the DEA, whereas NRSE requires several. We compare results for operating room managers at an Iowa hospital evaluating its growth potential for multiple surgical specialties. In addition, we address the problem of upward bias of the slack values of the super-efficient DEA model.

Can managed care plans control health care costs?

PubMed

Zwanziger, J; Melnick, G A

1996-01-01

The health insurance sector has been transformed in the past fifteen years, with managed care replacing indemnity insurance as the norm. This transformation was intended to change the nature of competition in the health care system so that market forces could be used to control costs. Empirical studies have shown that this objective has been met, as areas with high managed care penetration have tended to have much lower rates of increase in their costs. Creating a more efficient health care system will require additional efforts to produce useful measures of quality and to maintain competitive markets.

Outcomes of crew resource management training

NASA Technical Reports Server (NTRS)

Helmreich, Robert L.; Wilhelm, John A.

1991-01-01

Participants' self-reports and measures of attitudes regarding flightdeck management indicate that crew resource management training is favorably received and causes highly significant, positive changes in attitudes regarding crew coordination and personal capabilities. However, a subset of participants reacted negatively to the training and showed boomerangs (negative change) in attitudes. Explorations into the causes of this effect pinpoint personality factors and group dynamics as critical determinants of reactions to training and of the magnitude and direction of attitude changes. Implications of these findings for organizations desiring to enhance crew effectiveness are discussed, and areas of needed additional research are described.

76 FR 74038 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; Reef Fish Resources of the Gulf...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-30

...This notice announces that the Gulf of Mexico Fishery Management Council (Council) is considering creating additional restrictions limiting participation in the Red Snapper Individual Fishing Quota (IFQ) Program. If such management measures are implemented, the Council is considering January 1, 2012, as a possible control date. Anyone entering the program after the control date will not be assured of future access should a management regime that limits participation in the program be prepared and implemented. NMFS invites comments on the establishment of this control date.

Approach to Managing MeaSURES Data at the GSFC Earth Science Data and Information Services Center (GES DISC)

NASA Technical Reports Server (NTRS)

Vollmer, Bruce; Kempler, Steven J.; Ramapriyan, Hampapuram K.

2009-01-01

A major need stated by the NASA Earth science research strategy is to develop long-term, consistent, and calibrated data and products that are valid across multiple missions and satellite sensors. (NASA Solicitation for Making Earth System data records for Use in Research Environments (MEaSUREs) 2006-2010) Selected projects create long term records of a given parameter, called Earth Science Data Records (ESDRs), based on mature algorithms that bring together continuous multi-sensor data. ESDRs, associated algorithms, vetted by the appropriate community, are archived at a NASA affiliated data center for archive, stewardship, and distribution. See http://measures-projects.gsfc.nasa.gov/ for more details. This presentation describes the NASA GSFC Earth Science Data and Information Services Center (GES DISC) approach to managing the MEaSUREs ESDR datasets assigned to GES DISC. (Energy/water cycle related and atmospheric composition ESDRs) GES DISC will utilize its experience to integrate existing and proven reusable data management components to accommodate the new ESDRs. Components include a data archive system (S4PA), a data discovery and access system (Mirador), and various web services for data access. In addition, if determined to be useful to the user community, the Giovanni data exploration tool will be made available to ESDRs. The GES DISC data integration methodology to be used for the MEaSUREs datasets is presented. The goals of this presentation are to share an approach to ESDR integration, and initiate discussions amongst the data centers, data managers and data providers for the purpose of gaining efficiencies in data management for MEaSUREs projects.

Marketing a managed care plan: achieving product differentiation.

PubMed

Romeo, N C

1996-01-01

The health care marketplace is changing dramatically, even without federal reform measures. This is a volatile, yet promising, time to market a managed care plan. Before marketing the product, it is critical that the competition is thoroughly evaluated and consumer and employer needs are researched. The final product should be distinguishable from the competition and address market needs. Promotion can then begin, utilizing a proactive public relations and advertising campaign in addition to traditional methods of marketing.

NASA's EOSDIS, Trust and Certification

NASA Technical Reports Server (NTRS)

Ramapriyan, H. K.

2017-01-01

NASA's Earth Observing System Data and Information System (EOSDIS) has been in operation since August 1994, managing most of NASA's Earth science data from satellites, airborne sensors, filed campaigns and other activities. Having been designated by the Federal Government as a project responsible for production, archiving and distribution of these data through its Distributed Active Archive Centers (DAACs), the Earth Science Data and Information System Project (ESDIS) is responsible for EOSDIS, and is legally bound by the Office of Management and Budgets circular A-130, the Federal Records Act. It must follow the regulations of the National Institute of Standards and Technologies (NIST) and National Archive and Records Administration (NARA). It must also follow the NASA Procedural Requirement 7120.5 (NASA Space Flight Program and Project Management). All these ensure that the data centers managed by ESDIS are trustworthy from the point of view of efficient and effective operations as well as preservation of valuable data from NASA's missions. Additional factors contributing to this trust are an extensive set of internal and external reviews throughout the history of EOSDIS starting in the early 1990s. Many of these reviews have involved external groups of scientific and technological experts. Also, independent annual surveys of user satisfaction that measure and publish the American Customer Satisfaction Index (ACSI), where EOSDIS has scored consistently high marks since 2004, provide an additional measure of trustworthiness. In addition, through an effort initiated in 2012 at the request of NASA HQ, the ESDIS Project and 10 of 12 DAACs have been certified by the International Council for Science (ICSU) World Data System (WDS) and are members of the ICSUWDS. This presentation addresses questions such as pros and cons of the certification process, key outcomes and next steps regarding certification. Recently, the ICSUWDS and Data Seal of Approval (DSA) organizations merged their Core Trustworthy Data Repositories Requirements and require that members be recertified every three years. Given the rigor with which NASA manages the ESDIS Project and the DAACs, the recertification through WDSDSA, while involving some additional work, is a relatively simple process.

Identification of Measures and Indicators for the IT Security of Networked Medical Devices: A Delphi Study.

PubMed

Leber, Stefan; Ammenwerth, Elske

2017-01-01

The networking of medical devices or systems in a hospital network is the foundation for modern medical diagnostics and therapy. This, however, makes possible numerous hazards that could lead to risks for patients, clinical processes or data and information. The aim of the work was to develop a catalogue of measures and indicators for the effective support of the IT risk management process in a health facility. Through a qualitative and quantitative Delphi study among 21 experts, it was possible to identify an initial 51 practice-relevant measures of IT risk management that a hospital should implement. Additionally, 27 indicators were defined which can be used to measure the impact of these measures. Of the 51 measures, 35 were seen as especially important, particularly organizational measures. Of the 27 indicators, six were seen as especially important, particularly indicators to measure networking effectiveness. The study also investigated the impact of the measures on the indicators. A case study is planned to investigate the practicability of the identified measures and indicators.

Individual variability and environmental characteristics influence older adults' abilities to manage everyday technology.

PubMed

Malinowsky, Camilla; Almkvist, Ove; Nygård, Louise; Kottorp, Anders

2012-03-01

The ability to manage everyday technology (ET), such as computers and microwave ovens, is increasingly required in the performance of everyday activities and participation in society. This study aimed to identify aspects that influence the ability to manage ET among older adults with and without cognitive impairment. Older adults with mild Alzheimer's disease and mild cognitive impairment and without known cognitive impairment were assessed as they managed their ET at home. Data were collected using the Management of Everyday Technology Assessment (META). Rasch-based measures of the person's ability to manage ET were analyzed. These measures were used as dependent variables in backward procedure ANOVA analyses. Different predefined aspects that could influence the ability to manage ET were used as independent variables. Three aspects had a significant effect upon the ability to manage ET. These were: (1) variability in intrapersonal capacities (such as "the capacity to pay attention and focus", (2) environmental characteristics (such as "the impact of the design") and (3) diagnostic group. Variability in intrapersonal capacities seems to be of more importance than the actual level of intrapersonal capacity in relation to the ability to manage ET for this sample. This implies that investigations of ability to manage ET should also include intraperson variability. Additionally, adaptations in environmental characteristics could simplify the management of ET to support older adults as technology users.

Harnessing the Power of Intellectual Capital.

ERIC Educational Resources Information Center

Bassi, Laurie J.

1997-01-01

Describes intellectual capital--employees' brainpower, know-how, knowledge, and processes--and knowledge management--the processes by which a company creates and leverages intellectual capital--as the primary sources of competitive advantage in many industries. Offers ways to measure intellectual capital, a glossary, and additional resources. (JOW)

Pilot study: incorporation of pharmacogenetic testing in medication therapy management services.

PubMed

Haga, Susanne B; Allen LaPointe, Nancy M; Moaddeb, Jivan; Mills, Rachel; Patel, Mahesh; Kraus, William E

2014-11-01

Aim: To describe the rationale and design of a pilot study evaluating the integration of pharmacogenetic (PGx) testing into pharmacist-delivered medication therapy management (MTM). Study rationale: Clinical delivery approaches of PGx testing involving pharmacists may overcome barriers of limited physician knowledge about and experience with testing. Study design: We will assess the addition of PGx testing to MTM services for cardiology patients taking three or more medications including simvastatin or clopidogrel. We will measure the impact of MTM plus PGx testing on drug/dose adjustment and clinical outcomes. Factors associated with delivery, such as time to prepare and conduct MTM and consult with physicians will be recorded. Additionally, patient interest and satisfaction will be measured. Anticipated results: We anticipate that PGx testing can be practically integrated into standard a MTM service, providing a viable delivery model for testing. Conclusion: Given the lack of evidence of an effective PGx delivery models, this study will provide preliminary evidence regarding a pharmacist-delivered approach.

Patient outcomes and experiences of an acupuncture and self-care service for persistent low back pain in the NHS: a mixed methods approach

PubMed Central

2013-01-01

Background Supported self-management, acupuncture and information can help reduce the symptoms of low back pain. These approaches are currently recommended by NICE guidance as treatment options for patients with persistent low back pain. However, there has been no previous evaluation of a service providing them together for this common problem. The purpose of this service evaluation was to report patient outcomes and experiences of the Beating Back Pain Service (BBPS), a pilot service based in a primary and community care setting, delivering acupuncture, self-management and information to patients with chronic low back pain. Methods Patients completed a questionnaire at three time points: pre-BBPS, immediately post-BBPS and three months post-BBPS. Outcome measures included the Bournemouth Questionnaire (measuring musculoskeletal, MSK, problems), EuroQoL-5D (measuring quality of life), Pain and Self-efficacy Questionnaire, and additional questions on medication use, physical activity, understanding of pain and positive well-being. Additionally, the STarT Back (measuring risk of developing chronic pain) was collected at BBPS information sessions. Non-parametric tests were used to evaluate pre- and post- variables. Questionnaires also collected qualitative data (open-text responses) regarding patient views and experiences of the BBPS, which were analysed using thematic analysis. Results 80 (out of 108) patients who attended the initial BBPS information session agreed to participate in the service evaluation (mean age 47 years, 65% female). 65 patients attended subsequent BBPS acupuncture and/or self-management sessions and were asked to complete post-treatment questionnaires; complete datasets were available for 61 patients. There were statistically significant improvements over time for pain (p <0.0001), quality of life (p = 0.006), understanding of pain (p <0.001), physical activity (p = 0.047) and relaxation (p = 0.012). Post-hoc analysis revealed that scores improved between baseline and post-treatment, these improvements were maintained at 3-month follow-up (except relaxation). Patients receiving a combination of acupuncture and self-management sessions produced the most positive results. Patient satisfaction with the BBPS was high. Conclusions The BBPS provided a MSK pain management service that many patients found effective and valuable. Combining self-management with acupuncture was found to be particularly effective, although further consideration is required regarding how best to engage patients in self-management. PMID:24180515

Change in quality management in diabetes care groups and outpatient clinics after feedback and tailored support.

PubMed

Campmans-Kuijpers, Marjo J; Baan, Caroline A; Lemmens, Lidwien C; Rutten, Guy E

2015-02-01

To assess the change in level of diabetes quality management in primary care groups and outpatient clinics after feedback and tailored support. This before-and-after study with a 1-year follow-up surveyed quality managers on six domains of quality management. Questionnaires measured organization of care, multidisciplinary teamwork, patient centeredness, performance results, quality improvement policy, and management strategies (score range 0-100%). Based on the scores, responders received feedback and a benchmark and were granted access to a toolbox of quality improvement instruments. If requested, additional support in improving quality management was available, consisting of an elucidating phone call or a visit from an experienced consultant. After 1 year, the level of quality management was measured again. Of the initially 60 participating care groups, 51 completed the study. The total quality management score improved from 59.8% (95% CI 57.0-62.6%) to 65.1% (62.8-67.5%; P < 0.0001). The same applied to all six domains. The feedback and benchmark improved the total quality management score (P = 0.001). Of the 44 participating outpatient clinics, 28 completed the study. Their total score changed from 65.7% (CI 60.3-71.1%) to 67.3% (CI 62.9-71.7%; P = 0.30). Only the results in the domain multidisciplinary teamwork improved (P = 0.001). Measuring quality management and providing feedback and a benchmark improves the level of quality management in care groups but not in outpatient clinics. The questionnaires might also be a useful asset for other diabetes care groups, such as Accountable Care Organizations. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Use of 137Cs measurements to estimate changes in soil erosion rates associated with changes in soil management practices on cultivated land.

PubMed

Schuller, P; Walling, D E; Sepúlveda, A; Trumper, R E; Rouanet, J L; Pino, I; Castillo, A

2004-05-01

Intensification of agricultural production in south-central Chile since the 1970s has caused problems of increased soil erosion and associated soil degradation. These problems have prompted a shift from conventional tillage to no-till management practices. Faced with the need to establish the impact of this shift in soil management on rates of soil loss, the use of caesium-137 (137Cs) measurements has been explored. A novel procedure for using measurements of the 137Cs depth distribution to estimate rates of soil loss at a sampling point under the original conventional tillage and after the shift to no-till management has been developed. This procedure has been successfully applied to a study site at Buenos Aires farm near Carahue in the 9th region of Chile. The results obtained indicate that the shift from conventional tillage to no-till management has caused net rates of soil loss to decrease to about 40% of those existing under conventional tillage. This assessment of the impact of introducing no-till management at the study site must, however, be seen as provisional, since only a limited number of sampling points were used. A simplified procedure aimed at documenting the reduction in erosion rates at additional sampling points, based solely on measurements of the 137Cs inventory of bulk cores and the 137Cs activity in the upper part of the soil has been developed and successfully tested at the study site. Previous application of 137Cs measurements to estimate erosion rates has been limited to estimation of medium-term erosion rates during the period extending from the beginning of fallout receipt to the time of sampling. The procedures described in this paper, which permits estimation of the change in erosion rates associated with a shift in land management practices, must be seen as representing a novel application of 137Cs measurements in soil erosion investigations.

Capitalists, managers, professionals and mortality: findings from the Barcelona social class and all cause mortality longitudinal study.

PubMed

Muntaner, Carles; Borrell, Carme; Solà, Judit; Marì-Dell'olmo, Marc; Chung, Haejoo; Rodríguez-Sanz, Maica; Benach, Joan; Noh, Samuel

2009-11-01

To examine the effects of Neo-Marxian social class (i.e. measured as relations of control over productive assets) and potential mediators such as labour-market position, work organization, material deprivation and health behaviours upon mortality in Barcelona, Spain. Longitudinal data from the Barcelona 2000 Health Interview Survey (n = 7526) with follow-up interviews through the municipal census in 2008 (95.97% response rate) were used. Using data on relations of property, organizational power, and education, social classes were grouped according to Wright's scheme: capitalists, petit bourgeoisie, managers, supervisors, and skilled, semi-skilled and unskilled workers. Social class, measured as relations of control over productive assets, is an important predictor of mortality among working-class positions for men but not for women. Workers (hazard ratio 1.60, 95% confidence interval 1.10-2.35), managers and small employers had a higher risk of death than capitalists. The extensive use of conventional gradient measures of social stratification has neglected sociological measurements of social class conceptualized as relations of control over productive assets. This concept is capable of explaining how social inequalities are generated. To confirm the protective effect of the capitalist class position and the ''contradictory class location hypothesis'', additional efforts are needed to properly measure class among low-level supervisors, capitalists, managers, and small employers.

The Relationship of Individual Difference and Group Process Variables with Self-Managed Team Performance: A Field Investigation

DTIC Science & Technology

2001-12-15

emotional stability, openness to experience, agreeableness, learning and performance goal orientation) and process variables ( social cohesion and group...both subjective performance measures and 6 of the 7 objective performance measures over that of social cohesion . Social cohesion predicted unique...variance in team member satisfaction over that of group potency. Additionally, social cohesion mediated the relationship between agreeableness and team

Advancing nursing leadership: a model for program implementation and measurement.

PubMed

Omoike, Osei; Stratton, Karen M; Brooks, Beth A; Ohlson, Susan; Storfjell, Judy Lloyd

2011-01-01

Despite the abundant literature documenting the need for nurse management education and career development, only recently have professional standards been targeted for this group. Competency standards for nurse leaders repeatedly identify systems-level concepts including finance and budget, communication skills, strategic management, human resources management, change management, and computer technology skills. However, educational initiatives to meet these standards are still at the early stages and most nurse leaders continue to acquire knowledge and experience through "on-the-job" training. This article will illustrate the need for partnerships and collaboration between academia and hospitals to advance nursing leadership to the next century. In addition, a tool to measure the impact of a graduate certificate program in nursing administration on nurse leader competencies is presented. Overall, the certificate program has been successful in multiple ways; it has "graduated" almost 80 nurse leaders, improved participant competence in their role at the systems level, as well as providing an impetus for completion of a graduate degree post program.

Value of information and natural resources decision-making

USGS Publications Warehouse

Williams, Byron K.; Johnson, Fred A.

2015-01-01

Though the potential for information to measurably improve management has been highlighted for several decades, in recent years the “value of information” has surfaced with increasing frequency in natural resources. However, the use of this phrase belies the fact that many in natural resources have only a limited understanding about what it actually means, how to measure it, and what to do with it. We introduce and describe several forms of the value of information in a context of the management of renewable natural resources. The value of information is discussed in terms of a potential gain in value with the addition of new information, as well as a loss in value associated with the absence of information. Value metrics are developed for uncertainty about resource status as well as resource processes and responses to management. We provide a common notation for the metrics of value, and discuss linkages of the value of information to strategic approaches such as adaptive resources management and partially observable decision processes.

Measurement of Total Reactive Nitrogen (Nr) during the FIREX 2016 Lab Study

NASA Astrophysics Data System (ADS)

Roberts, J. M.; Liu, Y.; Stockwell, C.; Warneke, C.; Coggon, M.; Franchin, A.; Gilman, J.; De Gouw, J. A.; Jimenez, J. L.; Koss, A.; Krechmer, J. E.; Lerner, B. M.; Middlebrook, A. M.; Sekimoto, K.; Selimovic, V.; Yokelson, R. J.; Yuan, B.; Zarzana, K. J.; Brown, S. S.

2017-12-01

Wildfire is a significant source of nitrogen-containing gases and particles to the atmosphere. In addition, a warmer and drier climate is making wildfire an emerging air quality issue in North America. The nitrogen compounds emitted from biomass fires come solely from fuel nitrogen, as a result of pyrolytic and combustion processes, and range from highly reduced (NH3) to highly oxidized (HNO3/NO3-) species. A systematic understanding of the emissions and fate of these compounds is key to quantifying and predicting the role of wild fire in ozone and particle formation, so that wildfire management can be optimized. In addition, many wildfire-derived compounds have unique health impacts that also need to be managed. We have developed a method for the measurement of Total Reactive Nitrogen (Nr = all N-compounds except for N2 and N2O), based on catalytic conversion on a high temperature platinum catalyst, with detection by NO-O3 chemiluminescence. This instrument was fielded during the 2016 FIREX emissions studies at the USFS Missoula, MT., Fire Laboratory, along with a whole suite of measurements of individual gas and particle-phase species. The nitrogen balance of measured emissions will be discussed in the context of fuel-N, fuel type and fire phase (e.g. pyrolysis, flaming, smoldering stages).

Assessing the effect of increased managed care on hospitals.

PubMed

Mowll, C A

1998-01-01

This study uses a new relative risk methodology developed by the author to assess and compare certain performance indicators to determine a hospital's relative degree of financial vulnerability, based on its location, to the effects of increased managed care market penetration. The study also compares nine financial measures to determine whether hospital in states with a high degree of managed-care market penetration experience lower levels of profitability, liquidity, debt service, and overall viability than hospitals in low managed care states. A Managed Care Relative Financial Risk Assessment methodology composed of nine measures of hospital financial and utilization performance is used to develop a high managed care state Composite Index and to determine the Relative Financial Risk and the Overall Risk Ratio for hospitals in a particular state. Additionally, financial performance of hospitals in the five highest managed care states is compared to hospitals in the five lowest states. While data from Colorado and Massachusetts indicates that hospital profitability diminishes as the level of managed care market penetration increases, the overall study results indicate that hospitals in high managed care states demonstrate a better cash position and higher profitability than hospitals in low managed care states. Hospitals in high managed care states are, however, more heavily indebted in relation to equity and have a weaker debt service coverage capacity. Moreover, the overall financial health and viability of hospitals in high managed care states is superior to that of hospitals in low managed care states.

Setting objectives for managing Key deer

USGS Publications Warehouse

Diefenbach, Duane R.; Wagner, Tyler; Stauffer, Glenn E.

2014-01-01

The U.S. Fish and Wildlife Service (FWS) is responsible for the protection and management of Key deer (Odocoileus virginianus clavium) because the species is listed as Endangered under the Endangered Species Act (ESA). The purpose of the ESA is to protect and recover imperiled species and the ecosystems upon which they depend. There are a host of actions that could possibly be undertaken to recover the Key deer population, but without a clearly defined problem and stated objectives it can be difficult to compare and evaluate alternative actions. In addition, management goals and the acceptability of alternative management actions are inherently linked to stakeholders, who should be engaged throughout the process of developing a decision framework. The purpose of this project was to engage a representative group of stakeholders to develop a problem statement that captured the management problem the FWS must address with Key deer and identify objectives that, if met, would help solve the problem. In addition, the objectives were organized in a hierarchical manner (i.e., an objectives network) to show how they are linked, and measurable attributes were identified for each objective. We organized a group of people who represented stakeholders interested in and potentially affected by the management of Key deer. These stakeholders included individuals who represented local, state, and federal governments, non-governmental organizations, the general public, and local businesses. This stakeholder group met five full days over the course of an eight-week period to identify objectives that would address the following problem:“As recovery and removal from the Endangered Species list is the purpose of the Endangered Species Act, the U.S. Fish and Wildlife Service needs a management approach that will ensure a sustainable, viable, and healthy Key deer population. Urbanization has affected the behavior and population dynamics of the Key deer and the amount and characteristics of available habitat. The identified management approach must balance relevant social and economic concerns, Federal (e.g., Endangered Species Act, Wilderness Act, Refuge Act) and state regulations, and the conservation of biodiversity (e.g., Endangered/Threatened species, native habitat) in the Lower Keys.”The stakeholder group identified four fundamental objectives that are essential to addressing the problem: 1) Maximize a sustainable, viable, and healthy Key deer population, 2) Maximize value of Key deer to the People, 3) Minimize deer-related negative impacts to biodiversity, and 4) Minimize costs. In addition, the group identified 25 additional objectives that, if met, would help meet the fundamental objectives. The objectives network and measurable attributes identified by the stakeholder group can be used in the future to develop and evaluate potential management alternatives.

Novel Measures of Volume Status and Cardiac Function in Traumatic Shock

DTIC Science & Technology

2016-06-01

cardio -protective, fluid-limited method of resuscitation. In addition to providing insight into fluid management and cardiac function, the data indicate... cardio -protective method of resuscitation. 8.0 REFERENCES 1. Marik PE, Monnet X, Teboul JL. Hemodynamic parameters to guide fluid therapy. Ann

Patient satisfaction measurement in the disease management industry.

PubMed

Sen, Shaikat; Fawson, Paul; Cherrington, Graham; Douglas, Kathleen; Friedman, Neal; Maljanian, Rose; Fitzner, Karen; Tang, Pei; Soper, Steven; Wood, Steven

2005-10-01

In mid-2004, the Disease Management Association of America (DMAA) Patient Satisfaction Workgroup in association with J.D. Power and Associates (JDPA) conducted a literature review and a member survey to gain an understanding of the nature of patient satisfaction measurement as it pertains to disease management (DM) programs within the DM industry. A review of the relevant literature indicates that perhaps, with the exception of diabetes disease management, there are no prevalent, systematic, or statistically validated approaches for measuring patient satisfaction within the disease management industry. Most existing studies tend to focus on the effectiveness of a disease management program on clinical outcomes, with patient satisfaction measured only as a part of a battery of "outcome" measures. However, many of these studies do find positive associations between patient satisfaction and clinical outcomes. A majority of the 49 respondents who completed the member feedback survey hold relatively high positions in their organizations. The vast majority of respondents indicate their organizations conduct patient satisfaction surveys that assess overall satisfaction, satisfaction with materials and information provided, and with staff members. Patient satisfaction surveys are most common among the five common chronic diseases: diabetes, asthma, congestive heart failure (CHF), coronary artery disease (CAD), and chronic obstructive pulmonary disease (COPD). More than three in four respondents agree that patient satisfaction measurement is important to the long-term success of their programs. Respondents also indicate that along with intelligence on patients' overall satisfaction with the program, they would also like to gain an understanding of whether or not their programs actually help manage the patient's medical condition. Eight survey instruments currently in use and submitted by study participants were also reviewed. Most of these instruments are relatively short and basic, typically administered by mail, and vary in the types of questions and response categories presented to respondents. This research concludes that there exists an implied need for patient satisfaction measurement in the DM industry and an opportunity to develop and leverage a standardized measurement approach assessing patient satisfaction. Additionally, the authors suggest that there may be value to conceptualizing "patient satisfaction" not as an outcome in itself, but as a means to increase compliance, which, in turn, can improve medical outcomes.

Retail Building Guide for Entrance Energy Efficiency Measures

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stein, J.; Kung, F.

2012-03-01

This booklet is based on the findings of an infiltration analysis for supermarkets and large retail buildings without refrigerated cases. It enables retail building managers and engineers to calculate the energy savings potential for vestibule additions for supermarkets; and bay door operation changes in large retail stores without refrigerated cases. Retail managers can use initial estimates to decide whether to engage vendors or contractors of vestibules for pricing or site-specific analyses, or to decide whether to test bay door operation changes in pilot stores, respectively.

Interventional Management for Pelvic Pain.

PubMed

Nagpal, Ameet S; Moody, Erika L

2017-08-01

Interventional procedures can be applied for diagnostic evaluation and treatment of the patient with pelvic pain, often once more conservative measures have failed to provide relief. This article reviews interventional management strategies for pelvic pain. We review superior and inferior hypogastric plexus blocks, ganglion impar blocks, transversus abdominis plane blocks, ilioinguinal, iliohypogastric and genitofemoral blocks, pudendal nerve blocks, and selective nerve root blocks. Additionally, we discuss trigger point injections, sacroiliac joint injections, and neuromodulation approaches. Copyright © 2017 Elsevier Inc. All rights reserved.

The relationship between burnout and mobbing among hospital managers.

PubMed

Karsavuran, Seda; Kaya, Sıdıka

2017-05-01

Mobbing and burnout can cause serious consequences, especially for health workers and managers. Level of burnout and exposure to mobbing may trigger each other. There is a need to conduct additional and specific studies on the topic to develop some strategies. The purpose of this study is to determine the relationship between level of burnout and exposure to mobbing of the managers (head physician, assistant head physician, head nurse, assistant head nurse, administrator, assistant administrator) at the Ministry of Health hospitals. The "Leymann Inventory of Psychological Terrorization" scale was used to measure the level of exposure to mobbing and the "Maslach Burnout Inventory" scale was used to measure the level of burnout of hospital managers. The relationship between level of burnout and exposure to mobbing was analyzed by Pearson's Correlation Analysis. Participants and research context: The population of this study included managers (454 managers) at the Ministry of Health hospitals in the metropolitan area of Ankara between September 2010 and May 2011. All the managers were tried to conduct, but some managers did not want to reply to the questionnaire and some managers were not found at their workplace. Consequently, using a convenience sampling, 54% of the managers replied to the questionnaire (244 managers). Ethical consideration: The approval of the study was granted by the Ministry of Health in Turkey. Furthermore, the study was evaluated and accepted by the Education, Planning and Coordination Council of one of the education and research hospitals in the study. Positive relationships were found among each subdimension of the mobbing and emotional exhaustion and depersonalization. A negative relationship was found between each subdimension of the mobbing and personal accomplishment. In hospitals, by detecting mobbing actions, burnout may be prevented. Exposure to mobbing and burnout could be a serious problem for head nurses who are responsible for both the performance of the nurses and organization. Additionally, head nurses who are faced with mobbing and burnout are more likely to provide suboptimal services which could potentially result in negative outcomes. Therefore, this study draws attention to the importance of preventing these attitudes in the organization.

Sustainably connecting children with nature: an exploratory study of nature play area visitor impacts and their management

USGS Publications Warehouse

Browning, Matthew H.E.M.; Marion, Jeffrey L.; Gregoire, Timothy G.

2013-01-01

Parks are developing nature play areas to improve children's health and “connect” them with nature. However, these play areas are often located in protected natural areas where managers must balance recreation with associated environmental impacts. In this exploratory study, we sought to describe these impacts. We also investigated which ages, gender, and play group sizes most frequently caused impact and where impacts most frequently occur. We measured the lineal and aerial extent and severity of impacts at three play areas in the eastern United States. Methods included soil and vegetation loss calculations, qualitative searches and tree and shrub damage classifications. Additionally, we observed 12 h of play at five play areas. Results showed that measurable negative impacts were caused during 33% of the time children play. On average, 76% of groundcover vegetation was lost at recreation sites and 100% was lost at informal trails. In addition, approximately half of all trees and shrubs at sites were damaged. Meanwhile, soil exposure was 25% greater on sites and trails than at controls. Boys and small group sizes more frequently caused impact, and informal recreation sites were most commonly used for play. No statistically significant correlations were found between age or location and impact frequency. Managers interested in developing nature play areas should be aware of, but not deterred by these impacts. The societal benefits of unstructured play in nature may outweigh the environmental costs. Recommended management strategies include selecting impact-resistant sites, improving site resistance, promoting low impact practices, and managing adaptively.

Use of online health information to manage children's health care: a prospective study investigating parental decisions.

PubMed

Walsh, Anne M; Hamilton, Kyra; White, Katherine M; Hyde, Melissa K

2015-04-02

The use of the internet to access information is rapidly increasing; however, the quality of health information provided on various online sites is questionable. We aimed to examine the underlying factors that guide parents' decisions to use online information to manage their child's health care, a behaviour which has not yet been explored systematically. Parents (N = 391) completed a questionnaire assessing the standard theory of planned behaviour (TPB) measures of attitude, subjective norm, perceived behavioural control (PBC), and intention as well as the underlying TPB belief-based items (i.e., behavioural, normative, and control beliefs) in addition to a measure of perceived risk and demographic variables. Two months later, consenting parents completed a follow-up telephone questionnaire which assessed the decisions they had made regarding their use of online information to manage their child's health care during the previous 2 months. We found support for the TPB constructs of attitude, subjective norm, and PBC as well as the additional construct of perceived risk in predicting parents' intentions to use online information to manage their child's health care, with further support found for intentions, but not PBC, in predicting parents' behaviour. The results of the TPB belief-based analyses also revealed important information about the critical beliefs that guide parents' decisions to engage in this child health management behaviour. This theory-based investigation to understand parents' motivations and online information-seeking behaviour is key to developing recommendations and policies to guide more appropriate help-seeking actions among parents.

Trends in the Management of Nonviable Pregnancies of Unknown Location in the United States.

PubMed

Parks, Melissa A; Barnhart, Kurt T; Howard, David L

2018-06-06

When managing a nonviable pregnancy of unknown location (PUL), a debate has emerged in the literature whether to perform uterine curettage for definitive diagnosis of pregnancy location or administer methotrexate for a presumed ectopic pregnancy. The purpose of this study is to describe the treatment patterns when managing a PUL. A prospective, anonymous Internet based-electronic survey of PUL case scenarios was administered to a random sample of physicians across the United States. A total of 214 physicians responded. When presented with a PUL by ultrasound and a βhCG measurement of 3,270 mIU/mL, which is above the discriminatory level, 88.3% (188) would choose an additional βhCG measurement before recommending any intervention. When presented with a PUL by ultrasound and serial βhCG measurements demonstrating an inappropriate trend for a viable gestation, 36.5% would offer uterine curettage and 31.3% would offer methotrexate. Resident and private clinicians had a fourfold lower adjusted odds of choosing uterine curettage compared to academic physicians. Based on our findings, there does not appear to be a consensus regarding the management of a PUL. © 2018 S. Karger AG, Basel.

The effectiveness of a multidisciplinary pain management programme managing chronic pain.

PubMed

Dysvik, Elin; Vinsnes, Anne Guttormsen; Eikeland, Ole-Johan

2004-10-01

The aim of this study was to develop and evaluate the effects of a multidisciplinary pain management programme on coping, health-related quality of life and pain intensity. Seventy-six outpatients suffering from chronic pain completed this eight-week programme with the primary aims to increase coping, as measured by the Ways of Coping Checklist, and health-related quality of life, as measured by the Short Form-36 Health Survey. Therapeutic dialogues and education, combined with physical activity, were given in order to increase understanding of and attention to non-medical factors that might affect pain perception. The programme was active, time-limited and structured on the basis of multidisciplinary pain management programmes based on a cognitive-behavioural approach. The findings suggest that this programme has the potential to improve coping skills and health-related quality of life. Additionally, pain intensity, as measured by the Visual Analogue Scale, was reduced. Age and disability were revealed as the prominent predictors of change after treatment. The differences in this sample indicated that the drop-outs tended to be older and reported more health problems, although these findings were non-significant. Clinical and research implications are discussed.

Innovative approaches to glaucoma management of Boston keratoprosthesis type 1.

PubMed

Vajaranant, Thasarat S; Liu, Jessica; Wilensky, Jacob; Cortina, M Soledad; Aref, Ahmad A

2016-09-01

Glaucoma remains a prevalent disorder and visual limiting factor after Boston keratoprosthesis type 1 implantation. Patients with glaucoma have worse initial and late visual acuity outcomes after otherwise successful keratoprosthesis implantation. Management of glaucoma in the setting of a keratoprosthesis is challenging because of relatively rapid progression and an inability to accurately measure intraocular pressure (IOP). In addition, there are no standard guidelines for glaucoma surveillance and monitoring after keratoprosthesis surgery. This report provides a review of the current literature and offers innovative strategies that will overcome the challenges in managing glaucoma in the setting of a Boston keratoprosthesis type 1 implant. The topics that will be discussed in this section include alternative methods for IOP measurement, rationales and surgical techniques for a pars plana tube placement for glaucoma drainage device, effective medical and laser treatment, the risk for IOP elevations after YAG laser, and practical guides to glaucoma surveillance and monitoring.

The management of acute myocardial infarction: guidelines and audit standards. Report of a workshop of the Joint Audit Committee of the British Cardiac Society and the Royal College of Physicians.

PubMed

De Bono, D P; Hopkins, A

1994-01-01

Successful management of acute myocardial infarction depends in the first instance on the patient recognising the symptoms and seeking help as quickly as possible. Once in hospital, fast track admission procedures and protocols for pain relief, early thrombolysis and appropriate ancillary measures (eg aspirin, i.v. betablockers) should be promptly instituted. Specialist advice and, if necessary, transfer to specialist unit should be considered if additional complications arise. Follow-up management after discharge from hospital requires cooperation between primary and secondary care to prolong survival by reducing risk factors, using aspirin, betablockers and angiotensin converting enzyme inhibitors and instituting a suitable rehabilitation programme. Audit measures are included in the report to help general practitioners and hospital doctors review their practice and assess it against the standards set.

The Fishery Performance Indicators: A Management Tool for Triple Bottom Line Outcomes

PubMed Central

Anderson, James L.; Anderson, Christopher M.; Chu, Jingjie; Meredith, Jennifer; Asche, Frank; Sylvia, Gil; Smith, Martin D.; Anggraeni, Dessy; Arthur, Robert; Guttormsen, Atle; McCluney, Jessica K.; Ward, Tim; Akpalu, Wisdom; Eggert, Håkan; Flores, Jimely; Freeman, Matthew A.; Holland, Daniel S.; Knapp, Gunnar; Kobayashi, Mimako; Larkin, Sherry; MacLauchlin, Kari; Schnier, Kurt; Soboil, Mark; Tveteras, Sigbjorn; Uchida, Hirotsugu; Valderrama, Diego

2015-01-01

Pursuit of the triple bottom line of economic, community and ecological sustainability has increased the complexity of fishery management; fisheries assessments require new types of data and analysis to guide science-based policy in addition to traditional biological information and modeling. We introduce the Fishery Performance Indicators (FPIs), a broadly applicable and flexible tool for assessing performance in individual fisheries, and for establishing cross-sectional links between enabling conditions, management strategies and triple bottom line outcomes. Conceptually separating measures of performance, the FPIs use 68 individual outcome metrics—coded on a 1 to 5 scale based on expert assessment to facilitate application to data poor fisheries and sectors—that can be partitioned into sector-based or triple-bottom-line sustainability-based interpretative indicators. Variation among outcomes is explained with 54 similarly structured metrics of inputs, management approaches and enabling conditions. Using 61 initial fishery case studies drawn from industrial and developing countries around the world, we demonstrate the inferential importance of tracking economic and community outcomes, in addition to resource status. PMID:25946194

Simple street tree sampling

Treesearch

David J. Nowak; Jeffrey T. Walton; James Baldwin; Jerry Bond

2015-01-01

Information on street trees is critical for management of this important resource. Sampling of street tree populations provides an efficient means to obtain street tree population information. Long-term repeat measures of street tree samples supply additional information on street tree changes and can be used to report damages from catastrophic events. Analyses of...

42 CFR 62.54 - What must applications for the State Loan Repayment Program contain?

Code of Federal Regulations, 2014 CFR

2014-10-01

... area population without health insurance, and the health status of the population as measured by the... will accord special consideration to medically underserved areas with large minority populations; and... additional conditions of the grant. (Approved by the Office of Management and Budget under control number...

42 CFR 62.54 - What must applications for the State Loan Repayment Program contain?

Code of Federal Regulations, 2012 CFR

2012-10-01

... area population without health insurance, and the health status of the population as measured by the... will accord special consideration to medically underserved areas with large minority populations; and... additional conditions of the grant. (Approved by the Office of Management and Budget under control number...

42 CFR 62.54 - What must applications for the State Loan Repayment Program contain?

Code of Federal Regulations, 2013 CFR

2013-10-01

... area population without health insurance, and the health status of the population as measured by the... will accord special consideration to medically underserved areas with large minority populations; and... additional conditions of the grant. (Approved by the Office of Management and Budget under control number...

43 CFR 11.82 - Damage determination phase-alternatives for restoration, rehabilitation, replacement, and/or...

Code of Federal Regulations, 2012 CFR

2012-10-01

... additional injury resulting from the proposed actions, including long-term and indirect impacts, to the... baseline condition, as measured in terms of the physical, chemical, or biological properties that the... resources to baseline conditions as quickly as possible, to natural recovery with minimal management actions...

23 CFR 630.1108 - Work zone safety management measures and strategies.

Code of Federal Regulations, 2010 CFR

2010-04-01

... uniformed law enforcement officer and marked law enforcement vehicle in view of motorized traffic on a... and other contingencies. (e) Work Vehicles and Equipment. In addition to addressing risks to workers... contractor's choice of work scheduling and methodology; (6) For Lump Sum items, a contingency provision...

At a Minimum.

ERIC Educational Resources Information Center

Clark, Robert J.

1995-01-01

Before signing on with a private firm to manage schools, school boards should consider whether privatization will save the school district and the taxpayers money, lessen bureaucracy, and lead to higher test scores or other objective measures of improvement. In addition, boards should ask whether the proposal is free of bias and whether the…

Surface transportation security : TSA has taken actions to manage risk, improve coordination, and measure performance, but additional actions would enhance its efforts, April 21, 2010.

DOT National Transportation Integrated Search

2010-04-21

Terrorist attacks on surface transportation facilities in Moscow, Mumbai, London, and Madrid caused casualties and highlighted the vulnerability of such systems. The Transportation Security Administration (TSA), within the Department of Homeland Secu...

An aerial-photographic assessment of reenacted handcart treks on a section of the Mormon Pioneer National Historic Trail, Fremont County, Wyoming

USGS Publications Warehouse

McDougal, Robert R.; Waltermire, Robert G.; Aldridge, Cameron L.; Germaine, Stephen S.; Nielsen, Scott E.; Nielsen, Charlene C.; Hanson, Leanne; Bowen, Zachary H.

2008-01-01

Based on these results, there are identifiable management considerations. Toilet and rest sites need to be carefully located relative to where sensitive vegetation or soils occur. The analyses presented here indicate that limiting motorized vehicle use needs to be a priority over that of adjusting the number of trekkers. Additionally, monitoring of the Trail from Sixth Crossing to Rock Creek Hollow segment needs to consider explicit management targets, such as minimum acceptable levels of bare ground or trail width, and the establishment of permanent monitoring plots to evaluate targets and measure responses to altered management activities.

NDE in aerospace-requirements for science, sensors and sense.

PubMed

Heyman, J S

1989-01-01

The complexity of modern NDE (nondestructive evaluation) arises from four main factors: quantitative measurement, science, physical models for computational analysis, realistic interfacing with engineering decisions, and direct access to management priorities. Recent advances in the four factors of NDE are addressed. Physical models of acoustic propagation are presented that have led to the development of measurement technologies advancing the ability to assure that materials and structures will perform a design. In addition, a brief discussion is given of current research for future mission needs such as smart structures that sense their own health. Such advances permit projects to integrate design for inspection into their plans, bringing NDE into engineering and management priorities. The measurement focus is on ultrasonics with generous case examples. Problem solutions highlighted include critical stress in fasteners, residual stress in steel, NDE laminography, and solid rocket motor NDE.

NDE in aerospace - Requirements for science, sensors and sense

NASA Technical Reports Server (NTRS)

Heyman, Joseph S.

1989-01-01

The complexity of modern nondestructive evaluation (NDE) arises from four main factors: quantitative measurement science, physical models for computational analysis, realistic interfacing with engineering decisions, and direct access to management priorities. Recent advances in the four factors of NDE are addressed. Physical models of acoustic propagation are presented that have led to the development of measurement technologies advancing the ability to assure that materials and structures will perform as designed. In addition, a brief discussion is given of current research for future mission needs such as smart structures that sense their own health. Such advances permit projects to integrate design for inspection into their plans, bringing NDE into engineering and management priorities. The measurement focus is on ultrasonics with generous case examples. Problem solutions highlighted include critical stress in fasteners, residual stress in steel, NDE laminography, and solid rocket motor NDE.

Short term effectiveness and experiences of a peer guided web-based self-management intervention for young adults with juvenile idiopathic arthritis.

PubMed

Ammerlaan, Judy; van Os-Medendorp, Harmieke; de Boer-Nijhof, Nienke; Scholtus, Lieske; Kruize, Aike A; van Pelt, Philomine; Prakken, Berent; Bijlsma, Hans

2017-10-13

A web-based self-management intervention guided by peer-trainers was developed to support young adults' self-management in coping with Juvenile Idiopathic Arthritis (JIA). To investigate its effectiveness, a randomized controlled trial (RCT) was conducted. In addition, the content of the chat and participants' goals were studied to identify underlying processes. An RCT with a six-month follow up period was conducted among 72 young adults with JIA, aged between 16 and 25 years old, randomly assigned to the intervention or to the usual care control group. After 24 weeks, in both groups 24 participants completed all measurements. Intentions to treat analyses were carried out by means of linear mixed models for longitudinal measurements. With self-efficacy as primary outcome, self-management, disease activity, quality of life, absenteeism of school/work, health care medication use and adherence to the intervention were studied. The participants' goals, personal achievements, interactions on the chat, and their appreciation of the intervention were analyzed using thematic analyses. No significant differences were found on self-efficacy, quality of life, and self-management between the participants of the control group and the intervention group. In the intervention group, modeling and sharing experiences were the most recognized themes. Fifty-five goals were formulated and divided into the following categories: improvement and maintaining balance, setting and recognizing boundaries, communicating and coping with incomprehension. Adherence, appreciation of the own learning experience, and personal achievements were rated positively. The web-based intervention did not lead to an improvement of self-efficacy. However, additional qualitative analyses showed that the intervention was appreciated and valuable for the participants. More research is needed on how to measure the added value of this intervention compared to the usual care. Trial registration number NTR4679 .

The role of measuring airway hyperresponsiveness and inflammatory biomarkers in asthma

PubMed Central

Currie, Graeme P; Fardon, Tom C; Lee, Daniel KC

2005-01-01

Asthma is characterized by inflammation and airway hyperresponsiveness, which results in episodic airflow obstruction. It is diagnosed once a compatible clinical history plus objective evidence of diurnal variability in peak expiratory flow or significant reversibility to inhaled bronchodilator is documented. In accordance with current guidelines, measures of airway calibre and symptoms allow patients and clinicians to assess the degree of asthma control and titrate pharmacotherapy. However, these parameters fail to reflect the extent of underlying endobronchial inflammation and airway hyperresponsiveness, which in turn suggests that additional measures of asthma control may be of benefit. This evidence-based review highlights ways by which inflammation and airway hyperresponsiveness can be assessed and how they may provide additional useful information in the diagnosis and management of asthmatic patients. PMID:18360548

Upstream Structural Management Measures for an Urban Area Flooding in Turkey and their Consequences on Flood Risk Management

NASA Astrophysics Data System (ADS)

Akyurek, Z.; Bozoglu, B.; Girayhan, T.

2015-12-01

Flooding has the potential to cause significant impacts to economic activities as well as to disrupt or displace populations. Changing climate regimes such as extreme precipitation events increase flood vulnerability and put additional stresses on infrastructure. In this study the flood modelling in an urbanized area, namely Samsun-Terme in Blacksea region of Turkey is done. MIKE21 with flexible grid is used in 2- dimensional shallow water flow modelling. 1/1000 scaled maps with the buildings for the urbanized area and 1/5000 scaled maps for the rural parts are used to obtain DTM needed in the flood modelling. The bathymetry of the river is obtained from additional surveys. The main river passing through the urbanized area has a capacity of Q5 according to the design discharge obtained by simple ungauged discharge estimation depending on catchment area only. The effects of the available structures like bridges across the river on the flooding are presented. The upstream structural measures are studied on scenario basis. Four sub-catchments of Terme River are considered as contributing the downstream flooding. The existing circumstance of the Terme River states that the meanders of the river have a major effect on the flood situation and lead to approximately 35% reduction in the peak discharge between upstream and downstream of the river. It is observed that if the flow from the upstream catchments can be retarded through a detention pond constructed in at least two of the upstream catchments, estimated Q100 flood can be conveyed by the river without overtopping from the river channel. The operation of the upstream detention ponds and the scenarios to convey Q500 without causing flooding are also presented. Structural management measures to address changes in flood characteristics in water management planning are discussed. Flood risk is obtained by using the flood hazard maps and water depth-damage functions plotted for a variety of building types and occupancies. The estimated mean annual hazard for the area is calculated as $340 000 and it is estimated that the upstream structural management measures can decrease the direct economic risk 11% for the 500 return period flood.

Understanding Climate Adaptation on Public Lands in the Upper Midwest: Implications for Monitoring and Tracking Progress

NASA Astrophysics Data System (ADS)

Anhalt-Depies, Christine M.; Knoot, Tricia Gorby; Rissman, Adena R.; Sharp, Anthony K.; Martin, Karl J.

2016-05-01

There are limited examples of efforts to systematically monitor and track climate change adaptation progress in the context of natural resource management, despite substantial investments in adaptation initiatives. To better understand the status of adaptation within state natural resource agencies, we utilized and problematized a rational decision-making framework to characterize adaptation at the level of public land managers in the Upper Midwest. We conducted in-depth interviews with 29 biologists and foresters to provide an understanding of managers' experiences with, and perceptions of, climate change impacts, efforts towards planning for climate change, and a full range of actions implemented to address climate change. While the majority of managers identified climate change impacts affecting their region, they expressed significant uncertainty in interpreting those signals. Just under half of managers indicated planning efforts are underway, although most planning is remote from local management. Actions already implemented include both forward-looking measures and those aimed at coping with current impacts. In addition, cross-scale dynamics emerged as an important theme related to the overall adaptation process. The results hold implications for tracking future progress on climate change adaptation. Common definitions or measures of adaptation (e.g., presence of planning documents) may need to be reassessed for applicability at the level of public land managers.

Understanding Climate Adaptation on Public Lands in the Upper Midwest: Implications for Monitoring and Tracking Progress.

PubMed

Anhalt-Depies, Christine M; Knoot, Tricia Gorby; Rissman, Adena R; Sharp, Anthony K; Martin, Karl J

2016-05-01

There are limited examples of efforts to systematically monitor and track climate change adaptation progress in the context of natural resource management, despite substantial investments in adaptation initiatives. To better understand the status of adaptation within state natural resource agencies, we utilized and problematized a rational decision-making framework to characterize adaptation at the level of public land managers in the Upper Midwest. We conducted in-depth interviews with 29 biologists and foresters to provide an understanding of managers' experiences with, and perceptions of, climate change impacts, efforts towards planning for climate change, and a full range of actions implemented to address climate change. While the majority of managers identified climate change impacts affecting their region, they expressed significant uncertainty in interpreting those signals. Just under half of managers indicated planning efforts are underway, although most planning is remote from local management. Actions already implemented include both forward-looking measures and those aimed at coping with current impacts. In addition, cross-scale dynamics emerged as an important theme related to the overall adaptation process. The results hold implications for tracking future progress on climate change adaptation. Common definitions or measures of adaptation (e.g., presence of planning documents) may need to be reassessed for applicability at the level of public land managers.

Stroke unit Nurse Managers' views of individual and organizational factors liable to influence evidence-based practice: A survey.

PubMed

Drury, Peta; McInnes, Elizabeth; Hardy, Jennifer; Dale, Simeon; Middleton, Sandy

2016-04-01

The uptake of evidence into practice may be impeded or facilitated by individual and organizational factors within the local context. This study investigated Nurse Managers of New South Wales, Australia, stroke units (n = 19) in their views on: leadership ability (measured by the Leadership Practices Inventory), organizational learning (measured by the Organizational Learning Survey), attitudes and beliefs towards evidence-based practice (EBP) and readiness for change. Overall Nurse Managers reported high-level leadership skills and a culture of learning. Nurse Managers' attitude towards EBP was positive, although nursing colleague's attitudes were perceived as less positive. Nurse Managers agreed that implementing evidence in practice places additional demands on staff; and almost half (n = 9, 47%) reported that resources were not available for evidence implementation. The findings indicate that key persons responsible for evidence implementation are not allocated sufficient time to coordinate and implement guidelines into practice. The findings suggest that barriers to evidence uptake, including insufficient resources and time constraints, identified by Nurse Managers in this study are not likely to be unique to stroke units. Furthermore, Nurse Managers may be unable to address these organizational barriers (i.e. lack of resources) and thus provide all the components necessary to implement EBP. © 2015 John Wiley & Sons Australia, Ltd.

Turning on the care coordination switch in rural primary care: voices from the practices--clinician champions, clinician partners, administrators, and nurse care managers.

PubMed

Fagnan, Lyle J; Dorr, David A; Davis, Melinda; McGinnis, Paul; Mahler, Jo; King, Molly McCarthy; Michaels, LeAnn

2011-01-01

This study sought to understand the acceptability and feasibility of office-based nurse care management in medium to large rural primary care practices. A qualitative assessment of Care Management Plus (a focused medical home model for complex patients) implementation was conducted using semistructured interviews with 4 staff cohorts. Cohorts included clinician champions, clinician partners, practice administrators, and nurse care managers. Seven key implementation attributes were: a proven care coordination program; adequate staffing; practice buy-in; adequate time; measurement; practice facilitation; and functional information technology. Although staff was positive about the care coordination concept, model acceptability was varied and additional study is required to determine sustainability.

Comparison and Association of Intellectual Capital: An Investigation and Measurement of the Value of Intellectual Capital Assets and Their Contribution to Stakeholder Perception within the Framework of Higher Education

ERIC Educational Resources Information Center

Helm Stevens, Roxanne

2011-01-01

PROBLEM: Many of the preliminary approaches to strategic management of intellectual capital or knowledge assets have not been attempted in the not-for-profit arena. Additionally, because there is no marketplace value for not-for-profit firms or a valuation system for intangible assets, the identification and measurement necessary for efficient and…

Selenium Speciation and Management in Wet FGD Systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Searcy, K; Richardson, M; Blythe, G

2012-02-29

This report discusses results from bench- and pilot-scale simulation tests conducted to determine the factors that impact selenium speciation and phase partitioning in wet FGD systems. The selenium chemistry in wet FGD systems is highly complex and not completely understood, thus extrapolation and scale-up of these results may be uncertain. Control of operating parameters and application of scrubber additives have successfully demonstrated the avoidance or decrease of selenite oxidation at the bench and pilot scale. Ongoing efforts to improve sample handling methods for selenium speciation measurements are also discussed. Bench-scale scrubber tests explored the impacts of oxidation air rate, tracemore » metals, scrubber additives, and natural limestone on selenium speciation in synthetic and field-generated full-scale FGD liquors. The presence and concentration of redox-active chemical species as well as the oxidation air rate contribute to the oxidation-reduction potential (ORP) conditions in FGD scrubbers. Selenite oxidation to the undesirable selenate form increases with increasing ORP conditions, and decreases with decreasing ORP conditions. Solid-phase manganese [Mn(IV)] appeared to be the significant metal impacting the oxidation of selenite to selenate. Scrubber additives were tested for their ability to inhibit selenite oxidation. Although dibasic acid and other scrubber additives showed promise in early clear liquor (sodium based and without calcium solids) bench-scale tests, these additives did not show strong inhibition of selenite oxidation in tests with higher manganese concentrations and with slurries from full-scale wet FGD systems. In bench-tests with field liquors, addition of ferric chloride at a 250:1 iron-to-selenium mass ratio sorbed all incoming selenite to the solid phase, although addition of ferric salts had no impact on native selenate that already existed in the field slurry liquor sample. As ORP increases, selenite may oxidize to selenate more rapidly than it sorbs to ferric solids. Though it was not possible to demonstrate a decrease in selenium concentrations to levels below the project'ale testing were evident at the pilot scale. Specifically, reducing oxidation air rate and ORP tends to either retain selenium as selenite in the liquor or shift selenium phase partitioning to the solid phase. Oxidation air flow rate control may be one option for managing selenium behavior in FGD scrubbers. Units that cycle load widely may find it more difficult to impact ORP conditions with oxidation air flow rate control alone. Because decreasing oxidation air rates to the reaction tank showed that all new selenium reported to the solids, the addition of ferric chloride to the pilot scrubber could not show further improvements in selenium behavior. Ferric chloride addition did shift mercury to the slurry solids, specifically to the fine particles. Several competing pathways may govern the reporting of selenium to the slurry solids: co-precipitation with gypsum into the bulk solids and sorption or co-precipitation with iron into the fine particles. Simultaneous measurement of selenium and mercury behavior suggests a holistic management strategy is best to optimize the fate of both of these elements in FGD waters. Work conducted under this project evaluated sample handling and analytical methods for selenium speciation in FGD waters. Three analytical techniques and several preservation methods were employed. Measurements of selenium speciation over time indicated that for accurate selenium speciation, it is best to conduct measurements on unpreserved, filtered samples as soon after sampling as possible. The capital and operating costs for two selenium management strategies were considered: ferric chloride addition and oxidation air flow rate control. For ferric chloride addition, as might be expected the reagent makeup costs dominate the overall costs, and range from 0.22 to 0.29 mills/kWh. For oxidation air flow rate control, a cursory comparison of capital costs and turndown capabilities for multi-stage and single-stage centrifugal blowers and several flow control methods was completed. For greenfield systems, changing the selection of blower type and flow control method may have payback periods of 4 to 5 years or more if based on energy savings alone. However, the benefits to managing redox chemistry in the scrubber could far outweigh the savings in electricity costs under some circumstances.« less

Leveraging data to systematically improve care: coronary artery disease management at Geisinger.

PubMed

Graf, Thomas; Erskine, Alistair; Steele, Glenn D

2014-01-01

Coronary artery disease is complex chronic disease best managed by a team empowered by actionable data and a comprehensive approach, the ability to improve intermediate outcomes was dramatically enhanced after Geisinger created a system of care to do so. Continuous measurement of critical data elements of process and intermediate outcome measures allows the delivery of actionable information to the most appropriate team member, including the patients and family as team members. Continuous monitoring of the overall program looking for trends and opportunities across sites and regions allows for program enhancements. The comprehensive "all-or-none" bundled approach to care, which has already realized a 300% improvement, will be further enhanced by incorporating additional "Big Data" flows.

Appearing smart: the impression management of intelligence, person perception accuracy, and behavior in social interaction.

PubMed

Murphy, Nora A

2007-03-01

Intelligence is an important trait that affects everyday social interaction. The present research utilized the ecological perspective of social perception to investigate the impression management of intelligence and strangers' evaluations of targets' intelligence levels. The ability to effectively portray an impression of intelligence to outside judges as well as interaction partners was appraised and the effect of impression management on the accurate judgment of intelligence was assessed. In addition, targets' behavior was studied in relation to impression management, perceived intelligence, and actual measured intelligence. Impression-managing targets appeared more intelligent to video judges but not to their interaction partner as compared to controls. The intelligence quotient (IQ) of impression-managing targets was more accurately judged than controls' IQ. Impression-managing targets displayed distinct nonverbal behavioral patterns that differed from controls. Looking while speaking was a key behavior: It significantly correlated with IQ, was successfully manipulated by impression-managing targets, and contributed to higher perceived intelligence ratings.

The impact of advanced nurse practitioners on patient outcomes in chronic kidney disease: A systematic review.

PubMed

McCrory, Geraldine; Patton, Declan; Moore, Zena; O'Connor, Tom; Nugent, Linda

2018-06-11

Management of individuals with chronic kidney disease (CKD) requires a collaborative approach. Nurses have diversified their skills to take on roles which have been traditionally physician-led. The impact of such roles, mainly that of the advanced nurse practitioner (ANP), has not been previously assessed using a systematic approach. The aim of this systematic review (SR) was to determine the impact of the addition of an ANP on patient outcomes in adults with CKD. A SR, following the guidance of PRISMA was undertaken. Population: adults with CKD. ANP. Databases searched included The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase and Medline. Outcome measures were blood pressure (BP), lipids, haemoglobin A1c (HbA1c), phosphate and parathormone (PTH) measures and recommended medication use. Four studies met the inclusion criteria. All possessed external validity and demonstrated low risk for random sequence generation and allocation concealment but were at high risk of performance bias and detection bias. The addition of an ANP resulted in the superior management of BP in all studies. Three studies reported improved control of low-density lipoprotein (LDL) and PTH. One study reported greater achievement of phosphate control. Glycaemic control was equal in both groups. All studies reported higher rates of recommended medication use. The addition of an ANP is superior or equal to the usual care models for the management of BP, LDL, PTH and glycaemic control in adults with CKD. © 2018 European Dialysis and Transplant Nurses Association/European Renal Care Association.

The role of self-efficacy in inflammatory bowel disease management: preliminary validation of a disease-specific measure.

PubMed

Keefer, Laurie; Kiebles, Jennifer L; Taft, Tiffany H

2011-02-01

Inflammatory bowel diseases (IBDs) require self-management skills that may be influenced by self-efficacy (SE). Self-efficacy represents an individual's perception of his or her ability to organize and execute the behaviors necessary to manage disease. The goal of this study was to develop a valid and reliable measure of IBD-specific SE that can be used in clinical and research contexts. One hundred and twenty-two adults with a verified IBD diagnosis participated in the study. Data were pooled from 2 sources: patients from an outpatient university gastroenterology clinic (n=42) and a sample of online respondents (n=80). All participants (N=122) completed the IBD Self-Efficacy Scale (IBD-SES) and the Inflammatory Bowel Disease Questionnaire. Additionally, online participants completed the Brief Symptom Inventory-18 and the Rosenberg Self-Esteem Scale, whereas those in the clinic sample completed the Perceived Health Competence Scale, the Perceived Stress Questionnaire, and the Short Form Version 2 Health Survey. The IBD-SES was initially constructed to identify 4 distinct theoretical domains of self-efficacy: (1) managing stress and emotions, (2) managing medical care, (3) managing symptoms and disease, and (4) maintaining remission. The 29-item IBD-SES has high internal consistency (r=0.96), high test-retest reliability (r=0.90), and demonstrates strong construct and concurrent validity with established measures. The IBD-SES is a critical first step toward addressing an important psychological construct that could influence treatment outcomes in IBD.

Revaluing unmanaged forests for climate change mitigation.

PubMed

Krug, Joachim; Koehl, Michael; Kownatzki, Dierk

2012-11-14

Unmanaged or old-growth forests are of paramount importance for carbon sequestration and thus for the mitigation of climate change among further implications, e.g. biodiversity aspects. Still, the importance of those forests for climate change mitigation compared to managed forests is under controversial debate. We evaluate the adequacy of referring to CO2 flux measurements alone and include external impacts on growth (nitrogen immissions, increasing temperatures, CO2 enrichment, changed precipitation patterns) for an evaluation of central European forests in this context. We deduce that the use of CO2 flux measurements alone does not allow conclusions on a superiority of unmanaged to managed forests for mitigation goals. This is based on the critical consideration of uncertainties and the application of system boundaries. Furthermore, the consideration of wood products for material and energetic substitution obviously overrules the mitigation potential of unmanaged forests. Moreover, impacts of nitrogen immissions, CO2 enrichment of the atmosphere, increasing temperatures and changed precipitation patterns obviously lead to a meaningful increase in growth, even in forests of higher age. An impact of unmanaged forests on climate change mitigation cannot be valued by CO2 flux measurements alone. Further research is needed on cause and effect relationships between management practices and carbon stocks in different compartments of forest ecosystems in order to account for human-induced changes. Unexpected growth rates in old-growth forests - managed or not - can obviously be related to external impacts and additionally to management impacts. This should lead to the reconsideration of forest management strategies.

Angler satisfaction in South Dakota

USGS Publications Warehouse

Henderson, Kjetil R.; Gigliotti, Larry M.

2015-01-01

Many industries use satisfaction measures to evaluate performance. The South Dakota Department of Game, Fish and Parks identified satisfaction as one of their performance measures for evaluating fishing in South Dakota. In fisheries management, the perspectives’ of license buyers are valuable to determine if management activities are providing the benefits anticipated by biologists. Surveys of South Dakota anglers are conducted to better understand licensees in order to promote satisfying angling experiences. Internet surveys were distributed to all license buyers providing email addresses in 2011 and 2012. Angler satisfaction was analyzed by angler type (demographics and fishing characteristics) to further clarify performance measures. Most anglers (> 70%) were satisfied with their angling experiences. Nonresidents expressed higher levels of satisfaction with fishing in South Dakota in 2011 and 2012 than residents. Anglers’ rating of fishing quality was more strongly correlated with satisfaction than their reported number of fish harvested, which suggests that strategies to influence angler perceptions and expectations can also be employed to influence satisfaction (in addition to techniques influencing fish populations). This research further integrates sociological data into South Dakota fisheries management processes.

Safety behavior: Job demands, job resources, and perceived management commitment to safety.

PubMed

Hansez, Isabelle; Chmiel, Nik

2010-07-01

The job demands-resources model posits that job demands and resources influence outcomes through job strain and work engagement processes. We test whether the model can be extended to effort-related "routine" safety violations and "situational" safety violations provoked by the organization. In addition we test more directly the involvement of job strain than previous studies which have used burnout measures. Structural equation modeling provided, for the first time, evidence of predicted relationships between job strain and "routine" violations and work engagement with "routine" and "situational" violations, thereby supporting the extension of the job demands-resources model to safety behaviors. In addition our results showed that a key safety-specific construct 'perceived management commitment to safety' added to the explanatory power of the job demands-resources model. A predicted path from job resources to perceived management commitment to safety was highly significant, supporting the view that job resources can influence safety behavior through both general motivational involvement in work (work engagement) and through safety-specific processes.

Technical and Non-Technical Measures for air pollution emission reduction: The integrated assessment of the regional Air Quality Management Plans through the Italian national model

NASA Astrophysics Data System (ADS)

D'Elia, I.; Bencardino, M.; Ciancarella, L.; Contaldi, M.; Vialetto, G.

2009-12-01

The Italian Air Quality legislation underwent sweeping changes with the implementation of the 1996 European Air Quality Framework Directive when the Italian administrative Regions were entrusted with air quality management tasks. The most recent Regional Air Quality Management Plans (AQMPs) highlighted the importance of Non-Technical Measures (NTMs), in addition to Technical Measures (TMs), in meeting environmental targets. The aim of the present work is to compile a list of all the TMs and NTMs taken into account in the Italian Regional AQMPs and to give in the target year, 2010, an estimation of SO 2, NO x and PM 10 emission reductions, of PM 10 concentration and of the health impact of PM 2.5 concentrations in terms of Life Expectancy Reduction. In order to do that, RAINS-Italy, as part of the National Integrated Modeling system for International Negotiation on atmospheric pollution (MINNI), has been applied. The management of TMs and NTMs inside RAINS have often obliged both the introduction of exogenous driving force scenarios and the control strategy modification. This has inspired a revision of the many NTM definitions and a clear choice of the definition adopted. It was finally highlighted that only few TMs and NTMs implemented in the AQMPs represent effective measures in reaching the environmental targets.

50 CFR 622.31 - Prohibited gear and methods.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 8 2010-10-01 2010-10-01 false Prohibited gear and methods. 622.31... Management Measures § 622.31 Prohibited gear and methods. In addition to the prohibited gear/methods specified in this section, see §§ 622.33, 622.34, and 622.35 for seasonal/area prohibited gear/methods and...

Improving the soil moisture data record of the U.S. Climate Reference Network (USCRN) and Soil Climate Analysis Network (SCAN)

USDA-ARS?s Scientific Manuscript database

Soil moisture estimates are valuable for hydrologic modeling, drought prediction and management, climate change analysis, and agricultural decision support. However, in situ measurements of soil moisture have only become available within the past few decades with additional sensors being installed ...

California Psychological Inventory Dominance Scale Measurement Equivalence: General Population Normative and Indian, U.K., and U.S. Managerial Samples

ERIC Educational Resources Information Center

Kulas, John T.; Thompson, Richard C.; Anderson, Michael G.

2011-01-01

The California Psychological Inventory's Dominance scale was investigated for inconsistencies in item-trait associations across four samples (one American normative and three culturally dissociated manager groupings). The Kim, Cohen, and Park procedure was used, enabling simultaneous multigroup comparison in addition to the traditional…

Potential Impact of the Addition of a Writing Assessment on Admissions Decisions.

ERIC Educational Resources Information Center

Bridgeman, Brent; McHale, Frederick

1998-01-01

A study investigated the effect of adding a writing measure to the Graduate Management Admission Test on the gender/ethnic composition of an admissions pool. Standardized differences from the white male reference group were computed for men and women in four ethnic/minority groups: Whites, Asian-Americans, African-Americans, and…

Technology transfer through performance management: the effects of graphical feedback and positive reinforcement on drug treatment counselors' behavior.

PubMed

Andrzejewski, M E; Kirby, K C; Morral, A R; Iguchi, M Y

2001-07-01

After drug treatment counselors at a community-based methadone treatment clinic were trained in implementing a contingency management (CM) intervention, baseline measures of performance revealed that, on average, counselors were meeting the performance criteria specified by the treatment protocol about 42% of the time. Counselors were exposed to graphical feedback and a drawing for cash prizes in an additive within-subjects design to assess the effectiveness of these interventions in improving protocol adherence. Counselor performance measures increased to 71% during the graphical feedback condition, and to 81% during the drawing. Each counselor's performance improved during the intervention conditions. Additional analyses suggested that counselors did not have skill deficits that hindered implementation. Rather, protocol implementation occurred more frequently when consequences were added, thereby increasing the overall proportion of criteria met. Generalizations, however, may be limited due to a small sample size and possible confounding of time and intervention effects. Nonetheless, present results show promise that feedback and positive reinforcement could be used to improve technology transfer of behavioral interventions into community clinic settings.

Patient satisfaction and psychological well-being after internet-based cognitive behavioral stress management (IB-CBSM) for women with preterm labor: A randomized controlled trial.

PubMed

Scherer, S; Alder, J; Gaab, J; Berger, T; Ihde, K; Urech, C

2016-01-01

Despite its value for the management of psychological burden, little is known about the efficacy of and patient satisfaction with internet-based cognitive behavioral stress management (IB-CBSM) for women with preterm labor. The present study sets out to analyze stress/anxiety reduction, patient satisfaction and patient's working alliance in a group of 58 women with preterm labor participating in an online psychological stress management project. As part of the project, women were randomly assigned to online stress management or a control condition. Levels of stress and anxiety decreased significantly in both conditions from pre- to post-treatment measure. Participants in IB-CBSM reported significant higher working alliance inventory (WAI) scores in the task and goal subscale (p<.001; p<.05) than women in the control condition. In Addition the IB-CBSM group showed significant correlations of the WAI subscale task and goal and the stress/anxiety outcome. Regarding patient satisfaction, women in the IB-CBSM reported significantly higher satisfaction scores (p<.001) than women in the control condition. WAI explained nearly 40% of the variance in patient satisfaction. Furthermore, WAI mediates, at least in part, the relationship between group condition and patient satisfaction. The current analysis indicated that participants in IB-CBSM had higher WAI scores and were more satisfied with the program. In addition only the IB-CBSM group showed significant correlations of the WAI with the stress/anxiety reduction outcome. Based on these findings, it can be presumed that measures of agreement with working alliance parameters, especially task and goal components, are substantially important for more effective and satisfactory therapeutic interventions. Copyright © 2015 Elsevier Inc. All rights reserved.

Cost-effectiveness of environmental management for vector control in resource development projects.

PubMed

Bos, R

1991-01-01

Vector control methods are traditionally divided in chemical, biological and environmental management approaches, and this distinction also reflected in certain financial and economic aspects. This is particularly true for environmental modification, usually engineering or other structural works. It is highly capital intensive, as opposed to chemical and biological control which require recurrent expenditures, and discount rates are therefore a prominent consideration in deciding for one or the other approach. Environmental manipulation requires recurrent action, but can often be carried out with the community participation, which raises the issue of opportunity costs. The incorporation of environmental management in resource projects is generally impeded by economic considerations. The Internal Rate of Return continues to be a crucial criterion for funding agencies and development banks to support new projects; at the same time Governments of debt-riden countries in the Third World will do their best to avoid additional loans on such frills as environmental and health safeguards. Two approaches can be recommended to nevertheless ensure the incorporation of environmental management measures in resource projects in an affordable way. First, there are several examples of cases where environmental management measures either have a dual benefit (increasing both agricultural production and reducing vector-borne disease transmission) or can be implemented at zero costs. Second, the additional costs involved in structural modifications can be separated from the project development costs considered in the calculations of the Internal Rate of Return, and financial support can be sought from bilateral technical cooperation agencies particularly interested in environmental and health issues. There is a dearth of information in the cost-effectiveness of alternative vector control strategies in the developing country context. The process of integrating vector control in the general health services will make it even more difficult to gain a clear insight in the matter.

Benchmarking management practices in Australian public healthcare.

PubMed

Agarwal, Renu; Green, Roy; Agarwal, Neeru; Randhawa, Krithika

2016-01-01

The purpose of this paper is to investigate the quality of management practices of public hospitals in the Australian healthcare system, specifically those in the state-managed health systems of Queensland and New South Wales (NSW). Further, the authors assess the management practices of Queensland and NSW public hospitals jointly and globally benchmark against those in the health systems of seven other countries, namely, USA, UK, Sweden, France, Germany, Italy and Canada. In this study, the authors adapt the unique and globally deployed Bloom et al. (2009) survey instrument that uses a "double blind, double scored" methodology and an interview-based scoring grid to measure and internationally benchmark the management practices in Queensland and NSW public hospitals based on 21 management dimensions across four broad areas of management - operations, performance monitoring, targets and people management. The findings reveal the areas of strength and potential areas of improvement in the Queensland and NSW Health hospital management practices when compared with public hospitals in seven countries, namely, USA, UK, Sweden, France, Germany, Italy and Canada. Together, Queensland and NSW Health hospitals perform best in operations management followed by performance monitoring. While target management presents scope for improvement, people management is the sphere where these Australian hospitals lag the most. This paper is of interest to both hospital administrators and health care policy-makers aiming to lift management quality at the hospital level as well as at the institutional level, as a vehicle to consistently deliver sustainable high-quality health services. This study provides the first internationally comparable robust measure of management capability in Australian public hospitals, where hospitals are run independently by the state-run healthcare systems. Additionally, this research study contributes to the empirical evidence base on the quality of management practices in the Australian public healthcare systems of Queensland and NSW.

Hydrological information system based on on-line monitoring--from strategy to implementation in the Brantas River Basin, East Java, Indonesia.

PubMed

Marini, G W; Wellguni, H

2003-01-01

The worsening environmental situation of the Brantas River, East Java, is addressed by a comprehensive basin management strategy which relies on accurate water quantity and quality data retrieved from a newly installed online monitoring network. Integrated into a Hydrological Information System, the continuously measured indicative parameters allow early warning, control and polluter identification. Additionally, long-term analyses have been initiated for improving modelling applications like flood forecasting, water resource management and pollutant propagation. Preliminary results illustrate the efficiency of the installed system.

36 CFR 1236.24 - What are the additional requirements for managing unstructured electronic records?

Code of Federal Regulations, 2012 CFR

2012-07-01

... requirements for managing unstructured electronic records? 1236.24 Section 1236.24 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional Requirements for Electronic Records § 1236.24 What are the additional requirements for managing...

36 CFR 1236.24 - What are the additional requirements for managing unstructured electronic records?

Code of Federal Regulations, 2010 CFR

2010-07-01

... requirements for managing unstructured electronic records? 1236.24 Section 1236.24 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional Requirements for Electronic Records § 1236.24 What are the additional requirements for managing...

36 CFR 1236.24 - What are the additional requirements for managing unstructured electronic records?

Code of Federal Regulations, 2011 CFR

2011-07-01

... requirements for managing unstructured electronic records? 1236.24 Section 1236.24 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional Requirements for Electronic Records § 1236.24 What are the additional requirements for managing...

36 CFR 1236.24 - What are the additional requirements for managing unstructured electronic records?

Code of Federal Regulations, 2014 CFR

2014-07-01

... requirements for managing unstructured electronic records? 1236.24 Section 1236.24 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional Requirements for Electronic Records § 1236.24 What are the additional requirements for managing...

The use of Natural Flood Management to mitigate local flooding in the rural landscape

NASA Astrophysics Data System (ADS)

Wilkinson, Mark; Quinn, Paul; Ghimire, Sohan; Nicholson, Alex; Addy, Steve

2014-05-01

The past decade has seen increases in the occurrence of flood events across Europe, putting a growing number of settlements of varying sizes at risk. The issue of flooding in smaller villages is usually not well publicised. In these small communities, the cost of constructing and maintaining traditional flood defences often outweigh the potential benefits, which has led to a growing quest for more cost effective and sustainable approaches. Here we aim to provide such an approach that alongside flood risk reduction, also has multipurpose benefits of sediment control, water quality amelioration, and habitat creation. Natural flood management (NFM) aims to reduce flooding by working with natural features and characteristics to slow down or temporarily store flood waters. NFM measures include dynamic water storage ponds and wetlands, interception bunds, channel restoration and instream wood placement, and increasing soil infiltration through soil management and tree planting. Based on integrated monitoring and modelling studies, we demonstrate the potential to manage runoff locally using NFM in rural systems by effectively managing flow pathways (hill slopes and small channels) and by exploiting floodplains and buffers strips. Case studies from across the UK show that temporary storage ponds (ranging from 300 to 3000m3) and other NFM measures can reduce peak flows in small catchments (5 to 10 km2) by up to 15 to 30 percent. In addition, increasing the overall effective storage capacity by a network of NFM measures was found to be most effective for total reduction of local flood peaks. Hydraulic modelling has shown that the positioning of such features within the catchment, and how they are connected to the main channel, may also affect their effectiveness. Field evidence has shown that these ponds can collect significant accumulations of fine sediment during flood events. On the other hand, measures such as wetlands could also play an important role during low flow conditions, by providing base flows during drought conditions. Ongoing research using hydrological datasets aims to assess how these features function during low flow conditions and how storage ponds could be used as irrigation ponds in arable areas. To allow for effective implementation and upkeep of NFM measures on the ground, demonstration sites have been developed through a process of iterative stakeholder engagement. Coupled with the use of novel visualisation techniques, results are currently being communicated to a wider community of local landowners and catchment managers. The approach of using networks of interception bunds and offline storage areas in the rural landscape could potentially provide a cost effective means to reduce flood risk in small responsive catchments across Europe. As such it could provide an alternative or addition to traditional engineering techniques, while also effectively managing catchments to achieve multiple environmental objectives.

Implementing health management information systems: measuring success in Korea's health centers.

PubMed

Chae, Y M; Kim, S I; Lee, B H; Choi, S H; Kim, I S

1994-01-01

This article analyses the effects that the introduction and adoption of a health management information system (HMIS) can have on both the productivity of health center staff as well as on user-satisfaction. The focus is upon the service provided by the Kwonsun Health Center located in Suwon City, Korea. Two surveys were conducted to measure the changes in productivity and adoption (knowledge, persuasion, decision, implementation and confirmation) of health center staff over time. In addition, a third survey was conducted to measure the effects of HMIS on the level of satisfaction perceived by the visitors, by comparing the satisfaction level between the study health center and a similar health center identified as a control. The results suggest that HMIS increased the productivity and satisfaction of the staff but did not increase their persuasion and decision levels; and, that is also succeeded in increasing the levels of visitors' satisfaction with the services provided.

Distinguishing nanomaterial particles from background airborne particulate matter for quantitative exposure assessment

NASA Astrophysics Data System (ADS)

Ono-Ogasawara, Mariko; Serita, Fumio; Takaya, Mitsutoshi

2009-10-01

As the production of engineered nanomaterials quantitatively expands, the chance that workers involved in the manufacturing process will be exposed to nanoparticles also increases. A risk management system is needed for workplaces in the nanomaterial industry based on the precautionary principle. One of the problems in the risk management system is difficulty of exposure assessment. In this article, examples of exposure assessment in nanomaterial industries are reviewed with a focus on distinguishing engineered nanomaterial particles from background nanoparticles in workplace atmosphere. An approach by JNIOSH (Japan National Institute of Occupational Safety and Health) to quantitatively measure exposure to carbonaceous nanomaterials is also introduced. In addition to real-time measurements and qualitative analysis by electron microscopy, quantitative chemical analysis is necessary for quantitatively assessing exposure to nanomaterials. Chemical analysis is suitable for quantitative exposure measurement especially at facilities with high levels of background NPs.

The addition of upper cervical manipulative therapy in the treatment of patients with fibromyalgia: a randomized controlled trial.

PubMed

Moustafa, Ibrahim M; Diab, Aliaa A

2015-07-01

The aim of this study was to investigate the immediate and long-term effects of a one-year multimodal program, with the addition of upper cervical manipulative therapy, on fibromyalgia management outcomes in addition to three-dimensional (3D) postural measures. This randomized clinical trial with one-year follow-up was completed at the research laboratory of our university. A total of 120 (52 female) patients with fibromyalgia syndrome (FMS) and definite C1-2 joint dysfunction were randomly assigned to the control or an experimental group. Both groups received a multimodal program; additionally, the experimental group received upper cervical manipulative therapy. Primary outcomes were the Fibromyalgia Impact Questionnaire (FIQ), whereas secondary outcomes included Pain Catastrophizing Scale (PCS), algometric score, Pittsburgh Sleep Quality Index (PSQI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and 3D postural measures. Measures were assessed at three time intervals: baseline, 12 weeks, and 1 year after the 12-week follow-up. The general linear model with repeated measures indicated a significant group × time effect in favor of the experimental group on the measures of 3D postural parameters (P < .0005), FIQ (P < .0005), PCS (P < .0005), algometric score (F = P < .0005), PSQI (P < .0005), BAI (P < .0005), and BDI (P < .0005). The addition of the upper cervical manipulative therapy to a multimodal program is beneficial in treating patients with FMS.

The Superconducting Supercollider and US Science Policy

NASA Astrophysics Data System (ADS)

Marburger, John H.

2014-06-01

Reasons for the Superconducting Supercollider's (SSC's) termination include significant changes in the attitude of the government towards large scientific projects originating with management reforms introduced decades earlier. In the 1980s, the government insisted on inclusion of elements of these reforms in the SSC's management contract, including increased demands for accountability, additional liability for contractors, and sanctions for infractions. The SSC's planners could not have opted out of the reforms, which were by then becoming part of all large publicly funded projects. Once these reforms were in place, management mistakes in the SSC's planning and construction became highly visible, leading to termination of the machine. This episode contains two key lessons about science policy. One is that the momentum of the government's management reforms was unstoppable, and its impact on large scientific facilities and projects could not be reversed. The other is that specific measures such as cost and schedule-tracking systems to provide measures of program performance and impact were also inevitable; large scientific projects needed new parameters of accountability and transparency in what can be called the Principle of Assurance.

Identification of metrics to monitor salt marsh integrity on National Wildlife Refuges in relation to conservation and management objectives

USGS Publications Warehouse

Neckles, Hilary A.; Guntenspergen, Glenn R.; Shriver, W. George; Danz, Nicholas P.; Wiest, Whitney A.; Nagel, Jessica L.; Olker, Jennifer H.

2013-01-01

Implementation of these metrics for quantitative assessment of NWRS salt marsh integrity in FWS Region 5 requires developing sampling designs for each refuge. Additionally, it is important to determine how the monitoring information will be used within a management context. SDM should be used to complete the analysis of salt marsh management decisions. The next steps would involve 1) prioritizing and weighting the management objectives; 2) predicting responses to individual management actions in terms of objectives and metrics; 3) using multiattribute utility theory to convert all measurable attributes to a common utility scale; 4) determining the total management benefit of each action by summing utilities across objectives; and 5) maximizing the total management benefits within cost constraints for each refuge. This process would allow the optimum management decisions for NWRS salt marshes to be selected and implemented based directly on monitoring data and current understanding of marsh responses to management actions. Monitoring the outcome of management actions would then allow new monitoring data to be incorporated into subsequent decisions. 

Value measurement in health care: a new perspective.

PubMed

Michelman, J E; Rausch, P E; Barton, T L

1999-08-01

Vital to the success of any healthcare organization is the ability to obtain useful information and feedback about its performance. In particular, healthcare organizations need to begin to understand how non-value-adding work activities detract from their bottom lines. Additionally, financial managers and information systems need to provide data and reports throughout the continuum of care. Overall, healthcare organizations must align the management information and control systems with the planning and decision-making processes. The horizontal information system is a tool to manage three common problems facing today's healthcare managers: (1) the use of existing information to focus on control rather than improve business, (2) failure to focus on satisfying the customer, and (3) failure to combine their efforts with those of the employees by developing trust and a common focus.

Public health effects of inadequately managed stormwater runoff.

PubMed

Gaffield, Stephen J; Goo, Robert L; Richards, Lynn A; Jackson, Richard J

2003-09-01

This study investigated the scale of the public health risk from stormwater runoff caused by urbanization. We compiled turbidity data for municipal treated drinking water as an indication of potential risk in selected US cities and compared estimated costs of waterborne disease and preventive measures. Turbidity levels in other US cities were similar to those linked to illnesses in Milwaukee, Wis, and Philadelphia, Pa. The estimated annual cost of waterborne illness is comparable to the long-term capital investment needed for improved drinking water treatment and stormwater management. Although additional data on cost and effectiveness are needed, stormwater management to minimize runoff and associated pollution appears to make sense for protecting public health at the least cost.

Software risk management through independent verification and validation

NASA Technical Reports Server (NTRS)

Callahan, John R.; Zhou, Tong C.; Wood, Ralph

1995-01-01

Software project managers need tools to estimate and track project goals in a continuous fashion before, during, and after development of a system. In addition, they need an ability to compare the current project status with past project profiles to validate management intuition, identify problems, and then direct appropriate resources to the sources of problems. This paper describes a measurement-based approach to calculating the risk inherent in meeting project goals that leverages past project metrics and existing estimation and tracking models. We introduce the IV&V Goal/Questions/Metrics model, explain its use in the software development life cycle, and describe our attempts to validate the model through the reverse engineering of existing projects.

An 18-year-old patient with Prader-Willi syndrome: a case report on dental management under sedation and general anesthesia.

PubMed

Song, Ki Un; Nam, Ok Hyung; Kim, Mi Sun; Choi, Sung Chul; Lee, Hyo-Seol

2015-12-01

Prader-Willi syndrome (PWS) is a rare genetic disorder reported rarely in dentistry. Dental practitioners should know the features of PWS because affected patients have a variety of dental symptoms. The current report describes a case of PWS. An 18-year-old male patient presented with traumatic injuries. Initial emergency treatments were performed under sedation, and further treatments were conducted under general anesthesia. After adequate healing, periodic follow-up and dietary management according to the patient's age and nutritional phase were recommended. Dental management of PWS patients consists of active preventive measures in addition to dietary consultation according to age and nutritional phase.

Using biofeedback while immersed in a stressful videogame increases the effectiveness of stress management skills in soldiers.

PubMed

Bouchard, Stéphane; Bernier, François; Boivin, Eric; Morin, Brian; Robillard, Geneviève

2012-01-01

This study assessed the efficacy of using visual and auditory biofeedback while immersed in a tridimensional videogame to practice a stress management skill (tactical breathing). All 41 participants were soldiers who had previously received basic stress management training and first aid training in combat. On the first day, they received a 15-minute refresher briefing and were randomly assigned to either: (a) no additional stress management training (SMT) for three days, or (b) 30-minute sessions (one per day for three days) of biofeedback-assisted SMT while immersed in a horror/first-person shooter game. The training was performed in a dark and enclosed environment using a 50-inch television with active stereoscopic display and loudspeakers. On the last day, all participants underwent a live simulated ambush with an improvised explosive device, where they had to provide first aid to a wounded soldier. Stress levels were measured with salivary cortisol collected when waking-up, before and after the live simulation. Stress was also measured with heart rate at baseline, during an apprehension phase, and during the live simulation. Repeated-measure ANOVAs and ANCOVAs confirmed that practicing SMT was effective in reducing stress. Results are discussed in terms of the advantages of the proposed program for military personnel and the need to practice SMT.

Cost-effectiveness analysis of diarrhoea management approaches in Nigeria: A decision analytical model

PubMed Central

Ekwunife, Obinna I.

2017-01-01

Background Diarrhoea is a leading cause of death in Nigerian children under 5 years. Implementing the most cost-effective approach to diarrhoea management in Nigeria will help optimize health care resources allocation. This study evaluated the cost-effectiveness of various approaches to diarrhoea management namely: the ‘no treatment’ approach (NT); the preventive approach with rotavirus vaccine; the integrated management of childhood illness for diarrhoea approach (IMCI); and rotavirus vaccine plus integrated management of childhood illness for diarrhoea approach (rotavirus vaccine + IMCI). Methods Markov cohort model conducted from the payer’s perspective was used to calculate the cost-effectiveness of the four interventions. The markov model simulated a life cycle of 260 weeks for 33 million children under five years at risk of having diarrhoea (well state). Disability adjusted life years (DALYs) averted was used to quantify clinical outcome. Incremental cost-effectiveness ratio (ICER) served as measure of cost-effectiveness. Results Based on cost-effectiveness threshold of $2,177.99 (i.e. representing Nigerian GDP/capita), all the approaches were very cost-effective but rotavirus vaccine approach was dominated. While IMCI has the lowest ICER of $4.6/DALY averted, the addition of rotavirus vaccine was cost-effective with an ICER of $80.1/DALY averted. Rotavirus vaccine alone was less efficient in optimizing health care resource allocation. Conclusion Rotavirus vaccine + IMCI approach was the most cost-effective approach to childhood diarrhoea management. Its awareness and practice should be promoted in Nigeria. Addition of rotavirus vaccine should be considered for inclusion in the national programme of immunization. Although our findings suggest that addition of rotavirus vaccine to IMCI for diarrhoea is cost-effective, there may be need for further vaccine demonstration studies or real life studies to establish the cost-effectiveness of the vaccine in Nigeria. PMID:29261649

Impacts of nitrogen addition on plant biodiversity in mountain grasslands depend on dose, application duration and climate: a systematic review.

PubMed

Humbert, Jean-Yves; Dwyer, John M; Andrey, Aline; Arlettaz, Raphaël

2016-01-01

Although the influence of nitrogen (N) addition on grassland plant communities has been widely studied, it is still unclear whether observed patterns and underlying mechanisms are constant across biomes. In this systematic review, we use meta-analysis and metaregression to investigate the influence of N addition (here referring mostly to fertilization) upon the biodiversity of temperate mountain grasslands (including montane, subalpine and alpine zones). Forty-two studies met our criteria of inclusion, resulting in 134 measures of effect size. The main general responses of mountain grasslands to N addition were increases in phytomass and reductions in plant species richness, as observed in lowland grasslands. More specifically, the analysis reveals that negative effects on species richness were exacerbated by dose (ha(-1) year(-1) ) and duration of N application (years) in an additive manner. Thus, sustained application of low to moderate levels of N over time had effects similar to short-term application of high N doses. The climatic context also played an important role: the overall effects of N addition on plant species richness and diversity (Shannon index) were less pronounced in mountain grasslands experiencing cool rather than warm summers. Furthermore, the relative negative effect of N addition on species richness was more pronounced in managed communities and was strongly negatively related to N-induced increases in phytomass, that is the greater the phytomass response to N addition, the greater the decline in richness. Altogether, this review not only establishes that plant biodiversity of mountain grasslands is negatively affected by N addition, but also demonstrates that several local management and abiotic factors interact with N addition to drive plant community changes. This synthesis yields essential information for a more sustainable management of mountain grasslands, emphasizing the importance of preserving and restoring grasslands with both low agricultural N application and limited exposure to N atmospheric deposition. © 2015 John Wiley & Sons Ltd.

Posterior capsular rent: Prevention and management.

PubMed

Chakrabarti, Arup; Nazm, Nazneen

2017-12-01

This review article deals with a potentially sight threatening complication - rupture of the posterior capsule - during cataract surgery. Cataract surgery is the most commonly performed surgical procedure in ophthalmology and despite tremendous technical and technological advancements, posterior capsular rent (PCR) still occurs. PCR occurs both in the hands of experienced senior surgeons and the neophyte surgeons, although with a higher frequency in the latter group. Additionally, certain types of cataracts are prone to this development. If managed properly in a timely manner the eventual outcome may be no different from that of an uncomplicated case. However, improper management may lead to serious complications with a higher incidence of permanent visual disability. The article covers the management of posterior capsular rent from two perspectives: 1. Identifying patients at higher risk and measures to manage such patients by surgical discipline, and 2. Intraoperative management of posterior capsular rent and various case scenarios to minimize long-term complications.This review is written for experienced and not-so-experienced eye surgeons alike to understand and manage PCR.

Using info-Gap Decision Theory for Water Resources Planning Under Severe Uncertainty

NASA Astrophysics Data System (ADS)

Korteling, B.; Brazier, R.; Kapelan, Z.; Dessai, S.

2012-12-01

Water resource managers are required to develop comprehensive water resource plans based on severely uncertain information of the effects of climate change on local hydrology and future socio-economic changes on localised demand. In England and Wales, current water resource planning methodologies include a headroom estimation process that quantifies uncertainty based on only one point of an assumed range of deviations from the expected climate and projected demand 25 years into the future. There are many situations where there is not enough knowledge to be able to estimate a representative probability of occurrence, or to be confident that the tails of an assumed probability distribution will not exhibit unexpected skewness, or that the kurtosis of a distribution differs from the norm. These situations can be considered severely uncertain. Information-Gap decision theory offers a method to sample a wider range of uncertainty than with traditional methods, and as a result, compare the robustness of various water resource management options under conditions of severe uncertainty. A more robust management option is one that delivers the same level of performance as other options at higher levels of uncertainty. A case study is based on a Water Supply Area that encompasses the county of Cornwall in southwest England containing 17 reservoirs and 19 demand nodes. The performance success of management options are evaluated primarily by measures of water availability including a reservoir risk measure that tests the probability and magnitude that strategic reservoir storage levels fall below the drought management curve under adverse conditions and also a safety margin deficit that tests how quickly reservoir levels can return to optimum operating levels in favourable conditions. Multi-Criteria Decision Analysis (MCDA) is used to test the effectiveness of different management options with different weightings for metrics other than water availability including; capital and operating costs, costs to customers, carbon emissions, environmental impact and social acceptability. Findings show that beyond the uncertainty range explored with the traditional headroom method, preference reversals can occur, i.e. some management options that underperform at lower uncertainties, outperform at higher levels of uncertainty. This study also shows that when 50% or more of the population adopts demand side management, efficiency related measures and innovative options such as rainwater collection can perform equally well or better than some supply side options. The additional use of MCDA shifts the focus away from reservoir expansion options that perform best with respect to water availability, to combined strategies that include innovative demand side management actions of rainwater collection and greywater reuse as well as efficiency measures and additional regional transfers. This research illustrates how an Info-Gap based approach can offer a comprehensive picture of potential supply/demand futures and a rich variety of information to support adaptive management of water systems under severe uncertainty.

Management matters: Testing a mitigation strategy of nitrous oxide emissions on managed grassland

NASA Astrophysics Data System (ADS)

Fuchs, Kathrin; Hörtnagl, Lukas; Eugster, Werner; Koller, Patrick; Käslin, Florian; Merbold, Lutz

2017-04-01

The magnitude of greenhouse gas (GHG) exchange between managed grasslands and the atmosphere depends besides climate predominantly on management practices. While natural or extensively managed grasslands are known to function as GHG sinks, intensively managed grasslands are characterized by substantial nitrous oxide (N2O) emissions diminishing their sink function. One potential N2O mitigation strategy is to reduce the required amount of nitrogen (N) fertilizer input by using biological nitrogen fixation (BNF) via legumes. However, the effect of legumes on nitrous oxide emissions is still not fully understood. In this study we quantify net GHG fluxes from two differently managed grassland parcels (mitigation, control) and relate our results to productivity (yields). In addition, we aim at revealing the influence of various driver variables on N2O exchange. Our experimental setup consisted of an eddy covariance tower that measured the net exchange of the three major anthropogenic GHGs, nitrous oxide (N2O), methane (CH4) and carbon dioxide (CO2). Both grassland parcels can be covered with this tower due to two prevailing wind directions. GHG flux measurements were accompanied by measurements of commonly known driver variables such as water filled pore space, soil temperature, soil oxygen concentrations and mineral N to disentangle the soil meteorological influence of N2O fluxes from human drivers. Following organic fertilizer application, we measured elevated N2O emissions (>1 nmol m-2 s-1) at the control parcel and unchanged N2O emissions at the treatment parcel. Net annual fluxes were 54% and 50% lower at the experimental parcel in 2015 and 2016, respectively. Annual yields did not significantly differ between parcels, but were slightly lower at the experimental parcel compared to the control parcel. Significantly lower nitrous oxide fluxes under experimental management indicate that nitrous oxide emissions can be effectively reduced at very low costs with a clover-based management. Long-term effects on the N budget, implications for the quality of animal feed as well as potential consequences at the farming system level (i.e. manure management) need further evaluation.

Olefins and chemical regulation in Europe: REACH.

PubMed

Penman, Mike; Banton, Marcy; Erler, Steffen; Moore, Nigel; Semmler, Klaus

2015-11-05

REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals) is the European Union's chemical regulation for the management of risk to human health and the environment (European Chemicals Agency, 2006). This regulation entered into force in June 2007 and required manufacturers and importers to register substances produced in annual quantities of 1000 tonnes or more by December 2010, with further deadlines for lower tonnages in 2013 and 2018. Depending on the type of registration, required information included the substance's identification, the hazards of the substance, the potential exposure arising from the manufacture or import, the identified uses of the substance, and the operational conditions and risk management measures applied or recommended to downstream users. Among the content developed to support this information were Derived No-Effect Levels or Derived Minimal Effect Levels (DNELs/DMELs) for human health hazard assessment, Predicted No Effect Concentrations (PNECs) for environmental hazard assessment, and exposure scenarios for exposure and risk assessment. Once registered, substances may undergo evaluation by the European Chemicals Agency (ECHA) or Member State authorities and be subject to requests for additional information or testing as well as additional risk reduction measures. To manage the REACH registration and related activities for the European olefins and aromatics industry, the Lower Olefins and Aromatics REACH Consortium was formed in 2008 with administrative and technical support provided by Penman Consulting. A total of 135 substances are managed by this group including 26 individual chemical registrations (e.g. benzene, 1,3-butadiene) and 13 categories consisting of 5-26 substances. This presentation will describe the content of selected registrations prepared for 2010 in addition to the significant post-2010 activities. Beyond REACH, content of the registrations may also be relevant to other European activities, for example consideration of worker DNELs/DMELs for occupational exposure level setting, discussion of this aspect will be presented for 1,3-butadiene. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Das Bremerhavener Grundwasser im Klimawandel - Eine FREEWAT-Fallstudie

NASA Astrophysics Data System (ADS)

Panteleit, Björn; Jensen, Sven; Seiter, Katherina; Siebert, Yvonne

2018-01-01

A 3D structural model was created for the state of Bremen based on an extensive borehole database. Parameters were assigned to the model by interpretation and interpolation of the borehole descriptions. This structural model was transferred into a flow model via the FREEWAT platform, an open-source plug-in of the free QGIS software, with connection to the MODFLOW code. This groundwater management tool is intended for long-term use. As a case study for the FREEWAT Project, possible effects of climate change on groundwater levels in the Bremerhaven area have been simulated. In addition to the calibration year 2010, scenarios with a sea-level rise and decreasing groundwater recharge were simulated for the years 2040, 2070 and 2100. In addition to seawater intrusion in the coastal area, declining groundwater levels are also a concern. Possibilities for future groundwater management already include active control of the water level of a lake and the harbor basin. With the help of a focused groundwater monitoring program based on the model results, the planned flow model can become an important forecasting tool for groundwater management within the framework of the planned continuous model management and for representing the effects of changing climatic conditions and mitigation measures.

Postexposure management of healthcare personnel to infectious diseases.

PubMed

Bader, Mazen S; Brooks, Annie A; Srigley, Jocelyn A

2015-01-01

Healthcare personnel (HCP) are at risk of exposure to various pathogens through their daily tasks and may serve as a reservoir for ongoing disease transmission in the healthcare setting. Management of HCP exposed to infectious agents can be disruptive to patient care, time-consuming, and costly. Exposure of HCP to an infectious source should be considered an urgent medical concern to ensure timely management and administration of postexposure prophylaxis, if available and indicated. Infection control and occupational health departments should be notified for management of exposed HCP, identification of all contacts of the index case, and application of immediate infection control measures for the index case and exposed HCP, if indicated. This article reviews the main principles of postexposure management of HCP to infectious diseases, in general, and to certain common infections, in particular, categorized by their route of transmission, in addition to primary prevention of these infections.

The "Performance of Rotavirus and Oral Polio Vaccines in Developing Countries" (PROVIDE) study: description of methods of an interventional study designed to explore complex biologic problems.

PubMed

Kirkpatrick, Beth D; Colgate, E Ross; Mychaleckyj, Josyf C; Haque, Rashidul; Dickson, Dorothy M; Carmolli, Marya P; Nayak, Uma; Taniuchi, Mami; Naylor, Caitlin; Qadri, Firdausi; Ma, Jennie Z; Alam, Masud; Walsh, Mary Claire; Diehl, Sean A; Petri, William A

2015-04-01

Oral vaccines appear less effective in children in the developing world. Proposed biologic reasons include concurrent enteric infections, malnutrition, breast milk interference, and environmental enteropathy (EE). Rigorous study design and careful data management are essential to begin to understand this complex problem while assuring research subject safety. Herein, we describe the methodology and lessons learned in the PROVIDE study (Dhaka, Bangladesh). A randomized clinical trial platform evaluated the efficacy of delayed-dose oral rotavirus vaccine as well as the benefit of an injectable polio vaccine replacing one dose of oral polio vaccine. This rigorous infrastructure supported the additional examination of hypotheses of vaccine underperformance. Primary and secondary efficacy and immunogenicity measures for rotavirus and polio vaccines were measured, as well as the impact of EE and additional exploratory variables. Methods for the enrollment and 2-year follow-up of a 700 child birth cohort are described, including core laboratory, safety, regulatory, and data management practices. Intense efforts to standardize clinical, laboratory, and data management procedures in a developing world setting provide clinical trials rigor to all outcomes. Although this study infrastructure requires extensive time and effort, it allows optimized safety and confidence in the validity of data gathered in complex, developing country settings. © The American Society of Tropical Medicine and Hygiene.

1995 National assessment of United States oil and gas resources; results, methodology, and supporting data

USGS Publications Warehouse

Gautier, Donald L.; Dolton, G.L.; Takahashi, K.I.; Varnes, K.L.

1995-01-01

This report summarizes the results of a 3-year study of the oil and gas resources of the onshore and state waters of the United States by the U.S. Geological Survey. A parallel study of the Federal offshore is being conducted by the Minerals Management Service. Estimates are made of technically recoverable oil, including measured (proved) reserves, future additions to reserves in existing fields, and undiscovered resources. Estimates are also made of the technically recoverable conventional resources of natural gas in measured reserves, in anticipated growth of reserves in existing fields, and in undiscovered resources. Additionally, an assessment is made of recoverable resources in continuous-type (largely unconventional) accumulations in sandstones, shales, chalks, and coal beds.

Application of automated measurement stations for continuous water quality monitoring of the Dender river in Flanders, Belgium.

PubMed

Vandenberghe, V; Goethals, P L M; Van Griensven, A; Meirlaen, J; De Pauw, N; Vanrolleghem, P; Bauwens, W

2005-09-01

During the summer of 1999, two automated water quality measurement stations were installed along the Dender river in Belgium. The variables dissolved oxygen, temperature, conductivity, pH, rain-intensity, flow and solar radiation were measured continuously. In this paper these on-line measurement series are presented and interpreted using also additional measurements and ecological expert-knowledge. The purpose was to demonstrate the variability in time and space of the aquatic processes and the consequences of conducting and interpreting discrete measurements for river quality assessment and management. The large fluctuations of the data illustrated the importance of continuous measurements for the complete description and modelling of the biological processes in the river.

Pain Self-Management for Veterans: Development and Pilot Test of a Stage-Based Mobile-Optimized Intervention

PubMed Central

Levesque, Deborah A; Broderick, Lynne E; Bailey, Dustin G; Kerns, Robert D

2017-01-01

Background Chronic pain is a significant public health burden affecting more Americans than cardiovascular disease, diabetes, and cancer combined. Veterans are disproportionately affected by chronic pain. Among previously deployed soldiers and veterans, the prevalence of chronic pain is estimated between 44% and 60%. Objective The objective of this research was to develop and pilot-test Health eRide: Your Journey to Managing Pain, a mobile pain self-management program for chronic musculoskeletal pain for veterans. Based on the transtheoretical model of behavior change, the intervention is tailored to veterans’ stage of change for adopting healthy strategies for pain self-management and their preferred strategies. It also addresses stress management and healthy sleep, two components of promising integrated treatments for veterans with pain and co-occurring conditions, including posttraumatic stress disorder (PTSD) and traumatic brain injury. In addition, Health eRide leverages gaming principles, text messaging (short message service, SMS), and social networking to increase engagement and retention. Methods Pilot test participants were 69 veterans recruited in-person and by mail at a Veterans Health Administration facility, by community outreach, and by a Web-based survey company. Participants completed a mobile-delivered baseline assessment and Health eRide intervention session. During the next 30 days, they had access to a Personal Activity Center with additional stage-matched activities and information and had the option of receiving tailored text messages. Pre-post assessments, administered at baseline and the 30-day follow-up, included measures of pain, pain impact, use of pain self-management strategies, PTSD, and percentage in the Action or Maintenance stage for adopting pain self-management, managing stress, and practicing healthy sleep habits. Global impressions of change and program acceptability and usability were also assessed at follow-up. Results Among the 44 veterans who completed the 30-day post assessment, there were statistically significant pre-post reductions in pain (P<.001) and pain impact (P<.001); there was some reduction in symptoms of PTSD (P=.05). There were significant pre-post increases in the percentage of participants in the Action or Maintenance stage for adopting pain self-management (P=.01) and for managing stress (P<.001) but not for practicing healthy sleep habits (P=.11). The global impressions of change measure showed that a majority had experienced some level of improvement. User ratings of acceptability were quite high; ratings of usability fell slightly below the mean for digital programs. Conclusions Preliminary data demonstrate the potential impact of the Health eRide program for chronic musculoskeletal pain for veterans. The results underscore that simultaneously addressing other behaviors may be a promising approach to managing pain and comorbid conditions. Additional formative research is required to complete development of the Health eRide program and to address areas of usability requiring improvement. A randomized trial with longer follow-up is needed to demonstrate the program’s long-term effects on pain and pain self-management. PMID:29042341

The balanced scorecard: an integrative approach to performance evaluation.

PubMed

Oliveira, J

2001-05-01

In addition to strict financial outcomes, healthcare financial managers should assess intangible assets that affect the organization's bottom line, such as clinical processes, staff skills, and patient satisfaction and loyalty. The balanced scorecard, coupled with data-warehousing capabilities, offers a way to measure an organization's performance against its strategic objectives while focusing on building capabilities to achieve these objectives. The balanced scorecard examines performance related to finance, human resources, internal processes, and customers. Because the balanced scorecard requires substantial amounts of data, it is a necessity to establish an organizational data warehouse of clinical, operational, and financial data that can be used in decision support. Because it presents indicators that managers and staff can influence directly by their actions, the balanced-scorecard approach to performance measurement encourages behavioral changes aimed at achieving corporate strategies.

Evaluating disease management program effectiveness: an introduction to time-series analysis.

PubMed

Linden, Ariel; Adams, John L; Roberts, Nancy

2003-01-01

Currently, the most widely used method in the disease management (DM) industry for evaluating program effectiveness is referred to as the "total population approach." This model is a pretest-posttest design, with the most basic limitation being that without a control group, there may be sources of bias and/or competing extraneous confounding factors that offer a plausible rationale explaining the change from baseline. Furthermore, with the current inclination of DM programs to use financial indicators rather than program-specific utilization indicators as the principal measure of program success, additional biases are introduced that may cloud evaluation results. This paper presents a non-technical introduction to time-series analysis (using disease-specific utilization measures) as an alternative, and more appropriate, approach to evaluating DM program effectiveness than the current total population approach.

Effects of management of ecosystem carbon pools and fluxes in grassland ecosystems

NASA Astrophysics Data System (ADS)

Ryals, R.; Silver, W. L.

2010-12-01

Grasslands represent a large land-use footprint and have considerable potential to sequester carbon (C) in soil. Climate policies and C markets may provide incentives for land managers to pursue strategies that optimize soil C storage, yet we lack robust understanding of C sequestration in grasslands. Previous research has shown that management approaches such as organic amendments or vertical subsoiling can lead to larger soil C pools. These management approaches can both directly and indirectly affect soil C pools. We used well-replicated field experiments to explore the effects of these management strategies on ecosystem C pools and fluxes in two bioclimatic regions of California (Sierra Foothills Research and Extension Center (SFREC) and Nicasio Ranch). Our treatments included an untreated control, compost amendments, plowed (vertical subsoil), and compost + plow. The experiment was conducted over two years allowing us to compare dry (360 mm) and average (632 mm) rainfall conditions. Carbon dioxide (CO2) fluxes were measured weekly using a LI-8100 infrared gas analyzer. Methane (CH4) and nitrous oxide (N2O) fluxes were measured monthly using static flux chambers. Aboveground and belowground biomass were measured at the end of the growing season as an index of net primary productivity (NPP) in the annual plant dominated system. Soil moisture and temperature were measured continuously and averaged on hourly and daily timescales. Soil organic C and N concentrations were measured prior to the application of management treatments and at the ends of each growing season. Soils were collected to a 10 cm depth in year one and at four depth increments (0-10, 10-30, 30-50, and 50-100 cm) in year two. Soil C and N concentrations were converted to content using bulk density values for each plot. During both growing seasons, soil respiration rates were higher in the composted plots and lower in the plowed plots relative to controls at both sites. The effects on C loss via soil respiration were stronger in the first year, with compost soils experiencing a 21 ± 1 % greater cumulative loss at SFREC and 16 ± 3 % more at Nicasio. The second year showed a similar trend, but with a lower magnitude loss. Aboveground NPP responded positively to compost additions and negatively to plowing at both sites. At SFREC, we measured 58 % more ANPP in composted relative to control plots in year one (369 vs 230 g C/m2) and 56 % more in year two (327 vs 209 g C/m2). Aboveground NPP on plowed plots was 129 g C/m2 in year one, and 185 g C/m2 in year two. Plowed soils also showed a significant decline in soil C and N concentrations (C= 2.67 ± 0.13%, N = 0.20 ± 0.01%). Compost additions increased soil C and N concentrations (C= 3.92 ± 0.29%, N = 0.32 ± 0.02%) relative to control soils (C= 3.52 ± 0.20%, N = 0.27 ± 0.07%). Throughout the experiment, we did not detect significant treatment differences in CH4 or N2O fluxes, nor did we detect significant differences at any individual sampling point. These results suggest that compost addition can lead to an increase in ecosystem C storage, with a small offset from elevated soil respiration.

A Global Evaluation of Coral Reef Management Performance: Are MPAs Producing Conservation and Socio-Economic Improvements?

NASA Astrophysics Data System (ADS)

Hargreaves-Allen, Venetia; Mourato, Susana; Milner-Gulland, Eleanor Jane

2011-04-01

There is a consensus that Marine Protected Area (MPA) performance needs regular evaluation against clear criteria, incorporating counterfactual comparisons of ecological and socio-economic performance. However, these evaluations are scarce at the global level. We compiled self-reports from managers and researchers of 78 coral reef-based MPAs world-wide, on the conservation and welfare improvements that their MPAs provide. We developed a suite of performance measures including fulfilment of design and management criteria, achievement of aims, the cessation of banned or destructive activities, change in threats, and measurable ecological and socio-economic changes in outcomes, which we evaluated with respect to the MPA's age, geographical location and main aims. The sample was found to be broadly representative of MPAs generally, and suggests that many MPAs do not achieve certain fundamental aims including improvements in coral cover over time (in 25% of MPAs), and conflict reduction (in 25%). However, the large majority demonstrated improvements in terms of slowing coral loss, reducing destructive uses and increasing tourism and local employment, despite many being small, underfunded and facing multiple large scale threats beyond the control of managers. However spatial comparisons suggest that in some regions MPAs are simply mirroring outside changes, with demonstrates the importance of testing for additionality. MPA benefits do not appear to increase linearly over time. In combination with other management efforts and regulations, especially those relating to large scale threat reduction and targeted fisheries and conflict resolution instruments, MPAs are an important tool to achieve coral reef conservation globally. Given greater resources and changes which incorporate best available science, such as larger MPAs and no-take areas, networks and reduced user pressure, it is likely that performance could further be enhanced. Performance evaluation should test for the generation of additional ecological and socio-economic improvements over time and compared to unmanaged areas as part of an adaptive management regime.

78 FR 24360 - Fisheries Off West Coast States; Modifications of the West Coast Commercial and Recreational...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-25

... Director, Office of Sustainable Fisheries, National Marine Fisheries Service. [FR Doc. 2013-09808 Filed 4... remain in effect until modified by additional inseason action or superseded by the 2013 annual management measures on May 1, 2013. Comments will be accepted through May 10, 2013. ADDRESSES: You may submit comments...

75 FR 32771 - Notice of Public Information Collection(s) Being Submitted to the Office of Management and Budget...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-09

... economies of scale and other cost saving measures for deployments that are already planned. In addition, Petitioners could benefit from the announced plans of some commercial carriers to begin construction of LTE... an open platform for development and testing of public safety 700 MHz LTE broadband equipment. This...

Online Courses Assessment through Measuring and Archetyping of Usage Data

ERIC Educational Resources Information Center

Kazanidis, Ioannis; Theodosiou, Theodosios; Petasakis, Ioannis; Valsamidis, Stavros

2016-01-01

Database files and additional log files of Learning Management Systems (LMSs) contain an enormous volume of data which usually remain unexploited. A new methodology is proposed in order to analyse these data both on the level of both the courses and the learners. Specifically, "regression analysis" is proposed as a first step in the…

Increasing nursing treatment for pediatric procedural pain.

PubMed

Bice, April A; Gunther, Mary; Wyatt, Tami

2014-03-01

Procedural pain management is an underused practice in children. Despite the availability of efficacious treatments, many nurses do not provide adequate analgesia for painful interventions. Complementary therapies and nonpharmacologic interventions are additionally essential to managing pain. Owing to the increasing awareness of inadequate nursing utilization of pharmacologic measures for procedural pain, this paper focuses only on analgesic treatments. The aim of this review was to examine how varying degrees of quality improvement affect nursing utilization of treatments for routine pediatric procedural pain. A comprehensive search of databases including Cinahl, Medline/Pubmed, Web of Science, Google Scholar, Psycinfo, and Cochrane Library was performed. Sixty-two peer-reviewed research articles were examined. Ten articles focusing on quality improvement in pediatric pain management published in English from 2001 to 2011 were included. Three themes emerged: 1) increasing nursing knowledge; 2) nursing empowerment; and 3) protocol implementation. Research critique was completed with the use of guidelines and recommendations from Creswell (2009) and Garrard (2011). The literature reveals that nurses still think that pediatric pain management is essential. Quality improvement increases nursing utilization of procedural pain treatments. Although increasing nursing knowledge improves pediatric pain management, it appears that nursing empowerment and protocol implementation increase nursing compliance more than just education alone. Nurses providing pain management can enhance their individual practice with quality improvement measures that may increase nursing adherence to institutional and nationally recommended pediatric procedural pain management guidelines. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

American pain society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force.

PubMed

Gordon, Debra B; Dahl, June L; Miaskowski, Christine; McCarberg, Bill; Todd, Knox H; Paice, Judith A; Lipman, Arthur G; Bookbinder, Marilyn; Sanders, Steve H; Turk, Dennis C; Carr, Daniel B

2005-07-25

The American Pain Society (APS) set out to revise and expand its 1995 Quality Improvement Guidelines for the Treatment of Acute Pain and Cancer Pain and to facilitate improvements in the quality of pain management in all care settings. Eleven multidisciplinary members of the APS with expertise in quality improvement or measurement participated in the update. Five experts from organizations that focus on health care quality reviewed the final recommendations. MEDLINE and Cumulative Index to Nursing and Allied Health Literature databases were searched (1994-2004) to identify articles on pain quality measurement and quality improvement published after the development of the 1995 guidelines. The APS task force revised and expanded recommendations on the basis of the systematic review of published studies. The more than 3000 members of the APS were invited to provide input, and the 5 experts provided additional comments. The task force synthesized reviewers' comments into the final set of recommendations. The recommendations specify that all care settings formulate structured, multilevel systems approaches (sensitive to the type of pain, population served, and setting of care) that ensure prompt recognition and treatment of pain, involvement of patients and families in the pain management plan, improved treatment patterns, regular reassessment and adjustment of the pain management plan as needed, and measurement of processes and outcomes of pain management. Efforts to improve the quality of pain management must move beyond assessment and communication of pain to implementation and evaluation of improvements in pain treatment that are timely, safe, evidence based, and multimodal.

Improving patient satisfaction with pain management using Six Sigma tools.

PubMed

DuPree, Erin; Martin, Lisa; Anderson, Rebecca; Kathuria, Navneet; Reich, David; Porter, Carol; Chassin, Mark R

2009-07-01

Patient satisfaction as a direct and public measure of quality of care is changing the way hospitals address quality improvement. The feasibility of using the Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) methodology to improve patient satisfaction as it relates to pain management was evaluated. This project used the DMAIC methodology to improve patients' overall satisfaction with pain management on two inpatient units in an urban academic medical center. Pre- and postintervention patient surveys were conducted. The DMAIC methodology provided a data-driven structure to determine the optimal improvement strategies, as well as a long-term plan for maintaining any improvements. In addition, the Change Acceleration Process (CAP) was used throughout the project's various DMAIC stages to further the work of the team by creating a shared need to meet the objectives of the project. Overall satisfaction with pain management "excellent" ratings increased from 37% to 54%. Both units surpassed the goal of at least 50% of responses in the "excellent" category. Several key drivers of satisfaction with pain management were uncovered in the Analyze phase of the project, and each saw rating increases from the pre-intervention to postintervention surveys. Ongoing monitoring by the hospital inpatient satisfaction survey showed that the pain satisfaction score improved in subsequent quarters as compared with the pre-intervention period. The Six Sigma DMAIC methodology can be used successfully to improve patient satisfaction. The project led to measurable improvements in patient satisfaction with pain management, which have endured past the duration of the Six Sigma project. The Control phase of DMAIC allows the improvements to be incorporated into daily operations.

A randomized control trial measuring the effectiveness of a mouth-exercising device for mucosal burning in oral submucous fibrosis.

PubMed

Patil, Pravinkumar G; Hazarey, Vinay; Chaudhari, Rekha; Nimbalkar-Patil, Smita

2016-12-01

To evaluate effect of ice-cream stick exercise regimen with or without a mouth-exercising device (MED) on mucosal burning sensation in oral submucous fibrosis. In total, 282 patients with oral submucous fibrosis were treated with topical corticosteroid and oral antioxidant and the ice-cream stick exercise regimen. Patients in subgroups A1, A2, and A3 were additionally given a new MED. Patients in subgroups A1 and B1 patients with interincisal distance (IID) of 20 to 35 mm were managed without any additional therapy; patients in subgroups A2 and B2 with IID of 20 to 35 mm were additionally managed with intralesional injections; and those in subgroups A3 and B3 with IID less than 20 mm were managed surgically. Subjective evaluation of decrease in the oral mucosal burning was measured on a visual analogue scale (VAS). Analysis of variance and Tukey's multiple post hoc analysis were carried out to present the results. Patients using the MED, that is, subgroups A1, A2, and A3, showed reduction in burning sensation in the range of 64.8% to 71.1% and 27.8% to 30.9%, whereas in subgroups B1, B2, and B3, reduction in burning sensation ranged from 64.7% to 69.9% and from 29.3% to 38.6% after 6 months. The wo-way analysis of variance indicated statistically significant results in changes in initial VAS scores to 6-monthly VAS scores between MED users and non-MED users. The MED helps to enhance the rate of reduction of mucosal burning sensation, in addition to the conventional ice-cream stick regimen, as an adjunct to local and surgical treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

Geographic variations of soil phosphorus induced by long-term land and manure nutrient management practices

NASA Astrophysics Data System (ADS)

Dao, Thanh

2014-05-01

Most natural and agricultural ecosystems are deficient in phosphorus (P), and supplemental P must be provided to attain optimal levels of agronomic production. Animal manure is often used to supply needed plant nutrients to enhance production of feed and fiber crops for human and livestock consumption. Soils have been treated with large amounts of P-enriched manure, and have shown elevated P levels in watersheds where there is a high density of intensive confined animal agriculture. Long-term additions can have lasting effects on the geographic distribution of soil microbes associated with the turnover of major soil nutrients, in particular non-mobile one such as P. We determined the distribution of soil P forms in a 10-ha no-till field that received annual additions of dairy manure at 0, 15, and 30 kg P ha-1 at the field scale for 16 consecutive years. Spectroscopic analyses of the near-surface zone were performed by X-ray fluorescence in soil cores taken to a depth of 0.2 m. Geostatistical methods were used to determine the spatial structure of the soil compositional data. Soil X-ray fluorescence spectral attributes were obtained based on a set of five parallel transects established across five experimental blocks, i.e., a 5 × 5 rectangular grid pattern. Three subsets of each soil attribute were identified for the three rates of manure addition. Long-term manure addition, albeit liquid manure, resulted in significant variability in soil P distribution in the near surface zone. The heterogeneity persisted over years of continuous no-tillage management. Therefore, a high density of geo-referenced soil measurements must be made to estimate the status of a required plant nutrient, especially a non-mobile nutrient in soil. A large number of timely measurements would require a rapid geo-referenced soil sensing spectroscopic method such as X-ray fluorescence to manage in near real-time the observed spatial variability of manure-treated fields.

Economic evaluation of a mentorship and enhanced supervision program to improve quality of integrated management of childhood illness care in rural Rwanda.

PubMed

Manzi, Anatole; Mugunga, Jean Claude; Iyer, Hari S; Magge, Hema; Nkikabahizi, Fulgence; Hirschhorn, Lisa R

2018-01-01

Integrated management of childhood illness (IMCI) can reduce under-5 morbidity and mortality in low-income settings. A program to strengthen IMCI practices through Mentorship and Enhanced Supervision at Health centers (MESH) was implemented in two rural districts in eastern Rwanda in 2010. We estimated cost per improvement in quality of care as measured by the difference in correct diagnosis and correct treatment at baseline and 12 months of MESH. Costs of developing and implementing MESH were estimated in 2011 United States Dollars (USD) from the provider perspective using both top-down and bottom-up approaches, from programmatic financial records and site-level data. Improvement in quality of care attributed to MESH was measured through case management observations (n = 292 cases at baseline, 413 cases at 12 months), with outcomes from the intervention already published. Sensitivity analyses were conducted to assess uncertainty under different assumptions of quality of care and patient volume. The total annual cost of MESH was US$ 27,955.74 and the average cost added by MESH per IMCI patient was US$1.06. Salary and benefits accounted for the majority of total annual costs (US$22,400 /year). Improvements in quality of care after 12 months of MESH implementation cost US$2.95 per additional child correctly diagnosed and $5.30 per additional child correctly treated. The incremental costs per additional child correctly diagnosed and child correctly treated suggest that MESH could be an affordable method for improving IMCI quality of care elsewhere in Rwanda and similar settings. Integrating MESH into existing supervision systems would further reduce costs, increasing potential for spread.

Pain Assessment and Management After a Knowledge Translation Booster Intervention.

PubMed

Stevens, Bonnie J; Yamada, Janet; Promislow, Sara; Barwick, Melanie; Pinard, Marie

2016-10-01

Inadequate pain treatment leaves hospitalized children vulnerable to immediate and long-term sequelae. A multidimensional knowledge translation intervention (ie, the Evidence-based Practice for Improving Quality [EPIQ]) improved pain assessment, management, and intensity outcomes in 16 units at 8 Canadian pediatric hospitals. The sustained effectiveness of EPIQ over time is unknown, however. The goals of this study were to determine the following: (1) sustainability of the impact of EPIQ on pain assessment, management, and intensity outcomes 12, 24, and 36 months after EPIQ; (2) effectiveness of a pain practice change booster (Booster) intervention to sustain EPIQ outcomes over time; and (3) influence of context on sustainability. A prospective, repeated measures, cluster randomized controlled trial was undertaken in the 16 EPIQ units, 12 months after EPIQ completion, to determine the effectiveness of a practice change booster (Booster) to sustain EPIQ outcomes. Generalized estimating equation models examined outcomes controlling for child and unit contextual factors. Outcomes achieved during EPIQ were sustained in the use of any pain assessment measure (P = .01) and a validated pain assessment measure in the EPIQ units (P = .02) up to 36 months after EPIQ. Statistically significant improvements in pain management practices persisted in EPIQ units; results varied across time. There were no significant differences in outcomes after implementation of the Booster between the Booster and Nonbooster groups. Improved pain assessment and management practices were sustained after EPIQ; however, the Booster did not seem to provide additional impact. Copyright © 2016 by the American Academy of Pediatrics.

Hydrology of C-3 watershed, Seney National Wildlife Refuge, Michigan

USGS Publications Warehouse

Sweat, Michael J.

2001-01-01

Proposed changes to watershed management practices near C-3 Pool at Seney National Wildlife Refuge will affect surface-water flow patterns, ground-water levels, and possibly local plant communities. Data were collected between fall 1998 and spring 2000 to document existing conditions and to assess potential changes in hydrology that might occur as a consequence of modifications to water management practices in C-3 watershed.Minimum and maximum measured inflows and outflows for the study period are presented in light of proposed management changes to C-3 watershed. Streamflows ranged from 0 to 8.61 cubic meters per second. Low or zero flow was generally measured in late summer and early fall, and highest flows were measured during spring runoff and winter rain events. Ground-water levels varied by about a half meter, with levels closest to or above the land surface during spring runoff into the early summer, and with levels generally below land surface during late fall into early winter.A series of optional management practices that could conserve and restore habitat of the C-3 watershed is described. Modifications to the existing system of a drainage ditch and control structures are examined, as are the possibilities of reconnecting streams to their historical channels and the construction of additional or larger control structures to further manage the distribution of water in the watershed. The options considered could reduce erosion, restore presettlement streamflow conditions, and modify the ground-water gradient.

[Prompt control of an imported carbapenem-resistant Acinetobacter baumanii outbreak in a French intensive care unit].

PubMed

Guth, C; Cavalli, Z; Pernod, C; Lhopital, C; Wey, Pf; Gerome, P; Turc, J

2016-01-01

to describe the management and control of a limited outbreak of carbapenem-resistant Acinetobacter baumanii (CRAB) outbreak in a French intensive care unit. Careful review of the contact's and carrier's files and outbreak management procedures. An undiagnosed CRAB carrier was admitted to our intensive care unit after medical evacuation from Turkey. Despite preventive isolation and contact precautions, a secondary case was diagnosed 5 days after admission of the index case and resulted in the creation of a crisis unit. Prompt management included an epidemiologic investigation with contact screening and follow-up, environmental screening, and additional restrictive measures: isolation room, closure of adjacent rooms, patient cohorting with designated nurses, and reinforcement of contact precautions. restrictive management of CRAB outbreaks may allow prompt outbreak control and avoid prolonged room closures.

Emollient bath additives for the treatment of childhood eczema (BATHE): multicentre pragmatic parallel group randomised controlled trial of clinical and cost effectiveness

PubMed Central

Ridd, Matthew J; Francis, Nick A; Stuart, Beth; Rumsby, Kate; Chorozoglou, Maria; Becque, Taeko; Roberts, Amanda; Liddiard, Lyn; Nollett, Claire; Hooper, Julie; Prude, Martina; Wood, Wendy; Thomas, Kim S; Thomas-Jones, Emma; Williams, Hywel C; Little, Paul

2018-01-01

Abstract Objectives To determine the clinical effectiveness and cost effectiveness of including emollient bath additives in the management of eczema in children. Design Pragmatic randomised open label superiority trial with two parallel groups. Setting 96 general practices in Wales and western and southern England. Participants 483 children aged 1 to 11 years, fulfilling UK diagnostic criteria for atopic dermatitis. Children with very mild eczema and children who bathed less than once weekly were excluded. Interventions Participants in the intervention group were prescribed emollient bath additives by their usual clinical team to be used regularly for 12 months. The control group were asked to use no bath additives for 12 months. Both groups continued with standard eczema management, including leave-on emollients, and caregivers were given standardised advice on how to wash participants. Main outcome measures The primary outcome was eczema control measured by the patient oriented eczema measure (POEM, scores 0-7 mild, 8-16 moderate, 17-28 severe) weekly for 16 weeks. Secondary outcomes were eczema severity over one year (monthly POEM score from baseline to 52 weeks), number of eczema exacerbations resulting in primary healthcare consultation, disease specific quality of life (dermatitis family impact), generic quality of life (child health utility-9D), utilisation of resources, and type and quantity of topical corticosteroid or topical calcineurin inhibitors prescribed. Results 483 children were randomised and one child was withdrawn, leaving 482 children in the trial: 51% were girls (244/482), 84% were of white ethnicity (447/470), and the mean age was 5 years. 96% (461/482) of participants completed at least one post-baseline POEM, so were included in the analysis, and 77% (370/482) completed questionnaires for more than 80% of the time points for the primary outcome (12/16 weekly questionnaires to 16 weeks). The mean baseline POEM score was 9.5 (SD 5.7) in the bath additives group and 10.1 (SD 5.8) in the no bath additives group. The mean POEM score over the 16 week period was 7.5 (SD. 6.0) in the bath additives group and 8.4 (SD 6.0) in the no bath additives group. No statistically significant difference was found in weekly POEM scores between groups over 16 weeks. After controlling for baseline severity and confounders (ethnicity, topical corticosteroid use, soap substitute use) and allowing for clustering of participants within centres and responses within participants over time, POEM scores in the no bath additives group were 0.41 points higher than in the bath additives group (95% confidence interval −0.27 to 1.10), below the published minimal clinically important difference for POEM of 3 points. The groups did not differ in secondary outcomes, economic outcomes, or adverse effects. Conclusions This trial found no evidence of clinical benefit from including emollient bath additives in the standard management of eczema in children. Further research is needed into optimal regimens for leave-on emollient and soap substitutes. Trial registration Current Controlled Trials ISRCTN84102309. PMID:29724749

Data Validation Package, June 2016 Groundwater Sampling at the Hallam, Nebraska, Decommissioned Reactor Site, August 2016

DOE Office of Scientific and Technical Information (OSTI.GOV)

Surovchak, Scott; Miller, Michele

The 2008 Long-Term Surveillance Plan [LTSP] for the Decommissioned Hallam Nuclear Power Facility, Hallam, Nebraska (http://www.lm.doe.gov/Hallam/Documents.aspx) requires groundwater monitoring once every 2 years. Seventeen monitoring wells at the Hallam site were sampled during this event as specified in the plan. Planned monitoring locations are shown in Attachment 1, Sampling and Analysis Work Order. Water levels were measured at all sampled wells and at two additional wells (6A and 6B) prior to the start of sampling. Additionally, water levels of each sampled well were measured at the beginning of sampling. See Attachment 2, Trip Report, for additional details. Sampling and analysismore » were conducted as specified in Sampling and Analysis Plan for U.S. Department of Energy Office of Legacy Management Sites (LMS/PRO/S04351, continually updated, http://energy.gov/lm/downloads/sampling-and-analysis-plan-us-department- energy-office-legacy-management-sites). Gross alpha and gross beta are the only parameters that were detected at statistically significant concentrations. Time/concentration graphs of the gross alpha and gross beta data are included in Attachment 3, Data Presentation. The gross alpha and gross beta activity concentrations observed are consistent with values previously observed and are attributed to naturally occurring radionuclides (e.g., uranium and uranium decay chain products) in the groundwater.« less

Adaptation of Soil Physical Measurement Techniques for the Delineation of Mud and Lakebed Sediments at Neusiedler See

PubMed Central

Kogelbauer, Ilse; Heine, Erwin; D'Amboise, Christopher; Müllebner, Christoph; Sokol, Wolfgang; Loiskandl, Willibald

2013-01-01

For many water management issues of shallow lakes with non-consolidated sediments hydrographic surveys of the open water area and reed belt areas are required. In the frame of water management strategy for the steppe lake Neusiedler See, located between Austria and Hungary, a hydrographic survey was conducted. In the open water area (water depth ≥1 m) a sediment echosounder was used. To validate these measurements and to distinguish between water, mud, and sediment layers in the shallow lake and reed belt area additional measurements were needed. As no common standard methods are available yet, we developed a measurement system based on two commonly applied soil physical measurement techniques providing reproducible physical values: a capacitive sensor and a cone penetrometer combined with GNSS-positioning enable dynamic measurements of georeferenced vertical water-mud-bedsediments profiles. The system bases on site-specific calibrated sensors and allows instantaneous, in situ measurements. The measurements manifest a sharp water-mud interface by a sudden decline to smaller water content which is a function of the dielectric permittivity. A second decline indicates the transition to compacted mud. That is concurrently the density where the penetrometer starts registering significant penetration resistance. The penetrometer detects shallow lakebed-sediment layers. Within the lake survey this measurement system was successfully tested. PMID:24351626

Charge Management in LISA Pathfinder: The Continuous Discharging Experiment

NASA Astrophysics Data System (ADS)

Ewing, Becca Elizabeth

2018-01-01

Test mass charging is a significant source of excess force and force noise in LISA Pathfinder (LPF). The planned design scheme for mitigation of charge induced force noise in LISA is a continuous discharge by UV light illumination. We report on analysis of a charge management experiment on-board LPF conducted during December 2016. We discuss the measurement of test mass charging noise with and without continuous UV illumination, in addition to the dynamic response in the continuous discharge scheme. Results of the continuous discharge system will be discussed for their application to operating LISA with lower test mass charge.

Development and Validation of the Pediatric Diabetes Routines Questionnaire for Adolescents.

PubMed

Pierce, Jessica S; Jordan, Sara S; Arnau, Randolph C

2018-04-06

This study describes the development and psychometric evaluation of an adolescent self-report version of the Pediatric Diabetes Routines Questionnaire (PDRQ:A), a measure of diabetes-specific routines for youth with type 1 diabetes, and further validation of the parent-version (PDRQ:P) in an adolescent sample. Participants included 120 parent-adolescent dyads (ages 12-17) and an additional 24 parents who completed measures of diabetes-specific adolescent routines, general adolescent routines, diabetes self-care, and family support of youth diabetes care. The PDRQ:P/A demonstrated good internal consistency, test-retest reliability, and parent-child agreement, and adequate validity coefficients. Confirmatory factor analysis supported a one-factor model. Promising results were obtained. The PDRQ:P/A is a clinically feasible parent- and self-report measure that can provide valuable information regarding how frequently adolescents engage in their diabetes management tasks in a consistent manner. Addition of an adolescent report format will enhance the utility of the measure for clinical and research use.

Intracranial Pressure Monitoring—Review and Avenues for Development

PubMed Central

Dolmans, Rianne G. F.

2018-01-01

Intracranial pressure (ICP) monitoring is a staple of neurocritical care. The most commonly used current methods of monitoring in the acute setting include fluid-based systems, implantable transducers and Doppler ultrasonography. It is well established that management of elevated ICP is critical for clinical outcomes. However, numerous studies show that current methods of ICP monitoring cannot reliably define the limit of the brain’s intrinsic compensatory capacity to manage increases in pressure, which would allow for proactive ICP management. Current work in the field hopes to address this gap by harnessing live-streaming ICP pressure-wave data and a multimodal integration with other physiologic measures. Additionally, there is continued development of non-invasive ICP monitoring methods for use in specific clinical scenarios. PMID:29401746

The Orbital Workshop Waste Management Compartment

NASA Technical Reports Server (NTRS)

1972-01-01

This image is a wide-angle view of the Orbital Workshop waste management compartment. The waste management facilities presented a unique challenge to spacecraft designers. In addition to collection of liquid and solid human wastes, there was a medical requirement to dry all solid human waste products and to return the residue to Earth for examination. Liquid human waste (urine) was frozen for return to Earth. Total quantities of each astronaut's liquid and solid wastes were precisely measured. Cabin air was drawn into the toilet, shown on the wall at right in this photograph, and over the waste products to generate a flow of the waste in the desired direction. The air was then filtered for odor control and antiseptic purposes prior to being discharged back into the cabin.

Public Health Effects of Inadequately Managed Stormwater Runoff

PubMed Central

Gaffield, Stephen J.; Goo, Robert L.; Richards, Lynn A.; Jackson, Richard J.

2003-01-01

Objectives. This study investigated the scale of the public health risk from stormwater runoff caused by urbanization. Methods. We compiled turbidity data for municipal treated drinking water as an indication of potential risk in selected US cities and compared estimated costs of waterborne disease and preventive measures. Results. Turbidity levels in other US cities were similar to those linked to illnesses in Milwaukee, Wis, and Philadelphia, Pa. The estimated annual cost of waterborne illness is comparable to the long-term capital investment needed for improved drinking water treatment and stormwater management. Conclusions. Although additional data on cost and effectiveness are needed, stormwater management to minimize runoff and associated pollution appears to make sense for protecting public health at the least cost. PMID:12948975

Intraoperative blood glucose management: impact of a real-time decision support system on adherence to institutional protocol.

PubMed

Nair, Bala G; Grunzweig, Katherine; Peterson, Gene N; Horibe, Mayumi; Neradilek, Moni B; Newman, Shu-Fang; Van Norman, Gail; Schwid, Howard A; Hao, Wei; Hirsch, Irl B; Patchen Dellinger, E

2016-06-01

Poor perioperative glycemic management can lead to negative surgical outcome. Improved compliance to glucose control protocol could lead to better glucose management. An Anesthesia Information Management System based decision support system-Smart Anesthesia Manager™ (SAM) was used to generate real-time reminders to the anesthesia providers to closely adhere to our institutional glucose management protocol. Compliance to hourly glucose measurements and correct insulin dose adjustments was compared for the baseline period (12 months) without SAM and the intervention period (12 months) with SAM decision support. Additionally, glucose management parameters were compared for the baseline and intervention periods. A total of 1587 cases during baseline and 1997 cases during intervention met the criteria for glucose management (diabetic patients or non-diabetic patients with glucose level >140 mg/dL). Among the intervention cases anesthesia providers chose to use SAM reminders 48.7 % of the time primarily for patients who had diabetes, higher HbA1C or body mass index, while disabling the system for the remaining cases. Compliance to hourly glucose measurement and correct insulin doses increased significantly during the intervention period when compared with the baseline (from 52.6 to 71.2 % and from 13.5 to 24.4 %, respectively). In spite of improved compliance to institutional protocol, the mean glucose levels and other glycemic management parameters did not show significant improvement with SAM reminders. Real-time electronic reminders improved intraoperative compliance to institutional glucose management protocol though glycemic parameters did not improve even when there was greater compliance to the protocol.

Evaluating the Impact of Classroom Education on the Management of Septic Shock Using Human Patient Simulation.

PubMed

Lighthall, Geoffrey K; Bahmani, Dona; Gaba, David

2016-02-01

Classroom lectures are the mainstay of imparting knowledge in a structured manner and have the additional goals of stimulating critical thinking, lifelong learning, and improvements in patient care. The impact of lectures on patient care is difficult to examine in critical care because of the heterogeneity in patient conditions and personnel as well as confounders such as time pressure, interruptions, fatigue, and nonstandardized observation methods. The critical care environment was recreated in a simulation laboratory using a high-fidelity mannequin simulator, where a mannequin simulator with a standardized script for septic shock was presented to trainees. The reproducibility of this patient and associated conditions allowed the evaluation of "clinical performance" in the management of septic shock. In a previous study, we developed and validated tools for the quantitative analysis of house staff managing septic shock simulations. In the present analysis, we examined whether measures of clinical performance were improved in those cases where a lecture on the management of shock preceded a simulated exercise on the management of septic shock. The administration of the septic shock simulations allowed for performance measurements to be calculated for both medical interns and for subsequent management by a larger resident-led team. The analysis revealed that receiving a lecture on shock before managing a simulated patient with septic shock did not produce scores higher than for those who did not receive the previous lecture. This result was similar for both interns managing the patient and for subsequent management by a resident-led team. We failed to find an immediate impact on clinical performance in simulations of septic shock after a lecture on the management of this syndrome. Lectures are likely not a reliable sole method for improving clinical performance in the management of complex disease processes.

Future water supply management adaptation measures - case study of Ljubljana field aquifer

NASA Astrophysics Data System (ADS)

Čenčur Curk, B.; Zajc Benda, T.; Souvent, P.; Bračič Železnik, B.; Bogardi, I.

2012-04-01

The main drinking water supply problems are related to the significant change of groundwater quantity and quality observed in the last decades as an effect of land use practices and very likely also climate change. The latter may affect the ability of drinking water suppliers to provide enough water of sufficient quality to the consumers. These topics were studied in the frame of SEE project CC-WaterS (Climate Change and Impact on Water Supply) with the main goal to develop a water supply management system regarding optimisation of water extraction and land use restrictions under climate change scenarios for water suppliers, since existing management practices are mostly inadequate to reduce impacts of CC on water supply reliability. The main goal was a designation of appropriate measures and risk assessment to adapt water supply to changing climate and land use activities considering socio-economic aspects. This was accomplished by using 'Fuzzy Decimaker', which is a tool for selecting and ranking risk reduction measures or management actions for local waterworks or water authorities under the pressure of climate change. Firstly, management options were selected and ranked. For public water supply of Ljubljana, the capital of Slovenia, several management options were selected. For improvement of water supply and preservation of water resource quantities there is a need for engineering interventions, such as reducing water losses on pipelines. For improving drinking water safety and preserving water resource quality farmers are not allowed to use fertilisers in the first safeguarding zone and they get compensations for income reduction because of lower farming production. Compensations for farming restrictions in the second safeguarding zone were applied as additional management option. On the other hand, drinking water treatment is another management option to be considered. Trends in groundwater level are decreasing, above all recharge areas of waterworks; therefore there is a threat of reduction of water resource availability. For this following management options were proposed: artificial recharge with infiltration wells, setting up new and additional waterworks (one with river bank filtration, one with exploitation of local porous aquifer and one with deep groundwater exploitation from dolomite aquifer). Management actions can be evaluated according to several criteria, such as water supply risk reduction for the various users (drinking, agricultural, industrial and ecological), realization of the actions (cost, flexibility and leg time). Ranking criteria are characterized by different units (e.g. units of water supply (quantity) risk may involve number of unsupplied people, monetary terms, agricultural area or habitat loss). Decision making process is followed by defining relative weights, balancing factors and best and worst values for the indicators; calculating base risk and risk elements for each management option and sensitivity analysis. The result of this decision making process is evaluation of preferred management option(s) according to the ranking results.

Viability and Management Targets of Mediterranean Demersal Fisheries: The Case of the Aegean Sea.

PubMed

Tserpes, George; Nikolioudakis, Nikolaos; Maravelias, Christos; Carvalho, Natacha; Merino, Gorka

2016-01-01

Management of the Mediterranean demersal stocks has proven challenging mainly due to the multi-species character of the fisheries. In the present work, we focus on the multi-species demersal fisheries of the Aegean Sea (eastern Mediterranean) aiming to study the effects of different management measures on the main commercial stocks, as well as to explore the economic viability of the fisheries depending upon these resources, by means of simulated projections. Utilizing the limited available data, our results demonstrated that, under the current exploitation pattern, the economic viability of the fleets is threatened, particularly if fuel prices increase. Additionally, the biological targets set for the most exploited species, such as hake, will not be met under the current management regime. The projections also showed that the only management scenario under which both resource sustainability and economic viability of the fisheries are ensured is the decrease of fleet capacity in terms of vessel numbers. In this case, however, measures to support the fisheries-dependent communities need to be implemented to prevent the collapse of local economies due to employment decrease. Scenarios assuming selectivity improvements would be also beneficial for the stocks but they showed low economic performance and their application would threaten the viability of the fleets, particularly that of the trawlers.

Micrometeorological Mass Balance Measurements of Greenhouse Gas Emissions from Composting Green-waste

NASA Astrophysics Data System (ADS)

Kent, E. R.; Bailey, S.; Stephens, J.; Horwath, W. R.; Paw U, K.

2013-12-01

Managed decomposition of organic materials is increasingly being used as an alternative waste management option and the resulting compost can be used as a fertilizer and soil amendment in home gardens and agriculture. An additional benefit is the avoidance of methane emissions associated with anaerobic decomposition in landfills. Greenhouse gases are still emitted during the composting process, but few studies have measured emissions from a full-scale windrow of composting green-waste. This study uses a micrometeorological mass balance technique (upwind and downwind vertical profile measurements of trace gas concentrations and wind velocity) to calculate emissions of carbon dioxide, methane, and nitrous oxide from a pile of composting green-waste during the dry season in Northern California. The expected source pattern was observed in measured upwind-downwind concentration differences of all three gases averaged over the study period despite substantial noise seen in the half-hourly emission calculations. Sources of uncertainty are investigated and temporal patterns analyzed. An in-situ zero-source test was conducted to examine the mass balance technique when the source of emissions was removed. Results from the micrometeorological mass balance measurements are compared with measurements taken using the more common open chamber technique.

36 CFR § 1236.24 - What are the additional requirements for managing unstructured electronic records?

Code of Federal Regulations, 2013 CFR

2013-07-01

... requirements for managing unstructured electronic records? § 1236.24 Section § 1236.24 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional Requirements for Electronic Records § 1236.24 What are the additional requirements for...

Restoring fish ecological quality in estuaries: Implication of interactive and cumulative effects among anthropogenic stressors.

PubMed

Teichert, Nils; Borja, Angel; Chust, Guillem; Uriarte, Ainhize; Lepage, Mario

2016-01-15

Estuaries are subjected to multiple anthropogenic stressors, which have additive, antagonistic or synergistic effects. Current challenges include the use of large databases of biological monitoring surveys (e.g. the European Water Framework Directive) to help environmental managers prioritizing restoration measures. This study investigated the impact of nine stressor categories on the fish ecological status derived from 90 estuaries of the North East Atlantic countries. We used a random forest model to: 1) detect the dominant stressors and their non-linear effects; 2) evaluate the ecological benefits expected from reducing pressure from stressors; and 3) investigate the interactions among stressors. Results showed that largest restoration benefits were expected when mitigating water pollution and oxygen depletion. Non-additive effects represented half of pairwise interactions among stressors, and antagonisms were the most common. Dredged sediments, flow changes and oxygen depletion were predominantly implicated in non-additive interactions, whereas the remainder stressors often showed additive impacts. The prevalence of interactive impacts reflects a complex scenario for estuaries management; hence, we proposed a step-by-step restoration scheme focusing on the mitigation of stressors providing the maximum of restoration benefits under a multi-stress context. Copyright © 2015 Elsevier B.V. All rights reserved.

Managing workplace health promotion in municipal organizations: The perspective of senior managers.

PubMed

Larsson, Robert; Åkerlind, Ingemar; Sandmark, Hélène

2015-01-01

Previous research indicates that companies manage workplace health in various ways, but more in-depth empirical knowledge of how workplace health promotion (WHP) is managed in public sector organizations is needed. The aim of this study was to explore how WHP is managed and incorporated into the general management system in two large Swedish municipal organizations. A qualitative descriptive approach was used. Fourteen senior managers were purposefully selected and interviewed using semi-structured interviews. Documents were used as supplementary data. All data were analysed using qualitative content analysis. The management of WHP was described as a set of components that together contribute to the organization's capacity for WHP. The informants described WHP as dominated by fitness programmes and as following a problem-solving cycle, in which the annual employee survey emerged as an important managerial tool. Achieving feasible WHP measures and appropriate follow-ups were described as challenges. The provision of leadership competence for WHP and use of supportive resources were described as additional components. The WHP management approach needs to be broadened to include work environment and organizational factors. Further integration with occupational health and safety and the general management system in the organizations is also needed.

Additive Manufacturing: Which DLA-Managed Legacy Parts are Potential AM Candidates

DTIC Science & Technology

2016-07-01

R G ADDITIVE MANUFACTURING : WHICH DLA-MANAGED LEGACY PARTS ARE POTENTIAL AM CANDIDATES? REPORT DL501T1 J UL Y 2016...L Y 2 0 1 6 ADDITIVE MANUFACTURING : WHICH DLA-MANAGED LEGACY PARTS ARE POTENTIAL AM CANDIDATES? REPORT DL501T1 Thomas K . Pa rk s...DESIGNATED BY OTHER OFFICIAL DOCUMENTATION. LMI © 2016. ALL RIGHTS RESERVED. iii Additive Manufacturing : Which DLA-Managed Legacy Parts Are

Quantitative Risk Assessment for African Horse Sickness in Live Horses Exported from South Africa

PubMed Central

Sergeant, Evan S.

2016-01-01

African horse sickness (AHS) is a severe, often fatal, arbovirus infection of horses, transmitted by Culicoides spp. midges. AHS occurs in most of sub-Saharan Africa and is a significant impediment to export of live horses from infected countries, such as South Africa. A stochastic risk model was developed to estimate the probability of exporting an undetected AHS-infected horse through a vector protected pre-export quarantine facility, in accordance with OIE recommendations for trade from an infected country. The model also allows for additional risk management measures, including multiple PCR tests prior to and during pre-export quarantine and optionally during post-arrival quarantine, as well as for comparison of risk associated with exports from a demonstrated low-risk area for AHS and an area where AHS is endemic. If 1 million horses were exported from the low-risk area with no post-arrival quarantine we estimate the median number of infected horses to be 5.4 (95% prediction interval 0.5 to 41). This equates to an annual probability of 0.0016 (95% PI: 0.00015 to 0.012) assuming 300 horses exported per year. An additional PCR test while in vector-protected post-arrival quarantine reduced these probabilities by approximately 12-fold. Probabilities for horses exported from an area where AHS is endemic were approximately 15 to 17 times higher than for horses exported from the low-risk area under comparable scenarios. The probability of undetected AHS infection in horses exported from an infected country can be minimised by appropriate risk management measures. The final choice of risk management measures depends on the level of risk acceptable to the importing country. PMID:26986002

Quantitative Risk Assessment for African Horse Sickness in Live Horses Exported from South Africa.

PubMed

Sergeant, Evan S; Grewar, John D; Weyer, Camilla T; Guthrie, Alan J

2016-01-01

African horse sickness (AHS) is a severe, often fatal, arbovirus infection of horses, transmitted by Culicoides spp. midges. AHS occurs in most of sub-Saharan Africa and is a significant impediment to export of live horses from infected countries, such as South Africa. A stochastic risk model was developed to estimate the probability of exporting an undetected AHS-infected horse through a vector protected pre-export quarantine facility, in accordance with OIE recommendations for trade from an infected country. The model also allows for additional risk management measures, including multiple PCR tests prior to and during pre-export quarantine and optionally during post-arrival quarantine, as well as for comparison of risk associated with exports from a demonstrated low-risk area for AHS and an area where AHS is endemic. If 1 million horses were exported from the low-risk area with no post-arrival quarantine we estimate the median number of infected horses to be 5.4 (95% prediction interval 0.5 to 41). This equates to an annual probability of 0.0016 (95% PI: 0.00015 to 0.012) assuming 300 horses exported per year. An additional PCR test while in vector-protected post-arrival quarantine reduced these probabilities by approximately 12-fold. Probabilities for horses exported from an area where AHS is endemic were approximately 15 to 17 times higher than for horses exported from the low-risk area under comparable scenarios. The probability of undetected AHS infection in horses exported from an infected country can be minimised by appropriate risk management measures. The final choice of risk management measures depends on the level of risk acceptable to the importing country.

Using Biofeedback while Immersed in a Stressful Videogame Increases the Effectiveness of Stress Management Skills in Soldiers

PubMed Central

Bouchard, Stéphane; Bernier, François; Boivin, Éric; Morin, Brian; Robillard, Geneviève

2012-01-01

This study assessed the efficacy of using visual and auditory biofeedback while immersed in a tridimensional videogame to practice a stress management skill (tactical breathing). All 41 participants were soldiers who had previously received basic stress management training and first aid training in combat. On the first day, they received a 15-minute refresher briefing and were randomly assigned to either: (a) no additional stress management training (SMT) for three days, or (b) 30-minute sessions (one per day for three days) of biofeedback-assisted SMT while immersed in a horror/first-person shooter game. The training was performed in a dark and enclosed environment using a 50-inch television with active stereoscopic display and loudspeakers. On the last day, all participants underwent a live simulated ambush with an improvised explosive device, where they had to provide first aid to a wounded soldier. Stress levels were measured with salivary cortisol collected when waking-up, before and after the live simulation. Stress was also measured with heart rate at baseline, during an apprehension phase, and during the live simulation. Repeated-measure ANOVAs and ANCOVAs confirmed that practicing SMT was effective in reducing stress. Results are discussed in terms of the advantages of the proposed program for military personnel and the need to practice SMT. PMID:22558370

The contribution of changes in diet, exercise, and stress management to changes in coronary risk in women and men in the multisite cardiac lifestyle intervention program.

PubMed

Daubenmier, Jennifer J; Weidner, Gerdi; Sumner, Michael D; Mendell, Nancy; Merritt-Worden, Terri; Studley, Joli; Ornish, Dean

2007-02-01

The relative contribution of health behaviors to coronary risk factors in multicomponent secondary coronary heart disease (CHD) prevention programs is largely unknown. Our purpose is to evaluate the additive and interactive effects of 3-month changes in health behaviors (dietary fat intake, exercise, and stress management) on 3-month changes in coronary risk and psychosocial factors among 869 nonsmoking CHD patients (34% female) enrolled in the health insurance-based Multisite Cardiac Lifestyle Intervention Program. Analyses of variance for repeated measures were used to analyze health behaviors, coronary risk factors, and psychosocial factors at baseline and 3 months. Multiple regression analyses evaluated changes in dietary fat intake and hours per week of exercise and stress management as predictors of changes in coronary risk and psychosocial factors. Significant overall improvement in coronary risk was observed. Reductions in dietary fat intake predicted reductions in weight, total cholesterol, low-density lipoprotein cholesterol, and interacted with increased exercise to predict reductions in perceived stress. Increases in exercise predicted improvements in total cholesterol and exercise capacity (for women). Increased stress management was related to reductions in weight, total cholesterol/high-density lipoprotein cholesterol (for men), triglycerides, hemoglobin A1c (in patients with diabetes), and hostility. Improvements in dietary fat intake, exercise, and stress management were individually, additively and interactively related to coronary risk and psychosocial factors, suggesting that multicomponent programs focusing on diet, exercise, and stress management may benefit patients with CHD.

Managed approaches to multiple sclerosis in special populations.

PubMed

Sperandeo, Kara; Nogrady, Lisa; Moreo, Kathleen; Prostko, Chris R

2011-01-01

Multiple sclerosis (MS) is a chronic demyelinating disorder of the central nervous system that is classified as an immune-mediated inflammatory disease. In managed care, patients with MS can be managed through care coordination that engages an interprofessional approach to a comprehensive spectrum of preventive, medical, rehabilitative, cognitive, and long-term health care services. In addition, the management paradigm for MS is currently in a stage of rapid evolution, with a number of new agents, including more oral drugs, expected to become available in the near future. Pharmacy and therapeutic committees may soon be faced with evaluating a hierarchy of new scientific data to differentiate the safety and efficacy of these new agents. Decisions will need to be made regarding the utility of these potential new agents among existing therapies with longer-term safety and efficacy data available in the scientific literature. For those MS patients managed under Medicaid, formulary and medication management decisions may be further impacted by psychosocial, cultural, educational, attitudinal, and/or economic factors that may be unique to the Medicaid population. The need to maximize immediate and long-term resource utilization is usually an important consideration when managing a Medicaid population. There is also an increasing focus on quality measures and quality outcomes by the Centers for Medicare and Medicaid Services. Many managed care professionals can be involved in establishing quality measures and quality improvement processes to effectively appropriate and manage the resources required for Medicaid patients with MS. As a result, medication and medical management of this special population can involve a comprehensive approach by managed care professionals. For purposes of this article, the term "special populations" applies to patients with MS who are managed under Medicaid plans. To review (a) particular challenges managed care organizations (MCOs) encounter when managing special populations of Medicaid patients with MS, (b) recent efficacy and safety data for oral therapies for relapsing forms of MS, (c) costs of current MS therapies, and (d) potential strategies for managed care to improve care of their MS patient population and optimize clinical and economic outcomes. Review of recent published literature, abstracts related to MS presented at major medical conferences, and recommendations from key organizations including the U.S. Department of Health and Human Services and the National Multiple Sclerosis Society. The health economics of MS are a central issue for MCOs managing Medicaid patient populations. Additional challenges include the anticipated expansion of the marketplace to include several new oral agents and the lack of consensus guidelines for management of patients with MS. The benefit-risk profile of new agents will need to be considered in the context of established first-line parenteral drugs. Management of patients with MS should include an individualized approach for each patient as part of a shared decision-making process. In the overall management of special patient populations, case management and collaborative practice models in managed care may help to ensure that critical benchmarks are achieved.

Least tern (Sterna antillarum)

USGS Publications Warehouse

Thompson, B.C.; Jackson, J.J.; Burger, J.; Hill, L.A.; Kirsch, E.M.; Atwood, J.L.

1997-01-01

This species account discusses: distinguishing characteristics, distribution, systematics, migration, habitat, food habits, vocalizations, behavior (locomotion, maintenance, agonistic, sexual, social, interspecific), breeding (phenology, nest site, nest, eggs, incubation, development of the young, parental care), demography and populations (life span, mortality, dispersal and philopatry, population status), conservation and management, plumages and molt, and measurements. There is also a bibliography which lists key references for additional information. (DBO)

Evaluating forest management effects on erosion, sediment, and runoff: Caspar Creek and northwestern California

Treesearch

Raymond M. Rice; Robert R. Ziemer; Jack Lewis

2004-01-01

The effects of multiple logging disturbances on peak flows and suspended sediment loads from second-growth redwood watersheds were approximately additive. Downstream increases were no greater than would be expected from the proportion of the area disturbed. Annual sediment load increases of from 123 to 269% were measured in tributary watersheds but were not detected at...

"Forest management effects on erosion, sediment, and runoff: Lessons from Caspar Creek and northwestern California"

Treesearch

Raymond M. Rice; Robert R. Ziemer; Jack Lewis

2001-01-01

Abstract - The effects of multiple logging disturbances on peak flows and suspended sediment loads from second-growth redwood watersheds were approximately additive. Downstream increases were no greater than would be expected from the proportion of the area disturbed. Annual sediment load increases of from 123 to 269% were measured in tributary watersheds but were...

Monitoring sediment production from forest road approaches to stream crossing in the Virginia Piedmont

Treesearch

Kristopher R. Brown; W. Michael Aust; Kevin J. McGuire

2015-01-01

Reopening of abandoned legacy roads is common in forest operations and represents a reduced cost in comparison to new road construction. However, legacy roads may have lower road standards and require additional best management practice (BMP) implementation upon reopening to protect water quality. Silt fences and elevation measurements of trapped sediment were used to...

Recognition and resolution of potential workplace violence.

PubMed

White, P; Maybaum, J

1998-01-01

OSHA realizes the significance of providing a safe and healthy environment. Its objective is to eliminate or diminish employee exposure to workplace violence by establishing a preventive management program comprised of effective security mechanisms, administrative work practices and other safety control measures. In addition to creating a safer work environment, these systems strengthen employee confidence and productivity and reduce employer workers' compensation fees.

Methodology for calculation of carbon balances for biofuel crops production

NASA Astrophysics Data System (ADS)

Gerlfand, I.; Hamilton, S. K.; Snapp, S. S.; Robertson, G. P.

2012-04-01

Understanding the carbon balance implications for different biofuel crop production systems is important for the development of decision making tools and policies. We present here a detailed methodology for assessing carbon balances in agricultural and natural ecosystems. We use 20 years of data from Long-term Ecological Research (LTER) experiments at the Kellogg Biological Station (KBS), combined with models to produce farm level CO2 balances for different management practices. We compared four grain and one forage systems in the U.S. Midwest: corn (Zea mays) - soybean (Glycine max) - wheat (Triticum aestivum) rotations managed with (1) conventional tillage, (2) no till, (3) low chemical input, and (4) biologically-based (organic) practices; and (5) continuous alfalfa (Medicago sativa). In addition we use an abandoned agricultural field (successionnal ecosystem) as reference system. Measurements include fluxes of N2O and CH4, soil organic carbon change, agricultural yields, and agricultural inputs (e.g. fertilization and farm fuel use). In addition to measurements, we model carbon offsets associated with the use of bioenergy from agriculturally produced crops. Our analysis shows the importance of establishing appropriate system boundaries for carbon balance calculations. We explore how different assumptions regarding production methods and emission factors affect overall conclusions on carbon balances of different agricultural systems. Our results show management practices that have major the most important effects on carbon balances. Overall, agricultural management with conventional tillage was found to be a net CO2 source to the atmosphere, while agricultural management under reduced tillage, low input, or organic management sequestered carbon at rates of 93, -23, -51, and -14 g CO2e m-2 yr-1, respectively for conventionally tilled, no-till, low-input, and organically managed ecosystems. Perennial systems (alfalfa and the successionnal fields) showed net carbon sequestration of -44 and -382 g CO2e m-2 yr-1, respectively. When studied systems were assumed to be used for bioenergy production, all system exhibited carbon sequestration -- between -149 and -841 g CO2e m-2 yr-1, for conventionally tilled and successionnal ecosystems, respectively.

Management of Brackish Groundwater Extraction, San Diego-Tijuana area, USA and Mexico

NASA Astrophysics Data System (ADS)

Danskin, W. R.

2017-12-01

Management of brackish groundwater extraction from coastal sediment in the transboundary San Diego-Tijuana area, USA and Mexico, involves monitoring storage depletion, seawater intrusion, and land subsidence. In 2017, five additional extraction wells were installed, doubling capacity of the Reynolds Groundwater Desalination Facility. Environmental permits to expand capacity of the facility, and the recently-enacted Sustainable Groundwater Management Act (SGMA) by the State of California require monitoring the possible adverse effects of the additional extraction. Fortuitously, over the past 14 years, 12 deep multiple-depth, monitoring-well sites were installed by the United States Geological Survey (USGS) to aid in mapping the coastal geology and groundwater conditions. Now these sites are being used for groundwater management. Storage depletion is monitored daily via water levels measured using transducers installed permanently in each of the 4-6 piezometers at each site and transmitted automatically to the Internet. Seawater intrusion is tracked annually via electromagnetic geophysical logging in the deepest piezometer at each site, 500-800 meters below land surface, about twice the depth of the extraction wells. Land subsidence is determined annually from surveys of reference points installed at the well sites and from Interferometric Synthetic Aperature Radar (InSAR) satellite data. Management also involves use of a regional hydrologic model to simulate the likely location and timing of future storage depletion, seawater intrusion, and land subsidence.

A simple bedside approach to therapeutic goals achievement during the management of deceased organ donors--An adapted version of the "VIP" approach.

PubMed

Westphal, Glauco Adrieno

2016-02-01

The disproportion between the supply and demand of transplant organs could be alleviated by improving the quality of clinical management of deceased potential donors. As a large number of donor losses by cardiac arrest occur due to hemodynamic instability, without instituting all essential maintenance measures, it is likely that the application of simplified potential donor maintenance protocols will help to decrease potential donor losses and increase the supply of organs for transplantation. The Ventilation, Infusion and Pumping (VIP) strategy is a mnemonic method that brings together key aspects of the restoration of oxygen delivery to tissues during hemodynamic instability: adequate mechanical Ventilation, volume Infusion and evaluation of heart Pump effectiveness. The inclusion of the additional initials, "P" and "S," refers to Pharmacological treatment and Specificities involved in the etiology of shock. The use of simplified care standards can assist in adhering to essential potential donor management measures. Therefore, using a simplified method as the adapted VIP approach can contribute to improving management standards of potential organ donors and increasing the supply of organs for transplantation. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Social support and depression of adults with visual impairments.

PubMed

Papadopoulos, Konstantinos; Papakonstantinou, Doxa; Montgomery, Anthony; Solomou, Argyro

2014-07-01

Relatively little research exists with regard to the relationship between social support and depression among adults with visual impairments. Such a gap is noteworthy when one considers that individuals become more dependent on others as they enter middle and late adulthood. The present research will examine the association between social networks, social support and depression among adults with visual impairments. Seventy-seven adults with visual impairments participated in the study. Depression, social network and emotional/practical social support were measured with self-report measures. Additionally, the degree to which emotional/practical social support received were positive or negative and the ability of respondents to self-manage their daily living were assessed. Less than a third of respondents scored above the threshold for depressive symptoms. Depressive symptoms were not related to gender or vision status. Depression was correlated with age, educational level, less positive practical support, more negative practical support and more negative emotional support, with lower perceptions of self-management representing the most robust predictor of depression. Age moderated the relationship between depression and self-management, and between depression and negative emotional support. Lower perceptions of self-management and negative emotional support were significantly associated with depressive symptoms. Copyright © 2014 Elsevier Ltd. All rights reserved.

Hydrology and hydraulics expertise in participatory processes for climate change adaptation in the Dutch Meuse.

PubMed

Wesselink, Anna; de Vriend, Huib; Barneveld, Hermjan; Krol, Maarten; Bijker, Wiebe

2009-01-01

Many scientists feel that scientific outcomes are not sufficiently taken into account in policy-making. The research reported in this paper shows what happens with scientific information during such a process. In 2001 the Dutch Ministry of Transport, Public Works and Water Management commissioned their regional office in Limburg to assess how flood management objectives could be achieved in future in the Dutch Meuse valley, assuming climate change will increase peak discharges. To ensure political support, regional discussion rounds were to help assess the measures previously identified. This paper discusses the ways in which hydrological and hydraulic expertise was input, understood and used in this assessment process. Project participants as a group had no trouble contesting assumptions and outcomes. Nevertheless, water expertise was generally accepted as providing facts, once basic choices such as starting situation had been discussed and agreed. The technical constraints determined that politically unacceptable measures would have to be selected to achieve the legally binding flood management objective. As a result, no additional space will be set aside for future flood management beyond the already reserved floodplain. In this case, political arguments clearly prevail over policy objectives, with hydraulic expertise providing decisive arbitration between the two.

A comparison of strength-training, self-management and the combination for early osteoarthritis of the knee

PubMed Central

McKnight, Patrick E.; Kasle, Shelley; Going, Scott; Villaneuva, Isidro; Cornett, Michelle; Farr, Josh; Wright, Jill; Streeter, Clara; Zautra, Alex

2010-01-01

Objective To assess the relative effectiveness of combining self-management and strength-training for improving functional outcomes in early knee osteoarthritis patients. Methods A randomized intervention trial lasting 24 months conducted at an academic medical center. Community dwelling middle-aged adults (N=273), aged 34 to 65 with knee osteoarthritis, pain and self-reported physical disability completed a strength-training program, a self-management program, or a combined program. Outcomes included five physical function tests (leg press, range of motion, work capacity, balance, and stair climbing) and two self-reported measures of pain and disability. Results A total of 201 (73.6 %) participants completed the 2-year trial. Overall compliance was modest - strength-training (55.8 %), self-management (69.1 %), and combined (59.6 %) programs. The three groups showed a significant and large increase from pre- to post-treatment in all physical functioning measures including leg press (d =.85), range of motion (d=1.00), work capacity (d=.60), balance (d=.59), and stair climbing (d=.59). Additionally, all three groups showed decreased self-reported pain (d=-.51) and disability (d=-.55). There were no significant differences among groups. Conclusions Middle-aged, sedentary persons with mild early knee osteoarthritis benefited from strength-training, self-management, and the combination. These results suggest that both strength-training and self-management are suitable treatments for early onset of knee osteoarthritis in middle-aged adults. Self-management alone may offer the least burdensome treatment for early osteoarthritis. PMID:20191490

Use of fiberoptic endoscopic evaluation of swallowing (FEES) in the management of psychogenic dysphagia in children.

PubMed

Thottam, Prasad John; Silva, Rodrigo C; McLevy, Jennifer D; Simons, Jeffrey P; Mehta, Deepak K

2015-02-01

To describe the use of fiberoptic endoscopic evaluation of swallowing (FEES) as an adjunct in the management of children presenting with psychogenic dysphagia, defined as food avoidance and excessive fear of eating without identifiable anatomic or functional swallowing abnormalities. Case series of patients presenting to the otolaryngology clinic of a tertiary pediatric teaching hospital between 2007 and 2008 that were evaluated and managed with the utilization of FEES. The outcomes measured were age, gender, duration of symptoms, findings of FEES, additional work-up and resolution of symptoms at follow-up. Five patients (4 males, 1 female) with ages ranging from 5 to 13 years old (mean=8.6). The median duration of symptoms before presentation was 3 weeks. Four families described refusal of solids starting after choking episode and variable estimated weight loss (mean 2.8kg). One child presented with vague complaints of intermittent odynophagia and food refusal. Fiberoptic endoscopic evaluation of swallowing was performed on all patients. No abnormalities of the oropharyngeal swallow were appreciated. Additional management included different combinations of modified barium swallow study, esophagastroduodenoscopy (EGD), upper GI series, antibiotics, and psychotherapy. Mean follow-up with clinic visit was 4.2 months. Three of the five children reported complete resolution of symptoms after FEES at follow-up visit. Fiberoptic endoscopic evaluation of swallowing can be a useful management tool in children with psychogenic dysphagia as it provides direct visualization of the oropharyngeal swallowing mechanism. This can be used to provide visual reassure and biofeedback to patients and parents. Additional workup should be decided on an individual basis. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Ancillary study management systems: a review of needs

PubMed Central

2013-01-01

Background The valuable clinical data, specimens, and assay results collected during a primary clinical trial or observational study can enable researchers to answer additional, pressing questions with relatively small investments in new measurements. However, management of such follow-on, “ancillary” studies is complex. It requires coordinating across institutions, sites, repositories, and approval boards, as well as distributing, integrating, and analyzing diverse data types. General-purpose software systems that simplify the management of ancillary studies have not yet been explored in the research literature. Methods We have identified requirements for ancillary study management primarily as part of our ongoing work with a number of large research consortia. These organizations include the Center for HIV/AIDS Vaccine Immunology (CHAVI), the Immune Tolerance Network (ITN), the HIV Vaccine Trials Network (HVTN), the U.S. Military HIV Research Program (MHRP), and the Network for Pancreatic Organ Donors with Diabetes (nPOD). We also consulted with researchers at a range of other disease research organizations regarding their workflows and data management strategies. Lastly, to enhance breadth, we reviewed process documents for ancillary study management from other organizations. Results By exploring characteristics of ancillary studies, we identify differentiating requirements and scenarios for ancillary study management systems (ASMSs). Distinguishing characteristics of ancillary studies may include the collection of additional measurements (particularly new analyses of existing specimens); the initiation of studies by investigators unaffiliated with the original study; cross-protocol data pooling and analysis; pre-existing participant consent; and pre-existing data context and provenance. For an ASMS to address these characteristics, it would need to address both operational requirements (e.g., allocating existing specimens) and data management requirements (e.g., securely distributing and integrating primary and ancillary data). Conclusions The scenarios and requirements we describe can help guide the development of systems that make conducting ancillary studies easier, less expensive, and less error-prone. Given the relatively consistent characteristics and challenges of ancillary study management, general-purpose ASMSs are likely to be useful to a wide range of organizations. Using the requirements identified in this paper, we are currently developing an open-source, general-purpose ASMS based on LabKey Server (http://www.labkey.org) in collaboration with CHAVI, the ITN and nPOD. PMID:23294514

Animal biocalorimeter and waste management system

NASA Technical Reports Server (NTRS)

Poppendiek, Heinz F. (Inventor); Trimailo, William R. (Inventor)

1995-01-01

A biocalorimeter and waste management system is provided for making metabolic heat release measurements of animals or humans in a calorimeter (enclosure) using ambient air as a low velocity source of ventilating air through the enclosure. A shroud forces ventilating air to pass over the enclosure from an end open to ambient air at the end of the enclosure opposite its ventilating air inlet end and closed around the inlet end of the enclosure in order to obviate the need for regulating ambient air temperature. Psychrometers for measuring dry- and wet-bulb temperature of ventilating air make it possible to account for the sensible and latent heat additions to the ventilating air. A waste removal system momentarily recirculates high velocity air in a closed circuit through the calorimeter wherein a sudden rise in moisture is detected in the ventilating air from the outlet.

Nursing management of sensory overload in psychiatry – development of a theoretical framework model

PubMed

Scheydt, Stefan; Needham, Ian; Nielsen, Gunnar H; Behrens, Johann

2016-09-01

Background: The concept of “removal from stimuli” has already been examined by a Delphi-Study. However, some knowledge gaps remained open, which have now been further investigated. Aim: Examination of the concept “management of sensory overload in inpatient psychiatry” including its sub-concepts and specific measures. Method: Analysis of qualitative data about “removal from stimuli” by content analysis according to Mayring. Results: A theoretical description and definition of the concept could be achieved. In addition, sub-concepts (removal from stimuli, modulation of environmental factors, help somebody to help him-/herself) could be identified, theoretical defined and complemented by possible specific measures. Conclusions: The conceptual descriptions provide a further step to raise awareness of professionals in the subject area. Furthermore, we created a theoretical basis for further empirical studies.

Resolution of Probabilistic Weather Forecasts with Application in Disease Management.

PubMed

Hughes, G; McRoberts, N; Burnett, F J

2017-02-01

Predictive systems in disease management often incorporate weather data among the disease risk factors, and sometimes this comes in the form of forecast weather data rather than observed weather data. In such cases, it is useful to have an evaluation of the operational weather forecast, in addition to the evaluation of the disease forecasts provided by the predictive system. Typically, weather forecasts and disease forecasts are evaluated using different methodologies. However, the information theoretic quantity expected mutual information provides a basis for evaluating both kinds of forecast. Expected mutual information is an appropriate metric for the average performance of a predictive system over a set of forecasts. Both relative entropy (a divergence, measuring information gain) and specific information (an entropy difference, measuring change in uncertainty) provide a basis for the assessment of individual forecasts.

Impact of the lung oncology multidisciplinary team meetings on the management of patients with cancer.

PubMed

Ung, Kim Ann; Campbell, Belinda A; Duplan, Danny; Ball, David; David, Steven

2016-06-01

Multidisciplinary team (MDT) meetings are increasingly regarded as a component of multidisciplinary cancer care. We aimed to prospectively measure the impact of MDT meetings on clinicians' management plans for lung oncology patients, and the implementation rate of the meeting recommendations. Consecutive patient cases presented at the weekly lung oncology MDT meetings were prospectively enrolled. Investigators compared the clinicians' management plans pre-meeting with the consensus plans post-meeting. The meeting was considered to have an impact on management plans if ≥1 of the following changes were detected: tumor stage, histology, treatment intent or treatment modality, or if additional investigations were recommended. Investigators reviewed hospital patient records at 4 months to determine if the meeting recommendations were implemented. Reasons for non-implementation were also recorded. Of the 55 eligible cases, the MDT meeting changed management plans in 58% (CI 45-71%; P < 0.005). These changes included: additional investigations (59%), or changes in treatment modality (19%), treatment intent (9%), histology (6%) or tumor stage (6%). The meeting recommendations were implemented in 72% of cases. Reasons for non-implementation included deteriorating patient performance status, clinician's preference, the influence of new clinical information obtained after the meeting or patient decision. MDT meetings significantly impact on the management plans for lung oncology patients. The majority of MDT recommendations (72%) were implemented into patient care. These findings provide further evidence to support the role of MDT meetings as an essential part of the decision-making process for the optimal multidisciplinary management of patients with cancer. © 2014 Wiley Publishing Asia Pty Ltd.

Multitarget tracking in cluttered environment for a multistatic passive radar system under the DAB/DVB network

NASA Astrophysics Data System (ADS)

Shi, Yi Fang; Park, Seung Hyo; Song, Taek Lyul

2017-12-01

The target tracking using multistatic passive radar in a digital audio/video broadcast (DAB/DVB) network with illuminators of opportunity faces two main challenges: the first challenge is that one has to solve the measurement-to-illuminator association ambiguity in addition to the conventional association ambiguity between the measurements and targets, which introduces a significantly complex three-dimensional (3-D) data association problem among the target-measurement illuminator, this is because all the illuminators transmit the same carrier frequency signals and signals transmitted by different illuminators but reflected via the same target become indistinguishable; the other challenge is that only the bistatic range and range-rate measurements are available while the angle information is unavailable or of very poor quality. In this paper, the authors propose a new target tracking algorithm directly in three-dimensional (3-D) Cartesian coordinates with the capability of track management using the probability of target existence as a track quality measure. The proposed algorithm is termed sequential processing-joint integrated probabilistic data association (SP-JIPDA), which applies the modified sequential processing technique to resolve the additional association ambiguity between measurements and illuminators. The SP-JIPDA algorithm sequentially operates the JIPDA tracker to update each track for each illuminator with all the measurements in the common measurement set at each time. For reasons of fair comparison, the existing modified joint probabilistic data association (MJPDA) algorithm that addresses the 3-D data association problem via "supertargets" using gate grouping and provides tracks directly in 3-D Cartesian coordinates, is enhanced by incorporating the probability of target existence as an effective track quality measure for track management. Both algorithms deal with nonlinear observations using the extended Kalman filtering. A simulation study is performed to verify the superiority of the proposed SP-JIPDA algorithm over the MJIPDA in this multistatic passive radar system.

On Consistency Test Method of Expert Opinion in Ecological Security Assessment

PubMed Central

Wang, Lihong

2017-01-01

To reflect the initiative design and initiative of human security management and safety warning, ecological safety assessment is of great value. In the comprehensive evaluation of regional ecological security with the participation of experts, the expert’s individual judgment level, ability and the consistency of the expert’s overall opinion will have a very important influence on the evaluation result. This paper studies the consistency measure and consensus measure based on the multiplicative and additive consistency property of fuzzy preference relation (FPR). We firstly propose the optimization methods to obtain the optimal multiplicative consistent and additively consistent FPRs of individual and group judgments, respectively. Then, we put forward a consistency measure by computing the distance between the original individual judgment and the optimal individual estimation, along with a consensus measure by computing the distance between the original collective judgment and the optimal collective estimation. In the end, we make a case study on ecological security for five cities. Result shows that the optimal FPRs are helpful in measuring the consistency degree of individual judgment and the consensus degree of collective judgment. PMID:28869570

On Consistency Test Method of Expert Opinion in Ecological Security Assessment.

PubMed

Gong, Zaiwu; Wang, Lihong

2017-09-04

To reflect the initiative design and initiative of human security management and safety warning, ecological safety assessment is of great value. In the comprehensive evaluation of regional ecological security with the participation of experts, the expert's individual judgment level, ability and the consistency of the expert's overall opinion will have a very important influence on the evaluation result. This paper studies the consistency measure and consensus measure based on the multiplicative and additive consistency property of fuzzy preference relation (FPR). We firstly propose the optimization methods to obtain the optimal multiplicative consistent and additively consistent FPRs of individual and group judgments, respectively. Then, we put forward a consistency measure by computing the distance between the original individual judgment and the optimal individual estimation, along with a consensus measure by computing the distance between the original collective judgment and the optimal collective estimation. In the end, we make a case study on ecological security for five cities. Result shows that the optimal FPRs are helpful in measuring the consistency degree of individual judgment and the consensus degree of collective judgment.

International normalized ratio self-management lowers the risk of thromboembolic events after prosthetic heart valve replacement.

PubMed

Eitz, Thomas; Schenk, Soren; Fritzsche, Dirk; Bairaktaris, Andreas; Wagner, Otto; Koertke, Heinrich; Koerfer, Reiner

2008-03-01

Although prosthetic valves are durable and easy to implant, the need for lifetime warfarin-based anticoagulation restricts their exclusive usage. We investigated if anticoagulation self-management improves outcome in a single-center series. Between 1994 and 1998, 765 patients with prosthetic valve replacements were prospectively enrolled and randomized to receive conventional anticoagulation management by their primary physician (group 1, n = 295) or to pursue anticoagulation self-management (group 2, n = 470). A study head office was implemented to coordinate and monitor anticoagulation protocols, international normalized ratios (INR), and adverse events. Patients were instructed on how to obtain and test their own blood samples and to adjust warfarin dosages according to the measured INR (target range, 2.5 to 4). Mean INR values were slightly yet significantly smaller in group 1 than in group 2 (2.8 +/- 0.7 vs 3.0 +/- .6, p < 0.001). Moreover, INR values of patients with conventional INR management were frequently measured outside the INR target range, whereas those with anticoagulation self-management mostly remained within the range (35% vs 21%, p < 0.001). In addition, the scatter of INR values was smaller if self-managed. Freedom from thromboembolism at 3, 12, and 24 months, respectively, was 99%, 95%, and 91% in group 1 compared with 99%, 98%, and 96% in group 2 (p = 0.008). Bleeding events were similar in both groups. Time-related multivariate analysis identified INR self-management and higher INR as independent predictors for better outcome. Anticoagulation self-management can improve INR profiles up to 2 years after prosthetic valve replacement and reduce adverse events. Current indications of prosthetic rather than biologic valve implantations may be extended if the benefit of INR self-management is shown by future studies with longer follow-up.

Advancing current approaches to disease management evaluation: capitalizing on heterogeneity to understand what works and for whom.

PubMed

Elissen, Arianne M J; Adams, John L; Spreeuwenberg, Marieke; Duimel-Peeters, Inge G P; Spreeuwenberg, Cor; Linden, Ariel; Vrijhoef, Hubertus J M

2013-03-14

Evaluating large-scale disease management interventions implemented in actual health care settings is a complex undertaking for which universally accepted methods do not exist. Fundamental issues, such as a lack of control patients and limited generalizability, hamper the use of the 'gold-standard' randomized controlled trial, while methodological shortcomings restrict the value of observational designs. Advancing methods for disease management evaluation in practice is pivotal to learn more about the impact of population-wide approaches. Methods must account for the presence of heterogeneity in effects, which necessitates a more granular assessment of outcomes. This paper introduces multilevel regression methods as valuable techniques to evaluate 'real-world' disease management approaches in a manner that produces meaningful findings for everyday practice. In a worked example, these methods are applied to retrospectively gathered routine health care data covering a cohort of 105,056 diabetes patients who receive disease management for type 2 diabetes mellitus in the Netherlands. Multivariable, multilevel regression models are fitted to identify trends in clinical outcomes and correct for differences in characteristics of patients (age, disease duration, health status, diabetes complications, smoking status) and the intervention (measurement frequency and range, length of follow-up). After a median one year follow-up, the Dutch disease management approach was associated with small average improvements in systolic blood pressure and low-density lipoprotein, while a slight deterioration occurred in glycated hemoglobin. Differential findings suggest that patients with poorly controlled diabetes tend to benefit most from disease management in terms of improved clinical measures. Additionally, a greater measurement frequency was associated with better outcomes, while longer length of follow-up was accompanied by less positive results. Despite concerted efforts to adjust for potential sources of confounding and bias, there ultimately are limits to the validity and reliability of findings from uncontrolled research based on routine intervention data. While our findings are supported by previous randomized research in other settings, the trends in outcome measures presented here may have alternative explanations. Further practice-based research, perhaps using historical data to retrospectively construct a control group, is necessary to confirm results and learn more about the impact of population-wide disease management.

Quality Measures for the Care of Adult Patients with Obstructive Sleep Apnea

PubMed Central

Aurora, R. Nisha; Collop, Nancy A.; Jacobowitz, Ofer; Thomas, Sherene M.; Quan, Stuart F.; Aronsky, Amy J.

2015-01-01

Obstructive sleep apnea (OSA) is a prevalent disorder associated with a multitude of adverse outcomes when left untreated. There is significant heterogeneity in the evaluation and management of OSA resulting in variation in cost and outcomes. Thus, the goal for developing these measures was to have a way to evaluate the outcomes and reliability of the processes involved with the standard care approaches used in the diagnosis and management of OSA. The OSA quality care measures presented here focus on both outcomes and processes. The AASM commissioned the Adult OSA Quality Measures Workgroup to develop quality care measures aimed at optimizing care for adult patients with OSA. These quality care measures developed by the Adult OSA Quality Measures Workgroup are an extension of the original Centers for Medicare & Medicaid Services (CMS) approved Physician Quality Reporting System (PQRS) measures group for OSA. The measures are based on the available scientific evidence, focus on public safety, and strive to improve quality of life and cardiovascular outcomes for individual OSA patients. The three outcomes that were selected were as follows: (1) improve disease detection and categorization; (2) improve quality of life; and (3) reduce cardiovascular risk. After selecting these relevant outcomes, a total of ten process measures were chosen that could be applied and assessed for the purpose of accomplishing these outcomes. In the future, the measures described in this document may be reported through the PQRS in addition to, or as a replacement for, the current OSA measures group. The overall objective for the development of these measures is that implementation of these quality measures will result in improved patient outcomes, reduce the public health burden of OSA, and provide a measurable standard for evaluating and managing OSA. Citation: Aurora RN, Collop NA, Jacobowitz O, Thomas SM, Quan SF, Aronsky AJ. Quality measures for the care of adult patients with obstructive sleep apnea. J Clin Sleep Med 2015;11(3):357–383. PMID:25700878

Travellers and influenza: risks and prevention.

PubMed

Goeijenbier, M; van Genderen, P; Ward, B J; Wilder-Smith, A; Steffen, R; Osterhaus, A D M E

2017-01-01

Influenza viruses are among the major causes of serious human respiratory tract infection worldwide. In line with the high disease burden attributable to influenza, these viruses play an important, but often neglected, role in travel medicine. Guidelines and recommendations regarding prevention and management of influenza in travellers are scarce. Of special interest for travel medicine are risk populations and also circumstances that facilitate influenza virus transmission and spread, like travel by airplane or cruise ship and mass gatherings. We conducted a PUBMED/MEDLINE search for a combination of the MeSH terms Influenza virus, travel, mass gathering, large scale events and cruise ship. In addition we gathered guidelines and recommendations from selected countries and regarding influenza prevention and management in travellers. By reviewing these search results in the light of published knowledge in the fields of influenza prevention and management, we present best practice advice for the prevention and management of influenza in travel medicine. Seasonal influenza is among the most prevalent infectious diseases in travellers. Known host-associated risk factors include extremes of age and being immune-compromised, while the most relevant environmental factors are associated with holiday cruises and mass gatherings. Pre-travel advice should address influenza and its prevention for travellers, whenever appropriate on the basis of the epidemiological situation concerned. Preventative measures should be strongly recommended for travellers at high-risk for developing complications. In addition, seasonal influenza vaccination should be considered for any traveller wishing to reduce the risk of incapacitation, particularly cruise ship crew and passengers, as well as those participating in mass gatherings. Besides advice concerning preventive measures and vaccination, advice on the use of antivirals may be considered for some travellers. © International Society of Travel Medicine, 2016. Published by Oxford University Press.

Travellers and influenza: risks and prevention

PubMed Central

van Genderen, P.; Ward, B. J.; Wilder-Smith, A.; Steffen, R.; Osterhaus, A. D. M. E.

2017-01-01

Background: Influenza viruses are among the major causes of serious human respiratory tract infection worldwide. In line with the high disease burden attributable to influenza, these viruses play an important, but often neglected, role in travel medicine. Guidelines and recommendations regarding prevention and management of influenza in travellers are scarce. Of special interest for travel medicine are risk populations and also circumstances that facilitate influenza virus transmission and spread, like travel by airplane or cruise ship and mass gatherings. Methods: We conducted a PUBMED/MEDLINE search for a combination of the MeSH terms Influenza virus, travel, mass gathering, large scale events and cruise ship. In addition we gathered guidelines and recommendations from selected countries and regarding influenza prevention and management in travellers. By reviewing these search results in the light of published knowledge in the fields of influenza prevention and management, we present best practice advice for the prevention and management of influenza in travel medicine. Results: Seasonal influenza is among the most prevalent infectious diseases in travellers. Known host-associated risk factors include extremes of age and being immune-compromised, while the most relevant environmental factors are associated with holiday cruises and mass gatherings. Conclusions: Pre-travel advice should address influenza and its prevention for travellers, whenever appropriate on the basis of the epidemiological situation concerned. Preventative measures should be strongly recommended for travellers at high-risk for developing complications. In addition, seasonal influenza vaccination should be considered for any traveller wishing to reduce the risk of incapacitation, particularly cruise ship crew and passengers, as well as those participating in mass gatherings. Besides advice concerning preventive measures and vaccination, advice on the use of antivirals may be considered for some travellers. PMID:28077609

THE HUMAN BEHAVIOR RATING SCALE-BRIEF: A TOOL TO MEASURE 21ST CENTURY SKILLS OF K-12 LEARNERS.

PubMed

Woods-Groves, Suzanne

2015-06-01

Currently there is a call for brief concise measurements to appraise relevant 21st century college readiness skills in K-12 learners. This study employed K-12 teachers' ratings for over 3,000 students for an existing 91-item rating scale, the Human Behavior Rating Scale, that measured the 21st century skills of persistence, curiosity, externalizing affect, internalizing affect, and cognition. Teachers' ratings for K-12 learners were used to develop a brief, concise, and manageable 30-item tool, the Human Behavior Rating Scale-Brief. Results yielded high internal consistency coefficients and inter-item correlations. The items were not biased with regard to student sex or race, and were supported through confirmatory factor analyses. In addition, when teachers' ratings were compared with students' academic and behavioral performance data, moderate to strong relationships were revealed. This study provided an essential first step in the development of a psychometrically sound, manageable, and brief tool to appraise 21st century skills in K-12 learners.

Surveying perceptions of landslide risk management in Norway

NASA Astrophysics Data System (ADS)

Chiu, Jessica Ka Yi; Eidsvig, Unni

2016-04-01

Enhanced precipitation due to climate change leads to increase in both frequency and intensity of landslides in Norway. A proactive approach to risk management is therefore required to significantly reduce the losses associated with landslides. Opinions and perceptions from practitioners on the performance of landslide risk management can provide insights on areas for improvement in the landslide risk management strategies in Norway. The Risk Management Index (RMI), proposed by Cardona et al. (2004), is a well-established method to measure perceptions of disaster management of selected actors holistically. The RMI is measured based on opinion questionnaires to technical staff, decision-makers, and stakeholders involved in all stages of risk reduction strategies. It is a composite index that considers a wide variety of strategies to manage risks, including structural and non-structural measures, acceptance strategies, disaster management, and risk transfer. The RMI method was modified to be implemented in landslide hazards and to fit with Norwegian conditions. An opinion survey was conducted in autumn 2015 to measure perceptions of landslide risk management in Norway. Perceptions were surveyed for two time periods: 2015 and 2050, and are based on national, county, and municipality levels. Based on the survey results, performance of landslide risk management at any administrative levels in Norway is perceived to improve from `significant' in 2015 to `significant' to `outstanding' in 2050. Knowledge and technology, climate, risk perceptions, and anthropogenic activities are mostly considered by respondents for their 2050 perceptions. Several aspects of landslide risk management in Norway can be improved. For example, landslide hazard evaluation and mapping should be prioritised in Norway. Upgrading, retrofitting, and reconstruction of assets may also be included in the landslide risk reduction strategies. In addition, there should be more focus on inter-institutional organisation as well as allocation and use of financial resources for dealing with landslides at local levels. Although the survey was considered too difficult by some of the respondents, it can be regarded as a starting point to develop a common terminology/language in landslide risk management in Norway that allows mutual understandings among people with different backgrounds. The approach of surveying perceptions of landslide risk management can also be expanded to the public to enable comparisons of perceptions between experts and the public. Furthermore, the methodology can be applied to other types of natural hazards in Norway, such as floods. This project is supported by Klima2050 (http://www.klima2050.no/).

TeamSTEPPS for health care risk managers: Improving teamwork and communication.

PubMed

Cooke, Marcia

2016-07-01

Ineffective communication among the health care team is a leading cause of errors in the patient care setting. Studies assessing training related to communication and teamwork in the clinical team are prevalent, however, teamwork training at the administrative level is lacking. This includes individuals in leadership positions such as health care risk managers. The purpose was to determine the impact of an educational intervention on the knowledge and attitudes related to communication and teamwork in the health care risk management population. The educational intervention was an adaptation of a national teamwork training program and incorporated didactic content as well as video vignettes and small group activities. Measurement of knowledge and attitudes were used to determine the impact of the education program. Knowledge and attitudes were assessed pre- and postcourse. Findings indicate that teamwork education tailored to the needs of the specific audience resulted in knowledge gained and improved attitudes toward the components of teamwork. The attitudes that most significantly improved were related to team structure and situation monitoring. There was no improvement in participants' attitudes toward leadership, mutual support, and communication. Team training has been shown to improve safety culture, patient satisfaction, and clinical outcomes. Including risk managers in training on teamwork, communication, and collaboration can serve to foster a common language among clinicians and management. In addition, a measurement related to implementation in the health care setting may yield insight into the impact of training. Qualitative measurement may allow the researcher to delve deeper into how these health care facilities are using team training interventions. © 2016 American Society for Healthcare Risk Management of the American Hospital Association.

Clinical management provided by board-certificated physiatrists in early rehabilitation is a significant determinant of functional improvement in acute stroke patients: a retrospective analysis of Japan rehabilitation database.

PubMed

Kinoshita, Shoji; Kakuda, Wataru; Momosaki, Ryo; Yamada, Naoki; Sugawara, Hidekazu; Watanabe, Shu; Abo, Masahiro

2015-05-01

Early rehabilitation for acute stroke patients is widely recommended. We tested the hypothesis that clinical outcome of stroke patients who receive early rehabilitation managed by board-certificated physiatrists (BCP) is generally better than that provided by other medical specialties. Data of stroke patients who underwent early rehabilitation in 19 acute hospitals between January 2005 and December 2013 were collected from the Japan Rehabilitation Database and analyzed retrospectively. Multivariate linear regression analysis using generalized estimating equations method was performed to assess the association between Functional Independence Measure (FIM) effectiveness and management provided by BCP in early rehabilitation. In addition, multivariate logistic regression analysis was also performed to assess the impact of management provided by BCP in acute phase on discharge destination. After setting the inclusion criteria, data of 3838 stroke patients were eligible for analysis. BCP provided early rehabilitation in 814 patients (21.2%). Both the duration of daily exercise time and the frequency of regular conferencing were significantly higher for patients managed by BCP than by other specialties. Although the mortality rate was not different, multivariate regression analysis showed that FIM effectiveness correlated significantly and positively with the management provided by BCP (coefficient, .35; 95% confidence interval [CI], .012-.059; P < .005). In addition, multivariate logistic analysis identified clinical management by BCP as a significant determinant of home discharge (odds ratio, 1.24; 95% CI, 1.08-1.44; P < .005). Our retrospective cohort study demonstrated that clinical management provided by BCP in early rehabilitation can lead to functional recovery of acute stroke. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Cooperation for a competitive position: The impact of hospital cooperation behavior on organizational performance.

PubMed

Büchner, Vera Antonia; Hinz, Vera; Schreyögg, Jonas

2015-01-01

Several public policy initiatives, particularly those involving managed care, aim to enhance cooperation between partners in the health care sector because it is expected that such cooperation will reduce costs and generate additional revenue. However, empirical evidence regarding the effects of cooperation on hospital performance is scarce, particularly with respect to creating a comprehensive measure of cooperation behavior. The aim of this study is to investigate the impact of hospital cooperation behavior on organizational performance. We differentiate between horizontal and vertical cooperation using two alternative measures-cooperation depth and cooperation breadth-and include the interaction effects between both cooperation directions. Data are derived from a survey of German hospitals and combined with objective performance information from annual financial statements. Generalized linear regression models are used. The study findings provide insight into the nature of hospitals' cooperation behavior. In particular, we show that there are negative synergies between horizontal administrative cooperation behavior and vertical cooperation behavior. Whereas the depth and breadth of horizontal administrative cooperation positively affect financial performance (when there is no vertical cooperation), vertical cooperation positively affects financial performance (when there is no horizontal administrative cooperation) only when cooperation is broad (rather than deep). Horizontal cooperation is generally more effective than vertical cooperation at improving financial performance. Hospital managers should consider the negative interaction effect when making decisions about whether to recommend a cooperative relationship in a horizontal or vertical direction. In addition, managers should be aware of the limited financial benefit of cooperation behavior.

Effectiveness of a mood management component as an adjunct to a telephone counselling smoking cessation intervention for smokers with a past major depression: a pragmatic randomized controlled trial.

PubMed

van der Meer, Regina M; Willemsen, Marc C; Smit, Filip; Cuijpers, Pim; Schippers, Gerard M

2010-11-01

To assess whether the addition of a mood management component to telephone counselling produces higher abstinence rates in smokers with past major depression and helps to prevent recurrence of depressive symptoms. Pragmatic randomized controlled trial with two conditions, with follow-up at 6 and 12 months. The control intervention consisted of eight sessions of proactive telephone counselling. The mood management intervention was an integration of the control intervention with a mood management component. This component consisted of a self-help mood management manual, two more preparatory proactive telephone counselling sessions and supplementary homework assignments and advice. Dutch national smoking cessation quitline. A total of 485 daily smokers with past major depression, according to the DSM-IV. The primary outcome measure was prolonged abstinence and secondary outcome measures were 7-day point prevalence abstinence and depressive symptoms. The mood management intervention resulted in significantly higher prolonged abstinence rates at 6- and 12-month follow-up (30.5% and 23.9% in experimental condition, 22.3% and 14.0% in the control condition). The odds ratios were 1.60 (95% CI 1.06-2.42) and 1.96 (95% CI 1.22-3.14) for both follow-ups. The mood management intervention did not seem to prevent recurrence of depressive symptoms. Adding a mood management component to telephone counselling for smoking cessation in smokers with a past major depression increases cessation rates without necessarily reducing depressive symptoms. © 2010 The Authors, Addiction © 2010 Society for the Study of Addiction.

Peroral endoscopic myotomy

PubMed Central

Kumbhari, Vivek; Khashab, Mouen A

2015-01-01

Peroral endoscopic myotomy (POEM) incorporates concepts of natural orifice translumenal endoscopic surgery and achieves endoscopic myotomy by utilizing a submucosal tunnel as an operating space. Although intended for the palliation of symptoms of achalasia, there is mounting data to suggest it is also efficacious in the management of spastic esophageal disorders. The technique requires an understanding of the pathophysiology of esophageal motility disorders as well as knowledge of surgical anatomy of the foregut. POEM achieves short term response in 82% to 100% of patients with minimal risk of adverse events. In addition, it appears to be effective and safe even at the extremes of age and regardless of prior therapy undertaken. Although infrequent, the ability of the endoscopist to manage an intraprocedural adverse event is critical as failure to do so could result in significant morbidity. The major late adverse event is gastroesophageal reflux which appears to occur in 20% to 46% of patients. Research is being conducted to clarify the optimal technique for POEM and a personalized approach by measuring intraprocedural esophagogastric junction distensibility appears promising. In addition to esophageal disorders, POEM is being studied in the management of gastroparesis (gastric pyloromyotomy) with initial reports demonstrating technical feasibility. Although POEM represents a paradigm shift the management of esophageal motility disorders, the results of prospective randomized controlled trials with long-term follow up are eagerly awaited. PMID:25992188

Risk evaluation mitigation strategies: the evolution of risk management policy.

PubMed

Hollingsworth, Kristen; Toscani, Michael

2013-04-01

The United States Food and Drug Administration (FDA) has the primary regulatory responsibility to ensure that medications are safe and effective both prior to drug approval and while the medication is being actively marketed by manufacturers. The responsibility for safe medications prior to marketing was signed into law in 1938 under the Federal Food, Drug, and Cosmetic Act; however, a significant risk management evolution has taken place since 1938. Additional federal rules, entitled the Food and Drug Administration Amendments Act, were established in 2007 and extended the government's oversight through the addition of a Risk Evaluation and Mitigation Strategy (REMS) for certain drugs. REMS is a mandated strategy to manage a known or potentially serious risk associated with a medication or biological product. Reasons for this extension of oversight were driven primarily by the FDA's movement to ensure that patients and providers are better informed of drug therapies and their specific benefits and risks prior to initiation. This article provides an historical perspective of the evolution of medication risk management policy and includes a review of REMS programs, an assessment of the positive and negative aspects of REMS, and provides suggestions for planning and measuring outcomes. In particular, this publication presents an overview of the evolution of the REMS program and its implications.

Roundtable debate: Controversies in the management of the septic patient – desperately seeking consensus

PubMed Central

Waxman, Aaron B; Ward, Nicholas; Thompson, Taylor; Lilly, Craig M; Lisbon, Alan; Hill, Nicholas; Nasraway, Stanley A; Heard, Stephen; Corwin, Howard; Levy, Mitchell

2005-01-01

Despite continuous advances in technologic and pharmacologic management, the mortality rate from septic shock remains high. Care of patients with sepsis includes measures to support the circulatory system and treat the underlying infection. There is a substantial body of knowledge indicating that fluid resuscitation, vasopressors, and antibiotics accomplish these goals. Recent clinical trials have provided new information on the addition of individual adjuvant therapies. Consensus on how current therapies should be prescribed is lacking. We present the reasoning and preferences of a group of intensivists who met to discuss the management of an actual case. The focus is on management, with emphasis on the criteria by which treatment decisions are made. It is clear from the discussion that there are areas where there is agreement and areas where opinions diverge. This presentation is intended to show how experienced intensivists apply clinical science to their practice of critical care medicine. PMID:15693960

Behavioral and psychosocial effects of intensive lifestyle management for women with coronary heart disease.

PubMed

Toobert, D J; Glasgow, R E; Nettekoven, L A; Brown, J E

1998-11-01

Females, especially older women, historically have been excluded from coronary heart disease (CHD) studies. The PrimeTime program was a randomized clinical trial designed to study the effects of a comprehensive lifestyle management program (very low-fat vegetarian diet, smoking cessation, stress-management training, moderate exercise, and group support) on changes in behavioral risk factors among postmenopausal women with CHD. The study also explored program effects on four psychosocial clusters: coping with stress, distress, social support, and self-efficacy. The program produced significant behavioral improvements in 4- and 12-months adherence to diet, physical activity, and stress-management in the PrimeTime women compared to the Usual Care (UC) group. In addition, the PrimeTime participants demonstrated improvements relative to UC on psychosocial measures of self-efficacy, perceived social support, and ability to cope with stress. Strengths and weaknesses of the study, and implications for future research are discussed.

Managing encopresis in the elementary school setting: the school nurse's role.

PubMed

Garman, Kimberly; Ficca, Michelle

2012-06-01

Encopresis is a medical condition that is associated with incontinence in children. It leads to frustration and anxiety in both parents and children due to the presenting symptoms and the inability to control elimination patterns. There is overwhelming concern among families that a child with encopresis will be ostracized from peers and will suffer long-term psychological effects. It is therefore important to define encopresis to include the etiology, prevalence, and treatment measures in order to ensure a positive outcome. In addition, as a child enters elementary school, the school nurse plays a vital role in assisting the child to reach educational goals and managing health concerns. This article will guide the reader through the origin and diagnosis of encopresis as well as the principles of management. It will also delineate the school nurse role in managing encopresis in the school setting.

A Primary Care Approach to the Diagnosis and Management of Peripheral Arterial Disease

NASA Technical Reports Server (NTRS)

Dawson, David L.

2000-01-01

The objectives of this work are: (1) Be able to recognize characteristic symptoms of intermittent claudication (2) Diagnose PAD on the basis of history, physical exam, and simple limb blood pressure measurements (3) Recognize the significance of peripheral artery disease as a marker for coronary or cerebrovascular atherosclerosis (4) Provide appropriate medical management of atherosclerosis risk factors-- including use of antiplatelet therapy to reduce risk of myocardial infarction, stroke and death (5) Manage symptoms of intermittent claudication with program of smoking cessation, exercise, and medication The diagnosis of intermittent claudication secondary to peripheral artery disease (PAD) can often be made on the basis of history and physical examination. Additional evaluation of PAD is multi-modal and the techniques used will vary depending on the nature and severity of the patient's presenting problem. Most patients can be appropriately managed without referral for specialized diagnostic services or interventions.

Analysis of the UCSF Symptom Management Theory: Implications for Pediatric Oncology Nursing

PubMed Central

Linder, Lauri

2015-01-01

Symptom management research is a priority for both children and adults with cancer. The UCSF Symptom Management Theory (SMT) is a middle range theory depicting symptom management as a multidimensional process. A theory analysis using the process described by Walker and Avant evaluated the SMT with attention to application in research involving children with cancer. Application of the SMT in studies involving children has been limited to descriptive studies testing only portions of the theory. Findings of these studies have provided empiric support for the relationships proposed within the SMT. Considerations for future research involving children include attention to measurement of symptoms and clarity regarding the location of the parents and family within the model. With additional testing and refinement, the SMT has the potential to guide nursing research and practice to improve symptoms for children with cancer. PMID:20639345

Pain Self-Management for Veterans: Development and Pilot Test of a Stage-Based Mobile-Optimized Intervention.

PubMed

Johnson, Sara S; Levesque, Deborah A; Broderick, Lynne E; Bailey, Dustin G; Kerns, Robert D

2017-10-17

Chronic pain is a significant public health burden affecting more Americans than cardiovascular disease, diabetes, and cancer combined. Veterans are disproportionately affected by chronic pain. Among previously deployed soldiers and veterans, the prevalence of chronic pain is estimated between 44% and 60%. The objective of this research was to develop and pilot-test Health eRide: Your Journey to Managing Pain, a mobile pain self-management program for chronic musculoskeletal pain for veterans. Based on the transtheoretical model of behavior change, the intervention is tailored to veterans' stage of change for adopting healthy strategies for pain self-management and their preferred strategies. It also addresses stress management and healthy sleep, two components of promising integrated treatments for veterans with pain and co-occurring conditions, including posttraumatic stress disorder (PTSD) and traumatic brain injury. In addition, Health eRide leverages gaming principles, text messaging (short message service, SMS), and social networking to increase engagement and retention. Pilot test participants were 69 veterans recruited in-person and by mail at a Veterans Health Administration facility, by community outreach, and by a Web-based survey company. Participants completed a mobile-delivered baseline assessment and Health eRide intervention session. During the next 30 days, they had access to a Personal Activity Center with additional stage-matched activities and information and had the option of receiving tailored text messages. Pre-post assessments, administered at baseline and the 30-day follow-up, included measures of pain, pain impact, use of pain self-management strategies, PTSD, and percentage in the Action or Maintenance stage for adopting pain self-management, managing stress, and practicing healthy sleep habits. Global impressions of change and program acceptability and usability were also assessed at follow-up. Among the 44 veterans who completed the 30-day post assessment, there were statistically significant pre-post reductions in pain (P<.001) and pain impact (P<.001); there was some reduction in symptoms of PTSD (P=.05). There were significant pre-post increases in the percentage of participants in the Action or Maintenance stage for adopting pain self-management (P=.01) and for managing stress (P<.001) but not for practicing healthy sleep habits (P=.11). The global impressions of change measure showed that a majority had experienced some level of improvement. User ratings of acceptability were quite high; ratings of usability fell slightly below the mean for digital programs. Preliminary data demonstrate the potential impact of the Health eRide program for chronic musculoskeletal pain for veterans. The results underscore that simultaneously addressing other behaviors may be a promising approach to managing pain and comorbid conditions. Additional formative research is required to complete development of the Health eRide program and to address areas of usability requiring improvement. A randomized trial with longer follow-up is needed to demonstrate the program's long-term effects on pain and pain self-management. ©Sara S Johnson, Deborah A Levesque, Lynne E Broderick, Dustin G Bailey, Robert D Kerns. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 17.10.2017.

Shuttle on-orbit contamination and environmental effects

NASA Technical Reports Server (NTRS)

Leger, L. J.; Jacobs, S.; Ehlers, H. K. F.; Miller, E.

1985-01-01

Ensuring the compatibility of the space shuttle system with payloads and payload measurements is discussed. An extensive set of quantitative requirements and goals was developed and implemented by the space shuttle program management. The performance of the Shuttle system as measured by these requirements and goals was assessed partly through the use of the induced environment contamination monitor on Shuttle flights 2, 3, and 4. Contamination levels are low and generally within the requirements and goals established. Additional data from near-term payloads and already planned contamination measurements will complete the environment definition and allow for the development of contamination avoidance procedures as necessary for any payload.

Development of pig welfare assessment protocol integrating animal-, environment-, and management-based measures.

PubMed

Renggaman, Anriansyah; Choi, Hong L; Sudiarto, Sartika Ia; Alasaarela, Laura; Nam, Ok S

2015-01-01

Due to increased interest in animal welfare, there is now a need for a comprehensive assessment protocol to be used in intensive pig farming systems. There are two current welfare assessment protocols for pigs: Welfare Quality® Assessment Protocols (applicable in the Europe Union), that mostly focuses on animal-based measures, and the Swine Welfare Assurance Program (applicable in the United States), that mostly focuses on management- and environment-based measures. In certain cases, however, animal-based measures might not be adequate for properly assessing pig welfare status. Similarly, welfare assessment that relies only on environment- and management-based measures might not represent the actual welfare status of pigs. Therefore, the objective of this paper was to develop a new welfare protocol by integrating animal-, environment-, and management-based measures. The background for selection of certain welfare criteria and modification of the scoring systems from existing welfare assessment protocols are described. The developed pig welfare assessment protocol consists of 17 criteria that are related to four main principles of welfare (good feeding, good housing, good health, and appropriate behavior). Good feeding, good housing, and good health were assessed using a 3-point scale: 0 (good welfare), 1 (moderate welfare), and 2 (poor welfare). In certain cases, only a 2-point scale was used: 0 (certain condition is present) or 2 (certain condition is absent). Appropriate behavior was assessed by scan sampling of positive and negative social behaviors based on qualitative behavior assessment and human-animal relationship tests. Modification of the body condition score into a 3-point scale revealed pigs with a moderate body condition (score 1). Moreover, additional criteria such as feed quality confirmed that farms had moderate (score 1) or poor feed quality (score 2), especially those farms located in a high relative humidity region. The developed protocol can be utilized to assess welfare status in an intensive pig farming system. Although further improvements are still needed, this study is a first step in developing a pig welfare assessment protocol that combines animal-, environment-, and management-based measures.

15 CFR 921.33 - Boundary changes, amendments to the management plan, and addition of multiple-site components.

Code of Federal Regulations, 2010 CFR

2010-01-01

... management plan, and addition of multiple-site components. 921.33 Section 921.33 Commerce and Foreign Trade... management plan, and addition of multiple-site components. (a) Changes in the boundary of a Reserve and major... management plan shall address goals and objectives for all components of the multi-site Reserve and the...

An Electronic Adherence Measurement Intervention to Reduce Clinical Inertia in the Treatment of Uncontrolled Hypertension: The MATCH Cluster Randomized Clinical Trial.

PubMed

Kronish, Ian M; Moise, Nathalie; McGinn, Thomas; Quan, Yan; Chaplin, William; Gallagher, Benjamin D; Davidson, Karina W

2016-11-01

To appropriately manage uncontrolled hypertension, clinicians must decide whether blood pressure (BP) is above goal due to a need for additional medication or to medication nonadherence. Yet, clinicians are poor judges of adherence, and uncertainty about adherence may promote inertia with respect to medication modification. We aimed to determine the effect of sharing electronically-measured adherence data with clinicians on the management of uncontrolled hypertension. This was a cluster randomized trial. Twenty-four primary care providers (12 intervention, 12 usual care; cluster units) and 100 patients with uncontrolled hypertension (65 intervention, 35 usual care) were included in the study. At one visit per patient, clinicians in the intervention group received a report summarizing electronically measured adherence to the BP regimen and recommended clinical actions. Clinicians in the control group did not receive a report. The primary outcome was the proportion of visits with appropriate clinical management (i.e., treatment intensification among adherent patients and adherence counseling among nonadherent patients). Secondary outcomes included patient-rated quality of care and communication during the visit. The proportion of visits with appropriate clinical management was higher in the intervention group than the control group (45 out of 65; 69 %) versus (12 out of 35; 34 %; p = 0.001). A higher proportion of adherent patients in the intervention group had their regimen intensified (p = 0.01), and a higher proportion of nonadherent patients in the intervention group received adherence counseling (p = 0.005). Patients in the intervention group were more likely to give their clinician high ratings on quality of care (p = 0.05), and on measures of patient-centered (p = 0.001) and collaborative communication (p = 0.02). Providing clinicians with electronically-measured antihypertensive adherence reports reduces inertia in the management of uncontrolled hypertension. NCT01257347 ; http://clinicaltrials.gov/show/ NCT01257347.

Psychosocial and clinical risk factor profiles in managers.

PubMed

Kentner, M; Ciré, L; Scholl, J

2000-06-01

Over the past 10 years the IAS Foundation has performed more than 15,000 PREVENT check-ups on managers. In addition to a comprehensive clinical program of preventive examinations, the main emphasis is placed on extensive counseling. This counseling centres not only on personal behaviour patterns affecting the individual's health, but also on the psychomental capabilities of the patient within the context of the psychosocial stresses in managerial positions. Three cross-sectional studies examined: (1) the major cardiovascular risk factors (n = 974), (2) the psychosocial structure (n = 2,800) and (3) the relationships between clinical risk factors and psychological structural features (n = 200). According to expectations, managers showed somewhat lower cardiovascular risk levels than did other professional groups. However, nearly 70% of them reported various unspecific, psychovegetative complaints. Managers were subdivided into four psychological types, each representing roughly one quarter of the series: Type 1: anxiety, tension (20.5%); Type 2: repression, lack of self-control (22.2%); Type 3: challenge, ambition, self-control (27.6%); Type 4: healthy living, with self-control (29.7%). Type 3 resembles most closely classic type A behaviour and is seen in a good quarter of the overall cohort. This may indicate that not only people showing type A behaviour are predestined to occupy managerial positions, but that people with a type B structure also take up managerial positions. It is, however, in particular the type B behavioural patterns that are also associated with increased psychovegetative complaints. The relationships between psychosocial structural variables and clinical risk factors such as hypercholesteremia and high blood pressure are not very strong. Occupational health measures in organisations should also be established for managers, as they present an important employee group within the enterprise. In addition to examining them for cardiovascular risks, counseling and coaching programmes on preventive measures and recommended behaviour at work should be a primary concern.

Management of scars: updated practical guidelines and use of silicones.

PubMed

Meaume, Sylvie; Le Pillouer-Prost, Anne; Richert, Bertrand; Roseeuw, Diane; Vadoud, Javid

2014-01-01

Hypertrophic scars and keloids resulting from surgery, burns, trauma and infection can be associated with substantial physical and psychological distress. Various non-invasive and invasive options are currently available for the prevention and treatment of these scars. Recently, an international multidisciplinary group of 24 experts on scar management (dermatologists; plastic and reconstructive surgeons; general surgeons; physical medicine, rehabilitation and burns specialists; psychosocial and behavioural researchers; epidemiologists; beauticians) convened to update a set of practical guidelines for the prevention and treatment of hypertrophic and keloid scars on the basis of the latest published clinical evidence on existing scar management options. Silicone-based products such as sheets and gels are recommended as the gold standard, first-line, non-invasive option for both the prevention and treatment of scars. Other general scar preventative measures include avoiding sun exposure, compression therapy, taping and the use of moisturisers. Invasive treatment options include intralesional injections of corticosteroids and/or 5-fluorouracil, cryotherapy, radiotherapy, laser therapy and surgical excision. All of these options may be used alone or as part of combination therapy. Of utmost importance is the regular re-evaluation of patients every four to eight weeks to evaluate whether additional treatment is warranted. The amount of scar management measures that are applied to each wound depends on the patient's risk of developing a scar and their level of concern about the scar's appearance. The practical advice presented in the current guidelines should be combined with clinical judgement when deciding on the most appropriate scar management measures for an individual patient.

Risk management and measuring productivity with POAS--point of act system.

PubMed

Akiyama, Masanori; Kondo, Tatsuya

2007-01-01

The concept of our system is not only to manage material flows, but also to provide an integrated management resource, a means of correcting errors in medical treatment, and applications to EBM through the data mining of medical records. Prior to the development of this system, electronic processing systems in hospitals did a poor job of accurately grasping medical practice and medical material flows. With POAS (Point of Act System), hospital managers can solve the so-called, "man, money, material, and information" issues inherent in the costs of healthcare. The POAS system synchronizes with each department system, from finance and accounting, to pharmacy, to imaging, and allows information exchange. We can manage Man, Material, Money and Information completely by this system. Our analysis has shown that this system has a remarkable investment effect - saving over four million dollars per year - through cost savings in logistics and business process efficiencies. In addition, the quality of care has been improved dramatically while error rates have been reduced - nearly to zero in some cases.

[Endorsement of risk management and patient safety by certification of conformity in health care quality assessment].

PubMed

Waßmuth, Ralf

2015-01-01

Certification of conformity in health care should provide assurance of compliance with quality standards. This also includes risk management and patient safety. Based on a comprehensive definition of quality, beneficial effects on the management of risks and the enhancement of patient safety can be expected from certification of conformity. While these effects have strong face validity, they are currently not sufficiently supported by evidence from health care research. Whether this relates to a lack of evidence or a lack of investigation remains open. Advancing safety culture and "climate", as well as learning from adverse events rely in part on quality management and are at least in part reflected in the certification of healthcare quality. However, again, evidence of the effectiveness of such measures is limited. Moreover, additional factors related to personality, attitude and proactive action of healthcare professionals are crucial factors in advancing risk management and patient safety which are currently not adequately reflected in certification of conformity programs.

A Public-Private Partnership Improves Clinical Performance In A Hospital Network In Lesotho.

PubMed

McIntosh, Nathalie; Grabowski, Aria; Jack, Brian; Nkabane-Nkholongo, Elizabeth Limakatso; Vian, Taryn

2015-06-01

Health care public-private partnerships (PPPs) between a government and the private sector are based on a business model that aims to leverage private-sector expertise to improve clinical performance in hospitals and other health facilities. Although the financial implications of such partnerships have been analyzed, few studies have examined the partnerships' impact on clinical performance outcomes. Using quantitative measures that reflected capacity, utilization, clinical quality, and patient outcomes, we compared a government-managed hospital network in Lesotho, Africa, and the new PPP-managed hospital network that replaced it. In addition, we used key informant interviews to help explain differences in performance. We found that the PPP-managed network delivered more and higher-quality services and achieved significant gains in clinical outcomes, compared to the government-managed network. We conclude that health care public-private partnerships may improve hospital performance in developing countries and that changes in management and leadership practices might account for differences in clinical outcomes. Project HOPE—The People-to-People Health Foundation, Inc.

75 FR 60709 - Fisheries Off West Coast States; Notice of Availability for Amendments 16-5 and 23 to the Pacific...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-01

...NMFS announces that the Pacific Fishery Management Council (Council) has submitted Amendments 16-5 and 23 to the Pacific Coast Groundfish Fishery Management Plan (FMP) for Secretarial review. Amendment 16-5 would modify the FMP to implement an overfished species rebuilding plan for petrale sole and revise existing overfished species rebuilding plans. In addition, Amendment 16-5 would modify the default proxy values for FMSY and BMSY as they apply to the flatfish species, including petrale sole; and the harvest control rule policies. Amendment 23 introduces a new framework for fishery specifications and other measures for establishing Annual Catch Limits (ACLs) as required by the recent amendments to the Magnuson-Stevens Fishery Conservation and Management Act (Magnuson-Stevens Act).

Teaching children with autism appropriate play in unsupervised environments using a self-management treatment package.

PubMed Central

Stahmer, A C; Schreibman, L

1992-01-01

The present study used a self-management treatment package to teach 3 children with autism, who exhibited inappropriate play behaviors, to play appropriately in the absence of a treatment provider. After self-management training, generalization and maintenance of the behavior change were assessed. Because of the detrimental effects of self-stimulation (arm flapping, spinning toys, twirling, etc.) on learning, the relationship between self-stimulatory behaviors and appropriate play was measured. Results indicated that the children learned to exhibit appropriate play skills in unsupervised settings, appropriate play skills generalized to new settings, and 2 of the children maintained their gains at 1-month follow-up. In addition, self-stimulatory behaviors decreased as appropriate play increased. Treatment implications of these findings are discussed. PMID:1634432

Class relations and all-cause mortality: a test of Wright's social class scheme using the Barcelona 2000 Health Interview Survey.

PubMed

Muntaner, Carles; Borrell, Carme; Solà, Judit; Marí-Dell'Olmo, Marc; Chung, Haejoo; Rodríguez-Sanz, Maica; Benach, Joan; Rocha, Kátia B; Ng, Edwin

2011-01-01

The aim of this study is to test the effects of neo-Marxian social class and potential mediators such as labor market position, work organization, material deprivation, and health behaviors on all-cause mortality. The authors use longitudinal data from the Barcelona 2000 Health Interview Survey (N=7526), with follow-up interviews through the municipal census in 2008 (95.97% response rate). Using data on relations of property, organizational power, and education, the study groups social classes according to Wright's scheme: capitalists, petit bourgeoisie, managers, supervisors, and skilled, semi-skilled, and unskilled workers. Findings indicate that social class, measured as relations of control over productive assets, is an important predictor of mortality among working-class men but not women. Workers (hazard ratio = 1.60; 95% confidence interval, 1.10-2.35) but also managers and small employers had a higher risk of death compared with capitalists. The extensive use of conventional gradient measures of social stratification has neglected sociological measures of social class conceptualized as relations of control over productive assets. This concept is capable of explaining how social inequalities are generated. To confirm the protective effect of the capitalist class position and the "contradictory class location hypothesis," additional efforts are needed to properly measure class among low-level supervisors, capitalists, managers, and small employers.

Development of fast measurements of concentration of NORM U-238 by HPGe

NASA Astrophysics Data System (ADS)

Cha, Seokki; Kim, Siu; Kim, Geehyun

2017-02-01

Naturally Occureed Radioactive Material (NORM) generated from the origin of earth can be found all around us and even people who are not engaged in the work related to radiation have been exposed to unnecessary radiation. This NORM has a potential risk provided that is concentrated or transformed by artificial activities. Likewise, a development of fast measruement method of NORM is emerging to prevent the radiation exposure of the general public and person engaged in the work related to the type of business related thereto who uses the material in which NORM is concentrated or transfromed. Based on such a background, many of countries have tried to manage NORM and carried out regulatory legislation. To effienctly manage NORM, there is need for developing new measurement to quickly and accurately analyze the nuclide and concentration. In this study, development of the fast and reliable measurement was carried out. In addition to confirming the reliability of the fast measurement, we have obtained results that can suggest the possibility of developing another fast measurement. Therefore, as a follow-up, it is possible to develop another fast analytical measurement afterwards. The results of this study will be very useful for the regulatory system to manage NORM. In this study, a review of two indirect measurement methods of NORM U-238 that has used HPGe on the basis of the equilibrium theory of relationships of mother and daughter nuclide at decay-chain of NORM U-238 has been carried out. For comparative study(in order to know reliabily), direct measurement that makes use of alpha spectrometer with complicated pre-processing process was implemented.

Vertebrate herbivory in managed coastal wetlands: A manipulative experiment

USGS Publications Warehouse

Johnson, L.A.; Foote, A.L.

1997-01-01

Structural marsh management and nutria herbivory are both believed to strongly influence plant production in the brackish, deltaic marshes of coastal Louisiana, USA. Previous studies have tested the effects of structural management on aboveground biomass after implementing management, but very few studies have collected data before and after management. Thus, to test the effects of structural marsh management on Spartina patens (Ait.) Muhl. and Scirpus americanus Pers., the aboveground biomass of both species was estimated before and after the construction of shallow, leveed impoundments. The water level in each impoundment was managed with a single flap-gated culvert fitted with a variable crest weir. Additionally, the influence of nutria grazing on aboveground biomass was measured by nondestructively sampling fenced (ungrazed) and unfenced (grazed) plots in both managed and unmanaged areas. While there was no significant difference in S. patens production between managed and unmanaged areas, marsh management negatively affected Sc. americanus production the two species also differed in their responses to grazing. Grazing dramatically reduced the sedge, Sc. americanus, while the grass, S. patens, remained at similar biomass levels in grazed and ungrazed plant stands. These findings support the belief that herbivory has a strong influence on plant production, but do not support the claim that management increases plant production in the deltaic marshes of Louisiana.

Levels-of-growing-stock cooperative study in Douglas-fir: report no. 17—The Skykomish Study, 1961–93; The Clemons study, 1963–94.

Treesearch

James E. King; David D. Marshall; John F. Bell

2002-01-01

Stand treatments were completed as prescribed with an initial calibration cut and five thinnings resulting in eight new regimes for management of Douglas-fir (Pseudotsuga menziesii (Mirb.) Franco). Measurements were continued for an additional 14 years to observe stability and yields of stands in a postthinning holding period. Detailed descriptions...

The Berry Amendment: A Comprehensive Look at the History and Implications for Program Managers of Hand- and Measuring-Tool-Intensive Programs

DTIC Science & Technology

2014-09-01

2. Reciprocal use of DNADs ..................................................................30 E. BERRY AMENDMENT PROCESSES ...the contracting process or procuring of systems that do not totally meet the system requirements provided by the combat developer. From a government...as constraints, restrictions and exceptions provided by the Berry Amendment. Additionally, data will be collected on acquisition processes from

DOD Business Systems Modernization: Further Actions Needed to Address Challenges and Improve Accountability

DTIC Science & Technology

2013-05-01

to Lack Adequate Validation Page 35 GAO-13-557 DOD Business Systems Modernization provided a compliance dashboard to document BEA...campaigns, execute marketing campaigns, and measure and evaluate the performance of marketing campaigns. Order-to- Cash Accept and process customer... dashboards reflected related GAO reports. In addition, the department’s fiscal year 2014 investment management guidance issued by the Office of the

Searching for management approaches to reduce HAI transmission (SMART): a study protocol.

PubMed

McAlearney, Ann Scheck; Hefner, Jennifer L; Sieck, Cynthia J; Walker, Daniel M; Aldrich, Alison M; Sova, Lindsey N; Gaughan, Alice A; Slevin, Caitlin M; Hebert, Courtney; Hade, Erinn; Buck, Jacalyn; Grove, Michele; Huerta, Timothy R

2017-06-28

Healthcare-associated infections (HAIs) impact patients' lives through prolonged hospitalization, morbidity, and death, resulting in significant costs to both health systems and society. Central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) are two of the most preventable HAIs. As a result, these HAIs have been the focus of significant efforts to identify evidence-based clinical strategies to reduce infection rates. The Comprehensive Unit-based Safety Program (CUSP) provides a formal model for translating CLABSI-reduction evidence into practice. Yet, a national demonstration project found organizations experienced variable levels of success using CUSP to reduce CLABSIs. In addition, in Fiscal year 2019, Medicare will expand use of CLABSI and CAUTI metrics beyond ICUs to the entire hospital for reimbursement purposes. As a result, hospitals need guidance about how to successfully translate HAI-reduction efforts such as CUSP to non-ICU settings (clinical practice), and how to shape context (management practice)-including culture and management strategies-to proactively support clinical teams. Using a mixed-methods approach to evaluate the contribution of management factors to successful HAI-reduction efforts, our study aims to: (1) Develop valid and reliable measures of structural management practices associated with the recommended CLABSI Management Strategies for use as a survey (HAI Management Practice Guideline Survey) to support HAI-reduction efforts in both medical/surgical units and ICUs; (2) Develop, validate, and then deploy the HAI Management Practice Guideline Survey, first across Ohio hospitals, then nationwide, to determine the positive predictive value of the measurement instrument as it relates to CLABSI- and CAUTI-prevention; and (3) Integrate findings into a Management Practices Toolkit for HAI reduction that includes an organization-specific data dashboard for monitoring progress and an implementation program for toolkit use, and disseminate that Toolkit nationwide. Providing hospitals with the tools they need to successfully measure management structures that support clinical care provides a powerful approach that can be leveraged to reduce the incidence of HAIs experienced by patients. This study is critical to providing the information necessary to successfully "make health care safer" by providing guidance on how contextual factors within a healthcare setting can improve patient safety across hospitals.

Dental management of a pediatric patient with Burkitt lymphoma: a case report.

PubMed

Padmanabhan, M Y; Pandey, R K; Kumar, Archana; Radhakrishnan, Aparna

2012-06-01

Recent advancements in the field of cancer diagnosis and chemotherapy have led to higher rates of survival for children with malignant tumors. More than 75% of pediatric patients diagnosed with malignancies survive more than 5 years. These advancements have resulted in additional responsibilities for dental professionals to diagnose, evaluate, prevent, stabilize, and manage the oral and dental problems that can compromise the quality of life of these children. This case report highlights the importance of professional and self-administered oral prophylactic measures and patient compliance in the successful oral rehabilitation of a pediatric patient with Burkitt lymphoma. © 2012 Special Care Dentistry Association and Wiley Periodicals, Inc.

The workload analysis in welding workshop

NASA Astrophysics Data System (ADS)

Wahyuni, D.; Budiman, I.; Tryana Sembiring, M.; Sitorus, E.; Nasution, H.

2018-03-01

This research was conducted in welding workshop which produces doors, fences, canopies, etc., according to customer’s order. The symptoms of excessive workload were seen from the fact of employees complaint, requisition for additional employees, the lateness of completion time (there were 11 times of lateness from 28 orders, and 7 customers gave complaints). The top management of the workshop assumes that employees’ workload was still a tolerable limit. Therefore, it was required workload analysis to determine the number of employees required. The Workload was measured by using a physiological method and workload analysis. The result of this research can be utilized by the workshop for a better workload management.

Home-based diabetes self-management coaching delivered by paraprofessionals: A randomized controlled trial.

PubMed

Pauley, Tim; Gargaro, Judith; Chenard, Glen; Cavanagh, Helen; McKay, Sandra M

2016-01-01

This study evaluated paraprofessional-led diabetes self-management coaching (DSMC) among 94 clients with type 2 diabetes recruited from a Community Care Access Centre in Ontario, Canada. Subjects were randomized to standard care or standard care plus coaching. Measures included the Diabetes Self-Efficacy Scale (DSES), Insulin Management Diabetes Self-Efficacy Scale (IMDSES), and Hospital Anxiety and Depression Scale (HADS). Both groups showed improvement in DSES (6.6 + 1.5 vs. 7.2 + 1.5, p < .001) and IMDSES (113.5 + 20.6 vs. 125.7 + 22.3, p < .001); there were no between-groups differences. There were no between-groups differences in anxiety (p > .05 for all) or depression scores (p > .05 for all), or anxiety (p > .05 for all) or depression (p > .05 for all) categories at baseline, postintervention, or follow-up. While all subjects demonstrated significant improvements in self-efficacy measures, there is no evidence to support paraprofessional-led DSMC as an intervention which conveys additional benefits over standard care.

Disaster Risk Management and Measurement Indicators for Cultural Heritage in Taiwan

NASA Astrophysics Data System (ADS)

Yen, Y. N.; Cheng, C. F.; Cheng, H. M.

2015-08-01

Under the influence of global climate change, the risk preparedness has become a universal issue in different research fields. In the conservation of cultural heritage, disaster risk management is becoming one of the major research topics. Besides researches on the theory and mechanism of disaster risk management, the tools for the performance of site managers to protect cultural heritage is another important issue that needs development. UNESCO and ICOMOS have released some important documents on disaster risk management including its concept, identification, evaluation, mitigation, monitoring and resilience, etc. However, there is a big gap between concept and implementation in Taiwan. Presently there are 2000 monuments in Taiwan that hardly meet the modern code. First, based on international documents released, this research presents 13 disaster indicators on monuments and their environments. Next, 345 monuments in northern Taiwan are taken as examples to evaluate their risk situations with indicators designed in 2011. Some positive recommendations were given at the same time. As a result, a comparative evaluation was completed in 2012 and some key issues are found, such as too many electrical facilities, lack of efficient firefighting equipment, and a shortage of management mechanism, just to name a few. Through the improvement of the management, some major risk can be mitigated. In 2013~14, this research took 23 national monuments from the 345 monuments to evaluate their risk situations and compare the differences between national and local monuments. Results show that almost all management mechanisms in the national monuments have been established and are running well. However, problems like inappropriate electrical facilities and insufficient monitoring equipment remain. In addition, the performance of private monuments is not as good as public ones. Based on the collected information and evaluation, this research develops safety measures of heritage conservation in two aspects. One is for researchers to measure the risk of the heritage; the other is for site managers to manage the risk of their monument with ease. In conclusion, intendants of monuments in Taiwan have to develop more disaster risk management ideas to mitigate and prevent risks. In the meantime, the management and monitoring mechanisms available are helpful tools for risk mitigation. The awareness and training of the site managers are important issues for the implementation of risk prevention.

A comparison of food safety knowledge among restaurant managers, by source of training and experience, in Oklahoma County, Oklahoma.

PubMed

Lynch, Robert A; Elledge, Brenda L; Griffith, Charles C; Boatright, Daniel T

2003-09-01

The annual incidence of illness related to food consumption continues to present a challenge to environmental health management. A significant fraction of cases have been attributed to consumption of food in restaurants, and as the number of meals eaten away from the home continues to rise, the potential for large-scale foodborne-disease outbreaks will continue to increase. Food handlers in retail establishments contribute to the incidence of foodborne disease; therefore, it is essential that workers and management staff have a thorough understanding of safe food practices. Since the training, certification, and experience of food service managers vary greatly, it is also likely that managers' knowledge base may differ. In the study reported here, restaurant managers were administered a survey designed to measure their understanding of basic food safety principles. The sources of training, certification, and experience were found to significantly affect the level of food safety knowledge; however, increased hours of training did not increase knowledge. In addition, the time lapsed since training did not significantly affect the level of knowledge.

Quality of care in patients with psoriasis: an initial clinical study of an international disease management programme.

PubMed

de Korte, J; Van Onselen, J; Kownacki, S; Sprangers, M A G; Bos, J D

2005-01-01

Patients with psoriasis have to cope with their disease for many years or even throughout their entire life. To provide optimal care, a disease management programme was developed. This programme consisted of disease education, disease management training, and psychological support, together with topical treatment. To test a disease management programme in dermatological practice, to assess patients' satisfaction with this programme, and adherence to topical treatment. Additionally, disease severity and quality of life were assessed. An initial clinical investigation was conducted in 10 European treatment centres. A total of 330 patients were included. Patient satisfaction, adherence, disease severity and quality of life were measured with study-specific and standardized self-report questionnaires. Patients reported a high degree of satisfaction with the programme, and a high degree of adherence to topical treatment. Disease severity and quality of life significantly improved. The programme was well received by the participating professionals. The disease management programme was found to be a useful tool in the management of psoriasis, providing patients with relief from the burden of psoriasis in everyday life. A full-scale evaluation is recommended.

Recommended methods for the disposal of sanitary wastes from temporary field medical facilities.

PubMed

Reed, R A; Dean, P T

1994-12-01

Emergency field medical facilities constructed after a disaster are frequently managed by medical staff even though many of the day-to-day problems of hospital management are unrelated to medicine. In this paper we discuss the short-term management of one of these problems, namely the control and disposal of sanitary wastes. It is aimed at persons in the medical profession who may find themselves responsible for a temporary hospital and have little or no previous experience of managing such situations. The wastes commonly generated are excreta, sullage and refuse. In addition, surface water must also be considered because its inadequate disposal is a potential health hazard. The paper concentrates on short-term measures appropriate for the first six months of the hospital or clinic's existence. Facilities expected to last longer are recommended to install conventional waste management systems appropriate to the local community and conditions. In most situations, wastes should be disposed of underground either by burial (for solids) or infiltration (for liquids). The design, construction and management of appropriate disposal systems are described.

A Leadership Education and Development Program for Clinical Nurses.

PubMed

Fitzpatrick, Joyce J; Modic, Mary Beth; Van Dyk, Jennifer; Hancock, K Kelly

2016-11-01

The Leadership Education and Development (LEAD) Program was designed to transform care at the bedside by empowering clinical nurses as leaders. The heart of LEAD was enhancing communication skills of clinical nurses with clinical colleagues and, most importantly, patients and families. Key concepts of leadership/management were included: personal awareness, personal leadership skills/abilities, leading change, leading others individually and in teams, enhancing the patient/provider experience, and the leadership role in outcomes management. A quantitative, longitudinal, survey design was used with 2 cohorts. The program consisted of six 4-hour sessions for 3 to 6 months. Leadership practices were measured before program implementation, at the end of the program, and 3 months after program completion. There were significant increases in leadership practices sustained 3 months after program completion. A range of other outcome measures was included. There is a need for additional leadership development programs for clinical nurses.

Effect of entropy change of lithium intercalation in cathodes and anodes on Li-ion battery thermal management

NASA Astrophysics Data System (ADS)

Viswanathan, Vilayanur V.; Choi, Daiwon; Wang, Donghai; Xu, Wu; Towne, Silas; Williford, Ralph E.; Zhang, Ji-Guang; Liu, Jun; Yang, Zhenguo

The entropy changes (Δ S) in various cathode and anode materials, as well as in complete Li-ion batteries, were measured using an electrochemical thermodynamic measurement system (ETMS). LiCoO 2 has a much larger entropy change than electrodes based on LiNi xCo yMn zO 2 and LiFePO 4, while lithium titanate based anodes have lower entropy change compared to graphite anodes. The reversible heat generation rate was found to be a significant portion of the total heat generation rate. The appropriate combinations of cathode and anode were investigated to minimize reversible heat generation rate across the 0-100% state of charge (SOC) range. In addition to screening for battery electrode materials with low reversible heat, the techniques described in this paper can be a useful engineering tool for battery thermal management in stationary and transportation applications.

Developing an Extended Model of the Relation between Work Motivation and Health as Affected by the Work Ability as Part of a Corporate Age Management Approach

PubMed Central

Feißel, Annemarie; Peter, Richard; Swart, Enno

2018-01-01

Due to demographic changes, the employee structure in companies is changing dramatically. It will be necessary to offer employees suitable, age-adequate jobs. As one of its foremost goals, optimized business management strategies must create conditions for guaranteeing a person’s health, work ability, and work motivation. In the context of corporate age management concepts, the literature recommends to retain and integrate older employees in the organization. This paper aims at developing an extended model of the relation between work motivation and health as affected by work ability and at deriving a host of measures that enterprises can apply as part of a corporate age management policy to counteract the impact of demographic changes. The model also takes into consideration factors influencing the relation between work motivation and health as affected by work ability (socio-demographic parameters, occupation, work-related stress). Additionally, the extended model translates the literature-based results into a corporate setting by way of a corporate age management program. The model comprises a process focusing on retaining and promoting work ability in order to maintain or boost work motivation and health. The host of measures presented serves as a basis to preventively counter demographic change on an individual, interpersonal, and structural level. PMID:29673218

Developing an Extended Model of the Relation between Work Motivation and Health as Affected by the Work Ability as Part of a Corporate Age Management Approach.

PubMed

Feißel, Annemarie; Peter, Richard; Swart, Enno; March, Stefanie

2018-04-17

Due to demographic changes, the employee structure in companies is changing dramatically. It will be necessary to offer employees suitable, age-adequate jobs. As one of its foremost goals, optimized business management strategies must create conditions for guaranteeing a person’s health, work ability, and work motivation. In the context of corporate age management concepts, the literature recommends to retain and integrate older employees in the organization. This paper aims at developing an extended model of the relation between work motivation and health as affected by work ability and at deriving a host of measures that enterprises can apply as part of a corporate age management policy to counteract the impact of demographic changes. The model also takes into consideration factors influencing the relation between work motivation and health as affected by work ability (socio-demographic parameters, occupation, work-related stress). Additionally, the extended model translates the literature-based results into a corporate setting by way of a corporate age management program. The model comprises a process focusing on retaining and promoting work ability in order to maintain or boost work motivation and health. The host of measures presented serves as a basis to preventively counter demographic change on an individual, interpersonal, and structural level.

Long-term no-till and stover retention each decrease the global warming potential of irrigated continuous corn.

PubMed

Jin, Virginia L; Schmer, Marty R; Stewart, Catherine E; Sindelar, Aaron J; Varvel, Gary E; Wienhold, Brian J

2017-07-01

Over the last 50 years, the most increase in cultivated land area globally has been due to a doubling of irrigated land. Long-term agronomic management impacts on soil organic carbon (SOC) stocks, soil greenhouse gas (GHG) emissions, and global warming potential (GWP) in irrigated systems, however, remain relatively unknown. Here, residue and tillage management effects were quantified by measuring soil nitrous oxide (N 2 O) and methane (CH 4 ) fluxes and SOC changes (ΔSOC) at a long-term, irrigated continuous corn (Zea mays L.) system in eastern Nebraska, United States. Management treatments began in 2002, and measured treatments included no or high stover removal (0 or 6.8 Mg DM ha -1  yr -1 , respectively) under no-till (NT) or conventional disk tillage (CT) with full irrigation (n = 4). Soil N 2 O and CH 4 fluxes were measured for five crop-years (2011-2015), and ΔSOC was determined on an equivalent mass basis to ~30 cm soil depth. Both area- and yield-scaled soil N 2 O emissions were greater with stover retention compared to removal and for CT compared to NT, with no interaction between stover and tillage practices. Methane comprised <1% of total emissions, with NT being CH 4 neutral and CT a CH 4 source. Surface SOC decreased with stover removal and with CT after 14 years of management. When ΔSOC, soil GHG emissions, and agronomic energy usage were used to calculate system GWP, all management systems were net GHG sources. Conservation practices (NT, stover retention) each decreased system GWP compared to conventional practices (CT, stover removal), but pairing conservation practices conferred no additional mitigation benefit. Although cropping system, management equipment/timing/history, soil type, location, weather, and the depth to which ΔSOC is measured affect the GWP outcomes of irrigated systems at large, this long-term irrigated study provides valuable empirical evidence of how management decisions can impact soil GHG emissions and surface SOC stocks. © 2017 John Wiley & Sons Ltd.

Use of quality measures for Medicaid behavioral health services by state agencies: implications for health care reform.

PubMed

Seibert, Julie; Fields, Suzanne; Fullerton, Catherine Anne; Mark, Tami L; Malkani, Sabrina; Walsh, Christine; Ehrlich, Emily; Imshaug, Melina; Tabrizi, Maryam

2015-06-01

The structure-process-outcome quality framework espoused by Donabedian provides a conceptual way to examine and prioritize behavioral health quality measures used by states. This report presents an environmental scan of the quality measures and satisfaction surveys that state Medicaid managed care and behavioral health agencies used prior to Medicaid expansion in 2014. Data were collected by reviewing online documents related to Medicaid managed care contracts for behavioral health, quality strategies, quality improvement plans, quality and performance indicators data, annual outcomes reports, performance measure specification manuals, legislative reports, and Medicaid waiver requests for proposals. Information was publicly available for 29 states. Most states relied on process measures, along with some structure and outcome measures. Although all states reported on at least one process measure of behavioral health quality, 52% of states did not use any outcomes measures and 48% of states had no structure measures. A majority of the states (69%) used behavioral health measures from the National Committee for Quality Assurance's Healthcare Effectiveness Data and Information Set, and all but one state in the sample (97%) used consumer experience-of-care surveys. Many states supplemented these data with locally developed behavioral health indicators that rely on administrative and nonadministrative data. State Medicaid agencies are using nationally recognized as well as local measures to assess quality of behavioral health care. Findings indicate a need for additional nationally endorsed measures in the area of substance use disorders and treatment outcomes.

Optimal environmental management strategy and implementation for groundwater contamination prevention and restoration.

PubMed

Wang, Mingyu

2006-04-01

An innovative management strategy is proposed for optimized and integrated environmental management for regional or national groundwater contamination prevention and restoration allied with consideration of sustainable development. This management strategy accounts for availability of limited resources, human health and ecological risks from groundwater contamination, costs for groundwater protection measures, beneficial uses and values from groundwater protection, and sustainable development. Six different categories of costs are identified with regard to groundwater prevention and restoration. In addition, different environmental impacts from groundwater contamination including human health and ecological risks are individually taken into account. System optimization principles are implemented to accomplish decision-makings on the optimal resources allocations of the available resources or budgets to different existing contaminated sites and projected contamination sites for a maximal risk reduction. Established management constraints such as budget limitations under different categories of costs are satisfied at the optimal solution. A stepwise optimization process is proposed in which the first step is to select optimally a limited number of sites where remediation or prevention measures will be taken, from all the existing contaminated and projected contamination sites, based on a total regionally or nationally available budget in a certain time frame such as 10 years. Then, several optimization steps determined year-by-year optimal distributions of the available yearly budgets for those selected sites. A hypothetical case study is presented to demonstrate a practical implementation of the management strategy. Several issues pertaining to groundwater contamination exposure and risk assessments and remediation cost evaluations are briefly discussed for adequately understanding implementations of the management strategy.

Issues in Biomedical Research Data Management and Analysis: Needs and Barriers

PubMed Central

Anderson, Nicholas R.; Lee, E. Sally; Brockenbrough, J. Scott; Minie, Mark E.; Fuller, Sherrilynne; Brinkley, James; Tarczy-Hornoch, Peter

2007-01-01

Objectives A. Identify the current state of data management needs of academic biomedical researchers. B. Explore their anticipated data management and analysis needs. C. Identify barriers to addressing those needs. Design A multimodal needs analysis was conducted using a combination of an online survey and in-depth one-on-one semi-structured interviews. Subjects were recruited via an e-mail list representing a wide range of academic biomedical researchers in the Pacific Northwest. Measurements The results from 286 survey respondents were used to provide triangulation of the qualitative analysis of data gathered from 15 semi-structured in-depth interviews. Results Three major themes were identified: 1) there continues to be widespread use of basic general-purpose applications for core data management; 2) there is broad perceived need for additional support in managing and analyzing large datasets; and 3) the barriers to acquiring currently available tools are most commonly related to financial burdens on small labs and unmet expectations of institutional support. Conclusion Themes identified in this study suggest that at least some common data management needs will best be served by improving access to basic level tools such that researchers can solve their own problems. Additionally, institutions and informaticians should focus on three components: 1) facilitate and encourage the use of modern data exchange models and standards, enabling researchers to leverage a common layer of interoperability and analysis; 2) improve the ability of researchers to maintain provenance of data and models as they evolve over time though tools and the leveraging of standards; and 3) develop and support information management service cores that could assist in these previous components while providing researchers with unique data analysis and information design support within a spectrum of informatics capabilities. PMID:17460139

Measuring soil sustainability via soil resilience.

PubMed

Ludwig, Marie; Wilmes, Paul; Schrader, Stefan

2018-06-01

Soils are the nexus of water, energy and food, which illustrates the need for a holistic approach in sustainable soil management. The present study therefore aimed at identifying a bioindicator for the evaluation of soil management sustainability in a cross-disciplinary approach between soil science and multi-omics research. For this purpose we first discuss the remaining problems and challenges of evaluating sustainability and consequently suggest one measurable bioindicator for soil management sustainability. In this concept, we define soil sustainability as the maintenance of soil functional integrity. The potential to recover functional and structural integrity after a disturbance is generally defined as resilience. This potential is a product of the past and the present soil management, and at the same time prospect of possible soil responses to future disturbances. Additionally, it is correlated with the multiple soil functions and hence reflecting the multifunctionality of the soil system. Consequently, resilience can serve as a bioindicator for soil sustainability. The measurable part of soil resilience is the response diversity, calculated from the systematic contrasting of multi-omic markers for genetic potential and functional activity, and referred to as potential Maximum Ecological Performance (MEPpot) in this study. Calculating MEPpot will allow to determine the thresholds of resistance and resilience and potential tipping points for a regime shift towards irreversible or permanent unfavorable soil states for each individual soil considered. The calculation of such ecosystem thresholds is to our opinion the current global cross-disciplinary challenge. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

A hierarchical factor analysis of a safety culture survey.

PubMed

Frazier, Christopher B; Ludwig, Timothy D; Whitaker, Brian; Roberts, D Steve

2013-06-01

Recent reviews of safety culture measures have revealed a host of potential factors that could make up a safety culture (Flin, Mearns, O'Connor, & Bryden, 2000; Guldenmund, 2000). However, there is still little consensus regarding what the core factors of safety culture are. The purpose of the current research was to determine the core factors, as well as the structure of those factors that make up a safety culture, and establish which factors add meaningful value by factor analyzing a widely used safety culture survey. A 92-item survey was constructed by subject matter experts and was administered to 25,574 workers across five multi-national organizations in five different industries. Exploratory and hierarchical confirmatory factor analyses were conducted revealing four second-order factors of a Safety Culture consisting of Management Concern, Personal Responsibility for Safety, Peer Support for Safety, and Safety Management Systems. Additionally, a total of 12 first-order factors were found: three on Management Concern, three on Personal Responsibility, two on Peer Support, and four on Safety Management Systems. The resulting safety culture model addresses gaps in the literature by indentifying the core constructs which make up a safety culture. This clarification of the major factors emerging in the measurement of safety cultures should impact the industry through a more accurate description, measurement, and tracking of safety cultures to reduce loss due to injury. Copyright © 2013 National Safety Council and Elsevier Ltd. All rights reserved.

Quality improvement in childhood obesity management through the maintenance of certification process.

PubMed

Huang, Jeannie S; Chun, Stanford; Sandhu, Amanpreet; Terrones, Laura

2013-11-01

To assess the Health and Obesity: Prevention and Education (HOPE) Curriculum Project, a web-based clinician education program that promotes appropriate screening, prevention, and management of weight among youth by pediatric practitioners, based on the 2007 Expert Committee recommendations. The project currently provides Maintenance of Certification (MOC) Part 4 credit through the American Board of Pediatrics. Participants identified themselves to the HOPE MOC Part 4 program. Enrollees were required to complete all continuing medical education modules (10.5 hours). Knowledge acquisition and self-reported confidence levels related to screening, prevention, and management practices of pediatric obesity were measured using preknowledge and postknowledge questionnaires. Participants were also required to perform a quality improvement project and submit practice performance data from repeated medical chart reviews over time. Knowledge acquisition, self-efficacy, and practice performance data were analyzed using repeated-measures analyses. The 51 participants demonstrated significant improvements in knowledge acquisition and self-efficacy scores after viewing individual modules. In addition, participants demonstrated significant improvements in measured clinical compliance with recommended practices over time. Participation in the HOPE MOC Part 4 program appeared to improve knowledge acquisition, self-efficacy, and physician compliance with recommended practice recommendations for the screening, prevention, and management of pediatric obesity. Further data are required to determine whether such practice-based improvements translate into actual reduction in patient weight and/or reduction in health-related costs related to overweight and obesity in youth. Copyright © 2013 Mosby, Inc. All rights reserved.

Guidance documents: Continued support to improve operations of fish hatcheries and field sites to reduce the impact or prevent establishment of New Zealand Mudsnails and other invasive mollusks

USGS Publications Warehouse

Moffitt, Christine M.

2017-01-01

This project tested and revised a risk assessment/management tool authored by Moffitt and Stockton designed to provide hatchery biologists and others a structure to measure risk and provide tools to control, prevent or eliminate invasive New Zealand mudsnails (NZMS) and other invasive mollusks in fish hatcheries and hatchery operations. The document has two parts: the risk assessment tool, and an appendix that summarizes options for control or management.The framework of the guidance document for risk assessment/hatchery tool combines approaches used by the Hazard Analysis and Critical Control Points (HACCP) process with those developed by the Commission for Environmental Cooperation (CEC), of Canada, Mexico, and the United States, in the Tri-National Risk Assessment Guidelines for Aquatic Alien Invasive Species. The framework approach for this attached first document assesses risk potential with two activities: probability of infestation and consequences of infestation. Each activity is treated equally to determine the risk potential. These two activities are divided into seven basic elements that utilize scientific, technical, and other relevant information in the process of the risk assessment. To determine the probability of infestation four steps are used that have scores reported or determined and averaged. This assessment follows a familiar HACCP process to assess pathways of entry, entry potential, colonization potential, spread potential. The economic, environmental and social consequences are considered as economic impact, environmental impact, and social and cultural influences.To test this document, the Principal Investigator worked to identify interested hatchery managers through contacts at regional aquaculture meetings, fish health meetings, and through the network of invasive species managers and scientists participating in the Western Regional Panel on Aquatic Nuisance Species and the 100th Meridian Initiative's Columbia River Basin Team, and the Western New Zealand Mudsnail Conference in Seattle. Targeted hatchery workshops were conducted with staff at Dworshak National Fish Hatchery Complex (ID), Similkameen Pond, Oroville WA, and Ringold Springs State Hatchery (WA).As a result of communications with hatchery staff, invasive species managers, and on site assessments of hatchery facilities, the document was modified and enhanced. Additional resources were added to keep it up to date. The result is a more simplified tool that can lead hatchery or management personnel through the process of risk assessment and provide an introduction to the risk management and communication process.In addition to the typical HACCP processes, this tool adds steps to rate and consider uncertainty and the weight of evidence regarding options and monitoring results . Uncertainty of outcome exists in most tools that can be used to control or prevent NZMS or other invasive mollusks from infesting an area. In additional this document emphasizes that specific control tools and plans must be tailored to each specific setting to consider the economic, environmental and social influences. From the testing and evaluation process, there was a strong recognition that a number of control and prevention tools previously suggested and reported in the literature from laboratory and small scale trials may not be compatible with regional and national regulations, economic constraints, social or cultural constraints, engineering or water chemistry characteristics of each facility.The options for control are summarized in the second document, Review of Control Measures for Hatcheries Infested with NZMS (Appendix A) that provides sources for additional resources and specific tools, and guidance regarding the feasibility and success of each approach. This tool also emphasizes that management plans need to be adaptive and incorporate oversight from professionals familiar with measuring risks of fish diseases, and treatments (e.g. the fish health practitioners and water quality and effluent management teams). Finally, with such a team, the adaptive management approach must be ongoing, and become a regular component of hatchery operations.Although it was the intent that this two part document would be included as part of the revised National Management and Control Plan for the NZMS proposed by the U.S. Fish and Wildlife Service (USFWS) and others, it is provided as a stand-alone document.

Clinical Practice Guidelines for Delirium Management: Potential Application in Palliative Care

PubMed Central

Bush, Shirley H.; Bruera, Eduardo; Lawlor, Peter G.; Kanji, Salmaan; Davis, Daniel H.J.; Agar, Meera; Wright, David; Hartwick, Michael; Currow, David C.; Gagnon, Bruno; Simon, Jessica; Pereira, José L.

2014-01-01

Context Delirium occurs in patients across a wide array of health care settings. The extent to which formal management guidelines exist or are adaptable to palliative care is unclear. Objectives This review aims to 1) source published delirium management guidelines with potential relevance to palliative care settings, 2) discuss the process of guideline development, 3) appraise their clinical utility, and 4) outline the processes of their implementation and evaluation and make recommendations for future guideline development. Methods We searched PubMed (1990–2013), Scopus, U.S. National Guideline Clearinghouse, Google, and relevant reference lists to identify published guidelines for the management of delirium. This was supplemented with multidisciplinary input from delirium researchers and other relevant stakeholders at an international delirium study planning meeting. Results There is a paucity of high-level evidence for pharmacological and non-pharmacological interventions in the management of delirium in palliative care. However, multiple delirium guidelines for clinical practice have been developed, with recommendations derived from “expert opinion” for areas where research evidence is lacking. In addition to their potential benefits, limitations of clinical guidelines warrant consideration. Guidelines should be appraised and then adapted for use in a particular setting before implementation. Further research is needed on the evaluation of guidelines, as disseminated and implemented in a clinical setting, focusing on measurable outcomes in addition to their impact on quality of care. Conclusion Delirium clinical guidelines are available but the level of evidence is limited. More robust evidence is required for future guideline development. PMID:24766743

Biosecurity measures for backyard poultry in developing countries: a systematic review

PubMed Central

2012-01-01

Background Poultry represents an important sector in animal production, with backyard flocks representing a huge majority, especially in the developing countries. In these countries, villagers raise poultry to meet household food demands and as additional sources of incomes. Backyard production methods imply low biosecurity measures and high risk of infectious diseases, such as Newcastle disease or zoonosis such as Highly Pathogenic Avian Influenza (HPAI). We reviewed literature on biosecurity practices for prevention of infectious diseases, and published recommendations for backyard poultry and assessed evidence of their impact and feasibility, particularly in developing countries. Documents were sourced from the Food and Agriculture Organization (FAO) website, and from Pubmed and Google databases. Results A total of 62 peer-reviewed and non-referred documents were found, most of which were published recently (after 2004) and focused on HPAI/H5N1-related biosecurity measures (64%). Recommendations addressed measures for flock management, feed and water management, poultry trade and stock change, poultry health management and the risk to humans. Only one general guideline was found for backyard poultry-related biosecurity; the other documents were drawn up for specific developing settings and only engaged their authors (e.g. consultants). These national guidelines written by consultants generated recommendations regarding measures derived from the highest standards of commercial poultry production. Although biosecurity principles of isolation and containment are described in most documents, only a few documents were found on the impact of measures in family poultry settings and none gave any evidence of their feasibility and effectiveness for backyard poultry. Conclusions Given the persistent threat posed by HPAI/H5N1 to humans in developing countries, our findings highlight the importance of encouraging applied research toward identifying sustained and adapted biosecurity measures for smallholder poultry flocks in low-income countries. PMID:23216706

Which Triple Aim related measures are being used to evaluate population management initiatives? An international comparative analysis.

PubMed

Hendrikx, Roy J P; Drewes, Hanneke W; Spreeuwenberg, Marieke; Ruwaard, Dirk; Struijs, Jeroen N; Baan, Caroline A

2016-05-01

Population management (PM) initiatives are introduced in order to create sustainable health care systems. These initiatives should focus on the continuum of health and well-being of a population by introducing interventions that integrate various services. To be successful they should pursue the Triple Aim, i.e. simultaneously improve population health and quality of care while reducing costs per capita. This study explores how PM initiatives measure the Triple Aim in practice. An exploratory search was combined with expert consultations to identify relevant PM initiatives. These were analyzed based on general characteristics, utilized measures and related selection criteria. In total 865 measures were used by 20 PM initiatives. All quality of care domains were included by at least 11 PM initiatives, while most domains of population health and costs were included by less than 7 PM initiatives. Although their goals showed substantial overlap, the measures applied showed few similarities between PM initiatives and were predominantly selected based on local priority areas and data availability. Most PM initiatives do not measure the full scope of the Triple Aim. Additionally, variety between measures limits comparability between PM initiatives. Consensus on the coverage of Triple Aim domains and a set of standardized measures could further both the inclusion of the various domains as well as the comparability between PM initiatives. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Recommendations for Laboratory Containment and Management of Gene Drive Systems in Arthropods.

PubMed

Benedict, Mark Q; Burt, Austin; Capurro, Margareth L; De Barro, Paul; Handler, Alfred M; Hayes, Keith R; Marshall, John M; Tabachnick, Walter J; Adelman, Zach N

2018-01-01

Versatile molecular tools for creating driving transgenes and other invasive genetic factors present regulatory, ethical, and environmental challenges that should be addressed to ensure their safe use. In this article, we discuss driving transgenes and invasive genetic factors that can potentially spread after their introduction into a small proportion of individuals in a population. The potential of invasive genetic factors to increase their number in natural populations presents challenges that require additional safety measures not provided by previous recommendations regarding accidental release of arthropods. In addition to providing physical containment, invasive genetic factors require greater attention to strain management, including their distribution and identity confirmation. In this study, we focus on insects containing such factors with recommendations for investigators who are creating them, institutional biosafety committees charged with ensuring safety, funding agencies providing support, those managing insectaries handling these materials who are responsible for containment, and other persons who will be receiving insects-transgenic or not-from these facilities. We give specific examples of efforts to modify mosquitoes for mosquito-borne disease control, but similar considerations are relevant to other arthropods that are important to human health, the environment, and agriculture.

Recommendations for Laboratory Containment and Management of Gene Drive Systems in Arthropods

PubMed Central

Burt, Austin; Capurro, Margareth L.; De Barro, Paul; Handler, Alfred M.; Hayes, Keith R.; Marshall, John M.; Tabachnick, Walter J.; Adelman, Zach N.

2018-01-01

Abstract Versatile molecular tools for creating driving transgenes and other invasive genetic factors present regulatory, ethical, and environmental challenges that should be addressed to ensure their safe use. In this article, we discuss driving transgenes and invasive genetic factors that can potentially spread after their introduction into a small proportion of individuals in a population. The potential of invasive genetic factors to increase their number in natural populations presents challenges that require additional safety measures not provided by previous recommendations regarding accidental release of arthropods. In addition to providing physical containment, invasive genetic factors require greater attention to strain management, including their distribution and identity confirmation. In this study, we focus on insects containing such factors with recommendations for investigators who are creating them, institutional biosafety committees charged with ensuring safety, funding agencies providing support, those managing insectaries handling these materials who are responsible for containment, and other persons who will be receiving insects—transgenic or not—from these facilities. We give specific examples of efforts to modify mosquitoes for mosquito-borne disease control, but similar considerations are relevant to other arthropods that are important to human health, the environment, and agriculture. PMID:29040058

The effectiveness of weight management interventions in breastfeeding women--a systematic review and critical evaluation.

PubMed

Neville, Charlotte E; McKinley, Michelle C; Holmes, Valerie A; Spence, Dale; Woodside, Jayne V

2014-09-01

The postpartum period is a vulnerable time for excess weight retention, particularly for the increasing number of women who are overweight at the start of their pregnancy and subsequently find it difficult to lose additional weight gained during pregnancy. Although postpartum weight management interventions play an important role in breaking this potentially vicious cycle of weight gain, the effectiveness of such interventions in breastfeeding women remains unclear. Our aim was to systematically review the literature about the effectiveness of weight management interventions in breastfeeding women. Seven electronic databases were searched for eligible papers. Intervention studies included were carried out exclusively in breastfeeding mothers, ≤2 years postpartum and with a body mass index greater than 18.5 kg/m(2) , with an outcome measure of change in weight and/or body composition. Six studies met the selection criteria, and were stratified according to the type of intervention and outcome measures. Despite considerable heterogeneity among studies, the dietary-based intervention studies appeared to be the most efficacious in promoting weight loss; however, few studies were tailored toward the needs of breastfeeding women. Weight management interventions which include an energy-restricted diet may play a key role in successful postpartum weight loss for breastfeeding mothers. © 2014 Wiley Periodicals, Inc.

The use of an Energy Monitor in the management of diabetes: a pilot study.

PubMed

Voon, Rudi; Celler, Branko G; Lovell, Nigel H

2009-02-01

This study evaluated the use of an accelerometer-based device in helping to manage blood glucose levels (BGLs) in people with diabetes mellitus. Five people with diabetes were given a triaxial accelerometer-based device (Energy Monitor) that measured energy levels associated with activities of daily living. For 3 months, they were required to wear the device and to continue with their usual diabetes therapy. The body mass index (BMI) and glycosylated hemoglobin (HbA(1c)) were recorded to assess any potential improvement in blood glucose control. The relationship between BGL and measured energy level was also investigated. Overall, there was a significant reduction of HbA(1c) from 7.48 +/- 1.21% to 6.98 +/- 1.44% (P < 0.05). There was no significant change in BMI. It was also found that higher energy levels resulted in much lower fluctuations in BGL change between meals compared to low energy levels. Moreover, the weekly mean activity score showed an increase in activity levels from the second week to the final week. This pilot study demonstrated that the Energy Monitor could improve the management of diabetes by allowing people with diabetes to view and manage daily physical activity in addition to their usual diabetes therapy.

Making it fit: Associations of line managers' behaviours with the outcomes of an organizational-level intervention.

PubMed

Lundmark, Robert; von Thiele Schwarz, Ulrica; Hasson, Henna; Stenling, Andreas; Tafvelin, Susanne

2018-02-01

Line managers' behaviours are important during implementation of occupational health interventions. Still, little is known about how these behaviours are related to intervention outcomes. This study explored the relationship between line managers' intervention-specific transformational leadership (IsTL), intervention fit (the match between the intervention, persons involved, and the surrounding environment), and change in intrinsic motivation and vigour. Both direct and indirect relationships between IsTL and change in intrinsic motivation and vigour were tested. Ninety employees participating in an organizational-level occupational health intervention provided questionnaire ratings at baseline and after 6 months. The results showed IsTL to be related to intervention fit and intervention fit to be related to intrinsic motivation. Using intervention fit as a mediator, the total effects (direct and indirect combined) of IsTL on change in intrinsic motivation and vigour were significant. In addition, IsTL had a specific indirect effect on intrinsic motivation. This study is the first to use IsTL as a measure line managers' behaviours. It is also the first to empirically evaluate the association between intervention fit and intervention outcomes. By including these measures in evaluations of organizational-level occupational health interventions, we can provide more informative answers as to what can make interventions successful. Copyright © 2017 John Wiley & Sons, Ltd.

Management of the Critically Ill Marrow Transplant Patient

DTIC Science & Technology

1988-01-01

dose-limiting factor diation (TBI) on serum amylase. Total serum amylase (21, 81). In addition, in allogeneic (non-self) was measured on 30 patients...refractory lo other Iherapy. By Polyclonal immune serum globulin (ISC) or nature of the production process, however. antilymphocyte immuioglobulin (ALG) anti...8217 .tients by giving CMV-negative blood products struction of lymphocytes. In severe cases, hy- and by avoiding the use of CMV-positive mar- potension

Battle Management/Command and Control, and Communications (BM/C3), Environmental Assessment

DTIC Science & Technology

1987-08-01

Highway 94 outside the base (39). This addition can be mitigated through the use of van pools and other conservation measures. 3-4 Water Quality All...Facility Description Miller, Jim MS Earth Resources Reviewer Milliken, Larry BS Earth Resources Project Description Morelan, Edward A. MS Earth...1987. Telephone conversation with Edward A. Morelan. 11. Dennary, Andy, Civil Engineering Department, Peterson Air Force Base, Colorado. 21 May 1987

MDMA induced hyperthermia: a survivor with an initial body temperature of 42.9 degrees C.

PubMed Central

Mallick, A; Bodenham, A R

1997-01-01

A young male survived hyperpyrexia (42.9 degrees C) following MDMA ("Ecstasy") ingestion. He developed convulsions, rhabdomyolysis, metabolic acidosis, and respiratory failure. This was successfully managed by assisted ventilation, aggressive fluid therapy, and the early administration of dantrolene, in addition to cooling measures. This is the first report of a survivor with such a severe hyperpyrexia. Images Figure 1 PMID:9315942

Locus of Control, Risk Orientation, and Decision Making Among U.S. Army Aviators

DTIC Science & Technology

2009-09-01

accident groups. These two items assessed the perceived impact of Professionalism and Crew Management Skills on the outcome of the scenario. Overall...could potentially make an impact on safety. In addition to a simple conversion of existing civil scales to a military context, an innovative...invulnerable). Although the validity of the measurement instrument was not established, the documents nevertheless served to stir interest in the impact

Patient self-management and pharmacist-led patient self-management in Hong Kong: A focus group study from different healthcare professionals' perspectives

PubMed Central

2011-01-01

Background Patient self-management is a key approach to manage non-communicable diseases. A pharmacist-led approach in patient self-management means collaborative care between pharmacists and patients. However, the development of both patient self-management and role of pharmacists is limited in Hong Kong. The objectives of this study are to understand the perspectives of physicians, pharmacists, traditional Chinese medicine (TCM) practitioners, and dispensers on self-management of patients with chronic conditions, in addition to exploring the possibilities of developing pharmacist-led patient self-management in Hong Kong. Methods Participants were invited through the University as well as professional networks. Fifty-one participants comprised of physicians, pharmacists, TCM practitioners and dispensers participated in homogenous focus group discussions. Perspectives in patient self-management and pharmacist-led patient self-management were discussed. The discussions were audio recorded, transcribed and analysed accordingly. Results The majority of the participants were in support of patients with stable chronic diseases engaging in self-management. Medication compliance, monitoring of disease parameters and complications, lifestyle modification and identifying situations to seek help from health professionals were generally agreed to be covered in patient self-management. All pharmacists believed that they had extended roles in addition to drug management but the other three professionals believed that pharmacists were drug experts only and could only play an assisting role. Physicians, TCM practitioners, and dispensers were concerned that pharmacist-led patient self-management could be hindered, due to unfamiliarity with the pharmacy profession, the perception of insufficient training in disease management, and lack of trust of patients. Conclusions An effective chronic disease management model should involve patients in stable condition to participate in self-management in order to prevent health deterioration and to save healthcare costs. The role of pharmacists should not be limited to drugs and should be extended in the primary healthcare system. Pharmacist-led patient self-management could be developed gradually with the support of government by enhancing pharmacists' responsibilities in health services and developing public-private partnership with community pharmacists. Developing facilitating measures to enhance the implementation of the pharmacist-led approach should also be considered, such as allowing pharmacists to access electronic health records, as well as deregulation of more prescription-only medicines to pharmacy-only medicines. PMID:21609422

Patient self-management and pharmacist-led patient self-management in Hong Kong: a focus group study from different healthcare professionals' perspectives.

PubMed

Wong, Fiona Y Y; Chan, Frank W K; You, Joyce H S; Wong, Eliza L Y; Yeoh, E K

2011-05-24

Patient self-management is a key approach to manage non-communicable diseases. A pharmacist-led approach in patient self-management means collaborative care between pharmacists and patients. However, the development of both patient self-management and role of pharmacists is limited in Hong Kong. The objectives of this study are to understand the perspectives of physicians, pharmacists, traditional Chinese medicine (TCM) practitioners, and dispensers on self-management of patients with chronic conditions, in addition to exploring the possibilities of developing pharmacist-led patient self-management in Hong Kong. Participants were invited through the University as well as professional networks. Fifty-one participants comprised of physicians, pharmacists, TCM practitioners and dispensers participated in homogenous focus group discussions. Perspectives in patient self-management and pharmacist-led patient self-management were discussed. The discussions were audio recorded, transcribed and analysed accordingly. The majority of the participants were in support of patients with stable chronic diseases engaging in self-management. Medication compliance, monitoring of disease parameters and complications, lifestyle modification and identifying situations to seek help from health professionals were generally agreed to be covered in patient self-management. All pharmacists believed that they had extended roles in addition to drug management but the other three professionals believed that pharmacists were drug experts only and could only play an assisting role. Physicians, TCM practitioners, and dispensers were concerned that pharmacist-led patient self-management could be hindered, due to unfamiliarity with the pharmacy profession, the perception of insufficient training in disease management, and lack of trust of patients. An effective chronic disease management model should involve patients in stable condition to participate in self-management in order to prevent health deterioration and to save healthcare costs. The role of pharmacists should not be limited to drugs and should be extended in the primary healthcare system. Pharmacist-led patient self-management could be developed gradually with the support of government by enhancing pharmacists' responsibilities in health services and developing public-private partnership with community pharmacists. Developing facilitating measures to enhance the implementation of the pharmacist-led approach should also be considered, such as allowing pharmacists to access electronic health records, as well as deregulation of more prescription-only medicines to pharmacy-only medicines.

Thermophysical properties of LiCoO₂-LiMn₂O₄ blended electrode materials for Li-ion batteries.

PubMed

Gotcu, Petronela; Seifert, Hans J

2016-04-21

Thermophysical properties of two cathode types for lithium-ion batteries were measured by dependence on temperature. The cathode materials are commercial composite thick films containing LiCoO2 and LiMn2O4 blended active materials, mixed with additives (binder and carbon black) deposited on aluminium current collector foils. The thermal diffusivities of the cathode samples were measured by laser flash analysis up to 673 K. The specific heat data was determined based on measured composite specific heat, aluminium specific heat data and their corresponding measured mass fractions. The composite specific heat data was measured using two differential scanning calorimeters over the temperature range from 298 to 573 K. For a comprehensive understanding of the blended composite thermal behaviour, measurements of the heat capacity of an additional LiMn2O4 sample were performed, and are the first experimental data up to 700 K. Thermal conductivity of each cathode type and their corresponding blended composite layers were estimated from the measured thermal diffusivity, the specific heat capacity and the estimated density based on metallographic methods and structural investigations. Such data are highly relevant for simulation studies of thermal management and thermal runaway in lithium-ion batteries, in which the bulk properties are assumed, as a common approach, to be temperature independent.

Beyond Reading Alone: The Relationship Between Aural Literacy And Asthma Management

PubMed Central

Rosenfeld, Lindsay; Rudd, Rima; Emmons, Karen M.; Acevedo-García, Dolores; Martin, Laurie; Buka, Stephen

2010-01-01

Objectives To examine the relationship between literacy and asthma management with a focus on the oral exchange. Methods Study participants, all of whom reported asthma, were drawn from the New England Family Study (NEFS), an examination of links between education and health. NEFS data included reading, oral (speaking), and aural (listening) literacy measures. An additional survey was conducted with this group of study participants related to asthma issues, particularly asthma management. Data analysis focused on bivariate and multivariable logistic regression. Results In bivariate logistic regression models exploring aural literacy, there was a statistically significant association between those participants with lower aural literacy skills and less successful asthma management (OR:4.37, 95%CI:1.11, 17.32). In multivariable logistic regression analyses, controlling for gender, income, and race in separate models (one-at-a-time), there remained a statistically significant association between those participants with lower aural literacy skills and less successful asthma management. Conclusion Lower aural literacy skills seem to complicate asthma management capabilities. Practice Implications Greater attention to the oral exchange, in particular the listening skills highlighted by aural literacy, as well as other related literacy skills may help us develop strategies for clear communication related to asthma management. PMID:20399060

Self-efficacy and overprotection are related to quality of life, psychological well-being and self-management in cardiac patients.

PubMed

Joekes, Katherine; Van Elderen, Thérèse; Schreurs, Karlein

2007-01-01

This repeated-measures study explores how self-efficacy and overprotection relate to psychological well-being, health-related quality of life and self-management. Eighty-two cardiac patients, suffering from congestive heart failure (CHF) or myocardial infarction (MI), completed questionnaires at T1 and three months later. Perceived overprotection is associated with concurrent levels of anxiety and depression, and lowered quality of life. Self-efficacy is related to psychological well-being in both patient groups, but only associated with quality of life in CHF patients. In addition, self-efficacy predicts MI patients' self-management behaviours in the medium term. Findings have implications for cardiac rehabilitation, where attention may usefully be focused on enhancing self-efficacy and dealing with issues of support and overprotection by the partner.

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

Belford proactive flood solutions: scientific evidence to influence local and national policy by multi-purpose runoff management

NASA Astrophysics Data System (ADS)

Wilkinson, M.; Quinn, P. F.; Jonczyk, J.

2010-12-01

The increased risk from flooding continues to be of concern to governments all around the world and flood protection is becoming more of a challenge. In the UK, climate change projections indicate more extremes within the weather systems. In addition, there is an increased demand for using land in urban areas beside channels. These developments both put pressure on our flood defences and there is a need for new solutions to managing flood risk. There is currently support within the England and Wales Environment Agency for sustainable flood management solutions such as storage ponds, wetlands, beaver dams and willow riparian features (referred to here as Runoff Attenuation Features, or RAFs). However the effectiveness of RAFs are not known at the catchment scale since they have only really been trailed at the plot scale. These types of mitigation measure can offer benefits to water quality and create ecological habitats. The village of Belford, situated in the Belford Burn catchment (6km2), northern England, has suffered from numerous flood events. In addition, the catchment suffers from water quality issues within the channel and high sediment loads are having an impact on the ecology of the nearby estuary. There was a desire by the Local Environment Agency Flood Levy team to deliver an alternative catchment-based solution to the problem. With funding from the Northumbria Regional Flood Defence Committee, the Environment Agency North East Local Levy team and Newcastle University have created a partnership to address the flood problem trailing soft engineered RAF’s at the catchment scale. The partnership project, “Belford proactive flood solutions” is testing novel techniques in reducing flood risk in small sub-catchments for the Environment Agency. The project provides the information needed to understand whether the multi-functional mitigation measures are working at the sub-catchment scale. Data suggest that the mitigation measures present have delayed the overall travel time of the flood peak in the catchment by 33%. The current maximum flood storage capacity of all the features stands at around 15,000 m3. The evidence also suggests that a dam like in-stream mitigation measure can significantly reduce sediment load. Other benefits of some mitigation features include large increase in the population of water voles over the past two years. The scheme also acts as a demonstration site for interested stakeholders where they can learn about this approach to flood risk management and see the multipurpose benefits. As the project has progressed and lessons have been learnt, it has been possible to develop a runoff management toolkit for implementing these mitigation measures in other catchments of similar size. Already, the local Environment Agency has utilised the tools and recently applied similar mitigation measures to other catchments. On-going modelling exercises in the project are using the data to explore the up-scaling of the features to larger catchments.

Performance of residents and anesthesiologists in a simulation-based skill assessment.

PubMed

Murray, David J; Boulet, John R; Avidan, Michael; Kras, Joseph F; Henrichs, Bernadette; Woodhouse, Julie; Evers, Alex S

2007-11-01

Anesthesiologists and anesthesia residents are expected to acquire and maintain skills to manage a wide range of acute intraoperative anesthetic events. The purpose of this study was to determine whether an inventory of simulated intraoperative scenarios provided a reliable and valid measure of anesthesia residents' and anesthesiologists' skill. Twelve simulated acute intraoperative scenarios were designed to assess the performance of 64 residents and 35 anesthesiologists. The participants were divided into four groups based on their training and experience. There were 31 new CA-1, 12 advanced CA-1, and 22 CA-2/CA-3 residents as well as a group of 35 experienced anesthesiologists who participated in the assessment. Each participant managed a set of simulated events. The advanced CA-1 residents, CA-2/CA-3 residents, and 35 anesthesiologists managed 8 of 12 intraoperative simulation exercises. The 31 CA-1 residents each managed 3 intraoperative scenarios. The new CA-1 residents received lower scores on the simulated intraoperative events than the other groups of participants. The advanced CA-1 residents, CA-2/CA-3 residents, and anesthesiologists performed similarly on the overall assessment. There was a wide range of scores obtained by individuals in each group. A number of the exercises were difficult for the majority of participants to recognize and treat, but most events effectively discriminated among participants who achieved higher and lower overall scores. This simulation-based assessment provided a valid method to distinguish the skills of more experienced anesthesia residents and anesthesiologists from residents in early training. The overall score provided a reliable measure of a participant's ability to recognize and manage simulated acute intraoperative events. Additional studies are needed to determine whether these simulation-based assessments are valid measures of clinical performance.

The effects of Crew Resource Mangement (CRM) training in airline maintenance: Results following three years' experience

NASA Technical Reports Server (NTRS)

Taylor, J. C.; Robertson, M. M.

1995-01-01

This report describes three years' evaluation of the effects of one airline's Crew Resources Management (CRM) training operation for maintenance. This evaluation focuses on the post-training attitudes of maintenance managers' and technical support professionals, their reported behaviors, and the safety, efficiency and dependable maintenance performance of their units. The results reveal a strong positive effect of the training. The overall program represents the use of CRM training as a long-term commitment to improving performance through effective communication at all levels in airline maintenance operations. The initial findings described in our previous progress reports are reinforced and elaborated here. The current results benefit from the entire pre-post training survey, which now represents total attendance of all managers and staff professionals. Additionally there are now full results from the two-month, six-month, and 12-month follow-up questionnaires, together with as many as 33 months of post-training performance data, using several indicators. In this present report, we examine participants' attitudes, their reported behaviors following the training, the performance of their work units, and the relationships among these variables. Attitudes include those measured immediately before and after the training as well as participants' attitudes months after their training. Performance includes measures, by work units, of on-time flight departures, on-schedule maintenance releases, occupational and aircraft safety, and efficient labor costs. We report changes in these performance measures following training, as well their relationships with the training participants' attitudes. Highlights of results from this training program include increased safety and improved costs associated with positive attitudes about the use of more assertive communication, and the improved management of stress. Improved on-time performance is also related to those improved attitudes, as well as favorable attitudes about participative management.

13 CFR 124.704 - What additional management and technical assistance is reserved exclusively for concerns eligible...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false What additional management and.../SMALL DISADVANTAGED BUSINESS STATUS DETERMINATIONS 8(a) Business Development Management and Technical... management and technical assistance through its service providers exclusively to small business concerns...

77 FR 50523 - Texas Mid-Coast National Wildlife Refuge Complex, Brazoria, Fort Bend, Matagorda, and Wharton...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-21

... principles of fish and wildlife management, conservation, legal mandates, and our policies. In addition to outlining broad management direction on conserving wildlife and their habitats, CCPs identify wildlife... past management, future management, and issues common to both agencies. Additional public scoping for...

36 CFR 1236.22 - What are the additional requirements for managing electronic mail records?

Code of Federal Regulations, 2012 CFR

2012-07-01

... requirements for managing electronic mail records? 1236.22 Section 1236.22 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional... accordance with the provisions of GRS 23, Item 5. (5) Draft documents that are circulated on electronic mail...

36 CFR 1236.22 - What are the additional requirements for managing electronic mail records?

Code of Federal Regulations, 2014 CFR

2014-07-01

... requirements for managing electronic mail records? 1236.22 Section 1236.22 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional... accordance with the provisions of GRS 23, Item 5. (5) Draft documents that are circulated on electronic mail...

36 CFR 1236.22 - What are the additional requirements for managing electronic mail records?

Code of Federal Regulations, 2010 CFR

2010-07-01

... requirements for managing electronic mail records? 1236.22 Section 1236.22 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional... accordance with the provisions of GRS 23, Item 5. (5) Draft documents that are circulated on electronic mail...

36 CFR 1236.22 - What are the additional requirements for managing electronic mail records?

Code of Federal Regulations, 2011 CFR

2011-07-01

... requirements for managing electronic mail records? 1236.22 Section 1236.22 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional... accordance with the provisions of GRS 23, Item 5. (5) Draft documents that are circulated on electronic mail...

International-Aerial Measuring System (I-AMS) Training Program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wasiolek, Piotre T.; Malchor, Russell L.; Maurer, Richard J.

2015-10-01

Since the Fukushima reactor accident in 2011, there has been an increased interest worldwide in developing national capabilities to rapidly map and assess ground contamination resulting from nuclear reactor accidents. The capability to rapidly measure the size of the contaminated area, determine the activity level, and identify the radionuclides can aid emergency managers and decision makers in providing timely protective action recommendations to the public and first responders. The development of an aerial detection capability requires interagency coordination to assemble the radiation experts, detection system operators, and aviation aircrews to conduct the aerial measurements, analyze and interpret the data, andmore » provide technical assessments. The Office of International Emergency Management and Cooperation (IEMC) at the U.S. Department of Energy, National Nuclear Security Administration (DOE/NNSA) sponsors an International - Aerial Measuring System (I-AMS) training program for partner nations to develop and enhance their response to radiological emergencies. An initial series of courses can be conducted in the host country to assist in developing an aerial detection capability. As the capability develops and expands, additional experience can be gained through advanced courses with the opportunity to conduct aerial missions over a broad range of radiation environments.« less

Measuring and modeling the temporal dynamics of nitrogen balance in an experimental-scale paddy field

NASA Astrophysics Data System (ADS)

Tseng, C.; Lin, Y.

2013-12-01

Nitrogen balance involves many mechanisms and plays an important role to maintain the function of nature. Fertilizer application in agriculture activity is usually seen as a common and significant nitrogen input to environment. Improper fertilizer application on paddy field can result in great amount of various types of nitrogen losses. Hence, it is essential to understand and quantify the nitrogen dynamics in paddy field for fertilizer management and pollution control. In this study, we develop a model which considers major transformation processes of nitrogen (e.g. volatilization, nitrification, denitrification and plant uptake). In addition, we measured different types of nitrogen in plants, soil and water at plant growth stages in an experimental-scale paddy field in Taiwan. The measurement includes total nitrogen in plants and soil, and ammonium-N (NH4+-N), nitrate-N (NO3--N) and organic nitrogen in water. The measured data were used to calibrate the model parameters and validate the model for nitrogen balance simulation. The results showed that the model can accurately estimate the temporal dynamics of nitrogen balance in paddy field during the whole growth stage. This model might be helpful and useful for future fertilizer management and pollution control in paddy field.

Association between quality management and performance indicators in Dutch diabetes care groups: a cross-sectional study.

PubMed

Campmans-Kuijpers, Marjo J E; Baan, Caroline A; Lemmens, Lidwien C; Klomp, Maarten L H; Romeijnders, Arnold C M; Rutten, Guy E H M

2015-05-11

To enhance the quality of diabetes care in the Netherlands, so-called care groups with three to 250 general practitioners emerged to organise and coordinate diabetes care. This introduced a new quality management level in addition to the quality management of separate general practices. We hypothesised that this new level of quality management might be associated with the aggregate performance indicators on the patient level. Therefore, we aimed to explore the association between quality management at the care group level and its aggregate performance indicators. A cross-sectional study. All Dutch care groups (n=97). 23 care groups provided aggregate register-based performance indicators of all their practices as well as data on quality management measured with a questionnaire filled out by 1 or 2 of their quality managers. The association between quality management, overall and in 6 domains ('organisation of care', 'multidisciplinary teamwork', 'patient centredness', 'performance management', 'quality improvement policy' and 'management strategies') on the one hand and 3 process indicators (the percentages of patients with at least 1 measurement of glycated haemoglobin, lipid profile and systolic blood pressure), and 3 intermediate outcome indicators (the percentages of patients with glycated haemoglobin below 53 mmol/mol (7%); low-density lipoprotein cholesterol below 2.5 mmol/L; and systolic blood pressure below 140 mm Hg) by weighted univariable linear regression. The domain 'management strategies' was significantly associated with the percentage of patients with a glycated haemoglobin <53 mmol/mol (β 0.28 (0.09; 0.46) p=0.01) after correction for multiple testing. The other domains as well as overall quality management were not associated with aggregate process or outcome indicators. This first exploratory study on quality management showed weak or no associations between quality management of diabetes care groups and their performance. It remains uncertain whether this second layer on quality management adds to better quality of care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

77 FR 56669 - Proposed Flood Hazard Determinations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-13

...Comments are requested on proposed flood hazard determinations, which may include additions or modifications of any Base Flood Elevation (BFE), base flood depth, Special Flood Hazard Area (SFHA) boundary or zone designation, or regulatory floodway on the Flood Insurance Rate Maps (FIRMs), and where applicable, in the supporting Flood Insurance Study (FIS) reports for the communities listed in the table below. The purpose of this notice is to seek general information and comment regarding the preliminary FIRM, and where applicable, the FIS report that the Federal Emergency Management Agency (FEMA) has provided to the affected communities. The FIRM and FIS report are the basis of the floodplain management measures that the community is required either to adopt or to show evidence of having in effect in order to qualify or remain qualified for participation in the National Flood Insurance Program (NFIP). In addition, the FIRM and FIS report, once effective, will be used by insurance agents and others to calculate appropriate flood insurance premium rates for new buildings and the contents of those buildings.

Advancing current approaches to disease management evaluation: capitalizing on heterogeneity to understand what works and for whom

PubMed Central

2013-01-01

Background Evaluating large-scale disease management interventions implemented in actual health care settings is a complex undertaking for which universally accepted methods do not exist. Fundamental issues, such as a lack of control patients and limited generalizability, hamper the use of the ‘gold-standard’ randomized controlled trial, while methodological shortcomings restrict the value of observational designs. Advancing methods for disease management evaluation in practice is pivotal to learn more about the impact of population-wide approaches. Methods must account for the presence of heterogeneity in effects, which necessitates a more granular assessment of outcomes. Methods This paper introduces multilevel regression methods as valuable techniques to evaluate ‘real-world’ disease management approaches in a manner that produces meaningful findings for everyday practice. In a worked example, these methods are applied to retrospectively gathered routine health care data covering a cohort of 105,056 diabetes patients who receive disease management for type 2 diabetes mellitus in the Netherlands. Multivariable, multilevel regression models are fitted to identify trends in clinical outcomes and correct for differences in characteristics of patients (age, disease duration, health status, diabetes complications, smoking status) and the intervention (measurement frequency and range, length of follow-up). Results After a median one year follow-up, the Dutch disease management approach was associated with small average improvements in systolic blood pressure and low-density lipoprotein, while a slight deterioration occurred in glycated hemoglobin. Differential findings suggest that patients with poorly controlled diabetes tend to benefit most from disease management in terms of improved clinical measures. Additionally, a greater measurement frequency was associated with better outcomes, while longer length of follow-up was accompanied by less positive results. Conclusions Despite concerted efforts to adjust for potential sources of confounding and bias, there ultimately are limits to the validity and reliability of findings from uncontrolled research based on routine intervention data. While our findings are supported by previous randomized research in other settings, the trends in outcome measures presented here may have alternative explanations. Further practice-based research, perhaps using historical data to retrospectively construct a control group, is necessary to confirm results and learn more about the impact of population-wide disease management. PMID:23497125

Costs and possible benefits of a two-tier infection control management strategy consisting of active screening for multidrug-resistant organisms and tailored control measures.

PubMed

Mutters, N T; Günther, F; Frank, U; Mischnik, A

2016-06-01

Multidrug-resistant organisms (MDROs) are an economic burden, and infection control (IC) measures are cost- and labour-intensive. A two-tier IC management strategy was developed, including active screening, in order to achieve effective use of limited resources. Briefly, high-risk patients were differentiated from other patients, distinguished according to type of MDRO, and IC measures were implemented accordingly. To evaluate costs and benefits of this IC management strategy. The study period comprised 2.5 years. All high-risk patients underwent microbiological screening. Gram-negative bacteria (GNB) were classified as multidrug-resistant (MDR) and extensively drug-resistant (XDR). Expenses consisted of costs for staff, materials, laboratory, increased workload and occupational costs. In total, 39,551 patients were screened, accounting for 24.5% of all admissions. Of all screened patients, 7.8% (N=3,104) were MDRO positive; these patients were mainly colonized with vancomycin-resistant enterococci (37.3%), followed by meticillin-resistant Staphylococcus aureus (30.3%) and MDR-GNB (28.3%). The median length of stay (LOS) for all patients was 10 days (interquartile range 3-20); LOS was twice as long in colonized patients (P<0.001). Screening costs totalled 255,093.82€, IC measures cost 97,701.36€, and opportunity costs were 599,225.52€. The savings of this IC management strategy totalled 500,941.84€. Possible transmissions by undetected carriers would have caused additional costs of 613,648.90-4,974,939.26€ (i.e. approximately 600,000-5 million €). Although the costs of a two-tier IC management strategy including active microbiological screening are not trivial, these data indicate that the approach is cost-effective when prevented transmissions are included in the cost estimate. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

The additive value of N-terminal pro-B-type natriuretic peptide testing at the emergency department in patients with acute dyspnoea.

PubMed

van der Burg-de Graauw, N; Cobbaert, C M; Middelhoff, C J F M; Bantje, T A; van Guldener, C

2009-05-01

B-type natriuretic peptide (BNP) and its inactive counterpart NT-proBNP can help to identify or rule out heart failure in patients presenting with acute dyspnoea. It is not well known whether measurement of these peptides can be omitted in certain patient groups. We conducted a prospective observational study of 221 patients presenting with acute dyspnoea at the emergency department. The attending physicians estimated the probability of heart failure by clinical judgement. NT-proBNP was measured, but not reported. An independent panel made a final diagnosis of all available data including NT-proBNP level and judged whether and how NT-proBNP would have altered patient management. NT-proBNP levels were highest in patients with heart failure, alone or in combination with pulmonary failure. Additive value of NT-proBNP was present in 40 of 221 (18%) of the patients, and it mostly indicated that a more intensive treatment for heart failure would have been needed. Clinical judgement was an independent predictor of additive value of NT-proBNP with a maximum at a clinical probability of heart failure of 36%. NT-proBNP measurement has additive value in a substantial number of patients presenting with acute dyspnoea, but can possibly be omitted in patients with a clinical probability of heart failure of >70%.

Carbon Content of Managed Grasslands Under Mediterranean Climate and Implications for Carbon Sequestration

NASA Astrophysics Data System (ADS)

Owen, J. J.; Silver, W. L.

2012-12-01

Grasslands cover approximately 25% of the terrestrial land surface and typically have considerable carbon (C) storage potential in soils. Human activities have the potential to release or increase C stored in grassland soils. In California, where half the land area is comprised of grasslands, soil C content spans almost an order of magnitude and is not well correlated with climate. The role of management practices in these patterns has not been previously explored. We measured soil C pools and soil physical characteristics at 10 grazed grassland sites in Marin and Sonoma counties in California. At each site, 2 to 3 fields with similar soil units but under different management practices (including manure amendment, tilling, irrigation, and seeding) were sampled at intervals to 50 cm-depth. Soil C varied by a factor of 2 and manure additions tended to increase soil C content by 3 to 15%. Manure additions did not always increase soil C, however. Grazed but otherwise undisturbed conservation land at one site had higher soil C than the adjacent manured fields. This was likely due to the presence of tall grasses and scattered shrubs on the conservation land versus the ryegrass, orchard grass, and clover seeded on the other fields. Variations were greater between sites than between fields at the same site. Soil C percentage decreased with depth but typically more than half of the total soil C content was located below 10-cm-depth, as observed elsewhere in California. We found that California grasslands perform an important ecosystem service by storing C in soil. Management through manure addition can increase that storage, the amount of which primarily depends on climate and soil texture.

The Bilirubin Albumin Ratio in the Management of Hyperbilirubinemia in Preterm Infants to Improve Neurodevelopmental Outcome: A Randomized Controlled Trial – BARTrial

PubMed Central

van Imhoff, Deirdre E.; Bos, Arend F.; Lopriore, Enrico; Offringa, Martin; Ruiter, Selma A. J.; van Braeckel, Koen N. J. A.; Krabbe, Paul F. M.; Quik, Elise H.; van Toledo-Eppinga, Letty; Nuytemans, Debbie H. G. M.; van Wassenaer-Leemhuis, Aleid G.; Benders, Manon J. N.; Korbeeck-van Hof, Karen K. M.; van Lingen, Richard A.; Groot Jebbink, Liesbeth J. M.; Liem, Djien; Mansvelt, Petri; Buijs, Jan; Govaert, Paul; van Vliet, Ineke; Mulder, Twan L. M.; Wolfs, Cecile; Fetter, Willem P. F.; Laarman, Celeste

2014-01-01

Background and Objective High bilirubin/albumin (B/A) ratios increase the risk of bilirubin neurotoxicity. The B/A ratio may be a valuable measure, in addition to the total serum bilirubin (TSB), in the management of hyperbilirubinemia. We aimed to assess whether the additional use of B/A ratios in the management of hyperbilirubinemia in preterm infants improved neurodevelopmental outcome. Methods In a prospective, randomized controlled trial, 615 preterm infants of 32 weeks' gestation or less were randomly assigned to treatment based on either B/A ratio and TSB thresholds (consensus-based), whichever threshold was crossed first, or on the TSB thresholds only. The primary outcome was neurodevelopment at 18 to 24 months' corrected age as assessed with the Bayley Scales of Infant Development III by investigators unaware of treatment allocation. Secondary outcomes included complications of preterm birth and death. Results Composite motor (100±13 vs. 101±12) and cognitive (101±12 vs. 101±11) scores did not differ between the B/A ratio and TSB groups. Demographic characteristics, maximal TSB levels, B/A ratios, and other secondary outcomes were similar. The rates of death and/or severe neurodevelopmental impairment for the B/A ratio versus TSB groups were 15.4% versus 15.5% (P = 1.0) and 2.8% versus 1.4% (P = 0.62) for birth weights ≤1000 g and 1.8% versus 5.8% (P = 0.03) and 4.1% versus 2.0% (P = 0.26) for birth weights of >1000 g. Conclusions The additional use of B/A ratio in the management of hyperbilirubinemia in preterm infants did not improve their neurodevelopmental outcome. Trial Registration Controlled-Trials.com ISRCTN74465643 PMID:24927259

Burnout syndrome and wellbeing in anesthesiologists: the importance of emotion regulation strategies.

PubMed

Lapa, Teresa A; Madeira, Filipa M; Viana, Joaquim S; Pinto-Gouveia, José

2017-02-01

Anesthesiologists face stressful working conditions that can culminate in burnout syndrome. Despite various studies and protective measures which have attempted to prevent this situation, burnout continues to be a problem within the profession, impacting negatively on physicians' lives and their performance. In this review article mechanisms and consequences of burnout are described in addition to individual strategies for stress management and burnout reduction with potential impact on health care quality and wellbeing in anesthesiologists. Organizational strategies appear to have an important role in burnout reduction but need to be used in conjunction with individual programs. The latter are essential to both reducing stress and burnout in anesthesiologists and improving happiness and wellbeing. New measures of emotion regulation strategies such as mindfulness, self-compassion, resilience and empathy promotion have been shown to be approaches with substantial supporting evidence for reducing burnout and improving stress management. The evaluation and implementation of these self-regulatory competencies is a challenge. Further research is necessary to identify which programs will best suit the needs of anesthesiologists and to measure their effects on patient care and health care system quality.

Correlation between safety climate and contractor safety assessment programs in construction

PubMed Central

Sparer, EH1; Murphy, LA; Taylor, KM; Dennerlein, Jt

2015-01-01

Background Contractor safety assessment programs (CSAPs) measure safety performance by integrating multiple data sources together; however, the relationship between these measures of safety performance and safety climate within the construction industry is unknown. Methods 401 construction workers employed by 68 companies on 26 sites and 11 safety managers employed by 11 companies completed brief surveys containing a nine-item safety climate scale developed for the construction industry. CSAP scores from ConstructSecure, Inc., an online CSAP database, classified these 68 companies as high or low scorers, with the median score of the sample population as the threshold. Spearman rank correlations evaluated the association between the CSAP score and the safety climate score at the individual level, as well as with various grouping methodologies. In addition, Spearman correlations evaluated the comparison between manager-assessed safety climate and worker-assessed safety climate. Results There were no statistically significant differences between safety climate scores reported by workers in the high and low CSAP groups. There were, at best, weak correlations between workers’ safety climate scores and the company CSAP scores, with marginal statistical significance with two groupings of the data. There were also no significant differences between the manager-assessed safety climate and the worker-assessed safety climate scores. Conclusions A CSAP safety performance score does not appear to capture safety climate, as measured in this study. The nature of safety climate in construction is complex, which may be reflective of the challenges in measuring safety climate within this industry. PMID:24038403

A multivariate analysis of biophysical parameters of tallgrass prairie among land management practices and years

USGS Publications Warehouse

Griffith, J.A.; Price, K.P.; Martinko, E.A.

2001-01-01

Six treatments of eastern Kansas tallgrass prairie - native prairie, hayed, mowed, grazed, burned and untreated - were studied to examine the biophysical effects of land management practices on grasslands. On each treatment, measurements of plant biomass, leaf area index, plant cover, leaf moisture and soil moisture were collected. In addition, measurements were taken of the Normalized Difference Vegetation Index (NDVI), which is derived from spectral reflectance measurements. Measurements were taken in mid-June, mid-July and late summer of 1990 and 1991. Multivariate analysis of variance was used to determine whether there were differences in the set of variables among treatments and years. Follow-up tests included univariate t-tests to determine which variables were contributing to any significant difference. Results showed a significant difference (p < 0.0005) among treatments in the composite of parameters during each of the months sampled. In most treatment types, there was a significant difference between years within each month. The univariate tests showed, however, that only some variables, primarily soil moisture, were contributing to this difference. We conclude that biomass and % plant cover show the best potential to serve as long-term indicators of grassland condition as they generally were sensitive to effects of different land management practices but not to yearly change in weather conditions. NDVI was insensitive to precipitation differences between years in July for most treatments, but was not in the native prairie. Choice of sampling time is important for these parameters to serve effectively as indicators.

Methods for evaluating riparian habitats with applications to management

USGS Publications Warehouse

Platts, William S.; Armour, C.L.; Booth, G.D.; Bryant, M.; Bufford, J.L.; Cuplin, P.; Jensen, S.; Lienkaemper, G.W.; Minshall, G.W.; Monsen, S.T.; Nelson, R.L.; Sedell, J.R.; Tuhy, J.S.

1987-01-01

Riparian area planning and management is a major national issues today--something that should have been the case a century ago. A century of additive effects of land use has resulted in major impacts on many riparian stream habitats and their fisheries, wildlife, and domestic livestock use. Before scientists can evaluate the influences of various land and water uses on riparian environments, they must first understand these environments. This means being able to detect and measure with confidence the natural and artificial variation and instantaneous conditions of the riparian habitat. These conditions must then be related to the production capability of riparian habitat and any extraneous factors affecting this production potential.

Lasers and ancillary treatments for scar management Part 2: Keloid, hypertrophic, pigmented and acne scars

PubMed Central

McGoldrick, Rory Boyd; Theodorakopoulou, Evgenia; Azzopardi, Ernest Anthony; Murison, Maxwell

2017-01-01

The formation of a wide range of excessive scars following various skin injuries is a natural consequence of healing. Scars resulting from surgery or trauma affect approximately 100 million people per annum in the developed world and can have profound physical, aesthetic, psychological and social consequences. Thus, scar treatment is a priority for patient and physician alike. Laser treatment plays an important role in scar management with additional support from ancillary modalities. Subsequent to part 1: Burns scars, part 2 focuses on our strategies and literature review of treatment of keloid, hypertrophic, pigmented and acne scars where lasers are used in conjunction with other measures, and illustrated with case studies. PMID:29799579

How employee engagement matters for hospital performance.

PubMed

Lowe, Graham

2012-01-01

Managers increasingly understand that employee engagement is a prerequisite for high performance. This article examines how job, work environment, management and organizational factors influence levels of engagement among healthcare employees. Original data come from the Ontario Hospital Association-NRC Picker Employee Experience Survey, involving over 10,000 employees in 16 Ontario hospitals. The article provides a clear definition and measure of engagement relevant to healthcare. In addition to identifying the main drivers of engagement, findings shows that a high level of employee engagement is related to retention, patient-centred care, patient safety culture and employees' positive assessments of the quality of care or services provided by their team. Implications of these findings for healthcare leaders are briefly considered.

Norovirus

PubMed Central

Robilotti, Elizabeth; Deresinski, Stan

2015-01-01

SUMMARY Norovirus, an RNA virus of the family Caliciviridae, is a human enteric pathogen that causes substantial morbidity across both health care and community settings. Several factors enhance the transmissibility of norovirus, including the small inoculum required to produce infection (<100 viral particles), prolonged viral shedding, and its ability to survive in the environment. In this review, we describe the basic virology and immunology of noroviruses, the clinical disease resulting from infection and its diagnosis and management, as well as host and pathogen factors that complicate vaccine development. Additionally, we discuss overall epidemiology, infection control strategies, and global reporting efforts aimed at controlling this worldwide cause of acute gastroenteritis. Prompt implementation of infection control measures remains the mainstay of norovirus outbreak management. PMID:25567225

Do managed bees have negative effects on wild bees?: A systematic review of the literature

PubMed Central

Gratton, Claudio

2017-01-01

Managed bees are critical for crop pollination worldwide. As the demand for pollinator-dependent crops increases, so does the use of managed bees. Concern has arisen that managed bees may have unintended negative impacts on native wild bees, which are important pollinators in both agricultural and natural ecosystems. The goal of this study was to synthesize the literature documenting the effects of managed honey bees and bumble bees on wild bees in three areas: (1) competition for floral and nesting resources, (2) indirect effects via changes in plant communities, including the spread of exotic plants and decline of native plants, and (3) transmission of pathogens. The majority of reviewed studies reported negative effects of managed bees, but trends differed across topical areas. Of studies examining competition, results were highly variable with 53% reporting negative effects on wild bees, while 28% reported no effects and 19% reported mixed effects (varying with the bee species or variables examined). Equal numbers of studies examining plant communities reported positive (36%) and negative (36%) effects, with the remainder reporting no or mixed effects. Finally, the majority of studies on pathogen transmission (70%) reported potential negative effects of managed bees on wild bees. However, most studies across all topical areas documented the potential for impact (e.g. reporting the occurrence of competition or pathogens), but did not measure direct effects on wild bee fitness, abundance, or diversity. Furthermore, we found that results varied depending on whether managed bees were in their native or non-native range; managed bees within their native range had lesser competitive effects, but potentially greater effects on wild bees via pathogen transmission. We conclude that while this field has expanded considerably in recent decades, additional research measuring direct, long-term, and population-level effects of managed bees is needed to understand their potential impact on wild bees. PMID:29220412

Do managed bees have negative effects on wild bees?: A systematic review of the literature.

PubMed

Mallinger, Rachel E; Gaines-Day, Hannah R; Gratton, Claudio

2017-01-01

Managed bees are critical for crop pollination worldwide. As the demand for pollinator-dependent crops increases, so does the use of managed bees. Concern has arisen that managed bees may have unintended negative impacts on native wild bees, which are important pollinators in both agricultural and natural ecosystems. The goal of this study was to synthesize the literature documenting the effects of managed honey bees and bumble bees on wild bees in three areas: (1) competition for floral and nesting resources, (2) indirect effects via changes in plant communities, including the spread of exotic plants and decline of native plants, and (3) transmission of pathogens. The majority of reviewed studies reported negative effects of managed bees, but trends differed across topical areas. Of studies examining competition, results were highly variable with 53% reporting negative effects on wild bees, while 28% reported no effects and 19% reported mixed effects (varying with the bee species or variables examined). Equal numbers of studies examining plant communities reported positive (36%) and negative (36%) effects, with the remainder reporting no or mixed effects. Finally, the majority of studies on pathogen transmission (70%) reported potential negative effects of managed bees on wild bees. However, most studies across all topical areas documented the potential for impact (e.g. reporting the occurrence of competition or pathogens), but did not measure direct effects on wild bee fitness, abundance, or diversity. Furthermore, we found that results varied depending on whether managed bees were in their native or non-native range; managed bees within their native range had lesser competitive effects, but potentially greater effects on wild bees via pathogen transmission. We conclude that while this field has expanded considerably in recent decades, additional research measuring direct, long-term, and population-level effects of managed bees is needed to understand their potential impact on wild bees.

Fertilization effects on the electrical conductivity measured by EMI, ERT, and GPR

NASA Astrophysics Data System (ADS)

Weihermueller, L.; Kaufmann, M.; Steinberger, P.; Pätzold, S.; Vereecken, H.; Van Der Kruk, J.

2017-12-01

Near surface geophysics such as electromagnetic induction (EMI), electrical resistivity tomography (ERT), and ground penetrating radar (GPR) are widely used for field characterization, to delineate soil units, and to estimate soil texture, bulk densities and/or soil water contents. Hereby, the measured soil apparent conductivity (ECa) is often used. Soil ECa is governed by horizontal and vertical changes in soil texture, mineralogy, soil water content, and temperature, and the single contributions are not easy to disentangle. Within single fields and between fields fertilization management may vary spatially, which holds especially for field trials. As a result, ECa might vary due to differences in electrolyte concentration and subsequent pore fluid conductivity, but secondary fertilization effects might also play a major role in ECa differences such as differences in soil water uptake by growing plants. To study the direct effect of mineral fertilization on ECa, a field experiment was performed on 21 bare soil plots each of a size of 9 m2, where 7 different fertilization treatments were established in triplicates. As mineral fertilizers, commercial calcium ammonium nitrate and potassium chloride were chosen and applied in dosages of 200, 400, and 2000 kg ha-1 N equivalent. Additionally, soil water, soil temperature, and EC were recorded in a pit at different depths using commercial sensors. Changes in ECa were measured every 10 days using EMI and monthly using GPR and ERT. Additionally, soil samples were monthly taken at all plots and nitrate, chloride, and potassium contents were measured in the lab. The poster will show the effect of ECa changes due to fertilization and corresponding leaching of the fertilized elements over time. The experimental results provide information of how fertilization is influencing ECa readings and how long the fertilizers are influencing ECa measurements with geophysical instruments. This study helps to overcome restricted interpretation of ECa measurements on managed agricultural soils.

Fuel Thermo-physical Characterization Project. Fiscal Year 2014 Final Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Burkes, Douglas; Casella, Andrew M.; Buck, Edgar C.

2015-03-15

The Office of Material Management and Minimization (M3) Reactor Conversion Fuel Thermo-Physical Characterization Project at Pacific Northwest National Laboratory (PNNL) was tasked with using PNNL facilities and processes to receive irradiated low enriched uranium–molybdenum (LEU-Mo) fuel plate samples and perform analysis in support of the M3 Reactor Conversion Program. This work is in support of the M3 Reactor Conversion Fuel Development Pillar that is managed by Idaho National Laboratory. The primary research scope was to determine the thermo-physical properties as a function of temperature and burnup. Work conducted in Fiscal Year (FY) 2014 complemented measurements performed in FY 2013 onmore » four additional irradiated LEU-Mo fuel plate samples. Specifically, the work in FY 2014 investigated the influence of different processing methods on thermal property behavior, the absence of aluminum alloy cladding on thermal property behavior for additional model validation, and the influence of higher operating surface heat flux / more aggressive irradiation conditions on thermal property behavior. The model developed in FY 2013 and refined in FY 2014 to extract thermal properties of the U-Mo alloy from the measurements conducted on an integral fuel plate sample (i.e., U-Mo alloy with a thin Zr coating and clad in AA6061) continues to perform very well. Measurements conducted in FY 2014 on samples irradiated under similar conditions compare well to measurements performed in FY 2013. In general, there is no gross influence of fabrication method on thermal property behavior, although the difference in LEU-Mo foil microstructure does have a noticeable influence on recrystallization of grains during irradiation. Samples irradiated under more aggressive irradiation conditions, e.g., higher surface heat flux, revealed lower thermal conductivity when compared to samples irradiated at moderate surface heat fluxes, with the exception of one sample. This report documents thermal property measurements conducted in FY 2014 and compares results to values obtained from literature and measurements performed in FY 2013, where applicable, along with appropriate discussion.« less

Hydrogeology of glacial-terrain lakes, with management and planning applications

USGS Publications Warehouse

Born, S.M.; Smith, S.A.; Stephenson, D.A.

1979-01-01

The subject of the relationship between groundwater and lakes is characterized by sparse information and, in general, has received limited attention by hydrologists. Nevertheless, the hydrogeologic regime of lakes must be adequately assessed in order to intelligently manage lakes and their related shorelands. This paper is a compilation of hydrogeologic data for numerous lakes in North America and presents a preliminary classification framework for lakes based on hydrogeologic considerations. The classification leads to systematic categorization of lake types for planning and management purposes. The main hydrogeologic factors for assessing lake environments are: (1) regime dominance, the relative magnitude of groundwater in the total water budget of a lake; (2) system efficiency, a description of the rate aspects of surface and groundwater movement through a lake system; and (3) position within a groundwater flow system. We indicate the significance and difficulty of measuring these descriptive characteristics and provide examples of each category. Additionally, a variety of lake-related activities that illustrate the value of hydrogeologic information for planning and management purposes are presented. ?? 1979.

Safety culture: analysis of the causal relationships between its key dimensions.

PubMed

Fernández-Muñiz, Beatriz; Montes-Peón, José Manuel; Vázquez-Ordás, Camilo José

2007-01-01

Several fields are showing increasing interest in safety culture as a means of reducing accidents in the workplace. The literature shows that safety culture is a multidimensional concept. However, considerable confusion surrounds this concept, about which little consensus has been reached. This study proposes a model for a positive safety culture and tests this on a sample of 455 Spanish companies, using the structural equation modeling statistical technique. Results show the important role of managers in the promotion of employees' safe behavior, both directly, through their attitudes and behaviors, and indirectly, by developing a safety management system. This paper identifies the key dimensions of safety culture. In addition, a measurement scale for the safety management system is validated. This will assist organizations in defining areas where they need to progress if they wish to improve their safety. Also, we stress that managers need to be wholly committed to and personally involved in safety activities, thereby conveying the importance the firm attaches to these issues.

Explaining implementation behaviour of the National Incident Management System (NIMS).

PubMed

Jensen, Jessica; Youngs, George

2015-04-01

This paper explains the perceived implementation behaviour of counties in the United States with respect to the National Incident Management System (NIMS). The system represents a massive and historic policy mandate designed to restructure, standardise and thereby unify the efforts of a wide variety of emergency management entities. Specifically, this study examined variables identified in the NIMS and policy literature that might influence the behavioural intentions and actual behaviour of counties. It found that three key factors limit or promote how counties intend to implement NIMS and how they actually implement the system: policy characteristics related to NIMS, implementer views and a measure of local capacity. One additional variable-inter-organisational characteristics-was found to influence only actual behaviour. This study's findings suggest that the purpose underlying NIMS may not be fulfilled and confirm what disaster research has long suggested: the potential for standardisation in emergency management is limited. © 2015 The Author(s). Disasters © Overseas Development Institute, 2015.

Association between quality management and performance indicators in Dutch diabetes care groups: a cross-sectional study

PubMed Central

Campmans-Kuijpers, Marjo J E; Baan, Caroline A; Lemmens, Lidwien C; Klomp, Maarten L H; Romeijnders, Arnold C M; Rutten, Guy E H M

2015-01-01

Objectives To enhance the quality of diabetes care in the Netherlands, so-called care groups with three to 250 general practitioners emerged to organise and coordinate diabetes care. This introduced a new quality management level in addition to the quality management of separate general practices. We hypothesised that this new level of quality management might be associated with the aggregate performance indicators on the patient level. Therefore, we aimed to explore the association between quality management at the care group level and its aggregate performance indicators. Design A cross-sectional study. Setting All Dutch care groups (n=97). Participants 23 care groups provided aggregate register-based performance indicators of all their practices as well as data on quality management measured with a questionnaire filled out by 1 or 2 of their quality managers. Primary outcomes The association between quality management, overall and in 6 domains (‘organisation of care’, ‘multidisciplinary teamwork’, ‘patient centredness’, ‘performance management’, ‘quality improvement policy’ and ‘management strategies’) on the one hand and 3 process indicators (the percentages of patients with at least 1 measurement of glycated haemoglobin, lipid profile and systolic blood pressure), and 3 intermediate outcome indicators (the percentages of patients with glycated haemoglobin below 53 mmol/mol (7%); low-density lipoprotein cholesterol below 2.5 mmol/L; and systolic blood pressure below 140 mm Hg) by weighted univariable linear regression. Results The domain ‘management strategies’ was significantly associated with the percentage of patients with a glycated haemoglobin <53 mmol/mol (β 0.28 (0.09; 0.46) p=0.01) after correction for multiple testing. The other domains as well as overall quality management were not associated with aggregate process or outcome indicators. Conclusions This first exploratory study on quality management showed weak or no associations between quality management of diabetes care groups and their performance. It remains uncertain whether this second layer on quality management adds to better quality of care. PMID:25968001

75 FR 5715 - Identification of Additional Classes of Facilities for Development of Financial Responsibility...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-04

... addition, the Agency identified the Waste Management and Remediation Services industry (NAICS 562), the... Liability Act (CERCLA). In addition, the Agency identified the Waste Management and Remediation Services...

Risk-trading in flood management: An economic model.

PubMed

Chang, Chiung Ting

2017-09-15

Although flood management is no longer exclusively a topic of engineering, flood mitigation continues to be associated with hard engineering options. Flood adaptation or the capacity to adapt to flood risk, as well as a demand for internalizing externalities caused by flood risk between regions, complicate flood management activities. Even though integrated river basin management has long been recommended to resolve the above issues, it has proven difficult to apply widely, and sometimes even to bring into existence. This article explores how internalization of externalities as well as the realization of integrated river basin management can be encouraged via the use of a market-based approach, namely a flood risk trading program. In addition to maintaining efficiency of optimal resource allocation, a flood risk trading program may also provide a more equitable distribution of benefits by facilitating decentralization. This article employs a graphical analysis to show how flood risk trading can be implemented to encourage mitigation measures that increase infiltration and storage capacity. A theoretical model is presented to demonstrate the economic conditions necessary for flood risk trading. Copyright © 2017 Elsevier Ltd. All rights reserved.

Critical Zone Services as Environmental Assessment Criteria in Intensively Managed Agricultural Landscapes

NASA Astrophysics Data System (ADS)

Richardson, M.; Kumar, P.

2016-12-01

The critical zone (CZ) includes the biophysical processes occurring from the top of the vegetation canopy to the weathering zone below the groundwater table. CZ services provide a measure for the goods and benefits derived from CZ processes. In intensively managed landscapes (IML), the provisioning, supporting, and regulating services are altered through anthropogenic energy inputs to derive more productivity, as agricultural products, from these landscapes than would be possible under natural conditions. However, the energy or cost equivalents of alterations to CZ functions within landscape profiles are unknown. The valuation of CZ services in energy or monetary terms provides a more concrete tool for characterizing seemingly abstract environmental damages from agricultural production systems. A multi-layer canopy-root-soil model is combined with nutrient and water flux models to simulate the movement of nutrients throughout the soil system. This data enables the measurement of agricultural anthropogenic impacts to the CZ's nutrient cycling supporting services and atmospheric stabilizing regulating services defined by the flux of carbon and nutrients. Such measurements include soil carbon storage, soil carbon respiration, nitrate leaching, and nitrous oxide flux into the atmosphere. Additionally, the socioeconomic values of corn feed and ethanol define the primary productivity supporting services of each crop use.In the debate between feed production and corn-based ethanol production, measured nutrient CZ services can cost up to four times more than traditionally estimated CO2 equivalences for the entire bioenergy production system. Energy efficiency in addition to environmental impacts demonstrate how the inclusion of CZ services is necessary in accounting for the entire life cycle of agricultural production systems. These results conclude that feed production systems are more energy efficient and less environmentally costly than corn-based ethanol systems.

Effectiveness of nursing management information systems: a systematic review.

PubMed

Choi, Mona; Yang, You Lee; Lee, Sun-Mi

2014-10-01

The purpose of this study was to review evaluation studies of nursing management information systems (NMISs) and their outcome measures to examine system effectiveness. For the systematic review, a literature search of the PubMed, CINAHL, Embase, and Cochrane Library databases was conducted to retrieve original articles published between 1970 and 2014. Medical Subject Headings (MeSH) terms included informatics, medical informatics, nursing informatics, medical informatics application, and management information systems for information systems and evaluation studies and nursing evaluation research for evaluation research. Additionally, manag(*) and admin(*), and nurs(*) were combined. Title, abstract, and full-text reviews were completed by two reviewers. And then, year, author, type of management system, study purpose, study design, data source, system users, study subjects, and outcomes were extracted from the selected articles. The quality and risk of bias of the studies that were finally selected were assessed with the Risk of Bias Assessment Tool for Non-randomized Studies (RoBANS) criteria. Out of the 2,257 retrieved articles, a total of six articles were selected. These included two scheduling programs, two nursing cost-related programs, and two patient care management programs. For the outcome measurements, usefulness, time saving, satisfaction, cost, attitude, usability, data quality/completeness/accuracy, and personnel work patterns were included. User satisfaction, time saving, and usefulness mostly showed positive findings. The study results suggest that NMISs were effective in time saving and useful in nursing care. Because there was a lack of quality in the reviewed studies, well-designed research, such as randomized controlled trials, should be conducted to more objectively evaluate the effectiveness of NMISs.

Spatial Analysis of Soil Subsidence in Peat Meadow Areas in Friesland in Relation to Land and Water Management, Climate Change, and Adaptation

NASA Astrophysics Data System (ADS)

Brouns, Karlijn; Eikelboom, Tessa; Jansen, Peter C.; Janssen, Ron; Kwakernaak, Cees; van den Akker, Jan J. H.; Verhoeven, Jos T. A.

2015-02-01

Dutch peatlands have been subsiding due to peat decomposition, shrinkage and compression, since their reclamation in the 11th century. Currently, subsidence amounts to 1-2 cm/year. Water management in these areas is complex and costly, greenhouse gases are being emitted, and surface water quality is relatively poor. Regional and local authorities and landowners responsible for peatland management have recognized these problems. In addition, the Netherlands Royal Meteorological Institute predicts higher temperatures and drier summers, which both are expected to enhance peat decomposition. Stakeholder workshops have been organized in three case study areas in the province of Friesland to exchange knowledge on subsidence and explore future subsidence rates and the effects of land use and management changes on subsidence rates. Subsidence rates were up to 3 cm/year in deeply drained parcels and increased when we included climate change in the modeling exercises. This means that the relatively thin peat layers in this province (ca 1 m) would shrink or even disappear by the end of the century when current practices continue. Adaptation measures were explored, such as extensive dairy farming and the production of new crops in wetter conditions, but little experience has been gained on best practices. The workshops have resulted in useful exchange of ideas on possible measures and their consequences for land use and water management in the three case study areas. The province and the regional water board will use the results to develop land use and water management policies for the next decades.

360度評価における自由回答・選択式回答の混合データからの人事評価尺度発見

NASA Astrophysics Data System (ADS)

Asahi, Hidemasa; Ohsawa, Yukio

In this study, analysis has been executed on the free-description answers in the questionnaire of 360-degree feedback in personnel evaluation in an existing company. The aim of this analysis was to obtain a new evaluation index for the competencies of company managers, on which the company is expected to find a way of growth by enforcing innovative managers. We analyzed and visualized the mixture of textual and the categorical data from questionnaire results in the 360-degree feedback, and followed the presented process of chance discovery. In the case we used KeyGraph, the importance of managers' "trustworthiness" was discovered first. Then, following the process, we focused attention to managers' trustworthiness. That is, we executed a new 360-degree feedback with additional questions regarding managers' trustworthiness, in order to confirm the validity of the measurement. As a result, it turned out that the correlation of a manager's trustworthiness with his/her actions to surroundings, and with the business performances were high. This discovery presented with a useful measure for effective restructuring, leading to the growth of the company, and is currently being introduced to their personnel evaluations. This new process on the mixture of textual and categorical data was essential to this novel application of chance discovery to personnel evaluation. The presented success can be regarded as due to the human-centric process of mining scenarios from the mixed data.

Measures of upper limb function for people with neck pain: a systematic review of measurement and practical properties (protocol).

PubMed

Alreni, Ahmad Salah Eldin; Harrop, Deborah; Gumber, Anil; McLean, Sionnadh

2015-04-07

Upper limb disability is a common musculoskeletal condition frequently associated with neck pain. Recent literature has reported the need to utilise validated upper limb outcome measures in the assessment and management of patients with neck pain. However, there is a lack of clear guidance about the suitability of available measures, which may impede utilisation. This review will identify all available measures of upper limb function developed for use in neck pain patients and evaluate their measurement and practical properties in order to identify those measures that are most appropriate for use in clinical practice and research. This review will be performed in two phases. Phase one will identify all measures used to assess upper limb function for patients with neck pain. Phase two will identify all available studies of the measurement and practical properties of identified instrument. The COnsensus-based Standards for selection of health Measurement INstrument (COSMIN) will be used to evaluate the methodological quality of the included studies. To ensure methodological rigour, the findings of this review will be reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline. Optimal management of patients with neck pain should incorporate upper limb rehabilitation. The findings of this study will assist clinicians who seek to utilise suitable and accurate measures to assess upper limb function for a patient with neck pain. In addition, the findings of this study may suggest new research directions to support the development of upper limb outcome measures for patients with neck pain. PROSPERO CRD42015016624.

Impact of a new method of warfarin management on patient satisfaction, time, and cost.

PubMed

Meyer, Sarah; Frei, Christopher R; Daniels, Kelly R; Forcade, Nicolas A; Bussey, Marie; Bussey-Smith, Kristin L; Bussey, Henry I

2013-11-01

International normalized ratio self-testing with online remote monitoring and management (STORM₂) is an alternative to anticoagulation clinic management, but the patient's perspective of this method has not been evaluated in the United States; thus we sought to evaluate the impact of STORM₂ on patient satisfaction, time, and cost. Prospective pre- and postintervention study. Freestanding clinical research center. Forty-three patients treated with long-term warfarin therapy and monitored initially in the anticoagulation clinic setting and then with STORM₂, referred from 11 medical practices. Patients were asked to complete a survey and the Duke Anticoagulation Satisfaction Scale (DASS) before (at baseline) and after at least 3 months of STORM₂ (at follow-up). Patient satisfaction and time were assessed by survey and the DASS. Costs were measured from the patient's perspective. Overall 90% of responders preferred STORM₂ to traditional clinic management. The DASS questions indicated that patients were more satisfied with their anticoagulation treatment and more likely to recommend oral anticoagulation to a friend after experiencing STORM₂. In addition, patients found STORM₂ to be less complicated and more convenient than traditional clinic management. For each traditional monthly visit, patients drove 20 miles and expended a total of 1.8 hours; using 55¢/mile for mileage reimbursement and $15/hour for lost wages, the cost for each visit was $38. The total cost for four STORM₂ visits per month was $10, for a net savings of $28 per patient per month. A total of 76% of patients were willing to pay additional money to eliminate a monthly clinic visit. STORM₂ is more convenient, less complicated, preferred by patients, and saves patients time and money compared with clinic management. © 2013 Pharmacotherapy Publications, Inc.

Irrigation Trials for ET Estimation and Water Management in California Specialty Crops

NASA Astrophysics Data System (ADS)

Johnson, L.; Cahn, M.; Martin, F.; Lund, C.; Melton, F. S.

2012-12-01

Accurate estimation of crop evapotranspiration (ETc) can support efficient irrigation water management, which in turn brings benefits including surface water conservation, mitigation of groundwater depletion/degradation, energy savings, and crop quality assurance. Past research in California has revealed strong relationships between canopy fractional cover (Fc) and ETc of certain specialty crops, while additional research has shown the potential of monitoring Fc by satellite remote sensing. California's Central Coast is the leading region of cool season vegetable production in the U.S. Monterey County alone produces more than 80,000 ha of lettuce and broccoli (about half of U.S. production), valued at $1.5 billion in 2009. Under this study, we are conducting ongoing irrigation trials on these crops at the USDA Agricultural Research Station (Salinas) to compare irrigation scheduling via plant-based ETc approaches, by way of Fc, with current industry standard-practice. The following two monitoring approaches are being evaluated - 1) a remote sensing model employed by NASA's prototype Satellite Irrigation Management System, and 2) an online irrigation scheduling tool, CropManage, recently developed by U.C. Cooperative Extension. Both approaches utilize daily grass-reference ETo data as provided by the California Irrigation Management Irrigation System (CIMIS). A sensor network is deployed to monitor applied irrigation, volumetric soil water content, soil water potential, deep drainage, and standard meteorologic variables in order to derive ETc by a water balance approach. Evaluations of crop yield and crop quality are performed by the research team and by commercial growers. Initial results to-date indicate that applied water reductions based on Fc measurements are possible with little-to-no impact on yield of crisphead lettuce (Lactuca sativa). Additional results for both lettuce and broccoli trials, conducted during summer-fall 2012, are presented with respect to nutrient management and crop viability.

Stormwater Management Effects on Ecosystem Services: A Literature Review

NASA Astrophysics Data System (ADS)

Prudencio, L.; Null, S. E.

2016-12-01

Managing stormwater provides benefits for enhancing water supplies while reducing urban runoff. Yet, there has been little research focused on understanding how stormwater management affects ecosystem services, the benefits that ecosystems provide to humans. Garnering more knowledge of the changes to ecosystem services from stormwater management will ultimately improve management and decision-making. The objective of this research is to review and synthesize published literature on 1) ecosystem services and stormwater management and 2) changes in ecosystem services from anthropogenic impacts and climate warming, to establish a foundation for research at the intersection of ecosystems services, stormwater management, and global environmental change. We outline four research areas for ecosystem services and stormwater management that should be further explored. These four areas, named after the four types of ecosystem services, highlight context-specific research questions and human and climate change effects. We conclude that effective and sustainable stormwater management requires incorporating engineering, social, and environmental criteria to quantify benefits of provisioning, regulating, cultural, and supporting ecosystem services. Lastly, improved current and potential stormwater management policy may better support sustainable stormwater methods at the institutional level. Stormwater quality and monitoring could be improved through the use of the Clean Water Act (e.g. Total Maximum Daily Loads), the Endangered Species Act, and public health measures. Additional policies regulating groundwater quantity and quality have been and may continue to be implemented by states, encouraging sustainable and cleaner stormwater practices.

Complex ambulatory settings demand scheduling systems.

PubMed

Ross, K M

1998-01-01

Practice management systems are becoming more and more complex, as they are asked to integrate all aspects of patient and resource management. Although patient scheduling is a standard expectation in any ambulatory environment, facilities and equipment resource scheduling are additional functionalities of scheduling systems. Because these functions were not typically managed in manual patient scheduling, often the result was resource mismanagement, along with a potential negative impact on utilization, patient flow and provider productivity. As ambulatory organizations have become more seasoned users of practice management software, the value of resource scheduling has become apparent. Appointment scheduling within a fully integrated practice management system is recognized as an enhancement of scheduling itself and provides additional tools to manage other information needs. Scheduling, as one component of patient information management, provides additional tools in these areas.

The role of social media in online weight management: systematic review.

PubMed

Chang, Tammy; Chopra, Vineet; Zhang, Catherine; Woolford, Susan J

2013-11-28

Social media applications are promising adjuncts to online weight management interventions through facilitating education, engagement, and peer support. However, the precise impact of social media on weight management is unclear. The objective of this study was to systematically describe the use and impact of social media in online weight management interventions. PubMed, PsycINFO, EMBASE, Web of Science, and Scopus were searched for English-language studies published through March 25, 2013. Additional studies were identified by searching bibliographies of electronically retrieved articles. Randomized controlled trials of online weight management interventions that included a social media component for individuals of all ages were selected. Studies were evaluated using 2 systematic scales to assess risk of bias and study quality. Of 517 citations identified, 20 studies met eligibility criteria. All study participants were adults. Because the included studies varied greatly in study design and reported outcomes, meta-analysis of interventions was not attempted. Although message boards and chat rooms were the most common social media component included, their effect on weight outcomes was not reported in most studies. Only one study measured the isolated effect of social media. It found greater engagement of participants, but no difference in weight-related outcomes. In all, 65% of studies were of high quality; 15% of studies were at low risk of bias. Despite the widespread use of social media, few studies have quantified the effect of social media in online weight management interventions; thus, its impact is still unknown. Although social media may play a role in retaining and engaging participants, studies that are designed to measure its effect are needed to understand whether and how social media may meaningfully improve weight management.

The Role of Social Media in Online Weight Management: Systematic Review

PubMed Central

Chopra, Vineet; Zhang, Catherine; Woolford, Susan J

2013-01-01

Background Social media applications are promising adjuncts to online weight management interventions through facilitating education, engagement, and peer support. However, the precise impact of social media on weight management is unclear. Objective The objective of this study was to systematically describe the use and impact of social media in online weight management interventions. Methods PubMed, PsycINFO, EMBASE, Web of Science, and Scopus were searched for English-language studies published through March 25, 2013. Additional studies were identified by searching bibliographies of electronically retrieved articles. Randomized controlled trials of online weight management interventions that included a social media component for individuals of all ages were selected. Studies were evaluated using 2 systematic scales to assess risk of bias and study quality. Results Of 517 citations identified, 20 studies met eligibility criteria. All study participants were adults. Because the included studies varied greatly in study design and reported outcomes, meta-analysis of interventions was not attempted. Although message boards and chat rooms were the most common social media component included, their effect on weight outcomes was not reported in most studies. Only one study measured the isolated effect of social media. It found greater engagement of participants, but no difference in weight-related outcomes. In all, 65% of studies were of high quality; 15% of studies were at low risk of bias. Conclusions Despite the widespread use of social media, few studies have quantified the effect of social media in online weight management interventions; thus, its impact is still unknown. Although social media may play a role in retaining and engaging participants, studies that are designed to measure its effect are needed to understand whether and how social media may meaningfully improve weight management. PMID:24287455

Defense Small Business Innovation Research Program (SBIR). Volume 1. Army Abstracts of Phase 1 Awards 1990

DTIC Science & Technology

1990-01-01

RABRO DR E HAUPPAUGE, NY 11788 Program Manager: SULLIVAN S CHEN Contract #: Title: CORRELATION OF SOLDER JOINT MEASUREMENTS TO PROCESS VARIABLES FOR...ADDITION, THE SR& E NEURAL NETWORK WILL BE USED TO PERFORM SHAPE MATCHING BECAUSE IT IS NOT ORIENTATION INVARIANT. SINCE OUR TARGET DETECTOR IS A PIXEL...DEVELOPMENT METHODS AND TOOLS ARE NEEDED WHICH BOTH REDUCE DEVELOPMENT COSTS AND FACILITATE COMMUNICATION BETWEEN DEVELOPERS AND MAINTAINERS THROUGHOUT

Early Detection of Prostate Cancer with New Nanoparticle Based UltrasoundContrast Agents Targeted to PSMA

DTIC Science & Technology

2017-08-01

biodistribution studies with FMT, ultrasound imaging and ex vivo tissue analysis (months 10-14) 2d. Measure bubble dynamic parameters (months 10-14) 1...doctoral training studying post -transcriptional gene regulation National Institutes of Health-NICHD, Bethesda, MD Postdoctoral Fellow 02/1996 IRTA...and manage these studies . My research career has been hybrid consisting of experience in the biotech industry in addition to my academic position

Ada developers' supplement to the recommended approach

NASA Technical Reports Server (NTRS)

Kester, Rush; Landis, Linda

1993-01-01

This document is a collection of guidelines for programmers and managers who are responsible for the development of flight dynamics applications in Ada. It is intended to be used in conjunction with the Recommended Approach to Software Development (SEL-81-305), which describes the software development life cycle, its products, reviews, methods, tools, and measures. The Ada Developers' Supplement provides additional detail on such topics as reuse, object-oriented analysis, and object-oriented design.

A Group Wage Incentive System for Production Workers at Pearl Harbor Naval Shipyard: Test and Evaluation

DTIC Science & Technology

1985-09-01

assume they will result in a sweatshop atmosphere. Workers may have fears that management will tighten standards when performance improves or...the shop’s performance can have a major impact on overall shipyard performance. In addition, the potential for accurate performance measurement was... impact of this experimental productivity improvement technique on participants’ job attitudes is supported in the literature. White et al. (in

Plans for Assessing Contractor Performance for the Camp Lemonnier Base Operations Support Contract Needed Improvement

DTIC Science & Technology

2015-08-27

ensure the functional assessment plans ( FAP ) for the three services contained all contractor work requiring assessment, measurable performance...review the FAPs after development and revisions to the FAPs , and did not require additional controls over the contractor assessment process in an...revised as follows: • Business Management System B-14.3 was updated to require the contract officer representative conduct a FAP review to ensure

Cardiovascular risk outcome and program evaluation of a cluster randomised controlled trial of a community-based, lay peer led program for people with diabetes.

PubMed

Riddell, M A; Dunbar, J A; Absetz, P; Wolfe, R; Li, H; Brand, M; Aziz, Z; Oldenburg, B

2016-08-24

The 2013 Global Burden of Disease Study demonstrated the increasing burden of diabetes and the challenge it poses to the health systems of all countries. The chronic and complex nature of diabetes requires active self-management by patients in addition to clinical management in order to achieve optimal glycaemic control and appropriate use of available clinical services. This study is an evaluation of a "real world" peer support program aimed at improving the control and management of type 2 diabetes (T2DM) in Australia. The trial used a randomised cluster design with a peer support intervention and routine care control arms and 12-month follow up. Participants in both arms received a standardised session of self-management education at baseline. The intervention program comprised monthly community-based group meetings over 12 months led by trained peer supporters and active encouragement to use primary health care and other community resources and supports related to diabetes. Clinical, behavioural and other measures were collected at baseline, 6 and 12 months. The primary outcome was the predicted 5 year cardiovascular disease risk using the United Kingdom Prospective Diabetes Study (UKPDS) Risk Equation at 12 months. Secondary outcomes included clinical measures, quality of life, measures of support, psychosocial functioning and lifestyle measures. Eleven of 12 planned groups were successfully implemented in the intervention arm. Both the usual care and the intervention arms demonstrated a small reduction in 5 year UKPDS risk and the mean values for biochemical and anthropometric outcomes were close to target at 12 months. There were some small positive changes in self-management behaviours. The positive changes in self-management behaviours among intervention participants were not sufficient to reduce cardiovascular risk, possibly because approximately half of the study participants already had quite well controlled T2DM at baseline. Future research needs to address how to enhance community based programs so that they reach and benefit those most in need of resources and supports to improve metabolic control and associated clinical outcomes. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12609000469213 . Registered 16 June 2009.

Pain and pain management in haemophilia

PubMed Central

Auerswald, Günter; Dolan, Gerry; Duffy, Anne; Hermans, Cedric; Jiménez-Yuste, Victor; Ljung, Rolf; Morfini, Massimo; Lambert, Thierry; Šalek, Silva Zupančić

2016-01-01

Joint pain is common in haemophilia and may be acute or chronic. Effective pain management in haemophilia is essential to reduce the burden that pain imposes on patients. However, the choice of appropriate pain-relieving measures is challenging, as there is a complex interplay of factors affecting pain perception. This can manifest as differences in patients’ experiences and response to pain, which require an individualized approach to pain management. Prophylaxis with factor replacement reduces the likelihood of bleeds and bleed-related pain, whereas on-demand therapy ensures rapid bleed resolution and pain relief. Although use of replacement or bypassing therapy is often the first intervention for pain, additional pain relief strategies may be required. There is an array of analgesic options, but consideration should be paid to the adverse effects of each class. Nevertheless, a combination of medications that act at different points in the pain pathway may be beneficial. Nonpharmacological measures may also help patients and include active coping strategies; rest, ice, compression, and elevation; complementary therapies; and physiotherapy. Joint aspiration may also reduce acute joint pain, and joint steroid injections may alleviate chronic pain. In the longer term, increasing use of prophylaxis or performing surgery may be necessary to reduce the burden of pain caused by the degenerative effects of repeated bleeds. Whichever treatment option is chosen, it is important to monitor pain and adjust patient management accordingly. Beyond specific pain management approaches, ongoing collaboration between multidisciplinary teams, which should include physiotherapists and pain specialists, may improve outcomes for patients. PMID:27439216

Framework to evaluate the worth of hydraulic conductivity data for optimal groundwater resources management in ecologically sensitive areas

NASA Astrophysics Data System (ADS)

Feyen, Luc; Gorelick, Steven M.

2005-03-01

We propose a framework that combines simulation optimization with Bayesian decision analysis to evaluate the worth of hydraulic conductivity data for optimal groundwater resources management in ecologically sensitive areas. A stochastic simulation optimization management model is employed to plan regionally distributed groundwater pumping while preserving the hydroecological balance in wetland areas. Because predictions made by an aquifer model are uncertain, groundwater supply systems operate below maximum yield. Collecting data from the groundwater system can potentially reduce predictive uncertainty and increase safe water production. The price paid for improvement in water management is the cost of collecting the additional data. Efficient data collection using Bayesian decision analysis proceeds in three stages: (1) The prior analysis determines the optimal pumping scheme and profit from water sales on the basis of known information. (2) The preposterior analysis estimates the optimal measurement locations and evaluates whether each sequential measurement will be cost-effective before it is taken. (3) The posterior analysis then revises the prior optimal pumping scheme and consequent profit, given the new information. Stochastic simulation optimization employing a multiple-realization approach is used to determine the optimal pumping scheme in each of the three stages. The cost of new data must not exceed the expected increase in benefit obtained in optimal groundwater exploitation. An example based on groundwater management practices in Florida aimed at wetland protection showed that the cost of data collection more than paid for itself by enabling a safe and reliable increase in production.

Evaluation of a community health worker pilot intervention to improve diabetes management in Bangladeshi immigrants with type 2 diabetes in New York City.

PubMed

Islam, Nadia S; Wyatt, Laura C; Patel, Shilpa D; Shapiro, Ephraim; Tandon, S Darius; Mukherji, B Runi; Tanner, Michael; Rey, Mariano J; Trinh-Shevrin, Chau

2013-01-01

The purpose of this study is to explore the impact and feasibility of a pilot Community Health Worker (CHW) intervention to improve diabetes management among Bangladeshi-American individuals with type 2 diabetes living in New York City. Participants were recruited at clinic- and community-based venues. The intervention consisted of 6 monthly, CHW-facilitated group sessions on topics related to management of diabetes. Surveys were collected at baseline and follow-up time points. Study outcomes included clinical, behavioral, and satisfaction measures for participants, as well as qualitative measures from CHWs. Improvements were seen in diabetes knowledge, exercise and diet to control diabetes, frequency of checking feet, medication compliance, and self-efficacy of health and physical activity from baseline to 12 months. Additionally, there were decreases in A1C, weight, and body mass index. Program evaluation revealed a high acceptability of the intervention, and qualitative findings indicated that CHWs helped overcome barriers and facilitated program outcomes through communal concordance, trust, and leadership. The intervention demonstrated high acceptability and suggested efficacy in improving diabetes management outcomes among Bangladeshi immigrants in an urban setting. The US Bangladeshi population will continue to increase, and given the high rates of diabetes, as well as linguistic and economic barriers faced by this community, effective and culturally tailored health interventions are needed to overcome barriers and provide support for diabetes management.

Evaluation of a Community Health Worker Pilot Intervention to Improve Diabetes Management in Bangladeshi Immigrants with Type 2 Diabetes in New York City

PubMed Central

Islam, Nadia S.; Wyatt, Laura C.; Patel, Shilpa D.; Shapiro, Ephraim; Tandon, S.Darius; Mukherji, B. Runi; Tanner, Michael; Rey, Mariano J.; Trinh-Shevrin, Chau

2014-01-01

Purpose The purpose of this study is to explore the impact and feasibility of a pilot Community Health Worker (CHW) intervention to improve diabetes management among Bangladeshi-American individuals with Type 2 diabetes living in New York City. Methods Participants were recruited at clinic- and community-based venues. The intervention consisted of six monthly, CHW facilitated group sessions on topics related to management of diabetes. Surveys were collected at baseline and follow-up time points. Study outcomes included clinical, behavioral, and satisfaction measures for participants, as well as qualitative measures from CHWs. Results Improvements were seen in diabetes knowledge, exercise and diet to control diabetes, frequency of checking feet, medication compliance, and self-efficacy of health and physical activity from baseline to 12 months. Additionally, there were decreases in A1C, weight, and BMI. Program evaluation revealed a high acceptability of the intervention, and qualitative findings indicated that CHWs helped overcome barriers and facilitated program outcomes through communal concordance, trust and leadership. Conclusions The intervention demonstrated high acceptability and suggested efficacy in improving diabetes management outcomes among Bangladeshi immigrants in an urban setting. The U.S. Bangladeshi population will continue to increase, and given the high rates of diabetes, as well as linguistic and economic barriers faced by this community, effective and culturally-tailored health interventions are needed to overcome barriers and provide support for diabetes management. PMID:23749774

Cascade reservoir flood control operation based on risk grading and warning in the Upper Yellow River

NASA Astrophysics Data System (ADS)

Xuejiao, M.; Chang, J.; Wang, Y.

2017-12-01

Flood risk reduction with non-engineering measures has become the main idea for flood management. It is more effective for flood risk management to take various non-engineering measures. In this paper, a flood control operation model for cascade reservoirs in the Upper Yellow River was proposed to lower the flood risk of the water system with multi-reservoir by combining the reservoir flood control operation (RFCO) and flood early warning together. Specifically, a discharge control chart was employed to build the joint RFCO simulation model for cascade reservoirs in the Upper Yellow River. And entropy-weighted fuzzy comprehensive evaluation method was adopted to establish a multi-factorial risk assessment model for flood warning grade. Furthermore, after determining the implementing mode of countermeasures with future inflow, an intelligent optimization algorithm was used to solve the optimization model for applicable water release scheme. In addition, another model without any countermeasure was set to be a comparative experiment. The results show that the model developed in this paper can further decrease the flood risk of water system with cascade reservoirs. It provides a new approach to flood risk management by coupling flood control operation and flood early warning of cascade reservoirs.

Simulation of Long-Term Carbon and Nitrogen Dynamics in Grassland-Based Dairy Farming Systems to Evaluate Mitigation Strategies for Nutrient Losses

PubMed Central

Shah, Ghulam Abbas; Groot, Jeroen C.J.; Shah, Ghulam Mustafa; Lantinga, Egbert A.

2013-01-01

Many measures have been proposed to mitigate gaseous emissions and other nutrient losses from agroecosystems, which can have large detrimental effects for the quality of soils, water and air, and contribute to eutrophication and global warming. Due to complexities in farm management, biological interactions and emission measurements, most experiments focus on analysis of short-term effects of isolated mitigation practices. Here we present a model that allows simulating long-term effects at the whole-farm level of combined measures related to grassland management, animal housing and manure handling after excretion, during storage and after field application. The model describes the dynamics of pools of organic carbon and nitrogen (N), and of inorganic N, as affected by farm management in grassland-based dairy systems. We assessed the long-term effects of delayed grass mowing, housing type (cubicle and sloping floor barns, resulting in production of slurry and solid cattle manure, respectively), manure additives, contrasting manure storage methods and irrigation after application of covered manure. Simulations demonstrated that individually applied practices often result in compensatory loss pathways. For instance, methods to reduce ammonia emissions during storage like roofing or covering of manure led to larger losses through ammonia volatilization, nitrate leaching or denitrification after application, unless extra measures like irrigation were used. A strategy of combined management practices of delayed mowing and fertilization with solid cattle manure that is treated with zeolite, stored under an impermeable sheet and irrigated after application was effective to increase soil carbon stocks, increase feed self-sufficiency and reduce losses by ammonia volatilization and soil N losses. Although long-term datasets (>25 years) of farm nutrient dynamics and loss flows are not available to validate the model, the model is firmly based on knowledge of processes and measured effects of individual practices, and allows the integrated exploration of effective emission mitigation strategies. PMID:23826255

44 CFR 61.16 - Probation additional premium.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Probation additional premium. 61.16 Section 61.16 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE...

44 CFR 61.16 - Probation additional premium.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Probation additional premium. 61.16 Section 61.16 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE...

44 CFR 61.16 - Probation additional premium.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Probation additional premium. 61.16 Section 61.16 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE...

44 CFR 61.16 - Probation additional premium.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Probation additional premium. 61.16 Section 61.16 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE...

44 CFR 61.16 - Probation additional premium.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Probation additional premium. 61.16 Section 61.16 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program INSURANCE...

Risk management and measuring productivity with POAS--Point of Act System--a medical information system as ERP (Enterprise Resource Planning) for hospital management.

PubMed

Akiyama, M

2007-01-01

The concept of our system is not only to manage material flows, but also to provide an integrated management resource, a means of correcting errors in medical treatment, and applications to EBM (evidence-based medicine) through the data mining of medical records. Prior to the development of this system, electronic processing systems in hospitals did a poor job of accurately grasping medical practice and medical material flows. With POAS (Point of Act System), hospital managers can solve the so-called, "man, money, material, and information" issues inherent in the costs of healthcare. The POAS system synchronizes with each department system, from finance and accounting, to pharmacy, to imaging, and allows information exchange. We can manage Man (Business Process), Material (Medical Materials and Medicine), Money (Expenditure for purchase and Receipt), and Information (Medical Records) completely by this system. Our analysis has shown that this system has a remarkable investment effect - saving over four million dollars per year - through cost savings in logistics and business process efficiencies. In addition, the quality of care has been improved dramatically while error rates have been reduced - nearly to zero in some cases.

Clinical practice guidelines for delirium management: potential application in palliative care.

PubMed

Bush, Shirley H; Bruera, Eduardo; Lawlor, Peter G; Kanji, Salmaan; Davis, Daniel H J; Agar, Meera; Wright, David Kenneth; Hartwick, Michael; Currow, David C; Gagnon, Bruno; Simon, Jessica; Pereira, José L

2014-08-01

Delirium occurs in patients across a wide array of health care settings. The extent to which formal management guidelines exist or are adaptable to palliative care is unclear. This review aims to 1) source published delirium management guidelines with potential relevance to palliative care settings, 2) discuss the process of guideline development, 3) appraise their clinical utility, and 4) outline the processes of their implementation and evaluation and make recommendations for future guideline development. We searched PubMed (1990-2013), Scopus, U.S. National Guideline Clearinghouse, Google, and relevant reference lists to identify published guidelines for the management of delirium. This was supplemented with multidisciplinary input from delirium researchers and other relevant stakeholders at an international delirium study planning meeting. There is a paucity of high-level evidence for pharmacological and non-pharmacological interventions in the management of delirium in palliative care. However, multiple delirium guidelines for clinical practice have been developed, with recommendations derived from "expert opinion" for areas where research evidence is lacking. In addition to their potential benefits, limitations of clinical guidelines warrant consideration. Guidelines should be appraised and then adapted for use in a particular setting before implementation. Further research is needed on the evaluation of guidelines, as disseminated and implemented in a clinical setting, focusing on measurable outcomes in addition to their impact on quality of care. Delirium clinical guidelines are available but the level of evidence is limited. More robust evidence is required for future guideline development. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Developing additional capacity for wilderness management: An international exchange program between South Africa and United States wilderness rangers

Treesearch

Pierre van den Berg; Ralph Swain

2007-01-01

Wilderness managers have limited time to initiate international exchanges. Additionally, the benefits to developing capacity for wilderness management around the globe are not significant enough to make the effort cost-effective. International assistance, including wilderness management exchange programs, is critical to protecting wild areas around the globe. Former...

5 CFR 1001.101 - In addition to this part, what other rules of conduct apply to Office of Personnel Management...

Code of Federal Regulations, 2010 CFR

2010-01-01

... rules of conduct apply to Office of Personnel Management employees? 1001.101 Section 1001.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) REGULATIONS GOVERNING EMPLOYEES OF THE OFFICE OF PERSONNEL MANAGEMENT OPM EMPLOYEE RESPONSIBILITIES AND CONDUCT § 1001.101 In addition to this part...

5 CFR 1001.101 - In addition to this part, what other rules of conduct apply to Office of Personnel Management...

Code of Federal Regulations, 2011 CFR

2011-01-01

... rules of conduct apply to Office of Personnel Management employees? 1001.101 Section 1001.101 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) REGULATIONS GOVERNING EMPLOYEES OF THE OFFICE OF PERSONNEL MANAGEMENT OPM EMPLOYEE RESPONSIBILITIES AND CONDUCT § 1001.101 In addition to this part...

41 CFR 102-38.335 - Is there any additional personal property sales information that we must submit to the General...

Code of Federal Regulations, 2010 CFR

2010-07-01

... (GSA's) Asset Disposition Management System (ADMS), once that capability is established, any sales... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Is there any additional... Section 102-38.335 Public Contracts and Property Management Federal Property Management Regulations System...

41 CFR 102-83.30 - In addition to its mission and program requirements, are there any other issues that Federal...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false In addition to its... identifying the delineated area? 102-83.30 Section 102-83.30 Public Contracts and Property Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION REAL PROPERTY 83-LOCATION...

Radiotherapy for glioma during pregnancy: fetal dose estimates, risk assessment and clinical management.

PubMed

Haba, Y; Twyman, N; Thomas, S J; Overton, C; Dendy, P; Burnet, N G

2004-05-01

Cancer in pregnancy is relatively uncommon, but constitutes a major problem. We report the measurement of scatter dose to the fetus and the estimated fetal risk from that exposure in an illustrative case of a patient, 20 weeks pregnant, with a grade 3 anaplastic astrocytoma. A clinical decision was made to withhold radiotherapy, if possible, until after delivery. Sequential magnetic resonance imaging (MRI) showed no progression during the pregnancy. In the event, she was managed conservatively until the successful completion of her pregnancy. In case radiotherapy was required, an estimation of the fetal risk was made. Phantom measurements were undertaken to assess the likely fetal dose. Film badges were used to estimate the scattered radiation energy. Measurements were made on a Varian 600C at 6 MV and Asea Brown Boveri (ABB) accelerator at 8 and 16 MV. Doses were measured at 30, 45 and 60 cm from the isocentre; the fetus was assumed to lie at about 60 cm and not closer than 45 cm from the isocentre. Estimated doses to the position of the fetus were lowest with the 6 MV Varian accelerator. Using this machine without additional abdominal shielding, the estimated dose on the surface at 45 cm from the tumour volume was 2.2 cGy for a tumour dose of 54 Gy; using the ABB accelerator, the dose varied between 49-59 cGy. The energy of scattered radiation was in the range 208-688 keV, so that additional shielding would be practical to further reduce the fetal dose. The risk of cancer up to the age of 15 years attributable to radiation is 1 in 1700 per cGy, of which half will be fatal (i.e. 1 in 3300 per cGy). A dose of 2.2 cGy adds a risk of fatal cancer by the age 15 years of only 1 in 1500. Because the addition of shielding might halve the fetal dose, this risk should be reduced to 1 in 3000. For comparison, the overall UK risk of cancer up to the age 15 years is 1 in 650. In conclusion, careful choice of linear accelerator for the treatment of a pregnant woman and the use of additional shielding is valuable, as this can dramatically affect fetal dose.

Microbial ecology, bacterial pathogens, and antibiotic resistant genes in swine manure wastewater as influenced by three swine management systems.

PubMed

Brooks, John P; Adeli, Ardeshir; McLaughlin, Michael R

2014-06-15

The environmental influence of farm management in concentrated animal feeding operations (CAFO) can yield vast changes to the microbial biota and ecological structure of both the pig and waste manure lagoon wastewater. While some of these changes may not be negative, it is possible that CAFOs can enrich antibiotic resistant bacteria or pathogens based on farm type, thereby influencing the impact imparted by the land application of its respective wastewater. The purpose of this study was to measure the microbial constituents of swine-sow, -nursery, and -finisher farm manure lagoon wastewater and determine the changes induced by farm management. A total of 37 farms were visited in the Mid-South USA and analyzed for the genes 16S rRNA, spaQ (Salmonella spp.), Camp-16S (Campylobacter spp.), tetA, tetB, ermF, ermA, mecA, and intI using quantitative PCR. Additionally, 16S rRNA sequence libraries were created. Overall, it appeared that finisher farms were significantly different from nursery and sow farms in nearly all genes measured and in 16S rRNA clone libraries. Nearly all antibiotic resistance genes were detected in all farms. Interestingly, the mecA resistance gene (e.g. methicillin resistant Staphylococcus aureus) was below detection limits on most farms, and decreased as the pigs aged. Finisher farms generally had fewer antibiotic resistance genes, which corroborated previous phenotypic data; additionally, finisher farms produced a less diverse 16S rRNA sequence library. Comparisons of Camp-16S and spaQ GU (genomic unit) values to previous culture data demonstrated ratios from 10 to 10,000:1 depending on farm type, indicating viable but not cultivatable bacteria were dominant. The current study indicated that swine farm management schemes positively and negatively affect microbial and antibiotic resistant populations in CAFO wastewater which has future "downstream" implications from both an environmental and public health perspective. Published by Elsevier Ltd.

SFB 754 - Managing a large interdisciplinary collaborative research centre: what matters?

NASA Astrophysics Data System (ADS)

Schelten, Christiane; Antia, Avan; Braker, Gesche; Kamm, Ruth; Mehrtens, Hela

2016-04-01

The German Research Foundation (DFG) funds Collaborative Research Centres (CRCs - in German: Sonderforschungsbereiche SFBs) that are generally applied for by one university, but may also incorporate neighbouring universities or non-university research institutions. SFBs are crossing the boundaries of disciplines, as well as faculties, departments, institutions and institutes. The funding of an SFB can be up to 12 years (3 x 4 years). Kiel University and GEOMAR Helmholtz Centre for Ocean Research Kiel received funding for the SFB 754 'Climate-biogeochemical interactions in the tropical ocean' in 2008. Currently, the centre is in its third phase comprising 17 scientific subprojects, one outreach project, a central coordination and management subproject and a subproject covering the research expeditions with a total project budget of 12 Mio Euro. Around 100 scientists of interdisciplinary research fields (e.g. physical oceanography, micro-biology, palaeontology, chemistry, modelling) are actively involved. Besides generating high profile research, gender equality, early career support and data management are complementary goals of SFBs requested by the DFG. Within the SFB 754 the scientific coordination office is responsible for developing concepts and strategies to cover these additional requirements and over the past eight years the SFB 754 has been successful in setting up profound programmes and various measures. Some of the SFB 754 practices have been taken up by other projects, and hence allowed the SFB 754 to serve as a role model for 'best practice' within marine sciences in Kiel. A main reason for the success of the SFB 754 to work towards the additional goals set out in the DFGs SFB programme is that the project is well tied into existing structures and builds upon outstanding management expertise available in Kiel. Three examples are highlighted here: • young scientists programme (closely linked to a graduate school (Integrated School of Marine Sciences) and a postdoctoral network (Integrated Marine Postdoc Network) both set up by 'The Future Ocean', a project funded within the German Excellence Initiative • gender measures (close cooperation with the Central Office for Gender Equality, Diversity & Family at Kiel University) • data management (part of a joint GEOMAR data management group) Thus, a motivated and also creative coordination team interested in pioneer work is essential to manage a large interdisciplinary research community. Overall, networking, transparent management tools linked to active communication as well as fairness in processes such as the distribution of funds are basic prerequisites of trustful cooperation in large scientific consortia. (This presentation is linked to posters by Dr. Nina Bergmann, Dr. Gesche Braker, Dr. Ruth Kamm and Dr. Hela Mehrtens.)

Characteristics of acute care hospitals with diversity plans and translation services.

PubMed

Moseley, Charles B; Shen, Jay J; Ginn, Gregory O

2011-01-01

Hospitals provide diversity activities for a number of reasons. The authors examined community demand, resource availability, managed care, institutional pressure, and external orientation related variables that were associated with acute care hospital diversity plans and translation services. The authors used multiple logistic regression to analyze the data for 478 hospitals in the 2006 National Inpatient Sample (NIS) dataset that had available data on the racial and ethnic status of their discharges. We also used 2004 and 2006 American Hospital Association (AHA) data to measure the two dependent diversity variables and the other independent variables. We found that resource, managed care, and external orientation variables were associated with having a diversity plan and that resource, managed care, institutional, and external orientation variables were associated with providing translation services. The authors concluded that more evidence for diversity's impact, additional resources, and more institutional pressure may be needed to motivate more hospitals to provide diversity planning and translation services.

Medical management and strategies to prevent coronary artery disease in patients with type 2 diabetes mellitus.

PubMed

Sheikh-Ali, Mae; Raheja, Prafull; Borja-Hart, Nancy

2013-01-01

Coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM) is associated with increased immediate and long-term mortality compared with patients without T2DM. The amplified incidence of CAD stems partly from the aggregation of multiple risk factors, such as obesity, dyslipidemia, and hypertension, which occur in this population. In addition, there appear to be increased forces at play at the molecular and vascular levels in these individuals, which is evidenced by the increased thrombosis and inflammation that is seen in those with diabetic atherosclerosis. Hence, there is a growing need to emphasize early and vigilant risk factor management in patients with T2DM to help reduce their burden of cardiovascular-related mortality. In this article, we review the primary and secondary prevention measures as well as the management of CAD in patients with T2DM.

Plant disease management in organic farming systems.

PubMed

van Bruggen, Ariena H C; Gamliel, Abraham; Finckh, Maria R

2016-01-01

Organic farming (OF) has significantly increased in importance in recent decades. Disease management in OF is largely based on the maintenance of biological diversity and soil health by balanced crop rotations, including nitrogen-fixing and cover crops, intercrops, additions of manure and compost and reductions in soil tillage. Most soil-borne diseases are naturally suppressed, while foliar diseases can sometimes be problematic. Only when a severe disease outbreak is expected are pesticides used that are approved for OF. A detailed overview is given of cultural and biological control measures. Attention is also given to regulated pesticides. We conclude that a systems approach to disease management is required, and that interdisciplinary research is needed to solve lingering disease problems, especially for OF in the tropics. Some of the organic regulations are in need of revision in close collaboration with various stakeholders. © 2015 Society of Chemical Industry.

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

PubMed Central

Howlett, Jonathan G; McKelvie, Robert S; Costigan, Jeannine; Ducharme, Anique; Estrella-Holder, Estrellita; Ezekowitz, Justin A; Giannetti, Nadia; Haddad, Haissam; Heckman, George A; Herd, Anthony M; Isaac, Debra; Kouz, Simon; Leblanc, Kori; Liu, Peter; Mann, Elizabeth; Moe, Gordon W; O’Meara, Eileen; Rajda, Miroslav; Siu, Samuel; Stolee, Paul; Swiggum, Elizabeth; Zeiroth, Shelley

2010-01-01

Since 2006, the Canadian Cardiovascular Society heart failure (HF) guidelines have published annual focused updates for cardiovascular care providers. The 2010 Canadian Cardiovascular Society HF guidelines update focuses on an increasing issue in the western world – HF in ethnic minorities – and in an uncommon but important setting – the pregnant patient. Additionally, due to increasing attention recently given to the assessment of how care is delivered and measured, two critically important topics – disease management programs in HF and quality assurance – have been included. Both of these topics were written from a clinical perspective. It is hoped that the present update will become a useful tool for health care providers and planners in the ongoing evolution of care for HF patients in Canada. PMID:20386768

Pilot of the Chronic Disease Self-Management Program (CDSMP) for Adolescents and Young Adults with Sickle Cell Disease

PubMed Central

Crosby, Lori E.; Joffe, Naomi E.; Peugh, James; Ware, Russell E.; Britto, Maria T.

2016-01-01

Purpose This study evaluated the feasibility of a group self-management intervention, the well-established Stanford Chronic Disease Self-Management Program (CDSMP), for adolescents and young adults (AYA) with sickle cell disease (SCD). Methods A total of 22 AYA participants with SCD, ages 16 to 24 years, completed self-efficacy and quality of life (HRQOL) measures before the CDSMP, after, and 3 and 6 months later. Results This AYA cohort showed significant improvements in self-efficacy (primary outcome) after the intervention. Analyses of follow-up data revealed a medium effect of the CDSMP on patient activation 3 months post although this was not sustained. Participants were highly satisfied, but only 64% completed the program. Conclusions This study demonstrates that the CDSMP is acceptable, and has the ability to improve self-efficacy. Additional research is needed to determine feasibility and evaluate health outcomes for AYA with SCD. PMID:27793727

Quality of working life: an antecedent to employee turnover intention.

PubMed

Mosadeghrad, Ali Mohammad

2013-06-01

The purpose of this study was to measure the level of quality of work life (QWL) among hospital employees in Iran. Additionally, it aimed to identify the factors that are critical to employees' QWL. It also aimed to test a theoretical model of the relationship between employees' QWL and their intention to leave the organization. A survey study was conducted based on a sample of 608 hospital employees using a validated questionnaire. Face, content and construct validity were conducted on the survey instrument. Hospital employees reported low QWL. Employees were least satisfied with pay, benefits, job promotion, and management support. The most important predictor of QWL was management support, followed by job proud, job security and job stress. An inverse relationship was found between employees QWL and their turnover intention. This study empirically examined the relationships between employees' QWL and their turnover intention. Managers can take appropriate actions to improve employees' QWL and subsequently reduce employees' turnover.

Emollient bath additives for the treatment of childhood eczema (BATHE): multicentre pragmatic parallel group randomised controlled trial of clinical and cost effectiveness.

PubMed

Santer, Miriam; Ridd, Matthew J; Francis, Nick A; Stuart, Beth; Rumsby, Kate; Chorozoglou, Maria; Becque, Taeko; Roberts, Amanda; Liddiard, Lyn; Nollett, Claire; Hooper, Julie; Prude, Martina; Wood, Wendy; Thomas, Kim S; Thomas-Jones, Emma; Williams, Hywel C; Little, Paul

2018-05-03

To determine the clinical effectiveness and cost effectiveness of including emollient bath additives in the management of eczema in children. Pragmatic randomised open label superiority trial with two parallel groups. 96 general practices in Wales and western and southern England. 483 children aged 1 to 11 years, fulfilling UK diagnostic criteria for atopic dermatitis. Children with very mild eczema and children who bathed less than once weekly were excluded. Participants in the intervention group were prescribed emollient bath additives by their usual clinical team to be used regularly for 12 months. The control group were asked to use no bath additives for 12 months. Both groups continued with standard eczema management, including leave-on emollients, and caregivers were given standardised advice on how to wash participants. The primary outcome was eczema control measured by the patient oriented eczema measure (POEM, scores 0-7 mild, 8-16 moderate, 17-28 severe) weekly for 16 weeks. Secondary outcomes were eczema severity over one year (monthly POEM score from baseline to 52 weeks), number of eczema exacerbations resulting in primary healthcare consultation, disease specific quality of life (dermatitis family impact), generic quality of life (child health utility-9D), utilisation of resources, and type and quantity of topical corticosteroid or topical calcineurin inhibitors prescribed. 483 children were randomised and one child was withdrawn, leaving 482 children in the trial: 51% were girls (244/482), 84% were of white ethnicity (447/470), and the mean age was 5 years. 96% (461/482) of participants completed at least one post-baseline POEM, so were included in the analysis, and 77% (370/482) completed questionnaires for more than 80% of the time points for the primary outcome (12/16 weekly questionnaires to 16 weeks). The mean baseline POEM score was 9.5 (SD 5.7) in the bath additives group and 10.1 (SD 5.8) in the no bath additives group. The mean POEM score over the 16 week period was 7.5 (SD. 6.0) in the bath additives group and 8.4 (SD 6.0) in the no bath additives group. No statistically significant difference was found in weekly POEM scores between groups over 16 weeks. After controlling for baseline severity and confounders (ethnicity, topical corticosteroid use, soap substitute use) and allowing for clustering of participants within centres and responses within participants over time, POEM scores in the no bath additives group were 0.41 points higher than in the bath additives group (95% confidence interval -0.27 to 1.10), below the published minimal clinically important difference for POEM of 3 points. The groups did not differ in secondary outcomes, economic outcomes, or adverse effects. This trial found no evidence of clinical benefit from including emollient bath additives in the standard management of eczema in children. Further research is needed into optimal regimens for leave-on emollient and soap substitutes. Current Controlled Trials ISRCTN84102309. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Cardiopulmonary measurements in dogs undergoing gastropexy without gastrectomy for correction of gastric dilatation-volvulus.

PubMed

Wagner, A E; Dunlop, C I; Chapman, P L

1999-08-15

To measure cardiopulmonary variables, including cardiac index, in dogs with naturally acquired gastric dilatation-volvulus (GDV). Prospective clinical study. 6 dogs with GDV. In addition to typical medical and surgical management of GDV, the dorsal metatarsal and pulmonary arteries and right atrium of the dogs were catheterized to obtain cardiopulmonary measurements before and during anesthesia and surgery. All dogs underwent gastropexy but none required gastrectomy. Mean cardiac index and mean arterial blood pressure for this small population of dogs with GDV were not significantly different from those reported for clinically normal awake or anesthetized dogs. Dogs with naturally acquired GDV without gastric necrosis may not have the classic characteristics, including decreased cardiac index and hypotension, of hypovolemic circulatory shock.

50 CFR 648.108 - Framework adjustments to management measures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 8 2010-10-01 2010-10-01 false Framework adjustments to management measures. 648.108 Section 648.108 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL... Management Measures for the Summer Flounder Fisheries § 648.108 Framework adjustments to management measures...

Development of process data capturing, analysis and controlling for thermal spray techniques - SprayTracker

NASA Astrophysics Data System (ADS)

Kelber, C.; Marke, S.; Trommler, U.; Rupprecht, C.; Weis, S.

2017-03-01

Thermal spraying processes are becoming increasingly important in high-technology areas, such as automotive engineering and medical technology. The method offers the advantage of a local layer application with different materials and high deposition rates. Challenges in the application of thermal spraying result from the complex interaction of different influencing variables, which can be attributed to the properties of different materials, operating equipment supply, electrical parameters, flow mechanics, plasma physics and automation. In addition, spraying systems are subject to constant wear. Due to the process specification and the high demands on the produced coatings, innovative quality assurance tools are necessary. A central aspect, which has not yet been considered, is the data management in relation to the present measured variables, in particular the spraying system, the handling system, working safety devices and additional measuring sensors. Both the recording of all process-characterizing variables, their linking and evaluation as well as the use of the data for the active process control presuppose a novel, innovative control system (hardware and software) that was to be developed within the scope of the research project. In addition, new measurement methods and sensors are to be developed and qualified in order to improve the process reliability of thermal spraying.

A study of the additional costs of dispensing workers' compensation prescriptions.

PubMed

Schafermeyer, Kenneth W

2007-03-01

Although there is a significant amount of additional work involved in dispensing workers' compensation prescriptions, these costs have not been quantified. A study of the additional costs to dispense a workers' compensation prescription is needed to measure actual costs and to help determine the reasonableness of reimbursement for prescriptions dispensed under workers' compensation programs. The purpose of this study was to determine the minimum additional time and costs required to dispense workers' compensation prescriptions in Texas. A convenience sample of 30 store-level pharmacy staff members involved in submitting and processing prescription claims for the Texas Mutual workers' compensation program were interviewed by telephone. Data collected to determine the additional costs of dispensing a workers' compensation prescription included (1) the amount of additional time and personnel costs required to dispense and process an average workers' compensation prescription claim, (2) the difference in time required for a new versus a refilled prescription, (3) overhead costs for processing workers' compensation prescription claims by experienced experts at a central processing facility, (4) carrying costs for workers' compensation accounts receivable, and (5) bad debts due to uncollectible workers' compensation claims. The median of the sample pharmacies' additional costs for dispensing a workers' compensation prescription was estimated to be at least $9.86 greater than for a cash prescription. This study shows that the estimated costs for workers' compensation prescriptions were significantly higher than for cash prescriptions. These costs are probably much more than most employers, workers' compensation payers, and pharmacy managers would expect. It is recommended that pharmacy managers should estimate their own costs and compare these costs to actual reimbursement when considering the reasonableness of workers' compensation prescriptions and whether to accept these prescriptions.

50 CFR 648.130 - Scup framework adjustments to management measures.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 50 Wildlife and Fisheries 12 2013-10-01 2013-10-01 false Scup framework adjustments to management measures. 648.130 Section 648.130 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL... Management Measures for the Scup Fishery § 648.130 Scup framework adjustments to management measures. (a...

50 CFR 648.130 - Scup framework adjustments to management measures.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false Scup framework adjustments to management measures. 648.130 Section 648.130 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL... Management Measures for the Scup Fishery § 648.130 Scup framework adjustments to management measures. (a...

50 CFR 648.130 - Scup framework adjustments to management measures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 50 Wildlife and Fisheries 10 2011-10-01 2011-10-01 false Scup framework adjustments to management measures. 648.130 Section 648.130 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL... Management Measures for the Scup Fishery § 648.130 Scup framework adjustments to management measures. (a...

50 CFR 648.130 - Scup framework adjustments to management measures.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 50 Wildlife and Fisheries 12 2012-10-01 2012-10-01 false Scup framework adjustments to management measures. 648.130 Section 648.130 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL... Management Measures for the Scup Fishery § 648.130 Scup framework adjustments to management measures. (a...

Co-occurring nonnative woody shrubs have additive and non-additive soil legacies.

PubMed

Kuebbing, Sara E; Patterson, Courtney M; Classen, Aimée T; Simberloff, Daniel

2016-09-01

To maximize limited conservation funds and prioritize management projects that are likely to succeed, accurate assessment of invasive nonnative species impacts is essential. A common challenge to prioritization is a limited knowledge of the difference between the impacts of a single nonnative species compared to the impacts of nonnative species when they co-occur, and in particular predicting when impacts of co-occurring nonnative species will be non-additive. Understanding non-additivity is important for management decisions because the management of only one co-occurring invader will not necessarily lead to a predictable reduction in the impact or growth of the other nonnative plant. Nonnative plants are frequently associated with changes in soil biotic and abiotic characteristics, which lead to plant-soil interactions that influence the performance of other species grown in those soils. Whether co-occurring nonnative plants alter soil properties additively or non-additively relative to their effects on soils when they grow in monoculture is rarely addressed. We use a greenhouse plant-soil feedback experiment to test for non-additive soil impacts of two common invasive nonnative woody shrubs, Lonicera maackii and Ligustrum sinense, in deciduous forests of the southeastern United States. We measured the performance of each nonnative shrub, a native herbaceous community, and a nonnative woody vine in soils conditioned by each shrub singly or together in polyculture. Soils conditioned by both nonnative shrubs had non-additive impacts on native and nonnative performance. Root mass of the native herbaceous community was 1.5 times lower and the root mass of the nonnative L. sinense was 1.8 times higher in soils conditioned by both L. maackii and L. sinense than expected based upon growth in soils conditioned by either shrub singly. This result indicates that when these two nonnative shrubs co-occur, their influence on soils disproportionally favors persistence of the nonnative L. sinense relative to this native herbaceous community, and could provide an explanation of why native species abundance is frequently depressed in these communities. Additionally, the difference between native and nonnative performance demonstrates that invasive impact studies focusing on the impact only of single species can be insufficient for determining the impact of co-occurring invasive plant species. © 2016 by the Ecological Society of America.

78 FR 9660 - Pacific Halibut Fisheries; Catch Sharing Plan

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-11

... management measures that are not implemented through the IPHC. These measures include the sport fishery... Fishery Management Measures In this rulemaking, NMFS also proposes sport fishery management measures that.... In section 26 of the annual domestic management measures, ``Sport Fishing for Halibut,'' paragraph 1...

Make or Buy: Cost Impacts of Additive Manufacturing, 3D Laser Scanning Technology, and Collaborative Product Lifecycle Management on Ship Maintenance and Modernization

DTIC Science & Technology

2015-05-01

management during operations 4 Potential Technology 3: Additive Manufacturing (“ 3D Printing ”) 5 • 3D design/image (e.g. from 3D LS) of final part...1 Make or Buy: Cost Impacts of Additive Manufacturing, 3D Laser Scanning Technology, and Collaborative Product Lifecycle Management on Ship...DATES COVERED 00-00-2015 to 00-00-2015 4. TITLE AND SUBTITLE Make or Buy: Cost Impacts of Additive Manufacturing, 3D Laser Scanning Technology

Citizen empowerment in the domestic waste policy development in Lithuania

NASA Astrophysics Data System (ADS)

Stasiukynas, Andrius; Survila, Arvydas; Smalskys, Vainius

2017-04-01

Lithuania offers an interesting case of lagging in terms of domestic waste recycling in the European context. Despite the adoption of all relevant EU regulation, including a pricing system, which is designed to be more conducive for recycling. One important group of policy instruments which in the application of which Lithuania needs to improve, is public participation in environmental governance. The objective of this study is to relate the means of public participation and the decision-making on waste management and recycling outcomes. The study consisted of two stages. Stage one: key decision-making public agencies responsible for policy formulation and implementation of domestic waste management were identified. Later, an analysis of public available documentation covering decision-making in these institutions was conducted with the aim to measure the level of citizen engagement. Stage two: agency managers and staff responsible for citizen engagement were interviewed with the goal of evaluating their attitudes. Attitudes of officials are a crucial for a successful citizen engagement. The results showed that officials recognized very little the value of citizen engagement. They perceived contribution as an the creation of additional challenges to be tackled with, rather than help to lower service delivery costs and improve policy effectiveness. This renders the government with a depleted number of options of improving domestic waste management to "top-down" measures and imposition of financial incentives or costs.

Multidimensional Patient Impression of Change Following Interdisciplinary Pain Management.

PubMed

Gagnon, Christine M; Scholten, Paul; Atchison, James

2018-04-20

To assess patient impression of change following interdisciplinary pain management utilizing a newly developed Multidimensional Patient Impression of Change (MPIC) questionnaire. A heterogeneous group of chronic pain patients (N = 601) participated in an interdisciplinary treatment program. Programs included individual and group therapies (pain psychology, physical therapy, occupational therapy, relaxation training/biofeedback, aerobic conditioning, patient education and medical management). Patients completed measures of pain, mood, coping, physical functioning and pain acceptance both prior to and at completion of their treatment programs. The newly developed MPIC is an expansion to the Patient Global Impression of Change (PGIC) including seven additional domains (Pain, Mood, Sleep, Physical Functioning, Cope with Pain, Manage Pain Flare-ups, and Medication Effectiveness). The MPIC was administered to the patients post-treatment. There were statistically significant pre- to post-treatment improvements found on all outcome measures. The majority of these improvements were significantly correlated with all domains of the MPIC. The original PGIC item was significantly associated with all of the new MPIC domains and the domains were significantly associated with each other; but there were variations in the distribution of responses highlighting variation of perceived improvements among the domains. Our results support the use of the MPIC as a quick and easy post-treatment assessment screening tool. Future research is needed to examine relevant correlates to Medication Effectiveness. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Reservoir Sedimentation and Upstream Sediment Sources: Perspectives and Future Research Needs on Streambank and Gully Erosion.

PubMed

Fox, G A; Sheshukov, A; Cruse, R; Kolar, R L; Guertault, L; Gesch, K R; Dutnell, R C

2016-05-01

The future reliance on water supply and flood control reservoirs across the globe will continue to expand, especially under a variable climate. As the inventory of new potential dam sites is shrinking, construction of additional reservoirs is less likely compared to simultaneous flow and sediment management in existing reservoirs. One aspect of this sediment management is related to the control of upstream sediment sources. However, key research questions remain regarding upstream sediment loading rates. Highlighted in this article are research needs relative to measuring and predicting sediment transport rates and loading due to streambank and gully erosion within a watershed. For example, additional instream sediment transport and reservoir sedimentation rate measurements are needed across a range of watershed conditions, reservoir sizes, and geographical locations. More research is needed to understand the intricate linkage between upland practices and instream response. A need still exists to clarify the benefit of restoration or stabilization of a small reach within a channel system or maturing gully on total watershed sediment load. We need to better understand the intricate interactions between hydrological and erosion processes to improve prediction, location, and timing of streambank erosion and failure and gully formation. Also, improved process-based measurement and prediction techniques are needed that balance data requirements regarding cohesive soil erodibility and stability as compared to simpler topographic indices for gullies or stream classification systems. Such techniques will allow the research community to address the benefit of various conservation and/or stabilization practices at targeted locations within watersheds.

Reservoir Sedimentation and Upstream Sediment Sources: Perspectives and Future Research Needs on Streambank and Gully Erosion

NASA Astrophysics Data System (ADS)

Fox, G. A.; Sheshukov, A.; Cruse, R.; Kolar, R. L.; Guertault, L.; Gesch, K. R.; Dutnell, R. C.

2016-05-01

The future reliance on water supply and flood control reservoirs across the globe will continue to expand, especially under a variable climate. As the inventory of new potential dam sites is shrinking, construction of additional reservoirs is less likely compared to simultaneous flow and sediment management in existing reservoirs. One aspect of this sediment management is related to the control of upstream sediment sources. However, key research questions remain regarding upstream sediment loading rates. Highlighted in this article are research needs relative to measuring and predicting sediment transport rates and loading due to streambank and gully erosion within a watershed. For example, additional instream sediment transport and reservoir sedimentation rate measurements are needed across a range of watershed conditions, reservoir sizes, and geographical locations. More research is needed to understand the intricate linkage between upland practices and instream response. A need still exists to clarify the benefit of restoration or stabilization of a small reach within a channel system or maturing gully on total watershed sediment load. We need to better understand the intricate interactions between hydrological and erosion processes to improve prediction, location, and timing of streambank erosion and failure and gully formation. Also, improved process-based measurement and prediction techniques are needed that balance data requirements regarding cohesive soil erodibility and stability as compared to simpler topographic indices for gullies or stream classification systems. Such techniques will allow the research community to address the benefit of various conservation and/or stabilization practices at targeted locations within watersheds.

Irritable bowel syndrome in general practice: an overview.

PubMed

Oberndorff-Klein Woolthuis, A H; Brummer, R J M; de Wit, N J; Muris, J W M; Stockbrügger, R W

2004-01-01

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that is frequently seen in gastroenterological practice. Population-based studies have shown that at any point in time IBS symptoms are present in about 3%-22% of the general Western population. In general practice, half of all new patients have functional disorders and IBS is responsible for about five consultations per week. General practitioners (GPs) manage the majority of IBS patients, but most knowledge (and research) is based on the smaller percentage of patients managed in secondary care. There is a paucity of literature on differences or similarities between these two groups with regard to clinical characteristics or diagnostic approach. The literature published in English about IBS in general practice was reviewed. Irritable bowel syndrome is frequently encountered in primary care. Primary care IBS patients, compared to secondary care patients, are likely to be young, female and to have less severe symptoms. But this is only true for some symptoms; for example, non-abdominal complaints are equally reported in both groups. The disorder can be diagnosed safely using internationally agreed symptom-based criteria, such as the Rome II criteria. Additional diagnostic measures will be necessary to support the diagnosis in only a minority of situations. Many primary care IBS patients can be managed given adequate reassurance and education, frequently without additional pharmacological treatment.

44 CFR 13.6 - Additions and exceptions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Additions and exceptions. 13.6 Section 13.6 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT... requirements except in codified regulations published in the Federal Register. (b) Exceptions for classes of...

Coordination of short-term and long-term mitigation measures of hydro-meteorological risks: the importance of establishing a link between emergency management and spatial planning

NASA Astrophysics Data System (ADS)

Prenger-Berninghoff, Kathrin; Cortes, V. Juliette; Aye, Zar Chi; Sprague, Teresa

2013-04-01

The management of natural hazards involves, as generally known, the four stages of the risk management cycle: Prevention, preparedness, response and recovery. Accordingly, the mitigation of disasters can be performed in terms of short-term and long-term purposes. Whereas emergency management or civil protection helps to strengthen a community's capacity to be better prepared for natural hazards and to better respond in case a disaster strikes, thus addressing the short-term perspective, spatial planning serves long-term planning goals and can therefore implement long-term prevention measures. A purposefully applied risk mitigation strategy requires coordination of short-term and long-term mitigation measures and thus an effective coordination of emergency management and spatial planning. Several actors are involved in risk management and should consequently be linked throughout the whole risk management cycle. However, these actors, partly because of a historically fragmented administrative system, are hardly connected to each other, with spatial planning only having a negligible role compared to other actors1, a problem to which Young (2002) referred to as the "problem of interplay". In contrast, information transfer and decision-taking happen at the same time and are not coordinated among different actors. This applies to the prevention and preparedness phase as well as to the recovery phase, which basically constitutes the prevention phase for the next disaster2. Since investments in both risk prevention and emergency preparedness and response are considered necessary, a better coordination of the two approaches is required. In this regard, Decision Support Systems (DSS) can be useful in order to provide support in the decision-making aspect of risk management. The research work currently undertaken examines the problem of interplay in the four case study areas of the Marie Curie ITN, CHANGES3. The link between different risk management actors will be explored by means of exploratory questionnaires and interviews with government agencies, local administrations, community and research organizations on each study site. First results provided will address the general role of spatial planning in risk management. Additionally, preliminary observations are made in regard to the coordination of emergency preparedness and long-term spatial planning activities. The observations consider that integration facilitates proactive strategies that aim at preventing disaster occurrence and promote interaction between involved parties. Finally, consideration is given to the potential use of a DSS tool to cover both aspects of spatial planning and emergency management in the risk management cycle.

Morphological evidence for discrete stocks of yellow perch in Lake Erie

USGS Publications Warehouse

Kocovsky, Patrick M.; Knight, Carey T.

2012-01-01

Identification and management of unique stocks of exploited fish species are high-priority management goals in the Laurentian Great Lakes. We analyzed whole-body morphometrics of 1430 yellow perch Perca flavescens captured during 2007–2009 from seven known spawning areas in Lake Erie to determine if morphometrics vary among sites and management units to assist in identification of spawning stocks of this heavily exploited species. Truss-based morphometrics (n = 21 measurements) were analyzed using principal component analysis followed by ANOVA of the first three principal components to determine whether yellow perch from the several sampling sites varied morphometrically. Duncan's multiple range test was used to determine which sites differed from one another to test whether morphometrics varied at scales finer than management unit. Morphometrics varied significantly among sites and annually, but differences among sites were much greater. Sites within the same management unit typically differed significantly from one another, indicating morphometric variation at a scale finer than management unit. These results are largely congruent with recently-published studies on genetic variation of yellow perch from many of the same sampling sites. Thus, our results provide additional evidence that there are discrete stocks of yellow perch in Lake Erie and that management units likely comprise multiple stocks.

What we know about the purpose, theoretical foundation, scope and dimensionality of existing self-management measurement tools: A scoping review.

PubMed

Packer, Tanya L; Fracini, America; Audulv, Åsa; Alizadeh, Neda; van Gaal, Betsie G I; Warner, Grace; Kephart, George

2018-04-01

To identify self-report, self-management measures for adults with chronic conditions, and describe their purpose, theoretical foundation, dimensionality (multi versus uni), and scope (generic versus condition specific). A search of four databases (8479 articles) resulted in a scoping review of 28 self-management measures. Although authors identified tools as measures of self-management, wide variation in constructs measured, purpose, and theoretical foundations existed. Subscales on 13 multidimensional tools collectively measure domains of self-management relevant to clients, however no one tool's subscales cover all domains. Viewing self-management as a complex, multidimensional whole, demonstrated that existing measures assess different, related aspects of self-management. Activities and social roles, though important to patients, are rarely measured. Measures with capacity to quantify and distinguish aspects of self-management may promote tailored patient care. In selecting tools for research or assessment, the reason for development, definitions, and theories underpinning the measure should be scrutinized. Our ability to measure self-management must be rigorously mapped to provide comprehensive and system-wide care for clients with chronic conditions. Viewing self-management as a complex whole will help practitioners to understand the patient perspective and their contribution in supporting each individual patient. Copyright © 2017 Elsevier B.V. All rights reserved.

Thermal analysis and management of lithium-titanate batteries

NASA Astrophysics Data System (ADS)

Giuliano, Michael R.; Advani, Suresh G.; Prasad, Ajay K.

2011-08-01

Battery electric vehicles and hybrid electric vehicles demand batteries that can store large amounts of energy in addition to accommodating large charge and discharge currents without compromising battery life. Lithium-titanate batteries have recently become an attractive option for this application. High current thresholds allow these cells to be charged quickly as well as supply the power needed to drive such vehicles. These large currents generate substantial amounts of waste heat due to loss mechanisms arising from the cell's internal chemistry and ohmic resistance. During normal vehicle operation, an active cooling system must be implemented to maintain a safe cell temperature and improve battery performance and life. This paper outlines a method to conduct thermal analysis of lithium-titanate cells under laboratory conditions. Thermochromic liquid crystals were implemented to instantaneously measure the entire surface temperature field of the cell. The resulting temperature measurements were used to evaluate the effectiveness of an active cooling system developed and tested in our laboratory for the thermal management of lithium-titanate cells.

A randomized trial comparing INR monitoring devices in patients with anticoagulation self-management: evaluation of a novel error-grid approach.

PubMed

Hemkens, Lars G; Hilden, Kristian M; Hartschen, Stephan; Kaiser, Thomas; Didjurgeit, Ulrike; Hansen, Roland; Bender, Ralf; Sawicki, Peter T

2008-08-01

In addition to the metrological quality of international normalized ratio (INR) monitoring devices used in patients' self-management of long-term anticoagulation, the effectiveness of self-monitoring with such devices has to be evaluated under real-life conditions with a focus on clinical implications. An approach to evaluate the clinical significance of inaccuracies is the error-grid analysis as already established in self-monitoring of blood glucose. Two anticoagulation monitors were compared in a real-life setting and a novel error-grid instrument for oral anticoagulation has been evaluated. In a randomized crossover study 16 patients performed self-management of anticoagulation using the INRatio and the CoaguChek S system. Main outcome measures were clinically relevant INR differences according to established criteria and to the error-grid approach. A lower rate of clinically relevant disagreements according to Anderson's criteria was found with CoaguChek S than with INRatio without statistical significance (10.77% vs. 12.90%; P = 0.787). Using the error-grid we found principally consistent results: More measurement pairs with discrepancies of no or low clinical relevance were found with CoaguChek S, whereas with INRatio we found more differences with a moderate clinical relevance. A high rate of patients' satisfaction with both of the point of care devices was found with only marginal differences. A principal appropriateness of the investigated point-of-care devices to adequately monitor the INR is shown. The error-grid is useful for comparing monitoring methods with a focus on clinical relevance under real-life conditions beyond assessing the pure metrological quality, but we emphasize that additional trials using this instrument with larger patient populations are needed to detect differences in clinically relevant disagreements.

Simulating human photoreceptor optics using a liquid-filled photonic crystal fiber.

PubMed

Rativa, Diego; Vohnsen, Brian

2011-02-11

We introduce a liquid-filled photonic crystal fiber to simulate a retinal cone photoreceptor mosaic and the directionality selective mechanism broadly known as the Stiles-Crawford effect. Experimental measurements are realized across the visible spectrum to study waveguide coupling and directionality at different managed waveguide parameters. The crystal fiber method is a hybrid tool between theory and a real biological sample and a valuable addition as a retina model for real eye simulations.

Exposure to major volatile organic compounds and carbonyls in European indoor environments and associated health risk.

PubMed

Sarigiannis, Dimosthenis A; Karakitsios, Spyros P; Gotti, Alberto; Liakos, Ioannis L; Katsoyiannis, Athanasios

2011-05-01

This paper summarizes recent data on the occurrence of major organic compounds (benzene, toluene, xylenes, styrene, acetaldehyde, formaldehyde, naphthalene, limonene, α-pinene and ammonia, classified by the European Commission's INDEX strategy report as the priority pollutants to be regulated) and evaluates accordingly cancer and non-cancer risks posed by indoor exposure in dwellings and public buildings in European Union (EU) countries. The review process indicated that significant differences in indoor air quality exist within and among the countries where data were available, indicating corresponding differences in sources and emission strength of airborne chemicals, identified or not. Conservative exposure limits were not exceeded for non-carcinogenic effects, except for formaldehyde; for carcinogenic agents the estimated risks were up to three orders of magnitude higher than the one (10(-6)) proposed as acceptable by risk management bodies. However, the risk assessment evaluation process faces crucial difficulties, either due to the relative paucity of indoor air quality measurements in many EU countries, or by the lack of sampling consistency in the already existing studies, indicating the need for additional measurements of indoor air quality following a harmonized sampling and analytical protocol. Additionally, uncertainties embodied in the cancer potency factors and exposure limit values impose further difficulties in substance prioritization and risk management. Copyright © 2011 Elsevier Ltd. All rights reserved.

Management of persistent postconcussion symptoms in youth: a randomised control trial protocol

PubMed Central

Reed, Nick; Greenspoon, Dayna; Iverson, Grant L; DeMatteo, Carol; Fait, Philippe; Gauvin-Lepage, Jérôme; Hunt, Anne; Gagnon, Isabelle J

2015-01-01

Introduction Current management of concussion consists of early education, rest until symptom free, with gradual return to school and physical activity protocols. Although this management strategy is effective for most youth who sustain a concussion, it is not an appropriate strategy for youth with persistent postconcussion symptoms. Prolonged rest and periods of restricted activity may place youth at risk for secondary issues and contribute to the chronicity of postconcussion symptoms. The purpose of this study is to evaluate the efficacy of an active rehabilitation protocol for youth who are slow to recover from concussion. It is hypothesised that an active rehabilitation intervention can reduce persistent postconcussion symptoms, improve function and facilitate return to activity. This article describes the research protocol. Methods and analysis This is a randomised clinical trial with blinded outcome measurement. Participants will be recruited and randomly assigned to 1 of 2 treatment groups, an active rehabilitation intervention or a standard care education group. Both groups will receive standard care education. However, the active rehabilitation group will participate in an additional low-intensity exercise programme consisting of aerobic, coordination and visualisation exercises. Both the active rehabilitation and the standard care education interventions will be 6 weeks in duration. The primary outcome measure is postconcussion symptoms. Secondary outcome measures include functional recovery (cognitive, motor, psychosocial and emotional functioning) and return to activity. Outcome measures will be administered preintervention and postintervention. The primary outcome measure will also be repeated 2 weeks into the intervention period. Ethics and dissemination This study has been approved by the Holland Bloorview Kids Rehabilitation Hospital research ethics board (REB # 13-459). The findings from this study will be shared with the general public, sport associations, relevant brain injury organisations and healthcare professionals. Trial registration number NCT02257749. PMID:26231756

Delineation and validation of river network spatial scales for water resources and fisheries management.

PubMed

Wang, Lizhu; Brenden, Travis; Cao, Yong; Seelbach, Paul

2012-11-01

Identifying appropriate spatial scales is critically important for assessing health, attributing data, and guiding management actions for rivers. We describe a process for identifying a three-level hierarchy of spatial scales for Michigan rivers. Additionally, we conduct a variance decomposition of fish occurrence, abundance, and assemblage metric data to evaluate how much observed variability can be explained by the three spatial scales as a gage of their utility for water resources and fisheries management. The process involved the development of geographic information system programs, statistical models, modification by experienced biologists, and simplification to meet the needs of policy makers. Altogether, 28,889 reaches, 6,198 multiple-reach segments, and 11 segment classes were identified from Michigan river networks. The segment scale explained the greatest amount of variation in fish abundance and occurrence, followed by segment class, and reach. Segment scale also explained the greatest amount of variation in 13 of the 19 analyzed fish assemblage metrics, with segment class explaining the greatest amount of variation in the other six fish metrics. Segments appear to be a useful spatial scale/unit for measuring and synthesizing information for managing rivers and streams. Additionally, segment classes provide a useful typology for summarizing the numerous segments into a few categories. Reaches are the foundation for the identification of segments and segment classes and thus are integral elements of the overall spatial scale hierarchy despite reaches not explaining significant variation in fish assemblage data.

Delinquent Medical Service Accounts at Naval Medical Center Portsmouth Need Additional Management Oversight

DTIC Science & Technology

2015-03-04

H 4 , 2 0 1 5 Delinquent Medical Service Accounts at Naval Medical Center Portsmouth Need Additional Management Oversight Report No. DODIG-2015...04 MAR 2015 2. REPORT TYPE 3. DATES COVERED 00-00-2015 to 00-00-2015 4. TITLE AND SUBTITLE Delinquent Medical Service Accounts at Naval...i Results in Brief Delinquent Medical Service Accounts at Naval Medical Center Portsmouth Need Additional Management Oversight Visit us at

Skylab

NASA Image and Video Library

1972-05-01

This image is a wide-angle view of the Orbital Workshop waste management compartment. The waste management facilities presented a unique challenge to spacecraft designers. In addition to collection of liquid and solid human wastes, there was a medical requirement to dry all solid human waste products and to return the residue to Earth for examination. Liquid human waste (urine) was frozen for return to Earth. Total quantities of each astronaut's liquid and solid wastes were precisely measured. Cabin air was drawn into the toilet, shown on the wall at right in this photograph, and over the waste products to generate a flow of the waste in the desired direction. The air was then filtered for odor control and antiseptic purposes prior to being discharged back into the cabin.

Para-phenylenediamine allergy: current perspectives on diagnosis and management

PubMed Central

Mukkanna, Krishna Sumanth; Stone, Natalie M; Ingram, John R

2017-01-01

Para-phenylenediamine (PPD) is the commonest and most well-known component of hair dyes. Oxidative hair dyes and dark henna temporary tattoos contain PPD. Individuals may be sensitized to PPD by temporary henna tattooing in addition to dyeing their hair. PPD allergy can cause severe reactions and may result in complications. In recent years, frequency of positive patch test reactions to PPD has been increasing. Cross-sensitization to other contact allergens may occur, in particular to other hair dye components. Hairdressers are at a high risk for PPD allergy and require counseling regarding techniques to minimize exposure and protective measures while handling hair dye. We focus this review on the current perspectives of diagnosis and management of PPD allergy. PMID:28176912

Combining computerized social cognitive training with neuroplasticity-based auditory training in schizophrenia.

PubMed

Sacks, Stephanie; Fisher, Melissa; Garrett, Coleman; Alexander, Phillip; Holland, Christine; Rose, Demian; Hooker, Christine; Vinogradov, Sophia

2013-01-01

Social cognitive deficits are an important treatment target in schizophrenia, but it is unclear to what degree they require specialized interventions and which specific components of behavioral interventions are effective. In this pilot study, we explored the effects of a novel computerized neuroplasticity-based auditory training delivered in conjunction with computerized social cognition training (SCT) in patients with schizophrenia. Nineteen clinically stable schizophrenia subjects performed 50 hours of computerized exercises that place implicit, increasing demands on auditory perception, plus 12 hours of computerized training in emotion identification, social perception, and theory of mind tasks. All subjects were assessed with MATRICS-recommended measures of neurocognition and social cognition, plus a measure of self-referential source memory before and after the computerized training. Subjects showed significant improvements on multiple measures of neurocognition. Additionally, subjects showed significant gains on measures of social cognition, including the MSCEIT Perceiving Emotions, MSCEIT Managing Emotions, and self-referential source memory, plus a significant decrease in positive symptoms. Computerized training of auditory processing/verbal learning in schizophrenia results in significant basic neurocognitive gains. Further, addition of computerized social cognition training results in significant gains in several social cognitive outcome measures. Computerized cognitive training that directly targets social cognitive processes can drive improvements in these crucial functions.

The effectiveness of transcutaneous electrical nerve stimulation in the management of patients with complex regional pain syndrome: A randomized, double-blinded, placebo-controlled prospective study.

PubMed

Bilgili, Adem; Çakır, Tuncay; Doğan, Şebnem Koldaş; Erçalık, Tülay; Filiz, Meral Bilgilisoy; Toraman, Füsun

2016-11-21

To investigate the effect of transcutaneous electrical nerve stimulation (TENS) on clinical recovery in the management of patients with complex regional pain syndrome Type I (CRPS Type I). The study included 30 patients with stage 1 and 2 CRPS Type I in the upper extremities. The patients were randomly assigned into 2 groups, group 1 (n= 15) received conventional TENS therapy for 20 minutes, and group 2 (n= 15) received sham TENS therapy. The standard physical therapy program, which included contrast bath for 20 minutes; whirlpool bath for 15 minutes; assisted active and passive range of motion, and static stretching exercises up to the pain threshold, was also conducted in both groups. Therapy was scheduled for 15 sessions. A visual analogue scale (VAS) was used to assess spontaneous pain. The Leeds Assessment of Neuropathic Signs and Symptoms (LANSS) scale and the Douleur Neuropathique en 4 Questions (DN-4) were used to assess neuropathic pain. In addition, range of motion (ROM) was measured using a goniometer and volumetric measurements were taken to assess edema. Functional capacity was assessed using a hand dynamometer and the Duruöz Hand Index (DHI). All measurements were performed at baseline and after therapy. Significant improvements were achieved in spontaneous and neuropathic pain scores, edema, ROM, and functional capacity in both groups (p< 0.05). However, improvement was found to be significantly greater in group 1 regarding pain intensity, neuropathic pain assessed using LANNS, edema, and in the 2nd-3rd finger ROM measurements (p< 0.05). No significant difference was detected between groups regarding improvements in 4th-5th finger and wrist ROM measurements, grip strength, and DN4 and DHI scores (p> 0.05). The addition of TENS to the physical therapy program was seen to make a significant contribution to clinical recovery in CRPS Type 1.

78 FR 79636 - Restructuring of Regulations on the Importation of Plants for Planting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-31

...We are reopening the comment period for our proposed rule that would restructure the regulations governing the importation of plants for planting. We are requesting comments on our proposed framework for integrated pest risk management measures for plants for planting. We are especially interested in: The differences commenters perceive between International Standard for Phytosanitary Measures No. 36 and the North American Plant Protection Organization's Regional Standard for Phytosanitary Measures No. 24, and reasons to prefer one over the other as a basis for such measures; and how to address the risk posed when plant brokers purchase and move plants for planting after they leave their place of production and before they are exported to the United States. This action will allow interested persons additional time to prepare and submit comments on these topics.

Carbon stocks and carbon fluxes from a 10 year prescribed burning chronosequence on a UK blanket peat.

NASA Astrophysics Data System (ADS)

Clay, G. D.; Worrall, F.

2012-04-01

Prescribed burning is a common land management technique in many areas of the UK uplands. However, concern has been expressed at the impact of this management practice on carbon stocks and fluxes found in the carbon rich peat soils that underlie many of these areas. Existing data shows a range of results at differing spatial and temporal scales for a range of carbon pathways e.g. dissolved organic carbon (DOC), yet there are limited studies that monitor a suite of parameters under burning management. This study measured both carbon stocks and carbon fluxes from a chronosequence of prescribed burn sites in northern England. A range of carbon parameters were measured including: above-ground biomass and carbon stocks; net ecosystem exchange (NEE); ecosystem respiration (Reco); photosynthesis (Pg); and particulate organic carbon (POC). CO2 data was analysed using ANOVA to investigate any significant differences between burn years. Carbon budgets were also calculated using measured and modelled data. Analysis of the CO2 data showed that burning was a significant factor in measured CO2 readings but that other factors such as month of sampling explained a greater proportion of the variation in the data. Carbon budget results show that whilst all the sites were net sources of carbon, the most recent burns were smaller sources of carbon compared to the older burns (Burn year 2009: 85 ± 29 gC/m2/yr; Burn year 1999: 152 ± 12 gC/m2/yr). Additionally, the most recent burns were net sinks of gaseous CO2.

Correlation between safety climate and contractor safety assessment programs in construction.

PubMed

Sparer, Emily H; Murphy, Lauren A; Taylor, Kathryn M; Dennerlein, Jack T

2013-12-01

Contractor safety assessment programs (CSAPs) measure safety performance by integrating multiple data sources together; however, the relationship between these measures of safety performance and safety climate within the construction industry is unknown. Four hundred and one construction workers employed by 68 companies on 26 sites and 11 safety managers employed by 11 companies completed brief surveys containing a nine-item safety climate scale developed for the construction industry. CSAP scores from ConstructSecure, Inc., an online CSAP database, classified these 68 companies as high or low scorers, with the median score of the sample population as the threshold. Spearman rank correlations evaluated the association between the CSAP score and the safety climate score at the individual level, as well as with various grouping methodologies. In addition, Spearman correlations evaluated the comparison between manager-assessed safety climate and worker-assessed safety climate. There were no statistically significant differences between safety climate scores reported by workers in the high and low CSAP groups. There were, at best, weak correlations between workers' safety climate scores and the company CSAP scores, with marginal statistical significance with two groupings of the data. There were also no significant differences between the manager-assessed safety climate and the worker-assessed safety climate scores. A CSAP safety performance score does not appear to capture safety climate, as measured in this study. The nature of safety climate in construction is complex, which may be reflective of the challenges in measuring safety climate within this industry. Am. J. Ind. Med. 56:1463-1472, 2013. © 2013 Wiley Periodicals, Inc. © 2013 Wiley Periodicals, Inc.

Usual care and management of fall risk increasing drugs in older dizzy patients in Dutch general practice

PubMed Central

Stam, Hanneke; Harting, Thomas; van der Sluijs, Marjolijn; van Marum, Rob; van der Horst, Henriëtte; van der Wouden, Johannes C.; Maarsingh, Otto R.

2016-01-01

Objective For general practitioners (GPs) dizziness is a challenging condition to deal with. Data on the management of dizziness in older patients are mostly lacking. Furthermore, it is unknown whether GPs attempt to decrease Fall Risk Increasing Drugs (FRIDs) use in the management of dizziness in older patients. The aim of this study is to gain more insight into GP’s management of dizziness in older patients, including FRID evaluation and adjustment. Design Data were derived from electronic medical records, obtained over a 12-month period in 2013. Setting Forty-six Dutch general practices. Patients The study sample comprised of 2812 older dizzy patients of 65 years and over. Patients were identified using International Classification of Primary Care codes and free text. Main outcome measures Usual care was categorized into wait-and-see strategy (no treatment initiated); education and advice; additional testing; medication adjustment; and referral. Results Frequently applied treatments included a wait-and-see strategy (28.4%) and education and advice (28.0%). Additional testing was performed in 26.8%; 19.0% of the patients were referred. Of the patients 87.2% had at least one FRID prescription. During the observation period, GPs adjusted the use of one or more FRIDs for 11.7% of the patients. Conclusion This study revealed a wide variety in management strategies for dizziness in older adults. The referral rate for dizziness was high compared to prior research. Although many older dizzy patients use at least one FRID, FRID evaluation and adjustment is scarce. We expect that more FRID adjustments may reduce dizziness and dizziness-related impairment. Key PointsIt is important to know how general practitioners manage dizziness in older patients in order to assess potential cues for improvement.This study revealed a wide variety in management strategies for dizziness in older patients.There was a scarcity in Fall Risk Increasing Drug (FRID) evaluation and adjustment.The referral rate for dizziness was high compared with previous research. PMID:27049170

Quality assurance in military medical research and medical radiation accident management.

PubMed

Hotz, Mark E; Meineke, Viktor

2012-08-01

The provision of quality radiation-related medical diagnostic and therapeutic treatments cannot occur without the presence of robust quality assurance and standardization programs. Medical laboratory services are essential in patient treatment and must be able to meet the needs of all patients and the clinical personnel responsible for the medical care of these patients. Clinical personnel involved in patient care must embody the quality assurance process in daily work to ensure program sustainability. In conformance with the German Federal Government's concept for modern departmental research, the international standard ISO 9001, one of the relevant standards of the International Organization for Standardization (ISO), is applied in quality assurance in military medical research. By its holistic approach, this internationally accepted standard provides an excellent basis for establishing a modern quality management system in line with international standards. Furthermore, this standard can serve as a sound basis for the further development of an already established quality management system when additional standards shall apply, as for instance in reference laboratories or medical laboratories. Besides quality assurance, a military medical facility must manage additional risk events in the context of early recognition/detection of health risks of military personnel on deployment in order to be able to take appropriate preventive and protective measures; for instance, with medical radiation accident management. The international standard ISO 31000:2009 can serve as a guideline for establishing risk management. Clear organizational structures and defined work processes are required when individual laboratory units seek accreditation according to specific laboratory standards. Furthermore, international efforts to develop health laboratory standards must be reinforced that support sustainable quality assurance, as in the exchange and comparison of test results within the scope of external quality assurance, but also in the exchange of special diagnosis data among international research networks. In summary, the acknowledged standard for a quality management system to ensure quality assurance is the very generic standard ISO 9001.Health Phys. 103(2):221-225; 2012.

Cost-Effectiveness of Surgical Versus Conservative Treatment for Thoracolumbar Burst Fractures.

PubMed

Aras, Efe Levent; Bunger, Cody; Hansen, Ebbe Stender; Søgaard, Rikke

2016-02-01

Historical, register-based cohort study following 85 patients in the course of a time frame extending from 2 years before to 2 years after trauma occurrence. To investigate the cost-effectiveness of surgery versus conservative management for thoracolumbar burst fractures. Despite the prevalence of thoracolumbar burst fractures, consensus has still not been reached in terms of their clinical management and whereas from a health policy point of view, efficient use of resources is equally important, literature pertaining to this aspect is limited. Consecutive patients who were admitted to a university clinic between 2004 and 2008 because of CT-verified AO type A3 fractures (T11-L2), age 18 to 65 years Patients with neurological compromise, osteoporosis, or malignancy were not included. The cost parameter defined primary and secondary health-care use (2010 &OV0556;) and the effect parameter was based on three alternative measures of pain medication: morphine milligram and defined daily doses (DDD) of narcotic and nonnarcotic analgesics. For cost-effectiveness analysis, we employed a difference-in-difference approach, including control for treatment selection (age, sex, and fracture type). Nonparametric bootstrapping was used to estimate conventional 95% confidence intervals of mean estimates. When taking into consideration all health-care consumption, surgical management was observed to cost an additional &OV0556;10,734 (4215; 15,144) as compared with conservative management. The differences on morphine at 527(-3031; 6,016) milligram, narcotic analgesics at -8(-176; 127) DDD, and nonnarcotic analgesics at -3(-72; 58) DDD were all insignificant The probability for surgery being cost-effective did not exceed 50% for any value of willingness to pay for effect. Surgical management does not seem to be a cost-effective strategy as compared with conservative management for traumatic thoracolumbar burst fractures without neurological deficits. In addition, higher-volume studies examining the clinical effect of alternative management strategies would be valuable. 3.

Measuring animal personality for use in population management in zoos: suggested methods and rationale.

PubMed

Watters, Jason V; Powell, David M

2012-01-01

The concept that animals have personalities is gaining traction in the scientific community and is well established in zoos and aquariums. Applying knowledge of animal personalities has occurred more slowly and is most often only considered informally. However, animal personalities are likely to affect the welfare animals experience in captivity and thus should be of primary concern to zoo managers. In addition, animal personality likely affects the outcomes of zoo guest experiences and potentially guests' conservation-related behavior. With over 1,000,000 animals in the care of zoos internationally and hundreds of millions of visitors annually, it would be prudent and beneficial to maximize our use of animal personality data in zoos to effect positive conservation outcomes. Understanding how to broaden population planning techniques to include measures of animal personality and the important outcomes of welfare and education value is of prime importance to the zoo industry. In order to succeed, it is necessary to employ techniques that reliably assess animal personalities and provide measures that can easily be used in population planning models. We discuss the outcomes of recent workshops designed to determine the best techniques for measuring animal personalities in the zoo setting with the goal of incorporating personality into population planning. © 2011 Wiley Periodicals, Inc.

Effectiveness of Nursing Management Information Systems: A Systematic Review

PubMed Central

Choi, Mona; Yang, You Lee

2014-01-01

Objectives The purpose of this study was to review evaluation studies of nursing management information systems (NMISs) and their outcome measures to examine system effectiveness. Methods For the systematic review, a literature search of the PubMed, CINAHL, Embase, and Cochrane Library databases was conducted to retrieve original articles published between 1970 and 2014. Medical Subject Headings (MeSH) terms included informatics, medical informatics, nursing informatics, medical informatics application, and management information systems for information systems and evaluation studies and nursing evaluation research for evaluation research. Additionally, manag* and admin*, and nurs* were combined. Title, abstract, and full-text reviews were completed by two reviewers. And then, year, author, type of management system, study purpose, study design, data source, system users, study subjects, and outcomes were extracted from the selected articles. The quality and risk of bias of the studies that were finally selected were assessed with the Risk of Bias Assessment Tool for Non-randomized Studies (RoBANS) criteria. Results Out of the 2,257 retrieved articles, a total of six articles were selected. These included two scheduling programs, two nursing cost-related programs, and two patient care management programs. For the outcome measurements, usefulness, time saving, satisfaction, cost, attitude, usability, data quality/completeness/accuracy, and personnel work patterns were included. User satisfaction, time saving, and usefulness mostly showed positive findings. Conclusions The study results suggest that NMISs were effective in time saving and useful in nursing care. Because there was a lack of quality in the reviewed studies, well-designed research, such as randomized controlled trials, should be conducted to more objectively evaluate the effectiveness of NMISs. PMID:25405060

Preparing for Sea-level Rise: Conflicts and Opportunities in Coastal Wetlands Coexisting with Infrastructure

NASA Astrophysics Data System (ADS)

Rodriguez, J. F.; Saco, P. M.; Sandi, S. G.; Saintilan, N.; Riccardi, G.

2017-12-01

Even though on a large scale the sustainability and resilience of coastal wetlands to sea-level rise depends on the slope of the landscape and a balance between the rates of soil accretion and the sea-level rise, local man-made flow disturbances can have comparable effects. Coastal infrastructure controlling flow in the wetlands can pose an additional constraint on the adaptive capacity of these ecosystems, but can also present opportunities for targeted flow management to increase their resilience. Coastal wetlands in SE Australia are heavily managed and typically present infrastructure including flow control devices. How these flow control structures are operated respond to different ecological conservation objectives (i.e. bird, frog or fish habitat) that can sometimes be mutually exclusive. For example, promoting mangrove establishment to enhance fish habitat results in saltmarsh decline thus affecting bird habitat. Moreover, sea-level rise will change hydraulic conditions in wetlands and may result in some flow control structures and strategies becoming obsolete or even counterproductive. In order to address these problems and in support of future management of flows in coastal wetlands, we have developed a predictive tool for long-term wetland evolution that incorporates the effects of infrastructure and other perturbations to the tidal flow within the wetland (i.e. vegetation resistance) and determines how these flow conditions affect vegetation establishment and survival. We use the model to support management and analyse different scenarios of sea-level rise and flow control measures aimed at preserving bird habitat. Our results show that sea-level rise affects the efficiency of management measures and in some cases may completely override their effect. It also shows the potential of targeted flow management to compensate for the effects of sea-level rise.

A brief review and clinical application of heart rate variability biofeedback in sports, exercise, and rehabilitation medicine.

PubMed

Prinsloo, Gabriell E; Rauch, H G Laurie; Derman, Wayne E

2014-05-01

An important component of the effective management of chronic noncommunicable disease is the assessment and management of psychosocial stress. The measurement and modulation of heart rate variability (HRV) may be valuable in this regard. To describe the measurement and physiological control of HRV; to describe the impact of psychosocial stress on cardiovascular disease, metabolic syndrome, and chronic respiratory disease, and the relationship between these diseases and changes in HRV; and to describe the influence of biofeedback and exercise on HRV and the use of HRV biofeedback in the management of chronic disease. The PubMed, Medline, and Embase databases were searched (up to August 2013). Additional articles were obtained from the reference lists of relevant articles and reviews. Articles were individually selected for further review based on the quality and focus of the study, and the population studied. Heart rate variability is reduced in stress and in many chronic diseases, and may even predict the development and prognosis of some diseases. Heart rate variability can be increased with both exercise and biofeedback. Although the research on the effect of exercise is conflicting, there is evidence that aerobic training may increase HRV and cardiac vagal tone both in healthy individuals and in patients with disease. Heart rate variability biofeedback is also an effective method of increasing HRV and cardiac vagal tone, and has been shown to decrease stress and reduce the morbidity and mortality of disease. The assessment and management of psychosocial stress is a challenging but important component of effective comprehensive lifestyle interventions for the management of noncommunicable disease. It is, therefore, important for the sports and exercise physician to have an understanding of the therapeutic use of HRV modulation, both in the reduction of stress and in the management of chronic disease.

Effects of scale and logging on landscape structure in a forest mosaic.

PubMed

Leimgruber, P; McShea, W J; Schnell, G D

2002-03-01

Landscape structure in a forest mosaic changes with spatial scale (i.e. spatial extent) and thresholds may occur where structure changes markedly. Forest management alters landscape structure and may affect the intensity and location of thresholds. Our purpose was to examine landscape structure at different scales to determine thresholds where landscape structure changes markedly in managed forest mosaics of the Appalachian Mountains in the eastern United States. We also investigated how logging influences landscape structure and whether these management activities change threshold values. Using threshold and autocorrelation analyses, we found that thresholds in landscape indices exist at 400, 500, and 800 m intervals from the outer edge of management units in our study region. For landscape indices that consider all landcover categories, such as dominance and contagion, landscape structure and thresholds did not change after logging occurred. Measurements for these overall landscape indices were strongly influenced by midsuccessional deciduous forest, the most common landcover category in the landscape. When restricting analyses for mean patch size and percent cover to individual forest types, thresholds for early-successional forests changed after logging. However, logging changed the landscape structure at small spatial scale, but did not alter the structure of the entire forest mosaic. Previous forest management may already have increased the heterogeneity of the landscape beyond the point where additional small cuts alter the overall structure of the forest. Because measurements for landscape indices yield very different results at different spatial scales, it is important first to identify thresholds in order to determine the appropriate scales for landscape ecological studies. We found that threshold and autocorrelation analyses were simple but powerful tools for the detection of appropriate scales in the managed forest mosaic under study.

Emphasizing Spectrum Management for Sustainable Development Research and Applications in Disaster Management

NASA Technical Reports Server (NTRS)

Ambrose, Stephen; Habib, Shahid

2007-01-01

NASA's spaceborne Earth and Heliospheric Observatories and airborne sensors provide a plethora of measurements. These measurements are used in science research to understand the climatology of our home planet and the solar fluxes and cycle of the only star in our solar system 'Sun' which is critical driver for the retention of life on Earth. Specifically, these measurements help us to understand the water and energy cycle, the carbon cycle, weather and climate, atmospheric chemistry, solar variability, and solid Earth and interior to feed into sophisticated mathematical models to analyze and predict the Earth's behavior as an integrated system. The main thrust of this research is on improving the prediction capability in the areas of weather, long term climate and solid Earth processes, and further help the humanity and future generations in terms of societal benefits in managing natural disasters, sustainability issues and many more. This work is further linked with our contributions in the Global Earth Observing System of Systems (GEOSS) Specifically, the data and knowledge resulting from the Earth observing systems and analytical models of the Earth can be made available for assimilation into decision support systems to serve society for disaster management. Through partnerships with national and international agencies and organizations, NASA's Science Mission Directorate's, Applied Sciences Program contributes to benchmarking practical uses of observations and predictions from Earth science remote sensing systems research. The objective is to establish innovative solutions using Earth observations and science information to provide decision support that can be adapted in applications of national and international priority. We along with the international community will continue this critical field of investigation by using our existing and future sensors from space, airborne and insitue environment. In our quest to expanding our knowledge, there will be a need for deploying additional sensors to obtain high spatial, temporal and spectral resolution measurements. These sensors operate in multiple spectral band ranging from UV, visible, infrared, microwave and radio frequency ranges. Of a particular concern is the microwave frequency bands which play a key role in land, ocean, moisture sensing. This is because of a growing commercial demand in the area of high speed broadband communication all over the world, the electronic manufacturers are looking into high frequency microwave spectral bands. This may present a risk to the remote sensing sensors because of additional sources of noise that can impair the highly sensitive passive remote sensing instruments.

Validating the Patient Experience with Treatment and Self-Management (PETS), a patient-reported measure of treatment burden, in people with diabetes

PubMed Central

Rogers, Elizabeth A; Yost, Kathleen J; Rosedahl, Jordan K; Linzer, Mark; Boehm, Deborah H; Thakur, Azra; Poplau, Sara; Anderson, Roger T; Eton, David T

2017-01-01

Aims To validate a comprehensive general measure of treatment burden, the Patient Experience with Treatment and Self-Management (PETS), in people with diabetes. Methods We conducted a secondary analysis of a cross-sectional survey study with 120 people diagnosed with type 1 or type 2 diabetes and at least one additional chronic illness. Surveys included established patient-reported outcome measures and a 48-item version of the PETS, a new measure comprised of multi-item scales assessing the burden of chronic illness treatment and self-care as it relates to nine domains: medical information, medications, medical appointments, monitoring health, interpersonal challenges, health care expenses, difficulty with health care services, role activity limitations, and physical/mental exhaustion from self-management. Internal reliability of PETS scales was determined using Cronbach’s alpha. Construct validity was determined through correlation of PETS scores with established measures (measures of chronic condition distress, medication satisfaction, self-efficacy, and global well-being), and known-groups validity through comparisons of PETS scores across clinically distinct groups. In an exploratory test of predictive validity, step-wise regressions were used to determine which PETS scales were most associated with outcomes of chronic condition distress, overall physical and mental health, and medication adherence. Results Respondents were 37–88 years old, 59% female, 29% non-white, and 67% college-educated. PETS scales showed good reliability (Cronbach’s alphas ≥0.74). Higher PETS scale scores (greater treatment burden) were correlated with more chronic condition distress, less medication convenience, lower self-efficacy, and worse general physical and mental health. Participants less (versus more) adherent to medications and those with more (versus fewer) health care financial difficulties had higher mean PETS scores. Medication burden was the scale that was most consistently associated with well-being and patient-reported adherence. Conclusion The PETS is a reliable and valid measure for assessing perceived treatment burden in people coping with diabetes. PMID:29184456

Validating the Patient Experience with Treatment and Self-Management (PETS), a patient-reported measure of treatment burden, in people with diabetes.

PubMed

Rogers, Elizabeth A; Yost, Kathleen J; Rosedahl, Jordan K; Linzer, Mark; Boehm, Deborah H; Thakur, Azra; Poplau, Sara; Anderson, Roger T; Eton, David T

2017-01-01

To validate a comprehensive general measure of treatment burden, the Patient Experience with Treatment and Self-Management (PETS), in people with diabetes. We conducted a secondary analysis of a cross-sectional survey study with 120 people diagnosed with type 1 or type 2 diabetes and at least one additional chronic illness. Surveys included established patient-reported outcome measures and a 48-item version of the PETS, a new measure comprised of multi-item scales assessing the burden of chronic illness treatment and self-care as it relates to nine domains: medical information, medications, medical appointments, monitoring health, interpersonal challenges, health care expenses, difficulty with health care services, role activity limitations, and physical/mental exhaustion from self-management. Internal reliability of PETS scales was determined using Cronbach's alpha. Construct validity was determined through correlation of PETS scores with established measures (measures of chronic condition distress, medication satisfaction, self-efficacy, and global well-being), and known-groups validity through comparisons of PETS scores across clinically distinct groups. In an exploratory test of predictive validity, step-wise regressions were used to determine which PETS scales were most associated with outcomes of chronic condition distress, overall physical and mental health, and medication adherence. Respondents were 37-88 years old, 59% female, 29% non-white, and 67% college-educated. PETS scales showed good reliability (Cronbach's alphas ≥0.74). Higher PETS scale scores (greater treatment burden) were correlated with more chronic condition distress, less medication convenience, lower self-efficacy, and worse general physical and mental health. Participants less (versus more) adherent to medications and those with more (versus fewer) health care financial difficulties had higher mean PETS scores. Medication burden was the scale that was most consistently associated with well-being and patient-reported adherence. The PETS is a reliable and valid measure for assessing perceived treatment burden in people coping with diabetes.

MASM: a market architecture for sensor management in distributed sensor networks

NASA Astrophysics Data System (ADS)

Viswanath, Avasarala; Mullen, Tracy; Hall, David; Garga, Amulya

2005-03-01

Rapid developments in sensor technology and its applications have energized research efforts towards devising a firm theoretical foundation for sensor management. Ubiquitous sensing, wide bandwidth communications and distributed processing provide both opportunities and challenges for sensor and process control and optimization. Traditional optimization techniques do not have the ability to simultaneously consider the wildly non-commensurate measures involved in sensor management in a single optimization routine. Market-oriented programming provides a valuable and principled paradigm to designing systems to solve this dynamic and distributed resource allocation problem. We have modeled the sensor management scenario as a competitive market, wherein the sensor manager holds a combinatorial auction to sell the various items produced by the sensors and the communication channels. However, standard auction mechanisms have been found not to be directly applicable to the sensor management domain. For this purpose, we have developed a specialized market architecture MASM (Market architecture for Sensor Management). In MASM, the mission manager is responsible for deciding task allocations to the consumers and their corresponding budgets and the sensor manager is responsible for resource allocation to the various consumers. In addition to having a modified combinatorial winner determination algorithm, MASM has specialized sensor network modules that address commensurability issues between consumers and producers in the sensor network domain. A preliminary multi-sensor, multi-target simulation environment has been implemented to test the performance of the proposed system. MASM outperformed the information theoretic sensor manager in meeting the mission objectives in the simulation experiments.

Protocol for the ADDITION-Plus study: a randomised controlled trial of an individually-tailored behaviour change intervention among people with recently diagnosed type 2 diabetes under intensive UK general practice care.

PubMed

Griffin, Simon J; Simmons, Rebecca K; Williams, Kate M; Prevost, A Toby; Hardeman, Wendy; Grant, Julie; Whittle, Fiona; Boase, Sue; Hobbis, Imogen; Brage, Soren; Westgate, Kate; Fanshawe, Tom; Sutton, Stephen; Wareham, Nicholas J; Kinmonth, Ann Louise

2011-04-04

The increasing prevalence of type 2 diabetes poses both clinical and public health challenges. Cost-effective approaches to prevent progression of the disease in primary care are needed. Evidence suggests that intensive multifactorial interventions including medication and behaviour change can significantly reduce cardiovascular morbidity and mortality among patients with established type 2 diabetes, and that patient education in self-management can improve short-term outcomes. However, existing studies cannot isolate the effects of behavioural interventions promoting self-care from other aspects of intensive primary care management. The ADDITION-Plus trial was designed to address these issues among recently diagnosed patients in primary care over one year. ADDITION-Plus is an explanatory randomised controlled trial of a facilitator-led, theory-based behaviour change intervention tailored to individuals with recently diagnosed type 2 diabetes. 34 practices in the East Anglia region participated. 478 patients with diabetes were individually randomised to receive (i) intensive treatment alone (n = 239), or (ii) intensive treatment plus the facilitator-led individual behaviour change intervention (n = 239). Facilitators taught patients key skills to facilitate change and maintenance of key behaviours (physical activity, dietary change, medication adherence and smoking), including goal setting, action planning, self-monitoring and building habits. The intervention was delivered over one year at the participant's surgery and included a one-hour introductory meeting followed by six 30-minute meetings and four brief telephone calls. Primary endpoints are physical activity energy expenditure (assessed by individually calibrated heart rate monitoring and movement sensing), change in objectively measured dietary intake (plasma vitamin C), medication adherence (plasma drug levels), and smoking status (plasma cotinine levels) at one year. We will undertake an intention-to-treat analysis of the effect of the intervention on these measures, an assessment of cost-effectiveness, and analyse predictors of behaviour change in the cohort. The ADDITION-Plus trial will establish the medium-term effectiveness and cost-effectiveness of adding an externally facilitated intervention tailored to support change in multiple behaviours among intensively-treated individuals with recently diagnosed type 2 diabetes in primary care. Results will inform policy recommendations concerning the management of patients early in the course of diabetes. Findings will also improve understanding of the factors influencing change in multiple behaviours, and their association with health outcomes.

Expectations and needs of patients with a chronic disease toward self-management and eHealth for self-management purposes.

PubMed

Huygens, Martine W J; Vermeulen, Joan; Swinkels, Ilse C S; Friele, Roland D; van Schayck, Onno C P; de Witte, Luc P

2016-07-08

Self-management is considered as an essential component of chronic care by primary care professionals. eHealth is expected to play an important role in supporting patients in their self-management. For effective implementation of eHealth it is important to investigate patients' expectations and needs regarding self-management and eHealth. The objectives of this study are to investigate expectations and needs of people with a chronic condition regarding self-management and eHealth for self-management purposes, their willingness to use eHealth, and possible differences between patient groups regarding these topics. Five focus groups with people with diabetes (n = 14), COPD (n = 9), and a cardiovascular condition (n = 7) were conducted in this qualitative research. Separate focus groups were organized based on patients' chronic condition. The following themes were discussed: 1) the impact of the chronic disease on patients' daily life; 2) their opinions and needs regarding self-management; and 3) their expectations and needs regarding, and willingness to use, eHealth for self-management purposes. A conventional content analysis approach was used for coding. Patient groups seem to differ in expectations and needs regarding self-management and eHealth for self-management purposes. People with diabetes reported most needs and benefits regarding self-management and were most willing to use eHealth, followed by the COPD group. People with a cardiovascular condition mentioned having fewer needs for self-management support, because their disease had little impact on their life. In all patient groups it was reported that the patient, not the care professional, should choose whether or not to use eHealth. Moreover, participants reported that eHealth should not replace, but complement personal care. Many participants reported expecting feelings of anxiety by doing measurement themselves and uncertainty about follow-up of deviant data of measurements. In addition, many participants worried about the implementation of eHealth being a consequence of budget cuts in care. This study suggests that aspects of eHealth, and the way in which it should be implemented, should be tailored to the patient. Patients' expected benefits of using eHealth to support self-management and their perceived controllability over their disease seem to play an important role in patients' willingness to use eHealth for self-management purposes.

Food Waste to Energy: How Six Water Resource Recovery ...

EPA Pesticide Factsheets

Water Resource Recovery Facilities (WRRFs) with anaerobic digestion have been harnessing biogas for heat and power since at least the 1920’s. A few are approaching “energy neutrality” and some are becoming “energy positive” through a combination of energy efficiency measures and the addition of outside organic wastes. Enhancing biogas production by adding fats, oil and grease (FOG) to digesters has become a familiar practice. Less widespread is the addition of other types of food waste, ranging from municipally collected food scraps to the byproducts of food processing facilities and agricultural production. Co-digesting with food waste, however, is becoming more common. As energy prices rise and as tighter regulations increase the cost of compliance, WRRFs across the county are tapping excess capacity while tempering rates. This report presents the co-digestion practices, performance, and the experiences of six such WRRFs. The report describes the types of food waste co-digested and the strategies--specifically, the tools, timing, and partnerships--employed to manage the material. Additionally, the report describes how the facilities manage wastewater solids, providing information about power production, biosolids use, and program costs. This product is intended to describe the available infrastructure for energy recovery from co-digestion of food waste and wastewater treatment facilities.

Transfer effects of errorless Goal Management Training on cognitive function and quality of life in brain-injured persons.

PubMed

Bertens, Dirk; Kessels, Roy P C; Boelen, Danielle H E; Fasotti, Luciano

2016-01-01

Previous findings had shown that the addition of errorless learning to traditional Goal Management Training (GMT) resulted in superior results when training everyday tasks in persons with executive deficits after brain injury. To investigate the additional effects of an errorless GMT on cognitive function and quality of life after acquired brain injury. This is a supplementary analysis of findings from an RCT in which 67 patients with executive impairments after acquired brain injury were randomly allocated to an experimental errorless GMT (n = 33) or conventional GMT (n = 34) to train two individually chosen everyday tasks. Objective cognitive function using neuropsychological tests, subjective cognitive complaints and quality of life using questionnaires were assessed before and after training. No significant interaction effects between these three types of outcome measures and the two forms of GMT were found. Irrespective of treatment, performance on two executive tests (Modified Six Elements Test; p = 0.006, Zoo Map test; p = 0.001) improved and daily executive function problems as reported by the participants (EFI; p = 0.001) and proxies (DEX; p = 0.01) diminished. Besides the previously found superiority of errorless GMT when training everyday tasks, additional improvements in cognition and quality of life did not differ between the two treatments.

In view of standardization Part 2: Management of challenges in the initial treatment of burn patients in Burn Centers in Germany, Austria and Switzerland.

PubMed

Ziegler, Benjamin; Hirche, Christoph; Horter, Johannes; Kiefer, Jurij; Grützner, Paul Alfred; Kremer, Thomas; Kneser, Ulrich; Münzberg, Matthias

2017-03-01

Initial therapy of severe burns in specialized burn trauma centers is a challenging task faced by the treating multi-professional and interdisciplinary team. A lack of consistent operating procedures and varying structural conditions was recently demonstrated in preliminary data of our group. These results raised the question on how specific treatment measures in acute burn care are met in the absence of standardized guidelines. A specific questionnaire containing 57 multiple-choice questions was sent to all 22 major burn centers in Germany, Austria and Switzerland. The survey included standards of airway management and ventilation, fluid management and circulation, body temperature monitoring and management, topical burn wound treatment and a microbiological surveillance. Additionally, the distribution of standardized course systems was covered. 17 out of 22 questionnaires (77%) were returned completed. Regarding volume resuscitation, results showed a similar approach in estimating initial fluid while discrepancies persisted in the use of colloidal fluid and human albumin. Elective tracheostomy and the need for bronchoscopy with suspected inhalation injury were the most controversial issues revealed by the survey. Topical treatment of burned body surface also followed different principles regarding the use of synthetic epidermal skin substitutes or enzymatic wound debridement. Less discrepancy was found in basic diagnostic measures, body temperature management, estimation of the extent of burns and microbiological surveillance. While many burn-related issues are clearly not questionable and managed in a similar way in most participating facilities, we were able to show that the most contentious issues in burn trauma management involve initial volume resuscitation, management of inhalation trauma and topical burn wound treatment. Further research is required to address these topics and evaluate a potential superiority of a regime in order to increase the level of evidence. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Reality check of socio-hydrological interactions in water quality and ecosystem management

NASA Astrophysics Data System (ADS)

Destouni, Georgia; Fischer, Ida; Prieto, Carmen

2017-04-01

Socio-hydrological interactions in water management for improving water quality and ecosystem status include as key components both (i) the societal measures taken for mitigation and control, and (ii) the societal characterization and monitoring efforts made for choosing management targets and checking the effects of measures taken to reach the targets. This study investigates such monitoring, characterization and management efforts and effects over the first six-year management cycle of the EU Water Framework Directive (WFD). The investigation uses Sweden and the WFD-regulated management of its stream and lake waters as a concrete quantification example, with focus on the nutrient and eutrophication conditions that determine the most prominent water quality and ecosystem problems in need of mitigation in the Swedish waters. The case results show a relatively small available monitoring base for determination of these nutrient and eutrophication conditions, even though they constitute key parts in the overall WFD-based approach to classification and management of ecosystem status. Specifically, actual nutrient monitoring exists in only around 1% (down to 0.2% for nutrient loads) of the Swedish stream and lake water bodies; modeling is used to fill the gaps for the remaining unmonitored fraction of classified and managed waters. The available data show that the hydro-climatically driven stream water discharge is a primary explanatory variable for the resulting societal classification of ecosystem status in Swedish waters; this may be due to the discharge magnitude being dominant in determining nutrient loading to these waters. At any rate, with such a hydro-climatically related, rather than human-pressure related, determinant of the societal ecosystem-status classification, the main human-driven causes and effects of eutrophication may not be appropriately identified, and the measures taken for mitigating these may not be well chosen. The available monitoring data from Swedish waters support this hypothesis, by showing that the first WFD management cycle 2009-2015 has led to only slight changes in measured nutrient concentrations, with moderate-to-bad status waters mostly undergoing concentration increases. These management results are in direct contrast to the WFD management goals that ecosystem status in all member-state waters must be improved to at least good level, and in any case not be allowed to further deteriorate. In general, the present results show that societal approaches to ecosystem status classification, monitoring and improvement may need a focus shift for improved identification and quantification of the human-driven components of nutrient inputs, concentrations and loads in water environments. Dominant hydro-climatic change drivers and effects must of course also be understood and accounted for. However, adaptation to hydro-climatic changes should be additional to and aligned with, rather than instead of, necessary mitigation of human-driven eutrophication. The present case results call for further science-based testing and evidence of societal water quality and ecosystem management actually targeting and following up the potential achievement of such mitigation.

50 CFR 300.62 - Annual management measures.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 50 Wildlife and Fisheries 11 2012-10-01 2012-10-01 false Annual management measures. 300.62... REGULATIONS Pacific Halibut Fisheries § 300.62 Annual management measures. Annual management measures may be... of unloading and weighing, and sport fishing for halibut. The Assistant Administrator will publish...

50 CFR 300.62 - Annual management measures.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 50 Wildlife and Fisheries 11 2013-10-01 2013-10-01 false Annual management measures. 300.62... REGULATIONS Pacific Halibut Fisheries § 300.62 Annual management measures. Annual management measures may be... of unloading and weighing, and sport fishing for halibut. The Assistant Administrator will publish...

50 CFR 300.62 - Annual management measures.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 50 Wildlife and Fisheries 11 2014-10-01 2014-10-01 false Annual management measures. 300.62... REGULATIONS Pacific Halibut Fisheries § 300.62 Annual management measures. Annual management measures may be... of unloading and weighing, and sport fishing for halibut. The Assistant Administrator will publish...

Structural neurobiological correlates of Mayer-Salovery-Caruso Emotional Intelligence Test performance in early course schizophrenia.

PubMed

Wojtalik, Jessica A; Eack, Shaun M; Keshavan, Matcheri S

2013-01-10

The Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) is a key measure of social cognition in schizophrenia that has good psychometric properties and is recommended by the MATRICS committee. As a way to further investigate the validity of the MSCEIT, this study sought to examine the neurobiological correlates of MSCEIT performance in patients with early course schizophrenia. A total of 51 patients diagnosed with early course, stabilized schizophrenia or schizoaffective disorder completed structural magnetic resonance imaging (MRI) scans and the MSCEIT. Investigation of the associations between MSCEIT performance and gray matter morphology was examined by conducting voxel-based morphometry (VBM) analyses across hypothesized social-cognitive regions of interest using automated anatomical labeling in Statistical Parametric Mapping Software, version 5 (SPM5). All VBM analyses utilized general linear models examining gray matter density partitioned images, adjusting for demographic and illness-related confounds. VBM results were then followed up with confirmatory volumetric analyses. Patients with poorer overall and Facilitating, Understanding, and Managing Emotions subscale performances on the MSCEIT showed significantly reduced gray matter density in the left parahippocampal gyrus. Additionally, attenuated performance on the Facilitating and Managing Emotions subscales was significantly associated with reduced right posterior cingulate gray matter density. All associations observed between MSCEIT performance and gray matter density were supported with confirmatory gray matter volumetric analyses, with the exception of the association between the right posterior cingulate and the facilitation of emotions. These findings provide additional evidence for the MSCEIT as a valid social-cognitive measure by elucidating its correlates with neurobiological structures commonly implicated in emotion processing. These findings provide additional biological evidence supporting the use of the MSCEIT in cognitive enhancing clinical trials in schizophrenia. Copyright © 2012 Elsevier Inc. All rights reserved.

Hearing conservation and noise management practices in professional orchestras.

PubMed

O'Brien, Ian; Driscoll, Tim; Ackermann, Bronwen

2012-01-01

Hearing conservation and noise exposure management for professional orchestras is a difficult issue resistant to standard control measures as used in other industries with excessive noise problems. Although there has been a great deal of research into this area in terms of the audiological status of musicians and their exposure to noise, there are relatively few industry-specific strategies that can be adopted by an orchestra looking to address these issues. Australia does not have a uniform approach to hearing conservation management in its orchestras; however, each orchestra actively grapples with the challenges of balancing legal, practical, and artistic concerns. This study systematically investigated hearing conservation practices, noise exposure management, and audiological screening protocols in eight professional orchestras. The research involved personal interviews with staff at each orchestra, including inspection of venues and facilities. While all these orchestras were aware of the risks and were actively taking significant steps to reduce noise exposure, a range of approaches, with varying degrees of effectiveness and understanding of the issue, were found across the sector. There was limited evidence of educational programs for either the musicians at risk of excessive noise exposure or the staff responsible for devising and implementing control measures. In addition, the reported use of adequate personal hearing protection by musicians was poor. As Australia has recently introduced a national approach to workplace health and safety, a similar approach to noise and audiological management across the country's orchestral sector is proposed, drawn from existing research and practice. This will enable both consistent procedures and meaningful dialogue between the orchestras on the topics of hearing conservation, audiological monitoring, and educational practices.

Morphological traits of Pacific Flyway Canada Geese as an aid to subspecies identification and management

USGS Publications Warehouse

Pearce, John M.; Bollinger, Karen S.

2003-01-01

Subspecies of Canada Geese (Branta canadensis) exhibit wide variation in body size across their range. To monitor harvest levels in the Pacific Flyway, biologists commonly use culmen length and plumage color to differentiate among subspecies on sympatric wintering grounds. Among the four large-bodied Pacific subspecies (B. c. parvipes, B. c. occidentalis, B. c. fulva, and B. c. moffitti), overlap in culmen length and subjectivity of visually assessing color results in misclassification and inaccurate harvest estimates. We examined the morphology of Pacific large-bodied Canada Geese to characterize body size variation among subspecies and provide more discriminatory measures for harvest assessments. We found that culmen length, one of the most commonly used field measures, overlapped widely among subspecies, and it had little support for inclusion in discriminatory models. Morphological measures with greater explanatory power included bill width at nail, bill width at base, head length, and mid wing. If culmen length and plumage color continue to be used to assess winter harvest, we recommend the addition of at least one sex-specific measurement to reduce levels of misclassification among subspecies. If an additional morphological measure is included, further evaluation on the wintering grounds should be conducted as this measure's effectiveness may vary depending upon observer bias, temporal and spatial variation in subspecies abundance, and the proportion of birds accurately sexed by cloacal examination.

Data Validation Package - July 2016 Groundwater Sampling at the Gunnison, Colorado, Disposal Site

DOE Office of Scientific and Technical Information (OSTI.GOV)

Linard, Joshua; Campbell, Sam

Groundwater sampling at the Gunnison, Colorado, Disposal Site is conducted every 5 years to monitor disposal cell performance. During this event, samples were collected from eight monitoring wells as specified in the 1997 Long-Term Surveillance Plan for the Gunnison, Colorado, Disposal Site. Sampling and analyses were conducted as specified in the Sampling and Analysis Plan for US Department of Energy Office of Legacy Management Sites (LMS/PRO/S04351, continually updated, http://energy.gov/lm/downloads/sampling-and­ analysis-plan-us-department-energy-office-legacy-management-sites). Planned monitoring locations are shown in Attachment 1, Sampling and Analysis Work Order. A duplicate sample was collected from location 0723. Water levels were measured at all monitoring wells thatmore » were sampled and seven additional wells. The analytical data and associated qualifiers can be viewed in environmental database reports and are also available for viewing with dynamic mapping via the GEMS (Geospatial Environmental Mapping System) website at http://gems.lm.doe.gov/#. No issues were identified during the data validation process that require additional action or follow-up.« less

50 CFR 300.62 - Annual management measures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false Annual management measures. 300.62 Section... REGULATIONS Pacific Halibut Fisheries § 300.62 Annual management measures. Annual management measures may be... of unloading and weighing, and sport fishing for halibut. The Assistant Administrator will publish...

50 CFR 300.62 - Annual management measures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 50 Wildlife and Fisheries 9 2011-10-01 2011-10-01 false Annual management measures. 300.62 Section... REGULATIONS Pacific Halibut Fisheries § 300.62 Annual management measures. Annual management measures may be... of unloading and weighing, and sport fishing for halibut. The Assistant Administrator will publish...

Outcome of career expectancies and early professional burnout among newly qualified dentists.

PubMed

Gorter, R C; Storm, M K; te Brake, J H M; Kersten, H W; Eijkman, M A J

2007-08-01

To measure burnout development, outcome of expectations with regard to dental career and feelings of being unprepared for practice among newly graduated general dental practitioners. In 1997, 50 dentists were approached to fill in the Maslach Burnout Inventory, Dutch version (UBOS) and some additional variables between six months and one year after graduation at the Academic Centre for Dentistry Amsterdam (ACTA) (76% response). Six years later, in 2003, the same 50 dentists, plus another 60 who had graduated in the same period at ACTA, were approached (78% response). Using Repeated Measures analysis, mean scores of dentists for whom two measurements were available on the three UBOS subscales (N=24) showed no statistically significant changes over six years on Emotional Exhaustion, Depersonalisation, or Personal Accomplishment. The same was true for group means of all in 1997 (N=33) compared with all in 2003 (N=82). However, according to manual criteria, varying percentages (7.2% - 24.4%) of dentists showed an unfavourable level on either one of the UBOS dimensions. Factors most frequently mentioned to be responsible for being unprepared for practice were: law and insurance matters (61.2%), practice organisation (56.6%) and staff management (55.2%). Most frequently reported factors that came out (much) worse than expected were: stressfulness of work (45.1%), and staff management (43.4%). Burnout appears no threat for the average newly qualified dentist. However, some individuals report alarmingly high burnout scores at an early professional stage. Practice management is the professional aspect about which young professionals worry most. It is recommended that dental schools pay attention to practice management skills and the stressfulness of work in the curriculum. Also, longitudinal monitoring of dental students and newly qualified dentists on burnout development is strongly advocated.

Soil Emissions of N2O and NO in Agricultural Production Systems in the Upper Midwest U.S.: Management Controls and Measurement Issues (Invited)

NASA Astrophysics Data System (ADS)

Venterea, R. T.; Baker, J. M.

2009-12-01

Cropped fields in the upper Midwest have the potential to emit relatively large quantities of N2O and NO resulting from soil transformation of N fertilizers applied to crops such as corn and potatoes. The mitigation of N2O emissions may be an effective strategy for offsetting greenhouse gas emissions. While the rate of N fertilizer application exerts some control over N trace gas emission rates, a variety of other management practices and environmental factors interact to regulate these emissions. Observation-based studies are essential for improving models, developing accurate inventories, and documenting offsets. Since 2003, we have been examining the effects of management factors including: tillage, crop rotation, irrigation, and fertilizer chemical form and application method on N2O and NO emissions from corn and potato production systems using chamber-based measurement techniques. A summary of our findings will be presented, including: Application of anhydrous ammonia resulted in twice the N2O emissions compared to urea fertilizer, and twice the NO emissions compared to liquid urea ammonium nitrate (UAN) fertilizer. Growing corn continuously compared to in rotation with soybeans did not alter the amount of N2O emitted during the corn growing season. Reduced tillage (RT), often promoted as a means of reducing carbon losses to the atmosphere, also altered soil N2O emissions. However, the impact of RT on N2O emissions was found to vary, in both magnitude and direction, as a function of N fertilizer management. In addition to these studies, our efforts to overcome some of the inherent limitations of chamber-based flux measurement techniques will be discussed.

Assessing Sustainability in Environmental Management: A Case Study in Malaysia Industry

NASA Astrophysics Data System (ADS)

Turan, Faiz Mohd; Johan, Kartina; Lanang, Wan Nurul Syahirah Wan; Asmanizam, Asmadianatasha

2017-08-01

The scarcity in measuring the sustainability accomplishment has been restrained most of the companies in Malaysian industry. Currently, there are variety types of the measurement tools of the sustainability assessment that have been implemented. However, there are still not achieving the inclusive elements required by the worldwide claim. In fact, the contribution to the sustainability performance are only highlighted on the nature, financial along with society components. In addition, some of the companies are conducting their sustainability implementation individually. By means, this process approaching type is needed to be integrated into a systematic system approach. This paper is focussing on investigating the present sustainability tools in the environmental management system for Malaysian industry prior to the quantification of the sustainability parameters. Hence, the parameters of the sustainability have been evaluated then in order to accomplish this project. By reviewing on the methodology of this research it comprises of three phases where it starts with the analyzation of the parameters in environmental management system according to the Malaysian context of industry. Moving on to the next step is the quantification of the criterion and finally the normalisation process will be done to determine the results of this research either it is succeeded or vice versa. As a result, this research has come to the conclusion where the level of the sustainability compliance does not achieve the standard level of the targeted objectives though it has already surpassed the average level of the sustainability performance. In future, the understanding towards the sustainability assessment is acquired to be aligned unitedly in order to integrated the process approach into the systematic approach. Apart, this research will be able to help to provide a measurable framework yet finally bestowing the Malaysian industry with a continuous improvement roadmap in achieving excellence in environmental management system.

Hypothetical performance of syndrome-based management of acute paediatric admissions of children aged more than 60 days in a Kenyan district hospital.

PubMed Central

English, Mike; Berkley, James; Mwangi, Isiah; Mohammed, Shebbe; Ahmed, Maimuna; Osier, Faith; Muturi, Neema; Ogutu, Bernhards; Marsh, Kevin; Newton, Charles R. J. C.

2003-01-01

OBJECTIVE: To investigate whether the outpatient, syndrome-based approach of the Integrated Management of Childhood Illness (IMCI) protocol could be extended to the inpatient arena to give clear and simple minimum standards of care for poorly resourced facilities. METHODS: A prospective, one-year admission cohort retrospectively compared hypothetical performance of syndrome-based management with paediatrician-defined final diagnosis. Admission syndrome definitions were based on local adaptations to the IMCI protocol that encompassed 20 clinical features, measurement of oxygen saturation, and malaria microscopy. FINDINGS: After 315 children with clinically obvious diagnoses (e.g. sickle cell disease and burns) were excluded, 3705 admission episodes were studied. Of these, 2334 (63%) met criteria for at least one severe syndrome (mortality 8% vs <1% for "non-severe" cases), and half of these had features of two or more severe syndromes. No cases of measles were seen. Syndrome-based treatment would have been appropriate (sensitivity >95%) for severe pneumonia, severe malaria, and diarrhoea with severe dehydration, and probably for severe malnutrition (sensitivity 71%). Syndrome-directed treatment suggested the use of broad-spectrum antibiotics in 75/133 (56% sensitivity) children with bacteraemic and 63/71 (89% sensitivity) children with meningitis. CONCLUSIONS: Twenty clinical features, oxygen saturation measurements, and results of malaria blood slides could be used for inpatient, syndrome-based management of acute paediatric admissions. The addition of microscopy of the cerebrospinal fluid and haemoglobin measurements would improve syndrome-directed treatment considerably. This approach might rationalize admission policy and standardize inpatient paediatric care in resource-poor countries, although the clinical detection of bacteraemia remains a problem. PMID:12764512

Usefulness of posture training for patients with temporomandibular disorders.

PubMed

Wright, E F; Domenech, M A; Fischer, J R

2000-02-01

Many practitioners have found that posture training has a positive impact on temporomandibular, or TMD, symptoms. The authors conducted a study to evaluate its effectiveness. Sixty patients with TMD and a primary muscle disorder were randomized into two groups: one group received posture training and TMD self-management instructions while the control group received TMD self-management instructions only. Four weeks after the study began, the authors reexamined the subjects for changes in symptoms, pain-free opening and pressure algometer pain thresholds. In addition, pretreatment and posttreatment posture measurements were recorded for subjects in the treatment group. Statistically significant improvement was demonstrated by the modified symptom severity index, maximum pain-free opening and pressure algometer threshold measurements, as well as by the subjects' perceived TMD and neck symptoms. Subjects in the treatment group reported having experienced a mean reduction in TMD and neck symptoms of 41.9 and 38.2 percent, respectively, while subjects in the control group reported a mean reduction in these symptoms of 8.1 and 9.3 percent. Within the treatment group, the authors found significant correlations between improvements in TMD symptoms and improvements in neck symptoms (P < .005) as well as between TMD symptom improvement and the difference between head and shoulder posture measurements at the outset of treatment (P < .05). Posture training and TMD self-management instructions are significantly more effective than TMD self-management instructions alone for patients with TMD who have a primary muscle disorder. Patients with TMD who hold their heads farther forward relative to the shoulders have a high probability of experiencing symptom improvement as a result of posture training and being provided with selfmanagement instructions.

Rationale, design and conduct of a randomised controlled trial evaluating a primary care-based complex intervention to improve the quality of life of heart failure patients: HICMan (Heidelberg Integrated Case Management)

PubMed Central

Peters-Klimm, Frank; Müller-Tasch, Thomas; Schellberg, Dieter; Gensichen, Jochen; Muth, Christiane; Herzog, Wolfgang; Szecsenyi, Joachim

2007-01-01

Background Chronic congestive heart failure (CHF) is a complex disease with rising prevalence, compromised quality of life (QoL), unplanned hospital admissions, high mortality and therefore high burden of illness. The delivery of care for these patients has been criticized and new strategies addressing crucial domains of care have been shown to be effective on patients' health outcomes, although these trials were conducted in secondary care or in highly organised Health Maintenance Organisations. It remains unclear whether a comprehensive primary care-based case management for the treating general practitioner (GP) can improve patients' QoL. Methods/Design HICMan is a randomised controlled trial with patients as the unit of randomisation. Aim is to evaluate a structured, standardized and comprehensive complex intervention for patients with CHF in a 12-months follow-up trial. Patients from intervention group receive specific patient leaflets and documentation booklets as well as regular monitoring and screening by a prior trained practice nurse, who gives feedback to the GP upon urgency. Monitoring and screening address aspects of disease-specific self-management, (non)pharmacological adherence and psychosomatic and geriatric comorbidity. GPs are invited to provide a tailored structured counselling 4 times during the trial and receive an additional feedback on pharmacotherapy relevant to prognosis (data of baseline documentation). Patients from control group receive usual care by their GPs, who were introduced to guideline-oriented management and a tailored health counselling concept. Main outcome measurement for patients' QoL is the scale physical functioning of the SF-36 health questionnaire in a 12-month follow-up. Secondary outcomes are the disease specific QoL measured by the Kansas City Cardiomyopathy questionnaire (KCCQ), depression and anxiety disorders (PHQ-9, GAD-7), adherence (EHFScBS and SANA), quality of care measured by an adapted version of the Patient Chronic Illness Assessment of Care questionnaire (PACIC) and NT-proBNP. In addition, comprehensive clinical data are collected about health status, comorbidity, medication and health care utilisation. Discussion As the targeted patient group is mostly cared for and treated by GPs, a comprehensive primary care-based guideline implementation including somatic, psychosomatic and organisational aspects of the delivery of care (HICMAn) is a promising intervention applying proven strategies for optimal care. Trial registration Current Controlled Trials ISRCTN30822978. PMID:17716364

Rationale, design and conduct of a randomised controlled trial evaluating a primary care-based complex intervention to improve the quality of life of heart failure patients: HICMan (Heidelberg Integrated Case Management).

PubMed

Peters-Klimm, Frank; Müller-Tasch, Thomas; Schellberg, Dieter; Gensichen, Jochen; Muth, Christiane; Herzog, Wolfgang; Szecsenyi, Joachim

2007-08-23

Chronic congestive heart failure (CHF) is a complex disease with rising prevalence, compromised quality of life (QoL), unplanned hospital admissions, high mortality and therefore high burden of illness. The delivery of care for these patients has been criticized and new strategies addressing crucial domains of care have been shown to be effective on patients' health outcomes, although these trials were conducted in secondary care or in highly organised Health Maintenance Organisations. It remains unclear whether a comprehensive primary care-based case management for the treating general practitioner (GP) can improve patients' QoL. HICMan is a randomised controlled trial with patients as the unit of randomisation. Aim is to evaluate a structured, standardized and comprehensive complex intervention for patients with CHF in a 12-months follow-up trial. Patients from intervention group receive specific patient leaflets and documentation booklets as well as regular monitoring and screening by a prior trained practice nurse, who gives feedback to the GP upon urgency. Monitoring and screening address aspects of disease-specific self-management, (non)pharmacological adherence and psychosomatic and geriatric comorbidity. GPs are invited to provide a tailored structured counselling 4 times during the trial and receive an additional feedback on pharmacotherapy relevant to prognosis (data of baseline documentation). Patients from control group receive usual care by their GPs, who were introduced to guideline-oriented management and a tailored health counselling concept. Main outcome measurement for patients' QoL is the scale physical functioning of the SF-36 health questionnaire in a 12-month follow-up. Secondary outcomes are the disease specific QoL measured by the Kansas City Cardiomyopathy questionnaire (KCCQ), depression and anxiety disorders (PHQ-9, GAD-7), adherence (EHFScBS and SANA), quality of care measured by an adapted version of the Patient Chronic Illness Assessment of Care questionnaire (PACIC) and NT-proBNP. In addition, comprehensive clinical data are collected about health status, comorbidity, medication and health care utilisation. As the targeted patient group is mostly cared for and treated by GPs, a comprehensive primary care-based guideline implementation including somatic, psychosomatic and organisational aspects of the delivery of care (HICMAn) is a promising intervention applying proven strategies for optimal care.

School-based asthma disease management.

PubMed

Tinkelman, David; Schwartz, Abby

2004-06-01

Asthma is the most common chronic childhood illness and the leading cause of missed school days. School is a potential location for establishing an asthma education program for children and their parents/caregivers designed to improve disease management. To determine whether a comprehensive, school-based asthma management program, in addition to a conventional disease management program, can reduce measures of asthma control, student absenteeism, and caregiver lost workdays. School nurses recruited parents/caregivers of students with asthma from three urban elementary and middle schools. Children were identified as having asthma by a previous diagnosis from their personal physician. Parents were invited to attend educational sessions about the program. Students received peak flow meters and training in their use and had access to an interactive asthma diary to record symptoms, peak flow, and medicine usage. They received monthly asthma education at school and had access to an online asthma education program and additional handouts. Parents received several educational calls regarding asthma and had a 24-hour, 7-days-a-week emergency number to call if problems arose. At 6 months, missed school days and unscheduled doctor visits were reduced by two thirds (n = 41; p< 0.01 for each). Caregivers' perception of children's activity level increased by 11% (n = 26; p = 0.037). Daytime and nighttime frequency of symptoms dropped by 62% and 34%, respectively (n = 32; p < 0.007 and p<0.03 for each). These trends continued at 12 months, although only reduction in frequency of symptoms attained statistical significance. A comprehensive, school-based asthma management program can successfully improve asthma control and reduce absenteeism in elementary and middle school students and caregiver lost workdays.

Cost-effectiveness analysis of PET-CT-guided management for locally advanced head and neck cancer.

PubMed

Smith, A F; Hall, P S; Hulme, C T; Dunn, J A; McConkey, C C; Rahman, J K; McCabe, C; Mehanna, H

2017-11-01

A recent large United Kingdom (UK) clinical trial demonstrated that positron-emission tomography-computed tomography (PET-CT)-guided administration of neck dissection (ND) in patients with advanced head and neck cancer after primary chemo-radiotherapy treatment produces similar survival outcomes to planned ND (standard care) and is cost-effective over a short-term horizon. Further assessment of long-term outcomes is required to inform a robust adoption decision. Here we present results of a lifetime cost-effectiveness analysis of PET-CT-guided management from a UK secondary care perspective. Initial 6-month cost and health outcomes were derived from trial data; subsequent incidence of recurrence and mortality was simulated using a de novo Markov model. Health benefit was measured in quality-adjusted life years (QALYs) and costs reported in 2015 British pounds. Model parameters were derived from trial data and published literature. Sensitivity analyses were conducted to assess the impact of uncertainty and broader National Health Service (NHS) and personal social services (PSS) costs on the results. PET-CT management produced an average per-person lifetime cost saving of £1485 and an additional 0.13 QALYs. At a £20,000 willingness-to-pay per additional QALY threshold, there was a 75% probability that PET-CT was cost-effective, and the results remained cost-effective over the majority of sensitivity analyses. When adopting a broader NHS and PSS perspective, PET-CT management produced an average saving of £700 and had an 81% probability of being cost-effective. This analysis indicates that PET-CT-guided management is cost-effective in the long-term and supports the case for wide-scale adoption. Copyright © 2017 Elsevier Ltd. All rights reserved.

Exploring Crisis Management in U.S. Small Businesses

NASA Astrophysics Data System (ADS)

Williams, Jon

As a critical infrastructure, the US electricity grid supplies electricity to 340 million people within eight separate regions. The power infrastructure is vulnerable to many types of disasters capable of severing supplies of electricity. The impact on the employees and communities when small- and medium-size enterprises are shut down due to disasters can be severe. The purpose of the quantitative comparative study was to explore small- and medium-size enterprises crisis management strategies in the case of power infrastructure vulnerabilities. Perceptions of small business leaders were probed about crisis management planning relevant to three secondary factors: prior experience of crises, threat perceptions, and planning self-efficacy. Participants completed an adapted questionnaire instrument based on a five-point Likert scale for six sub-factors including resilience through planning, financial impact, operational crisis management, the perfect storm, the aftermath of survival, and atrophy. The instrument also measured three additional factors to include, prior experience of crises, threat perceptions, and planning self-efficacy, across seven types of crises. The results of this study indicated that of the 276 respondents, 104 had no crisis plans, but 172 did have crisis plans. Of those who had implemented crisis plans, 19% had specific provisions to address power outages or attacks on the electrical grid. Of the respondents who had not planned for power outages nor experienced significant losses of power, a statistically significant number acknowledged an external threat to their business. The majority of respondents indicated that long-term planning was related to resilience; however, the migration of crisis understanding into the planning process or implementation was not implemented. This heightened awareness of potential crises without the corresponding development and implementation of mitigation crisis plans requires additional research to understand drivers effecting the decision making process with crisis managers.

Efficacy of conservative treatment, without necrosectomy, for infected pancreatic necrosis: a systematic review and meta-analysis.

PubMed

Mouli, Venigalla Pratap; Sreenivas, Vishnubhatla; Garg, Pramod Kumar

2013-02-01

Conservative treatment (intensive care, a combination of antimicrobial agents, and nutritional support, with or without drainage of the infected fluid) has recently been shown to be effective for patients with infected pancreatic necrosis (IPN), but the data from individual studies are not robust enough to recommend it as the standard of care. We performed a systematic review and meta-analysis of studies related to primary conservative management for IPN. We performed a literature search of MEDLINE/PubMed from January 1990 to March 2012 for studies of a priori protocols for primary conservative treatment, without necrosectomy, for consecutive patients with IPN. We analyzed data from 8 studies, comprising 324 patients with IPN who received primary conservative management. We then analyzed an additional 4 studies (comprising 157 patients) that reported the efficacy of percutaneous drainage in nonconsecutive patients with IPN. Outcome measures were the success of conservative management strategy, need for necrosectomy, and mortality. There was significant heterogeneity in results among the studies. Based on a random effects model, conservative management was successful for 64% of patients (95% confidence interval [CI], 51%-78%); mortality was 12% (95% CI, 6%-18%), and 26% of patients required necrosectomy or additional surgery for complications (95% CI, 15%-37%). A separate analysis of 4 studies that reported outcomes of nonconsecutive patients with IPN following percutaneous drainage had comparable results; 50% had successful outcomes (95% CI, 43%-58%), mortality was 18% (95% CI, 6%-30%), and 38% of patients required surgery (95% CI, 20%-56%). Conservative management without necrosectomy is a successful approach for 64% of patients with IPN. This approach has low mortality and prevents surgical necrosectomy. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

An Environmental Management Maturity Model of Construction Programs Using the AHP-Entropy Approach.

PubMed

Bai, Libiao; Wang, Hailing; Huang, Ning; Du, Qiang; Huang, Youdan

2018-06-23

The accelerating process of urbanization in China has led to considerable opportunities for the development of construction projects, however, environmental issues have become an important constraint on the implementation of these projects. To quantitatively describe the environmental management capabilities of such projects, this paper proposes a 2-dimensional Environmental Management Maturity Model of Construction Program (EMMMCP) based on an analysis of existing projects, group management theory and a management maturity model. In this model, a synergetic process was included to compensate for the lack of consideration of synergies in previous studies, and it was involved in the construction of the first dimension, i.e., the environmental management index system. The second dimension, i.e., the maturity level of environment management, was then constructed by redefining the hierarchical characteristics of construction program (CP) environmental management maturity. Additionally, a mathematical solution to this proposed model was derived via the Analytic Hierarchy Process (AHP)-entropy approach. To verify the effectiveness and feasibility of this proposed model, a computational experiment was conducted, and the results show that this approach could not only measure the individual levels of different processes, but also achieve the most important objective of providing a reference for stakeholders when making decisions on the environmental management of construction program, which reflects this model is reasonable for evaluating the level of environmental management maturity in CP. To our knowledge, this paper is the first study to evaluate the environmental management maturity levels of CP, which would fill the gap between project program management and environmental management and provide a reference for relevant management personnel to enhance their environmental management capabilities.

Conjunction Assessment for Commercial Satellite Constellations Using Commercial Radar Data Sources

NASA Astrophysics Data System (ADS)

Nicolls, M.; Vittaldev, V.; Ceperley, D.; Creus-Costa, J.; Foster, C.; Griffith, N.; Lu, E.; Mason, J.; Park, I.; Rosner, C.; Stepan, L.

For companies with multiple orbital assets, managing the risk of collision with other low-Earth orbit (LEO) Resident Space Objects (RSOs) can amount to a significant operational burden. LeoLabs and Planet investigate the impact of a workflow that integrates commercial Space Situational Awareness (SSA) data into conjunction assessments for large satellite constellations. Radar measurements from LeoLabs are validated against truth orbits provided by the International Laser Ranging Service (ILRS) and to measurements from Planet’s on-board GPS instrumentation. The radar data is then used as input for orbit fits in order to form the basis of a conjunction assessment. To confirm the reliability of the orbit determination (OD), the generated ephemerides are validated against ILRS and GPS-derived orbits. In addition, a covariance realism assessment is performed in order to check for self-consistency by comparing the propagated orbit and the associated covariance against later measurements. Several cases are investigated to assess the benefits of integrating radar-derived products with Conjunction Data Messages (CDMs) received on Planet spacecraft. Conjunction assessment is refined using onboard GPS measurements from Planet satellites along with tracking measurements of the secondary RSO by LeoLabs. This study demonstrates that commercial data provided by LeoLabs is reliable, accurate, and timely, and that ephemeris generated from LeoLabs data provides solutions and insights which are consistent with those provided in CDMs. For the cases analyzed, the addition of commercial SSA data from LeoLabs has a positive impact on operations due to the additional information on the state of the secondary RSO which can lead to increased confidence in any maneuver-related decisions. Measurements from LeoLabs can also be used to improve conjunction assessment for commercial satellites that do not have any operator OD.

Is burnout related to allostatic load?

PubMed

Langelaan, Saar; Bakker, Arnold B; Schaufeli, Wilmar B; van Rhenen, Willem; van Doornen, Lorenz J P

2007-01-01

Burnout has a negative impact on physical health, but the mechanisms underlying this relation remain unclear. To elucidate these mechanisms, possible mediating physiological systems or risk factors for adverse health in burned-out employees should be investigated. The aim of the present study among 290 Dutch managers was to explore whether allostatic load mediates the relationship between burnout and physical health. Burned-out managers, as identified with the Maslach Burnout Inventory General Survey (MBI-GS), were compared with a healthy control group with regard to their allostatic load. The allostatic load index included eight parameters: Body-mass index (BMI), systolic and diastolic blood pressure (SBP and DBP), C-reactive protein (CRP), high-density lipoprotein (HDL), cholesterol, glycosylated hemoglobin (HbA1C) and glucose. Contrary to expectations, burned-out managers did not differ from healthy managers with regard to their scores on the allostatic load index. An additional analysis, using groups of managers in the extreme deciles of exhaustion (the core symptom of burnout), did also not reveal differences in allostatic load. Burnout seems not to be associated with this proxy measure of allostatic load. The mediating physiological mechanisms between burnout and objective physical health remain to be elucidated.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Elia, Valerio; Gnoni, Maria Grazia, E-mail: mariagrazia.gnoni@unisalento.it; Tornese, Fabiana

Highlights: • Pay-As-You-Throw (PAYT) schemes are becoming widespread in several countries. • Economic, organizational and technological issues have to be integrated in an efficient PAYT model design. • Efficiency refers to a PAYT system which support high citizen participation rates as well as economic sustainability. • Different steps and constraints have to be evaluated from collection services to type technologies. • An holistic approach is discussed to support PAYT systems diffusion. - Abstract: Pay-As-You-Throw (PAYT) strategies are becoming widely applied in solid waste management systems; the main purpose is to support a more sustainable – from economic, environmental and socialmore » points of view – management of waste flows. Adopting PAYT charging models increases the complexity level of the waste management service as new organizational issues have to be evaluated compared to flat charging models. In addition, innovative technological solutions could also be adopted to increase the overall efficiency of the service. Unit pricing, user identification and waste measurement represent the three most important processes to be defined in a PAYT system. The paper proposes a holistic framework to support an effective design and management process. The framework defines most critical processes and effective organizational and technological solutions for supporting waste managers as well as researchers.« less

Ventilator-associated pneumonia management in critical illness.

PubMed

Albertos, Raquel; Caralt, Berta; Rello, Jordi

2011-03-01

Ventilator-associated pneumonia (VAP) is a frequent adverse event in the intensive care unit.We review recent publications about the management and prevention of VAP. The latest care bundles introduced standard interventions to facilitate implementation of evidence-based clinical guidelines and to improve the outcome of patients. Recent studies find that prevention management of ventilated patients decreases the risk of VAP. Enteral feeding, considered a risk factor for VAP, currently has been recommended, with appropriate administration, for all critical ill patients if no contraindications exist. In view of the recently available data, it can be concluded that the implementation of care bundles on the general management of ventilated patients in daily practice has reduced the VAP rates. The main pharmacological measures to prevent VAP are proper hands hygiene, high nurse-to-patient ratio, avoid unnecessary transfer of ventilated patients, use of noninvasive mechanical ventilation, shortening weaning period, avoid the use of nasal intubation, prevent bio-film deposition in endotracheal tube, aspiration of subglottic secretions, maintenance of adequate pressure of endotracheal cuffs, avoid manipulation of ventilator circuits, semi-recumbent position and adequate enteral feeding.In addition, updated guidelines incorporate more comprehensive diagnostic protocols to the evidence-based management of VAP.

41 CFR 102-79.111 - Where may Executive agencies find additional information on Integrated Workplace concepts?

Code of Federal Regulations, 2013 CFR

2013-07-01

... 41 Public Contracts and Property Management 3 2013-07-01 2013-07-01 false Where may Executive agencies find additional information on Integrated Workplace concepts? 102-79.111 Section 102-79.111 Public Contracts and Property Management Federal Property Management Regulations System (Continued) FEDERAL...

41 CFR 102-79.111 - Where may Executive agencies find additional information on Integrated Workplace concepts?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false Where may Executive agencies find additional information on Integrated Workplace concepts? 102-79.111 Section 102-79.111 Public Contracts and Property Management Federal Property Management Regulations System (Continued) FEDERAL...

41 CFR 102-79.111 - Where may Executive agencies find additional information on Integrated Workplace concepts?

Code of Federal Regulations, 2014 CFR

2014-01-01

... 41 Public Contracts and Property Management 3 2014-01-01 2014-01-01 false Where may Executive agencies find additional information on Integrated Workplace concepts? 102-79.111 Section 102-79.111 Public Contracts and Property Management Federal Property Management Regulations System (Continued) FEDERAL...

41 CFR 102-79.111 - Where may Executive agencies find additional information on Integrated Workplace concepts?

Code of Federal Regulations, 2012 CFR

2012-01-01

... 41 Public Contracts and Property Management 3 2012-01-01 2012-01-01 false Where may Executive agencies find additional information on Integrated Workplace concepts? 102-79.111 Section 102-79.111 Public Contracts and Property Management Federal Property Management Regulations System (Continued) FEDERAL...

A home-made system for IPCE measurement of standard and dye-sensitized solar cells.

PubMed

Palma, Giuseppina; Cozzarini, Luca; Capria, Ennio; Fraleoni-Morgera, Alessandro

2015-01-01

A home-made system for incident photon-to-electron conversion efficiency (IPCE) characterization, based on a double-beam UV-Vis spectrophotometer, has been set up. In addition to its low cost (compared to the commercially available apparatuses), the double-beam configuration gives the advantage to measure, autonomously and with no need for supplementary equipment, the lamp power in real time, compensating possible variations of the spectral emission intensity and quality, thus reducing measurement times. To manage the optical and electronic components of the system, a custom software has been developed. Validations carried out on a common silicon-based photodiode and on a dye-sensitized solar cell confirm the possibility to adopt this system for determining the IPCE of solar cells, including dye-sensitized ones.

Comparison of different methods for the in situ measurement of forest litter moisture content

NASA Astrophysics Data System (ADS)

Schunk, C.; Ruth, B.; Leuchner, M.; Wastl, C.; Menzel, A.

2016-02-01

Dead fine fuel (e.g., litter) moisture content is an important parameter for both forest fire and ecological applications as it is related to ignitability, fire behavior and soil respiration. Real-time availability of this value would thus be a great benefit to fire risk management and prevention. However, the comprehensive literature review in this paper shows that there is no easy-to-use method for automated measurements available. This study investigates the applicability of four different sensor types (permittivity and electrical resistance measuring principles) for this measurement. Comparisons were made to manual gravimetric reference measurements carried out almost daily for one fire season and overall agreement was good (highly significant correlations with 0.792 < = r < = 0.947, p < 0.001). Standard deviations within sensor types were linearly correlated to daily sensor mean values; however, above a certain threshold they became irregular, which may be linked to exceedance of the working ranges. Thus, measurements with irregular standard deviations were considered unusable and relationships between gravimetric and automatic measurements of all individual sensors were compared only for useable periods. A large drift in these relationships became obvious from drought to drought period. This drift may be related to installation effects or settling and decomposition of the litter layer throughout the fire season. Because of the drift and the in situ calibration necessary, it cannot be recommended to use the methods presented here for monitoring purposes and thus operational hazard management. However, they may be interesting for scientific studies when some manual fuel moisture measurements are made anyway. Additionally, a number of potential methodological improvements are suggested.

Individual need satisfaction, organizational practices, and job satisfaction among laboratory professionals.

PubMed

Matteson, M T; Ivancevich, J M; McMahon, J T

1977-08-01

This study examines the role of 1) personal job-related needs and 2) certain organizational characteristics in affecting overall job satisfaction for a sample of 259 laboratory professionals, primarily medical technologists. Specific individual needs and specific organizational characteristics were found to be related to three measures of overall job satisfaction. Additional comparisons were made for administrators versus non-administrators and for differences associated with different sized organizations. Implications for the managers of medical technologists and other laboratory professionals are discussed.

A study of space shuttle energy management, approach and landing analysis

NASA Technical Reports Server (NTRS)

Morth, R.

1973-01-01

The steering system of the space shuttle vehicle is presented for the several hundred miles of flight preceding landing. The guidance scheme is characterized by a spiral turn to dissipate excess potential energy (altitude) prior to a standard straight-in final approach. In addition, the system features pilot oriented control, drag brakes, phugoid damping, and a navigational capacity founded upon an inertial measurement unit and an on-board computer. Analytic formulas are used to calculate, represent, and insure the workability of the system's specifications

Complexation of Statins with β-Cyclodextrin in Solutions of Small Molecular Additives and Macromolecular Colloids

NASA Astrophysics Data System (ADS)

Süle, András; Csempesz, Ferenc

The solubility of lovastatin and simvastatin (inevitable drugs in the management of cardiovascular diseases) was studied by phase-solubility measurements in multicomponent colloidal and non-colloidal media. Complexation in aqueous solutions of the highly lipophilic statins with β-cyclodextrin (β-CD) in the absence and the presence of dissolved polyvinyl pyrrolidone, its monomeric compound, tartaric acid and urea, respectively, were investigated. For the characterization of the CD-statin inclusion complexes, stability constants for the associates have been calculated.

50 CFR 648.108 - Framework adjustments to management measures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Management Measures for the Summer Flounder Fisheries § 648.108 Framework adjustments to management measures... Council, at any time, may initiate action to add or adjust management measures within the Summer Flounder... revised text is set forth as follows: § 648.108 Summer flounder gear restrictions. (a) General. (1) Otter...

Delinquent Medical Service Accounts at Brooke Army Medical Center Need Additional Management Oversight

DTIC Science & Technology

2014-08-13

No. DODIG-2014-101 A U G U S T 1 3 , 2 0 1 4 Delinquent Medical Service Accounts at Brooke Army Medical Center Need Additional Management...13 AUG 2014 2. REPORT TYPE 3. DATES COVERED 00-00-2014 to 00-00-2014 4. TITLE AND SUBTITLE Delinquent Medical Service Accounts at Brooke Army...Results in Brief Delinquent Medical Service Accounts at Brooke Army Medical Center Need Additional Management Oversight Visit us at www.dodig.mil

Nitrergic Mechanisms for Management of Recurrent Priapism

PubMed Central

Anele, Uzoma A.; Burnett, Arthur L.

2015-01-01

Introduction Priapism is a condition involving prolonged penile erection unrelated to sexual interest or desire. The ischemic type, including its recurrent variant, is often associated with both physical and psychological complications. As such, management is of critical importance. Ideal therapies for recurrent priapism should address its underlying pathophysiology. Aim To review the available literature on priapism management approaches particularly related to nitrergic mechanisms. Methods A literature review of the pathophysiology and management of priapism was performed using PubMed. Main Outcome Measure Publications pertaining to mechanisms of the molecular pathophysiology of priapism. Results Nitrergic mechanisms are characterized as major players in the molecular pathophysiology of priapism. PDE5 inhibitors represent an available therapeutic option with demonstrated ability in attenuating these underlying nitrergic derangements. Several additional signaling pathways have been found to play a role in the molecular pathophysiology of priapism and have also been associated with these nitrergic mechanisms. Conclusion An increasing understanding of the molecular pathophysiology of priapism has led to the discovery of new potential targets. Several mechanism-based therapeutic approaches may become available in the future. PMID:26478814

Project management practice and its effects on project success in Malaysian construction industry

NASA Astrophysics Data System (ADS)

Haron, N. A.; Devi, P.; Hassim, S.; Alias, A. H.; Tahir, M. M.; Harun, A. N.

2017-12-01

The rapid economic development has increased the demand for construction of infrastructure and facilities globally. Sustainable development and globalization are the new ‘Zeitgeist’ of the 21st century. In order to implement these projects successfully and to meet the functional aim of the projects within their lifetime, an efficient project management practice is needed. The aim of this study is to identify the critical success factors (CSFs) and the extent of use of project management practice which affects project success, especially during the implementation stage. Data were obtained from self-administered questionnaires with 232 respondents. A mixed method of data collection was adopted using semi-structured interview and questionnaire approach. The result of the analysis of data obtained showed that new and emerging criteria such as customer satisfaction, competency of the project team, and performance of subcontractors/suppliers are becoming measures of success in addition to the classic iron triangle’s view of time, cost and quality. An insight on the extent of use of different project management practice in the industry was also achieved from the study.

Application of PACE Principles for Population Health Management of Frail Older Adults.

PubMed

Stefanacci, Richard G; Reich, Shelley; Casiano, Alex

2015-10-01

To determine which practices would have the most impact on reducing hospital and emergency department admissions and nursing home placement among older adults with multiple comorbid conditions, a literature search and survey were conducted to identify and prioritize comprehensive care principles as practiced in the Program of All-inclusive Care for the Elderly (PACE). PACE medical directors and members of the PACE interdisciplinary team (IDT) were surveyed to gain their insights on the most impactful practices, which were identified as: End-of-Life Management, Caregiver Support, Management of Red Flags, Medication Management, Participant and Caregiver Health Care System Literacy, and Care Coordination. In addition, this research evaluated measures that could be used to assess an organization's level of success with regard to each of the 6 PACE practices identified. The results reported in this article, found through a survey with PACE medical directors and IDT members concerning effective interventions, can be viewed as strategies to improve care for older adults, enabling them to maintain their independence in the community, avoid the expense of facility-based care, and enhance their quality of life.

Impact of integrated upper limb spasticity management including botulinum toxin A on patient-centred goal attainment: rationale and protocol for an international prospective, longitudinal cohort study (ULIS-III)

PubMed Central

Turner-Stokes, Lynne; Ashford, Stephen; Jacinto, Jorge; Maisonobe, Pascal; Balcaitiene, Jovita; Fheodoroff, Klemens

2016-01-01

Objectives Describe the rationale and protocol for the Upper Limb International Spasticity (ULIS)-III study, which aims to evaluate the impact of integrated spasticity management, involving multiple botulinum toxin A (BoNT-A) injection cycles and concomitant therapies, on patient-centred goal attainment. Outline novel outcome assessment methods for ULIS-III and report initial evaluation data from goal setting in early stages of the study. Design Large international longitudinal cohort study of integrated upper limb spasticity management, including BoNT-A. Participants and setting ULIS-III is a 2-year study expected to enrol >1000 participants at 58 study centres across 14 countries. Interventions The study design is non-interventional and intended to reflect real-life clinical practice. It will describe injection practices and additional treatment strategies, and record clinical decision-making in a serial approach to long-term spasticity management. Outcome measures ULIS-III will use a goal-directed approach to selection of targeted standardised measures to capture the diversity of presentation, goals and outcomes. ULIS-III will implement the Upper Limb Spasticity Index, a battery of assessments including a structured approach to goal attainment scaling (Goal Attainment Scaling—Evaluation of Outcomes for Upper Limb Spasticity tool), alongside a limited set of standardised measures, chosen according to patients' selected goal areas. Concomitant therapy inputs, patient satisfaction with engagement in goal setting, health economic end points and health-related quality of life data will also be captured. Results of initial evaluation of goal quality Recruitment started in January 2015. By June 2015, 58 sites had been identified and initial data collected for 79 patients across 13 sites in 3 countries. Goal setting data were quality-checked and centres rated on the basis of function-related and Specific, Measurable, Achievable, Realistic, Timed (SMART) characteristics of goal statements. Overall, 11/13 centres achieved the highest rating (A++). Conclusions ULIS-III will provide valuable information regarding treatment of and outcomes from real-life upper limb spasticity management worldwide. Trial registration number NCT02454803; Pre-results. PMID:27315835

The development of a streamlined, coordinated and sustainable evaluation methodology for a diverse chronic disease management program.

PubMed

Berlowitz, David J; Graco, Marnie

2010-05-01

The Northern Alliance Hospital Admission Risk Program-Chronic Disease Management comprises 13 services delivering care to those with chronic disease and older people with complex care needs, who are frequent hospital users. To develop and implement a system-wide approach to the evaluation of this existing program. The Northern Clinical Research Centre audited all existing, routinely collected administrative data within the program and then met with each service to develop service specific outcome measures. The evaluators then developed and implemented a system-wide evaluation approach to measure performance in terms of: client profile; access and entry; service efficiency; client outcomes; and hospital demand. Data are collected electronically and more than 80% are derived from existing, administrative datasets, minimising staff and client burden. Additional data include client outcomes and a health related quality of life measure. The preliminary twelve month data suggest that clients have the equivalent of 'fair' or 'poor' self-reported health status (n = 862) and the average health utility scores are significantly (P < 0.05) worse than population control data. These analyses reveal, for the first time, that the Northern Alliance Hospital Admission Risk Program-Chronic Disease Management program is targeting appropriate clients. This methodology will enable many prospective assessments to be performed including; client outcome evaluation, service model comparisons, and cost-utility analyses. This evaluation approach demonstrates the feasibility of a highly coordinated 'whole of system' evaluation. Such an approach may ultimately contribute to the development of evidence-based policy.

Environmental management in North American mining sector.

PubMed

Asif, Zunaira; Chen, Zhi

2016-01-01

This paper reviews the environmental issues and management practices in the mining sector in the North America. The sustainable measures on waste management are recognized as one of the most serious environmental concerns in the mining industry. For mining activities, it will be no surprise that the metal recovery reagents and acid effluents are a threat to the ecosystem as well as hazards to human health. In addition, poor air quality and ventilation in underground mines can lead to occupational illness and death of workers. Electricity usage and fuel consumption are major factors that contribute to greenhouse gases. On the other hand, many sustainability challenges are faced in the management of tailings and disposal of waste rock. This paper aims to highlight the problems that arise due to poor air quality and acid mine drainage. The paper also addresses some of the advantages and limitations of tailing and waste rock management that still have to be studied in context of the mining sector. This paper suggests that implementation of suitable environmental management tools like life cycle assessment (LCA), cleaner production technologies (CPTs), and multicriteria decision analysis (MCD) are important as it ultimately lead to improve environmental performance and enabling a mine to focus on the next stage of sustainability.

Illness beliefs and self-management in children and young people with chronic illness: a systematic review.

PubMed

Law, Gary Urquhart; Tolgyesi, Charlotte Sarah; Howard, Ruth A

2014-01-01

To review the extent to which illness representations, based on Leventhal's Common Sense Model, relate to self-management in children and young people with chronic physical health conditions. A systematic literature review was carried out to identify relevant studies and each included paper was assessed for risk of bias. Fifteen papers met criteria for inclusion within the review. The majority of studies were cross-sectional, and small sample sizes for some studies made it difficult to generalise findings. The method of measuring both illness representations and outcomes varied. Timeline, identity, control and consequences beliefs were the most frequently assessed domains of illness representations included within the studies. While there is variability, there are indications that control beliefs, specifically treatment control beliefs, are more consistently and strongly associated with self-management than other representation domains. Control beliefs should be targeted for intervention in studies trying to improve adolescent self-management. In addition, the relationship between illness representations and self-management needs to be considered within both developmental and systemic contexts. It is likely that the variation in self-management will be more fully explained in future research that explores the combined effects of individual representations and the influence of wider contexts.

Imbedding HACCP principles in dairy herd health and production management: case report on calf rearing

PubMed Central

2008-01-01

Driven by consumer demands, European legislation has suggested the use of HACCP (Hazard Analysis Critical Control Point) as the quality risk management programme for the whole dairy chain. Until now, an exception has been made for primary producers, but as regulations evolve, on-farm HACCP-like programmes should be ready to assure food safety as well as animal health and animal welfare. In our field experiment, the HACCP-concept was used to combine both optimal farm management and formalisation of quality assurance in an on-farm situation in the Netherlands. The process of young stock rearing was chosen, since its importance for the future of the farm is often underestimated. Hazards and their associated risk factors can be controlled within the farm-specific standards and tolerances, as targets can be controlled by corrective measures and by implementation of farm-specific worksheets. The veterinarian is pivotal for the facility-based HACCP team, since he/she has knowledge about on-farm risk assessment and relations between clinical pathology, feed and farm management. The HACCP concept in combination with veterinary herd health and production management programmes offers a promising approach to optimise on-farm production processes (i.e., young stock rearing) in addition to a structural approach for quality risk management on dairy farms. PMID:21851722

Imbedding HACCP principles in dairy herd health and production management: case report on calf rearing.

PubMed

Boersema, Jsc; Noordhuizen, Jptm; Vieira, A; Lievaart, Jj; Baumgartner, W

2008-09-01

Driven by consumer demands, European legislation has suggested the use of HACCP (Hazard Analysis Critical Control Point) as the quality risk management programme for the whole dairy chain. Until now, an exception has been made for primary producers, but as regulations evolve, on-farm HACCP-like programmes should be ready to assure food safety as well as animal health and animal welfare. In our field experiment, the HACCP-concept was used to combine both optimal farm management and formalisation of quality assurance in an on-farm situation in the Netherlands. The process of young stock rearing was chosen, since its importance for the future of the farm is often underestimated. Hazards and their associated risk factors can be controlled within the farm-specific standards and tolerances, as targets can be controlled by corrective measures and by implementation of farm-specific worksheets. The veterinarian is pivotal for the facility-based HACCP team, since he/she has knowledge about on-farm risk assessment and relations between clinical pathology, feed and farm management. The HACCP concept in combination with veterinary herd health and production management programmes offers a promising approach to optimise on-farm production processes (i.e., young stock rearing) in addition to a structural approach for quality risk management on dairy farms.

Nurse case management for pregnant women experiencing or at risk for abuse.

PubMed

Curry, Mary Ann; Durham, Laurel; Bullock, Linda; Bloom, Tina; Davis, Jan

2006-01-01

To determine whether individualized nursing case management can decrease stress among pregnant women at risk for or in abusive relationships. A multisite randomized controlled trial. Two prenatal clinics in the Pacific Northwest and rural Midwest. 1,000 women who spoke English and were 13 to 23 weeks pregnant at time of recruitment. All intervention group women (N = 499) were offered an abuse video and had access to a nurse case manager 24/7. Additionally, participants at risk for or in abusive relationships received individualized nursing care management throughout the pregnancy. The most frequent nursing care management activities were providing support (38%) and assessing needs (32%). The nursing care management group received an average of 22 contacts, most (80%) by telephone and had a significant reduction in stress scores as measured by the Prenatal Psychosocial Profile. Compared to the control group, the differences were in the predicted direction, but not statistically different. A major finding was the choice by abused women to focus on basic needs and their pregnancies rather than the abuse, although all received safety planning. Pregnant women at risk for or in abusive relationships experience very stressful and complex lives. Nurses need to focus on the needs they identify, which may not be the abusive relationship.

Effects of land-use management on soil microbes to degrade organic matter through captured metagenomics and metatranscriptomics

NASA Astrophysics Data System (ADS)

Manoharan, Lokeshwaran; Ahren, Dag; Urich, Tim; Hedlund, Katarina

2017-04-01

The role of microbial communities in different soil ecosystem processes has been hard to determine in the past due to their vast diversity both in terms of taxonomy and functions. Molecular methods such as high-throughput sequencing of environmental communities have made it easier to delve into these diverse ecosystems and understand their functions. Trait-based approaches through quantification of functional genes and their expression have shown to be much more meaningful in explaining ecosystem functioning than the taxonomy based approaches. One such approach is the "captured metagenomics" technique where only the genetic regions of functional enzymes involved in a particular ecosystem process such as carbon metabolism is targeted from the genetic pool and sequenced. This allows focused investigations of ecosystem processes through functional genes in complex environments such as soils. In our study, we have implemented this method to look into the effects of land-use management on the functional genetic diversity of microbial communities to degrade soil organic matter (SOM). Soils from different agricultural and grassland fields in southern Sweden were chosen in this study. Oligonucleotide probes were generated based on the genetic sequences of enzymes involved in organic matter degradation from public databases. On the DNA level, there was a significant shift in the functional genetic diversity of microbes to degrade SOM due to land-use management. Grasslands had a higher abundance and diversity of genes coding for enzymes involved in SOM degradation than agricultural soils. The amount of nitrogen was the main factor that affected the functional diversity of the microbes that degrade SOM in these soils. Interestingly, there was no correlation between the functional diversity of microbes to their taxonomic diversity measured through traditional ribosomal sequencing. In addition, for the first time the capture method was used in large scale, targeting many genes coding for SOM degrading enzymes coupled with RNA/cDNA from the soils to quantify their expressions. For this, the soils from different land-use managements were treated with straw, while the microbial growth rates in these soils were also monitored for a month. RNA was extracted from at three different time points from both treated and untreated soils from different land-use managements. Agricultural soils with straw addition had higher relative microbial growth rates and higher abundance of gene sequences captured compared to the control and grassland soils. Land-use management seems to be the most significant factor in affecting the expression of SOM degrading genes in these soils. Additional analyses of the generated data are expected to provide valuable insights on how land-use management affects the microbial responses during addition of organic matter in soils.

Patient-centered activity monitoring in the self-management of chronic health conditions.

PubMed

Chiauzzi, Emil; Rodarte, Carlos; DasMahapatra, Pronabesh

2015-04-09

As activity tracking devices become smaller, cheaper, and more consumer-accessible, they will be used more extensively across a wide variety of contexts. The expansion of activity tracking and personal data collection offers the potential for patient engagement in the management of chronic diseases. Consumer wearable devices for activity tracking have shown promise in post-surgery recovery in cardiac patients, pulmonary rehabilitation, and activity counseling in diabetic patients, among others. Unfortunately, the data generated by wearable devices is seldom integrated into programmatic self-management chronic disease regimens. In addition, there is lack of evidence supporting sustained use or effects on health outcomes, as studies have primarily focused on establishing the feasibility of monitoring activity and the association of measured activity with short-term benefits. Monitoring devices can make a direct and real-time impact on self-management, but the validity and reliability of measurements need to be established. In order for patients to become engaged in wearable data gathering, key patient-centered issues relating to usefulness in care, motivation, the safety and privacy of information, and clinical integration need to be addressed. Because the successful usage of wearables requires an ability to comprehend and utilize personal health data, the user experience should account for individual differences in numeracy skills and apply evidence-based behavioral science principles to promote continued engagement. Activity monitoring has the potential to engage patients as advocates in their personalized care, as well as offer health care providers real world assessments of their patients' daily activity patterns. This potential will be realized as the voice of the chronic disease patients is accounted for in the design of devices, measurements are validated against existing clinical assessments, devices become part of the treatment 'prescription', behavior change programs are used to engage patients in self-management, and best practices for clinical integration are defined.

ICONS: Managing Care and Costs: The Sustained Cost Impact of Reduced Hospitalizations in a Partnership-Measurement Model of Disease Management.

PubMed

Paradis, Pierre Emmanuel; Nemis-White, Joanna; Meilleur, Marie-Claude; Ginn, Marissa; Cox, Jafna; Montague, Terrence

2010-01-01

Improving Cardiovascular Outcomes in Nova Scotia (ICONS) was a multidisciplinary-partnership, measurement-driven disease management project designed to improve the care and outcomes of patients with acute and chronic heart diseases in Nova Scotia. Previous analyses demonstrated beneficial clinical and macroeconomic end points at the population and system levels, including heightened awareness of the value of team care, increased use of proven therapies, decreased re-hospitalizations and a positive dollar return on investment for the economies of Nova Scotia and Canada. This article analyzes the additional cost-reduction benefits resulting from the reduced re-hospitalizations that occurred among patient populations with heart attacks and heart failure. Over the five-year course of ICONS, one-year readmissions and readmission rates fell continuously for both index disease states. Despite a general inflationary rise in real hospital costs, the per-event cost of readmissions expressed in constant 2002 dollars also decreased: from $10,377 in 1997 to $9,022 in 2002 for the heart attack patient population; and from $9,020 to $8,697 for patients with heart failure. Total real yearly costs for heart attack readmissions fell from $7.4 million in 1997 to $6.4 million in 2002, a 14% decrease; for heart failure, yearly costs decreased by 26%, from $9.2 million to $6.8 million. These microeconomic data supplement the previously reported improvements in patient care and the positive macroeconomic impact of ICONS. Overall, ICONS demonstrated that quality and cost of healthcare could be simultaneously and successfully managed over a sustained period of time for whole patient populations in a real-world setting. ICONS offers strong evidence of the value of the partnership-measurement model of disease management and prevention as a reproducible and desirable template for next-generation healthcare in Canada.

Quantifying resilience of multiple ecosystem services and biodiversity in a temperate forest landscape.

PubMed

Cantarello, Elena; Newton, Adrian C; Martin, Philip A; Evans, Paul M; Gosal, Arjan; Lucash, Melissa S

2017-11-01

Resilience is increasingly being considered as a new paradigm of forest management among scientists, practitioners, and policymakers. However, metrics of resilience to environmental change are lacking. Faced with novel disturbances, forests may be able to sustain existing ecosystem services and biodiversity by exhibiting resilience, or alternatively these attributes may undergo either a linear or nonlinear decline. Here we provide a novel quantitative approach for assessing forest resilience that focuses on three components of resilience, namely resistance, recovery, and net change, using a spatially explicit model of forest dynamics. Under the pulse set scenarios, we explored the resilience of nine ecosystem services and four biodiversity measures following a one-off disturbance applied to an increasing percentage of forest area. Under the pulse + press set scenarios, the six disturbance intensities explored during the pulse set were followed by a continuous disturbance. We detected thresholds in net change under pulse + press scenarios for the majority of the ecosystem services and biodiversity measures, which started to decline sharply when disturbance affected >40% of the landscape. Thresholds in net change were not observed under the pulse scenarios, with the exception of timber volume and ground flora species richness. Thresholds were most pronounced for aboveground biomass, timber volume with respect to the ecosystem services, and ectomycorrhizal fungi and ground flora species richness with respect to the biodiversity measures. Synthesis and applications . The approach presented here illustrates how the multidimensionality of stability research in ecology can be addressed and how forest resilience can be estimated in practice. Managers should adopt specific management actions to support each of the three components of resilience separately, as these may respond differently to disturbance. In addition, management interventions aiming to deliver resilience should incorporate an assessment of both pulse and press disturbances to ensure detection of threshold responses to disturbance, so that appropriate management interventions can be identified.

An Overview of the Challenges with and Proposed Solutions for the Ingest and Distribution Processes For Airborne Data Management

NASA Astrophysics Data System (ADS)

Northup, E. A.; Beach, A. L., III; Early, A. B.; Kusterer, J.; Quam, B.; Wang, D.; Chen, G.

2015-12-01

The current data management practices for NASA airborne field projects have successfully served science team data needs over the past 30 years to achieve project science objectives, however, users have discovered a number of issues in terms of data reporting and format. The ICARTT format, a NASA standard since 2010, is currently the most popular among the airborne measurement community. Although easy for humans to use, the format standard is not sufficiently rigorous to be machine-readable, and there lacks a standard variable naming convention among the many airborne measurement variables. This makes data use and management tedious and resource intensive, and also create problems in Distributed Active Archive Center (DAAC) data ingest procedures and distribution. Further, most DAACs use metadata models that concentrate on satellite data observations, making them less prepared to deal with airborne data. There also exists a substantial amount of airborne data distributed by websites designed for science team use that are less friendly to users unfamiliar with operations of airborne field studies. A number of efforts are underway to help overcome the issues with airborne data discovery and distribution. The ICARTT Refresh Earth Science Data Systems Working Group (ESDSWG) was established to enable a platform for atmospheric science data providers, users, and data managers to collaborate on developing new criteria for the file format in an effort to enhance airborne data usability. In addition, the NASA Langley Research Center Atmospheric Science Data Center (ASDC) has developed the Toolsets for Airborne Data (TAD) to provide web-based tools and centralized access to airborne in situ measurements of atmospheric composition. This presentation will discuss the aforementioned challenges and attempted solutions in an effort to demonstrate how airborne data management can be improved to streamline data ingest and discoverability to a broader user community.

Improving and ensuring best practice continence management in residential aged care.

PubMed

Heckenberg, Gayle

2008-06-01

Background  Continence Management within residential aged care is an every day component of care that requires assessment, implementation of strategies, resource allocation and evaluation. At times the management of incontinence of aged residents can be challenging and unsuccessful. The project chosen through the Clinical Fellowship program was Continence Management with the aim of raising awareness of best practice to assist in improving and providing person-centred resident care. Aims/objectives •  Review the literature on best practice management of incontinence •  Evaluate current practice in continence management for elderly residents within residential aged care services •  Improve adherence to best practice strategies of care for incontinence •  Raise awareness within the nursing home of the best practice management of incontinence •  Promote appropriate and effective use of resources for continence management •  Deliver individualised person-centred care to residents. •  Ensure best practice in continence management Methods  The Joanna Briggs Institute (JBI) Practical Application of Clinical Evidence System clinical audit tool was utilised to measure current practice against best practice. The results identify gaps that require improvement. The Getting Research into Practice process then allowed analysis of the level of compliance with each of the audit criteria, which would identify any barriers in implementing a selected course of action and aim to improve compliance. The project team was consulted with additional stakeholder consultation to form an action plan and implement strategies to improve practice. Results  Although 100% compliance with all audit criteria in audit 1 and 2 was not achieved, there was improvement in the criteria concerning the documented fluid intake for residents. Further strategies have been identified and implemented and this continues to be a 'work in progress'. Staff now have an acute awareness of what best practice means and the impact their practices have on continence management. The JBI clinical audit and feedback cycle will continue to facilitate the measuring and implementation of best practice for resident outcomes in residential aged care. © 2008 The Author. Journal Compilation © Blackwell Publishing Asia Pty Ltd.

Measurement Decision Risk - The Importance of Definitions

NASA Technical Reports Server (NTRS)

Mimbs, Scott M.

2008-01-01

One of the more misunderstood areas of metrology is the Test Uncertainty Ratio (TUR) and the Test Accuracy Ratio (TAR). There have been many definitions over the years, but why are these definitions important to a discussion on measurement decision risk? The importance lies in the clarity of communication. Problems can immediately arise in the application (or misapplication) of the definition of these terms. In other words, while it is important to understand the definitions, it is more important to understand concepts behind the definitions and to be precise in how they are applied. The objective of any measurement is a decision. Measurement Decision Risk is a way to look at the quality of a measurement, and although it is not a new concept, it has generated a lot of attention since its addition as a requirement in the new U.S. National Standard, ANSIINCSL Z540.3-2006. In addition to Measurement Decision Risk as the prime method of managing measurement risk, Z540.3 has added, as a fall-back, an explicit definition for TUR. The impact these new requirements may have on calibration service providers has become the topic of much discussion and in some cases concern. This paper will look at the concepts behind the definitions and how they relate to Measurement Decision Risk. Using common examples, this paper will also provide a comparison of various elements of risk related to measurement science using the concepts of TAR, TUR, accuracy ratios, and Consumer Risk (False Accept Risk). The goal of this paper is to provide a better understanding of their relevance to the measurement decision process.

Objective Versus Subjective Measures of Executive Functions: Predictors of Participation and Quality of Life in Parkinson Disease?

PubMed

Vlagsma, Thialda T; Koerts, Janneke; Tucha, Oliver; Dijkstra, Hilde T; Duits, Annelien A; van Laar, Teus; Spikman, Jacoba M

2017-11-01

To determine whether objective (neuropsychological tests) and subjective measures (questionnaires) of executive functions (EFs) are associated in patients with Parkinson disease (PD), and to determine to what extent level of participation and quality of life (QoL) of patients with PD can be predicted by these measures of EFs. Correlational research design (case-control and prediction design). Departments of neuropsychology of 3 medical centers. A sample (N=136) of patients with PD (n=42) and their relatives, and controls without PD (n=94). Not applicable. A test battery measuring EFs. In addition, patients, their relatives, and controls completed the Dysexecutive Questionnaire, Brock Adaptive Functioning Questionnaire, and Barkley Deficits in Executive Functioning Scale - time management questionnaires measuring complaints about EFs. Participation and QoL were measured with the Impact on Participation and Autonomy scale and the Parkinson's Disease Questionnaire-39, respectively. Patients with PD showed impairments in EFs on objective tests and reported significantly more complaints about EFs than did controls without PD. No associations were found between patients' performances on objective and subjective measures of EFs. However, both objective and subjective measures predicted patients' level of participation. In addition, subjective measures of EFs predicted QoL in patients with PD. These findings show that objective and subjective measures of EFs are not interchangeable and that both approaches predict level of participation and QoL in patients with PD. However, within this context, sex needs to be taken into account. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

The value of personal health records for chronic disease management: what do we know?

PubMed

Tenforde, Mark; Jain, Anil; Hickner, John

2011-05-01

Electronic personal health records (PHRs) allow patients access to their medical records, self-management tools, and new avenues of communication with their health care providers. They will likely become a valuable component of the primary care Patient-centered Medical Home model. Primary care physicians, who manage the majority of chronic disease, will use PHRs to help patients manage their diabetes and other chronic diseases requiring continuity of care and enhanced information flow between patient and physician. In this brief report, we explore the evidence for the value of PHRs in chronic disease management. We used a comprehensive review of MEDLINE articles published in English between January 2000 and September 2010 on personal health records and related search terms. Few published articles have described PHR programs designed for use in chronic disease management or PHR adoption and attitudes in the context of chronic disease management. Only three prospective randomized trials have evaluated the benefit of PHR use in chronic disease management, all in diabetes care. These trials showed small improvements in some but not all diabetes care measures. All three trials involved additional interventions, making it difficult to determine the influence of patient PHR use in improved outcomes. The evidence remains sparse to support the value of PHR use for chronic disease management. With the current policy focus on meaningful use of electronic and personal health records, it is crucial to investigate and learn from new PHR products so as to maximize the clinical value of this tool.

Quasi-Isentropic Compression of Wrought and Additively Manufactures 304L Stainless Steel

NASA Astrophysics Data System (ADS)

Specht, Paul; Brown, Justin; Wise, Jack; Furnish, Michael; Adams, David

2017-06-01

The thermodynamic and constitutive responses of both additively manufactured (AM) and traditional wrought processed 304L stainless steel (SS) were investigated through quasi-isentropic compression to peak stresses near 1Mbar using Sandia National Laboratories' Z machine. The AM 304L SS samples were made with a laser engineered net shaping (LENS™) technique. Compared to traditional wrought processed 304L SS, the AM samples were highly textured with larger grain sizes (i.e.near 1mm) and residual stresses (> 100 MPa). Interferometric measurements of interface velocities enabled inference of the quasi-isentropes for each fabrication type of 304L SS. Release from peak stress provided flow strength measurements of the wrought and AM 304L SS. Sandia National Laboratories is a multi-mission laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of Lockheed Martin Corporation, for the U.S. Department of Energy's National Nuclear Security Administration under contract DE-AC04-94AL85000. Approved For Unclassified Unlimited Release SAND2017-2040A.

Accounting for vulnerable populations in rural hazard mitigation plans: results of a survey of emergency managers.

PubMed

Horney, Jennifer A; Nguyen, Mai; Cooper, John; Simon, Matthew; Ricchetti-Masterson, Kristen; Grabich, Shannon; Salvesen, David; Berke, Philip

2013-01-01

Rural areas of the United States are uniquely vulnerable to the impacts of natural disasters. One possible way to mitigate vulnerability to disasters in rural communities is to have a high-quality hazard mitigation plan in place. To understand the resources available for hazard mitigation planning and determine how well hazard mitigation plans in rural counties meet the needs of vulnerable populations, we surveyed the lead planning or emergency management official responsible for hazard mitigation plans in 96 rural counties in eight states in the Southeastern United States. In most counties, emergency management was responsible for implementing the county's hazard mitigation plan and the majority of counties had experienced a presidentially declared disaster in the last 5 years. Our research findings demonstrated that there were differences in subjective measures of vulnerability (as reported by survey respondents) and objective measures of vulnerability (as determined by US Census data). In addition, although few counties surveyed included outreach to vulnerable groups as a part of their hazard mitigation planning process, a majority felt that their hazard mitigation plan addressed the needs of vulnerable populations "well" or "very well." These differences could result in increased vulnerabilities in rural areas, particularly for certain vulnerable groups.

Subtalar instability. Etiology, diagnosis, and management.

PubMed

Keefe, Daniel T; Haddad, Steven L

2002-09-01

Subtalar instability is an evolving disorder that seems to cause a portion of chronic hindfoot instability. It can be seen as an isolated problem, or more commonly, in combination with ankle instability. There seems to be many injury mechanisms, most of which seem to involve supination of the hindfoot, and all seem to attenuate the lateral ligaments of the ankle and subtalar joints. As the condition progresses, and additional sprains occur as a result of the alteration in subtalar joint mechanics, the remaining ligaments become attenuated. There are many methods described to diagnose subtalar instability, but no conclusive test has been devised. Thus, the diagnosis must be inferred from an accurate history, physical examination, conferring radiographic studies, and failure of nonoperative management (often, for ankle instability). As with other hindfoot injuries, many patients improve with conservative measures. These measures are early (ice and immobilization) and late (bracing and proprioceptive training). When patients do not improve or cannot tolerate bracing, recent studies have shown there is a role for ligamentous reconstruction. Most procedures attempt to recreate the lateral ligament structures, including the calcaneofibular, the cervical, and the interosseous talocalcaneal ligaments, which seem to have the best stabilizing effect on the hindfoot. With the advent of newer procedures and more aggressive surgical management, there may be a role for early anatomic repair and rehabilitation.

The important role of scattered trees on the herbaceous diversity of a grazed Mediterranean dehesa

NASA Astrophysics Data System (ADS)

López-Sánchez, Aida; San Miguel, Alfonso; López-Carrasco, Celia; Huntsinger, Lynn; Roig, Sonia

2016-10-01

Scattered trees are considered keystone structures and play an important role in Mediterranean sylvopastoral systems. Such systems are associated with high biodiversity and provide important natural resources and ecosystem services. In this study, we measured the contribution of scattered trees and different grazing management (cattle, sheep and wildlife only) to the diversity of the grassland sward in a dehesa (open holm oak woodland) located in Central Spain. We analyzed alpha and beta diversity through measurement of species richness, Shannon-Wiener, and Whittaker indices, respectively; and the floristic composition of the herb layer using subplots within two adjacent plots (trees present vs. trees absent) under three different grazing management regimes, including wildlife only, during a year. We found a 20-30% increment in the alpha diversity of wooded plots, compared to those without trees, regardless of grazing management. All beta indices calculated showed more than 60% species turnover. Wooded plots were occupied by different herbaceous species in different heterogeneous microsites (under the canopy, in the ecotone or on open land) created by the trees. Livestock grazing modified species composition (e.g. more nitrophilous species) compared to wildlife only plots. In addition to all their other benefits, trees are important to maintaining grassland diversity in Mediterranean dehesas.

Healthcare Quality Indicators for Physiotherapy Management in Hip and Knee Osteoarthritis and Rheumatoid Arthritis: A Delphi Study.

PubMed

Peter, W F; Hurkmans, E J; van der Wees, P J; Hendriks, E J M; van Bodegom-Vos, L; Vliet Vlieland, T P M

2016-12-01

The aim of the present study was to develop healthcare quality indicators (HCQIs) for the physiotherapy (PT) management of patients with hip or knee osteoarthritis (HKOA) or rheumatoid arthritis (RA) in the Netherlands. Two multidisciplinary expert panels, including patients, were instituted. A draft HCQI set was derived from recommendations included in two existing Dutch PT guidelines for HKOA and RA. The panels suggested additional topics, after which a Delphi procedure was performed. All propositions were scored for their potential to represent good-quality PT care (score range 0-9). Based on predefined rules, the Delphi panel HCQIs were discussed and selected. Lastly, every indicator was rephrased, resulting in its output consisting of a numerator and denominator, to facilitate comparisons within and among practices. After two Delphi rounds, two final sets of 17 HCQI - one for HKOA and one for RA - were composed, both containing 16 process indicators (regarding initial assessment, treatment and evaluation) and one outcome indicator. Two sets of HCQIs for PT management in HKOA and RA were developed for measuring the quality of PT care in daily clinical practice. Each indicator was formulated in a measurable way. Future research should focus on the feasibility of both indicator sets for daily clinical practice. Copyright © 2016 John Wiley & Sons, Ltd.

Combining remote sensing and on-site monitoring methods to investigate footpath erosion within a popular recreational heathland environment.

PubMed

Rodway-Dyer, Sue; Ellis, Nicola

2018-06-01

Footpaths are a prominent consequence of natural area tourism and reflect damage caused to valuable, sensitive habitats by people pressure. Degradation impacts on vegetation, wildlife, on and off-site soil movement and loss, creation of additional informal off-path footpaths (desire lines), and visual destruction of landscapes. Impacts need to be measured and monitored on a large temporal and spatial scale to aid in land management to maintain access and preserve natural environments. This study combined remote sensing (Light Detection and Ranging [LiDAR] and aerial photography) with on-site measurement of footpaths within a sensitive heathland habitat (Land's End, Cornwall, UK). Soil loss, slope angle change, vegetation damage and a hydrology model were combined to comprehensively study the site. Results showed 0.09 m mean soil loss over five years, footpath widening, increasing grass cover into heathland, and water channelling on the footpaths exacerbating erosion. The environments surrounding the footpaths were affected with visitors walking off path, requiring further management and monitoring. Multiple remote sensing techniques were highly successful in comprehensively assessing the area, particularly the hydrology model, demonstrating the potential of providing a valuable objective and quantitative monitoring and management tool. Copyright © 2018 Elsevier Ltd. All rights reserved.

Barriers to Optimal Pain Management in Aged Care Facilities: An Australian Qualitative Study.

PubMed

Veal, Felicity; Williams, Mackenzie; Bereznicki, Luke; Cummings, Elizabeth; Thompson, Angus; Peterson, Gregory; Winzenberg, Tania

2018-04-01

Up to 80% of residents in aged care facilities (ACFs) experience pain, which is often suboptimally managed. The purpose of this study was to characterize pain management in ACFs and identify the barriers to optimal pain management. This exploratory descriptive qualitative study used semistructured interviews in five Southern Tasmania, Australian ACFs. Interviewees included 23 staff members (18 nurses and 5 facility managers) and were conducted from September to November 2015. Interviews included questions about how pain was measured or assessed, what happened if pain was identified, barriers to pain management, and potential ways to overcome these barriers. Interviewees noted that there were no formal requirements regarding pain assessment at the ACFs reviewed; however, pain was often informally assessed. Staff noted the importance of adequate pain management for the residents' quality of life and employed both nonpharmacologic and pharmacologic techniques to reduce pain when identified. The barriers to optimal pain management included difficulty identifying and assessing pain, residents' resistance to reporting pain and/or taking medications, and communication barriers between the nursing staff and GPs. Staff interviewed were dedicated to managing residents' pain effectively; however, actions in a number of areas could improve resident outcomes. These include a more consistent approach to documenting pain in residents' progress notes and improving nurse-GP communications to ensure that new or escalating pain is identified and expedient changes can be made to the resident's management. Additionally, resident, family, nurse, and carer education, conducted within the facilities on a regular basis, could help improve the pain management of residents. Copyright © 2017. Published by Elsevier Inc.

The Development of A Performance Measurement Concept for the Royal Australian Air Force

DTIC Science & Technology

1992-09-01

knowledge of management accounting and performance measurement techniques. As the RAAF currently has no cost management and performance measurement system...provides a review of the current literature on management accounting for performance measurement, specifically referring to the problems of using...traditional management accounting methodologies as a basis for formulating performance measures. Chapter III explains the methodology used to conduct the

EPA Tribal Areas (4 of 4): Alaska Native Allotments

EPA Pesticide Factsheets

This dataset is a spatial representation of the Public Land Survey System (PLSS) in Alaska, generated from land survey records. The data represents a seamless spatial portrayal of native allotment land parcels, their legal descriptions, corner positioning and markings, and survey measurements. This data is intended for mapping purposes only and is not a substitute or replacement for the legal land survey records or other legal documents.Measurement and attribute data are collected from survey records using data entry screens into a relational database. The database design is based upon the FGDC Cadastral Content Data Standard. Corner positions are derived by geodetic calculations using measurement records. Closure and edgematching are applied to produce a seamless dataset. The resultant features do not preserve the original geometry of survey measurements, but the record measurements are reported as attributes. Additional boundary data are derived by spatial capture, protraction and GIS processing. The spatial features are stored and managed within the relational database, with active links to the represented measurement and attribute data.

Development and initial evaluation of an enhanced measure of boundary flexibility for the work and family domains.

PubMed

Matthews, Russell A; Barnes-Farrell, Janet L

2010-07-01

This manuscript reports the development of a measure of work and family domain boundary flexibility. Building on previous research, we propose an expanded definition of boundary flexibility that includes two components-flexibility-ability and flexibility-willingness-and we develop a measure designed to capture this more comprehensive definition of boundary flexibility. Flexibility-ability is conceptualized as an individual's perception of personal and situational constraints that affect boundary management, and flexibility-willingness is conceptualized as an individual difference variable that captures the motivation to engage in boundary flexing. An additional feature of domain boundaries, permeability, is also examined. Data are presented from two studies. Study 1 (N = 244) describes the development of a multiscale measure that extends current conceptual definitions of boundary flexibility. Study 2 (N = 225) describes the refinement and evaluation of this measure. Confirmatory factor analysis, reliability evidence, interscale correlations, and correlations with important work-family constructs (e.g., domain centrality, work-family conflict) provide initial construct validity evidence for the measure.

Can Secure Patient-Provider Messaging Improve Diabetes Care?

PubMed

Chung, Sukyung; Panattoni, Laura; Chi, Jeffrey; Palaniappan, Latha

2017-10-01

Internet-based secure messaging between patients and providers through a patient portal is now common in the practice of modern medicine. There is limited evidence on how messaging is associated with use and clinical quality measures among patients with type 2 diabetes. We examine whether messaging with physicians for medical advice is associated with fewer face-to-face visits and better diabetes management. Patients with diabetes who were enrolled in an online portal of an outpatient health care organization in 2011-2014 were studied ( N = 37,762 patient-years). Messages from/to primary care physicians or diabetes-related specialists for medical advice were considered. We estimated the association of messaging with diabetes quality measures, adjusting for patient and provider characteristics and patient-level clustering. Most patients (72%) used messaging, and those who made frequent visits were also more likely to message. Given visit frequency, no (vs. any) messaging was negatively associated with the likelihood of meeting an HbA 1c target of <8% (64 mmol/mol) (odds ratio [OR] 0.83 [95% CI 0.77, 0.90]). Among message users, additional messages (vs. 1) were associated with better outcome (two more messages: OR 1.17 [95% CI 1.06, 1.28]; three more messages: 1.38 [1.25, 1.53]; four more messages: 1.55 [1.43, 1.69]). The relationship was stronger for noninsulin users. Message frequency was also positively associated, but to a smaller extent, with process measures (e.g., eye examination). Physician-initiated messages had effects similar to those for patient-initiated messages. Patients with diabetes frequently used secure messaging for medical advice in addition to routine visits to care providers. Messaging was positively associated with better diabetes management in a large community outpatient practice. © 2017 by the American Diabetes Association.

Improving Quality of Care in Patients with Liver Cirrhosis.

PubMed

Saberifiroozi, Mehdi

2017-10-01

Liver cirrhosis is a major chronic disease in the field of digestive diseases. It causes more than one million deaths per year. Despite established evidence based guidelines, the adherence to standard of care or quality indicators are variable. Complete adherence to the recommendations of guidelines is less than 50%. To improve the quality of care in patients with cirrhosis, we need a more holistic view. Because of high rate of death due to cardiovascular disease and neoplasms, the care of comorbid conditions and risk factors such as smoking, hypertension, high blood sugar or cholesterol, would be important in addition to the management of primary liver disease. Despite a holistic multidisciplinary approach for this goal, the management of such patients should be patient centered and individualized. The diagnosis of underlying etiology and its appropriate treatment is the most important step. Definition and customizing the quality indicators for quality measure in patients are needed. Because most suggested quality indicators are designed for measuring the quality of care in decompensated liver cirrhosis, we need special quality indicators for compensated and milder forms of chronic liver disease as well. Training the patients for participation in their own management, design of special clinics with dedicated health professionals in a form of chronic disease model, is suggested for improvement of quality of care in this group of patients. Special day care centers by a dedicated gastroenterologist and a trained nurse may be a practical model for better management of such patients.