Identity and Access Management: Technological Implementation of Policy

ERIC Educational Resources Information Center

von Munkwitz-Smith, Jeff; West, Ann

2004-01-01

Navigating the multiple processes for accessing ever-multiplying campus information systems can be a daunting task for students, faculty, and staff. This article provides a brief overview of Identity and Access Management Services. The authors review key characteristics and components of this new information architecture and address the issue of…

Teaching Multiple Online Sections/Courses: Tactics and Techniques

ERIC Educational Resources Information Center

Bates, Rodger; LaBrecque, Bryan; Fortner, Emily

2016-01-01

The challenge of teaching online increases as the number of sections or courses increase in a semester. The tactics and techniques which enrich online instruction in the tradition of quality matters can be modified and adapted to the demands of multiple instructional needs during a semester. This paper addresses time management and instructional…

Recent research on the management of hemlock-spruce forests in southeast Alaska for multiple values.

Treesearch

Michael H. McClellan

2005-01-01

This is a review of research findings from silvicultural studies that addressed information needs identified during the revision of the Tongass National Forest land management plan. A central concern of resource managers is balancing tradeoffs among habitat concerns, wood production, wood-product quality, and operability on the Tongass. This paper provides a historical...

Chemical Inventory Management at NASA Lewis Research Center

NASA Technical Reports Server (NTRS)

Kraft, Shirley S.; Homan, Joseph R.; Bajorek, Michael J.; Dominguez, Manuel B.; Smith, Vanessa L.

1997-01-01

The Chemical Management System (CMS) is a client/server application developed with Power Builder and Sybase for the Lewis Research Center (LeRC). Power Builder is a client-server application development tool, Sybase is a Relational Database Management System. The entire LeRC community can access the CMS from any desktop environment. The multiple functions and benefits of the CMS are addressed.

Multiple methods for multiple futures: Integrating qualitative scenario planning and quantitative simulation modeling for natural resource decision making

USGS Publications Warehouse

Symstad, Amy J.; Fisichelli, Nicholas A.; Miller, Brian W.; Rowland, Erika; Schuurman, Gregor W.

2017-01-01

Scenario planning helps managers incorporate climate change into their natural resource decision making through a structured “what-if” process of identifying key uncertainties and potential impacts and responses. Although qualitative scenarios, in which ecosystem responses to climate change are derived via expert opinion, often suffice for managers to begin addressing climate change in their planning, this approach may face limits in resolving the responses of complex systems to altered climate conditions. In addition, this approach may fall short of the scientific credibility managers often require to take actions that differ from current practice. Quantitative simulation modeling of ecosystem response to climate conditions and management actions can provide this credibility, but its utility is limited unless the modeling addresses the most impactful and management-relevant uncertainties and incorporates realistic management actions. We use a case study to compare and contrast management implications derived from qualitative scenario narratives and from scenarios supported by quantitative simulations. We then describe an analytical framework that refines the case study’s integrated approach in order to improve applicability of results to management decisions. The case study illustrates the value of an integrated approach for identifying counterintuitive system dynamics, refining understanding of complex relationships, clarifying the magnitude and timing of changes, identifying and checking the validity of assumptions about resource responses to climate, and refining management directions. Our proposed analytical framework retains qualitative scenario planning as a core element because its participatory approach builds understanding for both managers and scientists, lays the groundwork to focus quantitative simulations on key system dynamics, and clarifies the challenges that subsequent decision making must address.

Multiple trauma in children: critical care overview.

PubMed

Wetzel, Randall C; Burns, R Cartland

2002-11-01

Multiple trauma is more than the sum of the injuries. Management not only of the physiologic injury but also of the pathophysiologic responses, along with integration of the child's emotional and developmental needs and the child's family, forms the basis of trauma care. Multiple trauma in children also elicits profound psychological responses from the healthcare providers involved with these children. This overview will address the pathophysiology of multiple trauma in children and the general principles of trauma management by an integrated trauma team. Trauma is a systemic disease. Multiple trauma stimulates the release of multiple inflammatory mediators. A lethal triad of hypothermia, acidosis, and coagulopathy is the direct result of trauma and secondary injury from the systemic response to trauma. Controlling and responding to the secondary pathophysiologic sequelae of trauma is the cornerstone of trauma management in the multiply injured, critically ill child. Damage control surgery is a new, rational approach to the child with multiple trauma. The selection of children for damage control surgery depends on the severity of injury. Major abdominal vascular injuries and multiple visceral injuries are best considered for this approach. The effective management of childhood multiple trauma requires a combined team approach, consideration of the child and family, an organized trauma system, and an effective quality assurance and improvement mechanism.

Making decisions in complex landscapes: Headwater stream management across multiple federal agencies

USGS Publications Warehouse

Katz, Rachel; Grant, Evan H. Campbell; Runge, Michael C.; Connery, Bruce; Crockett, Marquette; Herland, Libby; Johnson, Sheela; Kirk, Dawn; Wofford, Jeb; Bennett, Rick; Nislow, Keith; Norris, Marian; Hocking, Daniel; Letcher, Benjamin; Roy, Allison

2014-01-01

Headwater stream ecosystems are vulnerable to numerous threats associated with climate and land use change. In the northeastern US, many headwater stream species (e.g., brook trout and stream salamanders) are of special conservation concern and may be vulnerable to climate change influences, such as changes in stream temperature and streamflow. Federal land management agencies (e.g., US Fish and Wildlife Service, National Park Service, USDA Forest Service, Bureau of Land Management and Department of Defense) are required to adopt policies that respond to climate change and may have longer-term institutional support to enforce such policies compared to state, local, non-governmental, or private land managers. However, federal agencies largely make management decisions in regards to headwater stream ecosystems independently. This fragmentation of management resources and responsibilities across the landscape may significantly impede the efficiency and effectiveness of conservation actions, and higher degrees of collaboration may be required to achieve conservation goals. This project seeks to provide an example of cooperative landscape decision-making to address the conservation of headwater stream ecosystems. We identified shared and contrasting objectives of each federal agency and potential collaboration opportunities that may increase efficient and effective management of headwater stream ecosystems in two northeastern US watersheds. These workshops provided useful insights into the adaptive capacity of federal institutions to address threats to headwater stream ecosystems. Our ultimate goal is to provide a decision-making framework and analysis that addresses large-scale conservation threats across multiple stakeholders, as a demonstration of cooperative landscape conservation for aquatic ecosystems. Additionally, we aim to provide new scientific knowledge and a regional perspective to resource managers to help inform local management decisions.

Integrating Land Cover Modeling and Adaptive Management to Conserve Endangered Species and Reduce Catastrophic Fire Risk

NASA Technical Reports Server (NTRS)

Breininger, David; Duncan, Brean; Eaton, Mitchell; Johnson, Fred; Nichols, James

2014-01-01

Land cover modeling is used to inform land management, but most often via a two-step process where science informs how management alternatives can influence resources and then decision makers can use this to make decisions. A more efficient process is to directly integrate science and decision making, where science allows us to learn to better accomplish management objectives and is developed to address specific decisions. Co-development of management and science is especially productive when decisions are complicated by multiple objectives and impeded by uncertainty. Multiple objectives can be met by specification of tradeoffs, and relevant uncertainty can be addressed through targeted science (i.e., models and monitoring). We describe how to integrate habitat and fuels monitoring with decision making focused on dual objectives of managing for endangered species and minimizing catastrophic fire risk. Under certain conditions, both objectives might be achieved by a similar management policy, but habitat trajectories suggest tradeoffs. Knowledge about system responses to actions can be informed by applying competing management actions to different land units in the same system state and by ideas about fire behavior. Monitoring and management integration is important to optimize state-specific management decisions and increase knowledge about system responses. We believe this approach has broad utility for and cover modeling programs intended to inform decision making.

Planning and Implementing Total Quality Management in the Royal Australian Air Force: A Multiple Case Study Analysis

DTIC Science & Technology

1990-09-01

change barriers, and necessary checks and balances built into processes. Furthermore, this assessment should address management system variables which...organisation’s 69 immediate product and their worklife . Focus must be maintained on improving RAAF processes. In addition to a quality committee structure as

Concepts and considerations of tooth wear: Part II--The mechanical component.

PubMed

Raigrodski, Ariel J; Dogan, Sami

2008-05-01

Identification of etiological factors is essential for successful management of tooth wear. In many cases, the diagnosis may be complicated because of the multiple etiologic factors which may confound the clinical appearance of tooth wear. Comprehensively addressing all of these factors is paramount to the long-term success of patient management.

Managing Air Quality - Multi-Pollutant Planning and Control

EPA Pesticide Factsheets

Describes how planning controls for multiple pollutants at the same time can save money and time and achieve significant benefits, and how control strategies can address both climate change and air quality.

Clinicians' Perspectives on Managing Symptom Clusters in Advanced Cancer: A Semistructured Interview Study.

PubMed

Dong, Skye T; Butow, Phyllis N; Agar, Meera; Lovell, Melanie R; Boyle, Frances; Stockler, Martin; Forster, Benjamin C; Tong, Allison

2016-04-01

Managing symptom clusters or multiple concurrent symptoms in patients with advanced cancer remains a clinical challenge. The optimal processes constituting effective management of symptom clusters remain uncertain. To describe the attitudes and strategies of clinicians in managing multiple co-occurring symptoms in patients with advanced cancer. Semistructured interviews were conducted with 48 clinicians (palliative care physicians [n = 10], oncologists [n = 6], general practitioners [n = 6], nurses [n = 12], and allied health providers [n = 14]), purposively recruited from two acute hospitals, two palliative care centers, and four community general practices in Sydney, Australia. Transcripts were analyzed using thematic analysis and adapted grounded theory. Six themes were identified: uncertainty in decision making (inadequacy of scientific evidence, relying on experiential knowledge, and pressure to optimize care); attunement to patient and family (sensitivity to multiple cues, prioritizing individual preferences, addressing psychosocial and physical interactions, and opening Pandora's box); deciphering cause to guide intervention (disaggregating symptoms and interactions, flexibility in assessment, and curtailing investigative intrusiveness); balancing complexities in medical management (trading off side effects, minimizing mismatched goals, and urgency in resolving severe symptoms); fostering hope and empowerment (allaying fear of the unknown, encouraging meaning making, championing patient empowerment, and truth telling); and depending on multidisciplinary expertise (maximizing knowledge exchange, sharing management responsibility, contending with hierarchical tensions, and isolation and discontinuity of care). Management of symptom clusters, as both an art and a science, is currently fraught with uncertainty in decision making. Strengthening multidisciplinary collaboration, continuity of care, more pragmatic planning of clinical trials to address more than one symptom, and training in symptom cluster management are required. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Therapeutics for multiple sclerosis symptoms.

PubMed

Ben-Zacharia, Aliza Bitton

2011-01-01

Symptoms management in multiple sclerosis is an integral part of its care. Accurate assessment and addressing the different symptoms provides increased quality of life among patients with multiple sclerosis. Multiple sclerosis symptoms may be identified as primary, secondary, or tertiary symptoms. Primary symptoms, such as weakness, sensory loss, and ataxia, are directly related to demyelination and axonal loss. Secondary symptoms, such as urinary tract infections as a result of urinary retention, are a result of the primary symptoms. Tertiary symptoms, such as reactive depression or social isolation, are a result of the social and psychological consequences of the disease. Common multiple sclerosis symptoms include fatigue and weakness; decreased balance, spasticity and gait problems; depression and cognitive issues; bladder, bowel, and sexual deficits; visual and sensory loss; and neuropathic pain. Less-common symptoms include dysarthria and dysphagia, vertigo, and tremors. Rare symptoms in multiple sclerosis include seizures, hearing loss, and paralysis. Symptom management includes nonpharmacological methods, such as rehabilitation and psychosocial support, and pharmacological methods, ie, medications and surgical procedures. The keys to symptom management are awareness, knowledge, and coordination of care. Symptoms have to be recognized and management needs to be individualized. Multiple sclerosis therapeutics include nonpharmacological strategies that consist of lifestyle modifications, rehabilitation, social support, counseling, and pharmacological agents or surgical procedures. The goal is vigilant management to improve quality of life and promote realistic expectations and hope. © 2011 Mount Sinai School of Medicine.

Trading off species protection and timber production in forests managed for multiple objectives

Treesearch

Vladimir Marianov; Stephanie Snyder; Charles ReVelle

2004-01-01

We address a multiobjective forest-management problem that maximizes harvested timber volume and maximizes the protection of species through the selection of protected habitat reserves. As opposed to reserving parcels of the forest for general habitat purposes, as most published works do, the model we present, and its several variants, concentrate on the preservation...

Multiple Myeloma, Version 2.2016

PubMed Central

Anderson, Kenneth C.; Alsina, Melissa; Atanackovic, Djordje; Biermann, J. Sybil; Chandler, Jason C.; Costello, Caitlin; Djulbegovic, Benjamin; Fung, Henry C.; Gasparetto, Cristina; Godby, Kelly; Hofmeister, Craig; Holmberg, Leona; Holstein, Sarah; Huff, Carol Ann; Kassim, Adetola; Krishnan, Amrita Y.; Kumar, Shaji K.; Liedtke, Michaela; Lunning, Matthew; Raje, Noopur; Singhal, Seema; Smith, Clayton; Somlo, George; Stockerl-Goldstein, Keith; Treon, Steven P.; Weber, Donna; Yahalom, Joachim; Shead, Dorothy A.; Kumar, Rashmi

2016-01-01

Multiple myeloma (MM) is a malignant neoplasm of plasma cells that accumulate in bone marrow, leading to bone destruction and marrow failure. Recent statistics from the American Cancer Society indicate that the incidence of MM is increasing. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) included in this issue address management of patients with solitary plasmacytoma and newly diagnosed MM. PMID:26553768

Using landscape limnology to classify freshwater ecosystems for multi-ecosystem management and conservation

USGS Publications Warehouse

Soranno, Patricia A.; Cheruvelil, Kendra Spence; Webster, Katherine E.; Bremigan, Mary T.; Wagner, Tyler; Stow, Craig A.

2010-01-01

Governmental entities are responsible for managing and conserving large numbers of lake, river, and wetland ecosystems that can be addressed only rarely on a case-by-case basis. We present a system for predictive classification modeling, grounded in the theoretical foundation of landscape limnology, that creates a tractable number of ecosystem classes to which management actions may be tailored. We demonstrate our system by applying two types of predictive classification modeling approaches to develop nutrient criteria for eutrophication management in 1998 north temperate lakes. Our predictive classification system promotes the effective management of multiple ecosystems across broad geographic scales by explicitly connecting management and conservation goals to the classification modeling approach, considering multiple spatial scales as drivers of ecosystem dynamics, and acknowledging the hierarchical structure of freshwater ecosystems. Such a system is critical for adaptive management of complex mosaics of freshwater ecosystems and for balancing competing needs for ecosystem services in a changing world.

Traditional vs. Contemporary Management Control Practices for Developing Public Health Policies

PubMed Central

Naranjo-Gil, David; Sánchez-Expósito, María Jesús; Gómez-Ruiz, Laura

2016-01-01

Public health policies must address multiple goals and complex community health needs. Recently, management control practices have emerged to provide a broader type of information for evaluating the effectiveness of healthcare policies, and relate activities and processes to multiple strategic outcomes. This study compares the effect of traditional and contemporary management control practices on the achievement of public health policies. It is also analyzed how two different uses of such practices (enabling vs. coercive) facilitate the achievement of public health policies. Relationships are explored using data collected from managers from public health agencies and public hospitals in Spain. The findings show that contemporary management control practices are more suitable than traditional practices to achieve public health policies. Furthermore, results show that public health policies are better achieved when managers use management control practices in an enabling way rather than in a coercive way. PMID:27428985

Integrating land cover modeling and adaptive management to conserve endangered species and reduce catastrophic fire risk

USGS Publications Warehouse

Breininger, David; Duncan, Brean; Eaton, Mitchell J.; Johnson, Fred; Nichols, James

2014-01-01

Land cover modeling is used to inform land management, but most often via a two-step process, where science informs how management alternatives can influence resources, and then, decision makers can use this information to make decisions. A more efficient process is to directly integrate science and decision-making, where science allows us to learn in order to better accomplish management objectives and is developed to address specific decisions. Co-development of management and science is especially productive when decisions are complicated by multiple objectives and impeded by uncertainty. Multiple objectives can be met by the specification of tradeoffs, and relevant uncertainty can be addressed through targeted science (i.e., models and monitoring). We describe how to integrate habitat and fuel monitoring with decision-making focused on the dual objectives of managing for endangered species and minimizing catastrophic fire risk. Under certain conditions, both objectives might be achieved by a similar management policy; other conditions require tradeoffs between objectives. Knowledge about system responses to actions can be informed by developing hypotheses based on ideas about fire behavior and then applying competing management actions to different land units in the same system state. Monitoring and management integration is important to optimize state-specific management decisions and to increase knowledge about system responses. We believe this approach has broad utility and identifies a clear role for land cover modeling programs intended to inform decision-making.

Ecological and evolutionary approaches to managing honey bee disease

PubMed Central

Brosi, Berry J.; Delaplane, Keith S.; Boots, Michael; de Roode, Jacobus C.

2017-01-01

Honey bee declines are a serious threat to global agricultural security and productivity. While multiple factors contribute to these declines, parasites are a key driver. Disease problems in honey bees have intensified in recent years, despite increasing attention to addressing them. Here we argue that we must focus on the principles of disease ecology and evolution to understand disease dynamics, assess the severity of disease threats, and manage these threats via honey bee management. We cover the ecological context of honey bee disease, including both host and parasite factors driving current transmission dynamics, and then discuss evolutionary dynamics including how beekeeping management practices may drive selection for more virulent parasites. We then outline how ecological and evolutionary principles can guide disease mitigation in honey bees, including several practical management suggestions for addressing short- and long-term disease dynamics and consequences. PMID:29046562

Conducting an audit to improve the facilitation of emergency maternal and newborn referral in northern Ghana.

PubMed

Awoonor-Williams, John Koku; Bailey, Patricia E; Yeji, Francis; Adongo, Ayire Emmanuel; Baffoe, Peter; Williams, Afua; Mercer, Sarah

2015-10-01

Ghana Health Service conducted an audit to strengthen the referral system for pregnant or recently pregnant women and newborns in northern Ghana. The audit took place in 16 facilities with two 3-month cycles of data collection in 2011. Midwife-led teams tracked 446 referred women until they received definitive treatment. Between the two audit cycles, teams identified and implemented interventions to address gaps in referral services. During this time period, we observed important increases in facilitating referral mechanisms, including a decrease in the dependence on taxis in favour of national or facility ambulances/vehicles; an increase in health workers escorting referrals to the appropriate receiving facility; greater use of referral slips and calling ahead to alert receiving facilities and higher feedback rates. As referral systems require attention from multiple levels of engagement, on the provider end we found that regional managers increasingly resolved staffing shortages; district management addressed the costliness and lack of transport and increased midwives' ability to communicate with pregnant women and drivers; and that facility staff increasingly adhered to guidelines and facilitating mechanisms. By conducting an audit of maternal and newborn referrals, the Ghana Health Service identified areas for improvement that service providers and management at multiple levels addressed, demonstrating a platform for problem solving that could be a model elsewhere.

Ecological and evolutionary approaches to managing honeybee disease.

PubMed

Brosi, Berry J; Delaplane, Keith S; Boots, Michael; de Roode, Jacobus C

2017-09-01

Honeybee declines are a serious threat to global agricultural security and productivity. Although multiple factors contribute to these declines, parasites are a key driver. Disease problems in honeybees have intensified in recent years, despite increasing attention to addressing them. Here we argue that we must focus on the principles of disease ecology and evolution to understand disease dynamics, assess the severity of disease threats, and control these threats via honeybee management. We cover the ecological context of honeybee disease, including both host and parasite factors driving current transmission dynamics, and then discuss evolutionary dynamics including how beekeeping management practices may drive selection for more virulent parasites. We then outline how ecological and evolutionary principles can guide disease mitigation in honeybees, including several practical management suggestions for addressing short- and long-term disease dynamics and consequences.

A centralized audio presentation manager

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

Papp, A.L. III; Blattner, M.M.

1994-05-16

The centralized audio presentation manager addresses the problems which occur when multiple programs running simultaneously attempt to use the audio output of a computer system. Time dependence of sound means that certain auditory messages must be scheduled simultaneously, which can lead to perceptual problems due to psychoacoustic phenomena. Furthermore, the combination of speech and nonspeech audio is examined; each presents its own problems of perceptibility in an acoustic environment composed of multiple auditory streams. The centralized audio presentation manager receives abstract parameterized message requests from the currently running programs, and attempts to create and present a sonic representation in themore » most perceptible manner through the use of a theoretically and empirically designed rule set.« less

Simulating the cumulative effects of multiple forest management strategies on landscape measures of forest sustainability

Treesearch

Eric J. Gustafson; David E. Lytle; Randy Swaty; Craig Loehle

2007-01-01

While the cumulative effects of the actions of multiple owners have long been recognized as critically relevant to efforts to maintain sustainable forests at the landscape scale, few studies have addressed these effects. We used the HARVEST timber harvest simulator to predict the cumulative effects of four owner groups (two paper companies, a state forest and non-...

Wyoming Basin Rapid Ecoregional Assessment

USGS Publications Warehouse

Carr, Natasha B.; Means, Robert E.

2013-01-01

The overall goal of the Wyoming Basin Rapid Ecoregional Assessment (REA) is to provide information that supports regional planning and analysis for the management of ecological resources. The REA provides an assessment of baseline ecological conditions, an evaluation of current risks from drivers of ecosystem change (including energy development, fire, and invasive species), and a predictive capacity for evaluating future risks (including climate change). Additionally, the REA may be used for identifying priority areas for conservation or restoration and for assessing cumulative effects of multiple land uses. The Wyoming Basin REA will address Management Questions developed by the Bureau of Land Management and other agency partners for 8 major biomes and 19 species or species assemblages. The maps developed for addressing Management Questions will be integrated into overall maps of landscape-level ecological values and risks. The maps can be used to address the goals of the REA at a number of levels: for individual species, species assemblages, aquatic and terrestrial systems, and for the entire ecoregion. This allows flexibility in how the products of the REA are compiled to inform planning and management actions across a broad range of spatial scales.

Multi-objective reverse logistics model for integrated computer waste management.

PubMed

Ahluwalia, Poonam Khanijo; Nema, Arvind K

2006-12-01

This study aimed to address the issues involved in the planning and design of a computer waste management system in an integrated manner. A decision-support tool is presented for selecting an optimum configuration of computer waste management facilities (segregation, storage, treatment/processing, reuse/recycle and disposal) and allocation of waste to these facilities. The model is based on an integer linear programming method with the objectives of minimizing environmental risk as well as cost. The issue of uncertainty in the estimated waste quantities from multiple sources is addressed using the Monte Carlo simulation technique. An illustrated example of computer waste management in Delhi, India is presented to demonstrate the usefulness of the proposed model and to study tradeoffs between cost and risk. The results of the example problem show that it is possible to reduce the environmental risk significantly by a marginal increase in the available cost. The proposed model can serve as a powerful tool to address the environmental problems associated with exponentially growing quantities of computer waste which are presently being managed using rudimentary methods of reuse, recovery and disposal by various small-scale vendors.

Governance of environmental risk: new approaches to managing stakeholder involvement.

PubMed

Benn, Suzanne; Dunphy, Dexter; Martin, Andrew

2009-04-01

Disputes concerning industrial legacies such as the disposal of toxic wastes illustrate changing pressures on corporations and governments. Business and governments are now confronted with managing the expectations of a society increasingly aware of the social and environmental impacts and risks associated with economic development and demanding more equitable distribution and democratic management of such risks. The closed managerialist decision-making of the powerful bureaucracies and corporations of the industrial era is informed by traditional management theory which cannot provide a framework for the adequate governance of these risks. Recent socio-political theories have conceptualised some key themes that must be addressed in a more fitting approach to governance. We identify more recent management and governance theory which addresses these themes and develop a process-based approach to governance of environmental disputes that allows for the evolving nature of stakeholder relations in a highly complex multiple stakeholder arena.

Case Report: Perioperative management of a pregnant poly trauma patient for spine fixation surgery.

PubMed

Vandse, Rashmi; Cook, Meghan; Bergese, Sergio

2015-01-01

Trauma is estimated to complicate approximately one in twelve pregnancies, and is currently a leading non-obstetric cause of maternal death. Pregnant trauma patients requiring non-obstetric surgery pose a number of challenges for anesthesiologists. Here we present the successful perioperative management of a pregnant trauma patient with multiple injuries including occult pneumothorax who underwent T9 to L1 fusion in prone position, and address the pertinent perioperative anesthetic considerations and management.

Breaking down barriers in cooperative fault management: Temporal and functional information displays

NASA Technical Reports Server (NTRS)

Potter, Scott S.; Woods, David D.

1994-01-01

At the highest level, the fundamental question addressed by this research is how to aid human operators engaged in dynamic fault management. In dynamic fault management there is some underlying dynamic process (an engineered or physiological process referred to as the monitored process - MP) whose state changes over time and whose behavior must be monitored and controlled. In these types of applications (dynamic, real-time systems), a vast array of sensor data is available to provide information on the state of the MP. Faults disturb the MP and diagnosis must be performed in parallel with responses to maintain process integrity and to correct the underlying problem. These situations frequently involve time pressure, multiple interacting goals, high consequences of failure, and multiple interleaved tasks.

Reducing, Maintaining, or Escalating Uncertainty? The Development and Validation of Four Uncertainty Preference Scales Related to Cancer Information Seeking and Avoidance.

PubMed

Carcioppolo, Nick; Yang, Fan; Yang, Qinghua

2016-09-01

Uncertainty is a central characteristic of many aspects of cancer prevention, screening, diagnosis, and treatment. Brashers's (2001) uncertainty management theory details the multifaceted nature of uncertainty and describes situations in which uncertainty can both positively and negatively affect health outcomes. The current study extends theory on uncertainty management by developing four scale measures of uncertainty preferences in the context of cancer. Two national surveys were conducted to validate the scales and assess convergent and concurrent validity. Results support the factor structure of each measure and provide general support across multiple validity assessments. These scales can advance research on uncertainty and cancer communication by providing researchers with measures that address multiple aspects of uncertainty management.

Multiple scales modelling approaches to social interaction in crowd dynamics and crisis management. Comment on "Human behaviours in evacuation crowd dynamics: From modelling to "big data" toward crisis management" by Nicola Bellomo et al.

NASA Astrophysics Data System (ADS)

Trucu, Dumitru

2016-09-01

In this comprehensive review concerning the modelling of human behaviours in crowd dynamics [3], the authors explore a wide range of mathematical approaches spanning over multiple scales that are suitable to describe emerging crowd behaviours in extreme situations. Focused on deciphering the key aspects leading to emerging crowd patterns evolutions in challenging times such as those requiring an evacuation on a complex venue, the authors address this complex dynamics at both microscale (individual level), mesoscale (probability distributions of interacting individuals), and macroscale (population level), ultimately aiming to gain valuable understanding and knowledge that would inform decision making in managing crisis situations.

A hierarchical-multiobjective framework for risk management

NASA Technical Reports Server (NTRS)

Haimes, Yacov Y.; Li, Duan

1991-01-01

A broad hierarchical-multiobjective framework is established and utilized to methodologically address the management of risk. United into the framework are the hierarchical character of decision-making, the multiple decision-makers at separate levels within the hierarchy, the multiobjective character of large-scale systems, the quantitative/empirical aspects, and the qualitative/normative/judgmental aspects. The methodological components essentially consist of hierarchical-multiobjective coordination, risk of extreme events, and impact analysis. Examples of applications of the framework are presented. It is concluded that complex and interrelated forces require an analysis of trade-offs between engineering analysis and societal preferences, as in the hierarchical-multiobjective framework, to successfully address inherent risk.

Advancing drug availability-experiences from Africa.

PubMed

Powell, Richard A; Kaye, Richard Mugula; Ddungu, Henry; Mwangi-Powell, Faith

2010-07-01

International health and drug regulatory authorities acknowledge that analgesics (especially opioids) are insufficiently available for pain management in many countries. In Africa, reported morphine consumption is far below the global mean, with multiple factors hampering opioid supply. Since 2006, the African Palliative Care Association has hosted three regional drug availability workshops across the continent to address this issue. Using an interactive format, the workshops have identified country-specific barriers to opioid and other essential medication accessibility before supporting participants to develop action plans to address recognized impediments. Despite multiple challenges, a number of successes have arisen from the implementation of the plans. However, key issues remain, including the introduction of supportive policy environments, effective educational initiatives, and measures to address supply-chain obstacles impeding drug availability. Copyright 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Proceedings of the Mobile Satellite System Architectures and Multiple Access Techniques Workshop

NASA Technical Reports Server (NTRS)

Dessouky, Khaled

1989-01-01

The Mobile Satellite System Architectures and Multiple Access Techniques Workshop served as a forum for the debate of system and network architecture issues. Particular emphasis was on those issues relating to the choice of multiple access technique(s) for the Mobile Satellite Service (MSS). These proceedings contain articles that expand upon the 12 presentations given in the workshop. Contrasting views on Frequency Division Multiple Access (FDMA), Code Division Multiple Access (CDMA), and Time Division Multiple Access (TDMA)-based architectures are presented, and system issues relating to signaling, spacecraft design, and network management constraints are addressed. An overview article that summarizes the issues raised in the numerous discussion periods of the workshop is also included.

MAGGnet: An international network to foster mitigation of agricultural greenhouse gases

USDA-ARS?s Scientific Manuscript database

Research networks provide a framework for review, synthesis, and systematic testing of theories by multiple scientists across international borders critical for addressing global-scale issues. In 2012, a greenhouse gas (GHG) research network referred to as MAGGnet (Managing Agricultural Greenhouse ...

Managing Multiple Risk Factors.

DTIC Science & Technology

1998-09-01

to the racial differences in cardiovascular risk and events among women. High levels of socioeconomic stress, higher dietary fat intake and sedentary ... lifestyle are more prevalent among black than white women. The proposed study will address the issue of whether the cluster of risk factors for

Medicaid's Complex Goals: Challenges for Managed Care and Behavioral Health

PubMed Central

Gold, Marsha; Mittler, Jessica

2000-01-01

The Medicaid program has become increasingly complex as policymakers use it to address various policy objectives, leading to structural tensions that surface with Medicaid managed care. In this article, we illustrate this complexity by focusing on the experience of three States with behavioral health carveouts—Maryland, Oregon, and Tennessee. Converting to Medicaid managed care forces policymakers to confront Medicaid's competing policy objectives, multiplicity of stakeholders, and diverse patients, many with complex needs. Emerging Medicaid managed care systems typically represent compromises in which existing inequities and fragmentation are reconfigured rather than eliminated. PMID:12500322

Recommendations for the detection and therapeutic management of cognitive impairment in multiple sclerosis.

PubMed

Bensa, C; Bodiguel, E; Brassat, D; Laplaud, D; Magy, L; Ouallet, J-C; Zephir, H; De Seze, J; Blanc, F

2012-11-01

The aim of the Multiple Sclerosis Think Tank (Groupe de réflexion sur la sclérose en plaques [GRESEP]) is to prescribe recommendations following a systematic literature search and using a Rand Corporation and California University (RAND/UCLA) appropriateness derived method, in response to practical questions that are raised in the management of patients with multiple sclerosis (MS). The topics of this working program were chosen because they were not addressed in the French recommendations and because of the few data in the literature that enabled practices to be based on validated data. Following the theme on useful serum testing with suspected multiple sclerosis, the subjects of the present work concern the detection and management of cognitive impairment in the beginning stages of the disease course. Two clinical questions were asked: which complementary exams (besides physical examination and neuropsychological tests) would help in the screening of cognitive impairment at the beginning of the disease? What care management should the person with MS and cognitive impairment be offered (treatments and neurocognitive rehabilitation)? The recommendations are the result of a consensus amongst a working group, a rating group and a reading group comprised of hospital neurologists involved in the management of patients with multiple sclerosis. Each recommendation is presented with the degree of consensus that it was accorded. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

How Can eHealth Technology Address Challenges Related to Multimorbidity? Perspectives from Patients with Multiple Chronic Conditions.

PubMed

Zulman, Donna M; Jenchura, Emily C; Cohen, Danielle M; Lewis, Eleanor T; Houston, Thomas K; Asch, Steven M

2015-08-01

Patient eHealth technology offers potential support for disease self-management, but the value of existing applications for patients with multiple chronic conditions (MCCs) is unclear. To understand self-management and health care navigation challenges that patients face due to MCCs and to identify opportunities to support these patients through new and enhanced eHealth technology. After administering a screening survey, we conducted 10 focus groups of 3-8 patients grouped by age, sex, and common chronic conditions. Patients discussed challenges associated with having MCCs and their use of (and desires from) technology to support self-management. Three investigators used standard content analysis methods to code the focus group transcripts. Emergent themes were reviewed with all collaborators, and final themes and representative quotes were validated with a sample of participants. Fifty-three individuals with ≥3 chronic conditions and experience using technology for health-related purposes. Focus group participants had an average of five chronic conditions. Participants reported using technology most frequently to search for health information (96%), communicate with health care providers (92%), track medical information (83%), track medications (77%), and support decision-making about treatment (55%). Three themes emerged to guide eHealth technology development: (1) Patients with MCCs manage a high volume of information, visits, and self-care tasks; (2) they need to coordinate, synthesize, and reconcile health information from multiple providers and about different conditions; (3) their unique position at the hub of multiple health issues requires self-advocacy and expertise. Focus groups identified desirable eHealth resources and tools that reflect these themes. Although patients with multiple health issues use eHealth technology to support self-care for specific conditions, they also desire tools that transcend disease boundaries. By addressing the holistic needs of patients with MCCs, eHealth technology can advance health care from a disease-centered to a patient-centered model.

An Integrated Nursing Management Information System: From Concept to Reality

PubMed Central

Pinkley, Connie L.; Sommer, Patricia K.

1988-01-01

This paper addresses the transition from the conceptualization of a Nursing Management Information System (NMIS) integrated and interdependent with the Hospital Information System (HIS) to its realization. Concepts of input, throughout, and output are presented to illustrate developmental strategies used to achieve nursing information products. Essential processing capabilities include: 1) ability to interact with multiple data sources; 2) database management, statistical, and graphics software packages; 3) online, batch and reporting; and 4) interactive data analysis. Challenges encountered in system construction are examined.

Advanced Development of Certified OS Kernels

DTIC Science & Technology

2015-06-01

It provides an infrastructure to map a physical page into multiple processes’ page maps in different address spaces. Their ownership mechanism ensures...of their shared memory infrastructure . Trap module The trap module specifies the behaviors of exception handlers and mCertiKOS system calls. In...layers), 1 pm for the shared memory infrastructure (3 layers), 3.5 pm for the thread management (10 layers), 1 pm for the process management (4 layers

Critically evaluating best management practices for preventing freshwater turtle extinctions.

PubMed

Spencer, R-J; Van Dyke, J U; Thompson, Michael B

2017-12-01

Ex situ conservation tools, such as captive breeding for reintroduction, are considered a last resort to recover threatened or endangered species, but they may also help reduce anthropogenic threats where it is difficult or impossible to address them directly. Headstarting, or captive rearing of eggs or neonate animals for subsequent release into the wild, is controversial because it treats only a symptom of a larger conservation problem; however, it may provide a mechanism to address multiple threats, particularly near population centers. We conducted a population viability analysis of Australia's most widespread freshwater turtle, Chelodina longicollis, to determine the effect of adult roadkill (death by collision with motor vehicles), which is increasing, and reduced recruitment through nest predation from introduced European red foxes (Vulpes vulpes). We also modeled management scenarios to test the effectiveness of headstarting, fox management, and measures to reduce mortality on roads. Only scenarios with headstarting from source populations eliminated all risks of extinction and allowed population growth. Small increases in adult mortality (2%) had the greatest effect on population growth and extinction risk. Where threats simultaneously affected other life-history stages (e.g., recruitment), eliminating harvest pressures on adult females alone did not eliminate the risk of population extinction. In our models, one source population could supply enough hatchlings annually to supplement 25 other similar-sized populations such that extinction was avoided. Based on our results, we believe headstarting should be a primary tool for managing freshwater turtles for which threats affect multiple life-history stages. We advocate the creation of source populations for managing freshwater turtles that are greatly threatened at multiple life-history stages, such as depredation of eggs by invasive species and adult mortality via roadkill. © 2017 Society for Conservation Biology.

Integrating management tools and concepts to develop an estuarine planning support system: A case study of the Humber Estuary, Eastern England.

PubMed

Lonsdale, Jemma-Anne; Weston, Keith; Barnard, Steve; Boyes, Suzanne J; Elliott, Michael

2015-11-15

Estuaries are important because of their multiple uses and users which often makes them challenging to manage since management must strike a balance between the needs of users, the estuaries' ecological and economic value and the context of multiple legislative drivers. To facilitate management we have therefore developed an Estuarine Planning Support System (EPSS) framework using the Humber Estuary, Eastern England, as a case study which integrates the current legislation tools and concepts. This integrated EPSS framework is an improvement on previous approaches for assessing cumulative impacts as it takes into account legislative drivers, management tools and other mechanisms for controlling plans/projects specific to the estuary. It therefore enables managers and users to assess and address both the current state and the way in which a new industrial, port or urban development could impact an estuary in an accessible and understandable framework. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Informed actions: where to cost effectively manage multiple threats to species to maximize return on investment.

PubMed

Auerbach, Nancy A; Tulloch, Ayesha I T; Possingham, Hugh P

Conservation practitioners, faced with managing multiple threats to biodiversity and limited funding, must prioritize investment in different management actions. From an economic perspective, it is routine practice to invest where the highest rate of return is expected. This return-on-investment (ROI) thinking can also benefit species conservation, and researchers are developing sophisticated approaches to support decision-making for cost-effective conservation. However, applied use of these approaches is limited. Managers may be wary of “black-box” algorithms or complex methods that are difficult to explain to funding agencies. As an alternative, we demonstrate the use of a basic ROI analysis for determining where to invest in cost-effective management to address threats to species. This method can be applied using basic geographic information system and spreadsheet calculations. We illustrate the approach in a management action prioritization for a biodiverse region of eastern Australia. We use ROI to prioritize management actions for two threats to a suite of threatened species: habitat degradation by cattle grazing, and predation by invasive red foxes (Vulpes vulpes). We show how decisions based on cost-effective threat management depend upon how expected benefits to species are defined and how benefits and costs co-vary. By considering a combination of species richness, restricted habitats, species vulnerability, and costs of management actions, small investments can result in greater expected benefit compared with management decisions that consider only species richness. Furthermore, a landscape management strategy that implements multiple actions is more efficient than managing only for one threat, or more traditional approaches that don't consider ROI. Our approach provides transparent and logical decision support for prioritizing different actions intended to abate threats associated with multiple species; it is of use when managers need a justifiable and repeatable approach to investment.

Evolving Organizational Structures in Special Education.

ERIC Educational Resources Information Center

McCarthy, Eileen F., Ed.; Sage, Daniel D., Ed.

The monograph addresses evolving organizational structures in special education from the perspectives of theory and practice. The initial paper, "Issues in Organizational Structure" (D. Sage), focuses on how the multiple units and operations of the special education system should be related and how the management authority and responsibility for…

A Word to the Wise: Advice for Scientists Engaged in Collaborative Adaptive Management

NASA Astrophysics Data System (ADS)

Hopkinson, Peter; Huber, Ann; Saah, David S.; Battles, John J.

2017-05-01

Collaborative adaptive management is a process for making decisions about the environment in the face of uncertainty and conflict. Scientists have a central role to play in these decisions. However, while scientists are well trained to reduce uncertainty by discovering new knowledge, most lack experience with the means to mitigate conflict in contested situations. To address this gap, we drew from our efforts coordinating a large collaborative adaptive management effort, the Sierra Nevada Adaptive Management Project, to offer advice to our fellow environmental scientists. Key challenges posed by collaborative adaptive management include the confusion caused by multiple institutional cultures, the need to provide information at management-relevant scales, frequent turnover in participants, fluctuations in enthusiasm among key constituencies, and diverse definitions of success among partners. Effective strategies included a dedication to consistency, a commitment to transparency, the willingness to communicate frequently via multiple forums, and the capacity for flexibility. Collaborative adaptive management represents a promising, new model for scientific engagement with the public. Learning the lessons of effective collaboration in environmental management is an essential task to achieve the shared goal of a sustainable future.

Forest management and economics

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

Buongiorno, J.; Gilless, J.K.

1987-01-01

This volume provides a survey of quantitative methods, guiding the reader through formulation and analysis of models that address forest management problems. The authors use simple mathematics, graphics, and short computer programs to explain each method. Emphasizing applications, they discuss linear, integer, dynamic, and goal programming; simulation; network modeling; and econometrics, as these relate to problems of determining economic harvest schedules in even-aged and uneven-aged forests, the evaluation of forest policies, multiple-objective decision making, and more.

Faculty Sufficiency and AACSB Accreditation Compliance within a Global University: A Mathematical Modeling Approach

ERIC Educational Resources Information Center

Boronico, Jess; Murdy, Jim; Kong, Xinlu

2014-01-01

This manuscript proposes a mathematical model to address faculty sufficiency requirements towards assuring overall high quality management education at a global university. Constraining elements include full-time faculty coverage by discipline, location, and program, across multiple campus locations subject to stated service quality standards of…

Crafting Coherence: How Schools Strategically Manage Multiple, External Demands

ERIC Educational Resources Information Center

Honig, Meredith I.; Hatch, Thomas C.

2004-01-01

"Policy coherence" is an often cited but seldom achieved education policy goal. We argue that addressing this policy-practice gap requires a reconceptualization of coherence not as the objective alignment of external requirements but as a dynamic process. This article elaborates this re-conceptualization using theories of institutional…

A keyword approach to finding common ground in community-based definitions of human well-being

EPA Science Inventory

Ecosystem-based management involves the integration of ecosystem services and their human beneficiaries into decision making. This can occur at multiple scales; addressing global issues such as climate change down to local problems such as flood protection and maintaining water q...

Pain management in the nursing home.

PubMed

Dumas, Linda G; Ramadurai, Murali

2009-06-01

This article is about pain management and some of the best practices to address the problem of pain in nursing home patients who have a serious illness and multiple comorbid conditions. Management of the emotional distress that accompanies chronic or acute pain is of foremost concern. In this article, the topics discussed include general pain management in a nursing home for a long-term care resident who has chronic pain, the relief of symptoms and suffering in a patient who is on palliative care and hospice, and the pain management of a postoperative patient with acute pain for a short transitional period (post-acute illness or surgery).

Overview of Contemporary Issues of Forest Research and Management in China

NASA Astrophysics Data System (ADS)

He, Hong S.; Shifley, Stephen R.; Thompson, Frank R.

2011-12-01

With 207 million ha of forest covering 22% of its land area, China ranks fifth in the world in forest area. Rapid economic growth, climate change, and forest disturbances pose new, complex challenges for forest research and management. Progress in meeting these challenges is relevant beyond China, because China's forests represent 34% of Asia's forests and 5% of the worlds' forests. To provide a broader understanding of these management challenges and of research and policies that address them, we organized this special issue on contemporary forest research and management issues in China. At the national level, papers review major forest types and the evolution of sustainable forestry, the development of China's forest-certification efforts, the establishment of a forest inventory system, and achievements and challenges in insect pest control in China. Papers focused on Northern China address historical, social, and political factors that have shaped the region's forests; the use of forest landscape models to assess how forest management can achieve multiple objectives; and analysis and modeling of fuels and fire behavior. Papers addressing Central and South China describe the "Grain for Green" program, which converts low productivity cropland to grassland and woodland to address erosion and soil carbon sequestration; the potential effects of climate change on CO2 efflux and soil respiration; and relationships between climate and net primary productivity. China shares many forest management and research issues with other countries, but in other cases China's capacity to respond to forest management challenges is unique and bears watching by the rest of the world.

Assessing and managing multiple risks in a changing world ...

EPA Pesticide Factsheets

Roskilde University (Denmark) hosted a November 2015 workshop, Environmental Risk—Assessing and Managing Multiple Risks in a Changing World. This Focus article presents the consensus recommendations of 30 attendees from 9 countries regarding implementation of a common currency (ecosystem services) for holistic environmental risk assessment and management; improvements to risk assessment and management in a complex, human-modified, and changing world; appropriate development of protection goals in a 2-stage process; dealing with societal issues; risk-management information needs; conducting risk assessment of risk management; and development of adaptive and flexible regulatory systems. The authors encourage both cross-disciplinary and interdisciplinary approaches to address their 10 recommendations: 1) adopt ecosystem services as a common currency for risk assessment and management; 2) consider cumulative stressors (chemical and nonchemical) and determine which dominate to best manage and restore ecosystem services; 3) fully integrate risk managers and communities of interest into the risk-assessment process; 4) fully integrate risk assessors and communities of interest into the risk-management process; 5) consider socioeconomics and increased transparency in both risk assessment and risk management; 6) recognize the ethical rights of humans and ecosystems to an adequate level of protection; 7) determine relevant reference conditions and the proper ecological c

Transboundary fisheries science: Meeting the challenges of inland fisheries management in the 21st century

USGS Publications Warehouse

Midway, Stephen R.; Wagner, Tyler; Zydlewski, Joseph D.; Irwin, Brian J.; Paukert, Craig P.

2016-01-01

Managing inland fisheries in the 21st century presents several obstacles, including the need to view fisheries from multiple spatial and temporal scales, which usually involves populations and resources spanning sociopolitical boundaries. Though collaboration is not new to fisheries science, inland aquatic systems have historically been managed at local scales and present different challenges than in marine or large freshwater systems like the Laurentian Great Lakes. Therefore, we outline a flexible strategy that highlights organization, cooperation, analytics, and implementation as building blocks toward effectively addressing transboundary fisheries issues. Additionally, we discuss the use of Bayesian hierarchical models (within the analytical stage), due to their flexibility in dealing with the variability present in data from multiple scales. With growing recognition of both ecological drivers that span spatial and temporal scales and the subsequent need for collaboration to effectively manage heterogeneous resources, we expect implementation of transboundary approaches to become increasingly critical for effective inland fisheries management.

Policy challenges and approaches for the conservation of mangrove forests in Southeast Asia.

PubMed

Friess, Daniel A; Thompson, Benjamin S; Brown, Ben; Amir, A Aldrie; Cameron, Clint; Koldewey, Heather J; Sasmito, Sigit D; Sidik, Frida

2016-10-01

Many drivers of mangrove forest loss operate over large scales and are most effectively addressed by policy interventions. However, conflicting or unclear policy objectives exist at multiple tiers of government, resulting in contradictory management decisions. To address this, we considered four approaches that are being used increasingly or could be deployed in Southeast Asia to ensure sustainable livelihoods and biodiversity conservation. First, a stronger incorporation of mangroves into marine protected areas (that currently focus largely on reefs and fisheries) could resolve some policy conflicts and ensure that mangroves do not fall through a policy gap. Second, examples of community and government comanagement exist, but achieving comanagement at scale will be important in reconciling stakeholders and addressing conflicting policy objectives. Third, private-sector initiatives could protect mangroves through existing and novel mechanisms in degraded areas and areas under future threat. Finally, payments for ecosystem services (PES) hold great promise for mangrove conservation, with carbon PES schemes (known as blue carbon) attracting attention. Although barriers remain to the implementation of PES, the potential to implement them at multiple scales exists. Closing the gap between mangrove conservation policies and action is crucial to the improved protection and management of this imperiled coastal ecosystem and to the livelihoods that depend on them. © 2016 Society for Conservation Biology.

Structured decision making for managing pneumonia epizootics in bighorn sheep

USGS Publications Warehouse

Sells, Sarah N.; Mitchell, Michael S.; Edwards, Victoria L.; Gude, Justin A.; Anderson, Neil J.

2016-01-01

Good decision-making is essential to conserving wildlife populations. Although there may be multiple ways to address a problem, perfect solutions rarely exist. Managers are therefore tasked with identifying decisions that will best achieve desired outcomes. Structured decision making (SDM) is a method of decision analysis used to identify the most effective, efficient, and realistic decisions while accounting for values and priorities of the decision maker. The stepwise process includes identifying the management problem, defining objectives for solving the problem, developing alternative approaches to achieve the objectives, and formally evaluating which alternative is most likely to accomplish the objectives. The SDM process can be more effective than informal decision-making because it provides a transparent way to quantitatively evaluate decisions for addressing multiple management objectives while incorporating science, uncertainty, and risk tolerance. To illustrate the application of this process to a management need, we present an SDM-based decision tool developed to identify optimal decisions for proactively managing risk of pneumonia epizootics in bighorn sheep (Ovis canadensis) in Montana. Pneumonia epizootics are a major challenge for managers due to long-term impacts to herds, epistemic uncertainty in timing and location of future epizootics, and consequent difficulty knowing how or when to manage risk. The decision tool facilitates analysis of alternative decisions for how to manage herds based on predictions from a risk model, herd-specific objectives, and predicted costs and benefits of each alternative. Decision analyses for 2 example herds revealed that meeting management objectives necessitates specific approaches unique to each herd. The analyses showed how and under what circumstances the alternatives are optimal compared to other approaches and current management. Managers can be confident that these decisions are effective, efficient, and realistic because they explicitly account for important considerations managers implicitly weigh when making decisions, including competing management objectives, uncertainty in potential outcomes, and risk tolerance.

The role of comorbidities in patients' hypertension self-management.

PubMed

Fix, Gemmae M; Cohn, Ellen S; Solomon, Jeffrey L; Cortés, Dharma E; Mueller, Nora; Kressin, Nancy R; Borzecki, Ann; Katz, Lois A; Bokhour, Barbara G

2014-06-01

We sought to understand barriers to hypertension self-management in patients with hypertension and comorbidities. We conducted semi-structured, qualitative interviews with 48 patients with uncontrolled hypertension and at least one comorbidity to learn about beliefs and behaviors that might affect hypertension self-management. Using a grounded theory strategy, we analyzed interview transcripts detailing patients' hypertension self-management behaviors vis-à-vis a framework including Explanatory Models-a patient's understanding of the pathophysiology, cause, course, treatment, and severity of an illness, such as hypertension. We identified four factors that interfered with hypertension self-management. (1) Interdependence: Participants saw hypertension as interconnected to their comorbidities and subsequently had difficulty separating information about their illnesses. (2) Low priority: Compared to other conditions, participants assigned hypertension a lower priority. (3) Conflicts: Participants struggled with conflicts between hypertension self-management practices and those for comorbidities. (4) Managing multiple medications: Polypharmacy led to patients' confusion and concern about taking medications as prescribed. Participants did not experience hypertension as a discreet clinical condition; rather, they self-managed hypertension concurrently with other conditions, leading to a breakdown in hypertension self-management. We provide strategies to address each of the four barriers to better equip providers in addressing their clinically salient concerns.

Citizen Science: Data Sharing For, By, and With the Public

NASA Astrophysics Data System (ADS)

Wiggins, A.

2017-12-01

Data sharing in citizen science is just as challenging as it is for any other type of science, except that there are more parties involved, with more diverse needs and interests. This talk provides an overview of the challenges and current efforts to advance data sharing in citizen science, and suggests refocusing data management activities on supporting the needs of multiple audiences. Early work on data sharing in citizen science advocated applying the standards and practices of academia, which can only address the needs of one of several audiences for citizen science data, and academics are not always the primary audience. Practitioners still need guidance on how to better share data other key parties, such as participants and policymakers, and which data management practices to prioritize for addressing the needs of multiple audiences. The benefits to the project of investing scarce resources into data products and dissemination strategies for each target audience still remain variable, unclear, or unpredictable. And as projects mature and change, the importance of data sharing activities and audiences are likely to change as well. This combination of multiple diverse audiences, shifting priorities, limited resources, and unclear benefits creates a perfect storm of conditions to suppress data sharing. Nonetheless, many citizen science projects make the effort, with exemplars showing substantial returns on data stewardship investments, and international initiatives are underway to bolster the data sharing capacity of the field. To improve the state of data sharing in citizen science, strategic use of limited resources suggests prioritizing data management activities that support the needs of multiple audiences. These may include better transparency about data access and usage, and standardized reporting of broader impacts from secondary data users, to both reward projects and incentivize further data sharing.

Multiple sclerosis: individualized disease susceptibility and therapy response.

PubMed

Pravica, Vera; Markovic, Milos; Cupic, Maja; Savic, Emina; Popadic, Dusan; Drulovic, Jelena; Mostarica-Stojkovic, Marija

2013-02-01

Multiple sclerosis (MS) is a heterogeneous disease in which diverse genetic, pathological and clinical backgrounds lead to variable therapy response. Accordingly, MS care should be tailored to address disease traits unique to each person. At the core of personalized management is the emergence of new knowledge, enabling optimized treatment and disease-modifying therapies. This overview analyzes the promise of genetic and nongenetic biomarkers in advancing decision-making algorithms to assist diagnosis or in predicting the disease course and therapy response in any given MS patient.

Estimating and controlling workplace risk: an approach for occupational hygiene and safety professionals.

PubMed

Toffel, Michael W; Birkner, Lawrence R

2002-07-01

The protection of people and physical assets is the objective of health and safety professionals and is accomplished through the paradigm of anticipation, recognition, evaluation, and control of risks in the occupational environment. Risk assessment concepts are not only used by health and safety professionals, but also by business and financial planners. Since meeting health and safety objectives requires financial resources provided by business and governmental managers, the hypothesis addressed here is that health and safety risk decisions should be made with probabilistic processes used in financial decision-making and which are familiar and recognizable to business and government planners and managers. This article develops the processes and demonstrates the use of incident probabilities, historic outcome information, and incremental impact analysis to estimate risk of multiple alternatives in the chemical process industry. It also analyzes how the ethical aspects of decision-making can be addressed in formulating health and safety risk management plans. It is concluded that certain, easily understood, and applied probabilistic risk assessment methods used by business and government to assess financial and outcome risk have applicability to improving workplace health and safety in three ways: 1) by linking the business and health and safety risk assessment processes to securing resources, 2) by providing an additional set of tools for health and safety risk assessment, and 3) by requiring the risk assessor to consider multiple risk management alternatives.

Quantifying multiple telecouplings using an integrated suite of spatially-explicit tools

NASA Astrophysics Data System (ADS)

Tonini, F.; Liu, J.

2016-12-01

Telecoupling is an interdisciplinary research umbrella concept that enables natural and social scientists to understand and generate information for managing how humans and nature can sustainably coexist worldwide. To systematically study telecoupling, it is essential to build a comprehensive set of spatially-explicit tools for describing and quantifying multiple reciprocal socioeconomic and environmental interactions between a focal area and other areas. Here we introduce the Telecoupling Toolbox, a new free and open-source set of tools developed to map and identify the five major interrelated components of the telecoupling framework: systems, flows, agents, causes, and effects. The modular design of the toolbox allows the integration of existing tools and software (e.g. InVEST) to assess synergies and tradeoffs associated with policies and other local to global interventions. We show applications of the toolbox using a number of representative studies that address a variety of scientific and management issues related to telecouplings throughout the world. The results suggest that the toolbox can thoroughly map and quantify multiple telecouplings under various contexts while providing users with an easy-to-use interface. It provides a powerful platform to address globally important issues, such as land use and land cover change, species invasion, migration, flows of ecosystem services, and international trade of goods and products.

DataHub: Knowledge-based data management for data discovery

NASA Astrophysics Data System (ADS)

Handley, Thomas H.; Li, Y. Philip

1993-08-01

Currently available database technology is largely designed for business data-processing applications, and seems inadequate for scientific applications. The research described in this paper, the DataHub, will address the issues associated with this shortfall in technology utilization and development. The DataHub development is addressing the key issues in scientific data management of scientific database models and resource sharing in a geographically distributed, multi-disciplinary, science research environment. Thus, the DataHub will be a server between the data suppliers and data consumers to facilitate data exchanges, to assist science data analysis, and to provide as systematic approach for science data management. More specifically, the DataHub's objectives are to provide support for (1) exploratory data analysis (i.e., data driven analysis); (2) data transformations; (3) data semantics capture and usage; analysis-related knowledge capture and usage; and (5) data discovery, ingestion, and extraction. Applying technologies that vary from deductive databases, semantic data models, data discovery, knowledge representation and inferencing, exploratory data analysis techniques and modern man-machine interfaces, DataHub will provide a prototype, integrated environement to support research scientists' needs in multiple disciplines (i.e. oceanography, geology, and atmospheric) while addressing the more general science data management issues. Additionally, the DataHub will provide data management services to exploratory data analysis applications such as LinkWinds and NCSA's XIMAGE.

Application of LAC-type processes and concepts to nonrecreation management issues in protected areas

Treesearch

Linda Merigliano; David N. Cole; David J. Parsons

1997-01-01

When Limits of Acceptable Change concepts are applied to nonrecreational issues, two primary problems are encountered: (1) developing zoning schemes which are compatible when multiple issues are addressed, and (2) defining the desired condition and establishing measurable standards for ecosystem attributes which change in unpredictable ways. Approaches to overcome...

Research and cumulative watershed effects

Treesearch

L. M. Reid

1993-01-01

The mandate for land managers to address cumulative watershed effects (CWEs) requires that planners evaluate the potential impacts of their activities on multiple beneficial uses within the context of other coexisting activities in a watershed. Types of CWEs vary with the types of land-use activities and their modes of interaction, but published studies illustrate...

HDF Update

NASA Technical Reports Server (NTRS)

Pourmal, Elena

2016-01-01

The HDF Group maintains and evolves HDF software used by NASA ESDIS program to manage remote sense data. In this talk we will discuss new features of HDF (Virtual Datasets, Single writerMultiple reader access, Community supported HDF5 compression filters) that address storage and IO performance requirements of the applications that work with the ESDIS data products.

Modeling Success: Using Preenrollment Data to Identify Academically At-Risk Students

ERIC Educational Resources Information Center

Gansemer-Topf, Ann M.; Compton, Jonathan; Wohlgemuth, Darin; Forbes, Greg; Ralston, Ekaterina

2015-01-01

Improving student success and degree completion is one of the core principles of strategic enrollment management. To address this principle, institutional data were used to develop a statistical model to identify academically at-risk students. The model employs multiple linear regression techniques to predict students at risk of earning below a…

The Effects of Racial Conflict on Organizational Performance: A Search for Theory

ERIC Educational Resources Information Center

Byrd, Marilyn Y.

2007-01-01

This article addresses the effect of racial conflict on organizational performance as an issue that needs theoretical support in the foundational theories of human resource development (HRD). While the field of HRD recognizes theories from multiple disciplines, the field lacks a theoretical framework to inform leadership in managing racial…

A structured analysis of uncertainty surrounding modeled impacts of groundwater-extraction rules

NASA Astrophysics Data System (ADS)

Guillaume, Joseph H. A.; Qureshi, M. Ejaz; Jakeman, Anthony J.

2012-08-01

Integrating economic and groundwater models for groundwater-management can help improve understanding of trade-offs involved between conflicting socioeconomic and biophysical objectives. However, there is significant uncertainty in most strategic decision-making situations, including in the models constructed to represent them. If not addressed, this uncertainty may be used to challenge the legitimacy of the models and decisions made using them. In this context, a preliminary uncertainty analysis was conducted of a dynamic coupled economic-groundwater model aimed at assessing groundwater extraction rules. The analysis demonstrates how a variety of uncertainties in such a model can be addressed. A number of methods are used including propagation of scenarios and bounds on parameters, multiple models, block bootstrap time-series sampling and robust linear regression for model calibration. These methods are described within the context of a theoretical uncertainty management framework, using a set of fundamental uncertainty management tasks and an uncertainty typology.

Progress Toward Future Runway Management

NASA Technical Reports Server (NTRS)

Lohr, Gary W.; Brown, Sherilyn A.; Atkins, Stephen; Eisenhawer, Stephen W.; Bott, Terrance F.; Long, Dou; Hasan, Shahab

2011-01-01

The runway is universally acknowledged as a constraining factor to capacity in the National Airspace System (NAS). It follows that investigation of the effective use of runways, both in terms of selection and assignment, is paramount to the efficiency of future NAS operations. The need to address runway management is not a new idea; however, as the complexities of factors affecting runway selection and usage increase, the need for effective research in this area correspondingly increases. Under the National Aeronautics and Space Administration s Airspace Systems Program, runway management is a key research area. To address a future NAS which promises to be a complex landscape of factors and competing interests among users and operators, effective runway management strategies and capabilities are required. This effort has evolved from an assessment of current practices, an understanding of research activities addressing surface and airspace operations, traffic flow management enhancements, among others. This work has yielded significant progress. Systems analysis work indicates that the value of System Oriented Runway Management tools is significantly increased in the metroplex environment over that of the single airport case. Algorithms have been developed to provide runway configuration recommendations for a single airport with multiple runways. A benefits analysis has been conducted that indicates the SORM benefits include supporting traffic growth, cost reduction as a result of system efficiency, NAS optimization from metroplex operations, fairness in aircraft operations, and rational decision making.

Setting conservation management thresholds using a novel participatory modeling approach.

PubMed

Addison, P F E; de Bie, K; Rumpff, L

2015-10-01

We devised a participatory modeling approach for setting management thresholds that show when management intervention is required to address undesirable ecosystem changes. This approach was designed to be used when management thresholds: must be set for environmental indicators in the face of multiple competing objectives; need to incorporate scientific understanding and value judgments; and will be set by participants with limited modeling experience. We applied our approach to a case study where management thresholds were set for a mat-forming brown alga, Hormosira banksii, in a protected area management context. Participants, including management staff and scientists, were involved in a workshop to test the approach, and set management thresholds to address the threat of trampling by visitors to an intertidal rocky reef. The approach involved trading off the environmental objective, to maintain the condition of intertidal reef communities, with social and economic objectives to ensure management intervention was cost-effective. Ecological scenarios, developed using scenario planning, were a key feature that provided the foundation for where to set management thresholds. The scenarios developed represented declines in percent cover of H. banksii that may occur under increased threatening processes. Participants defined 4 discrete management alternatives to address the threat of trampling and estimated the effect of these alternatives on the objectives under each ecological scenario. A weighted additive model was used to aggregate participants' consequence estimates. Model outputs (decision scores) clearly expressed uncertainty, which can be considered by decision makers and used to inform where to set management thresholds. This approach encourages a proactive form of conservation, where management thresholds and associated actions are defined a priori for ecological indicators, rather than reacting to unexpected ecosystem changes in the future. © 2015 The Authors Conservation Biology published by Wiley Periodicals, Inc. on behalf of Society for Conservation Biology.

An integrated modeling approach to support management decisions of coupled groundwater-agricultural systems under multiple uncertainties

NASA Astrophysics Data System (ADS)

Hagos Subagadis, Yohannes; Schütze, Niels; Grundmann, Jens

2015-04-01

The planning and implementation of effective water resources management strategies need an assessment of multiple (physical, environmental, and socio-economic) issues, and often requires new research in which knowledge of diverse disciplines are combined in a unified methodological and operational frameworks. Such integrative research to link different knowledge domains faces several practical challenges. Such complexities are further compounded by multiple actors frequently with conflicting interests and multiple uncertainties about the consequences of potential management decisions. A fuzzy-stochastic multiple criteria decision analysis tool was developed in this study to systematically quantify both probabilistic and fuzzy uncertainties associated with complex hydrosystems management. It integrated physical process-based models, fuzzy logic, expert involvement and stochastic simulation within a general framework. Subsequently, the proposed new approach is applied to a water-scarce coastal arid region water management problem in northern Oman, where saltwater intrusion into a coastal aquifer due to excessive groundwater extraction for irrigated agriculture has affected the aquifer sustainability, endangering associated socio-economic conditions as well as traditional social structure. Results from the developed method have provided key decision alternatives which can serve as a platform for negotiation and further exploration. In addition, this approach has enabled to systematically quantify both probabilistic and fuzzy uncertainties associated with the decision problem. Sensitivity analysis applied within the developed tool has shown that the decision makers' risk aversion and risk taking attitude may yield in different ranking of decision alternatives. The developed approach can be applied to address the complexities and uncertainties inherent in water resources systems to support management decisions, while serving as a platform for stakeholder participation.

Science of Integrated Approaches to Natural Resources Management

NASA Astrophysics Data System (ADS)

Tengberg, Anna; Valencia, Sandra

2017-04-01

To meet multiple environmental objectives, integrated programming is becoming increasingly important for the Global Environmental Facility (GEF), the financial mechanism of the multilateral environmental agreements, including the United Nations Convention to Combat Desertification (UNCCD). Integration of multiple environmental, social and economic objectives also contributes to the achievement of the Sustainable Development Goals (SDGs) in a timely and cost-effective way. However, integration is often not well defined. This paper therefore focuses on identifying key aspects of integration and assessing their implementation in natural resources management (NRM) projects. To that end, we draw on systems thinking literature, and carry out an analysis of a random sample of GEF integrated projects and in-depth case studies demonstrating lessons learned and good practices in addressing land degradation and other NRM challenges. We identify numerous challenges and opportunities of integrated approaches that need to be addressed in order to maximise the catalytic impact of the GEF during problem diagnosis, project design, implementation and governance. We highlight the need for projects to identify clearer system boundaries and main feedback mechanisms within those boundaries, in order to effectively address drivers of environmental change. We propose a theory of change for Integrated Natural Resources Management (INRM) projects, where short-term environmental and socio-economic benefits will first accrue at the local level. Implementation of improved INRM technologies and practices at the local level can be extended through spatial planning, strengthening of innovation systems, and financing and incentive mechanisms at the watershed and/or landscape/seascape level to sustain and enhance ecosystem services at larger scales and longer time spans. We conclude that the evolving scientific understanding of factors influencing social, technical and institutional innovations and transitions towards sustainable management of natural resources should be harnessed and integrated into GEF's influencing models and theory of change, and be coupled with updated approaches for learning, adaptive management and scaling up.

Operations management system advanced automation: Fault detection isolation and recovery prototyping

NASA Technical Reports Server (NTRS)

Hanson, Matt

1990-01-01

The purpose of this project is to address the global fault detection, isolation and recovery (FDIR) requirements for Operation's Management System (OMS) automation within the Space Station Freedom program. This shall be accomplished by developing a selected FDIR prototype for the Space Station Freedom distributed processing systems. The prototype shall be based on advanced automation methodologies in addition to traditional software methods to meet the requirements for automation. A secondary objective is to expand the scope of the prototyping to encompass multiple aspects of station-wide fault management (SWFM) as discussed in OMS requirements documentation.

Biology and Management of the Mexican Rice Borer (Lepidoptera: Crambidae) in Rice in the United States

PubMed Central

Beuzelin, J. M.; Wilson, B. E.; VanWeelden, M. T.; Mészáros, A.; Way, M. O.; Stout, M. J.; Reagan, T. E.

2016-01-01

The Mexican rice borer, Eoreuma loftini (Dyar), is an invasive pest of rice, Oryza sativa L., in the Gulf Coast region of the United States. This pest also damages sugarcane, Saccharum spp. hybrids; corn, Zea mays L.; and sorghum, Sorghum bicolor (L.) Moench, and feeds on weedy noncrop grasses. Multiple aspects of integrated pest management including use of pheromone traps, manipulation of planting dates, harvest cutting height, stubble management, noncrop host management, soil fertility management, host plant resistance, use of insecticides, and biological control have been studied for Mexican rice borer management. However, the current management strategy in rice primarily relies on the use of chlorantraniliprole insecticide seed treatments. This profile addresses Mexican rice borer biology and management in rice in the United States. PMID:28670487

Assessing hospital emergency management plans: a guide for infection preventionists.

PubMed

Rebmann, Terri

2009-11-01

Hospital emergency management plans are essential and must include input from an infection preventionist (IP). Multiple hospital planning documents exist, but many do not address infection prevention issues, combine them with noninfection prevention issues, or are disease/event specific. An all-encompassing emergency management planning guide for IPs is needed. A literature review and Internet search were conducted in December 2008. Data from relevant sources were extracted. A spreadsheet was created that delineated hospital emergency management plan components of interest to IPs. Of the sources screened, 49 were deemed relevant. Eleven domains were identified: (1) having a plan; (2) assessing hospital readiness; (3) having infection prevention policies and procedures; (4) having occupational health policies and procedures; (5) conducting surveillance and triage; (6) reporting incidents, having a communication plan, and managing information; (7) having laboratory support; (8) addressing surge capacity issues; (9) having anti-infective therapy and/or vaccines; (10) providing infection prevention education; and (11) managing physical plant issues. Infection preventionists should use this article as an assessment tool for evaluating their hospital emergency management plan and for developing policies and procedures that will decrease the risk of infection transmission during a mass casualty event.

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.

Lessons learned in multisite, nursing education research while studying a technology learning innovation.

PubMed

North, Sarah; Giddens, Jean

2013-10-01

Multiple challenges must be addressed when educational research is being conducted that involves a teaching innovation at multiple sites over time, including the consistent adoption and use of the intervention, attrition, response rates, and other aspects related to managing a complex study. After an 18-month nursing education study was conducted at multiple institutions across the United States, the authors' study team reflected on strategies that worked well, the challenges faced, and what could have been done differently. This article details the challenges and offers recommendations for other researchers conducting similar studies. Recommendations related to communication and engagement, innovation fidelity, survey fatigue, multiple institutional review board applications, and flexibility are provided. Copyright 2013, SLACK Incorporated.

A literal use of "forest health" safeguards against misuse and misapplication

Treesearch

Kenneth F. Raffa; Brian Aukema; Barbara J. Bentz; Allan Carroll; Nadir Erbilgin; Daniel A. Herms; Jeffrey A. Hicke; Richard W. Hofstetter; Steven Katovich; B. Staffan Lindgren; Jesse Logan; William Mattson; A. Steven Munson; Daniel J. Robison; Diana L. Six; Patrick C. Tobin; Philip A. Townsend; Kimberly F. Wallin

2009-01-01

"Forest Health" has become one of the most widely used terms in ecosystem management. Its popularity derives from powerful personal imagery, connecting the fragility of health with ecosystems. It addresses a need for an efficient term to describe the vitality of the world's forests, a usage we support. However, broad adoption has brought multiple usages...

Defining an economics research program to describe and evaluate ecosystem services.

Treesearch

Jeffrey D. Kline

2007-01-01

Balancing society’s multiple and sometimes competing objectives regarding forests calls for information describing the direct and indirect benefits resulting from forest policy and management, whether to address wildfire, loss of open space, unmanaged recreation, ecosystem restoration, or other objectives. The USDA Forest Service recently has proposed the concept of...

Responding to climate change impacts in the Sky Island Region: From planning to action

Treesearch

Louise W. Misztal; Gregg Garfin; Lara Hansen

2013-01-01

Addressing the increasing effects of climate change on natural resources requires multiple organizations, agencies, and institutions working cooperatively to incorporate climate change into resource management. In the Sky Island region of the southwestern United States and northern Mexico, Sky Island Alliance, a non-governmental organization, has convened a series of...

Integrating Vegetation Classification, Mapping, and Strategic Inventory for Forest Management

Treesearch

C. K. Brewer; R. Bush; D. Berglund; J. A. Barber; S. R. Brown

2006-01-01

Many of the analyses needed to address multiple resource issues are focused on vegetation pattern and process relationships and most rely on the data models produced from vegetation classification, mapping, and/or inventory. The Northern Region Vegetation Mapping Project (R1-VMP) data models are based on these three integrally related, yet separate processes. This...

Time management strategies for research productivity.

PubMed

Chase, Jo-Ana D; Topp, Robert; Smith, Carol E; Cohen, Marlene Z; Fahrenwald, Nancy; Zerwic, Julie J; Benefield, Lazelle E; Anderson, Cindy M; Conn, Vicki S

2013-02-01

Researchers function in a complex environment and carry multiple role responsibilities. This environment is prone to various distractions that can derail productivity and decrease efficiency. Effective time management allows researchers to maintain focus on their work, contributing to research productivity. Thus, improving time management skills is essential to developing and sustaining a successful program of research. This article presents time management strategies addressing behaviors surrounding time assessment, planning, and monitoring. Herein, the Western Journal of Nursing Research editorial board recommends strategies to enhance time management, including setting realistic goals, prioritizing, and optimizing planning. Involving a team, problem-solving barriers, and early management of potential distractions can facilitate maintaining focus on a research program. Continually evaluating the effectiveness of time management strategies allows researchers to identify areas of improvement and recognize progress.

The Baltic Sea as a time machine for the future coastal ocean.

PubMed

Reusch, Thorsten B H; Dierking, Jan; Andersson, Helen C; Bonsdorff, Erik; Carstensen, Jacob; Casini, Michele; Czajkowski, Mikolaj; Hasler, Berit; Hinsby, Klaus; Hyytiäinen, Kari; Johannesson, Kerstin; Jomaa, Seifeddine; Jormalainen, Veijo; Kuosa, Harri; Kurland, Sara; Laikre, Linda; MacKenzie, Brian R; Margonski, Piotr; Melzner, Frank; Oesterwind, Daniel; Ojaveer, Henn; Refsgaard, Jens Christian; Sandström, Annica; Schwarz, Gerald; Tonderski, Karin; Winder, Monika; Zandersen, Marianne

2018-05-01

Coastal global oceans are expected to undergo drastic changes driven by climate change and increasing anthropogenic pressures in coming decades. Predicting specific future conditions and assessing the best management strategies to maintain ecosystem integrity and sustainable resource use are difficult, because of multiple interacting pressures, uncertain projections, and a lack of test cases for management. We argue that the Baltic Sea can serve as a time machine to study consequences and mitigation of future coastal perturbations, due to its unique combination of an early history of multistressor disturbance and ecosystem deterioration and early implementation of cross-border environmental management to address these problems. The Baltic Sea also stands out in providing a strong scientific foundation and accessibility to long-term data series that provide a unique opportunity to assess the efficacy of management actions to address the breakdown of ecosystem functions. Trend reversals such as the return of top predators, recovering fish stocks, and reduced input of nutrient and harmful substances could be achieved only by implementing an international, cooperative governance structure transcending its complex multistate policy setting, with integrated management of watershed and sea. The Baltic Sea also demonstrates how rapidly progressing global pressures, particularly warming of Baltic waters and the surrounding catchment area, can offset the efficacy of current management approaches. This situation calls for management that is (i) conservative to provide a buffer against regionally unmanageable global perturbations, (ii) adaptive to react to new management challenges, and, ultimately, (iii) multisectorial and integrative to address conflicts associated with economic trade-offs.

The Baltic Sea as a time machine for the future coastal ocean

PubMed Central

Reusch, Thorsten B. H.; Andersson, Helen C.; Bonsdorff, Erik; Carstensen, Jacob; Kuosa, Harri; Laikre, Linda; Melzner, Frank; Oesterwind, Daniel; Sandström, Annica; Schwarz, Gerald; Winder, Monika; Zandersen, Marianne

2018-01-01

Coastal global oceans are expected to undergo drastic changes driven by climate change and increasing anthropogenic pressures in coming decades. Predicting specific future conditions and assessing the best management strategies to maintain ecosystem integrity and sustainable resource use are difficult, because of multiple interacting pressures, uncertain projections, and a lack of test cases for management. We argue that the Baltic Sea can serve as a time machine to study consequences and mitigation of future coastal perturbations, due to its unique combination of an early history of multistressor disturbance and ecosystem deterioration and early implementation of cross-border environmental management to address these problems. The Baltic Sea also stands out in providing a strong scientific foundation and accessibility to long-term data series that provide a unique opportunity to assess the efficacy of management actions to address the breakdown of ecosystem functions. Trend reversals such as the return of top predators, recovering fish stocks, and reduced input of nutrient and harmful substances could be achieved only by implementing an international, cooperative governance structure transcending its complex multistate policy setting, with integrated management of watershed and sea. The Baltic Sea also demonstrates how rapidly progressing global pressures, particularly warming of Baltic waters and the surrounding catchment area, can offset the efficacy of current management approaches. This situation calls for management that is (i) conservative to provide a buffer against regionally unmanageable global perturbations, (ii) adaptive to react to new management challenges, and, ultimately, (iii) multisectorial and integrative to address conflicts associated with economic trade-offs. PMID:29750199

Analysing the impact of multiple stressors in aquatic biomonitoring data: A 'cookbook' with applications in R.

PubMed

Feld, Christian K; Segurado, Pedro; Gutiérrez-Cánovas, Cayetano

2016-12-15

Multiple stressors threaten biodiversity and ecosystem integrity, imposing new challenges to ecosystem management and restoration. Ecosystem managers are required to address and mitigate the impact of multiple stressors, yet the knowledge required to disentangle multiple-stressor effects is still incomplete. Experimental studies have advanced the understanding of single and combined stressor effects, but there is a lack of a robust analytical framework, to address the impact of multiple stressors based on monitoring data. Since 2000, the monitoring of Europe's waters has resulted in a vast amount of biological and environmental (stressor) data of about 120,000 water bodies. For many reasons, this data is rarely exploited in the multiple-stressor context, probably because of its rather heterogeneous nature: stressors vary and are mixed with broad-scale proxies of environmental stress (e.g. land cover), missing values and zero-inflated data limit the application of statistical methods and biological indicators are often aggregated (e.g. taxon richness) and do not respond stressor-specific. Here, we present a 'cookbook' to analyse the biological response to multiple stressors using data from biomonitoring schemes. Our 'cookbook' includes guidance for the analytical process and the interpretation of results. The 'cookbook' is accompanied by scripts, which allow the user to run a stepwise analysis based on his/her own data in R, an open-source language and environment for statistical computing and graphics. Using simulated and real data, we show that the recommended procedure is capable of identifying stressor hierarchy (importance) and interaction in large datasets. We recommend a minimum number of 150 independent observations and a minimum stressor gradient length of 75% (of the most relevant stressor's gradient in nature), to be able to reliably rank the stressor's importance, detect relevant interactions and estimate their standardised effect size. We conclude with a brief discussion of the advantages and limitations of this protocol. Copyright © 2016 Elsevier B.V. All rights reserved.

Interval-parameter chance-constraint programming model for end-of-life vehicles management under rigorous environmental regulations.

PubMed

Simic, Vladimir

2016-06-01

As the number of end-of-life vehicles (ELVs) is estimated to increase to 79.3 million units per year by 2020 (e.g., 40 million units were generated in 2010), there is strong motivation to effectively manage this fast-growing waste flow. Intensive work on management of ELVs is necessary in order to more successfully tackle this important environmental challenge. This paper proposes an interval-parameter chance-constraint programming model for end-of-life vehicles management under rigorous environmental regulations. The proposed model can incorporate various uncertainty information in the modeling process. The complex relationships between different ELV management sub-systems are successfully addressed. Particularly, the formulated model can help identify optimal patterns of procurement from multiple sources of ELV supply, production and inventory planning in multiple vehicle recycling factories, and allocation of sorted material flows to multiple final destinations under rigorous environmental regulations. A case study is conducted in order to demonstrate the potentials and applicability of the proposed model. Various constraint-violation probability levels are examined in detail. Influences of parameter uncertainty on model solutions are thoroughly investigated. Useful solutions for the management of ELVs are obtained under different probabilities of violating system constraints. The formulated model is able to tackle a hard, uncertainty existing ELV management problem. The presented model has advantages in providing bases for determining long-term ELV management plans with desired compromises between economic efficiency of vehicle recycling system and system-reliability considerations. The results are helpful for supporting generation and improvement of ELV management plans. Copyright © 2016 Elsevier Ltd. All rights reserved.

Strategies in disability management. Corporate disability management programs implemented at the work site.

PubMed

Kalina, C M

1999-10-30

Managers are challenged to demonstrate all programs as economically essential to the business, generating an appreciable return on investment. Further challenge exists to blend and integrate clinical and business objectives in program development. Disability management programs must be viewed as economically essential to the financial success of the business to assure management support for clinical interventions and return-to-work strategies essential for a successful program. This paper discusses a disability management program integrating clinical and business goals and objectives in return-to-work strategies to effect positive clinical, social-cultural, and business results. Clinical, educational, social, and economic challenges in the development, implementation, and continued management of a disability program at a large corporation with multiple global work sites are defined. Continued discussion addresses the effective clinical interventions and educational strategies utilized successfully within the workplace environment in response to each defined challenge. A multiple disciplinary team approach, clinical and business outcome measures, and quality assurance indicators are discussed as major program components. This article discusses a successful program approach focusing on business process and methodology. These parameters are used to link resources to strategy, developing a product for implementing and managing a program demonstrating economic value added through effective clinical medical case management.

Advancing Cyberinfrastructure to support high resolution water resources modeling

NASA Astrophysics Data System (ADS)

Tarboton, D. G.; Ogden, F. L.; Jones, N.; Horsburgh, J. S.

2012-12-01

Addressing the problem of how the availability and quality of water resources at large scales are sensitive to climate variability, watershed alterations and management activities requires computational resources that combine data from multiple sources and support integrated modeling. Related cyberinfrastructure challenges include: 1) how can we best structure data and computer models to address this scientific problem through the use of high-performance and data-intensive computing, and 2) how can we do this in a way that discipline scientists without extensive computational and algorithmic knowledge and experience can take advantage of advances in cyberinfrastructure? This presentation will describe a new system called CI-WATER that is being developed to address these challenges and advance high resolution water resources modeling in the Western U.S. We are building on existing tools that enable collaboration to develop model and data interfaces that link integrated system models running within an HPC environment to multiple data sources. Our goal is to enhance the use of computational simulation and data-intensive modeling to better understand water resources. Addressing water resource problems in the Western U.S. requires simulation of natural and engineered systems, as well as representation of legal (water rights) and institutional constraints alongside the representation of physical processes. We are establishing data services to represent the engineered infrastructure and legal and institutional systems in a way that they can be used with high resolution multi-physics watershed modeling at high spatial resolution. These services will enable incorporation of location-specific information on water management infrastructure and systems into the assessment of regional water availability in the face of growing demands, uncertain future meteorological forcings, and existing prior-appropriations water rights. This presentation will discuss the informatics challenges involved with data management and easy-to-use access to high performance computing being tackled in this project.

Design requirements for SRB production control system. Volume 2: System requirements and conceptual description

NASA Technical Reports Server (NTRS)

1981-01-01

In the development of the business system for the SRB automated production control system, special attention had to be paid to the unique environment posed by the space shuttle. The issues posed by this environment, and the means by which they were addressed, are reviewed. The change in management philosphy which will be required as NASA switches from one-of-a-kind launches to multiple launches is discussed. The implications of the assembly process on the business system are described. These issues include multiple missions, multiple locations and facilities, maintenance and refurbishment, multiple sources, and multiple contractors. The implications of these aspects on the automated production control system are reviewed including an assessment of the six major subsystems, as well as four other subsystem. Some general system requirements which flow through the entire business system are described.

The construction of feelings of justice in environmental management: An empirical study of multiple biodiversity conflicts in Calakmul, Mexico.

PubMed

Lecuyer, Lou; White, Rehema M; Schmook, Birgit; Lemay, Violaine; Calmé, Sophie

2018-05-01

A failure to address social concerns in biodiversity conservation can lead to feelings of injustice among some actors, and hence jeopardize conservation goals. The complex socio-cultural and political context of the Calakmul Biosphere Reserve, Mexico, has historically led to multiple biodiversity conflicts. Our goal, in this case study, was to explore perceptions of justice held by local actors in relation to biodiversity conflicts. We then aimed to determine the following: 1) people's definitions of their feelings of justice; 2) the criteria used in this assessment; 3) variability in the criteria influencing them; and 4) implications for environmental management in the region and beyond. We worked with five focus groups, exploring three examples of biodiversity conflict around forest, water and jaguar management with a total of 41 ranchers, farmers and representatives of local producers. Our results demonstrated that people constructed their feelings of justice around four dimensions of justice: recognition (acknowledging individuals' rights, values, cultures and knowledge systems); ecological (fair and respectful treatment of the natural environment), procedural (fairness in processes of environmental management), distributive (fairness in the distribution of costs and benefits). We identified a list of criteria the participants used in their appraisal of justice and sources of variation such as the social scale of focus and participant role, and whom they perceived to be responsible for resource management. We propose a new framework that conceptualizes justice-as-recognition and ecological justice as forms of conditional justices, and procedural and distributive justices as forms of practical justice. Conditional justice allows us to define who is a legitimate source of justice norms and if nature should be integrated in the scope of justice; hence, conditional justice underpins other dimensions of justice. On the other hand, procedural and distributive address the daily practices of fair processes and distribution. We propose that the perception of justice is a neglected but important aspect to include in integrative approaches to managing biodiversity conflicts. Addressing demands of justice in environmental management will require us to consider more than the distribution of costs and benefits among actors. We also need to respect the plurality of fairness perspectives and to recognize the benefits of dialogical approaches to achieve more successful environmental management. Copyright © 2018 Elsevier Ltd. All rights reserved.

Developing objectives with multiple stakeholders: adaptive management of horseshoe crabs and Red Knots in the Delaware Bay

USGS Publications Warehouse

McGowan, Conor P.; Lyons, James E.; Smith, David

2015-01-01

Structured decision making (SDM) is an increasingly utilized approach and set of tools for addressing complex decisions in environmental management. SDM is a value-focused thinking approach that places paramount importance on first establishing clear management objectives that reflect core values of stakeholders. To be useful for management, objectives must be transparently stated in unambiguous and measurable terms. We used these concepts to develop consensus objectives for the multiple stakeholders of horseshoe crab harvest in Delaware Bay. Participating stakeholders first agreed on a qualitative statement of fundamental objectives, and then worked to convert those objectives to specific and measurable quantities, so that management decisions could be assessed. We used a constraint-based approach where the conservation objectives for Red Knots, a species of migratory shorebird that relies on horseshoe crab eggs as a food resource during migration, constrained the utility of crab harvest. Developing utility functions to effectively reflect the management objectives allowed us to incorporate stakeholder risk aversion even though different stakeholder groups were averse to different or competing risks. While measurable objectives and quantitative utility functions seem scientific, developing these objectives was fundamentally driven by the values of the participating stakeholders.

Developing Objectives with Multiple Stakeholders: Adaptive Management of Horseshoe Crabs and Red Knots in the Delaware Bay

NASA Astrophysics Data System (ADS)

McGowan, Conor P.; Lyons, James E.; Smith, David R.

2015-04-01

Structured decision making (SDM) is an increasingly utilized approach and set of tools for addressing complex decisions in environmental management. SDM is a value-focused thinking approach that places paramount importance on first establishing clear management objectives that reflect core values of stakeholders. To be useful for management, objectives must be transparently stated in unambiguous and measurable terms. We used these concepts to develop consensus objectives for the multiple stakeholders of horseshoe crab harvest in Delaware Bay. Participating stakeholders first agreed on a qualitative statement of fundamental objectives, and then worked to convert those objectives to specific and measurable quantities, so that management decisions could be assessed. We used a constraint-based approach where the conservation objectives for Red Knots, a species of migratory shorebird that relies on horseshoe crab eggs as a food resource during migration, constrained the utility of crab harvest. Developing utility functions to effectively reflect the management objectives allowed us to incorporate stakeholder risk aversion even though different stakeholder groups were averse to different or competing risks. While measurable objectives and quantitative utility functions seem scientific, developing these objectives was fundamentally driven by the values of the participating stakeholders.

Disorders of Excessive Daytime Sleepiness Including Narcolepsy and Idiopathic Hypersomnia.

PubMed

Berkowski, Joseph Andrew; Shelgikar, Anita Valanju

2016-09-01

Central disorders of hypersomnolence are rare conditions with a poorly understood pathophysiology, making the identification and management challenging for sleep clinicians. Clinical history is essential for ruling out secondary causes of hypersomnolence and distinguishing among diagnoses. Current diagnostic criteria rely heavily on the polysomnogram and multiple sleep latency test. The current focus of treatment of hypersomnolence is on drugs that promote alertness. Additionally, in the case of narcolepsy type 1, medication management addresses control of cataplexy, the hallmark symptom of this disorder. Elucidation of pathophysiology of these disorders in the future will be essential to better categorization and management. Published by Elsevier Inc.

Limited salvage logging effects on forest regeneration after moderate-severity windthrow

Treesearch

C.J. Peterson

2008-01-01

Recent conceptual advances address forest response to multiple disturbances within a brief time period, providing an ideal framework for examining the consequences of natural disturbances followed by anthropogenic management activities. The combination of two or more disturbances in a short period may produce ‘‘ecological surprises,’’...

Congruent management of multiple resources: proceedings from the Wood Compatibility Initiative workshop.

Treesearch

Adelaide C. Johnson; Richard W. Haynes; Robert A. Monserud

2002-01-01

The Wood Compatibility Initiative (WCI) addresses options that may increase the compatibility between wood production and other societal values derived from forestlands. The set of 25 papers included in this proceedings presents the summaries of WCI-related research, compiled from a workshop held December 4-7th 2001 at the Skamania Lodge in Stevenson, Washington. The...

Current and future molecular approaches to investigate the white pine blister rust pathosystem

Treesearch

B. A. Richardson; A. K. M. Ekramoddoulah; J.-J. Liu; M.-S. Kim; N. B. Klopfenstein

2010-01-01

Molecular genetics is proving to be especially useful for addressing a wide variety of research and management questions on the white pine blister rust pathosystem. White pine blister rust, caused by Cronartium ribicola, is an ideal model for studying biogeography, genetics, and evolution because: (1) it involves an introduced pathogen; (2) it includes multiple primary...

Wireless Distribution Systems To Support Medical Response to Disasters

PubMed Central

Arisoylu, Mustafa; Mishra, Rajesh; Rao, Ramesh; Lenert, Leslie A.

2005-01-01

We discuss the design of multi-hop access networks with multiple gateways that supports medical response to disasters. We examine and implement protocols to ensure high bandwidth, robust, self-healing and secure wireless multi-hop access networks for extreme conditions. Address management, path setup, gateway discovery and selection protocols are described. Future directions and plans are also considered. PMID:16779171

The Multiple Sclerosis Self-Management Scale

PubMed Central

Ghahari, Setareh; Khoshbin, Lana S.

2014-01-01

Background: The Multiple Sclerosis Self-Management Scale (MSSM) is currently the only measure that was developed specifically to address self-management among individuals with multiple sclerosis (MS). While good internal consistency (α = 0.85) and construct validity have been demonstrated, other psychometric properties have not been established. This study was undertaken to evaluate the criterion validity, test-retest reliability, and face validity of the MSSM. Methods: Thirty-one individuals with MS who met the inclusion criteria were recruited to complete a series of questionnaires at two time points. At Time 1, participants completed the MSSM and two generic self-management tools—the Partners in Health (PIH-12) and the Health Education Impact Questionnaire (heiQ)—as well as a short questionnaire to capture participants' opinions about the MSSM. At Time 2, approximately 2 weeks after Time 1, participants completed the MSSM again. Results: The available MSSM factors showed moderate to high correlations with both PIH-12 and heiQ and were deemed to have satisfactory test-retest reliability. Face validity pointed to areas of the MSSM that need to be revised in future work. As indicated by the participants, some dimensions of MS self-management are missing in the MSSM and some items such as medication are redundant. Conclusions: This study provides evidence for the reliability and validity of the MSSM; however, further changes are required for both researchers and clinicians to use the tool meaningfully in practice. PMID:25061429

Managing comorbidities in COPD

PubMed Central

Hillas, Georgios; Perlikos, Fotis; Tsiligianni, Ioanna; Tzanakis, Nikolaos

2015-01-01

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Age and smoking are common risk factors for COPD and other illnesses, often leading COPD patients to demonstrate multiple coexisting comorbidities. COPD exacerbations and comorbidities contribute to the overall severity in individual patients. Clinical trials investigating the treatment of COPD routinely exclude patients with multiple comorbidities or advanced age. Clinical practice guidelines for a specific disease do not usually address comorbidities in their recommendations. However, the management and the medical intervention in COPD patients with comorbidities need a holistic approach that is not clearly established worldwide. This holistic approach should include the specific burden of each comorbidity in the COPD severity classification scale. Further, the pharmacological and nonpharmacological management should also include optimal interventions and risk factor modifications simultaneously for all diseases. All health care specialists in COPD management need to work together with professionals specialized in the management of the other major chronic diseases in order to provide a multidisciplinary approach to COPD patients with multiple diseases. In this review, we focus on the major comorbidities that affect COPD patients. We present an overview of the problems faced, the reasons and risk factors for the most commonly encountered comorbidities, and the burden on health care costs. We also provide a rationale for approaching the therapeutic options of the COPD patient afflicted by comorbidity. PMID:25609943

Regional Management Units for Marine Turtles: A Novel Framework for Prioritizing Conservation and Research across Multiple Scales

PubMed Central

Wallace, Bryan P.; DiMatteo, Andrew D.; Hurley, Brendan J.; Finkbeiner, Elena M.; Bolten, Alan B.; Chaloupka, Milani Y.; Hutchinson, Brian J.; Abreu-Grobois, F. Alberto; Amorocho, Diego; Bjorndal, Karen A.; Bourjea, Jerome; Bowen, Brian W.; Dueñas, Raquel Briseño; Casale, Paolo; Choudhury, B. C.; Costa, Alice; Dutton, Peter H.; Fallabrino, Alejandro; Girard, Alexandre; Girondot, Marc; Godfrey, Matthew H.; Hamann, Mark; López-Mendilaharsu, Milagros; Marcovaldi, Maria Angela; Mortimer, Jeanne A.; Musick, John A.; Nel, Ronel; Pilcher, Nicolas J.; Seminoff, Jeffrey A.; Troëng, Sebastian; Witherington, Blair; Mast, Roderic B.

2010-01-01

Background Resolving threats to widely distributed marine megafauna requires definition of the geographic distributions of both the threats as well as the population unit(s) of interest. In turn, because individual threats can operate on varying spatial scales, their impacts can affect different segments of a population of the same species. Therefore, integration of multiple tools and techniques — including site-based monitoring, genetic analyses, mark-recapture studies and telemetry — can facilitate robust definitions of population segments at multiple biological and spatial scales to address different management and research challenges. Methodology/Principal Findings To address these issues for marine turtles, we collated all available studies on marine turtle biogeography, including nesting sites, population abundances and trends, population genetics, and satellite telemetry. We georeferenced this information to generate separate layers for nesting sites, genetic stocks, and core distributions of population segments of all marine turtle species. We then spatially integrated this information from fine- to coarse-spatial scales to develop nested envelope models, or Regional Management Units (RMUs), for marine turtles globally. Conclusions/Significance The RMU framework is a solution to the challenge of how to organize marine turtles into units of protection above the level of nesting populations, but below the level of species, within regional entities that might be on independent evolutionary trajectories. Among many potential applications, RMUs provide a framework for identifying data gaps, assessing high diversity areas for multiple species and genetic stocks, and evaluating conservation status of marine turtles. Furthermore, RMUs allow for identification of geographic barriers to gene flow, and can provide valuable guidance to marine spatial planning initiatives that integrate spatial distributions of protected species and human activities. In addition, the RMU framework — including maps and supporting metadata — will be an iterative, user-driven tool made publicly available in an online application for comments, improvements, download and analysis. PMID:21253007

A game theory analysis of green infrastructure stormwater management policies

NASA Astrophysics Data System (ADS)

William, Reshmina; Garg, Jugal; Stillwell, Ashlynn S.

2017-09-01

Green stormwater infrastructure has been demonstrated as an innovative water resources management approach that addresses multiple challenges facing urban environments. However, there is little consensus on what policy strategies can be used to best incentivize green infrastructure adoption by private landowners. Game theory, an analysis framework that has historically been under-utilized within the context of stormwater management, is uniquely suited to address this policy question. We used a cooperative game theory framework to investigate the potential impacts of different policy strategies used to incentivize green infrastructure installation. The results indicate that municipal regulation leads to the greatest reduction in pollutant loading. However, the choice of the "best" regulatory approach will depend on a variety of different factors including politics and financial considerations. Large, downstream agents have a disproportionate share of bargaining power. Results also reveal that policy impacts are highly dependent on agents' spatial position within the stormwater network, leading to important questions of social equity and environmental justice.

Linking an agency strategic review to increase knowledge management: San Francisco County Human Service Agency.

PubMed

Harrison, Lindsay

2012-01-01

Led by the agency director, the agency engaged in a Strategic Review, based on a comprehensive assessment of agency performance that identified strategies to improve organizational effectiveness through increased data-informed practice and knowledge management. The Strategic Review gathered information on staff perceptions, perceptions of external stakeholders, changing citywide and neighborhood demographics, policy mandates, and budget and workload issues. The need for the review was based upon multiple, substantial changes not addressed in the 2000 Strategic Plan, including the 2004 merger of the Department of Human Services and the Department of Aging and Adult Services, changes among the executive management team, transitions among key political entities, new policy mandates and changing budget allocations. This case study describes the Strategic Review process and content, summarizing key challenges and lessons related to addressing workload demands, fostering positive staff attitudes, balancing internal and external information needs, and integrating data use and planning processes across the agency. Copyright © Taylor & Francis Group, LLC

Pelvic fracture in multiple trauma: are we still up-to-date with massive fluid resuscitation?

PubMed

Burkhardt, Markus; Kristen, Alexander; Culemann, Ulf; Koehler, Daniel; Histing, Tina; Holstein, Joerg H; Pizanis, Antonius; Pohlemann, Tim

2014-10-01

Until today the mortality of complex pelvic trauma remains unacceptably high. On the one hand this could be attributed to a biological limit of the survivable trauma load, on the other hand side an ongoing inadequate treatment might be conceivable too. For the management of multiple trauma patients with life-threatening pelvic fractures, there is ongoing international debate on the adequate therapeutic strategy, e.g. arterial embolization or pelvic packing, as well as aggressive or restrained volume therapy. Whereas traditional pelvis-specific trauma algorithms still recommend massive fluid resuscitation, there is upcoming evidence that a restrained volume therapy in the preclinical setting may improve trauma outcomes. Less intravenous fluid administration may also reduce haemodilution and concomitant trauma-associated coagulopathy. After linking the data of the TraumaRegister DGU(®) and the German Pelvic Injury Register, for the first time, the initial fluid management for complex pelvic traumas as well as for different Tile/OTA types of pelvic ring fractures could be addressed. Unfortunately, the results could not answer the question of the adequate fluid resuscitation but confirmed the actuality of massive fluid resuscitation in the prehospital and emergency room setting. Low-volume resuscitation seems not yet accepted in practice in managing multiple trauma patients with pelvic fractures at least in Germany. Nevertheless, prevention of exsanguination and of complications like multiple organ dysfunction syndrome still poses a major challenge in the management of complex pelvic ring injuries. Even nowadays, fluid management for trauma, not only for pelvic fractures, remains a controversial area and further research is mandatory. Copyright © 2014 Elsevier Ltd. All rights reserved.

Important considerations for feasibility studies in physical activity research involving persons with multiple sclerosis: a scoping systematic review and case study.

PubMed

Learmonth, Yvonne C; Motl, Robert W

2018-01-01

Much research has been undertaken to establish the important benefits of physical activity in persons with multiple sclerosis (MS). There is disagreement regarding the strength of this research, perhaps because the majority of studies on physical activity and its benefits have not undergone initial and systematic feasibility testing. We aim to address the feasibility processes that have been examined within the context of physical activity interventions in MS. A systematic scoping review was conducted based on a literature search of five databases to identify feasibility processes described in preliminary studies of physical activity in MS. We read and extracted methodology from each study based on the following feasibility metrics: process (e.g. recruitment), resource (e.g. monetary costs), management (e.g. personnel time requirements) and scientific outcomes (e.g. clinical/participant reported outcome measures). We illustrate the use of the four feasibility metrics within a randomised controlled trial of a home-based exercise intervention in persons with MS. Twenty-five studies were identified. Resource feasibility (e.g. time and resources) and scientific outcomes feasibility (e.g. clinical outcomes) methodologies were applied and described in many studies; however, these metrics have not been systematically addressed. Metrics related to process feasibility (e.g. recruitment) and management feasibility (e.g. human and data management) are not well described within the literature. Our case study successfully enabled us to address the four feasibility metrics, and we provide new information on management feasibility (i.e. estimate data completeness and estimate data entry) and scientific outcomes feasibility (i.e. determining data collection materials appropriateness). Our review highlights the existing research and provides a case study which assesses important metrics of study feasibility. This review serves as a clarion call for feasibility trials that will substantially strengthen the foundation of research on exercise in MS.

Multi-Objective Reinforcement Learning for Cognitive Radio-Based Satellite Communications

NASA Technical Reports Server (NTRS)

Ferreira, Paulo Victor R.; Paffenroth, Randy; Wyglinski, Alexander M.; Hackett, Timothy M.; Bilen, Sven G.; Reinhart, Richard C.; Mortensen, Dale J.

2016-01-01

Previous research on cognitive radios has addressed the performance of various machine-learning and optimization techniques for decision making of terrestrial link properties. In this paper, we present our recent investigations with respect to reinforcement learning that potentially can be employed by future cognitive radios installed onboard satellite communications systems specifically tasked with radio resource management. This work analyzes the performance of learning, reasoning, and decision making while considering multiple objectives for time-varying communications channels, as well as different cross-layer requirements. Based on the urgent demand for increased bandwidth, which is being addressed by the next generation of high-throughput satellites, the performance of cognitive radio is assessed considering links between a geostationary satellite and a fixed ground station operating at Ka-band (26 GHz). Simulation results show multiple objective performance improvements of more than 3.5 times for clear sky conditions and 6.8 times for rain conditions.

Multi-Objective Reinforcement Learning for Cognitive Radio Based Satellite Communications

NASA Technical Reports Server (NTRS)

Ferreira, Paulo; Paffenroth, Randy; Wyglinski, Alexander; Hackett, Timothy; Bilen, Sven; Reinhart, Richard; Mortensen, Dale John

2016-01-01

Previous research on cognitive radios has addressed the performance of various machine learning and optimization techniques for decision making of terrestrial link properties. In this paper, we present our recent investigations with respect to reinforcement learning that potentially can be employed by future cognitive radios installed onboard satellite communications systems specifically tasked with radio resource management. This work analyzes the performance of learning, reasoning, and decision making while considering multiple objectives for time-varying communications channels, as well as different crosslayer requirements. Based on the urgent demand for increased bandwidth, which is being addressed by the next generation of high-throughput satellites, the performance of cognitive radio is assessed considering links between a geostationary satellite and a fixed ground station operating at Ka-band (26 GHz). Simulation results show multiple objective performance improvements of more than 3:5 times for clear sky conditions and 6:8 times for rain conditions.

Improving our legacy: Incorporation of adaptive management into state wildlife action plans

USGS Publications Warehouse

Fontaine, J.J.

2011-01-01

The loss of biodiversity is a mounting concern, but despite numerous attempts there are few large scale conservation efforts that have proven successful in reversing current declines. Given the challenge of biodiversity conservation, there is a need to develop strategic conservation plans that address species declines even with the inherent uncertainty in managing multiple species in complex environments. In 2002, the State Wildlife Grant program was initiated to fulfill this need, and while not explicitly outlined by Congress follows the fundamental premise of adaptive management, 'Learning by doing'. When action is necessary, but basic biological information and an understanding of appropriate management strategies are lacking, adaptive management enables managers to be proactive in spite of uncertainty. However, regardless of the strengths of adaptive management, the development of an effective adaptive management framework is challenging. In a review of 53 State Wildlife Action Plans, I found a keen awareness by planners that adaptive management was an effective method for addressing biodiversity conservation, but the development and incorporation of explicit adaptive management approaches within each plan remained elusive. Only ???25% of the plans included a framework for how adaptive management would be implemented at the project level within their state. There was, however, considerable support across plans for further development and implementation of adaptive management. By furthering the incorporation of adaptive management principles in conservation plans and explicitly outlining the decision making process, states will be poised to meet the pending challenges to biodiversity conservation. ?? 2010 .

Improving our legacy: incorporation of adaptive management into state wildlife action plans.

PubMed

Fontaine, Joseph J

2011-05-01

The loss of biodiversity is a mounting concern, but despite numerous attempts there are few large scale conservation efforts that have proven successful in reversing current declines. Given the challenge of biodiversity conservation, there is a need to develop strategic conservation plans that address species declines even with the inherent uncertainty in managing multiple species in complex environments. In 2002, the State Wildlife Grant program was initiated to fulfill this need, and while not explicitly outlined by Congress follows the fundamental premise of adaptive management, 'Learning by doing'. When action is necessary, but basic biological information and an understanding of appropriate management strategies are lacking, adaptive management enables managers to be proactive in spite of uncertainty. However, regardless of the strengths of adaptive management, the development of an effective adaptive management framework is challenging. In a review of 53 State Wildlife Action Plans, I found a keen awareness by planners that adaptive management was an effective method for addressing biodiversity conservation, but the development and incorporation of explicit adaptive management approaches within each plan remained elusive. Only ~25% of the plans included a framework for how adaptive management would be implemented at the project level within their state. There was, however, considerable support across plans for further development and implementation of adaptive management. By furthering the incorporation of adaptive management principles in conservation plans and explicitly outlining the decision making process, states will be poised to meet the pending challenges to biodiversity conservation. Published by Elsevier Ltd.

A Multi-stakeholder Approach to Moving Beyond Tree Mortality in the Sierra Nevada

NASA Astrophysics Data System (ADS)

Balachowski, J.; Buluc, L.; Fischer, C.; Ko, J.; Ostoja, S.

2017-12-01

The US Forest Service has estimated that 102 million trees have died in California since 2010. This die off event has been attributed to the combined effects of historical land management practices, fire suppression, insect outbreaks, and climate-related stressors. This tree mortality event represents the largest and most significant ecological disturbance in California in centuries, if not longer. Both scientists and managers recognize the need to rethink our approach to forest management in the face of a changing climate and increasingly frequent, uncharacteristically large wildfires, while budgets and staffing capacity continue to decrease. Addressing the uncertainly in managing under climate change with fewer financial resources will require multiple partners and stakeholders—including federal and state agencies, local governments, and non-governmental organizations—to work together to identify common goals and paths moving forward. The USDA California Climate Hub and USFS Region 5 convened a symposium on drought and tree mortality in July 2017. With nearly 170 attendees across a wide range of sectors, the event provided a meaningful opportunity for reflection, analysis, and consideration of next steps. Among the outcomes of this symposium was the identification of areas in which our capacity for individual and synergistic action is stronger, and those in which it is lacking that will thus require additional attention and effort. From this symposium, which included a series of smaller, stakeholder and partner working groups, we collectively identified research and information needs, possible policy adjustments, future management actions, and funding needs and opportunities. Here, we present these findings and suggest approaches for addressing the current tree mortality event based on the shared interests of multiple, diverse stakeholder groups.

Community-Based Participatory Research to Promote Healthy Diet and Nutrition and Prevent and Control Obesity Among African-Americans: a Literature Review.

PubMed

Coughlin, Steven S; Smith, Selina A

2017-04-01

The literature on community-based participatory research (CBPR) approaches for promoting healthy diet and nutrition and preventing and controlling obesity in African-American communities was systematically reviewed as part of the planning process for new research. CBPR studies of diet, nutrition, and weight management among African-Americans were identified from 1989 through October 31, 2015, using PubMed and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases and MeSH term and keyword searches. A total of 16 CBPR studies on healthy diet, nutrition, and weight management among African-Americans were identified; outcome evaluation results were available for all but two. Of the remaining 14 studies, 11 focused on adults, 1 on children, and 2 on both children and adults. Eight studies employed CBPR methods to address diet, nutrition, and weight management in church settings. Four had a cluster-randomized controlled design. Others had a pre-post test, quasi-experimental, or uncontrolled design. Only one study addressed four levels of the socioecological model; none addressed all five levels of the model. The studies identified in this review indicate that CBPR approaches can be effective for promoting healthy diet, nutrition, and weight management among African-American adults, but there is a need for additional studies with rigorous study designs that overcome methodologic limitations of many existing studies. There is only limited evidence for the effectiveness of CBPR approaches for promoting healthy eating and weight control among African-American children and adolescents. To address health disparities, additional CBPR studies are needed to promote healthy diet, nutrition, and weight management in African-American communities. Of particular interest are multilevel CBPR studies that include interventions aimed at multiple levels of the socioecological model.

Focusing biodiversity research on the needs of decision makers

NASA Astrophysics Data System (ADS)

Smythe, Katie D.; Bernabo, J. Christopher; Carter, Thomas B.; Jutro, Peter R.

1996-11-01

The project on Biodiversity Uncertainties and Research Needs (BURN) ensures the advancement of usable knowledge on biodiversity by obtaining input from decision makers on their priority information needs about biodiversity and then using this input to engage leading scientists in designing policy-relevant research. Decision makers articulated concerns related to four issues: significance of biodiversity; status and trends of biodiversity; management for biodiversity; and the linkage of social, cultural, economic, legal, and biological objectives. Leading natural and social scientists then identified the research required to address the decision makers' needs and determined the probability of success. The diverse group of experts reached consensus on several fundamental issues, helping to clarify the role of biodiversity in land and resource management. The BURN participants identified several features that should be incorporated into policy-relevant research plans and management strategies for biodiversity. Research and assessment efforts should be: multidisciplinary and integrative, participatory with stakeholder involvement, hierarchical (multiple scales), and problem- and region-specific. The activities should be focused regionally within a global perspective. Meta-analysis of existing data is needed on all fronts to assess the state of the science. More specifically, the scientists recommended six priority research areas that should be pursued to address the information needs articulated by decision makers: (1) characterization of biodiversity, (2) environmental valuation, (3) management for sustainability—for humans and the environment (adaptive management), (4) information management strategies, (5) governance and stewardship issues, and (6) communication and outreach. Broad recommendations were developed for each research area to provide direction for research planning and resource management strategies. The results will directly benefit those groups that require biodiversity research to address their needs—whether to develop policy, manage natural resources, or make other decisions affecting biodiversity.

Managing multiple roles: development of the Work-Family Conciliation Strategies Scale.

PubMed

Matias, Marisa; Fontaine, Anne Marie

2014-07-17

Juggling the demands of work and family is becoming increasingly difficult in today's world. As dual-earners are now a majority and men and women's roles in both the workplace and at home have changed, questions have been raised regarding how individuals and couples can balance family and work. Nevertheless, research addressing work-family conciliation strategies is limited to a conflict-driven approach and context-specific instruments are scarce. This study develops an instrument for assessing how dual-earners manage their multiple roles detaching from a conflict point of view highlighting the work-family conciliation strategies put forward by these couples. Through qualitative and quantitative procedures the Work-Family Conciliation Strategies Scales was developed and is composed by 5 factors: Couple Coping; Positive Attitude Towards Multiple Roles, Planning and Management Skills, Professional Adjustments and Institutional Support; with good adjustment [χ2/df = 1.22; CFI = .90, RMSEA = .04, SRMR = .08.] and good reliability coefficients [from .67 to .87]. The developed scale contributes to research because of its specificity to the work-family framework and its focus on the proactive nature of balancing work and family roles. The results support further use of this instrument.

Precision medicine in chronic disease management: The multiple sclerosis BioScreen.

PubMed

Gourraud, Pierre-Antoine; Henry, Roland G; Cree, Bruce A C; Crane, Jason C; Lizee, Antoine; Olson, Marram P; Santaniello, Adam V; Datta, Esha; Zhu, Alyssa H; Bevan, Carolyn J; Gelfand, Jeffrey M; Graves, Jennifer S; Goodin, Douglas S; Green, Ari J; von Büdingen, H-Christian; Waubant, Emmanuelle; Zamvil, Scott S; Crabtree-Hartman, Elizabeth; Nelson, Sarah; Baranzini, Sergio E; Hauser, Stephen L

2014-11-01

We present a precision medicine application developed for multiple sclerosis (MS): the MS BioScreen. This new tool addresses the challenges of dynamic management of a complex chronic disease; the interaction of clinicians and patients with such a tool illustrates the extent to which translational digital medicine-that is, the application of information technology to medicine-has the potential to radically transform medical practice. We introduce 3 key evolutionary phases in displaying data to health care providers, patients, and researchers: visualization (accessing data), contextualization (understanding the data), and actionable interpretation (real-time use of the data to assist decision making). Together, these form the stepping stones that are expected to accelerate standardization of data across platforms, promote evidence-based medicine, support shared decision making, and ultimately lead to improved outcomes. © 2014 American Neurological Association.

Personalised Care Plan Management Utilizing Guideline-Driven Clinical Decision Support Systems.

PubMed

Laleci Erturkmen, Gokce Banu; Yuksel, Mustafa; Sarigul, Bunyamin; Lilja, Mikael; Chen, Rong; Arvanitis, Theodoros N

2018-01-01

Older age is associated with an increased accumulation of multiple chronic conditions. The clinical management of patients suffering from multiple chronic conditions is very complex, disconnected and time-consuming with the traditional care settings. Integrated care is a means to address the growing demand for improved patient experience and health outcomes of multimorbid and long-term care patients. Care planning is a prevalent approach of integrated care, where the aim is to deliver more personalized and targeted care creating shared care plans by clearly articulating the role of each provider and patient in the care process. In this paper, we present a method and corresponding implementation of a semi-automatic care plan management tool, integrated with clinical decision support services which can seamlessly access and assess the electronic health records (EHRs) of the patient in comparison with evidence based clinical guidelines to suggest personalized recommendations for goals and interventions to be added to the individualized care plans.

MSAT signalling and network management architectures

NASA Technical Reports Server (NTRS)

Garland, Peter; Keelty, J. Malcolm

1989-01-01

Spar Aerospace has been active in the design and definition of Mobile Satellite Systems since the mid 1970's. In work sponsored by the Canadian Department of Communications, various payload configurations have evolved. In addressing the payload configuration, the requirements of the mobile user, the service provider and the satellite operator have always been the most important consideration. The current Spar 11 beam satellite design is reviewed, and its capabilities to provide flexibility and potential for network growth within the WARC87 allocations are explored. To enable the full capabilities of the payload to be realized, a large amount of ground based Switching and Network Management infrastructure will be required, when space segment becomes available. Early indications were that a single custom designed Demand Assignment Multiple Access (DAMA) switch should be implemented to provide efficient use of the space segment. As MSAT has evolved into a multiple service concept, supporting many service providers, this architecture should be reviewed. Some possible signalling and Network Management solutions are explored.

Li-Fraumeni syndrome: cancer risk assessment and clinical management.

PubMed

McBride, Kate A; Ballinger, Mandy L; Killick, Emma; Kirk, Judy; Tattersall, Martin H N; Eeles, Rosalind A; Thomas, David M; Mitchell, Gillian

2014-05-01

Carriers of germline mutations in the TP53 gene, encoding the cell-cycle regulator and tumour suppressor p53, have a markedly increased risk of cancer-related morbidity and mortality during both childhood and adulthood, and thus require appropriate and effective cancer risk management. However, the predisposition of such patients to multiorgan tumorigenesis presents a specific challenge for cancer risk management programmes. Herein, we review the clinical implications of germline mutations in TP53 and the evidence for cancer screening and prevention strategies in individuals carrying such mutations, as well as examining the potential psychosocial implications of lifelong management for a ubiquitous cancer risk. In addition, we propose an evidence-based framework for the clinical management of TP53 mutation carriers and provide a platform for addressing the management of other cancer predisposition syndromes that can affect multiple organs.

Academic Leadership: Management of Groups or Leadership of Teams? A Multiple-Case Study on Designing and Implementing a Team-Based Development Programme for Academic Leadership

ERIC Educational Resources Information Center

Söderhjelm, Teresa; Björklund, Christina; Sandahl, Christer; Bolander-Laksov, Klara

2018-01-01

Demands on academic leadership are increasing, which raises the need for leadership training. This article describes development and implementation of a group training intervention in academic leadership at a departmental level. Little systematic research has addressed the question of what forms of leadership training are associated with…

A bioeconomic analysis of an emerald ash borer invasion of an urban forest with multiple jurisdictions

Treesearch

Kent F. Kovacs; Robert G. Haight; Rodrigo J. Mercader; Deborah G. McCullough

2014-01-01

Bio-invasions occur in management mosaics where local control affects spread and damage across political boundaries. We address two obstacles to local implementation of optimal regional control of a bio-invasion that damages public and private resources across jurisdictions: lack of local funds to protect the public resource and lack of access to protect the private...

Using structured decision making with landowners to address private forest management and parcelization: balancing multiple objectives and incorporating uncertainty

Treesearch

Paige F. B. Ferguson; Michael J. Conroy; John F. Chamblee; Jeffrey Hepinstall-Cymerman

2015-01-01

Parcelization and forest fragmentation are of concern for ecological, economic, and social reasons. Efforts to keep large, private forests intact may be supported by a decision-making process that incorporates landowners’ objectives and uncertainty. We used structured decision making (SDM) with owners of large, private forests in Macon County, North Carolina....

Self-management priority setting and decision-making in adults with multimorbidity: A narrative review of literature

PubMed Central

Bratzke, Lisa C.; Muehrer, Rebecca J.; Kehl, Karen A.; Lee, Kyoung Suk; Ward, Earlise C.; Kwekkeboom, Kristine L.

2014-01-01

Objectives The purpose of this narrative review was to synthesize current research findings related to self-management, in order to better understand the processes of priority setting and decision-making in among adults with multimorbidity. Design A narrative literature review was undertaken, synthesizing findings from published, peer-reviewed empirical studies that addressed priority setting and/or decision-making in self-management of multimorbidity. Data sources A search of PubMed, PsychINFO, CINAHL and SocIndex databases was conducted from database inception through December 2013. References lists from selected empirical studies and systematic reviews were evaluated to identify any additional relevant articles. Review methods Full text of potentially eligible articles were reviewed and selected for inclusion if they described empirical studies that addressed priority setting or decision-making in self-management of multimorbidity among adults. Two independent reviewers read each selected article and extracted relevant data to an evidence table. Processes and factors and processes of multimorbidity self-management were identified and sorted into categories of priority setting, decision-making, and facilitators/barriers. Results Thirteen articles were selected for inclusion; most were qualitative studies describing processes, facilitators, and barriers of multimorbidity self-management. The findings revealed that patients prioritize a dominant chronic illness and re-prioritize over time as conditions and treatments change; that multiple facilitators (e.g. support programs) and barriers (e.g. lack of financial resources) impact individuals’ self-management priority setting and decision-making ability; as do individual beliefs, preferences, and attitudes (e.g., perceived personal control, preferences regarding treatment). Conclusions Health care providers need to be cognizant that individuals with multimorbidity engage in day-to-day priority setting and decision-making among their multiple chronic illnesses and respective treatments. Researchers need to develop and test interventions that support day-to-day priority setting and decision-making and improve health outcomes for individuals with multimorbidity. PMID:25468131

Self-management priority setting and decision-making in adults with multimorbidity: a narrative review of literature.

PubMed

Bratzke, Lisa C; Muehrer, Rebecca J; Kehl, Karen A; Lee, Kyoung Suk; Ward, Earlise C; Kwekkeboom, Kristine L

2015-03-01

The purpose of this narrative review was to synthesize current research findings related to self-management, in order to better understand the processes of priority setting and decision-making among adults with multimorbidity. A narrative literature review was undertaken, synthesizing findings from published, peer-reviewed empirical studies that addressed priority setting and/or decision-making in self-management of multimorbidity. A search of PubMed, PsychINFO, CINAHL and SocIndex databases was conducted from database inception through December 2013. References lists from selected empirical studies and systematic reviews were evaluated to identify any additional relevant articles. Full text of potentially eligible articles were reviewed and selected for inclusion if they described empirical studies that addressed priority setting or decision-making in self-management of multimorbidity among adults. Two independent reviewers read each selected article and extracted relevant data to an evidence table. Processes and factors of multimorbidity self-management were identified and sorted into categories of priority setting, decision-making, and facilitators/barriers. Thirteen articles were selected for inclusion; most were qualitative studies describing processes, facilitators, and barriers of multimorbidity self-management. The findings revealed that patients prioritize a dominant chronic illness and re-prioritize over time as conditions and treatments change; that multiple facilitators (e.g. support programs) and barriers (e.g. lack of financial resources) impact individuals' self-management priority setting and decision-making ability; as do individual beliefs, preferences, and attitudes (e.g., perceived personal control, preferences regarding treatment). Health care providers need to be cognizant that individuals with multimorbidity engage in day-to-day priority setting and decision-making among their multiple chronic illnesses and respective treatments. Researchers need to develop and test interventions that support day-to-day priority setting and decision-making and improve health outcomes for individuals with multimorbidity. Copyright © 2014 Elsevier Ltd. All rights reserved.

Determinants of compliance with nasal continuous positive airway pressure treatment applied in a community setting.

PubMed

Ball, E M.; Banks, M B.

2001-05-01

Objectives: To assess determinants of nasal continuous positive airway pressure (CPAP) compliance when applied in a community setting.Background: One-third of obstructive sleep apnea patients eventually refuse CPAP therapy. Treatment outcomes may be improved by identifying predictors of CPAP failure, including whether management by primary care physicians without sleep consultation affects results.Methods: Polysomnogram, chart review, and questionnaire results for regular CPAP users (n=123) were compared with those returning the CPAP machine (n=26).Results: Polysomnographic data and the presence of multiple sleep disorders were only modestly predictive of CPAP compliance. Striking differences in questionnaire responses separated CPAP users from non-users, who reported less satisfaction with all phases of their diagnosis and management. Rates of CPAP use were not significantly different between patients managed solely by their primary care physician or by a sleep consultant.Conclusions: Polysomnographic findings are unlikely to identify eventual CPAP non-compliers in a cost-effective fashion. Improvements in sleep apnea management may result from addressing the role of personality factors and multiple sleep disorders in determining compliance. In this practice setting, management by primary care physicians did not significantly degrade CPAP compliance.

Retaining nurses in metropolitan areas: insights from senior nurse and human resource managers.

PubMed

Drennan, Vari M; Halter, Mary; Gale, Julia; Harris, Ruth

2016-11-01

To investigate the views of senior nurse and human resource managers of strategies to retain hospital nurses in a metropolitan area. Against a global shortage, retaining nurses is a management imperative for the quality of hospital services. Semi-structured interviews, thematically analysed. Metropolitan areas have many health organisations in geographical proximity, offering nurses choices in employer and employment. Senior nurse and human resource managers recognised the complexity of factors influencing nurse turnover, including those that 'pulled' nurses out of their jobs to other posts and factors that 'pushed' nurses to leave. Four themes emerged in retaining nurses: strategy and leadership, including analysis of workforce and leavers' data, remuneration, the type of nursing work and career development and the immediate work environment. In contexts where multiple organisations compete for nurses, addressing retention through strategic leadership is likely to be important in paying due attention and apportioning resources to effective strategies. Aside from good human resource management practices for all, strategies tailored to different segments of the nursing workforce are likely to be important. This metropolitan study suggests attention should be paid to strategies that address remuneration, progressing nursing careers and the immediate work environment. © 2016 The Authors Journal of Nursing Management Published by John Wiley & Sons Ltd.

System Oriented Runway Management: A Research Update

NASA Technical Reports Server (NTRS)

Lohr, Gary W.; Brown, Sherilyn A.; Stough, Harry P., III; Eisenhawer, Steve; Atkins, Stephen; Long, Dou

2011-01-01

The runway configuration used by an airport has significant implications with respect to its capacity and ability to effectively manage surface and airborne traffic. Aircraft operators rely on runway configuration information because it can significantly affect an airline's operations and planning of their resources. Current practices in runway management are limited by a relatively short time horizon for reliable weather information and little assistance from automation. Wind velocity is the primary consideration when selecting a runway configuration; however when winds are below a defined threshold, discretion may be used to determine the configuration. Other considerations relevant to runway configuration selection include airport operator constraints, weather conditions (other than winds) traffic demand, user preferences, surface congestion, and navigational system outages. The future offers an increasingly complex landscape for the runway management process. Concepts and technologies that hold the potential for capacity and efficiency increases for both operations on the airport surface and in terminal and enroute airspace are currently under investigation. Complementary advances in runway management are required if capacity and efficiency increases in those areas are to be realized. The System Oriented Runway Management (SORM) concept has been developed to address this critical part of the traffic flow process. The SORM concept was developed to address all aspects of runway management for airports of varying sizes and to accommodate a myriad of traffic mixes. SORM, to date, addresses the single airport environment; however, the longer term vision is to incorporate capabilities for multiple airport (Metroplex) operations as well as to accommodate advances in capabilities resulting from ongoing research. This paper provides an update of research supporting the SORM concept including the following: a concept of overview, results of a TRCM simulation, single airport and Metroplex modeling effort and a benefits assessment.

Leaf LIMS: A Flexible Laboratory Information Management System with a Synthetic Biology Focus.

PubMed

Craig, Thomas; Holland, Richard; D'Amore, Rosalinda; Johnson, James R; McCue, Hannah V; West, Anthony; Zulkower, Valentin; Tekotte, Hille; Cai, Yizhi; Swan, Daniel; Davey, Robert P; Hertz-Fowler, Christiane; Hall, Anthony; Caddick, Mark

2017-12-15

This paper presents Leaf LIMS, a flexible laboratory information management system (LIMS) designed to address the complexity of synthetic biology workflows. At the project's inception there was a lack of a LIMS designed specifically to address synthetic biology processes, with most systems focused on either next generation sequencing or biobanks and clinical sample handling. Leaf LIMS implements integrated project, item, and laboratory stock tracking, offering complete sample and construct genealogy, materials and lot tracking, and modular assay data capture. Hence, it enables highly configurable task-based workflows and supports data capture from project inception to completion. As such, in addition to it supporting synthetic biology it is ideal for many laboratory environments with multiple projects and users. The system is deployed as a web application through Docker and is provided under a permissive MIT license. It is freely available for download at https://leaflims.github.io .

Moving Toward Space Internetworking via DTN: Its Operational Challenges, Benefits, and Management

NASA Technical Reports Server (NTRS)

Barkley, Erik; Burleigh, Scott; Gladden, Roy; Malhotra, Shan; Shames, Peter

2010-01-01

The international space community has begun to recognize that the established model for management of communications with spacecraft - commanded data transmission over individual pair-wise contacts - is operationally unwieldy and will not scale in support of increasingly complex and sophisticated missions such as NASA's Constellation project. Accordingly, the international Inter-Agency Operations Advisory Group (IOAG) ichartered a Space Internetworking Strategy Group (SISG), which released its initial recommendations in a November 2008 report. The report includes a recommendation that the space flight community adopt Delay-Tolerant Networking (DTN) to address the problem of interoperability and communication scaling, especially in mission environments where there are multiple spacecraft operating in concert. This paper explores some of the issues that must be addressed in implementing, deploying, and operating DTN as part of a multi-mission, multi-agency space internetwork as well as benefits and future operational scenarios afforded by DTN-based space internetworking.

How can we exploit above–belowground interactions to assist in addressing the challenges of food security?

PubMed Central

Orrell, Peter; Bennett, Alison E.

2013-01-01

Can above–belowground interactions help address issues of food security? We address this question in this manuscript, and review the intersection of above–belowground interactions and food security. We propose that above–belowground interactions could address two strategies identified by Godfray etal. (2010): reducing the Yield Gap, and Increasing Production Limits. In particular, to minimize the difference between potential and realized production (The Yield Gap) above–belowground interactions could be manipulated to reduce losses to pests and increase crop growth (and therefore yields). To Increase Production Limits we propose two mechanisms: utilizing intercropping (which uses multiple aspects of above–belowground interactions) and breeding for traits that promote beneficial above–belowground interactions, as well as breeding mutualistic organisms to improve their provided benefit. As a result, if they are managed correctly, there is great potential for above–belowground interactions to contribute to food security. PMID:24198821

Clostridium difficile in the Long-Term Care Facility: Prevention and Management

PubMed Central

Jump, Robin L. P.; Donskey, Curtis J.

2014-01-01

Residents of long-term care facilities are at high risk for Clostridium difficile infection due to frequent antibiotic exposure in a population already rendered vulnerable to infection due to advanced age, multiple comorbid conditions and communal living conditions. Moreover, asymptomatic carriage of toxigenic C. difficile and recurrent infections are prevalent in this population. Here, we discuss epidemiology and management of C. difficile infection among residents of long-term care facilities. Also, recognizing that both the population and culture differs significantly from that of hospitals, we also address prevention strategies specific to LTCFs. PMID:25685657

Center for Plasma Edge Simulation (CPES) -- Rutgers University Final Report

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

Parashar, Manish

2014-03-06

The CPES scientific simulations run at scale on leadership class machines, collaborate at runtime and produce and exchange large data sizes, which present multiple I/O and data management challenges. During the CPES project, the Rutgers team worked with the rest of the CPES team to address these challenges at different levels, and specifically (1) at the data transport and communication level through the DART (Decoupled and Asynchronous Remote Data Transfers) framework, and (2) at the data management and services level through the DataSpaces and ActiveSpaces frameworks. These frameworks and their impact are briefly described.

Unanswered clinical questions in the management of cardiometabolic risk in the elderly: a statement of the Spanish Society of Internal Medicine.

PubMed

Gómez-Huelgas, Ricardo; Giner-Galvañ, Vicente; Mostaza, José M; Cuende, José I; de Miguel-Yanes, Jose M; Rovira, Eduardo; Sánchez-Fuentes, Demetrio; Suárez Fernández, Carmen; Román Sánchez, Pilar

2014-12-18

Despite the progressive increase in life expectancy and the relationship between aging with multi-morbidities and the increased use of healthcare resources, current clinical practice guidelines (CPG) on cardiometabolic risk cannot be adequately applied to elderly subjects with multiple chronic conditions. Its management frequently becomes complicated by both, an excessive use of medications that may lead to overtreatment, drug interactions and increased toxicity, and errors in dosage and non-compliance. Concerned by this gap, the Spanish Society of Internal Medicine created a group of independent experts on cardiometabolic risk who discussed what they considered to be unanswered questions in the management of elderly patients. Current guidelines do not specifically address the problem of elderly with multiple chronic conditions. For this reason, the combined use of the limited available evidence, clinical experience and common sense, could all help us to address this unmet need. In very old people, life expectancy and functionality are the most important factors for guiding potential treatments. Their higher propensity to develop serious adverse events and their shorter lifespan could prevent them from obtaining the potential benefits of the interventions administered. In this document, experts on cardiometabolic risk factors have established a number of consensual recommendations that have taken into account international guidelines and clinical experience, and have also considered the more effective use of healthcare resources. This document is intended to provide general recommendations for clinicians and to promote the effective use of procedures and medications.

An Assessment of Institutional Capacity for Integrated Landscape Management in Eastern Cameroon.

PubMed

Brown, H Carolyn Peach

2018-07-01

Landscape approaches have become prominent in efforts to address issues of conservation and development through bringing together different actors and sectors, to reconcile diverse land uses, and promote synergies. Some have suggested that integrated landscape management approaches are consistent with the goals of REDD+ and offer a strategy to address multiple goals of climate change mitigation, biodiversity conservation, maintenance of ecosystem services, and socio-economic development. Institutional or governance arrangements have been shown to be a critical component in influencing outcomes in landscapes. Using diverse methodologies, this study investigated the capacity of institutions to support the planning, implementation, and resource mobilization needed to integrate climate change mitigation, conservation, and livelihood goals in a forest mosaic landscape in East Cameroon. Results showed that diverse institutions are present in the landscape, including institutions of relevant government agencies, local government, local non-government, the private sector, and hybrid institutions of conservation, development and research institutions. However, the overall institutional capacity for integrated landscape planning and management in the study area is limited, although some institutions exhibit increased capacity in some areas over others. Multiple strategies can be employed to build the necessary human, financial, and leadership capacity, and facilitate the institutional planning and coordination that is foundational to multi-stakeholder landscape governance. Given the complexity of integrating climate change mitigation, conservation and livelihood goals in a landscape, building such institutional capacity is a long term endeavour that requires sustained effort and ongoing financial, technical and human resource support.

Air Traffic Management Technology Demonstration-1 Concept of Operations (ATD-1 ConOps), Version 2.0

NASA Technical Reports Server (NTRS)

Baxley, Brian T.; Johnson, William C.; Swenson, Harry N.; Robinson, John E.; Prevot, Tom; Callantine, Todd J.; Scardina, John; Greene, Michael

2013-01-01

This document is an update to the operations and procedures envisioned for NASA s Air Traffic Management (ATM) Technology Demonstration #1 (ATD-1). The ATD-1 Concept of Operations (ConOps) integrates three NASA technologies to achieve high throughput, fuel-efficient arrival operations into busy terminal airspace. They are Traffic Management Advisor with Terminal Metering (TMA-TM) for precise time-based schedules to the runway and points within the terminal area, Controller-Managed Spacing (CMS) decision support tools for terminal controllers to better manage aircraft delay using speed control, and Flight deck Interval Management (FIM) avionics and flight crew procedures to conduct airborne spacing operations. The ATD-1 concept provides de-conflicted and efficient operations of multiple arrival streams of aircraft, passing through multiple merge points, from top-of-descent (TOD) to the Final Approach Fix. These arrival streams are Optimized Profile Descents (OPDs) from en route altitude to the runway, using primarily speed control to maintain separation and schedule. The ATD-1 project is currently addressing the challenges of integrating the three technologies, and their implantation into an operational environment. The ATD-1 goals include increasing the throughput of high-density airports, reducing controller workload, increasing efficiency of arrival operations and the frequency of trajectory-based operations, and promoting aircraft ADS-B equipage.

Evaluating integrated watershed management using multiple criteria analysis--a case study at Chittagong Hill Tracts in Bangladesh.

PubMed

Biswas, Shampa; Vacik, Harald; Swanson, Mark E; Haque, S M Sirajul

2012-05-01

Criteria and indicators assessment is one of the ways to evaluate management strategies for mountain watersheds. One framework for this, Integrated Watershed Management (IWM), was employed at Chittagong Hill Tracts region of Bangladesh using a multi-criteria analysis approach. The IWM framework, consisting of the design and application of principles, criteria, indicators, and verifiers (PCIV), facilitates active participation by diverse professionals, experts, and interest groups in watershed management, to explicitly address the demands and problems to measure the complexity of problems in a transparent and understandable way. Management alternatives are developed to fulfill every key component of IWM considering the developed PCIV set and current situation of the study area. Different management strategies, each focusing on a different approach (biodiversity conservation, flood control, soil and water quality conservation, indigenous knowledge conservation, income generation, watershed conservation, and landscape conservation) were assessed qualitatively on their potential to improve the current situation according to each verifier of the criteria and indicator set. Analytic Hierarchy Process (AHP), including sensitivity analysis, was employed to identify an appropriate management strategy according to overall priorities (i.e., different weights of each principle) of key informants. The AHP process indicated that a strategy focused on conservation of biodiversity provided the best option to address watershed-related challenges in the Chittagong Hill Tracts, Bangladesh.

Extensible Interest Management for Scalable Persistent Distributed Virtual Environments

DTIC Science & Technology

1999-12-01

Calvin, Cebula et al. 1995; Morse, Bic et al. 2000) uses a two grid, with each grid cell having two multicast addresses. An entity expresses interest...Entity distribution for experimental runs 78 s I * • ...... ^..... * * a» Sis*«*»* 1 ***** Jj |r...Multiple Users and Shared Applications with VRML. VRML 97, Monterey, CA. pp. 33-40. Calvin, J. O., D. P. Cebula , et al. (1995). Data Subscription in

The need and approach for characterization - U.S. air force perspectives on materials state awareness

NASA Astrophysics Data System (ADS)

Aldrin, John C.; Lindgren, Eric A.

2018-04-01

This paper expands on the objective and motivation for NDE-based characterization and includes a discussion of the current approach using model-assisted inversion being pursued within the Air Force Research Laboratory (AFRL). This includes a discussion of the multiple model-based methods that can be used, including physics-based models, deep machine learning, and heuristic approaches. The benefits and drawbacks of each method is reviewed and the potential to integrate multiple methods is discussed. Initial successes are included to highlight the ability to obtain quantitative values of damage. Additional steps remaining to realize this capability with statistical metrics of accuracy are discussed, and how these results can be used to enable probabilistic life management are addressed. The outcome of this initiative will realize the long-term desired capability of NDE methods to provide quantitative characterization to accelerate certification of new materials and enhance life management of engineered systems.

Current evaluation and management of spondylolysis and spondylolisthesis.

PubMed

McTimoney, C A Michelle; Micheli, Lyle J

2003-02-01

Spondylolysis occurs with a prevalence of 4% to 6% in the general population. Although the etiology of this lesion is still unclear, it has been shown to have both hereditary and acquired risk factors, with an increased prevalence in men and athletes participating in certain high-risk sports. Spondylolisthesis occurs in a significant proportion of individuals with bilateral spondylolysis. Predicting risk factors for progression of the slip in spondylolisthesis has proven difficult. Multiple imaging techniques are helpful in the diagnosis of spondylolysis and spondylolisthesis, with recent research addressing the utility of magnetic resonance imaging in the diagnosis and management of pars lesions. The management guidelines have remained largely unchanged since early recommendations. Recently, the addition of a bone growth stimulator to the management of difficult cases has shown promise.

Urban ecosystem services for resilience planning and management in New York City.

PubMed

McPhearson, Timon; Hamstead, Zoé A; Kremer, Peleg

2014-05-01

We review the current state of knowledge about urban ecosystem services in New York City (NYC) and how these services are regulated, planned for, and managed. Focusing on ecosystem services that have presented challenges in NYC-including stormwater quality enhancement and flood control, drinking water quality, food provisioning and recreation-we find that mismatches between the scale of production and scale of management occur where service provision is insufficient. Adequate production of locally produced services and services which are more accessible when produced locally is challenging in the context of dense urban development that is characteristic of NYC. Management approaches are needed to address scale mismatches in the production and consumption of ecosystem services. By coordinating along multiple scales of management and promoting best management practices, urban leaders have an opportunity to ensure that nature and ecosystem processes are protected in cities to support the delivery of fundamental urban ecosystem services.

Managing aquatic ecosystems and water resources under multiple stress--an introduction to the MARS project.

PubMed

Hering, Daniel; Carvalho, Laurence; Argillier, Christine; Beklioglu, Meryem; Borja, Angel; Cardoso, Ana Cristina; Duel, Harm; Ferreira, Teresa; Globevnik, Lidija; Hanganu, Jenica; Hellsten, Seppo; Jeppesen, Erik; Kodeš, Vit; Solheim, Anne Lyche; Nõges, Tiina; Ormerod, Steve; Panagopoulos, Yiannis; Schmutz, Stefan; Venohr, Markus; Birk, Sebastian

2015-01-15

Water resources globally are affected by a complex mixture of stressors resulting from a range of drivers, including urban and agricultural land use, hydropower generation and climate change. Understanding how stressors interfere and impact upon ecological status and ecosystem services is essential for developing effective River Basin Management Plans and shaping future environmental policy. This paper details the nature of these problems for Europe's water resources and the need to find solutions at a range of spatial scales. In terms of the latter, we describe the aims and approaches of the EU-funded project MARS (Managing Aquatic ecosystems and water Resources under multiple Stress) and the conceptual and analytical framework that it is adopting to provide this knowledge, understanding and tools needed to address multiple stressors. MARS is operating at three scales: At the water body scale, the mechanistic understanding of stressor interactions and their impact upon water resources, ecological status and ecosystem services will be examined through multi-factorial experiments and the analysis of long time-series. At the river basin scale, modelling and empirical approaches will be adopted to characterise relationships between multiple stressors and ecological responses, functions, services and water resources. The effects of future land use and mitigation scenarios in 16 European river basins will be assessed. At the European scale, large-scale spatial analysis will be carried out to identify the relationships amongst stress intensity, ecological status and service provision, with a special focus on large transboundary rivers, lakes and fish. The project will support managers and policy makers in the practical implementation of the Water Framework Directive (WFD), of related legislation and of the Blueprint to Safeguard Europe's Water Resources by advising the 3rd River Basin Management Planning cycle, the revision of the WFD and by developing new tools for diagnosing and predicting multiple stressors. Copyright © 2014. Published by Elsevier B.V.

The Saskatchewan River Basin - a large scale observatory for water security research (Invited)

NASA Astrophysics Data System (ADS)

Wheater, H. S.

2013-12-01

The 336,000 km2 Saskatchewan River Basin (SaskRB) in Western Canada illustrates many of the issues of Water Security faced world-wide. It poses globally-important science challenges due to the diversity in its hydro-climate and ecological zones. With one of the world's more extreme climates, it embodies environments of global significance, including the Rocky Mountains (source of the major rivers in Western Canada), the Boreal Forest (representing 30% of Canada's land area) and the Prairies (home to 80% of Canada's agriculture). Management concerns include: provision of water resources to more than three million inhabitants, including indigenous communities; balancing competing needs for water between different uses, such as urban centres, industry, agriculture, hydropower and environmental flows; issues of water allocation between upstream and downstream users in the three prairie provinces; managing the risks of flood and droughts; and assessing water quality impacts of discharges from major cities and intensive agricultural production. Superimposed on these issues is the need to understand and manage uncertain water futures, including effects of economic growth and environmental change, in a highly fragmented water governance environment. Key science questions focus on understanding and predicting the effects of land and water management and environmental change on water quantity and quality. To address the science challenges, observational data are necessary across multiple scales. This requires focussed research at intensively monitored sites and small watersheds to improve process understanding and fine-scale models. To understand large-scale effects on river flows and quality, land-atmosphere feedbacks, and regional climate, integrated monitoring, modelling and analysis is needed at large basin scale. And to support water management, new tools are needed for operational management and scenario-based planning that can be implemented across multiple scales and multiple jurisdictions. The SaskRB has therefore been developed as a large scale observatory, now a Regional Hydroclimate Project of the World Climate Research Programme's GEWEX project, and is available to contribute to the emerging North American Water Program. State-of-the-art hydro-ecological experimental sites have been developed for the key biomes, and a river and lake biogeochemical research facility, focussed on impacts of nutrients and exotic chemicals. Data are integrated at SaskRB scale to support the development of improved large scale climate and hydrological modelling products, the development of DSS systems for local, provincial and basin-scale management, and the development of related social science research, engaging stakeholders in the research and exploring their values and priorities for water security. The observatory provides multiple scales of observation and modelling required to develop: a) new climate, hydrological and ecological science and modelling tools to address environmental change in key environments, and their integrated effects and feedbacks at large catchment scale, b) new tools needed to support river basin management under uncertainty, including anthropogenic controls on land and water management and c) the place-based focus for the development of new transdisciplinary science.

LANDSCAPE MANAGEMENT FOR SUSTAINABLE SUPPLIES OF BIOENERGY FEEDSTOCK AND ENHANCED SOIL QUALITY

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

Douglas L. Karlen; David J. Muth, Jr.

2012-09-01

Agriculture can simultaneously address global food, feed, fiber, and energy challenges provided our soil, water, and air resources are not compromised in doing so. As we embark on the 19th Triennial Conference of the International Soil and Tillage Research Organization (ISTRO), I am pleased to proclaim that our members are well poised to lead these endeavors because of our comprehensive understanding of soil, water, agricultural and bio-systems engineering processes. The concept of landscape management, as an approach for integrating multiple bioenergy feedstock sources, including biomass residuals, into current crop production systems, is used as the focal point to show howmore » these ever-increasing global challenges can be met in a sustainable manner. Starting with the 2005 Billion Ton Study (BTS) goals, research and technology transfer activities leading to the 2011 U.S. Department of Energy (DOE) Revised Billion Ton Study (BT2) and development of a residue management tool to guide sustainable crop residue harvest will be reviewed. Multi-location USDA-Agricultural Research Service (ARS) Renewable Energy Assessment Project (REAP) team research and on-going partnerships between public and private sector groups will be shared to show the development of landscape management strategies that can simultaneously address the multiple factors that must be balanced to meet the global challenges. Effective landscape management strategies recognize the importance of nature’s diversity and strive to emulate those conditions to sustain multiple critical ecosystem services. To illustrate those services, the soil quality impact of harvesting crop residues are presented to show how careful, comprehensive monitoring of soil, water and air resources must be an integral part of sustainable bioenergy feedstock production systems. Preliminary analyses suggest that to sustain soil resources within the U.S. Corn Belt, corn (Zea mays L.) stover should not be harvested if average grain yields are less than 11 Mg ha-1 (175 bu ac-1) unless more intensive landscape management practices are implemented. Furthermore, although non-irrigated corn grain yields east and west of the primary Corn Belt may not consistently achieve the 11 Mg ha-1 yield levels, corn can still be part of an overall landscape approach for sustainable feedstock production. Another option for producers with consistently high yields (> 12.6 Mg ha-1 or 200 bu ac-1) that may enable them to sustainably harvest even more stover is to decrease their tillage intensity which will reduce fuel use, preserve rhizosphere carbon, and/or help maintain soil structure and soil quality benefits often attributed to no-till production systems. In conclusion, I challenge all ISTRO scientists to critically ask if your research is contributing to improved soil and crop management strategies that effectively address the complexity associated with sustainable food, feed, fiber and fuel production throughout the world.« less

Addressing the Hard Factors for Command File Errors by Probabilistic Reasoning

NASA Technical Reports Server (NTRS)

Meshkat, Leila; Bryant, Larry

2014-01-01

Command File Errors (CFE) are managed using standard risk management approaches at the Jet Propulsion Laboratory. Over the last few years, more emphasis has been made on the collection, organization, and analysis of these errors for the purpose of reducing the CFE rates. More recently, probabilistic modeling techniques have been used for more in depth analysis of the perceived error rates of the DAWN mission and for managing the soft factors in the upcoming phases of the mission. We broadly classify the factors that can lead to CFE's as soft factors, which relate to the cognition of the operators and hard factors which relate to the Mission System which is composed of the hardware, software and procedures used for the generation, verification & validation and execution of commands. The focus of this paper is to use probabilistic models that represent multiple missions at JPL to determine the root cause and sensitivities of the various components of the mission system and develop recommendations and techniques for addressing them. The customization of these multi-mission models to a sample interplanetary spacecraft is done for this purpose.

Lifestyle medicine: the future of chronic disease management.

PubMed

Kushner, Robert F; Sorensen, Kirsten Webb

2013-10-01

Lifestyle medicine is a new discipline that has recently emerged as a systematized approach for management of chronic disease. The practice of lifestyle medicine requires skills and competency in addressing multiple health risk behaviours and improving self-management. Targets include diet, physical activity, behaviour change, body weight control, treatment plan adherence, stress and coping, spirituality, mind body techniques, tobacco and substance abuse. This review focuses on the impact of a healthy lifestyle on chronic disease, the rarity of good health and the challenges of implementing a lifestyle medicine programme. Unhealthy lifestyle behaviours are at the root of the global burden of noncommunicable diseases and account for about 63% of all deaths. Over the past several years, there has been an increased interest in evaluating the benefit of adhering to 'low-risk lifestyle' behaviours and ideal 'cardiovascular health metrics'. Although a healthy lifestyle has repeatedly been shown to improve mortality, the population prevalence of healthy living remains low. Lifestyle medicine presents a new and challenging approach to address the prevention and treatment of noncommunicable diseases, the most important and prevalent causes for increased morbidity and mortality worldwide.

Application of Remote Sensing for Forest Management in Nepal

NASA Astrophysics Data System (ADS)

Bajracharya, B.; Matin, M. A.

2016-12-01

Large area of the Hindu Kush Himalayan (HKH) region is covered by forest that is playing a vital role to address the challenges of climate change and livelihood options for a growing population. Effective management of forest cover needs establishment of regular monitoring system for forest. Supporting REDD assessment needs reliable baseline assessment of forest biomass and its monitoring at multiple scale. Adaptation of forest to climate change needs understanding vulnerability of forests and dependence of local communities on these forest. We present here different forest monitoring products developed under the SERVIR-Himalaya programme to address these issues. Landsat 30 meter images were used for decadal land cover change assessment and annual forest change hotspot monitoring. Methodology developed for biomass estimation at national and sub-national level biomass estimation. Decision support system was developed for analysis of forest vulnerability and dependence and selection of adaptation options based on resource availability. These products are forming the basis for development of an integrated system that will be very useful for comprehensive forest monitoring and long term strategy development for sustainable forest management.

Do current European policies support soil multifunctionality?

NASA Astrophysics Data System (ADS)

Helming, Katharina; Glaesner, Nadia; de Vries, Wim

2017-04-01

Soils are multifunctional. Maximising one function, e.g. production of biomass, is often at the costs of the other functions, e.g. water purification, carbon sequestration, nutrient recycling, habitat provision. Sustainable soil management actually means the minimization of trade-offs between multiple soil functions. While Europe does not have a policy that explicitly focuses on soil functions, a number of policies exist in the agricultural, environmental and climate domains that may affect soil functions, in particular food production, water purification, climate change mitigation, biodiversity conservation. The objective of this study was to identify gaps and overlaps in existing EU legislation that is related to soil functions. We conducted a cross-policy analysis of 19 legislative policies at European level. Results revealed two key findings: (i) soil functions are addressed in existing legislation but with the approach to their conservation rather than their improvement. (ii) Different legislations addressed isolated soil functions but there is no policy in place that actually addressed the soil multifunctionality, which is the integrated balancing of the multitude of functions. Because soil degradation is ongoing in Europe, it raises the question whether existing legislation is sufficient for maintaining soil resources and achieving sustainable soil management. Addressing soil functions individually in various directives fails to account for the multifunctionality of soil. Here, research has a role to play to better reveal the interacting processes between soil functions and their sensitivity to soil management decisions and to translate such understanding into policy recommendation. We conclude the presentation with some insights into a research approach that integrates the soil systems into the socio-economic systems to improve the understanding of soil management pressures, soil functional reactions and their impacts on societal value systems, including resource efficiency, ecosystem services and intergenerational equity.

Securely and Flexibly Sharing a Biomedical Data Management System

PubMed Central

Wang, Fusheng; Hussels, Phillip; Liu, Peiya

2011-01-01

Biomedical database systems need not only to address the issues of managing complex data, but also to provide data security and access control to the system. These include not only system level security, but also instance level access control such as access of documents, schemas, or aggregation of information. The latter is becoming more important as multiple users can share a single scientific data management system to conduct their research, while data have to be protected before they are published or IP-protected. This problem is challenging as users’ needs for data security vary dramatically from one application to another, in terms of who to share with, what resources to be shared, and at what access level. We develop a comprehensive data access framework for a biomedical data management system SciPort. SciPort provides fine-grained multi-level space based access control of resources at not only object level (documents and schemas), but also space level (resources set aggregated in a hierarchy way). Furthermore, to simplify the management of users and privileges, customizable role-based user model is developed. The access control is implemented efficiently by integrating access privileges into the backend XML database, thus efficient queries are supported. The secure access approach we take makes it possible for multiple users to share the same biomedical data management system with flexible access management and high data security. PMID:21625285

NeXOS, developing and evaluating a new generation of insitu ocean observation systems.

NASA Astrophysics Data System (ADS)

Delory, Eric; del Rio, Joaquin; Golmen, Lars; Roar Hareide, Nils; Pearlman, Jay; Rolin, Jean-Francois; Waldmann, Christoph; Zielinski, Oliver

2017-04-01

Ocean biological, chemical or physical processes occur over widely varying scales in space and time: from micro- to kilometer scales, from less than seconds to centuries. While space systems supply important data and information, insitu data is necessary for comprehensive modeling and forecasting of ocean dynamics. Yet, collection of in-situ observation on these scales is inherently challenging and remains generally difficult and costly in time and resources. This paper address the innovations and significant developments for a new generation of insitu sensors in FP7 European Union project "Next generation, Cost- effective, Compact, Multifunctional Web Enabled Ocean Sensor Systems Empowering Marine, Maritime and Fisheries Management" or "NeXOS" for short. Optical and acoustics sensors are the focus of NeXOS but NeXOS moves beyond just sensors as systems that simultaneously address multiple objectives and applications are becoming increasingly important. Thus NeXOS takes a perspective of both sensors and sensor systems with significant advantages over existing observing capabilities via the implementation of innovations such as multiplatform integration, greater reliability through better antifouling management and greater sensor and data interoperability through use of OGC standards. This presentation will address the sensor system development and field-testing of the new NeXOS sensor systems. This is being done on multiple platforms including profiling floats, gliders, ships, buoys and subsea stations. The implementation of a data system based on SWE and PUCK furthers interoperability across measurements and platforms. This presentation will review the sensor system capabilities, the status of field tests and recommendations for long-term ocean monitoring.

Integrating multiple disturbance aspects: management of an invasive thistle, Carduus nutans.

PubMed

Zhang, Rui; Shea, Katriona

2012-11-01

Disturbances occur in most ecological systems, and play an important role in biological invasions. We delimit five key disturbance aspects: intensity, frequency, timing, duration and extent. Few studies address more than one of these aspects, yet interactions and interdependence between aspects may lead to complex outcomes. In a two-cohort experimental study, we examined how multiple aspects (intensity, frequency and timing) of a mowing disturbance regime affect the survival, phenology, growth and reproduction of an invasive thistle Carduus nutans (musk thistle). Our results show that high intensity and late timing strongly delay flowering phenology and reduce plant survival, capitulum production and plant height. A significant interaction between intensity and timing further magnifies the main effects. Unexpectedly, high frequency alone did not effectively reduce reproduction. However, a study examining only frequency and intensity, and not timing, would have erroneously attributed the importance of timing to frequency. We used management of an invasive species as an example to demonstrate the importance of a multiple-aspect disturbance framework. Failure to consider possible interactions, and the inherent interdependence of certain aspects, could result in misinterpretation and inappropriate management efforts. This framework can be broadly applied to improve our understanding of disturbance effects on individual responses, population dynamics and community composition.

Review of the novelties from the 32nd ECTRIMS Congress, 2016, presented at the 9th Post-ECTRIMS Meeting (I).

PubMed

Fernandez, O; Oterino, A; Oreja-Guevara, C; Prieto, J M; Mendibe-Bilbao, M M; Garcia-Merino, J A; Ramio-Torrenta, Ll; Ginestal, R; Meca-Lallana, J E; Romero-Pinel, L; Munoz, D; Oliva-Nacarino, P; Calles-Hernandez, M C; Izquierdo, G; Martinez-Gines, M L; Saiz, A; Comabella, M; Casanova-Estruch, B; Brieva, Ll; Arroyo, R; Rodriguez-Antiguedad, A

2017-07-01

For the ninth year in a row the Post-ECTRIMS Meeting has been held in Madrid (Spain) with the aim of presenting and discussing the hottest issues debated at the ECTRIMS Congress by renowned specialists in multiple sclerosis in our country. One outcome of this scientific activity, endorsed by the Spanish Neurology Society, is this review article, which is published in two parts. This first part addresses family planning, pregnancy management and the role of breastfeeding in women with multiple sclerosis. Attention is drawn to the paediatric population, to magnetic resonance imaging features and to the genetic-environmental risk factors for developing the disease in children, without neglecting the risk factors for development in adults. The review updates the epidemiology of cognitive deterioration in patients with multiple sclerosis, the advantages and disadvantages of available assessment tools, and current management approaches, while also insisting on the importance of cognitive involvement during the course of the disease. Furthermore, the concept of individualised, precision medicine is introduced, from the diagnosis of the disease until its treatment, with the controversies that inevitably arise in patient management, above all with regard to the change of treatment and the handling of associated risks.

Challenges and Experiences of Building Multidisciplinary Datasets across Cultures

NASA Astrophysics Data System (ADS)

Jamiyansharav, K.; Laituri, M.; Fernandez-Gimenez, M.; Fassnacht, S. R.; Venable, N. B. H.; Allegretti, A. M.; Reid, R.; Baival, B.; Jamsranjav, C.; Ulambayar, T.; Linn, S.; Angerer, J.

2017-12-01

Efficient data sharing and management are key challenges to multidisciplinary scientific research. These challenges are further complicated by adding a multicultural component. We address the construction of a complex database for social-ecological analysis in Mongolia. Funded by the National Science Foundation (NSF) Dynamics of Coupled Natural and Human (CNH) Systems, the Mongolian Rangelands and Resilience (MOR2) project focuses on the vulnerability of Mongolian pastoral systems to climate change and adaptive capacity. The MOR2 study spans over three years of fieldwork in 36 paired districts (Soum) from 18 provinces (Aimag) of Mongolia that covers steppe, mountain forest steppe, desert steppe and eastern steppe ecological zones. Our project team is composed of hydrologists, social scientists, geographers, and ecologists. The MOR2 database includes multiple ecological, social, meteorological, geospatial and hydrological datasets, as well as archives of original data and survey in multiple formats. Managing this complex database requires significant organizational skills, attention to detail and ability to communicate within collective team members from diverse disciplines and across multiple institutions in the US and Mongolia. We describe the database's rich content, organization, structure and complexity. We discuss lessons learned, best practices and recommendations for complex database management, sharing, and archiving in creating a cross-cultural and multi-disciplinary database.

Big data and high-performance analytics in structural health monitoring for bridge management

NASA Astrophysics Data System (ADS)

Alampalli, Sharada; Alampalli, Sandeep; Ettouney, Mohammed

2016-04-01

Structural Health Monitoring (SHM) can be a vital tool for effective bridge management. Combining large data sets from multiple sources to create a data-driven decision-making framework is crucial for the success of SHM. This paper presents a big data analytics framework that combines multiple data sets correlated with functional relatedness to convert data into actionable information that empowers risk-based decision-making. The integrated data environment incorporates near real-time streams of semi-structured data from remote sensors, historical visual inspection data, and observations from structural analysis models to monitor, assess, and manage risks associated with the aging bridge inventories. Accelerated processing of dataset is made possible by four technologies: cloud computing, relational database processing, support from NOSQL database, and in-memory analytics. The framework is being validated on a railroad corridor that can be subjected to multiple hazards. The framework enables to compute reliability indices for critical bridge components and individual bridge spans. In addition, framework includes a risk-based decision-making process that enumerate costs and consequences of poor bridge performance at span- and network-levels when rail networks are exposed to natural hazard events such as floods and earthquakes. Big data and high-performance analytics enable insights to assist bridge owners to address problems faster.

Evolution of shuttle avionics redundancy management/fault tolerance

NASA Technical Reports Server (NTRS)

Boykin, J. C.; Thibodeau, J. R.; Schneider, H. E.

1985-01-01

The challenge of providing redundancy management (RM) and fault tolerance to meet the Shuttle Program requirements of fail operational/fail safe for the avionics systems was complicated by the critical program constraints of weight, cost, and schedule. The basic and sometimes false effectivity of less than pure RM designs is addressed. Evolution of the multiple input selection filter (the heart of the RM function) is discussed with emphasis on the subtle interactions of the flight control system that were found to be potentially catastrophic. Several other general RM development problems are discussed, with particular emphasis on the inertial measurement unit RM, indicative of the complexity of managing that three string system and its critical interfaces with the guidance and control systems.

Enhanced project management tool

NASA Technical Reports Server (NTRS)

Hsu, Chen-Jung (Inventor); Patel, Hemil N. (Inventor); Maluf, David A. (Inventor); Moh Hashim, Jairon C. (Inventor); Tran, Khai Peter B. (Inventor)

2012-01-01

A system for managing a project that includes multiple tasks and a plurality of workers. Input information includes characterizations based upon a human model, a team model and a product model. Periodic reports, such as one or more of a monthly report, a task plan report, a schedule report, a budget report and a risk management report, are generated and made available for display or further analysis or collection into a customized report template. An extensible database allows searching for information based upon context and upon content. Seven different types of project risks are addressed, including non-availability of required skill mix of workers. The system can be configured to exchange data and results with corresponding portions of similar project analyses, and to provide user-specific access to specified information.

Flexible resource management and its effect on project cost and duration

NASA Astrophysics Data System (ADS)

Pinha, Denis C.; Ahluwalia, Rashpal S.

2018-06-01

In practice, most projects result in cost overruns and schedule slippage due to poor resource management. This paper presents an approach that aims at reducing project duration and costs by empowering project managers to assess different scenarios. The proposed approach addresses combinatorial modes for tasks, multi-skilled resources, and multiple calendars for resources. A case study reported in the literature is presented to demonstrate the capabilities of this method. As for practical implications, this approach enhances the decision-making process which results in improved solutions in terms of total project duration and cost. From an academic viewpoint, this paper adds empirical evidence to enrich the existing literature, as it highlights relevant issues to model properly the complexity of real-life projects.

The ins and outs of managing avoidance diets for food allergies.

PubMed

Shaker, Marcus; Venter, Carina

2016-08-01

Food allergic reactions have become more prevalent and management of food allergies requires dietary avoidance of triggers that may place children at nutritional risk. Immunoglobulin E and non-immunoglobulin E-mediated food allergies lead to dietary avoidance. Although some children outgrow food allergies or become tolerant to cooked/baked versions of the allergen, many do not. Multiple food avoidance increases the risk for inadequate nutrient intake, including protein, calcium, vitamin D, and others. Multidisciplinary management of patients requires careful attention to growth, particularly height, and nutrition. Although attention to accurate diagnosis of food allergy is key, understanding nutritional risks of children with food allergies can lead to opportunities to address potential deficiencies resulting from food allergen avoidance.

Variability in perceived satisfaction of reservoir management objectives

USGS Publications Warehouse

Owen, W.J.; Gates, T.K.; Flug, M.

1997-01-01

Fuzzy set theory provides a useful model to address imprecision in interpreting linguistically described objectives for reservoir management. Fuzzy membership functions can be used to represent degrees of objective satisfaction for different values of management variables. However, lack of background information, differing experiences and qualifications, and complex interactions of influencing factors can contribute to significant variability among membership functions derived from surveys of multiple experts. In the present study, probabilistic membership functions are used to model variability in experts' perceptions of satisfaction of objectives for hydropower generation, fish habitat, kayaking, rafting, and scenery preservation on the Green River through operations of Flaming Gorge Dam. Degree of variability in experts' perceptions differed among objectives but resulted in substantial uncertainty in estimation of optimal reservoir releases.

Understanding Existing Salmonid Habitat Availability and Connectivity to Improve River Management

NASA Astrophysics Data System (ADS)

Duffin, J.; Yager, E.; Tonina, D.; Benjankar, R. M.

2017-12-01

In the Pacific Northwest river restoration is common for salmon conservation. Mangers need methods to help target restoration to problem areas in rivers to create habitat that meets a species' needs. Hydraulic models and habitat suitability curves provide basic information on habitat availability and overall quality, but these analyses need to be expanded to address habitat quality based on the accessibility of habitats required for multiple life stages. Scientists are starting to use connectivity measurements to understand the longitudinal proximity of habitat patches, which can be used to address the habitat variability of a reach. By evaluating the availability and quality of habitat and calculating the connectivity between complementary habitats, such as spawning and rearing habitats, we aim to identify areas that should be targeted for restoration. To meet these goals, we assessed Chinook salmon habitat on the Lemhi River in Idaho. The depth and velocity outputs from a 2D hydraulic model are used in conjunction with locally created habitat suitability curves to evaluate the availability and quality of habitat for multiple Chinook salmon life stages. To assess the variability of the habitat, connectivity between habitat patches necessary for different life stages is calculated with a proximity index. A spatial representation of existing habitat quality and connectivity between complimentary habitats can be linked to river morphology by the evaluation of local geomorphic characteristics, including sinuosity and channel units. The understanding of the current habitat availability for multiple life stage needs, the connectivity between these habitat patches, and their relationship with channel morphology can help managers better identify restoration needs and direct their limited resources.

A Decision Support Framework for Feasibility Analysis of International Space Station (ISS) Research Capability Enhancing Options

NASA Technical Reports Server (NTRS)

Ortiz, James N.; Scott,Kelly; Smith, Harold

2004-01-01

The assembly and operation of the ISS has generated significant challenges that have ultimately impacted resources available to the program's primary mission: research. To address this, program personnel routinely perform trade-off studies on alternative options to enhance research. The approach, content level of analysis and resulting outputs of these studies vary due to many factors, however, complicating the Program Manager's job of selecting the best option. To address this, the program requested a framework be developed to evaluate multiple research-enhancing options in a thorough, disciplined and repeatable manner, and to identify the best option on the basis of cost, benefit and risk. The resulting framework consisted of a systematic methodology and a decision-support toolset. The framework provides quantifiable and repeatable means for ranking research-enhancing options for the complex and multiple-constraint domain of the space research laboratory. This paper describes the development, verification and validation of this framework and provides observations on its operational use.

Performance management of multiple access communication networks

NASA Astrophysics Data System (ADS)

Lee, Suk; Ray, Asok

1993-12-01

This paper focuses on conceptual design, development, and implementation of a performance management tool for computer communication networks to serve large-scale integrated systems. The objective is to improve the network performance in handling various types of messages by on-line adjustment of protocol parameters. The techniques of perturbation analysis of Discrete Event Dynamic Systems (DEDS), stochastic approximation (SA), and learning automata have been used in formulating the algorithm of performance management. The efficacy of the performance management tool has been demonstrated on a network testbed. The conceptual design presented in this paper offers a step forward to bridging the gap between management standards and users' demands for efficient network operations since most standards such as ISO (International Standards Organization) and IEEE address only the architecture, services, and interfaces for network management. The proposed concept of performance management can also be used as a general framework to assist design, operation, and management of various DEDS such as computer integrated manufacturing and battlefield C(sup 3) (Command, Control, and Communications).

Is this what you need? Direct feedback help climate change information exchange

NASA Astrophysics Data System (ADS)

Bachelet, D. M.; Brown, M.; Gough, M.; Basin, D.

2015-12-01

The combination of projected climate change and land use adds uncertainty to the long-term effectiveness of current management strategies. Managers need reliable information to adjust their strategies as population density increases. However they are currently overwhelmed by the diversity of available information and the multiplicity of sources. CBI's goal is to centralize and package effectively the usable information for land managers and for the general public in order to increase awareness and promote preparation for the challenges ahead. We are designing conservation planning atlases in Data Basin for a number of landscape conservation cooperatives to address this need. We are adding some user-friendly tools to specifically serve the available climate projections and land use data in a meaningful way. By working closely with a group of managers, our goal is to understand how consideration of these projections figures into the decision-making process and refine the ways we can deliver relevant metrics. We have been holding interviews to gather information and critical feedback on existing climate-related web pages and tools, providing us with benchmarks for improvement. As it turned out, the student-manager dialogue added a component of climate change education and awareness of available tools to the project. Through an iterative process we plan to continue this exchange and address the variety of issues managers continually have to face to maintain healthy ecosystems.

Assistive technologies for self-managed pressure ulcer prevention in spinal cord injury: a scoping review.

PubMed

Tung, James Y; Stead, Brent; Mann, William; Ba'Pham; Popovic, Milos R

2015-01-01

Pressure ulcers (PUs) in individuals with spinal cord injury (SCI) present a persistent and costly problem. Continuing effort in developing new technologies that support self-managed care is an important prevention strategy. Specifically, the aims of this scoping review are to review the key concepts and factors related to self-managed prevention of PUs in individuals with SCI and appraise the technologies available to assist patients in self-management of PU prevention practices. There is broad consensus that sustaining long-term adherence to prevention regimens is a major concern. Recent literature highlights the interactions between behavioral and physiological risk factors. We identify four technology categories that support self-management: computer-based educational technologies demonstrated improved short-term gains in knowledge (2 studies), interface pressure mapping technologies demonstrated improved adherence to pressure-relief schedules up to 3 mo (5 studies), electrical stimulation confirmed improvements in tissue tolerance after 8 wk of training (3 studies), and telemedicine programs demonstrated improvements in independence and reduced hospital visits over 6 mo (2 studies). Overall, self-management technologies demonstrated low-to-moderate effectiveness in addressing a subset of risk factors. However, the effectiveness of technologies in preventing PUs is limited due to a lack of incidence reporting. In light of the key findings, we recommend developing integrated technologies that address multiple risk factors.

NASA's ATM Technology Demonstration-1: Integrated Concept of Arrival Operations

NASA Technical Reports Server (NTRS)

Baxley, Brian T.; Swenson, Harry N.; Prevot, Thomas; Callantine, Todd J.

2012-01-01

This paper describes operations and procedures envisioned for NASA s Air Traffic Management (ATM) Technology Demonstration #1 (ATD-1). The ATD-1 Concept of Operations (ConOps) demonstration will integrate three NASA technologies to achieve high throughput, fuel-efficient arrival operations into busy terminal airspace. They are Traffic Management Advisor with Terminal Metering (TMA-TM) for precise time-based schedules to the runway and points within the terminal area, Controller-Managed Spacing (CMS) decision support tools for terminal controllers to better manage aircraft delay using speed control, and Flight deck Interval Management (FIM) avionics and flight crew procedures to conduct airborne spacing operations. The ATD-1 concept provides de-conflicted and efficient operations of multiple arrival streams of aircraft, passing through multiple merge points, from top-of-descent (TOD) to touchdown. It also enables aircraft to conduct Optimized Profile Descents (OPDs) from en route altitude to the runway, using primarily speed control to maintain separation and schedule. The ATD-1 project is currently addressing the challenges of integrating the three technologies, and implantation into an operational environment. Goals of the ATD-1 demonstration include increasing the throughput of high-density airports, reducing controller workload, increasing efficiency of arrival operations and the frequency of trajectory-based operations, and promoting aircraft ADS-B equipage.

Control Channel Vulnerability Analysis of the Institute of Electrical and Electronics Engineers 802.16m-2011 and 802.16- 2009 Standards

DTIC Science & Technology

2012-09-01

scheduler to adapt its uplink and downlink assignments to channel conditions. Sleep mode is used by the MS to minimize power drain and radio...is addressed in one resource unit, while for multi-user (MU) schemes , multiple users can be scheduled in one resource unit. Open-loop techniques...17  7.  Mobility and Power Management ......................................... 18  8.  Scheduling Services

Comprehensive mitigation framework for concurrent application of multiple clinical practice guidelines.

PubMed

Wilk, Szymon; Michalowski, Martin; Michalowski, Wojtek; Rosu, Daniela; Carrier, Marc; Kezadri-Hamiaz, Mounira

2017-02-01

In this work we propose a comprehensive framework based on first-order logic (FOL) for mitigating (identifying and addressing) interactions between multiple clinical practice guidelines (CPGs) applied to a multi-morbid patient while also considering patient preferences related to the prescribed treatment. With this framework we respond to two fundamental challenges associated with clinical decision support: (1) concurrent application of multiple CPGs and (2) incorporation of patient preferences into the decision making process. We significantly expand our earlier research by (1) proposing a revised and improved mitigation-oriented representation of CPGs and secondary medical knowledge for addressing adverse interactions and incorporating patient preferences and (2) introducing a new mitigation algorithm. Specifically, actionable graphs representing CPGs allow for parallel and temporal activities (decisions and actions). Revision operators representing secondary medical knowledge support temporal interactions and complex revisions across multiple actionable graphs. The mitigation algorithm uses the actionable graphs, revision operators and available (and possibly incomplete) patient information represented in FOL. It relies on a depth-first search strategy to find a valid sequence of revisions and uses theorem proving and model finding techniques to identify applicable revision operators and to establish a management scenario for a given patient if one exists. The management scenario defines a safe (interaction-free) and preferred set of activities together with possible patient states. We illustrate the use of our framework with a clinical case study describing two patients who suffer from chronic kidney disease, hypertension, and atrial fibrillation, and who are managed according to CPGs for these diseases. While in this paper we are primarily concerned with the methodological aspects of mitigation, we also briefly discuss a high-level proof of concept implementation of the proposed framework in the form of a clinical decision support system (CDSS). The proposed mitigation CDSS "insulates" clinicians from the complexities of the FOL representations and provides semantically meaningful summaries of mitigation results. Ultimately we plan to implement the mitigation CDSS within our MET (Mobile Emergency Triage) decision support environment. Copyright © 2016 Elsevier Inc. All rights reserved.

Developing dimensions for a multicomponent multidisciplinary approach to obesity management: a qualitative study.

PubMed

Cochrane, Anita J; Dick, Bob; King, Neil A; Hills, Andrew P; Kavanagh, David J

2017-10-16

There have been consistent recommendations for multicomponent and multidisciplinary approaches for obesity management. However, there is no clear agreement on the components, disciplines or processes to be considered within such an approach. In this study, we explored multicomponent and multidisciplinary approaches through an examination of knowledge, skills, beliefs, and recommendations of stakeholders involved in obesity management. These stakeholders included researchers, practitioners, educators, and patients. We used qualitative action research methods, including convergent interviewing and observation, to assist the process of inquiry. The consensus was that a multicomponent and multidisciplinary approach should be based on four central meta-components (patient, practitioner, process, and environmental factors), and specific components of these factors were identified. Psychologists, dieticians, exercise physiologists and general practitioners were nominated as key practitioners to be included. A complex condition like obesity requires that multiple components be addressed, and that both patients and multiple disciplines are involved in developing solutions. Implementing cycles of continuous improvement to deal with complexity, instead of trying to control for it, offers an effective way to deal with complex, changing multisystem problems like obesity.

Systematic Review of Programs Treating High-Need and High-Cost People With Multiple Chronic Diseases or Disabilities in the United States, 2008–2014

PubMed Central

Bleich, Sara N.; Sherrod, Cheryl; Chiang, Anne; Boyd, Cynthia; Wolff, Jennifer; DuGoff, Eva; Salzberg, Claudia; Anderson, Keely; Leff, Bruce

2015-01-01

Introduction Finding ways to provide better and less expensive health care for people with multiple chronic conditions or disability is a pressing concern. The purpose of this systematic review was to evaluate different approaches for caring for this high-need and high-cost population. Methods We searched Medline for articles published from May 31, 2008, through June 10, 2014, for relevant studies. Articles were considered eligible for this review if they met the following criteria: included people with multiple chronic conditions (behavioral or mental health) or disabilities (2 or more); addressed 1 or more of clinical outcomes, health care use and spending, or patient satisfaction; and compared results from an intervention group with a comparison group or baseline measurements. We extracted information on program characteristics, participant characteristics, and significant (positive and negative) clinical findings, patient satisfaction, and health care use outcomes. For each outcome, the number of significant and positive results was tabulated. Results Twenty-seven studies were included across 5 models of care. Of the 3 studies reporting patient satisfaction outcomes, 2 reported significant improvements; both were randomized controlled trials (RCTs). Of the 14 studies reporting clinical outcomes, 12 reported improvements (8 were RCTs). Of the 13 studies reporting health care use and spending outcomes, 12 reported significant improvements (2 were RCTs). Two models of care — care and case management and disease management — reported improvements in all 3 outcomes. For care and case management models, most improvements were related to health care use. For the disease management models, most improvements were related to clinical outcomes. Conclusions Care and case management as well as disease management may be promising models of care for people with multiple chronic conditions or disabilities. More research and consistent methods are needed to understand the most appropriate care for these high-need and high-cost patients. PMID:26564013

Systematic Review of Programs Treating High-Need and High-Cost People With Multiple Chronic Diseases or Disabilities in the United States, 2008-2014.

PubMed

Bleich, Sara N; Sherrod, Cheryl; Chiang, Anne; Boyd, Cynthia; Wolff, Jennifer; DuGoff, Eva; Chang, Eva; Salzberg, Claudia; Anderson, Keely; Leff, Bruce; Anderson, Gerard

2015-11-12

Finding ways to provide better and less expensive health care for people with multiple chronic conditions or disability is a pressing concern. The purpose of this systematic review was to evaluate different approaches for caring for this high-need and high-cost population. We searched Medline for articles published from May 31, 2008, through June 10, 2014, for relevant studies. Articles were considered eligible for this review if they met the following criteria: included people with multiple chronic conditions (behavioral or mental health) or disabilities (2 or more); addressed 1 or more of clinical outcomes, health care use and spending, or patient satisfaction; and compared results from an intervention group with a comparison group or baseline measurements. We extracted information on program characteristics, participant characteristics, and significant (positive and negative) clinical findings, patient satisfaction, and health care use outcomes. For each outcome, the number of significant and positive results was tabulated. Twenty-seven studies were included across 5 models of care. Of the 3 studies reporting patient satisfaction outcomes, 2 reported significant improvements; both were randomized controlled trials (RCTs). Of the 14 studies reporting clinical outcomes, 12 reported improvements (8 were RCTs). Of the 13 studies reporting health care use and spending outcomes, 12 reported significant improvements (2 were RCTs). Two models of care - care and case management and disease management - reported improvements in all 3 outcomes. For care and case management models, most improvements were related to health care use. For the disease management models, most improvements were related to clinical outcomes. Care and case management as well as disease management may be promising models of care for people with multiple chronic conditions or disabilities. More research and consistent methods are needed to understand the most appropriate care for these high-need and high-cost patients.

Drinking water quality management: a holistic approach.

PubMed

Rizak, S; Cunliffe, D; Sinclair, M; Vulcano, R; Howard, J; Hrudey, S; Callan, P

2003-01-01

A growing list of water contaminants has led to some water suppliers relying primarily on compliance monitoring as a mechanism for managing drinking water quality. While such monitoring is a necessary part of drinking water quality management, experiences with waterborne disease threats and outbreaks have shown that compliance monitoring for numerical limits is not, in itself, sufficient to guarantee the safety and quality of drinking water supplies. To address these issues, the Australian National Health and Medical Research Council (NHMRC) has developed a Framework for Management of Drinking Water Quality (the Framework) for incorporation in the Australian Drinking Water Guidelines, the primary reference on drinking water quality in Australia. The Framework was developed specifically for drinking water supplies and provides a comprehensive and preventive risk management approach from catchment to consumer. It includes holistic guidance on a range of issues considered good practice for system management. The Framework addresses four key areas: Commitment to Drinking Water Quality Management, System Analysis and System Management, Supporting Requirements, and Review. The Framework represents a significantly enhanced approach to the management and regulation of drinking water quality and offers a flexible and proactive means of optimising drinking water quality and protecting public health. Rather than the primary reliance on compliance monitoring, the Framework emphasises prevention, the importance of risk assessment, maintaining the integrity of water supply systems and application of multiple barriers to assure protection of public health. Development of the Framework was undertaken in collaboration with the water industry, regulators and other stakeholder, and will promote a common and unified approach to drinking water quality management throughout Australia. The Framework has attracted international interest.

Characterization of Thermal and Mechanical Impact on Aluminum Honeycomb Structures

NASA Technical Reports Server (NTRS)

Robinson, Christen M.

2013-01-01

This study supports NASA Kennedy Space Center's research in the area of intelligent thermal management systems and multifunctional thermal systems. This project addresses the evaluation of the mechanical and thermal properties of metallic cellular solid (MCS) materials; those that are lightweight; high strength, tunable, multifunctional and affordable. A portion of the work includes understanding the mechanical properties of honeycomb structured cellular solids upon impact testing under ambient, water-immersed, liquid nitrogen-cooled, and liquid nitrogen-immersed conditions. Additionally, this study will address characterization techniques of the aluminum honeycomb's ability to resist multiple high-rate loadings or impacts in varying environmental conditions, using various techniques for the quantitative and qualitative determination for commercial applicability.

Interval-parameter semi-infinite fuzzy-stochastic mixed-integer programming approach for environmental management under multiple uncertainties.

PubMed

Guo, P; Huang, G H

2010-03-01

In this study, an interval-parameter semi-infinite fuzzy-chance-constrained mixed-integer linear programming (ISIFCIP) approach is developed for supporting long-term planning of waste-management systems under multiple uncertainties in the City of Regina, Canada. The method improves upon the existing interval-parameter semi-infinite programming (ISIP) and fuzzy-chance-constrained programming (FCCP) by incorporating uncertainties expressed as dual uncertainties of functional intervals and multiple uncertainties of distributions with fuzzy-interval admissible probability of violating constraint within a general optimization framework. The binary-variable solutions represent the decisions of waste-management-facility expansion, and the continuous ones are related to decisions of waste-flow allocation. The interval solutions can help decision-makers to obtain multiple decision alternatives, as well as provide bases for further analyses of tradeoffs between waste-management cost and system-failure risk. In the application to the City of Regina, Canada, two scenarios are considered. In Scenario 1, the City's waste-management practices would be based on the existing policy over the next 25 years. The total diversion rate for the residential waste would be approximately 14%. Scenario 2 is associated with a policy for waste minimization and diversion, where 35% diversion of residential waste should be achieved within 15 years, and 50% diversion over 25 years. In this scenario, not only landfill would be expanded, but also CF and MRF would be expanded. Through the scenario analyses, useful decision support for the City's solid-waste managers and decision-makers has been generated. Three special characteristics of the proposed method make it unique compared with other optimization techniques that deal with uncertainties. Firstly, it is useful for tackling multiple uncertainties expressed as intervals, functional intervals, probability distributions, fuzzy sets, and their combinations; secondly, it has capability in addressing the temporal variations of the functional intervals; thirdly, it can facilitate dynamic analysis for decisions of facility-expansion planning and waste-flow allocation within a multi-facility, multi-period and multi-option context. Copyright 2009 Elsevier Ltd. All rights reserved.

Arthroscopic Management of Anterior, Posterior, and Multidirectional Shoulder Instabilities.

PubMed

Field, Larry D; Ryu, Richard K N; Abrams, Jeffrey S; Provencher, Matthew

2016-01-01

Arthroscopic shoulder stabilization offers several potential advantages compared with open surgery, including the opportunity to more accurately evaluate the glenohumeral joint at the time of diagnostic assessment; comprehensively address multiple pathologic lesions that may be identified; and avoid potential complications unique to open stabilization, such as postoperative subscapularis failure. A thorough understanding of normal shoulder anatomy and biomechanics, along with the pathoanatomy responsible for anterior, posterior, and multidirectional shoulder instability patterns, is very important in the management of patients who have shoulder instability. The treating physician also must be familiar with diagnostic imaging and physical examination maneuvers that are required to accurately diagnose shoulder instability.

Web Application Software for Ground Operations Planning Database (GOPDb) Management

NASA Technical Reports Server (NTRS)

Lanham, Clifton; Kallner, Shawn; Gernand, Jeffrey

2013-01-01

A Web application facilitates collaborative development of the ground operations planning document. This will reduce costs and development time for new programs by incorporating the data governance, access control, and revision tracking of the ground operations planning data. Ground Operations Planning requires the creation and maintenance of detailed timelines and documentation. The GOPDb Web application was created using state-of-the-art Web 2.0 technologies, and was deployed as SaaS (Software as a Service), with an emphasis on data governance and security needs. Application access is managed using two-factor authentication, with data write permissions tied to user roles and responsibilities. Multiple instances of the application can be deployed on a Web server to meet the robust needs for multiple, future programs with minimal additional cost. This innovation features high availability and scalability, with no additional software that needs to be bought or installed. For data governance and security (data quality, management, business process management, and risk management for data handling), the software uses NAMS. No local copy/cloning of data is permitted. Data change log/tracking is addressed, as well as collaboration, work flow, and process standardization. The software provides on-line documentation and detailed Web-based help. There are multiple ways that this software can be deployed on a Web server to meet ground operations planning needs for future programs. The software could be used to support commercial crew ground operations planning, as well as commercial payload/satellite ground operations planning. The application source code and database schema are owned by NASA.

Web-based self-management for patients with multiple sclerosis: a practical, randomized trial.

PubMed

Miller, Deborah M; Moore, Shirley M; Fox, Robert J; Atreja, Ashish; Fu, Alex Z; Lee, Jar-Chi; Saupe, Welf; Stadtler, Maria; Chakraborty, Swati; Harris, C M; Rudick, Richard A

2011-01-01

No studies have addressed the use of electronic personal health records (e-PHRs) for self-management in complex neurological disorders. We assessed and tested an Internet-based self-management system that utilized the e-PHR and determined its impact on self-assessed well-being, clinician-assessed well-being, and healthcare utilization in patients with multiple sclerosis (MS). Subjects were randomized to usual care (a secure Web-based messaging system) or active intervention, which included secure messaging, self-monitoring, self-management of MS symptoms, and communication about upcoming clinic visits. Computers and Internet access were provided. Subjects were included if they had MS, lived within the county or region surrounding our MS center, had at least two appointments at our center in the previous 12 months, and demonstrated basic typing and computer skills. Study duration was 12 months. Of 220 subjects completing informed consent, 206 met the inclusion criteria. At the study's end, 83 subjects remained in the usual care group and 84 in the enhanced care group. Both groups used the available system components. The groups did not significantly differ on the primary endpoints or healthcare utilization. Self-management support is an emerging aspect of chronic care management. We established the feasibility of conducting a randomized, controlled trial using e-PHRs for patient self-management. We did not find that e-PHR-enabled self-management augmented multidisciplinary MS center-based care, possibly because the differences between interventions were not great enough.

Cooperative science to inform Lake Ontario management: Research from the 2013 Lake Ontario CSMI program

USGS Publications Warehouse

Watkins, James M.; Weidel, Brian C.; Fisk, Aaron T.; Rudstam, Lars G.

2017-01-01

Since the mid-1970s, successful Lake Ontario management actions including nutrient load and pollution reductions, habitat restoration, and fish stocking have improved Lake Ontario. However, several new obstacles to maintenance and restoration have emerged. This special issue presents management-relevant research from multiple agency surveys in 2011 and 2012 and the 2013 Cooperative Science and Monitoring Initiative (CSMI), that span diverse lake habitats, species, and trophic levels. This research focused on themes of nutrient loading and fate; vertical dynamics of primary and secondary production; fish abundance and behavior; and food web structure. Together these papers identify the status of many of the key drivers of the Lake Ontario ecosystem and contribute to addressing lake-scale questions and management information needs in Lake Ontario and the other Great Lakes and connecting water bodies.

A Semantic Web Management Model for Integrative Biomedical Informatics

PubMed Central

Deus, Helena F.; Stanislaus, Romesh; Veiga, Diogo F.; Behrens, Carmen; Wistuba, Ignacio I.; Minna, John D.; Garner, Harold R.; Swisher, Stephen G.; Roth, Jack A.; Correa, Arlene M.; Broom, Bradley; Coombes, Kevin; Chang, Allen; Vogel, Lynn H.; Almeida, Jonas S.

2008-01-01

Background Data, data everywhere. The diversity and magnitude of the data generated in the Life Sciences defies automated articulation among complementary efforts. The additional need in this field for managing property and access permissions compounds the difficulty very significantly. This is particularly the case when the integration involves multiple domains and disciplines, even more so when it includes clinical and high throughput molecular data. Methodology/Principal Findings The emergence of Semantic Web technologies brings the promise of meaningful interoperation between data and analysis resources. In this report we identify a core model for biomedical Knowledge Engineering applications and demonstrate how this new technology can be used to weave a management model where multiple intertwined data structures can be hosted and managed by multiple authorities in a distributed management infrastructure. Specifically, the demonstration is performed by linking data sources associated with the Lung Cancer SPORE awarded to The University of Texas MDAnderson Cancer Center at Houston and the Southwestern Medical Center at Dallas. A software prototype, available with open source at www.s3db.org, was developed and its proposed design has been made publicly available as an open source instrument for shared, distributed data management. Conclusions/Significance The Semantic Web technologies have the potential to addresses the need for distributed and evolvable representations that are critical for systems Biology and translational biomedical research. As this technology is incorporated into application development we can expect that both general purpose productivity software and domain specific software installed on our personal computers will become increasingly integrated with the relevant remote resources. In this scenario, the acquisition of a new dataset should automatically trigger the delegation of its analysis. PMID:18698353

Allocation and management issues in multiple-transaction open access transmission networks

NASA Astrophysics Data System (ADS)

Tao, Shu

This thesis focuses on some key issues related to allocation and management by the independent grid operator (IGO) of unbundled services in multiple-transaction open access transmission networks. The three unbundled services addressed in the thesis are transmission real power losses, reactive power support requirements from generation sources, and transmission congestion management. We develop the general framework that explicitly represents multiple transactions undertaken simultaneously in the transmission grid. This framework serves as the basis for formulating various problems treated in the thesis. We use this comprehensive framework to develop a physical-flow-based mechanism to allocate the total transmission losses to each transaction using the system. An important property of the allocation scheme is its capability to effectively deal with counter flows that result in the presence of specific transactions. Using the loss allocation results as the basis, we construct the equivalent loss compensation concept and apply it to develop flexible and effective procedures for compensating losses in multiple-transaction networks. We present a new physical-flow-based mechanism for allocating the reactive power support requirements provided by generators in multiple-transaction networks. The allocatable reactive support requirements are formulated as the sum of two specific components---the voltage magnitude variation component and the voltage angle variation component. The formulation utilizes the multiple-transaction framework and makes use of certain simplifying approximations. The formulation leads to a natural allocation as a function of the amount of each transaction. The physical interpretation of each allocation as a sensitivity of the reactive output of a generator is discussed. We propose a congestion management allocation scheme for multiple-transaction networks. The proposed scheme determines the allocation of congestion among the transactions on a physical-flow basis. It also proposes a congestion relief scheme that removes the congestion attributed to each transaction on the network in a least-cost manner to the IGO and determines the appropriate transmission charges to each transaction for its transmission usage. The thesis provides a compendium of problems that are natural extensions of the research results reported here and appear to be good candidates for future work.

Building on common ground to address biodiversity conflicts and foster collaboration in environmental management.

PubMed

Lecuyer, Lou; White, Rehema M; Schmook, Birgit; Calmé, Sophie

2018-08-15

Conservation biology faces critical challenges that require collaborative approaches, including novel strategies to support interactions among actors in biodiversity conflicts. The goals of this study were to investigate the concept of common ground across multiple issues and to explore its practical application for the support of environmental management. We conceptually defined common ground as the areas of relevance underlying the suite of issues expressed by people regarding environmental management in a particular context. We then empirically tested this in the Calakmul region of Mexico, where the complex socio-historical context and high biodiversity have created environmental management challenges that are now being addressed by a local, multi-stakeholder management board. We conducted 26 open interviews with members of the board and a further round of quantitative prioritisation of issues raised. Using a coding process designed to reveal common ground, we categorized the issues at four levels ranging from coarse to fine (themes, topics, sub-topics and perspectives). We then analysed two levels, topics (n = 14 issues) and sub-topics (n = 51 issues). To do so, we built common ground matrices to identify and analyze common ground among actors and across issues. First, cluster and non-metrical data analyses revealed the diversity of actor positions and the lack of consistent grouping among actors by occupational activity. This demonstrated that focusing on actors' differences might be misleading, and that actors' views were not closely aligned with their roles. Second, we located issues according to their levels of common ground and importance among actors. We showed that by not focusing on single issue conflicts, the identification of common ground across multiple issues can pinpoint synergies. We then proposed a framework for collaboration that prioritizes issues of high importance with greater common ground (e.g. sustainable resource use activities), to support the development of trust and norms of reciprocity among actors, strengthening the potential for future cooperation. By adopting this approach, environmental managers could support the initial stages of collaborative conservation strategies, engaging with other actors to seek common ground, avoid the creation of polarised groups and help effectively manage biodiversity conflicts. Copyright © 2018 Elsevier Ltd. All rights reserved.

Assessing and managing multiple risks in a changing world-The Roskilde recommendations.

PubMed

Selck, Henriette; Adamsen, Peter B; Backhaus, Thomas; Banta, Gary T; Bruce, Peter K H; Burton, G Allen; Butts, Michael B; Boegh, Eva; Clague, John J; Dinh, Khuong V; Doorn, Neelke; Gunnarsson, Jonas S; Hauggaard-Nielsen, Henrik; Hazlerigg, Charles; Hunka, Agnieszka D; Jensen, John; Lin, Yan; Loureiro, Susana; Miraglia, Simona; Munns, Wayne R; Nadim, Farrokh; Palmqvist, Annemette; Rämö, Robert A; Seaby, Lauren P; Syberg, Kristian; Tangaa, Stine R; Thit, Amalie; Windfeld, Ronja; Zalewski, Maciej; Chapman, Peter M

2017-01-01

Roskilde University (Denmark) hosted a November 2015 workshop, Environmental Risk-Assessing and Managing Multiple Risks in a Changing World. This Focus article presents the consensus recommendations of 30 attendees from 9 countries regarding implementation of a common currency (ecosystem services) for holistic environmental risk assessment and management; improvements to risk assessment and management in a complex, human-modified, and changing world; appropriate development of protection goals in a 2-stage process; dealing with societal issues; risk-management information needs; conducting risk assessment of risk management; and development of adaptive and flexible regulatory systems. The authors encourage both cross-disciplinary and interdisciplinary approaches to address their 10 recommendations: 1) adopt ecosystem services as a common currency for risk assessment and management; 2) consider cumulative stressors (chemical and nonchemical) and determine which dominate to best manage and restore ecosystem services; 3) fully integrate risk managers and communities of interest into the risk-assessment process; 4) fully integrate risk assessors and communities of interest into the risk-management process; 5) consider socioeconomics and increased transparency in both risk assessment and risk management; 6) recognize the ethical rights of humans and ecosystems to an adequate level of protection; 7) determine relevant reference conditions and the proper ecological context for assessments in human-modified systems; 8) assess risks and benefits to humans and the ecosystem and consider unintended consequences of management actions; 9) avoid excessive conservatism or possible underprotection resulting from sole reliance on binary, numerical benchmarks; and 10) develop adaptive risk-management and regulatory goals based on ranges of uncertainty. Environ Toxicol Chem 2017;36:7-16. © 2016 SETAC. © 2016 SETAC.

Operationalizing Dynamic Ocean Management (DOM): Understanding the Incentive Structure, Policy and Regulatory Context for DOM in Practice

NASA Astrophysics Data System (ADS)

Lewison, R. L.; Saumweber, W. J.; Erickson, A.; Martone, R. G.

2016-12-01

Dynamic ocean management, or management that uses near real-time data to guide the spatial distribution of commercial activities, is an emerging approach to balance ocean resource use and conservation. Employing a wide range of data types, dynamic ocean management in a fisheries context can be used to meet multiple objectives - managing target quota, bycatch reduction, and reducing interactions with species of conservation concern. There is a growing list of DOM applications currently in practice in fisheries around the world, yet the approach is new enough that both fishers and fisheries managers are unclear how DOM can be applied to their fishery. Here, we use the experience from dynamic ocean management applications that are currently in practice to address the commonly asked question "How can dynamic management approaches be implemented in a traditionally managed fishery?". Combining knowledge from the DOM participants with a review of regulatory frameworks and incentive structures, stakeholder participation, and technological requirements of DOM in practice, we identify ingredients that have supported successful implementation of this new management approach.

How to Assess Vulnerabilities of Water Policies to Global Change?

NASA Astrophysics Data System (ADS)

Kumar, A.; Haasnoot, M.; Weijs, S.

2017-12-01

Water managers are confronted with uncertainties arising from hydrological, societal, economical and political drivers. To manage these uncertainties two paradigms have been identified: top-down and bottom-up approaches. Top-down or prediction-based approaches use socio-economic scenarios together with a discrete set of GCM projections (often downscaled) to assess the expected impact of drivers and policies on water resource system through various hydrological and social systems models. Adaptation strategies to alleviate these impacts are then identified and tested against the scenarios. To address GCM and downscaling uncertainties, these approaches put more focus on climate predictions, rather than the decision problem itself. Triggered by the wish to have a more scenario-neutral approach and address downscaling uncertainties, recent analyses have been shifted towards vulnerability-based (bottom-up or decision-centric) approaches. They begin at the local scale by addressing socio-economic responses to climate, often involving stakeholder's input; identify vulnerabilities under a larger sample of plausible futures and evaluate sensitivity and robustness of possible adaptation options. Several bottom-up approaches have emerged so far and are increasingly recommended. Fundamentally they share several core ideas, however, subtle differences exist in vulnerability assessment, visualization tools for exploring vulnerabilities and computational methods used for identifying robust water policies. Through this study, we try to identify how these approaches are progressing, how the climate and non-climate uncertainties are being confronted and how to integrate existing and new tools. We find that choice of a method may depend on the number of vulnerability drivers identified and type of threshold levels (environmental conditions or policy objectives) defined. Certain approaches are suited well for assessing adaptive capacities, tipping points and sequencing of decisions. However, visualization of the vulnerability domain is still challenging if multiple drivers are present. New emerging tools are focused on generating synthetic scenarios, addressing multiple objectives, linking decision-making frameworks to adaptation pathways and communicating risks to the stakeholders.

Visions of Restoration in Fire-Adapted Forest Landscapes: Lessons from the Collaborative Forest Landscape Restoration Program.

PubMed

Urgenson, Lauren S; Ryan, Clare M; Halpern, Charles B; Bakker, Jonathan D; Belote, R Travis; Franklin, Jerry F; Haugo, Ryan D; Nelson, Cara R; Waltz, Amy E M

2017-02-01

Collaborative approaches to natural resource management are becoming increasingly common on public lands. Negotiating a shared vision for desired conditions is a fundamental task of collaboration and serves as a foundation for developing management objectives and monitoring strategies. We explore the complex socio-ecological processes involved in developing a shared vision for collaborative restoration of fire-adapted forest landscapes. To understand participant perspectives and experiences, we analyzed interviews with 86 respondents from six collaboratives in the western U.S., part of the Collaborative Forest Landscape Restoration Program established to encourage collaborative, science-based restoration on U.S. Forest Service lands. Although forest landscapes and group characteristics vary considerably, collaboratives faced common challenges to developing a shared vision for desired conditions. Three broad categories of challenges emerged: meeting multiple objectives, collaborative capacity and trust, and integrating ecological science and social values in decision-making. Collaborative groups also used common strategies to address these challenges, including some that addressed multiple challenges. These included use of issue-based recommendations, field visits, and landscape-level analysis; obtaining support from local agency leadership, engaging facilitators, and working in smaller groups (sub-groups); and science engagement. Increased understanding of the challenges to, and strategies for, developing a shared vision of desired conditions is critical if other collaboratives are to learn from these efforts.

Visions of Restoration in Fire-Adapted Forest Landscapes: Lessons from the Collaborative Forest Landscape Restoration Program

NASA Astrophysics Data System (ADS)

Urgenson, Lauren S.; Ryan, Clare M.; Halpern, Charles B.; Bakker, Jonathan D.; Belote, R. Travis; Franklin, Jerry F.; Haugo, Ryan D.; Nelson, Cara R.; Waltz, Amy E. M.

2017-02-01

Collaborative approaches to natural resource management are becoming increasingly common on public lands. Negotiating a shared vision for desired conditions is a fundamental task of collaboration and serves as a foundation for developing management objectives and monitoring strategies. We explore the complex socio-ecological processes involved in developing a shared vision for collaborative restoration of fire-adapted forest landscapes. To understand participant perspectives and experiences, we analyzed interviews with 86 respondents from six collaboratives in the western U.S., part of the Collaborative Forest Landscape Restoration Program established to encourage collaborative, science-based restoration on U.S. Forest Service lands. Although forest landscapes and group characteristics vary considerably, collaboratives faced common challenges to developing a shared vision for desired conditions. Three broad categories of challenges emerged: meeting multiple objectives, collaborative capacity and trust, and integrating ecological science and social values in decision-making. Collaborative groups also used common strategies to address these challenges, including some that addressed multiple challenges. These included use of issue-based recommendations, field visits, and landscape-level analysis; obtaining support from local agency leadership, engaging facilitators, and working in smaller groups (sub-groups); and science engagement. Increased understanding of the challenges to, and strategies for, developing a shared vision of desired conditions is critical if other collaboratives are to learn from these efforts.

[Tuberculosis patient disease knowledge, attitudes and behavioral intentions: the impact of individualized counseling].

PubMed

Wu, Shiau-Jiun; Lu, Po-Liang; Chen, Yen-Hsu; Pan, Hui-Juan; Feng, Ming-Chu

2011-12-01

The Taiwan government currently promotes a case management approach to tuberculosis (TB) treatment to address the growing number of TB and multiple drug-resistant TB cases in Taiwan. The approach aims to improve medical follow-up and monitor quality of care. The efficacy of this case management approach has yet to be evaluated. The current study was designed to evaluate the effect of individualized case manager counseling on TB patient disease knowledge, attitudes, and behavioral intention. This study employed a one-group pretest-posttest quasi-experimental design. Participants first answered an initial questionnaire survey including three structured scales that addressed, respectively, the facets of disease knowledge, attitudes, and behavioral intention. TB case managers then delivered two- stage counseling to participants based on assessed individual needs and outstanding issues identified in questionnaire answers. A second questionnaire survey was administered 30~42 days after the intervention. Data on a total of 96 TB patients were collected. Key study findings were (1) individualized counseling significantly improved TB patient disease knowledge (p < .001) and (2) TB patient attitudes correlated significantly and positively with behavior intention (p < .001). Individualized counseling provided during the early stages of TB helps elevate patient awareness of the importance of treatment, enhances compliance and increases the cure rate.

NEXT Propellant Management System Integration With Multiple Ion Thrusters

NASA Technical Reports Server (NTRS)

Sovey, James S.; Soulas, George C.; Herman, Daniel A.

2011-01-01

As a critical part of the NEXT test validation process, a multiple-string integration test was performed on the NEXT propellant management system and ion thrusters. The objectives of this test were to verify that the PMS is capable of providing stable flow control to multiple thrusters operating over the NEXT system throttling range and to demonstrate to potential users that the NEXT PMS is ready for transition to flight. A test plan was developed for the sub-system integration test for verification of PMS and thruster system performance and functionality requirements. Propellant management system calibrations were checked during the single and multi-thruster testing. The low pressure assembly total flow rates to the thruster(s) were within 1.4 percent of the calibrated support equipment flow rates. The inlet pressures to the main, cathode, and neutralizer ports of Thruster PM1R were measured as the PMS operated in 1-thruster, 2-thruster, and 3-thruster configurations. It was found that the inlet pressures to Thruster PM1R for 2-thruster and 3-thruster operation as well as single thruster operation with the PMS compare very favorably indicating that flow rates to Thruster PM1R were similar in all cases. Characterizations of discharge losses, accelerator grid current, and neutralizer performance were performed as more operating thrusters were added to the PMS. There were no variations in these parameters as thrusters were throttled and single and multiple thruster operations were conducted. The propellant management system power consumption was at a fixed voltage to the DCIU and a fixed thermal throttle temperature of 75 C. The total power consumed by the PMS was 10.0, 17.9, and 25.2 W, respectively, for single, 2-thruster, and 3-thruster operation with the PMS. These sub-system integration tests of the PMS, the DCIU Simulator, and multiple thrusters addressed, in part, the NEXT PMS and propulsion system performance and functionality requirements.

Improving self-management of cancer risk factors, underscreening for cancer and depression among general practice patients: study protocol of a randomised controlled trial

PubMed Central

Carey, Mariko; Sanson-Fisher, Rob; Oldmeadow, Christopher; Mansfield, Elise; Walsh, Justin

2016-01-01

Introduction General practitioners have a key role in reducing cancer risk factors, screening for cancer and managing depression. Given the time-limited nature of consultations, a new and more time-efficient approach is needed which addresses multiple health needs simultaneously, and encourages patient self-management to address health risks. The aim of this cluster randomised controlled trial is to test the effectiveness of a patient feedback intervention in improving patient self-management of health needs related to smoking, risky alcohol consumption and underscreening for cancers at 1 month follow-up. Methods and analysis Adult general practice patients will be invited to participate in a baseline survey to assess cancer risk factors, screening needs and depression. A total of 360 participants identified by the baseline survey as having at least one health need (a self-reported cancer risk factor, underscreening for cancer, or an elevated depression score) will be randomised to an intervention or control group. Participants in the intervention group will receive tailored printed feedback summarising their identified health needs and recommended self-management actions to address these. All participants will be invited to complete a telephone interview 1 month following recruitment to assess self-management actions taken in relation to health needs identified in the baseline survey. Control group participants will receive tailored printed feedback on their identified health needs after their follow-up interview. A logistic regression model, with group allocation as the main predictor, will be used to assess the impact of the intervention on self-management actions. Ethical considerations and dissemination Participants identified as being at risk of depression will be advised to speak with their doctor. Results will be disseminated via publication in peer-reviewed journals. The study has been approved by the University of Newcastle Human Research Ethics Committee. Trial registration number ACTRN12616001443482. PMID:27864255

MOSAIC--A Modular Approach to Data Management in Epidemiological Studies.

PubMed

Bialke, M; Bahls, T; Havemann, C; Piegsa, J; Weitmann, K; Wegner, T; Hoffmann, W

2015-01-01

In the context of an increasing number of multi-centric studies providing data from different sites and sources the necessity for central data management (CDM) becomes undeniable. This is exacerbated by a multiplicity of featured data types, formats and interfaces. In relation to methodological medical research the definition of central data management needs to be broadened beyond the simple storage and archiving of research data. This paper highlights typical requirements of CDM for cohort studies and registries and illustrates how orientation for CDM can be provided by addressing selected data management challenges. Therefore in the first part of this paper a short review summarises technical, organisational and legal challenges for CDM in cohort studies and registries. A deduced set of typical requirements of CDM in epidemiological research follows. In the second part the MOSAIC project is introduced (a modular systematic approach to implement CDM). The modular nature of MOSAIC contributes to manage both technical and organisational challenges efficiently by providing practical tools. A short presentation of a first set of tools, aiming for selected CDM requirements in cohort studies and registries, comprises a template for comprehensive documentation of data protection measures, an interactive reference portal for gaining insights and sharing experiences, supplemented by modular software tools for generation and management of generic pseudonyms, for participant management and for sophisticated consent management. Altogether, work within MOSAIC addresses existing challenges in epidemiological research in the context of CDM and facilitates the standardized collection of data with pre-programmed modules and provided document templates. The necessary effort for in-house programming is reduced, which accelerates the start of data collection.

Grand challenges in the management and conservation of North American inland fishes and fisheries

USGS Publications Warehouse

Lynch, Abigail; Cooke, Steven J.; Beard, Douglas; Kao, Yu-Chun; Lorenzen, Kai; Song, Andrew M.; Allen, Micheal S.; Basher, Zeenatul; Bunnell, David B.; Camp, Edward V.; Cowx, Ian G.; Freedman, Jonathan A.; Nguyen, Vivian M.; Nohner, Joel K.; Rogers, Mark W.; Siders, Zachary A.; Taylor, William W.; Youn, So-Jung

2017-01-01

Even with long-standing management and extensive science support, North American inland fish and fisheries still face many conservation and management challenges. We used a grand challenges approach to identify critical roadblocks that if removed would help solve important problems in the management and long-term conservation of North American inland fish and fisheries. We identified seven grand challenges within three themes (valuation, governance, and externalities) and 34 research needs and management actions. The major themes identified are to (1) raise awareness of diverse values associated with inland fish and fisheries, (2) govern inland fish and fisheries to satisfy multiple use and conservation objectives, and (3) ensure productive inland fisheries given nonfishing sector externalities. Addressing these grand challenges will help the broader community understand the diverse values of inland fish and fisheries, promote open forums for engagement of diverse stakeholders in fisheries management, and better integrate the inland fish sector into the greater water and land use policy process.

Balancing exploration, uncertainty and computational demands in many objective reservoir optimization

NASA Astrophysics Data System (ADS)

Zatarain Salazar, Jazmin; Reed, Patrick M.; Quinn, Julianne D.; Giuliani, Matteo; Castelletti, Andrea

2017-11-01

Reservoir operations are central to our ability to manage river basin systems serving conflicting multi-sectoral demands under increasingly uncertain futures. These challenges motivate the need for new solution strategies capable of effectively and efficiently discovering the multi-sectoral tradeoffs that are inherent to alternative reservoir operation policies. Evolutionary many-objective direct policy search (EMODPS) is gaining importance in this context due to its capability of addressing multiple objectives and its flexibility in incorporating multiple sources of uncertainties. This simulation-optimization framework has high potential for addressing the complexities of water resources management, and it can benefit from current advances in parallel computing and meta-heuristics. This study contributes a diagnostic assessment of state-of-the-art parallel strategies for the auto-adaptive Borg Multi Objective Evolutionary Algorithm (MOEA) to support EMODPS. Our analysis focuses on the Lower Susquehanna River Basin (LSRB) system where multiple sectoral demands from hydropower production, urban water supply, recreation and environmental flows need to be balanced. Using EMODPS with different parallel configurations of the Borg MOEA, we optimize operating policies over different size ensembles of synthetic streamflows and evaporation rates. As we increase the ensemble size, we increase the statistical fidelity of our objective function evaluations at the cost of higher computational demands. This study demonstrates how to overcome the mathematical and computational barriers associated with capturing uncertainties in stochastic multiobjective reservoir control optimization, where parallel algorithmic search serves to reduce the wall-clock time in discovering high quality representations of key operational tradeoffs. Our results show that emerging self-adaptive parallelization schemes exploiting cooperative search populations are crucial. Such strategies provide a promising new set of tools for effectively balancing exploration, uncertainty, and computational demands when using EMODPS.

Additive effects prevail: The response of biota to multiple stressors in an intensively monitored watershed.

PubMed

Gieswein, Alexander; Hering, Daniel; Feld, Christian K

2017-09-01

Freshwater ecosystems are impacted by a range of stressors arising from diverse human-caused land and water uses. Identifying the relative importance of single stressors and understanding how multiple stressors interact and jointly affect biology is crucial for River Basin Management. This study addressed multiple human-induced stressors and their effects on the aquatic flora and fauna based on data from standard WFD monitoring schemes. For altogether 1095 sites within a mountainous catchment, we used 12 stressor variables covering three different stressor groups: riparian land use, physical habitat quality and nutrient enrichment. Twenty-one biological metrics calculated from taxa lists of three organism groups (fish, benthic invertebrates and aquatic macrophytes) served as response variables. Stressor and response variables were subjected to Boosted Regression Tree (BRT) analysis to identify stressor hierarchy and stressor interactions and subsequently to Generalised Linear Regression Modelling (GLM) to quantify the stressors standardised effect size. Our results show that riverine habitat degradation was the dominant stressor group for the river fauna, notably the bed physical habitat structure. Overall, the explained variation in benthic invertebrate metrics was higher than it was in fish and macrophyte metrics. In particular, general integrative (aggregate) metrics such as % Ephemeroptera, Plecoptera and Trichoptera (EPT) taxa performed better than ecological traits (e.g. % feeding types). Overall, additive stressor effects dominated, while significant and meaningful stressor interactions were generally rare and weak. We concluded that given the type of stressor and ecological response variables addressed in this study, river basin managers do not need to bother much about complex stressor interactions, but can focus on the prevailing stressors according to the hierarchy identified. Copyright © 2017 Elsevier B.V. All rights reserved.

Multidisciplinary design and analytic approaches to advance prospective research on the multilevel determinants of child health.

PubMed

Johnson, Sara B; Little, Todd D; Masyn, Katherine; Mehta, Paras D; Ghazarian, Sharon R

2017-06-01

Characterizing the determinants of child health and development over time, and identifying the mechanisms by which these determinants operate, is a research priority. The growth of precision medicine has increased awareness and refinement of conceptual frameworks, data management systems, and analytic methods for multilevel data. This article reviews key methodological challenges in cohort studies designed to investigate multilevel influences on child health and strategies to address them. We review and summarize methodological challenges that could undermine prospective studies of the multilevel determinants of child health and ways to address them, borrowing approaches from the social and behavioral sciences. Nested data, variation in intervals of data collection and assessment, missing data, construct measurement across development and reporters, and unobserved population heterogeneity pose challenges in prospective multilevel cohort studies with children. We discuss innovations in missing data, innovations in person-oriented analyses, and innovations in multilevel modeling to address these challenges. Study design and analytic approaches that facilitate the integration across multiple levels, and that account for changes in people and the multiple, dynamic, nested systems in which they participate over time, are crucial to fully realize the promise of precision medicine for children and adolescents. Copyright © 2017 Elsevier Inc. All rights reserved.

SGLT2 inhibitor/DPP-4 inhibitor combination therapy - complementary mechanisms of action for management of type 2 diabetes mellitus.

PubMed

Dey, Jayant

2017-05-01

Type 2 diabetes mellitus is a progressive disease with multiple underlying pathophysiologic defects. Monotherapy alone cannot maintain glycemic control and leads to treatment failure. Ideally, a combination of glucose-lowering agents should have complementary mechanisms of action that address multiple pathophysiologic pathways, can be used at all stages of the disease, and be generally well tolerated with no increased risk of hypoglycemia, cardiovascular events, or weight gain. The combination should also provide conveniences for patients, such as oral dosing, single-pill formulations, and once-daily administration, potentially translating to improved adherence. Two classes of glucose-lowering agents that meet these criteria are the sodium glucose cotransporter-2 (SGLT2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors. This article reviews the rationale for combination therapy with these agents, and evidence from clinical trials with empagliflozin and linagliptin or dapagliflozin and saxagliptin in the management of type 2 diabetes mellitus. Both combinations have been approved as single-pill formulations.

Ecologically sustainable weed management: How do we get from proof-of-concept to adoption?

PubMed

Liebman, Matt; Baraibar, Bàrbara; Buckley, Yvonne; Childs, Dylan; Christensen, Svend; Cousens, Roger; Eizenberg, Hanan; Heijting, Sanne; Loddo, Donato; Merotto, Aldo; Renton, Michael; Riemens, Marleen

2016-07-01

Weed management is a critically important activity on both agricultural and non-agricultural lands, but it is faced with a daunting set of challenges: environmental damage caused by control practices, weed resistance to herbicides, accelerated rates of weed dispersal through global trade, and greater weed impacts due to changes in climate and land use. Broad-scale use of new approaches is needed if weed management is to be successful in the coming era. We examine three approaches likely to prove useful for addressing current and future challenges from weeds: diversifying weed management strategies with multiple complementary tactics, developing crop genotypes for enhanced weed suppression, and tailoring management strategies to better accommodate variability in weed spatial distributions. In all three cases, proof-of-concept has long been demonstrated and considerable scientific innovations have been made, but uptake by farmers and land managers has been extremely limited. Impediments to employing these and other ecologically based approaches include inadequate or inappropriate government policy instruments, a lack of market mechanisms, and a paucity of social infrastructure with which to influence learning, decision-making, and actions by farmers and land managers. We offer examples of how these impediments are being addressed in different parts of the world, but note that there is no clear formula for determining which sets of policies, market mechanisms, and educational activities will be effective in various locations. Implementing new approaches for weed management will require multidisciplinary teams comprised of scientists, engineers, economists, sociologists, educators, farmers, land managers, industry personnel, policy makers, and others willing to focus on weeds within whole farming systems and land management units. © 2016 by the Ecological Society of America.

Management of side effects during and post-treatment in breast cancer survivors.

PubMed

Palesh, Oxana; Scheiber, Caroline; Kesler, Shelli; Mustian, Karen; Koopman, Cheryl; Schapira, Lidia

2018-03-01

Cancer-related fatigue, insomnia, and cancer-related cognitive impairment are commonly experienced symptoms that share psychological and physical manifestations. One or more of these symptoms will affect nearly all patients at some point during their course of treatment or survivorship. These side effects are burdensome and reduce patients' quality of life well beyond their cancer diagnosis and associated care treatments. Cancer-related fatigue, insomnia, and cancer-related cognitive impairment are likely to have multiple etiologies that make it difficult to identify the most effective method to manage them. In this review, we summarized the information on cancer-related fatigue, insomnia, and cancer-related cognitive impairment incidence and prevalence among breast cancer patients and survivors as well as recent research findings on pharmaceutical, psychological, and exercise interventions that have shown effectiveness in the treatment of these side effects. Our review revealed that most current pharmaceutical interventions tend to ameliorate symptoms only temporarily without addressing the underlying causes. Exercise and behavioral interventions are consistently more effective at managing chronic symptoms and possibly address an underlying etiology. Future research is needed to investigate effective interventions that can be delivered directly in clinic to a large portion of patients and survivors. © 2017 Wiley Periodicals, Inc.

E-health systems for management of MDR-TB in resource-poor environments: a decade of experience and recommendations for future work.

PubMed

Fraser, Hamish S F; Habib, Ali; Goodrich, Mark; Thomas, David; Blaya, Joaquin A; Fils-Aime, Joseph Reginald; Jazayeri, Darius; Seaton, Michael; Khan, Aamir J; Choi, Sharon S; Kerrison, Foster; Falzon, Dennis; Becerra, Mercedes C

2013-01-01

Multi-drug resistant TB (MDR-TB) is a complex infectious disease that is a growing threat to global health. It requires lengthy treatment with multiple drugs and specialized laboratory testing. To effectively scale up treatment to thousands of patients requires good information systems to support clinical care, reporting, drug forecasting, supply chain management and monitoring. Over the last decade we have developed the PIH-EMR electronic medical record system, and subsequently OpenMRS-TB, to support the treatment of MDR-TB in Peru, Haiti, Pakistan, and other resource-poor environments. We describe here the experience with implementing these systems and evaluating many aspects of their performance, and review other systems for MDR-TB management. We recommend a new approach to information systems to address the barriers to scale up MDR-TB treatment, particularly access to the appropriate drugs and lab data. We propose moving away from fragmented, vertical systems to focus on common platforms, addressing all stages of TB care, support for open data standards and interoperability, care for a wide range of diseases including HIV, integration with mHealth applications, and ability to function in resource-poor environments.

Time for chronic disease care and management

PubMed Central

Montague, Terrence J; Gogovor, Amédé; Krelenbaum, Marilyn

2007-01-01

To manage the future costs and quality of care, a health strategy must move beyond the individual, acute care model and address the care of older people with chronic, and often multiple, diseases. This strategy must address the issue of care gaps, ie, the differences between best care and usual care. It should also embrace broad partnerships in which providers may be a cross-disciplinary team of nurses, physicians and pharmacists; the patient partners may include all patients in the community with a disease or group of diseases; and the system managers should work with all to seek improved long-term care and share the governance of interventions and resources. This partnership is activated by repeated and widely communicated measurements of actual practices and outcomes, facilitating rapid knowledge gain and translation, including unmasking the invisible wait list of unmeasured care gaps. It drives continuous improvement in practices and outcomes. The time is right for such care models. There is increasing evidence of their clinical and financial benefits. There is a clear and immediate opportunity to evaluate them as part of a health strategy for effective chronic care in our aging society. Things can be better. PMID:17932573

Time for chronic disease care and management.

PubMed

Montague, Terrence J; Gogovor, Amédé; Krelenbaum, Marilyn

2007-10-01

To manage the future costs and quality of care, a health strategy must move beyond the individual, acute care model and address the care of older people with chronic, and often multiple, diseases. This strategy must address the issue of care gaps, ie, the differences between best care and usual care. It should also embrace broad partnerships in which providers may be a cross-disciplinary team of nurses, physicians and pharmacists; the patient partners may include all patients in the community with a disease or group of diseases; and the system managers should work with all to seek improved long-term care and share the governance of interventions and resources. This partnership is activated by repeated and widely communicated measurements of actual practices and outcomes, facilitating rapid knowledge gain and translation, including unmasking the invisible wait list of unmeasured care gaps. It drives continuous improvement in practices and outcomes. The time is right for such care models. There is increasing evidence of their clinical and financial benefits. There is a clear and immediate opportunity to evaluate them as part of a health strategy for effective chronic care in our aging society. Things can be better.

Assessing and managing stressors in a changing marine environment.

PubMed

Chapman, Peter M

2017-11-30

We are facing a dynamic future in the face of multiple stressors acting individually and in combination: climate change; habitat change/loss; overfishing; invasive species; harmful algal blooms/eutrophication; and, chemical contaminants. Historic assessment and management approaches will be inadequate for addressing risks from climate change and other stressors. Wicked problems (non-linear, complex, competing risks and benefits, not easily solvable), will become increasingly common. We are facing irreversible changes to our planetary living conditions. Agreed protection goals and considering both the negatives (risks) and the positives (benefits) of all any and all actions are required, as is judicious and appropriate use of the Precautionary Principle. Researchers and managers need to focus on: determining tipping points (alternative stable points); maintaining ecosystem services; and, managing competing ecosystem services. Marine (and other) scientists are urged to focus their research on wicked problems to allow for informed decision-making on a planetary basis. Copyright © 2016 Elsevier Ltd. All rights reserved.

epiDMS: Data Management and Analytics for Decision-Making From Epidemic Spread Simulation Ensembles.

PubMed

Liu, Sicong; Poccia, Silvestro; Candan, K Selçuk; Chowell, Gerardo; Sapino, Maria Luisa

2016-12-01

Carefully calibrated large-scale computational models of epidemic spread represent a powerful tool to support the decision-making process during epidemic emergencies. Epidemic models are being increasingly used for generating forecasts of the spatial-temporal progression of epidemics at different spatial scales and for assessing the likely impact of different intervention strategies. However, the management and analysis of simulation ensembles stemming from large-scale computational models pose challenges, particularly when dealing with multiple interdependent parameters, spanning multiple layers and geospatial frames, affected by complex dynamic processes operating at different resolutions. We describe and illustrate with examples a novel epidemic simulation data management system, epiDMS, that was developed to address the challenges that arise from the need to generate, search, visualize, and analyze, in a scalable manner, large volumes of epidemic simulation ensembles and observations during the progression of an epidemic. epiDMS is a publicly available system that facilitates management and analysis of large epidemic simulation ensembles. epiDMS aims to fill an important hole in decision-making during healthcare emergencies by enabling critical services with significant economic and health impact. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Managing the identification of the mortal victims run over by a train in the Castelldefels railway accident (Barcelona).

PubMed

Barbería, Eneko; Martin-Fumadó, Carles; Galtés, Ignasi; Subirana-Domenech, Mercé; Puigbarraca-Sol, Lourdes; Vidal-Gutiérrez, Claudina; Valverde-Villarreal, Juan Luis; Castellà-García, Josep; Medallo-Muñiz, Jordi

2015-09-01

The identification of disaster victims is the formal, organized process of identifying multiple bodies after an incident with multiple victims. The appropriate management of these incidents, particularly of the bodies, is one of the most crucial aspects of disaster response and its importance has led to the evolution of the concept of Disaster Victim Management. The aim of this study is to report how the process of identifying the 12 mortal victims of a railway accident in June 2010 in Castelldefels (Barcelona) was managed. The methodology used complied with the National Protocol for medical forensic and scientific police response to mass casualty incidents. The family assistance center also served as an ante mortem (AM) office. Despite the fragmentation of the bodies, all the victims were identified satisfactorily. The main problems observed during the management of the disaster were due to the state of the bodies, which raised many doubts as to the number of fatalities. The experience prompted a proposal to establish some recommendations on limiting the number of fragments to be analyzed genetically. We would like to stress the importance of setting up a Data Integration Center which brought together all the participating institutions, and collected and supervised all the different identification reports in a single comprehensive text addressed to the competent legal authority. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A Case Study on Neural Inspired Dynamic Memory Management Strategies for High Performance Computing.

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

Vineyard, Craig Michael; Verzi, Stephen Joseph

As high performance computing architectures pursue more computational power there is a need for increased memory capacity and bandwidth as well. A multi-level memory (MLM) architecture addresses this need by combining multiple memory types with different characteristics as varying levels of the same architecture. How to efficiently utilize this memory infrastructure is an unknown challenge, and in this research we sought to investigate whether neural inspired approaches can meaningfully help with memory management. In particular we explored neurogenesis inspired re- source allocation, and were able to show a neural inspired mixed controller policy can beneficially impact how MLM architectures utilizemore » memory.« less

Automatic HDL firmware generation for FPGA-based reconfigurable measurement and control systems with mezzanines in FMC standard

NASA Astrophysics Data System (ADS)

Wojenski, Andrzej; Kasprowicz, Grzegorz; Pozniak, Krzysztof T.; Romaniuk, Ryszard

2013-10-01

The paper describes a concept of automatic firmware generation for reconfigurable measurement systems, which uses FPGA devices and measurement cards in FMC standard. Following sections are described in details: automatic HDL code generation for FPGA devices, automatic communication interfaces implementation, HDL drivers for measurement cards, automatic serial connection between multiple measurement backplane boards, automatic build of memory map (address space), automatic generated firmware management. Presented solutions are required in many advanced measurement systems, like Beam Position Monitors or GEM detectors. This work is a part of a wider project for automatic firmware generation and management of reconfigurable systems. Solutions presented in this paper are based on previous publication in SPIE.

Evaluation of Ensemble Water Supply and Demands Forecasts for Water Management in the Klamath River Basin

NASA Astrophysics Data System (ADS)

Broman, D.; Gangopadhyay, S.; McGuire, M.; Wood, A.; Leady, Z.; Tansey, M. K.; Nelson, K.; Dahm, K.

2017-12-01

The Upper Klamath River Basin in south central Oregon and north central California is home to the Klamath Irrigation Project, which is operated by the Bureau of Reclamation and provides water to around 200,000 acres of agricultural lands. The project is managed in consideration of not only water deliveries to irrigators, but also wildlife refuge water demands, biological opinion requirements for Endangered Species Act (ESA) listed fish, and Tribal Trust responsibilities. Climate change has the potential to impact water management in terms of volume and timing of water and the ability to meet multiple objectives. Current operations use a spreadsheet-based decision support tool, with water supply forecasts from the National Resources Conservation Service (NRCS) and California-Nevada River Forecast Center (CNRFC). This tool is currently limited in its ability to incorporate in ensemble forecasts, which offer the potential for improved operations by quantifying forecast uncertainty. To address these limitations, this study has worked to develop a RiverWare based water resource systems model, flexible enough to use across multiple decision time-scales, from short-term operations out to long-range planning. Systems model development has been accompanied by operational system development to handle data management and multiple modeling components. Using a set of ensemble hindcasts, this study seeks to answer several questions: A) Do a new set of ensemble streamflow forecasts have additional skill beyond what?, and allow for improved decision making under changing conditions? B) Do net irrigation water requirement forecasts developed in this project to quantify agricultural demands and reservoir evaporation forecasts provide additional benefits to decision making beyond water supply forecasts? C) What benefit do ensemble forecasts have in the context of water management decisions?

Every Child Left Behind -- Addressing One Important Effect of Multiple Deployments

DTIC Science & Technology

2009-03-25

St ra te gy Re se ar ch Pr oj ec t EVERY CHILD LEFT BEHIND – ADDRESSING ONE IMPORTANT EFFECT OF MULTIPLE DEPLOYMENTS BY LIEUTENANT COLONEL TYLER J...To) 4. TITLE AND SUBTITLE Every Child Left Behind – Addressing One Important Effect of Multiple Deployments 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c...Form 298 (Rev. 8-98) Prescribed by ANSI Std. Z39.18 USAWC STRATEGY RESEARCH PROJECT EVERY CHILD LEFT BEHIND – ADDRESSING ONE IMPORTANT EFFECT OF

Timing of Surgery and Rehabilitation to Optimize Outcome for Patients with Multiple Ligament Knee Injuries: A Multicenter Clinical Trial

DTIC Science & Technology

2017-10-01

those of the author(s) and should not be construed as an official Department of the Army position, policy or decision unless so designated by other...display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT DATE October 2017 2. REPORT TYPE Annual 3...frequently associated with concomitant injuries to nerves, vessels, tendons, cartilage and menisci. Non -operative management of MLKIs results in poor

From Classroom to Wardroom: Internalizing, Integrating and Reinforcing Leadership and Management, Education and Training (LMET) Skills in the Navy

DTIC Science & Technology

1983-12-01

8217 by business concerns. Every handicraft, all human dealings, are constantly in that danger. (Heidegger, 1954) Emile Durkheim addressed the problem... Durkheim , 1893) Weber, in his controversial study, The Protestant Ethic and the Spirit of Capitalization, also noted this "multiplicity of perspectives and...196n....... • Durkheim , E., The Division of Labor in Society, Macmillan Publishing Co., Inc., 1933. Eddy, W.B., "From Training to Organization Change

A Model for the Management of Supplemental Care Expenditures for Computed Tomography (CT) Scans at Irwin Army Community Hospital, Fort Riley, Kansas

DTIC Science & Technology

1989-07-24

NUMBER ORGANIZATION (If applicable) Bc. ADDRESS (City, State, and ZIP Code) 10 SOURCE OF FUNDING NUMBERS PROGRAM IPROJECT ITASK IWORK UNIT ELEMENT NO NO...A mobile CT scanner with transporter vehicle has been purchased for IACH by Defense Personnel Support Center as part of a multiple unit purchase...lag time inherent in the procurement of high-cost, high technology medical equipment. Current indications are that the unit will be 1 installed some

Contracting Officer's Technical Representatives

NASA Technical Reports Server (NTRS)

Brisbin, Steve

1997-01-01

The Breakout Session is a traditional conference instrument used by the NASA Occupational Health Program (OHP) as a method to convene people with common interests. Typically these sessions provide discussion of current topics of high priority and currency and allow multiple views and opinions to be shared and evaluated by all participants. Since the Contracting Officer's Technical Representatives (COTRs) occupy the technical focus of support contract management, this particular group, attended by 20 representatives, addressed issues and topics at the forefront of operational concerns.

Improving the integration of recreation management with management of other natural resources by applying concepts of scale from ecology.

PubMed

Morse, Wayde C; Hall, Troy E; Kruger, Linda E

2009-03-01

In this article, we examine how issues of scale affect the integration of recreation management with the management of other natural resources on public lands. We present two theories used to address scale issues in ecology and explore how they can improve the two most widely applied recreation-planning frameworks. The theory of patch dynamics and hierarchy theory are applied to the recreation opportunity spectrum (ROS) and the limits of acceptable change (LAC) recreation-planning frameworks. These frameworks have been widely adopted internationally, and improving their ability to integrate with other aspects of natural resource management has significant social and conservation implications. We propose that incorporating ecologic criteria and scale concepts into these recreation-planning frameworks will improve the foundation for integrated land management by resolving issues of incongruent boundaries, mismatched scales, and multiple-scale analysis. Specifically, we argue that whereas the spatially explicit process of the ROS facilitates integrated decision making, its lack of ecologic criteria, broad extent, and large patch size decrease its usefulness for integration at finer scales. The LAC provides explicit considerations for weighing competing values, but measurement of recreation disturbances within an LAC analysis is often done at too fine a grain and at too narrow an extent for integration with other recreation and resource concerns. We suggest that planners should perform analysis at multiple scales when making management decisions that involve trade-offs among competing values. The United States Forest Service is used as an example to discuss how resource-management agencies can improve this integration.

Knowledge production and learning for sustainable landscapes: seven steps using social-ecological systems as laboratories.

PubMed

Angelstam, Per; Elbakidze, Marine; Axelsson, Robert; Dixelius, Malcolm; Törnblom, Johan

2013-03-01

There are multiple challenges regarding use and governance of landscapes' goods, functions and intangible values for ecosystem health and human well-being. One group of challenges is to measure and assess principal sustainability dimensions through performance targets, so stakeholders have transparent information about states and trends. Another group is to develop adaptive governance at multiple levels, and management of larger geographical areas across scales. Addressing these challenges, we present a framework for transdisciplinary research using multiple landscapes as place-based case studies that integrates multiple research disciplines and non-academic actors: (1) identify a suite of landscapes, and for each (2) review landscape history, (3) map stakeholders, use and non-use values, products and land use, (4) analyze institutions, policies and the system of governance, (5) measure ecological, economic, social and cultural sustainability, (6) assess sustainability dimensions and governance, and finally (7) make comparisons and synthesize. Collaboration, communication and dissemination are additional core features. We discuss barriers bridges and bridges for applying this approach.

Scalable multi-sample single-cell data analysis by Partition-Assisted Clustering and Multiple Alignments of Networks

PubMed Central

Samusik, Nikolay; Wang, Xiaowei; Guan, Leying; Nolan, Garry P.

2017-01-01

Mass cytometry (CyTOF) has greatly expanded the capability of cytometry. It is now easy to generate multiple CyTOF samples in a single study, with each sample containing single-cell measurement on 50 markers for more than hundreds of thousands of cells. Current methods do not adequately address the issues concerning combining multiple samples for subpopulation discovery, and these issues can be quickly and dramatically amplified with increasing number of samples. To overcome this limitation, we developed Partition-Assisted Clustering and Multiple Alignments of Networks (PAC-MAN) for the fast automatic identification of cell populations in CyTOF data closely matching that of expert manual-discovery, and for alignments between subpopulations across samples to define dataset-level cellular states. PAC-MAN is computationally efficient, allowing the management of very large CyTOF datasets, which are increasingly common in clinical studies and cancer studies that monitor various tissue samples for each subject. PMID:29281633

UK guidance on the management of personal dosimetry systems for healthcare staff working at multiple organizations.

PubMed

Rogers, Andy; Chapple, Claire-Louise; Murray, Maria; Platton, David; Saunderson, John

2017-11-01

There has been concern expressed by the UK regulator, the Health & Safety Executive, regarding the management of occupation dose for healthcare radiation workers who work across multiple organizations. In response to this concern, the British Institute of Radiology led a working group of relevant professional bodies to develop guidance in this area. The guidance addresses issues of general system management that would apply to all personal dosimetry systems, regardless of whether or not the workers within that system work across organizational boundaries, along with exploring efficient strategies to comply with legislation where those workers do indeed work across organizational boundaries. For those specific instances, the guidance discusses both system requirements to enable organizations to co-operate (Ionising Radiation Regulations 1999 Regulation 15), as well as specific instances of staff exposure. This is broken down into three categories-low, medium and high risk. A suggested approach to each is given to guide employers and their radiation advisers in adopting sensible strategies for the monitoring of their staff and the subsequent sharing of dosimetry data to ensure overall compliance with both dose limits and optimization requirements.

North Carolina Medicaid recipient management lock-in program: the pharmacist's perspective.

PubMed

Werth, S Rose; Sachdeva, Nidhi; Roberts, Andrew W; Garrettson, Mariana; Ringwalt, Chris; Moss, Leslie A; Pikoulas, Theodore; Skinner, Asheley Cockrell

2014-11-01

The misuse and abuse of prescription opioids have become an urgent health issue in North Carolina (NC), particularly among Medicaid patients who suffer high rates of morbidity and mortality due to abuse and overdose. The NC Division of Medical Assistance (DMA) implemented a recipient management lock-in program, which limits identified patients for a 12-month period to 1 prescriber and 1 pharmacy for benzodiazepine, opiate, and certain anxiolytic prescriptions in order to prevent misuse and reduce overutilization of Medicaid benefits.  To (a) evaluate pharmacists' perceptions of the implementation of the NC recipient management lock-in program (MLIP) and (b) determine how the beliefs and attitudes of pharmacists could promote or inhibit its success.  We conducted 12 structured phone interviews with NC pharmacists serving lock-in patients. Interview responses were analyzed through construct analysis, which identified themes organized into 3 domains: organization and implementation, perceived effectiveness, and acceptability.  Most respondents reported a positive experience with the program but expressed doubt concerning its impact on prescription drug abuse. The program successfully utilized the pharmacist role as a gatekeeper of controlled substances, and the procedures of the program required no active effort on pharmacists' part. However, respondents suggested that the DMA improve communication and outreach to address pharmacists' lack of knowledge about the program's purpose and confusion over remediating problems that arise with lock-in patients. The DMA should also address the ways in which the program can interfere with access to health care and treatment, allow patients to see multiple physicians within the same clinic, and clarify procedures for patients whose complex health issues require multiple specialists.  Although possible improvements were identified, the NC MLIP has strong potential for success as it utilizes pharmacists' medication gate-keeping role, while minimizing the effort required for successful implementation.

Mammal responses to the human footprint vary across species and stressors.

PubMed

Toews, Mary; Juanes, Francis; Burton, A Cole

2018-07-01

A rapidly expanding human footprint - comprised of anthropogenic land-use change and infrastructure - is profoundly affecting wildlife distributions worldwide. Cumulative effects management (CEM) is a regional approach that seeks to manage combined effects of the human footprint on biodiversity across large spatial scales. Challenges to implementing this approach include a lack of ecological data at large spatial scales, the high cost of monitoring multiple indicators, and the need to manage multiple footprints across industries. To inform development of effective CEM, we used large mammals as indicators to address the following questions: a) do species respond more strongly to individual footprint features or to cumulative effects (combined area of all footprint types, measured as total footprint), b) which features elicit the strongest responses across species, and c) are the direction of responses to footprint consistent? We used data from 12 years of snowtrack surveys (2001-2013) in the boreal forest of Alberta, coupled with regional footprint and landcover data, to develop generalized linear mixed-effects models relating the relative abundance of five boreal mammals [gray wolf (Canis lupus), Canada lynx (Lynx canadensis), coyote (Canis latrans), white-tailed deer (Odocoileus virginianus) and moose (Alces alces)] to individual and cumulative effects of the human footprint. We found that across species the strongest responses were to agriculture, roads, and young cutblocks (<10 years), suggesting these as potential priority stressors to address within CEM. Most species also responded to total footprint, indicating that in the absence of detailed information on individual features, this coarse measure can serve as an index of cumulative effects. There was high variability in direction and magnitude of responses across species, indicating that community-level responses are likely and should be considered within CEM planning. Copyright © 2018 Elsevier Ltd. All rights reserved.

How Perceptions of Mental Illness Impact EAP Utilization.

PubMed

McRee, Jayme

2017-01-01

Studies of employee assistance program (EAP) clinical use across multiple industries and multiple EAP delivery models range from highs greater than 5% to lows of less than 1 %. Despite the range in utilization, the rates of employee behaviors that indicate a behavioral health issue are significantly higher, suggesting far too little use of EAPs overall. Studies of the costs to an employer for an employee with a mental health issue are as high as 37% lost annual productivity. EAPs have attempted to raise utilization through a variety of efforts, with mixed results. Most EAP utilization initiatives fail to address the impact of stigma, misunderstandings about mental illness and the reluctance of many employees to seek counseling as an option for better management of stress, work-life balance and overall mental wellness. For both employers and EAPs, addressing the impact of stigma and perceptions of mental illness is costly, requiring greater direct employee engagement and education. However, it is a more effective means of increasing EAP use than current practices and, ultimately, can result in significantly higher net gains in productivity while reducing employers' direct costs.

MABEL at IPAC: managing address books and email lists at the Infrared Processing and Analysis Center

NASA Astrophysics Data System (ADS)

Crane, Megan; Brinkworth, Carolyn; Gelino, Dawn; O'Leary, Ellen

2012-09-01

The Infrared Processing and Analysis Center (IPAC), located on the campus of the California Institute of Technology, is NASA's multi-mission data center for infrared astrophysics. Some of IPAC's services include administering data analysis funding awards to the astronomical community, organizing conferences and workshops, and soliciting and selecting fellowship and observing proposals. As most of these services are repeated annually or biannually, it becomes necessary to maintain multiple lists of email contacts associated with each service. MABEL is a PHP/MySQL web database application designed to facilitate this process. It serves as an address book containing up-to-date contact information for thousands of recipients. Recipients may be assigned to any number of email lists categorized by IPAC project and team. Lists may be public (viewable by all project members) or private (viewable only by team members). MABEL can also be used to send HTML or plain-text emails to multiple lists at once and prevents duplicate emails to a single recipient. This work was performed at the California Institute of Technology under contract to the National Aeronautics and Space Administration.

Why infectious disease research needs community ecology

PubMed Central

Johnson, Pieter T. J.; de Roode, Jacobus C.; Fenton, Andy

2016-01-01

Infectious diseases often emerge from interactions among multiple species and across nested levels of biological organization. Threats as diverse as Ebola virus, human malaria, and bat white-nose syndrome illustrate the need for a mechanistic understanding of the ecological interactions underlying emerging infections. We describe how recent advances in community ecology can be adopted to address contemporary challenges in disease research. These analytical tools can identify the factors governing complex assemblages of multiple hosts, parasites, and vectors, and reveal how processes link across scales from individual hosts to regions. They can also determine the drivers of heterogeneities among individuals, species, and regions to aid targeting of control strategies. We provide examples where these principles have enhanced disease management and illustrate how they can be further extended. PMID:26339035

Dilemmas in Treating Smoldering Multiple Myeloma

PubMed Central

Ahn, Inhye E.; Mailankody, Sham; Korde, Neha; Landgren, Ola

2015-01-01

Novel therapies hold promise for high-risk smoldering multiple myeloma (SMM). Recent studies suggest that modern combination approaches can be options for high-risk SMM to obtain deep molecular responses with favorable toxicity profiles. Although pioneering treatment trials based on small numbers of patients suggest progression-free and overall survival benefits, application of the data to real-life practice remains to be validated. Therapeutic modulation of disease tempo, disease burden, clonal evolution, and tumor microenvironment in SMM remains to be understood and calls for reliable biomarkers reflective of disease biology. Here, we review studies that open a new management platform for SMM, address ongoing dilemmas in practice and under investigation, and highlight emerging scientific questions in the era of SMM treatment. PMID:25422486

Educational interventions to enhance competencies for interprofessional collaboration among nurse and physician managers: An integrative review.

PubMed

Clausen, Christina; Cummins, Kelly; Dionne, Kelley

2017-11-01

Collaborative leadership and management structures are critical to transforming care delivery. Both nurse and physician managers are uniquely positioned to co-lead. However, little is known on how to prepare and support individuals for these co-leader arrangements. The re-design of healthcare professional education focuses on interprofessional collaboration, mutual learning, and a competency-based approach. While competencies for interprofessional collaboration have been delineated, competencies for collaborative management practice have yet to be addressed. An integrative review of empirical studies on existing educational interventions was conducted to critically appraise and synthesise the results regarding collaborative competence among nurse and physician leaders. We reviewed how these interventions have been designed, implemented, and evaluated within workplace settings in order to inform our understanding of what components are effective or ineffective for the future development of an educational programme. This review reports on key characteristics of nine empirical studies and emphasises that: a uniprofessional approach to leadership development is predominant within educational programmes and that the assessment of shared learning experiences are not addressed; there are inconsistency in terms used to describe competencies by individual researchers and limitations within the competency frameworks used in the studies reviewed; and there is a lack of suitable instruments available to assess whether competencies have been achieved through the educational programmes. None of the studies discussed the process of how individuals learned specific competencies or whether learning outcome were achieved. Educational programmes were developed based on a perceived lack of leadership preparation and orientation programmes for leaders in formal management positions and used multiple interventions. Only two of the programmes involved organisational or systems level competencies. Interprofessional co-leading requires enhanced capabilities and capacity for managers. There is a need for developing an in-action education intervention that addresses the unique learning needs of co-leader arrangements particularly among nurses and physicians who are new to their role.

Insider Threat and Information Security Management

NASA Astrophysics Data System (ADS)

Coles-Kemp, Lizzie; Theoharidou, Marianthi

The notion of insider has multiple facets. An organization needs to identify which ones to respond to. The selection, implementetion and maintenance of information security countermeasures requires a complex combination of organisational policies, functions and processes, which form Information Security Management. This chapter examines the role of current information security management practices in addressing the insider threat. Most approaches focus on frameworks for regulating insider behaviour and do not allow for the various cultural responses to the regulatory and compliance framework. Such responses are not only determined by enforcement of policies and awareness programs, but also by various psychological and organisational factors at an individual or group level. Crime theories offer techniques that focus on such cultural responses and can be used to enhance the information security management design. The chapter examines the applicability of several crime theories and concludes that they can contribute in providing additional controls and redesign of information security management processes better suited to responding to the insider threat.

An SSH key management system: easing the pain of managing key/user/account associations

NASA Astrophysics Data System (ADS)

Arkhipkin, D.; Betts, W.; Lauret, J.; Shiryaev, A.

2008-07-01

Cyber security requirements for secure access to computing facilities often call for access controls via gatekeepers and the use of two-factor authentication. Using SSH keys to satisfy the two factor authentication requirement has introduced a potentially challenging task of managing the keys and their associations with individual users and user accounts. Approaches for a facility with the simple model of one remote user corresponding to one local user would not work at facilities that require a many-to-many mapping between users and accounts on multiple systems. We will present an SSH key management system we developed, tested and deployed to address the many-to-many dilemma in the environment of the STAR experiment. We will explain its use in an online computing context and explain how it makes possible the management and tracing of group account access spread over many sub-system components (data acquisition, slow controls, trigger, detector instrumentation, etc.) without the use of shared passwords for remote logins.

Management of the marine environment: integrating ecosystem services and societal benefits with the DPSIR framework in a systems approach.

PubMed

Atkins, Jonathan P; Burdon, Daryl; Elliott, Mike; Gregory, Amanda J

2011-02-01

Ever increasing and diverse use of the marine environment is leading to human-induced changes in marine life, habitats and landscapes, making necessary the development of marine policy that considers all members of the user community and addresses current, multiple, interacting uses. Taking a systems approach incorporating an understanding of The Ecosystem Approach, we integrate the DPSIR framework with ecosystem services and societal benefits, and the focus this gives allows us to create a specific framework for supporting decision making in the marine environment. Based on a linking of these three concepts, we present a set of basic postulates for the management of the marine environment and emphasise that these postulates should hold for marine management to be achieved. We illustrate these concepts using two case studies: the management of marine aggregates extraction in UK waters and the management of marine biodiversity at Flamborough Head, UK. Copyright © 2010 Elsevier Ltd. All rights reserved.

Facilitating adaptive management in a government program: A household energy efficiency case study.

PubMed

Curtis, Jim; Graham, Alex; Ghafoori, Eraj; Pyke, Susan; Kaufman, Stefan; Boulet, Mark

2017-02-01

Interim evaluations of government programs can sometimes reveal lower than expected outcomes, leading to the question of how adjustments can be made while the program is still underway. Although adaptive management frameworks can provide a practical roadmap to address this question, a lack of successful learnings and poor implementation have hampered the progress and wider application of adaptive management. Using a case study involving an energy efficiency government program targeting low-income households, this article provides supporting evidence on how adaptive management can be facilitated and applied. Factors such as proactive and responsive leadership, establishing a research-practice interface, and recognizing the skills, expertise, and contributions of multiple stakeholders guided adjustments to the program, and later paved the way for longer-term organizational learning that impacted how other programs are delivered. Implications for knowledge and practice, and a discussion of the challenges faced in the program, advance current thinking in adaptive management. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Core of Care Management: The Role of Authentic Relationships in Caring for Patients with Frequent Hospitalizations

PubMed Central

Hawthorne, Margaret; LaNoue, Marianna; Brenner, Jeffrey

2016-01-01

Abstract In the movement to improve the health of patients with multiple chronic conditions and vulnerabilities, while reducing the need for hospitalizations, care management programs have garnered wide attention and support. The qualitative data presented in this paper sheds new light on key components of successful chronic care management programs. By going beyond a task- and temporal-based framework, this analysis identifies and defines the importance of “authentic healing relationships” in driving individual and systemic change. Drawing on the voices of 30 former clients of the Camden Coalition of Healthcare Providers, the investigators use qualitative methods to identify and elaborate the core elements of the authentic healing relationship—security, genuineness, and continuity—a relationship that is linked to patient motivation and active health management. Although not readily found in the traditional health care delivery system, these authentic healing relationships present significant implications for addressing the persistent health-related needs of patients with frequent hospitalizations. (Population Health Management 2016;19:248–256) PMID:26565379

Aquifer-yield continuum as a guide and typology for science-based groundwater management

NASA Astrophysics Data System (ADS)

Pierce, Suzanne A.; Sharp, John M.; Guillaume, Joseph H. A.; Mace, Robert E.; Eaton, David J.

2013-03-01

Groundwater availability is at the core of hydrogeology as a discipline and, simultaneously, the concept is the source of ambiguity for management and policy. Aquifer yield has undergone multiple definitions resulting in a range of scientific methods to calculate and model availability reflecting the complexity of combined scientific, management, policy, and stakeholder processes. The concept of an aquifer-yield continuum provides an approach to classify groundwater yields along a spectrum, from non-use through permissive sustained, sustainable, maximum sustained, safe, permissive mining to maximum mining yields, that builds on existing literature. Additionally, the aquifer-yield continuum provides a systems view of groundwater availability to integrate physical and social aspects in assessing management options across aquifer settings. Operational yield describes the candidate solutions for operational or technical implementation of policy, often relating to a consensus yield that incorporates human dimensions through participatory or adaptive governance processes. The concepts of operational and consensus yield address both the social and the technical nature of science-based groundwater management and governance.

Global-view coefficients: a data management solution for parallel quantum Monte Carlo applications: A DATA MANAGEMENT SOLUTION FOR QMC APPLICATIONS

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

Niu, Qingpeng; Dinan, James; Tirukkovalur, Sravya

2016-01-28

Quantum Monte Carlo (QMC) applications perform simulation with respect to an initial state of the quantum mechanical system, which is often captured by using a cubic B-spline basis. This representation is stored as a read-only table of coefficients and accesses to the table are generated at random as part of the Monte Carlo simulation. Current QMC applications, such as QWalk and QMCPACK, replicate this table at every process or node, which limits scalability because increasing the number of processors does not enable larger systems to be run. We present a partitioned global address space approach to transparently managing this datamore » using Global Arrays in a manner that allows the memory of multiple nodes to be aggregated. We develop an automated data management system that significantly reduces communication overheads, enabling new capabilities for QMC codes. Experimental results with QWalk and QMCPACK demonstrate the effectiveness of the data management system.« less

A web-based approach to managing stress and mood disorders in the workforce.

PubMed

Billings, Douglas W; Cook, Royer F; Hendrickson, April; Dove, David C

2008-08-01

To evaluate the effectiveness of a web-based multimedia health promotion program for the workplace, designed to help reduce stress and to prevent depression, anxiety, and substance abuse. Using a randomized controlled trial design, 309 working adults were randomly assigned to the web-based condition or to a wait-list control condition. All participants were assessed on multiple self-reported outcomes at pretest and posttest. Relative to controls, the web-based group reduced their stress, increased their knowledge of depression and anxiety, developed more positive attitudes toward treatment, and adopted a more healthy approach to alcohol consumption. We found that a brief and easily adaptable web-based stress management program can simultaneously reduce worker stress and address stigmatized behavioral health problems by embedding this prevention material into a more positive stress management framework.

Assessing risk from a stakeholder perspective

NASA Technical Reports Server (NTRS)

Cooper, L. P.

2003-01-01

Planetary exploration missions are subject to a vast array of interpretations of 'success' based on the concerns of multiple stakeholder groups. While project risk management generally focuses on issues of cost/schedule constraints or reliability issues, a broader interpretation of 'risk' as it applies to stakeholders such as sponsors (e.g., NASA), the public at large, the scientific community, the home organization, and the project team itself can provide important insights into the full spectrum of risk that needs to be managed. This paper presents a stakeholder view of risk which is divided into failure, not-a-failure, success, and stunning-success zones. Using the Mars Pathfinder mission as an example, an alternative interpretation of the risks to that mission is presented from the view of key stakeholders. The implications of the stakeholder perspective to project risk management are addressed.

LHCb migration from Subversion to Git

NASA Astrophysics Data System (ADS)

Clemencic, M.; Couturier, B.; Closier, J.; Cattaneo, M.

2017-10-01

Due to user demand and to support new development workflows based on code review and multiple development streams, LHCb decided to port the source code management from Subversion to Git, using the CERN GitLab hosting service. Although tools exist for this kind of migration, LHCb specificities and development models required careful planning of the migration, development of migration tools, changes to the development model, and redefinition of the release procedures. Moreover we had to support a hybrid situation with some software projects hosted in Git and others still in Subversion, or even branches of one projects hosted in different systems. We present the way we addressed the special LHCb requirements, the technical details of migrating large non standard Subversion repositories, and how we managed to smoothly migrate the software projects following the schedule of each project manager.

Methods for exploring uncertainty in groundwater management predictions

USGS Publications Warehouse

Guillaume, Joseph H. A.; Hunt, Randall J.; Comunian, Alessandro; Fu, Baihua; Blakers, Rachel S; Jakeman, Anthony J.; Barreteau, Olivier; Hunt, Randall J.; Rinaudo, Jean-Daniel; Ross, Andrew

2016-01-01

Models of groundwater systems help to integrate knowledge about the natural and human system covering different spatial and temporal scales, often from multiple disciplines, in order to address a range of issues of concern to various stakeholders. A model is simply a tool to express what we think we know. Uncertainty, due to lack of knowledge or natural variability, means that there are always alternative models that may need to be considered. This chapter provides an overview of uncertainty in models and in the definition of a problem to model, highlights approaches to communicating and using predictions of uncertain outcomes and summarises commonly used methods to explore uncertainty in groundwater management predictions. It is intended to raise awareness of how alternative models and hence uncertainty can be explored in order to facilitate the integration of these techniques with groundwater management.

Hyperpigmentation therapy: a review.

PubMed

Desai, Seemal R

2014-08-01

With an increasing number of multicultural patients and those of different backgrounds presenting in dermatology clinics, issues facing patients with higher Fitzpatrick skin classifications, often referred to as skin of color patients, are on the rise. Knowledge of the diagnostic dilemmas, cutting edge treatment options, and latest clinical research in the diagnosis and management of cutaneous anomalies in skin of color patients is of paramount importance. Of the most common complaints in patients with skin of color is hyperpigmentation. Despite the availability of multiple treatments for the condition, hyperpigmentation continues to present clinical management challenges for dermatologists. Difficulty may be traced to physician or patient reluctance to use certain agents or interventions, failure to identify and avoid contributing factors, and insufficient attention paid to the psychosocial aspects of the disease. This review addresses a variety of issues including the diagnosis and management of hyperpigmentation.

Venue of receiving diabetes self-management education and training and its impact on oral diabetic medication adherence.

PubMed

Wu, Jun; Davis-Ajami, Mary Lynn; Noxon, Virginia; Lu, Zhiqiang Kevin

2017-04-01

To determine predictors associated with the diabetes self-management education and training (DSME) venue and its impact on oral antidiabetic (OAD) medication adherence. The Medical Expenditure Panel Survey household component (MEPS-HC) data (2010-2012) identified adults with diabetes prescribed OAD medication(s) who completed a supplemental Diabetes Care Survey (DCS). Based on the DCS responses to questions about the number and type of DSME venue(s), two groups were created: (1) multiple venues (a physician or health professional plus internet and/or group classes) vs (2) single venue (physician or health professional only). The medication possession ratio (MPR) measured medication adherence, with 0.80 the cut-point defining adherent. Logistic regression examined factors associated with the DSME venue and its effect on OAD medication adherence. Of the 2119 respondents, 41.6% received DSME from multiple venues. Age (<65years), education-level (college or higher), high-income, and diet modification were significantly more likely associated with receiving DSME from multiple venues. In single vs multiple venues, medication adherence was suboptimal (mean MPR 0.66 vs 0.64, p=0.245), and venue showed no influence on adherence (OR: 0.92, 95% CI, 0.73-1.16). Sociodemographic characteristics influence where adults with diabetes receive DSME. Adding different DSME venues may not address suboptimal OAD medication adherence. Copyright © 2016 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

A challenge for land and risk managers: differents stakeholders, differents definitions of the risks

NASA Astrophysics Data System (ADS)

Fernandez, M.; Ruegg, J.

2012-04-01

In developing countries, mountain populations and territories are subject to multiple risks and vulnerabilities. In addition, they face even greater challenges than developed countries due to lack of knowledge, resources and technology. There are many different types of actors in society that manage risk at various scales and levels (i.e. engineers, geologists, administrators, land use planners, merchants and local indigenous and non-indigenous people). Because of limited resources and possibilities to reduce all types of risk, these different actors, or 'risk managers' have to choose and compete to prioritize which types of risks to address. This paper addresses a case study from San Cristobal Altaverapaz, Guatemala where a large landslide "Los Chorros", a catastrophic collapse of 6 millions cubic meters of rock, is affecting several communities and one of the country's main west-east access highways. In this case, the government established that the "primary" risk is the landslide, whereas other local stakeholders consider the primary risks to be economic This paper, situated at the cross section between political science, geography and disaster risk management, addresses the social conflict and competition for priorities and solutions for risk management, depending on the group of actors based on the on-going Los Chorros, Guatemala landslide mitigation process. This work is based on the analysis of practices, (Practical Science), policies and institutions in order to understand how the inclusion of multiple stakeholders in determining risk priorities can lead to more sustainable risk management in a given territory. The main objective of this investigation is first to identify and understand the juxtaposition of different readings of the risk equation, usually considered the interface between vulnerability, exposure and hazards. Secondly, it is to analyze the mechanisms of actions taken by various stakeholders, or risk managers. The analysis focuses on the various solutions proposed for reducing vulnerabilities (and consequentially their risks). To resolve a post-disaster situation, the actors prioritize one main type of vulnerability to address a set of vulnerabilities (in a multi-vulnerability context). With this choice, they define their own acceptable risk limits and the type of action that is most relevant. In doing so, they have to determine what elements can be changed and improved and which elements must be considered essential and preserved or the priority variables. These may include: equipment, production facilities, networks, services, modes of production and organizations, etc. or various economic and social capitals upon which individuals and groups rely for recovering from a post-disaster situation. Depending on the actor, certain factors will be will be emphasized over others and these may change over time. Linked with this political, institutional and geographical analysis of risk management, this work also questions who are the legitimate actors and the right criteria to prioritize risk reduction actions using public funds criteria and finally, which motivations are satisfied. In this sense, the challenge for managers of natural hazards is to move from risk management in the strict sense, which focuses mainly on hazards only, to a broader risks management, taking into consideration what is important for society and for the functioning of systems (what have not be vulnerable in a territorial system). In a context where risk and risk management is produced and managed by both formal and informal stakeholders, the main issue is how to engage the various stakeholders and evaluate different priorities of risk in order to determine which actions are best suited for a more balanced approach to risk management. This case study demonstrates that reducing landslide risk is subject to interpretation depending on the stakeholder and the result of priorities, providing on the role of each actor, their needs and range of action with a territory.

Service delivery under translation: multi-stakeholder accountability in the non-profit community sector in New Zealand.

PubMed

Boon, Bronwyn; Greatbanks, Richard; Munro, Jenny; Gaffney, Michael

2017-03-01

This paper addresses the challenge reported in the research literature of providing adequate accounts of service quality and value to multiple stakeholders. Rather than starting with a particular accountability practice, we examine the accounts of complex service delivery and results from the perspective of five key stakeholder groups. The case study at the empirical centre of this research is a small New Zealand non-profit organisation that provides community-based wraparound casework to young people, and their families, with multiple and complex needs. This paper reports on data collected during 2009-2012 through interviews with five key stakeholders of this service: the young people, the caseworkers, the co-providers, the managers and the funders. Drawing on translation theory, the different points of reference and the consequential shifts in focus, content and meaning within the multiple stakeholder accounts are traced. The findings show that while each stakeholder group brings a unique point of reference to the service delivery, there are degrees of overlap in the focus and content of the accounts. This is particularly evident in the 'relationship' dimension. While overlaps may exist, points of invisibility are also revealed. Accountability tensions can be traced directly to these points of invisibility. As a result of this analysis, it is argued that more explicit attention to the impact of multiple stakeholders at the level of epistemology provides a mechanism for addressing some of the tensions routinely raised. © 2015 John Wiley & Sons Ltd.

Understanding and managing compliance in the nature conservation context.

PubMed

Arias, Adrian

2015-04-15

Nature conservation relies largely on peoples' rule adherence. However, noncompliance in the conservation context is common: it is one of the largest illegal activities in the world, degrading societies, economies and the environment. Understanding and managing compliance is key for ensuring effective conservation, nevertheless crucial concepts and tools are scattered in a wide array of literature. Here I review and integrate these concepts and tools in an effort to guide compliance management in the conservation context. First, I address the understanding of compliance by breaking it down into five key questions: who?, what?, when?, where? and why?. A special focus is given to 'why?' because the answer to this question explains the reasons for compliance and noncompliance, providing critical information for management interventions. Second, I review compliance management strategies, from voluntary compliance to coerced compliance. Finally, I suggest a system, initially proposed for tax compliance, to balance these multiple compliance management strategies. This paper differs from others by providing a broad yet practical scope on theory and tools for understanding and managing compliance in the nature conservation context. Copyright © 2015 Elsevier Ltd. All rights reserved.

Merging Methods to Manage Uncertainty: Combining Simulation Modeling and Scenario Planning to Inform Resource Management Under Climate Change

NASA Astrophysics Data System (ADS)

Miller, B. W.; Schuurman, G. W.; Symstad, A.; Fisichelli, N. A.; Frid, L.

2017-12-01

Managing natural resources in this era of anthropogenic climate change is fraught with uncertainties around how ecosystems will respond to management actions and a changing climate. Scenario planning (oftentimes implemented as a qualitative, participatory exercise for exploring multiple possible futures) is a valuable tool for addressing this challenge. However, this approach may face limits in resolving responses of complex systems to altered climate and management conditions, and may not provide the scientific credibility that managers often require to support actions that depart from current practice. Quantitative information on projected climate changes and ecological responses is rapidly growing and evolving, but this information is often not at a scale or in a form that is `actionable' for resource managers. We describe a project that sought to create usable information for resource managers in the northern Great Plains by combining qualitative and quantitative methods. In particular, researchers, resource managers, and climate adaptation specialists co-produced a simulation model in conjunction with scenario planning workshops to inform natural resource management in southwest South Dakota. Scenario planning for a wide range of resources facilitated open-minded thinking about a set of divergent and challenging, yet relevant and plausible, climate scenarios and management alternatives that could be implemented in the simulation. With stakeholder input throughout the process, we built a simulation of key vegetation types, grazing, exotic plants, fire, and the effects of climate and management on rangeland productivity and composition. By simulating multiple land management jurisdictions, climate scenarios, and management alternatives, the model highlighted important tradeoffs between herd sizes and vegetation composition, and between the short- versus long-term costs of invasive species management. It also identified impactful uncertainties related to the effects of fire and grazing on vegetation. Ultimately, this integrative and iterative approach yielded counter-intuitive and surprising findings, and resulted in a more tractable set of possible futures for resource management planning.

Integrating human health and ecological concerns in risk assessments.

PubMed

Cirone, P A; Bruce Duncan, P

2000-11-03

The interconnections between ecosystems, human health and welfare have been increasingly recognized by the US government, academia, and the public. This paper continues this theme by addressing the use of risk assessment to integrate people into a single assessment. In a broad overview of the risk assessment process we stress the need to build a conceptual model of the whole system including multiple species (humans and other ecological entities), stressors, and cumulative effects. We also propose converging landscape ecology and evaluation of ecosystem services with risk assessment to address these cumulative responses. We first look at how this integration can occur within the problem formulation step in risk assessment where the system is defined, a conceptual model created, a subset of components and functions selected, and the analytical framework decided in a context that includes the management decisions. A variety of examples of problem formulations (salmon, wild insects, hyporheic ecosystems, ultraviolet (UV) radiation, nitrogen fertilization, toxic chemicals, and oil spills) are presented to illustrate how treating humans as components of the landscape can add value to risk assessments. We conclude that the risk assessment process should help address the urgent needs of society in proportion to importance, to provide a format to communicate knowledge and understanding, and to inform policy and management decisions.

Understanding enabling capacities for managing the 'wicked problem' of nonpoint source water pollution in catchments: a conceptual framework.

PubMed

Patterson, James J; Smith, Carl; Bellamy, Jennifer

2013-10-15

Nonpoint source (NPS) water pollution in catchments is a 'wicked' problem that threatens water quality, water security, ecosystem health and biodiversity, and thus the provision of ecosystem services that support human livelihoods and wellbeing from local to global scales. However, it is a difficult problem to manage because water catchments are linked human and natural systems that are complex, dynamic, multi-actor, and multi-scalar in nature. This in turn raises questions about understanding and influencing change across multiple levels of planning, decision-making and action. A key challenge in practice is enabling implementation of local management action, which can be influenced by a range of factors across multiple levels. This paper reviews and synthesises important 'enabling' capacities that can influence implementation of local management action, and develops a conceptual framework for understanding and analysing these in practice. Important enabling capacities identified include: history and contingency; institutional arrangements; collaboration; engagement; vision and strategy; knowledge building and brokerage; resourcing; entrepreneurship and leadership; and reflection and adaptation. Furthermore, local action is embedded within multi-scalar contexts and therefore, is highly contextual. The findings highlight the need for: (1) a systemic and integrative perspective for understanding and influencing change for managing the wicked problem of NPS water pollution; and (2) 'enabling' social and institutional arenas that support emergent and adaptive management structures, processes and innovations for addressing NPS water pollution in practice. These findings also have wider relevance to other 'wicked' natural resource management issues facing similar implementation challenges. Copyright © 2013 Elsevier Ltd. All rights reserved.

Canadian residents' perceived manager training needs.

PubMed

Stergiopoulos, Vicky; Lieff, Susan; Razack, Saleem; Lee, A Curtis; Maniate, Jerry M; Hyde, Stacey; Taber, Sarah; Frank, Jason R

2010-01-01

Despite widespread endorsement for administrative training during residency, teaching and learning in this area remains intermittent and limited in most programmes. To inform the development of a Manager Train-the-Trainer program for faculty, the Royal College of Physicians and Surgeons of Canada undertook a survey of perceived Manager training needs among postgraduate trainees. A representative sample of Canadian specialty residents received a web-based questionnaire in 2009 assessing their perceived deficiencies in 13 Manager knowledge and 11 Manager skill domains, as determined by gap scores (GSs). GSs were defined as the difference between residents' perceived current and desired level of knowledge or skill in selected Manager domains. Residents' educational preferences for furthering their Manager knowledge and skills were also elicited. Among the 549 residents who were emailed the survey, 199 (36.2%) responded. Residents reported significant gaps in most knowledge and skills domains examined. Residents' preferred educational methods for learning Manager knowledge and skills included workshops, web-based formats and interactive small groups. The results of this national survey, highlighting significant perceived gaps in multiple Manager knowledge and skills domains, may inform the development of Manager curricula and faculty development activities to address deficiencies in training in this important area.

Large scale database scrubbing using object oriented software components.

PubMed

Herting, R L; Barnes, M R

1998-01-01

Now that case managers, quality improvement teams, and researchers use medical databases extensively, the ability to share and disseminate such databases while maintaining patient confidentiality is paramount. A process called scrubbing addresses this problem by removing personally identifying information while keeping the integrity of the medical information intact. Scrubbing entire databases, containing multiple tables, requires that the implicit relationships between data elements in different tables of the database be maintained. To address this issue we developed DBScrub, a Java program that interfaces with any JDBC compliant database and scrubs the database while maintaining the implicit relationships within it. DBScrub uses a small number of highly configurable object-oriented software components to carry out the scrubbing. We describe the structure of these software components and how they maintain the implicit relationships within the database.

Scientific Guidance for Rehabilitation of the Chesapeake Bay Ecosystem under the Changing Climate.

NASA Astrophysics Data System (ADS)

Boesch, D. F.; Johnson, Z. P.; Li, M.

2017-12-01

While the Chesapeake Bay is an estuary and not a marginal sea on the scale of the Baltic Sea or the Gulf of Mexico, it has a complex set of environmental issues and multiple political jurisdictions such that it can serve as a test bed for science-informed management in larger marine systems. In particular, the Chesapeake Bay possesses a relatively advanced effort to ameliorate eutrophication, reduce toxic stresses, rehabilitate critical habitats, and sustainably utilized resources. Furthermore, both scientists and managers are addressing these challenges while now beginning to incorporate the effects of changes in temperature, precipitation and runoff, sea level, ocean boundary conditions, and pH. Increases in temperature and sea level are already apparent and future conditions can be estimated from global model projections, although sea level and ocean exchanges are also affected by variations in Gulf Stream flows and mesoscale climate. Changes in the volume, seasonality and variability in freshwater delivery from the multiple rivers discharging to the bay are harder to project with confidence, but may have pervasive consequences for circulation, reducing nutrient loads to ameliorate eutrophication, biogeochemical processes, and biotic distributions and dynamics. Science is now challenged to inform multiple adaptation strategies, including minimizing the vulnerability of humans and infrastructure, sustaining important tidal wetlands, managing sediment resources, sustaining living resources, redefining achievable ecosystem rehabilitation goals, and achieving shifting goals for nutrient load reductions. At the same time, science will also have to identify effective means to meet these challenges while also reducing greenhouse gas emissions.

Complex interventions can increase osteoporosis investigations and treatment: a systematic review and meta-analysis.

PubMed

Kastner, M; Perrier, L; Munce, S E P; Adhihetty, C C; Lau, A; Hamid, J; Treister, V; Chan, J; Lai, Y; Straus, S E

2018-01-01

Osteoporosis is affecting over 200 million people worldwide. Despite available guidelines, care for these patients remains sub-optimal. We developed an osteoporosis tool to address the multiple dimensions of chronic disease management. Findings from its evaluation showed a significant increase from baseline in osteoporosis investigations and treatment, so we are revising this tool to include multiple chronic conditions including an update of evidence about osteoporosis. Our objectives were to conduct a systematic review of osteoporosis interventions in adults at risk for osteoporosis. We searched bibliometric databases for randomized controlled trials (RCTs) in any language evaluating osteoporosis disease management interventions in adults at risk for osteoporosis. Reviewer pairs independently screened citations and full-text articles, extracted data, and assessed risk of bias. Analysis included random effects meta-analysis. Primary outcomes were osteoporosis investigations and treatment, and fragility fractures. Fifty-five RCTs and one companion report were included in the analysis representing 165,703 patients. Our findings from 55 RCTs and 18 sub-group meta-analyses showed that complex implementation interventions with multiple components consisting of at least education + feedback + follow-up significantly increased the initiation of osteoporosis medications, and interventions with at least education + follow-up significantly increased the initiation of osteoporosis investigations. No significant impact was found for any type of intervention to reduce fracture. Complex interventions that include at least education + follow-up or feedback have the most potential for increasing osteoporosis investigations and treatment. Patient education appears to be an important component in osteoporosis disease management.

Innovation in health service management: Adoption of project management offices to support major health care transformation.

PubMed

Lavoie-Tremblay, Mélanie; Aubry, Monique; Cyr, Guylaine; Richer, Marie-Claire; Fortin-Verreault, Jean-François; Fortin, Claude; Marchionni, Caroline

2017-11-01

To explore the characteristics that influence project management offices acceptance and adoption in healthcare sector. The creation of project management offices has been suggested as a promising avenue to promote successful organisational change and facilitate evidence-based practice. However, little is known about the characteristics that promote their initial adoption and acceptance in health care sector. This knowledge is important in the context where many organisations are considering implementing project management offices with nurse managers as leaders. A descriptive multiple case study design was used. The unit of analysis was the project management offices. The study was conducted in three university-affiliated teaching hospitals in 2013-14 (Canada). Individual interviews (n = 34) were conducted with senior managers. Results reveal that project management offices dedicated to project and change management constitute an innovation and an added value that addresses tangible needs in the field. Project management offices are an innovation highly compatible with health care managers and their approach has parallels to the process of clinical problem solving and reasoning well-known to adopters. This knowledge is important in a context where many nurses hold various roles in project management offices, such as Director, project manager, clinical expert and knowledge broker. © 2017 John Wiley & Sons Ltd.

Office management of gait disorders in the elderly

PubMed Central

Lam, Robert

2011-01-01

Abstract Objective To provide family physicians with an approach to office management of gait disorders in the elderly. Sources of information Ovid MEDLINE was searched from 1950 to July 2010 using subject headings for gait or neurologic gait disorders combined with physical examination. Articles specific to family practice or family physicians were selected. Relevant review articles and original research were used when appropriate and applicable to the elderly. Main message Gait and balance disorders in the elderly are difficult to recognize and diagnose in the family practice setting because they initially present with subtle undifferentiated manifestations, and because causes are usually multifactorial, with multiple diseases developing simultaneously. To further complicate the issue, these manifestations can be camouflaged in elderly patients by the physiologic changes associated with normal aging. A classification of gait disorders based on sensorimotor levels can be useful in the approach to management of this problem. Gait disorders in patients presenting to family physicians in the primary care setting are often related to joint and skeletal problems (lowest-level disturbances), as opposed to patients referred to neurology specialty clinics with sensory ataxia, myelopathy, multiple strokes, and parkinsonism (lowest-, middle-, and highest-level disturbances). The difficulty in diagnosing gait disorders stems from the challenge of addressing early undifferentiated disease caused by multiple disease processes involving all sensorimotor levels. Patients might present with a nonspecific “cautious” gait that is simply an adaptation of the body to disease limitations. This cautious gait has a mildly flexed posture with reduced arm swing and a broadening of the base of support. This article reviews the focused history (including medication review), practical physical examination, investigations, and treatments that are key to office management of gait disorders. Conclusion Family physicians will find it helpful to classify gait disorders based on sensorimotor level as part of their approach to office management of elderly patients. Managing gait disorders at early stages can help prevent further deconditioning and mobility impairment. PMID:21753097

A statistically rigorous sampling design to integrate avian monitoring and management within Bird Conservation Regions.

PubMed

Pavlacky, David C; Lukacs, Paul M; Blakesley, Jennifer A; Skorkowsky, Robert C; Klute, David S; Hahn, Beth A; Dreitz, Victoria J; George, T Luke; Hanni, David J

2017-01-01

Monitoring is an essential component of wildlife management and conservation. However, the usefulness of monitoring data is often undermined by the lack of 1) coordination across organizations and regions, 2) meaningful management and conservation objectives, and 3) rigorous sampling designs. Although many improvements to avian monitoring have been discussed, the recommendations have been slow to emerge in large-scale programs. We introduce the Integrated Monitoring in Bird Conservation Regions (IMBCR) program designed to overcome the above limitations. Our objectives are to outline the development of a statistically defensible sampling design to increase the value of large-scale monitoring data and provide example applications to demonstrate the ability of the design to meet multiple conservation and management objectives. We outline the sampling process for the IMBCR program with a focus on the Badlands and Prairies Bird Conservation Region (BCR 17). We provide two examples for the Brewer's sparrow (Spizella breweri) in BCR 17 demonstrating the ability of the design to 1) determine hierarchical population responses to landscape change and 2) estimate hierarchical habitat relationships to predict the response of the Brewer's sparrow to conservation efforts at multiple spatial scales. The collaboration across organizations and regions provided economy of scale by leveraging a common data platform over large spatial scales to promote the efficient use of monitoring resources. We designed the IMBCR program to address the information needs and core conservation and management objectives of the participating partner organizations. Although it has been argued that probabilistic sampling designs are not practical for large-scale monitoring, the IMBCR program provides a precedent for implementing a statistically defensible sampling design from local to bioregional scales. We demonstrate that integrating conservation and management objectives with rigorous statistical design and analyses ensures reliable knowledge about bird populations that is relevant and integral to bird conservation at multiple scales.

A statistically rigorous sampling design to integrate avian monitoring and management within Bird Conservation Regions

PubMed Central

Hahn, Beth A.; Dreitz, Victoria J.; George, T. Luke

2017-01-01

Monitoring is an essential component of wildlife management and conservation. However, the usefulness of monitoring data is often undermined by the lack of 1) coordination across organizations and regions, 2) meaningful management and conservation objectives, and 3) rigorous sampling designs. Although many improvements to avian monitoring have been discussed, the recommendations have been slow to emerge in large-scale programs. We introduce the Integrated Monitoring in Bird Conservation Regions (IMBCR) program designed to overcome the above limitations. Our objectives are to outline the development of a statistically defensible sampling design to increase the value of large-scale monitoring data and provide example applications to demonstrate the ability of the design to meet multiple conservation and management objectives. We outline the sampling process for the IMBCR program with a focus on the Badlands and Prairies Bird Conservation Region (BCR 17). We provide two examples for the Brewer’s sparrow (Spizella breweri) in BCR 17 demonstrating the ability of the design to 1) determine hierarchical population responses to landscape change and 2) estimate hierarchical habitat relationships to predict the response of the Brewer’s sparrow to conservation efforts at multiple spatial scales. The collaboration across organizations and regions provided economy of scale by leveraging a common data platform over large spatial scales to promote the efficient use of monitoring resources. We designed the IMBCR program to address the information needs and core conservation and management objectives of the participating partner organizations. Although it has been argued that probabilistic sampling designs are not practical for large-scale monitoring, the IMBCR program provides a precedent for implementing a statistically defensible sampling design from local to bioregional scales. We demonstrate that integrating conservation and management objectives with rigorous statistical design and analyses ensures reliable knowledge about bird populations that is relevant and integral to bird conservation at multiple scales. PMID:29065128

Office management of gait disorders in the elderly.

PubMed

Lam, Robert

2011-07-01

To provide family physicians with an approach to office management of gait disorders in the elderly. Ovid MEDLINE was searched from 1950 to July 2010 using subject headings for gait or neurologic gait disorders combined with physical examination. Articles specific to family practice or family physicians were selected. Relevant review articles and original research were used when appropriate and applicable to the elderly. Gait and balance disorders in the elderly are difficult to recognize and diagnose in the family practice setting because they initially present with subtle undifferentiated manifestations, and because causes are usually multifactorial, with multiple diseases developing simultaneously. To further complicate the issue, these manifestations can be camouflaged in elderly patients by the physiologic changes associated with normal aging. A classification of gait disorders based on sensorimotor levels can be useful in the approach to management of this problem. Gait disorders in patients presenting to family physicians in the primary care setting are often related to joint and skeletal problems (lowest-level disturbances), as opposed to patients referred to neurology specialty clinics with sensory ataxia, myelopathy, multiple strokes, and parkinsonism (lowest-, middle-, and highest-level disturbances). The difficulty in diagnosing gait disorders stems from the challenge of addressing early undifferentiated disease caused by multiple disease processes involving all sensorimotor levels. Patients might present with a nonspecific "cautious" gait that is simply an adaptation of the body to disease limitations. This cautious gait has a mildly flexed posture with reduced arm swing and a broadening of the base of support. This article reviews the focused history (including medication review), practical physical examination, investigations, and treatments that are key to office management of gait disorders. Family physicians will find it helpful to classify gait disorders based on sensorimotor level as part of their approach to office management of elderly patients. Managing gait disorders at early stages can help prevent further deconditioning and mobility impairment.

Community-acquired pneumonia in children - a changing spectrum of disease.

PubMed

le Roux, David M; Zar, Heather J

2017-10-01

Pneumonia remains the leading cause of death in children outside the neonatal period, despite advances in prevention and management. Over the last 20 years, there has been a substantial decrease in the incidence of childhood pneumonia and pneumonia-associated mortality. New conjugate vaccines against Haemophilus influenzae type b and Streptococcus pneumoniae have contributed to decreases in radiologic, clinical and complicated pneumonia cases and have reduced hospitalization and mortality. The importance of co-infections with multiple pathogens and the predominance of viral-associated disease are emerging. Better access to effective preventative and management strategies is needed in low- and middle-income countries, while new strategies are needed to address the residual burden of disease once these have been implemented.

Creation and implementation of SAMPRO™: A school-based asthma management program

PubMed Central

Lemanske, Robert F.; Kakumanu, Sujani; Shanovich, Kathleen; Antos, Nicholas; Cloutier, Michelle M.; Mazyck, Donna; Phipatanakul, Wanda; Schantz, Shirley; Szefler, Stanley; Vandlik, Renee; Williams, Paul

2016-01-01

Clinicians who care for children with asthma have an obligation to coordinate asthma care with the schools. Aside from routine clinical care of asthmatic children, providers must educate the family and child about the need for an asthma treatment plan in school and support the school nurse meeting the needs of the student requiring school-based asthma care. The following article was developed by multiple stakeholders to address this need. It describes the 4 components of the School-based Asthma Management Program (SAMPRO™). SAMPRO™ details elements necessary for the education of children, families, clinicians, and school-based personnel based on a “circle of support” that would enhance multidirectional communication and promote better care for children with asthma within the school setting. PMID:27596707

Engineering the ATLAS TAG Browser

NASA Astrophysics Data System (ADS)

Zhang, Qizhi; ATLAS Collaboration

2011-12-01

ELSSI is a web-based event metadata (TAG) browser and event-level selection service for ATLAS. In this paper, we describe some of the challenges encountered in the process of developing ELSSI, and the software engineering strategies adopted to address those challenges. Approaches to management of access to data, browsing, data rendering, query building, query validation, execution, connection management, and communication with auxiliary services are discussed. We also describe strategies for dealing with data that may vary over time, such as run-dependent trigger decision decoding. Along with examples, we illustrate how programming techniques in multiple languages (PHP, JAVASCRIPT, XML, AJAX, and PL/SQL) have been blended to achieve the required results. Finally, we evaluate features of the ELSSI service in terms of functionality, scalability, and performance.

A framework for measuring self-management effectiveness and health care use among pediatric asthma patients and families

PubMed Central

Rangachari, Pavani

2017-01-01

Asthma is associated with substantial health care expenditures, including an estimated US$56 billion per year in direct costs. A recurring theme in the asthma management literature is that costly asthma symptoms, including hospitalizations and multiple emergency department (ED)/outpatient visits, can often be prevented through patient/family adherence to the national (National Institutes of Health Expert Panel Report-3) guidelines for effective self-management of asthma, specifically 1) medication adherence and 2) environmental trigger avoidance, as outlined in the patient’s personalized Asthma-Action Plan. It is important to note however that while effective self-management of asthma is known to reduce ED visits and hospitalizations, the relationship between asthma self-management effectiveness and outpatient visit frequency remains ambiguous, reflecting a gap in the literature. For instance, do patients/families who self-manage effectively visit outpatient clinics more frequently for asthma care (compared to those who do not self-manage effectively), after accounting for differences in asthma severity, demographic characteristics, and risk factors? Do patients/families who visit outpatient clinics more frequently for asthma care, in turn have fewer ED and inpatient encounters for asthma? On the other hand, do patients/families who do not revisit outpatient clinics regularly have higher ED visits and hospitalizations? It is important to address these gaps, in order to reduce the costs and public health burden of asthma. This paper provides a foundation for addressing these gaps, by conducting an integrative review of the asthma management literature, to develop a conceptual framework for measuring self-management effectiveness and health care use among pediatric asthma patients/families. In doing so, the paper lays the groundwork for future research seeking to explicate the relationship between asthma self-management effectiveness and health care use, which in turn has potential to engage asthma providers in promoting ideal self-management and optimal health care use for pediatric asthma, in accordance with national evidence-based guidelines for asthma management. PMID:28442924

AMCP Partnership Forum: Biosimilars--Ready, Set, Launch.

PubMed

2016-04-01

Through 2020, reference biologic products will lose patent protection that will be worth $54 billion to the U.S. economy. Consequently, interest in biosimilars is intensifying across the health care industry. Managed care organizations (MCOs) are depending on the savings opportunity that bio-similars promise. After the first FDA approval of a biosimilar in March 2015, the Academy of Managed Care Pharmacy (AMCP) convened a biosimilar Partnership Forum on June 10-11, 2015. The goal of this forum was to address current readiness of MCOs to optimize biosimilars; identify gaps, challenges, and opportunities with regard to biosimilars; and recommend education and training content to help AMCP best meet the needs of its members and stakeholders. The forum brought together multiple stakeholders from MCOs, pharmacy benefit managers, specialty pharmacies, integrated delivery networks, federal government and standards setting organizations, consumer advocacy groups, and the pharmaceutical industry. Through a series of 4 one-hour webinars and a 1.5-day live workgroup session, participants identified current challenges and readiness issues in addressing biosimilars. These challenges included lack of a consolidated educational strategy for incorporating biosimilars into the clinical decision-making process; deficiencies in current levels of federal (e.g., the FDA) or state (e.g., departments of insurance) guidance; limited intelligence on pricing strategies and consideration of stakeholder contracting alignment and risk sharing; and operational implementation issues. Participants identified necessary tactics for executing a successful bio-similar strategy. These tactics included creating a broad multiple stakeholder coalition to support educational efforts to gain public, provider, and other stakeholder acceptance; aligning utilization incentives through reimbursement policies and programs; encouraging benefit design and stakeholder collaboration; advancing the coding and technology infrastructure to support operations, contracting, billing, reimbursement, and reporting needs; and having appropriate active surveillance mechanisms to enable assessment of the clinical performance of biosimilars and their innovator products. Participants recommended guidance for AMCP to optimally support its membership and stakeholders with educational and training programs at multiple venues; a platform for regular communications and updates; and advocacy, community promotion, and education. The AMCP Partnership Forum entitled "Biosimilars-Ready, Set, Launch" and the development of this report were supported by Abbvie, Amgen, Apotex, Boehringer, Merck, Momenta, and Sandoz.

Effective planning and management as critical factors in urban water supply and management in Umuahia and Aba, Abia State, Nigeria

NASA Astrophysics Data System (ADS)

Uchegbu, Smart N.

Plan and policy development usually define the course, goal, execution, success or failure of any public utilities initiative. Urban water supply is not an exception. Planning and management in public water supply systems often determine the quality of service the water supply authorities can render. This paper, therefore, addresses the issue of effective planning and management as critical determinants of urban water supply and management with respect to two Nigerian cities Umuahia and Aba both in Abia State. Appropriate sampling methods systematic sampling and cluster techniques were employed in order to collect data for the study. The collected data were analyzed using multiple linear regression. The findings of the study indicate that planning and management indices such as funding, manpower, water storage tank capacity greatly influence the volume of water supplied in the study areas. Funding was identified as a major determinant of the efficiency of the water supply system. Therefore, the study advocates the need for sector reforms that would usher in private participants in the water sector both for improved funding and enhanced productivity.

Incorporating Green Infrastructure into Water Resources Management Plans to Address Water Quality Impairments

NASA Astrophysics Data System (ADS)

Piscopo, A. N.; Detenbeck, N. E.

2017-12-01

Managers of urban watersheds with excessive nutrient loads are more frequently turning to green infrastructure (GI) to manage their water quality impairments. The effectiveness of GI is dependent on a number of factors, including (1) the type and placement of GI within the watershed, (2) the specific nutrients to be treated, and (3) the uncertainty in future climates. Although many studies have investigated the effectiveness of individual GI units for different types of nutrients, relatively few have considered the effectiveness of GI on a watershed scale, the scale most relevant to management plans. At the watershed scale, endless combinations of GI type and location are possible, each with different effectiveness in reducing nutrient loads, minimizing costs, and maximizing co-benefits such as reducing runoff. To efficiently generate management plan options that balance the tradeoffs between these objectives, we simulate candidate options using EPA's Stormwater Management Model for multiple future climates and determine the Pareto optimal set of solution options using a multi-objective evolutionary algorithm. Our approach is demonstrated for an urban watershed in Rockville, Maryland.

Overactive bladder in the vulnerable elderly

PubMed Central

Wolff, Gillian F; Kuchel, George A; Smith, Phillip P

2014-01-01

Overactive bladder (OAB) is a common problem that may occur in individuals of all ages. It has a considerable impact on patient quality of life, and although moderately effective management strategies do exist, this condition often remains undiagnosed and untreated. OAB needs to be viewed as a symptom complex. Its presentation and management are complicated in the vulnerable elderly by the presence of baseline frailty and multiple coexisting chronic conditions. Furthermore, and beyond a simple understanding of symptomatology, providers must address patient goals and motivations as well as the expectations of caretakers. These multiple levels of perception, function, expectations, and treatment efficacy/risks must be tailored to the individual patient. While the vulnerable elderly patient may often have evidence of urinary tract dysfunction, OAB and urge urinary incontinence in this population must be understood as a multifactorial geriatric syndrome and viewed in the context of medical and functional baseline and precipitating risk factors. Expectations and goals must be tailored to the resources of vulnerable elderly patients and their caregivers, and care must be coordinated with other medical care providers. The management of OAB in the vulnerable elderly often poses significant management challenges. Nonetheless, with a thoughtful approach and an aim towards future research specifically for this population, significant reductions in morbidity and mortality long with enhancement in health-related quality of life are possible. PMID:25328867

Population genetics suggest that multiple invasion processes need to be addressed in the management plan of a plant disease vector.

PubMed

Anderson, Kylie L; Congdon, Bradley C

2013-06-01

The use of a multidisciplinary approach is becoming increasingly important when developing management strategies that mitigate the economic and biological costs associated with invasive pests. A framework of simulated dispersal is combined with life-history information and analyses of population genetic structure to investigate the invasion dynamics of a plant disease vector, the island sugarcane planthopper (Eumetopina flavipes), through an archipelago of significant Australian quarantine concern. Analysis of eight microsatellite loci from 648 individuals suggests that frequent, wind-assisted immigration from multiple sources in Papua New Guinea contributes significantly to repeated colonization of far northern islands. However, intermittent wind-assisted immigration better explains patterns of genetic diversity and structure in the southern islands and on the tip of mainland Australia. Significant population structuring associated with the presence of clusters of highly related individuals results from breeding in-situ following colonization, with little postestablishment movement. Results also suggest that less important secondary movements occur between islands; these appear to be human mediated and restricted by quarantine zones. Control of the planthopper may be very difficult on islands close to Papua New Guinea given the apparent propensity for multiple invasion, but may be achievable further south where local populations appear highly independent and isolated.

Systems Engineering and Integration for Advanced Life Support System and HST

NASA Technical Reports Server (NTRS)

Kamarani, Ali K.

2005-01-01

Systems engineering (SE) discipline has revolutionized the way engineers and managers think about solving issues related to design of complex systems: With continued development of state-of-the-art technologies, systems are becoming more complex and therefore, a systematic approach is essential to control and manage their integrated design and development. This complexity is driven from integration issues. In this case, subsystems must interact with one another in order to achieve integration objectives, and also achieve the overall system's required performance. Systems engineering process addresses these issues at multiple levels. It is a technology and management process dedicated to controlling all aspects of system life cycle to assure integration at all levels. The Advanced Integration Matrix (AIM) project serves as the systems engineering and integration function for the Human Support Technology (HST) program. AIM provides means for integrated test facilities and personnel for performance trade studies, analyses, integrated models, test results, and validated requirements of the integration of HST. The goal of AIM is to address systems-level integration issues for exploration missions. It will use an incremental systems integration approach to yield technologies, baselines for further development, and possible breakthrough concepts in the areas of technological and organizational interfaces, total information flow, system wide controls, technical synergism, mission operations protocols and procedures, and human-machine interfaces.

SERVIR HIMALYA: Enabling Improved Environmental Management and Livelihoods in the HKH

NASA Astrophysics Data System (ADS)

Bajracharya, B.; Murthy, M. S. R.; Shrestha, B.

2014-11-01

With an overarching goal to improve environmental management and resilience to climate change, SERVIR-Himalaya is established as a collaborative initiative of USAID, NASA and ICIMOD. The SERVIR-Himalaya has been the key instrument to provide integrated and innovative geospatial solutions for generation and dissemination of information and knowledge resources on mountain environments. The SERVIR applications, products and services are viewed as essential cross-cutting elements to achieve the greater impacts on addressing Himalayan livelihood challenges. The broad thematic areas which are also subset of the societal benefit areas of Global Earth Observation (GEO), namely - agriculture and food security, ecosystems and sustainable landscapes, and disaster risk management are addressed. On the cross-cutting theme, SERVIR Himalaya is also focusing on developing regional level applications providing key information systems and services on multiple themes of regional significance. The regional level science applications include use of MODIS satellite information products and services for environmental and natural resources monitoring in the Himalayan region. Regional and national training and workshops, on-the-job training, internships and exchange programs and technical backstopping are key capacity building components to enhance the capacity of partners from national institutions in the regional member countries. These efforts are also seen as receiving feedback on the science applications, identify additional needs, and increase synergy by exploring opportunities for collaboration.

Progress and challenges of disaster health management in China: a scoping review.

PubMed

Zhong, Shuang; Clark, Michele; Hou, Xiang-Yu; Zang, Yuli; FitzGerald, Gerard

2014-01-01

Despite the importance of an effective health system response to various disasters, relevant research is still in its infancy, especially in middle- and low-income countries. This paper provides an overview of the status of disaster health management in China, with its aim to promote the effectiveness of the health response for reducing disaster-related mortality and morbidity. A scoping review method was used to address the recent progress of and challenges to disaster health management in China. Major health electronic databases were searched to identify English and Chinese literature that were relevant to the research aims. The review found that since 2003 considerable progress has been achieved in the health disaster response system in China. However, there remain challenges that hinder effective health disaster responses, including low standards of disaster-resistant infrastructure safety, the lack of specific disaster plans, poor emergency coordination between hospitals, lack of portable diagnostic equipment and underdeveloped triage skills, surge capacity, and psychological interventions. Additional challenges include the fragmentation of the emergency health service system, a lack of specific legislation for emergencies, disparities in the distribution of funding, and inadequate cost-effective considerations for disaster rescue. One solution identified to address these challenges appears to be through corresponding policy strategies at multiple levels (e.g. community, hospital, and healthcare system level).

Is rangeland agriculture sustainable?

PubMed

Heitschmidt, R K; Vermeire, L T; Grings, E E

2004-01-01

The objective of this paper is to examine the sustainability of rangeland agriculture (i.e., managed grazing) on a world-wide basis, with a focus on North America. Sustainability is addressed on three fronts: 1) ecological, 2) economic, and 3) social acceptance. Based on previous and on-going research, we suggest that employment of science-based rangeland grazing management strategies and tactics can ensure ecological sustainability. The formidable challenge in employing such technology centers around the need to balance efficiency of solar energy capture and subsequent harvest efficiencies across an array of highly spatially and temporally variable vegetation growing conditions using animals that graze selectively. Failure to meet this fundamental challenge often accelerates rangeland desertification processes, and in some instances, enhances rate and extent of the invasion of noxious weeds. We also suggest that the fundamental reason that ecologically sound grazing management technologies are often not employed in the management of grazed ecological systems is because social values drive management decisions more so than ecological science issues. This is true in both well-developed societies with substantial economic resources and in less-developed societies with few economic resources. However, the social issues driving management are often entirely different, ranging from multiple-use issues in developed countries to human day-to-day survival issues in poorly developed countries. We conclude that the long-term sustainability of rangeland agriculture in 1) developed societies depends on the ability of rangeland agriculturalists to continually respond in a dynamic, positive, proactive manner to ever-changing social values and 2) less-developed societies on their ability to address the ecological and social consequences arising from unsustainable human populations before the adoption of science-based sustainable rangeland management technologies.

Challenge of improving postoperative pain management: case studies of three acute pain services in the UK National Health Service.

PubMed

Powell, A E; Davies, H T O; Bannister, J; Macrae, W A

2009-06-01

Previous national survey research has shown significant deficits in routine postoperative pain management in the UK. This study used an organizational change perspective to explore in detail the organizational challenges faced by three acute pain services in improving postoperative pain management. Case studies were conducted comprising documentary review and semi-structured interviews (71) with anaesthetists, surgeons, nurses, other health professionals, and managers working in and around three broadly typical acute pain services. Although the precise details differed to some degree, the three acute pain services all faced the same broad range of inter-related challenges identified in the organizational change literature (i.e. structural, political, cultural, educational, emotional, and physical/technological challenges). The services were largely isolated from wider organizational objectives and activities and struggled to engage other health professionals in improving postoperative pain management against a background of limited resources, turbulent organizational change, and inter- and intra-professional politics. Despite considerable efforts they struggled to address these challenges effectively. The literature on organizational change and quality improvement in health care suggests that it is only by addressing the multiple challenges in a comprehensive way across all levels of the organization and health-care system that sustained improvements in patient care can be secured. This helps to explain why the hard work and commitment of acute pain services over the years have not always resulted in significant improvements in routine postoperative pain management for all surgical patients. Using this literature and adopting a whole-organization quality improvement approach tailored to local circumstances may produce a step-change in the quality of routine postoperative pain management.

'Normal' and 'failing' mothers: Women's constructions of maternal subjectivity while living with multiple sclerosis.

PubMed

Parton, Chloe; Katz, Terri; Ussher, Jane M

2017-10-01

Multiple sclerosis causes physical and cognitive impairment that can impact women's experiences of motherhood. This study examined how women construct their maternal subjectivities, or sense of self as a mother, drawing on a framework of biographical disruption. A total of 20 mothers with a multiple sclerosis diagnosis took part in semi-structured interviews. Transcripts were analysed using thematic decomposition to identify subject positions that women adopted in relation to cultural discourses of gender, motherhood and illness. Three main subject positions were identified: 'The Failing Mother', 'Fear of Judgement and Burdening Others' and 'The Normal Mother'. Women's sense of self as the 'Failing Mother' was attributed to the impact of multiple sclerosis, contributing to biographical disruption and reinforced through 'Fear of Judgement and Burdening Others' within social interactions. In accounts of the 'Normal Mother', maternal subjectivity was renegotiated by adopting strategies to manage the limitations of multiple sclerosis on mothering practice. This allowed women to self-position as 'good' mothers. Health professionals can assist women by acknowledging the embodied impact of multiple sclerosis on maternal subjectivities, coping strategies that women employ to address potential biographical disruption, and the cultural context of mothering, which contributes to women's experience of subjectivity and well-being when living with multiple sclerosis.

Use of multicriteria decision analysis to address conservation conflicts.

PubMed

Davies, A L; Bryce, R; Redpath, S M

2013-10-01

Conservation conflicts are increasing on a global scale and instruments for reconciling competing interests are urgently needed. Multicriteria decision analysis (MCDA) is a structured, decision-support process that can facilitate dialogue between groups with differing interests and incorporate human and environmental dimensions of conflict. MCDA is a structured and transparent method of breaking down complex problems and incorporating multiple objectives. The value of this process for addressing major challenges in conservation conflict management is that MCDA helps in setting realistic goals; entails a transparent decision-making process; and addresses mistrust, differing world views, cross-scale issues, patchy or contested information, and inflexible legislative tools. Overall we believe MCDA provides a valuable decision-support tool, particularly for increasing awareness of the effects of particular values and choices for working toward negotiated compromise, although an awareness of the effect of methodological choices and the limitations of the method is vital before applying it in conflict situations. © 2013 Society for Conservation Biology.

Systems engineering and integration of control centers in support of multiple programs. [ground control for STS payloads and unmanned vehicles

NASA Technical Reports Server (NTRS)

Miller, David N.

1989-01-01

The NASA Johnson Space Center's new Multiprogram Control Center (MPCC) addresses the control requirements of complex STS payloads as well as unmanned vehicles. An account is given of the relationship of the MPCC to the STS Mission Control Center, with a view to significant difficulties that may be encountered and solutions thus far devised for generic problems. Examples of MPCC workstation applications encompass telemetry decommutation, engineering unit conversion, data-base management, trajectory processing, and flight design.

Multi-Objective Hybrid Optimal Control for Multiple-Flyby Interplanetary Mission Design Using Chemical Propulsion

NASA Technical Reports Server (NTRS)

Englander, Jacob; Vavrina, Matthew

2015-01-01

The customer (scientist or project manager) most often does not want just one point solution to the mission design problem Instead, an exploration of a multi-objective trade space is required. For a typical main-belt asteroid mission the customer might wish to see the trade-space of: Launch date vs. Flight time vs. Deliverable mass, while varying the destination asteroid, planetary flybys, launch year, etcetera. To address this question we use a multi-objective discrete outer-loop which defines many single objective real-valued inner-loop problems.

An enhanced export coefficient based optimization model for supporting agricultural nonpoint source pollution mitigation under uncertainty.

PubMed

Rong, Qiangqiang; Cai, Yanpeng; Chen, Bing; Yue, Wencong; Yin, Xin'an; Tan, Qian

2017-02-15

In this research, an export coefficient based dual inexact two-stage stochastic credibility constrained programming (ECDITSCCP) model was developed through integrating an improved export coefficient model (ECM), interval linear programming (ILP), fuzzy credibility constrained programming (FCCP) and a fuzzy expected value equation within a general two stage programming (TSP) framework. The proposed ECDITSCCP model can effectively address multiple uncertainties expressed as random variables, fuzzy numbers, pure and dual intervals. Also, the model can provide a direct linkage between pre-regulated management policies and the associated economic implications. Moreover, the solutions under multiple credibility levels can be obtained for providing potential decision alternatives for decision makers. The proposed model was then applied to identify optimal land use structures for agricultural NPS pollution mitigation in a representative upstream subcatchment of the Miyun Reservoir watershed in north China. Optimal solutions of the model were successfully obtained, indicating desired land use patterns and nutrient discharge schemes to get a maximum agricultural system benefits under a limited discharge permit. Also, numerous results under multiple credibility levels could provide policy makers with several options, which could help get an appropriate balance between system benefits and pollution mitigation. The developed ECDITSCCP model can be effectively applied to addressing the uncertain information in agricultural systems and shows great applicability to the land use adjustment for agricultural NPS pollution mitigation. Copyright © 2016 Elsevier B.V. All rights reserved.

Implementing regional sediment management to sustain navigation at an energetic tidal inlet

USGS Publications Warehouse

Moritz, H.R.; Gelfenbaum, G.R.; Kaminsky, G.M.; Ruggiero, P.; Oltman-shay, J.; Mckillip, D.J.

2007-01-01

Regional Sediment Management (RSM) is a systems-based approach for managing multiple projects involving sediment. RSM fosters balance between infrastructure and natural system processes, resulting in reduced project costs and achievement of greater benefits. This paper introduces the RSM concept and describes how RSM is being implemented at the Mouth of the Columbia River to sustain the inlet's 100-year old navigation infrastructure and adjacent shore lands. Implementing RSM at this energetic inlet involves feeding the inlet's morphology using dredged material, and letting nature do the work of dispersing the placed dredged material to supplement the inlet's sediment budget, without compromising the reliability of the navigation channel. The paper discusses the types of data that are being collected and analyzed to understand the environmental forcing affecting the inlet's morphology. The paper also addresses how dredged material disposal is being conducted to implement RSM.

Data, Meet Compute: NASA's Cumulus Ingest Architecture

NASA Technical Reports Server (NTRS)

Quinn, Patrick

2018-01-01

NASA's Earth Observing System Data and Information System (EOSDIS) houses nearly 30PBs of critical Earth Science data and with upcoming missions is expected to balloon to between 200PBs-300PBs over the next seven years. In addition to the massive increase in data collected, researchers and application developers want more and faster access - enabling complex visualizations, long time-series analysis, and cross dataset research without needing to copy and manage massive amounts of data locally. NASA has looked to the cloud to address these needs, building its Cumulus system to manage the ingest of diverse data in a wide variety of formats into the cloud. In this talk, we look at what Cumulus is from a high level and then take a deep dive into how it manages complexity and versioning associated with multiple AWS Lambda and ECS microservices communicating through AWS Step Functions across several disparate installations

Transforming cold chain performance and management in lower-income countries.

PubMed

Brison, Mike; LeTallec, Yann

2017-04-19

In many countries, one of the common factors limiting full and equitable access to effective immunization is the existence of gaps in cold chain and logistics (CCL) systems. This article focuses on the critical contribution that better management of CCL performance can make in addressing these barriers, as well as some essential practices needed to achieve and sustain these gains. These include (i) an emphasis on continuous improvement in CCL performance indicators, (ii) strong coordination and accountability across multiple stakeholders, and (iii) making the most of limited financial resources. This article is informed by the Clinton Health Access Initiative's (CHAI's) experience working with National Immunization Programs (NIPs) and immunization partners to improve the effectiveness and efficiency of CCL systems (including CCE deployment and maintenance, temperature monitoring and control, stock management and distribution) across ten Gavi-supported "focus" countries. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Expansion of electronic health record-based screening, prevention, and management of diabetes in New York City.

PubMed

Albu, Jeanine; Sohler, Nancy; Matti-Orozco, Brenda; Sill, Jordan; Baxter, Daniel; Burke, Gary; Young, Edwin

2013-01-01

To address the increasing burden of diabetes in New York City, we designed 2 electronic health records (EHRs)-facilitated diabetes management systems to be implemented in 6 primary care practices on the West Side of Manhattan, a standard system and an enhanced system. The standard system includes screening for diabetes. The enhanced system includes screening and ensures close patient follow-up; it applies principles of the chronic care model, including community-clinic linkages, to the management of patients newly diagnosed with diabetes and prediabetes through screening. We will stagger implementation of the enhanced system across the 6 clinics allowing comparison, through a quasi-experimental design (pre-post difference with a control group), of patients treated in the enhanced system with similar patients treated in the standard system. The findings could inform health system practices at multiple levels and influence the integration of community resources into routine diabetes care.

Major Environmental Issues of the Baltic Sea and Science Based Decision Support Strategies towards an Improved Environmental Status

NASA Astrophysics Data System (ADS)

Humborg, C.

2017-12-01

The Baltic Sea is especially susceptible to multiple human impacts due to its estuarine mixing patterns and long water residence times. Temporally and spatially, it is one of the best investigated marginal seas worldwide allowing for a deep knowledge of natural and human processes forming this unique brackish ecosystem. In this presentation, we shortly summarize the physical, biogeochemical and ecological settings of the Baltic Sea and address major human drivers and pressures threatening its ecosystem. Further, we summarize the scientific and political efforts that led to the formulation of Baltic Sea Action Plan, a milestone for eutrophication management and European environmental governance. Further, we summarize the efforts and societal pitfalls towards an Ecosystem Based Fisheries Management, strategies to decrease loads of environmental pollutants and management of marine biodiversity/habitat issues in the unique Baltic Sea context.

Proposed model of integrated care to improve health outcomes for individuals with multimorbidities

PubMed Central

Sampalli, Tara; Fox, Roy A; Dickson, Robert; Fox, Jonathan

2012-01-01

Multimorbidity is defined as the coexistence of multiple chronic conditions. Individuals with multimorbidity typically present with complex needs and show significant changes in their functional health and quality of life. Multimorbidity in the aging population is well recognized, but there has been limited research on ways to manage the problem effectively. More recent studies have demonstrated a high prevalence of multimorbidity in the younger demographics aged under 65 years. There is a definite need to develop models of care that can manage these individuals effectively and mitigate the impact of illness on individuals and the financial burden to the health care system. An integrated model of care has been developed and implemented in a facility in Nova Scotia that routinely treats individuals with multiple chronic conditions. This care model is designed to address the specific needs of this complex patient population, with integrated and coordinated care modules that meet the needs of the person versus the disease. The results of a pilot evaluation of this care model are also discussed. PMID:23118532

Diabetes in people with an intellectual disability: a systematic review of prevalence, incidence and impact.

PubMed

McVilly, K; McGillivray, J; Curtis, A; Lehmann, J; Morrish, L; Speight, J

2014-08-01

To establish the prevalence and incidence of type 1 and type 2 diabetes in people with an intellectual and developmental disability and determine their impact on health and well-being and to appraise the evidence available to inform good practice in diabetes management for people with intellectual and developmental disabilities. We conducted separate searches of multiple databases (EMBASE, CINAHL, MEDLINE, PsycINFO, SCOPUS, Web of Science, PUBMED and Cochrane Library) to find relevant articles. A total of 13 studies were identified: 13 addressed the prevalence of diabetes in people with intellectual and developmental disability, three addressed the impact of diabetes on their health and well-being and three addressed the management of diabetes. The prevalence of diabetes in people with intellectual and developmental disability remains uncertain, and the incidence of diabetes in this group of people is unknown. There is some evidence to support the assertion that people with intellectual and developmental disability might be at greater risk of diabetes than the general population. Overall, the quality of the evidence on which to base prevention and management strategies is variable. There is a paucity of research focusing on the prevalence, incidence and impact of diabetes among people with intellectual and developmental disability. Further research is needed to inform policy and practice in this area and, in particular, work is needed to develop methodologies, evaluation tools, educational resources and diabetes care support services appropriate to the needs of people with intellectual and developmental disability. © 2014 The Authors. Diabetic Medicine © 2014 Diabetes UK.

Approaches in highly parameterized inversion - GENIE, a general model-independent TCP/IP run manager

USGS Publications Warehouse

Muffels, Christopher T.; Schreuder, Willem A.; Doherty, John E.; Karanovic, Marinko; Tonkin, Matthew J.; Hunt, Randall J.; Welter, David E.

2012-01-01

GENIE is a model-independent suite of programs that can be used to generally distribute, manage, and execute multiple model runs via the TCP/IP infrastructure. The suite consists of a file distribution interface, a run manage, a run executer, and a routine that can be compiled as part of a program and used to exchange model runs with the run manager. Because communication is via a standard protocol (TCP/IP), any computer connected to the Internet can serve in any of the capacities offered by this suite. Model independence is consistent with the existing template and instruction file protocols of the widely used PEST parameter estimation program. This report describes (1) the problem addressed; (2) the approach used by GENIE to queue, distribute, and retrieve model runs; and (3) user instructions, classes, and functions developed. It also includes (4) an example to illustrate the linking of GENIE with Parallel PEST using the interface routine.

Nitrogen dynamics in managed boreal forests: Recent advances and future research directions.

PubMed

Sponseller, Ryan A; Gundale, Michael J; Futter, Martyn; Ring, Eva; Nordin, Annika; Näsholm, Torgny; Laudon, Hjalmar

2016-02-01

Nitrogen (N) availability plays multiple roles in the boreal landscape, as a limiting nutrient to forest growth, determinant of terrestrial biodiversity, and agent of eutrophication in aquatic ecosystems. We review existing research on forest N dynamics in northern landscapes and address the effects of management and environmental change on internal cycling and export. Current research foci include resolving the nutritional importance of different N forms to trees and establishing how tree-mycorrhizal relationships influence N limitation. In addition, understanding how forest responses to external N inputs are mediated by above- and belowground ecosystem compartments remains an important challenge. Finally, forestry generates a mosaic of successional patches in managed forest landscapes, with differing levels of N input, biological demand, and hydrological loss. The balance among these processes influences the temporal patterns of stream water chemistry and the long-term viability of forest growth. Ultimately, managing forests to keep pace with increasing demands for biomass production, while minimizing environmental degradation, will require multi-scale and interdisciplinary perspectives on landscape N dynamics.

Adding Hierarchical Objects to Relational Database General-Purpose XML-Based Information Managements

NASA Technical Reports Server (NTRS)

Lin, Shu-Chun; Knight, Chris; La, Tracy; Maluf, David; Bell, David; Tran, Khai Peter; Gawdiak, Yuri

2006-01-01

NETMARK is a flexible, high-throughput software system for managing, storing, and rapid searching of unstructured and semi-structured documents. NETMARK transforms such documents from their original highly complex, constantly changing, heterogeneous data formats into well-structured, common data formats in using Hypertext Markup Language (HTML) and/or Extensible Markup Language (XML). The software implements an object-relational database system that combines the best practices of the relational model utilizing Structured Query Language (SQL) with those of the object-oriented, semantic database model for creating complex data. In particular, NETMARK takes advantage of the Oracle 8i object-relational database model using physical-address data types for very efficient keyword searches of records across both context and content. NETMARK also supports multiple international standards such as WEBDAV for drag-and-drop file management and SOAP for integrated information management using Web services. The document-organization and -searching capabilities afforded by NETMARK are likely to make this software attractive for use in disciplines as diverse as science, auditing, and law enforcement.

Cardiovascular risk in rheumatoid arthritis: assessment, management and next steps

PubMed Central

Zegkos, Thomas; Kitas, George; Dimitroulas, Theodoros

2016-01-01

Rheumatoid arthritis (RA) is associated with increased cardiovascular (CV) morbidity and mortality which cannot be fully explained by traditional CV risk factors; cumulative inflammatory burden and antirheumatic medication-related cardiotoxicity seem to be important contributors. Despite the acknowledgment and appreciation of CV disease burden in RA, optimal management of individuals with RA represents a challenging task which remains suboptimal. To address this need, the European League Against Rheumatism (EULAR) published recommendations suggesting the adaptation of traditional risk scores by using a multiplication factor of 1.5 if two of three specific criteria are fulfilled. Such guidance requires proper coordination of several medical specialties, including general practitioners, rheumatologists, cardiologists, exercise physiologists and psychologists to achieve a desirable result. Tight control of disease activity, management of traditional risk factors and lifestyle modification represent, amongst others, the most important steps in improving CV disease outcomes in RA patients. Rather than enumerating studies and guidelines, this review attempts to critically appraise current literature, highlighting future perspectives of CV risk management in RA. PMID:27247635

Insurance-related and financial challenges reported by managed care enrollees with breast cancer.

PubMed

Klimmek, Rachel; Snow, Denise; Wenzel, Jennifer

2010-10-01

Cancer survivors in the United States often encounter significant challenges in obtaining and paying for medical care. Multiple research studies have examined these issues in Medicare and Medicaid populations and the underinsured, but very little is known about insurance-related challenges encountered by cancer survivors enrolled in private insurance programs such as managed care. This secondary analysis of data explored the insurance-related and financial challenges reported by women enrolled in a managed care organization during cancer treatment and early follow-up. The researchers reviewed semistructured interviews with 14 women with breast cancer near the time of diagnosis, midway through treatment, and after treatment completion. Most women reported considerable stress related to performance of insurance-related tasks during or immediately after treatment, which resulted in negative emotional and psychological experiences. This article presents recommendations for how oncology nurses can intervene to assess and address these challenges and their effects. Future research should examine best practices related to nursing management of insurance-related and financial challenges during cancer.

Optimising the application of multiple-capture traps for invasive species management using spatial simulation.

PubMed

Warburton, Bruce; Gormley, Andrew M

2015-01-01

Internationally, invasive vertebrate species pose a significant threat to biodiversity, agricultural production and human health. To manage these species a wide range of tools, including traps, are used. In New Zealand, brushtail possums (Trichosurus vulpecula), stoats (Mustela ermine), and ship rats (Rattus rattus) are invasive and there is an ongoing demand for cost-effective non-toxic methods for controlling these pests. Recently, traps with multiple-capture capability have been developed which, because they do not require regular operator-checking, are purported to be more cost-effective than traditional single-capture traps. However, when pest populations are being maintained at low densities (as is typical of orchestrated pest management programmes) it remains uncertain if it is more cost-effective to use fewer multiple-capture traps or more single-capture traps. To address this uncertainty, we used an individual-based spatially explicit modelling approach to determine the likely maximum animal-captures per trap, given stated pest densities and defined times traps are left between checks. In the simulation, single- or multiple-capture traps were spaced according to best practice pest-control guidelines. For possums with maintenance densities set at the lowest level (i.e. 0.5/ha), 98% of all simulated possums were captured with only a single capacity trap set at each site. When possum density was increased to moderate levels of 3/ha, having a capacity of three captures per trap caught 97% of all simulated possums. Results were similar for stoats, although only two potential captures per site were sufficient to capture 99% of simulated stoats. For rats, which were simulated at their typically higher densities, even a six-capture capacity per trap site only resulted in 80% kill. Depending on target species, prevailing density and extent of immigration, the most cost-effective strategy for pest control in New Zealand might be to deploy several single-capture traps rather than investing in fewer, but more expense, multiple-capture traps.

Molecular Pharmacology of δ-Opioid Receptors

PubMed Central

Gendron, Louis; Cahill, Catherine M.; von Zastrow, Mark; Schiller, Peter W.

2016-01-01

Opioids are among the most effective analgesics available and are the first choice in the treatment of acute severe pain. However, partial efficacy, a tendency to produce tolerance, and a host of ill-tolerated side effects make clinically available opioids less effective in the management of chronic pain syndromes. Given that most therapeutic opioids produce their actions via µ-opioid receptors (MOPrs), other targets are constantly being explored, among which δ-opioid receptors (DOPrs) are being increasingly considered as promising alternatives. This review addresses DOPrs from the perspective of cellular and molecular determinants of their pharmacological diversity. Thus, DOPr ligands are examined in terms of structural and functional variety, DOPrs’ capacity to engage a multiplicity of canonical and noncanonical G protein–dependent responses is surveyed, and evidence supporting ligand-specific signaling and regulation is analyzed. Pharmacological DOPr subtypes are examined in light of the ability of DOPr to organize into multimeric arrays and to adopt multiple active conformations as well as differences in ligand kinetics. Current knowledge on DOPr targeting to the membrane is examined as a means of understanding how these receptors are especially active in chronic pain management. Insight into cellular and molecular mechanisms of pharmacological diversity should guide the rational design of more effective, longer-lasting, and better-tolerated opioid analgesics for chronic pain management. PMID:27343248

'The surface management system' (SuMS) database: a surface-based database to aid cortical surface reconstruction, visualization and analysis

NASA Technical Reports Server (NTRS)

Dickson, J.; Drury, H.; Van Essen, D. C.

2001-01-01

Surface reconstructions of the cerebral cortex are increasingly widely used in the analysis and visualization of cortical structure, function and connectivity. From a neuroinformatics perspective, dealing with surface-related data poses a number of challenges. These include the multiplicity of configurations in which surfaces are routinely viewed (e.g. inflated maps, spheres and flat maps), plus the diversity of experimental data that can be represented on any given surface. To address these challenges, we have developed a surface management system (SuMS) that allows automated storage and retrieval of complex surface-related datasets. SuMS provides a systematic framework for the classification, storage and retrieval of many types of surface-related data and associated volume data. Within this classification framework, it serves as a version-control system capable of handling large numbers of surface and volume datasets. With built-in database management system support, SuMS provides rapid search and retrieval capabilities across all the datasets, while also incorporating multiple security levels to regulate access. SuMS is implemented in Java and can be accessed via a Web interface (WebSuMS) or using downloaded client software. Thus, SuMS is well positioned to act as a multiplatform, multi-user 'surface request broker' for the neuroscience community.

Direction Finding Using Multiple MEMS Acoustic Sensors

DTIC Science & Technology

2015-09-01

ADDRESS(ES) Naval Postgraduate School Monterey, CA 93943-5000 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING /MONITORING AGENCY NAME...6 B. OBJECTIVE AND THESIS ORGANIZATION ..................................10 II. DIRECTION FINDING USING MULTIPLE

Comprehensive Civil Information Management: How to Provide It

DTIC Science & Technology

2012-04-04

5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT NUMBER...Management, Non-Government Organizations , International Organizations , Interagency 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18...Information Support Operations, Psychological Operations, Flat Technology, Knowledge Management, Non-Government Organizations , International

Beyond Adapting to Climate Change: Embedding Adaptation in Responses to Multiple Threats and Stresses

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

Wilbanks, Thomas J; Kates, Dr. Robert W.

2010-01-01

Climate change impacts are already being experienced in every region of the United States and every part of the world most severely in Arctic regions and adaptation is needed now. Although climate change adaptation research is still in its infancy, significant adaptation planning in the United States has already begun in a number of localities. This article seeks to broaden the adaptation effort by integrating it with broader frameworks of hazards research, sustainability science, and community and regional resilience. To extend the range of experience, we draw from ongoing case studies in the Southeastern United States and the environmental historymore » of New Orleans to consider the multiple threats and stresses that all communities and regions experience. Embedding climate adaptation in responses to multiple threats and stresses helps us to understand climate change impacts, themselves often products of multiple stresses, to achieve community acceptance of needed adaptations as co-benefits of addressing multiple threats, and to mainstream the process of climate adaptation through the larger envelope of social relationships, communication channels, and broad-based awareness of needs for risk management that accompany community resilience.« less

Who to Blame: Irrational Decision-Makers or Stupid Modelers? (Arne Richter Award for Outstanding Young Scientists Lecture)

NASA Astrophysics Data System (ADS)

Madani, Kaveh

2016-04-01

Water management benefits from a suite of modelling tools and techniques that help simplifying and understanding the complexities involved in managing water resource systems. Early water management models were mainly concerned with optimizing a single objective, related to the design, operations or management of water resource systems (e.g. economic cost, hydroelectricity production, reliability of water deliveries). Significant improvements in methodologies, computational capacity, and data availability over the last decades have resulted in developing more complex water management models that can now incorporate multiple objectives, various uncertainties, and big data. These models provide an improved understanding of complex water resource systems and provide opportunities for making positive impacts. Nevertheless, there remains an alarming mismatch between the optimal solutions developed by these models and the decisions made by managers and stakeholders of water resource systems. Modelers continue to consider decision makers as irrational agents who fail to implement the optimal solutions developed by sophisticated and mathematically rigours water management models. On the other hand, decision makers and stakeholders accuse modelers of being idealist, lacking a perfect understanding of reality, and developing 'smart' solutions that are not practical (stable). In this talk I will have a closer look at the mismatch between the optimality and stability of solutions and argue that conventional water resources management models suffer inherently from a full-cooperation assumption. According to this assumption, water resources management decisions are based on group rationality where in practice decisions are often based on individual rationality, making the group's optimal solution unstable for individually rational decision makers. I discuss how game theory can be used as an appropriate framework for addressing the irrational "rationality assumption" of water resources management models and for better capturing the social aspects of decision making in water management systems with multiple stakeholders.

Multi-target drugs to address multiple checkpoints in complex inflammatory pathologies: evolutionary cues for novel "first-in-class" anti-inflammatory drug candidates: a reviewer's perspective.

PubMed

Mathew, Geetha; Unnikrishnan, M K

2015-10-01

Inflammation is a complex, metabolically expensive process involving multiple signaling pathways and regulatory mechanisms which have evolved over evolutionary timescale. Addressing multiple targets of inflammation holistically, in moderation, is probably a more evolutionarily viable strategy, as compared to current therapy which addresses drug targets in isolation. Polypharmacology, addressing multiple targets, is commonly used in complex ailments, suggesting the superior safety and efficacy profile of multi-target (MT) drugs. Phenotypic drug discovery, which generated successful MT and first-in-class drugs in the past, is now re-emerging. A multi-pronged approach, which modulates the evolutionarily conserved, robust and pervasive cellular mechanisms of tissue repair, with AMPK at the helm, regulating the complex metabolic/immune/redox pathways underlying inflammation, is perhaps a more viable strategy than addressing single targets in isolation. Molecules that modulate multiple molecular mechanisms of inflammation in moderation (modulating TH cells toward the anti-inflammatory phenotype, activating AMPK, stimulating Nrf2 and inhibiting NFκB) might serve as a model for a novel Darwinian "first-in-class" therapeutic category that holistically addresses immune, redox and metabolic processes associated with inflammatory repair. Such a multimodal biological activity is supported by the fact that several non-calorific pleiotropic natural products with anti-inflammatory action have been incorporated into diet (chiefly guided by the adaptive development of olfacto-gustatory preferences over evolutionary timescales) rendering such molecules, endowed with evolutionarily privileged molecular scaffolds, naturally oriented toward multiple targets.

Variables contributing to an excellent customer service management profile within the regulated electric utility industry: A comparison of self-concept with customer satisfaction for customer service management

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

Johnson, L.E.

1991-01-01

This research sought to address the relationship between self-concept and customer satisfaction: can customer satisfaction with a major electric utility be explained in terms of the self-reported, self-concept of the utility's managers The population to which the results of this study were generalized consisted of customer service managers in public electric utilities across the United States. In order to represent this population, a sample was selected consisting of customer service managers at a midwestern electric utility based in a large metropolitan area. Participants in this study were managers of four direct customer contact service organizations within six geographic division organizations.more » The methodology included comparisons of these four customer contact service organizations on twelve independent, self-concept variables and six customer satisfaction dependent variables using Analysis of Variance (ANOVA), Scheffe' tests, Chi-Square, and Stepwise multiple regression. The groups were found not to be significantly different and knowledge of the self-concept scores for managers will not increase the ability to predict customer satisfaction over no knowledge of self-concept scores.« less

Using participatory action research in a community-based initiative addressing complex mental health needs.

PubMed

Knightbridge, Stephen M; King, Robert; Rolfe, Timothy J

2006-04-01

This paper describes the first phase of a larger project that utilizes participatory action research to examine complex mental health needs across an extensive group of stakeholders in the community. Within an objective qualitative analysis of focus group discussions the social ecological model is utilized to explore how integrative activities can be informed, planned and implemented across multiple elements and levels of a system. Seventy-one primary care workers, managers, policy-makers, consumers and carers from across the southern metropolitan and Gippsland regions of Victoria, Australia took part in seven focus groups. All groups responded to an identical set of focusing questions. Participants produced an explanatory model describing the service system, as it relates to people with complex needs, across the levels of social ecological analysis. Qualitative themes analysis identified four priority areas to be addressed in order to improve the system's capacity for working with complexity. These included: (i) system fragmentation; (ii) integrative case management practices; (iii) community attitudes; and (iv) money and resources. The emergent themes provide clues as to how complexity is constructed and interpreted across the system of involved agencies and interest groups. The implications these findings have for the development and evaluation of this community capacity-building project were examined from the perspective of constructing interventions that address both top-down and bottom-up processes.

The management of new primary care organizations: an international perspective.

PubMed

Meads, Geoffrey; Wild, Andrea; Griffiths, Frances; Iwami, Michiyo; Moore, Phillipa

2006-08-01

Management practice arising from parallel policies for modernizing health systems is examined across a purposive sample of 16 countries. In each, novel organizational developments in primary care are a defining feature of the proposed future direction. Semistructured interviews with national leaders in primary care policy development and local service implementation indicate that management strategies, which effectively address the organized resistance of medical professions to modernizing policies, have these four consistent characteristics: extended community and patient participation models; national frameworks for interprofessional education and representation; mechanisms for multiple funding and accountabilities; and the diversification of non-governmental organizations and their roles. The research, based on a two-year fieldwork programme, indicates that at the meso-level of management planning and practice, there is a considerable potential for exchange and transferable learning between previously unconnected countries. The effectiveness of management strategies abroad, for example, in contexts where for the first time alternative but comparable new primary care organizations are exercising responsibilities for local resource utilization, may be understood through the application of stakeholder analyses, such as those employed to promote parity of relationships in NHS primary care trusts.

A framework for sustainable invasive species management: environmental, social and economic objectives

USGS Publications Warehouse

Larson, Diane L.; Phillips-Mao, Laura; Quiram, Gina; Sharpe, Leah; Stark, Rebecca; Sugita, Shinya; Weiler, Annie

2011-01-01

Applying the concept of sustainability to invasive species management (ISM) is challenging but necessary, given the increasing rates of invasion and the high costs of invasion impacts and control. To be sustainable, ISM must address environmental, social, and economic factors (or *pillars*) that influence the causes, impacts, and control of invasive species across multiple spatial and temporal scales. Although these pillars are generally acknowledged, their implementation is often limited by insufficient control options and significant economic and political constraints. In this paper, we outline specific objectives in each of these three *pillars* that, if incorporated into a management plan, will improve the plan's likelihood of sustainability. We then examine three case studies that illustrate how these objectives can be effectively implemented. Each pillar reinforces the others, such that the inclusion of even a few of the outlined objectives will lead to more effective management that achieves ecological goals, while generating social support and long-term funding to maintain projects to completion. We encourage agency directors and policy-makers to consider sustainability principles when developing funding schemes, management agendas, and policy.

Managing perceived conflicts of interest while ensuring the continued innovation of medical technology.

PubMed

Van Haute, Andrew

2011-09-01

If it were not for the ongoing collaboration between vascular surgeons and the medical technology industry, many of these advanced treatments used every day in vascular interventional surgery would not exist. The flip side of this coin is that these vital relationships create multiple roles for surgeons and must be appropriately managed. The dynamic process of innovation, along with factors such as product delivery technique refinement, education, testing and clinical trials, and product support, all make it necessary for ongoing and close collaboration between surgeons and the device industry. This unique relationship sometimes leads to the perception of conflicts of interest for physicians, in part because the competing pressures from the multiple, overlapping roles as clinician/caregiver/investigator/innovator/customer are significant. To address this issue, the Advanced Medical Technology Association (AdvaMed), the nation's largest medical technology association representing medical device and diagnostics companies, developed a Code of Ethics to guide medical technology companies in their interactions with health care professionals. First introduced in 1993, the AdvaMed Code strongly encourages both industry and physicians to commit to openness and high ethical standards in the conduct of their business interactions. The AdvaMed Code addresses many of the types of interactions that can occur between companies and health care professionals, including training, consulting agreements, the provision of demonstration and evaluation units, and charitable donations. By following the Code, companies send a strong message that treatment decisions must always be based on the best interest of the patient. Copyright © 2011. Published by Mosby, Inc.

WPBMB Entrez: An interface to NCBI Entrez for Wordpress.

PubMed

Gohara, David W

2018-03-01

Research-oriented websites are an important means for the timely communication of information. These websites fall under a number of categories including: research laboratories, training grant and program projects, and online service portals. Invariably there is content on a site, such as publication listings, that require frequent updating. A number of content management systems exist to aid in the task of developing and managing a website, each with their strengths and weaknesses. One popular choice is Wordpress, a free, open source and actively developed application for the creation of web content. During a recent site redesign for our department, the need arose to ensure publications were up to date for each of the research labs and department as a whole. Several plugins for Wordpress offer this type of functionality, but in many cases the plugins are either no longer maintained, are missing features that would require the use of several, possibly incompatible, plugins or lack features for layout on a webpage. WPBMB Entrez was developed to address these needs. WPBMB Entrez utilizes a subset of NCBI Entrez and RCSB databases to maintain up to date records of publications, and publication related information on Wordpress-based websites. The core functionality uses the same search query syntax as on the NCBI Entrez site, including advanced query syntaxes. The plugin is extensible allowing for rapid development and addition of new data sources as the need arises. WPBMB Entrez was designed to be easy to use, yet flexible enough to address more complex usage scenarios. Features of the plugin include: an easy to use interface, design customization, multiple templates for displaying publication results, a caching mechanism to reduce page load times, supports multiple distinct queries and retrieval modes, and the ability to aggregate multiple queries into unified lists. Additionally, developer documentation is provided to aid in customization of the plugin. WPBMB Entrez is available at no cost, is open source and works with all recent versions of Wordpress. Copyright © 2017 Elsevier B.V. All rights reserved.

A legal framework to enable sharing of Clinical Decision Support knowledge and services across institutional boundaries.

PubMed

Hongsermeier, Tonya; Maviglia, Saverio; Tsurikova, Lana; Bogaty, Dan; Rocha, Roberto A; Goldberg, Howard; Meltzer, Seth; Middleton, Blackford

2011-01-01

The goal of the CDS Consortium (CDSC) is to assess, define, demonstrate, and evaluate best practices for knowledge management and clinical decision support in healthcare information technology at scale - across multiple ambulatory care settings and Electronic Health Record technology platforms. In the course of the CDSC research effort, it became evident that a sound legal foundation was required for knowledge sharing and clinical decision support services in order to address data sharing, intellectual property, accountability, and liability concerns. This paper outlines the framework utilized for developing agreements in support of sharing, accessing, and publishing content via the CDSC Knowledge Management Portal as well as an agreement in support of deployment and consumption of CDSC developed web services in the context of a research project under IRB oversight.

Challenges for data storage in medical imaging research.

PubMed

Langer, Steve G

2011-04-01

Researchers in medical imaging have multiple challenges for storing, indexing, maintaining viability, and sharing their data. Addressing all these concerns requires a constellation of tools, but not all of them need to be local to the site. In particular, the data storage challenges faced by researchers can begin to require professional information technology skills. With limited human resources and funds, the medical imaging researcher may be better served with an outsourcing strategy for some management aspects. This paper outlines an approach to manage the main objectives faced by medical imaging scientists whose work includes processing and data mining on non-standard file formats, and relating those files to the their DICOM standard descendents. The capacity of the approach scales as the researcher's need grows by leveraging the on-demand provisioning ability of cloud computing.

Precision medicine in chronic disease management: the MS BioScreen

PubMed Central

Gourraud, Pierre-Antoine; Henry, Roland; Cree, Bruce AC; Crane, Jason C; Lizee, Antoine; Olson, Marram P; Santaniello, Adam V.; Datta, Esha; Zhu, Alyssa H.; Bevan, Carolyn J.; Gelfand, Jeffrey M.; Graves, Jennifer A.; Goodin, Douglas E.; Green, Ari; von Büdingen, H.-Christian; Waubant, Emmanuelle; Zamvil, Scott S.; Crabtree-Hartman, Elizabeth; Nelson, Sarah; Baranzini, Sergio E.; Hauser, Stephen L.

2014-01-01

We present a precision medicine application developed for multiple sclerosis (MS): the MS BioScreen. This new tool addresses the challenges of dynamic management of a complex chronic disease; the interaction of clinicians and patients with such a tool illustrates the extent to which translational digital medicine – i.e. the application of information technology to medicine—has the potential to radically transform medical practice. We introduce three key evolutionary phases in displaying data to health care providers, patients, and researchers: visualization (accessing data), contextualization (understanding the data), and actionable interpretation (real-time use of the data to assist decision-making). Together these form the stepping-stones that are expected to accelerate standardization of data across platforms, promote evidence-based medicine, support shared decision-making, and ultimately lead to improved outcomes. PMID:25263997

Ethical dilemmas in journal publication.

PubMed

Babalola, Olubukola; Grant-Kels, Jane M; Parish, Lawrence Charles

2012-01-01

Physicians often face tremendous pressures and incentives to publish, sometimes leading to a compromise of ethical standards, either consciously or unconsciously. From the vantage of ethical authorship, we discuss what constitutes authorship; avoidance of ghost authorship; plagiarism, as well as self-plagiarism and duplicate publication; falsification; and fabrication. Editors also face ethical challenges, including how best to manage peer-review bias, to address reviewer tardiness, and to locate reviewers with appropriate expertise and professionalism. Editors need to deal with authors who fragment their work into multiple publications to enhance their curriculum vitae ("salami factor"), as well as to manage the financial benefits of advertising and to avoid conflicts of interest for the journal. Both authors and editors should be straightforward and principled throughout the publication process. Copyright © 2012 Elsevier Inc. All rights reserved.

Generation of priority research questions to inform conservation policy and management at a national level.

PubMed

Rudd, Murray A; Beazley, Karen F; Cooke, Steven J; Fleishman, Erica; Lane, Daniel E; Mascia, Michael B; Roth, Robin; Tabor, Gary; Bakker, Jiselle A; Bellefontaine, Teresa; Berteaux, Dominique; Cantin, Bernard; Chaulk, Keith G; Cunningham, Kathryn; Dobell, Rod; Fast, Eleanor; Ferrara, Nadia; Findlay, C Scott; Hallstrom, Lars K; Hammond, Thomas; Hermanutz, Luise; Hutchings, Jeffrey A; Lindsay, Kathryn E; Marta, Tim J; Nguyen, Vivian M; Northey, Greg; Prior, Kent; Ramirez-Sanchez, Saudiel; Rice, Jake; Sleep, Darren J H; Szabo, Nora D; Trottier, Geneviève; Toussaint, Jean-Patrick; Veilleux, Jean-Philippe

2011-06-01

Integrating knowledge from across the natural and social sciences is necessary to effectively address societal tradeoffs between human use of biological diversity and its preservation. Collaborative processes can change the ways decision makers think about scientific evidence, enhance levels of mutual trust and credibility, and advance the conservation policy discourse. Canada has responsibility for a large fraction of some major ecosystems, such as boreal forests, Arctic tundra, wetlands, and temperate and Arctic oceans. Stressors to biological diversity within these ecosystems arise from activities of the country's resource-based economy, as well as external drivers of environmental change. Effective management is complicated by incongruence between ecological and political boundaries and conflicting perspectives on social and economic goals. Many knowledge gaps about stressors and their management might be reduced through targeted, timely research. We identify 40 questions that, if addressed or answered, would advance research that has a high probability of supporting development of effective policies and management strategies for species, ecosystems, and ecological processes in Canada. A total of 396 candidate questions drawn from natural and social science disciplines were contributed by individuals with diverse organizational affiliations. These were collaboratively winnowed to 40 by our team of collaborators. The questions emphasize understanding ecosystems, the effects and mitigation of climate change, coordinating governance and management efforts across multiple jurisdictions, and examining relations between conservation policy and the social and economic well-being of Aboriginal peoples. The questions we identified provide potential links between evidence from the conservation sciences and formulation of policies for conservation and resource management. Our collaborative process of communication and engagement between scientists and decision makers for generating and prioritizing research questions at a national level could be a model for similar efforts beyond Canada. ©2010 Society for Conservation Biology.

PANDA: A distributed multiprocessor operating system

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

Chubb, P.

1989-01-01

PANDA is a design for a distributed multiprocessor and an operating system. PANDA is designed to allow easy expansion of both hardware and software. As such, the PANDA kernel provides only message passing and memory and process management. The other features needed for the system (device drivers, secondary storage management, etc.) are provided as replaceable user tasks. The thesis presents PANDA's design and implementation, both hardware and software. PANDA uses multiple 68010 processors sharing memory on a VME bus, each such node potentially connected to others via a high speed network. The machine is completely homogeneous: there are no differencesmore » between processors that are detectable by programs running on the machine. A single two-processor node has been constructed. Each processor contains memory management circuits designed to allow processors to share page tables safely. PANDA presents a programmers' model similar to the hardware model: a job is divided into multiple tasks, each having its own address space. Within each task, multiple processes share code and data. Tasks can send messages to each other, and set up virtual circuits between themselves. Peripheral devices such as disc drives are represented within PANDA by tasks. PANDA divides secondary storage into volumes, each volume being accessed by a volume access task, or VAT. All knowledge about the way that data is stored on a disc is kept in its volume's VAT. The design is such that PANDA should provide a useful testbed for file systems and device drivers, as these can be installed without recompiling PANDA itself, and without rebooting the machine.« less

Threat assessment and sensor management in a modular architecture

NASA Astrophysics Data System (ADS)

Page, S. F.; Oldfield, J. P.; Islip, S.; Benfold, B.; Brandon, R.; Thomas, P. A.; Stubbins, D. J.

2016-10-01

Many existing asset/area protection systems, for example those deployed to protect critical national infrastructure, are comprised of multiple sensors such as EO/IR, radar, and Perimeter Intrusion Detection Systems (PIDS), loosely integrated with a central Command and Control (C2) system. Whilst some sensors provide automatic event detection and C2 systems commonly provide rudimentary multi-sensor rule based alerting, the performance of such systems is limited by the lack of deep integration and autonomy. As a result, these systems have a high degree of operator burden. To address these challenges, an architectural concept termed "SAPIENT" was conceived. SAPIENT is based on multiple Autonomous Sensor Modules (ASMs) connected to a High-Level Decision Making Module (HLDMM) that provides data fusion, situational awareness, alerting, and sensor management capability. The aim of the SAPIENT concept is to allow for the creation of a surveillance system, in a modular plug-and-play manner, that provides high levels of autonomy, threat detection performance, and reduced operator burden. This paper considers the challenges associated with developing an HLDMM aligned with the SAPIENT concept, through the discussion of the design of a realised HLDMM. Particular focus is drawn to how high levels of system level performance can be achieved whilst retaining modularity and flexibility. A number of key aspects of our HLDMM are presented, including an integrated threat assessment and sensor management framework, threat sequence matching, and ASM trust modelling. The results of real-world testing of the HLDMM, in conjunction with multiple Laser, Radar, and EO/IR sensors, in representative semi-urban environments, are discussed.

Wetlands as large-scale nature-based solutions: status and future challenges for research and management

NASA Astrophysics Data System (ADS)

Thorslund, Josefin; Jarsjö, Jerker; Destouni, Georgia

2017-04-01

Wetlands are often considered as nature-based solutions that can provide a multitude of services of great social, economic and environmental value to humankind. The services may include recreation, greenhouse gas sequestration, contaminant retention, coastal protection, groundwater level and soil moisture regulation, flood regulation and biodiversity support. Changes in land-use, water use and climate can all impact wetland functions and occur at scales extending well beyond the local scale of an individual wetland. However, in practical applications, management decisions usually regard and focus on individual wetland sites and local conditions. To understand the potential usefulness and services of wetlands as larger-scale nature-based solutions, e.g. for mitigating negative impacts from large-scale change pressures, one needs to understand the combined function multiple wetlands at the relevant large scales. We here systematically investigate if and to what extent research so far has addressed the large-scale dynamics of landscape systems with multiple wetlands, which are likely to be relevant for understanding impacts of regional to global change. Our investigation regards key changes and impacts of relevance for nature-based solutions, such as large-scale nutrient and pollution retention, flow regulation and coastal protection. Although such large-scale knowledge is still limited, evidence suggests that the aggregated functions and effects of multiple wetlands in the landscape can differ considerably from those observed at individual wetlands. Such scale differences may have important implications for wetland function-effect predictability and management under large-scale change pressures and impacts, such as those of climate change.

75 FR 61704 - Fisheries of the South Atlantic; South Atlantic Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-06

... of black sea bass and golden tilefish; Amendment 24 addressing management of red grouper and Amendment 22 addressing long- term management of red snapper, and the Comprehensive Annual Catch Limit (ACL... & 10 to the Snapper Grouper Fishery Management Plan (FMP) addressing trip limits and changes to red...

General Use of UAS in EW Environment-EW Concepts and Tactics for Single or Multiple UAS Over the Net-Centric Battlefield

DTIC Science & Technology

2009-09-01

Tactics for Single or Multiple UAS over the Net-Centric Battlefield 6. AUTHOR( S ) Mustafa Gokhan Erdemli 5. FUNDING NUMBERS 7. PERFORMING ORGANIZATION...NAME( S ) AND ADDRESS(ES) Naval Postgraduate School Monterey, CA 93943-5000 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING...MONITORING AGENCY NAME( S ) AND ADDRESS(ES) N/A 10. SPONSORING/MONITORING AGENCY REPORT NUMBER 11. SUPPLEMENTARY NOTES The views expressed in this

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

Peterson, Mark J; Efroymson, Rebecca Ann; Adams, Marshall

The long-term ecological recovery of an impaired stream in response to an industrial facility's pollution abatement actions and the implications of the biological monitoring effort to environmental management is the subject of this special issue of Environmental Management. This final article focuses on the synthesis of the biological monitoring program's components and methods, the efficacy of various biological monitoring techniques to environmental management, and the lessons learned from the program that might be applicable to the design and application of other programs. The focus of the 25-year program has been on East Fork Poplar Creek, an ecologically impaired stream inmore » Oak Ridge, Tennessee with varied and complex stressors from a Department of Energy facility in its headwaters. Major components of the long-term program included testing and monitoring of invertebrate and fish toxicity, bioindicators of fish health, fish contaminant accumulation, and instream communities (including periphyton, benthic macroinvertebrate, and fish). Key parallel components of the program include water chemistry sampling and data management. Multiple lines of evidence suggested positive ecological responses during three major pollution abatement periods. Based on this case study and the related literature, effective environmental management of impaired streams starts with program design that is consistent across space and time, but also adaptable to changing conditions. The biological monitoring approaches used for the program provided a strong basis for assessments of recovery from remedial actions, and the likely causes of impairment. This case study provides a unique application of multidisciplinary and quantitative techniques to address multiple and complex regulatory and programmatic goals, environmental stressors, and remedial actions.« less

Conservation of northern bobwhite on private lands in Georgia, USA under uncertainty about landscape-level habitat effects

USGS Publications Warehouse

Howell, J.E.; Moore, C.T.; Conroy, M.J.; Hamrick, R.G.; Cooper, R.J.; Thackston, R.E.; Carroll, J.P.

2009-01-01

Large-scale habitat enhancement programs for birds are becoming more widespread, however, most lack monitoring to resolve uncertainties and enhance program impact over time. Georgia?s Bobwhite Quail Initiative (BQI) is a competitive, proposal-based system that provides incentives to landowners to establish habitat for northern bobwhites (Colinus virginianus). Using data from monitoring conducted in the program?s first years (1999?2001), we developed alternative hierarchical models to predict bobwhite abundance in response to program habitat modifications on local and regional scales. Effects of habitat and habitat management on bobwhite population response varied among geographical scales, but high measurement variability rendered the specific nature of these scaled effects equivocal. Under some models, BQI had positive impact at both local farm scales (1, 9 km2), particularly when practice acres were clustered, whereas other credible models indicated that bird response did not depend on spatial arrangement of practices. Thus, uncertainty about landscape-level effects of management presents a challenge to program managers who must decide which proposals to accept. We demonstrate that optimal selection decisions can be made despite this uncertainty and that uncertainty can be reduced over time, with consequent improvement in management efficacy. However, such an adaptive approach to BQI program implementation would require the reestablishment of monitoring of bobwhite abundance, an effort for which funding was discontinued in 2002. For landscape-level conservation programs generally, our approach demonstrates the value in assessing multiple scales of impact of habitat modification programs, and it reveals the utility of addressing management uncertainty through multiple decision models and system monitoring.

The impact of health information technology on collaborative chronic care management.

PubMed

Marchibroda, Janet M

2008-03-01

Chronic disease is a growing problem in the United States. More than 125 million Americans had at least 1 chronic care condition in 2000, and this number is expected to grow to 157 million by the year 2020.1 Some of the challenges associated with current chronic care management approaches can be addressed through the use of health information technology (IT) and health information exchange. To review the current challenges of chronic care management and explore how health IT and health information exchange efforts at the national, state, and local levels can be leveraged to address some of these challenges. Efforts to effectively manage chronic care have been hampered by a number of factors, including a fragmented health care system and the need for more coordination across the health care setting; the lack of interoperable clinical information systems, which would help provide readily available, comprehensive information about the patient to those who deliver care, those who manage care, and those who receive care, and finally, the current predominantly fee-for-service reimbursement system that rewards volume and fragmentation, and does not effectively align incentives with the goals of chronic care management. The introduction of health IT, including electronic health records and health information exchange, holds great promise for addressing many of the barriers to effective chronic care management, by providing important clinical information about the patient when it is needed, and where it is needed, in a timely, secure fashion. Having information from the care delivery process readily available through health IT and health information exchange at the national, state, and local levels supports key components of the chronic care management process, including those related to measurement, clinical decision support, collaboration and coordination, and consumer activation. Those engaged in chronic care management should seek to leverage health IT and health information exchange initiatives particularly at the local levels. Community-based initiatives have built social capital and trust across multiple stakeholders; enabled access to clinical data derived from the care delivery process that only resides locally; and in many cases aligned incentives around the mobilization of clinical information across care settings. All of these elements are critical to the long-term success of chronic care management. While there is good research regarding interdisciplinary care models, more research is still needed to identify policies, practices, and strategies for facilitating and building cooperation among those engaged in chronic care management, and those engaged in multi-stakeholder efforts involved in the exchange of clinical health information electronically.

75 FR 41790 - Address Management Services-Elimination of the Manual Card Option for Address Sequencing Services

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-19

... Electronic Address Sequencing (EAS) service processes a customer's addresses file for walk sequence and/or... POSTAL SERVICE 39 CFR Part 111 Address Management Services--Elimination of the Manual Card Option for Address Sequencing Services AGENCY: Postal Service TM . ACTION: Proposed rule. SUMMARY: The Postal...

The fundamental role of ecological feedback mechanisms for the adaptive management of seagrass ecosystems - a review.

PubMed

Maxwell, Paul S; Eklöf, Johan S; van Katwijk, Marieke M; O'Brien, Katherine R; de la Torre-Castro, Maricela; Boström, Christoffer; Bouma, Tjeerd J; Krause-Jensen, Dorte; Unsworth, Richard K F; van Tussenbroek, Brigitta I; van der Heide, Tjisse

2017-08-01

Seagrass meadows are vital ecosystems in coastal zones worldwide, but are also under global threat. One of the major hurdles restricting the success of seagrass conservation and restoration is our limited understanding of ecological feedback mechanisms. In these ecosystems, multiple, self-reinforcing feedbacks can undermine conservation efforts by masking environmental impacts until the decline is precipitous, or alternatively they can inhibit seagrass recovery in spite of restoration efforts. However, no clear framework yet exists for identifying or dealing with feedbacks to improve the management of seagrass ecosystems. Here we review the causes and consequences of multiple feedbacks between seagrass and biotic and/or abiotic processes. We demonstrate how feedbacks have the potential to impose or reinforce regimes of either seagrass dominance or unvegetated substrate, and how the strength and importance of these feedbacks vary across environmental gradients. Although a myriad of feedbacks have now been identified, the co-occurrence and likely interaction among feedbacks has largely been overlooked to date due to difficulties in analysis and detection. Here we take a fundamental step forward by modelling the interactions among two distinct above- and belowground feedbacks to demonstrate that interacting feedbacks are likely to be important for ecosystem resilience. On this basis, we propose a five-step adaptive management plan to address feedback dynamics for effective conservation and restoration strategies. The management plan provides guidance to aid in the identification and prioritisation of likely feedbacks in different seagrass ecosystems. © 2016 Cambridge Philosophical Society.

Modeling, Simulation and Performance Analysis of Multiple-Input Multiple-Output (MIMO) Systems with Multicarrier Time Delay Diversity Modulation

DTIC Science & Technology

2005-09-01

6. AUTHOR( S ) Muhammad Shahid 5. FUNDING NUMBERS 7. PERFORMING ORGANIZATION NAME( S ) AND ADDRESS(ES) Naval Postgraduate School Monterey, CA 93943...5000 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING /MONITORING AGENCY NAME( S ) AND ADDRESS(ES) N/A 10. SPONSORING/MONITORING...streams which are assigned to the K subcarriers [1]. The symbol duration of the input serial data is ’sT with serial data rate of ’ 𔃻s s f T

Managing endangered species within the use-preservation paradox: the Florida manatee (Trichechus manatus latirostris) as a tourism attraction.

PubMed

Sorice, Michael G; Shafer, C Scott; Ditton, Robert B

2006-01-01

A significant challenge to wildlife managers in tourism settings is to provide visitors with opportunities to observe rare and endangered wildlife while simultaneously protecting the target species from deleterious impacts. Nearly 100,000 people annually visit Crystal River, Florida, USA to observe and swim with the Florida manatee, an endangered species. This research aimed to investigate and describe human-manatee interactions in a tourism context, to understand the salient issues related to such interactions as identified by stakeholders, and to recommend a course of action to address multiple interests in the planning and management of human-manatee interactions. Five issues were identified by all stakeholder groups: water quality, harassment, density and crowding, education, and enforcement. Currently, the U.S. Fish and Wildlife Service, which is responsible for manatee management, does not have mechanisms in place to manage the tourism component of the manatee encounter. Although a regulatory approach can be taken, a better approach would be to create an organization of tour operators to establish "best practices" that reflect the goal of the managing agency to enhance manatee protection (and thus ensure their livelihood) and to enhance the visitor experience.

Wildlife tracking data management: a new vision.

PubMed

Urbano, Ferdinando; Cagnacci, Francesca; Calenge, Clément; Dettki, Holger; Cameron, Alison; Neteler, Markus

2010-07-27

To date, the processing of wildlife location data has relied on a diversity of software and file formats. Data management and the following spatial and statistical analyses were undertaken in multiple steps, involving many time-consuming importing/exporting phases. Recent technological advancements in tracking systems have made large, continuous, high-frequency datasets of wildlife behavioural data available, such as those derived from the global positioning system (GPS) and other animal-attached sensor devices. These data can be further complemented by a wide range of other information about the animals' environment. Management of these large and diverse datasets for modelling animal behaviour and ecology can prove challenging, slowing down analysis and increasing the probability of mistakes in data handling. We address these issues by critically evaluating the requirements for good management of GPS data for wildlife biology. We highlight that dedicated data management tools and expertise are needed. We explore current research in wildlife data management. We suggest a general direction of development, based on a modular software architecture with a spatial database at its core, where interoperability, data model design and integration with remote-sensing data sources play an important role in successful GPS data handling.

Teaching customer-centric operations management - evidence from an experiential learning-oriented mass customisation class

NASA Astrophysics Data System (ADS)

Medini, Khaled

2018-01-01

The increase of individualised customer demands and tough competition in the manufacturing sector gave rise to more customer-centric operations management such as products and services (mass) customisation. Mass customisation (MC), which inherits the 'economy of scale' from mass production (MP), aims to meet specific customer demands with near MP efficiency. Such an overarching concept has multiple impacts on operations management. This requires highly qualified and multi-skilled engineers who are well prepared for managing MC. Therefore, this concept should be properly addressed by engineering education curricula which needs to keep up with the emerging business trends. This paper introduces a novel course about MC and variety in operations management which recalls several Experiential Learning (EL) practices consistently with the principle of an active learning. The paper aims to analyse to which extent EL can improve the efficiency of the teaching methods and the retention rate in the context of operations management. The proposed course is given to engineering students whose' perceptions are collected using semi-structured questionnaires and analysed quantitatively and qualitatively. The paper highlights the relevance (i) of teaching MC, and (ii) of active learning in engineering education, through the specific application in the domain of MC.

Wildlife tracking data management: a new vision

PubMed Central

Urbano, Ferdinando; Cagnacci, Francesca; Calenge, Clément; Dettki, Holger; Cameron, Alison; Neteler, Markus

2010-01-01

To date, the processing of wildlife location data has relied on a diversity of software and file formats. Data management and the following spatial and statistical analyses were undertaken in multiple steps, involving many time-consuming importing/exporting phases. Recent technological advancements in tracking systems have made large, continuous, high-frequency datasets of wildlife behavioural data available, such as those derived from the global positioning system (GPS) and other animal-attached sensor devices. These data can be further complemented by a wide range of other information about the animals' environment. Management of these large and diverse datasets for modelling animal behaviour and ecology can prove challenging, slowing down analysis and increasing the probability of mistakes in data handling. We address these issues by critically evaluating the requirements for good management of GPS data for wildlife biology. We highlight that dedicated data management tools and expertise are needed. We explore current research in wildlife data management. We suggest a general direction of development, based on a modular software architecture with a spatial database at its core, where interoperability, data model design and integration with remote-sensing data sources play an important role in successful GPS data handling. PMID:20566495

Managing Endangered Species Within the Use-Preservation Paradox: The Florida Manatee ( Trichechus manatus latirostris) as a Tourism Attraction

NASA Astrophysics Data System (ADS)

Sorice, Michael G.; Shafer, C. Scott; Ditton, Robert B.

2006-01-01

A significant challenge to wildlife managers in tourism settings is to provide visitors with opportunities to observe rare and endangered wildlife while simultaneously protecting the target species from deleterious impacts. Nearly 100,000 people annually visit Crystal River, Florida, USA to observe and swim with the Florida manatee, an endangered species. This research aimed to investigate and describe human-manatee interactions in a tourism context, to understand the salient issues related to such interactions as identified by stakeholders, and to recommend a course of action to address multiple interests in the planning and management of human-manatee interactions. Five issues were identified by all stakeholder groups: water quality, harassment, density and crowding, education, and enforcement. Currently, the U.S. Fish and Wildlife Service, which is responsible for manatee management, does not have mechanisms in place to manage the tourism component of the manatee encounter. Although a regulatory approach can be taken, a better approach would be to create an organization of tour operators to establish “best practices” that reflect the goal of the managing agency to enhance manatee protection (and thus ensure their livelihood) and to enhance the visitor experience.

Wildfire Decision Making Under Uncertainty

NASA Astrophysics Data System (ADS)

Thompson, M.

2013-12-01

Decisions relating to wildfire management are subject to multiple sources of uncertainty, and are made by a broad range of individuals, across a multitude of environmental and socioeconomic contexts. In this presentation I will review progress towards identification and characterization of uncertainties and how this information can support wildfire decision-making. First, I will review a typology of uncertainties common to wildfire management, highlighting some of the more salient sources of uncertainty and how they present challenges to assessing wildfire risk. This discussion will cover the expanding role of burn probability modeling, approaches for characterizing fire effects, and the role of multi-criteria decision analysis, and will provide illustrative examples of integrated wildfire risk assessment across a variety of planning scales. Second, I will describe a related uncertainty typology that focuses on the human dimensions of wildfire management, specifically addressing how social, psychological, and institutional factors may impair cost-effective risk mitigation. This discussion will encompass decision processes before, during, and after fire events, with a specific focus on active management of complex wildfire incidents. An improved ability to characterize uncertainties faced in wildfire management could lead to improved delivery of decision support, targeted communication strategies, and ultimately to improved wildfire management outcomes.

Progress and challenges of disaster health management in China: a scoping review

PubMed Central

Zhong, Shuang; Clark, Michele; Hou, Xiang-Yu; Zang, Yuli; FitzGerald, Gerard

2014-01-01

Background Despite the importance of an effective health system response to various disasters, relevant research is still in its infancy, especially in middle- and low-income countries. Objective This paper provides an overview of the status of disaster health management in China, with its aim to promote the effectiveness of the health response for reducing disaster-related mortality and morbidity. Design A scoping review method was used to address the recent progress of and challenges to disaster health management in China. Major health electronic databases were searched to identify English and Chinese literature that were relevant to the research aims. Results The review found that since 2003 considerable progress has been achieved in the health disaster response system in China. However, there remain challenges that hinder effective health disaster responses, including low standards of disaster-resistant infrastructure safety, the lack of specific disaster plans, poor emergency coordination between hospitals, lack of portable diagnostic equipment and underdeveloped triage skills, surge capacity, and psychological interventions. Additional challenges include the fragmentation of the emergency health service system, a lack of specific legislation for emergencies, disparities in the distribution of funding, and inadequate cost-effective considerations for disaster rescue. Conclusions One solution identified to address these challenges appears to be through corresponding policy strategies at multiple levels (e.g. community, hospital, and healthcare system level). PMID:25215910

Addressing Methodological Challenges in Large Communication Data Sets: Collecting and Coding Longitudinal Interactions in Home Hospice Cancer Care.

PubMed

Reblin, Maija; Clayton, Margaret F; John, Kevin K; Ellington, Lee

2016-07-01

In this article, we present strategies for collecting and coding a large longitudinal communication data set collected across multiple sites, consisting of more than 2000 hours of digital audio recordings from approximately 300 families. We describe our methods within the context of implementing a large-scale study of communication during cancer home hospice nurse visits, but this procedure could be adapted to communication data sets across a wide variety of settings. This research is the first study designed to capture home hospice nurse-caregiver communication, a highly understudied location and type of communication event. We present a detailed example protocol encompassing data collection in the home environment, large-scale, multisite secure data management, the development of theoretically-based communication coding, and strategies for preventing coder drift and ensuring reliability of analyses. Although each of these challenges has the potential to undermine the utility of the data, reliability between coders is often the only issue consistently reported and addressed in the literature. Overall, our approach demonstrates rigor and provides a "how-to" example for managing large, digitally recorded data sets from collection through analysis. These strategies can inform other large-scale health communication research.

Re-thinking wastewater landscapes: combining innovative strategies to address tomorrow's urban wastewater treatment challenges.

PubMed

Smith, B R

2009-01-01

Most major cities worldwide face urban water management challenges relating to drinking supply, stormwater and wastewater treatment, and ecological preservation. In light of climate change and finite natural resources, addressing these challenges in sustainable ways will require innovative solutions arising from interdisciplinary collaboration. This article summarizes five major urban water management strategies that bridge the fields of engineering, ecology, landscape architecture, and urban planning. A conceptual implementation of these strategies is demonstrated through a design for a small constructed wetland treatment system in San Francisco, California. The proposed decentralized system described in this article consists of a detention basin, vegetated and open free water surface wetlands, and ultraviolet disinfection. In wet weather, the system would detain and treat combined sewer discharges (CSD), and in dry weather it would treat residential greywater for toilet flushing and irrigation in a nearby neighborhood. It is designed to adapt over time to changing climatic conditions and treatment demands. Importantly, this proposal demonstrates how constructed wetland engineers can incorporate multiple benefits into their systems, offering a vision of how wastewater infrastructure can be an attractive community, educational, recreational, and habitat amenity through the integration of engineering, ecology, and landscape design.

Patient Privacy, Consent, and Identity Management in Health Information Exchange

PubMed Central

Hosek, Susan D.; Straus, Susan G.

2013-01-01

Abstract The Military Health System (MHS) and the Veterans Health Administration (VHA) have been among the nation's leaders in health information technology (IT), including the development of health IT systems and electronic health records that summarize patients' care from multiple providers. Health IT interoperability within MHS and across MHS partners, including VHA, is one of ten goals in the current MHS Strategic Plan. As a step toward achieving improved interoperability, the MHS is seeking to develop a research roadmap to better coordinate health IT research efforts, address IT capability gaps, and reduce programmatic risk for its enterprise projects. This article contributes to that effort by identifying gaps in research, policy, and practice involving patient privacy, consent, and identity management that need to be addressed to bring about improved quality and efficiency of care through health information exchange. Major challenges include (1) designing a meaningful patient consent procedure, (2) recording patients' consent preferences and designing procedures to implement restrictions on disclosures of protected health information, and (3) advancing knowledge regarding the best technical approaches to performing patient identity matches and how best to monitor results over time. Using a sociotechnical framework, this article suggests steps for overcoming these challenges and topics for future research. PMID:28083296

Breathing SPACE-a practical approach to the breathless patient.

PubMed

Hopkinson, Nicholas S; Baxter, Noel

2017-01-30

Breathlessness is a common symptom that may have multiple causes in any one individual and causes that may change over time. Breathlessness campaigns encourage people to see their General Practitioner if they are unduly breathless. Members of the London Respiratory Network collaborated to develop a tool that would encourage a holistic approach to breathlessness, which was applicable both at the time of diagnosis and during ongoing management. This has led to the development of the aide memoire "Breathing SPACE", which encompasses five key themes-smoking, pulmonary disease, anxiety/psychosocial factors, cardiac disease, and exercise/fitness. A particular concern was to ensure that high-value interventions (smoking cessation and exercise interventions) are prioritised across the life-course and throughout the course of disease management. The approach is relevant both to well people and in those with an underling diagnosis or diagnoses. The inclusion of anxiety draws attention to the importance of mental health issues. Parity of esteem requires the physical health problems of people with mental illness to be addressed. The SPACE mnemonic also addresses the problem of underdiagnosis of heart disease in people with lung disease and vice versa, as well as the systematic undertreatment of these conditions where they do co-occur.

Addressing Methodological Challenges in Large Communication Datasets: Collecting and Coding Longitudinal Interactions in Home Hospice Cancer Care

PubMed Central

Reblin, Maija; Clayton, Margaret F; John, Kevin K; Ellington, Lee

2015-01-01

In this paper, we present strategies for collecting and coding a large longitudinal communication dataset collected across multiple sites, consisting of over 2000 hours of digital audio recordings from approximately 300 families. We describe our methods within the context of implementing a large-scale study of communication during cancer home hospice nurse visits, but this procedure could be adapted to communication datasets across a wide variety of settings. This research is the first study designed to capture home hospice nurse-caregiver communication, a highly understudied location and type of communication event. We present a detailed example protocol encompassing data collection in the home environment, large-scale, multi-site secure data management, the development of theoretically-based communication coding, and strategies for preventing coder drift and ensuring reliability of analyses. Although each of these challenges have the potential to undermine the utility of the data, reliability between coders is often the only issue consistently reported and addressed in the literature. Overall, our approach demonstrates rigor and provides a “how-to” example for managing large, digitally-recorded data sets from collection through analysis. These strategies can inform other large-scale health communication research. PMID:26580414

Cross-continuum Care Continuity: Achieving Seamless Care and Managing Comorbidities.

PubMed

Boston-Fleischhauer, Carol; Rose, Robert; Hartwig, Laurie

As healthcare systems continue to design care models responsive to payment changes and the assumption of clinical and financial risk, the need exists for a comprehensive approach to address cross-continuum care transitions. This article will highlight key learnings from the Nurse Executive Center's research on achieving care continuity. The business case for developing a cross-continuum care transition strategy will be discussed, as well as systemic enablers for the achievement of seamless care. A case study example of 1 system's solution for supporting the multiple comorbid patient population as part of its cross-continuum care transition strategy will be examined.

Identifying mismatches between institutional perceptions of water-related risk drivers and water management strategies in three river basin areas

NASA Astrophysics Data System (ADS)

Räsänen, Aleksi; Juhola, Sirkku; Monge Monge, Adrián; Käkönen, Mira; Kanninen, Markku; Nygren, Anja

2017-07-01

Water-related risks and vulnerabilities are driven by variety of stressors, including climate and land use change, as well as changes in socio-economic positions and political landscapes. Hence, water governance, which addresses risks and vulnerabilities, should target multiple stressors. We analyze the institutional perceptions of the drivers and strategies for managing water-related risks and vulnerabilities in three regionally important river basin areas located in Finland, Mexico, and Laos. Our analysis is based on data gathered through participatory workshops and complemented by qualitative content analysis of relevant policy documents. The identified drivers and proposed risk reduction strategies showed the multidimensionality and context-specificity of water-related risks and vulnerabilities across study areas. Most of the identified drivers were seen to increase risks, but some of the drivers were positive trends, and drivers also included also policy instruments that can both increase or decrease risks. Nevertheless, all perceived drivers were not addressed with suggested risk reduction strategies. In particular, most of the risk reduction strategies were incremental adjustments, although many of the drivers classified as most important were large-scale trends, such as climate change, land use changes and increase in foreign investments. We argue that there is a scale mismatch between the identified drivers and suggested strategies, which questions the opportunity to manage the drivers by single-scale incremental adjustments. Our study suggests that for more sustainable risk and vulnerability reduction, the root causes of water-related risks and vulnerabilities should be addressed through adaptive multi-scale governance that carefully considers the context-specificity and the multidimensionality of the associated drivers and stressors.

Addressing the Multiple Drivers of Wetland Ecosystems Degradation in Lagos, Nigeria

NASA Astrophysics Data System (ADS)

Agboola, J.; Ndimele, P. E.; Odunuga, S.; Akanni, A.; Kosemani, B.; Ahove, M.

2015-12-01

Several body of knowledge have noted the importance of wetland ecosystems in climate moderation, resource supply and flood risk reduction amongst others. Relevant as it may, rapidly increasing population and uncontrolled urban development poses a challenge in some regions and require understanding of the ecosystem components and drivers of change over a long period of time. Thus, the main thrust of this paper is to analyse multiple drivers of wetland ecosystems degradation in the last 30 years in the Lagos megacity using field study, desktop review, satellite data and laboratory analysis. Key drivers identified includes: conversion of wetlands to settlements and waste sink, land use planning that neglects wetland conservation and restoration, ineffective legal status for wetlands, over exploitation leading to degradation and fragmentation of wetland ecosystems governance. In stemming further loss of this vital ecosystem, this study adopted and proposed respectively, the Drivers, Pressure, State, Impact and Response (DPSIR) and Integrated Planning Approach (IPA) frameworks in analysing policy and governance issues in wetland development. These analyses figured out amongst others, strict conservation and sustainable use of wetland resources, habitat restoration, climate adaptation measures, legal protection and wetland management institution as major responses to current multiple pressures facing wetland ecosystems in Lagos. For these frameworks to be made meaningful, weak coordination among government agencies and institutional capacity in implementation and law enforcement, unsustainable resource extraction by private/business organization and issues on alternative sources of income on the part of the local communities amongst others needs to be addressed.

Analyzing Uncertainty and Risk in the Management of Water Resources in the State Of Texas

NASA Astrophysics Data System (ADS)

Singh, A.; Hauffpauir, R.; Mishra, S.; Lavenue, M.

2010-12-01

The State of Texas updates its state water plan every five years to determine the water demand required to meet its growing population. The plan compiles forecasts of water deficits from state-wide regional water planning groups as well as the water supply strategies to address these deficits. To date, the plan has adopted a deterministic framework, where reference values (e.g., best estimates, worst-case scenario) are used for key factors such as population growth, demand for water, severity of drought, water availability, etc. These key factors can, however, be affected by multiple sources of uncertainties such as - the impact of climate on surface water and groundwater availability, uncertainty in population projections, changes in sectoral composition of the economy, variability in water usage, feasibility of the permitting process, cost of implementation, etc. The objective of this study was to develop a generalized and scalable methodology for addressing uncertainty and risk in water resources management both at the regional and the local water planning level. The study proposes a framework defining the elements of an end-to-end system model that captures the key components of demand, supply and planning modules along with their associated uncertainties. The framework preserves the fundamental elements of the well-established planning process in the State of Texas, promoting an incremental and stakeholder-driven approach to adding different levels of uncertainty (and risk) into the decision-making environment. The uncertainty in the water planning process is broken down into two primary categories: demand uncertainty and supply uncertainty. Uncertainty in Demand is related to the uncertainty in population projections and the per-capita usage rates. Uncertainty in Supply, in turn, is dominated by the uncertainty in future climate conditions. Climate is represented in terms of time series of precipitation, temperature and/or surface evaporation flux for some future time period of interest, which can be obtained as outputs of global climate models (GCMs). These are then linked with hydrologic and water-availability models (WAMs) to estimate water availability for the worst drought conditions under each future climate scenario. Combining the demand scenarios with the water availability scenarios yields multiple scenarios for water shortage (or surplus). Given multiple shortage/surplus scenarios, various water management strategies can be assessed to evaluate the reliability of meeting projected deficits. These reliabilities are then used within a multi-criteria decision-framework to assess trade-offs between various water management objectives, thus helping to make more robust decisions while planning for the water needs of the future.

Toward sustainable environmental quality: Identifying priority research questions for Latin America.

PubMed

Furley, Tatiana Heid; Brodeur, Julie; Silva de Assis, Helena C; Carriquiriborde, Pedro; Chagas, Katia R; Corrales, Jone; Denadai, Marina; Fuchs, Julio; Mascarenhas, Renata; Miglioranza, Karina Sb; Miguez Caramés, Diana Margarita; Navas, José Maria; Nugegoda, Dayanthi; Planes, Estela; Rodriguez-Jorquera, Ignacio Alejandro; Orozco-Medina, Martha; Boxall, Alistair Ba; Rudd, Murray A; Brooks, Bryan W

2018-05-01

The Global Horizon Scanning Project (GHSP) is an innovative initiative that aims to identify important global environmental quality research needs. Here we report 20 key research questions from Latin America (LA). Members of the Society of Environmental Toxicology and Chemistry (SETAC) LA and other scientists from LA were asked to submit research questions that would represent priority needs to address in the region. One hundred questions were received, then partitioned among categories, examined, and some rearranged during a workshop in Buenos Aires, Argentina. Twenty priority research questions were subsequently identified. These research questions included developing, improving, and harmonizing across LA countries methods for 1) identifying contaminants and degradation products in complex matrices (including biota); 2) advancing prediction of contaminant risks and effects in ecosystems, addressing lab-to-field extrapolation challenges, and understanding complexities of multiple stressors (including chemicals and climate change); and 3) improving management and regulatory tools toward achieving sustainable development. Whereas environmental contaminants frequently identified in these key questions were pesticides, pharmaceuticals, endocrine disruptors or modulators, plastics, and nanomaterials, commonly identified environmental challenges were related to agriculture, urban effluents, solid wastes, pulp and paper mills, and natural extraction activities. Several interesting research topics included assessing and preventing pollution impacts on conservation protected areas, integrating environment and health assessments, and developing strategies for identification, substitution, and design of less hazardous chemicals (e.g., green chemistry). Finally, a recurrent research need included developing an understanding of differential sensitivity of regional species and ecosystems to environmental contaminants and other stressors. Addressing these critical questions will support development of long-term strategic research efforts to advance more sustainable environmental quality and protect public health and the environment in LA. Integr Environ Assess Manag 2018;14:344-357. © 2018 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC). © 2018 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Medical photography: current technology, evolving issues and legal perspectives.

PubMed

Harting, M T; DeWees, J M; Vela, K M; Khirallah, R T

2015-04-01

Medical photographic image capture and data management has undergone a rapid and compelling change in complexity over the last 20 years. This is because of multiple factors, including significant advances in ease of photograph capture, alongside an evolution of mechanisms of data portability/dissemination, combined with governmental focus on health information privacy. Literature to guide medical, legal, governmental and business professionals when dealing with issues related to medical photography is virtually nonexistent. Herein, we will address the breadth of uses of medical photography, device properties/specific devices utilised for image capture, methods of data transfer and dissemination and patient perceptions and attitudes regarding photography in a medical setting. In addition, we will address the legal implications, including legal precedent, copyright and privacy law, informed consent, protected health information and the Health Insurance Portability and Accountability Act (HIPAA), as they pertain to medical photography. © 2015 John Wiley & Sons Ltd.

Discontinuities, cross-scale patterns, and the organization of ecosystems

USGS Publications Warehouse

Nash, Kirsty L.; Allen, Craig R.; Angeler, David G.; Barichievy, Chris; Eason, Tarsha; Garmestani, Ahjond S.; Graham, Nicholas A.J.; Granholm, Dean; Knutson, Melinda; Nelson, R. John; Nystrom, Magnus; Stow, Craig A.; Sandstrom, Shana M.

2014-01-01

Ecological structures and processes occur at specific spatiotemporal scales, and interactions that occur across multiple scales mediate scale-specific (e.g., individual, community, local, or regional) responses to disturbance. Despite the importance of scale, explicitly incorporating a multi-scale perspective into research and management actions remains a challenge. The discontinuity hypothesis provides a fertile avenue for addressing this problem by linking measureable proxies to inherent scales of structure within ecosystems. Here we outline the conceptual framework underlying discontinuities and review the evidence supporting the discontinuity hypothesis in ecological systems. Next we explore the utility of this approach for understanding cross-scale patterns and the organization of ecosystems by describing recent advances for examining nonlinear responses to disturbance and phenomena such as extinctions, invasions, and resilience. To stimulate new research, we present methods for performing discontinuity analysis, detail outstanding knowledge gaps, and discuss potential approaches for addressing these gaps.

Challenges of information security incident learning: An industrial case study in a Chinese healthcare organization.

PubMed

He, Ying; Johnson, Chris

2017-12-01

Security incidents can have negative impacts on healthcare organizations, and the security of medical records has become a primary concern of the public. However, previous studies showed that organizations had not effectively learned lessons from security incidents. Incident learning as an essential activity in the "follow-up" phase of security incident response lifecycle has long been addressed but not given enough attention. This paper conducted a case study in a healthcare organization in China to explore their current obstacles in the practice of incident learning. We interviewed both IT professionals and healthcare professionals. The results showed that the organization did not have a structured way to gather and redistribute incident knowledge. Incident response was ineffective in cycling incident knowledge back to inform security management. Incident reporting to multiple stakeholders faced a great challenge. In response to this case study, we suggest the security assurance modeling framework to address those obstacles.

Does surgical stabilization improve outcomes in patients with isolated multiple distracted and painful non-flail rib fractures?

PubMed

Girsowicz, Elie; Falcoz, Pierre-Emmanuel; Santelmo, Nicola; Massard, Gilbert

2012-03-01

A best evidence topic was constructed according to a structured protocol. The question addressed was whether surgical stabilization is effective in improving the outcomes of patients with isolated multiple distracted and painful non-flail rib fractures. Of the 356 papers found using a report search, nine presented the best evidence to answer the clinical question. The authors, journal, date and country of publication, study type, group studied, relevant outcomes and results of these papers are given. We conclude that, on the whole, the nine retrieved studies clearly support the use of surgical stabilization in the management of isolated multiple non-flail and painful rib fractures for improving patient outcomes. The interest and benefit was shown not only in terms of pain (McGill pain questionnaire) and respiratory function (forced vital capacity, forced expiratory volume in 1 s and carbon monoxide diffusing capacity), but also in improved quality of life (RAND 36-Item Health Survey) and reduced socio-professional disability. Indeed, most of the authors justified surgical management based on the fact that the results of surgical stabilization showed improvement in short- and long-term patient outcomes, with fast reduction in pain and disability, as well as lower average wait before recommencing normal activities. Hence, the current evidence shows surgical stabilization to be safe and effective in alleviating post-operative pain and in improving patient recovery, thus enhancing the outcome after isolated multiple rib fractures. However, given the little published evidence, prospective trials are necessary to confirm these encouraging results.

Setting a research agenda for progressive multiple sclerosis: the International Collaborative on Progressive MS.

PubMed

Fox, Robert J; Thompson, Alan; Baker, David; Baneke, Peer; Brown, Doug; Browne, Paul; Chandraratna, Dhia; Ciccarelli, Olga; Coetzee, Timothy; Comi, Giancarlo; Feinstein, Anthony; Kapoor, Raj; Lee, Karen; Salvetti, Marco; Sharrock, Kersten; Toosy, Ahmed; Zaratin, Paola; Zuidwijk, Kim

2012-11-01

Despite significant progress in the development of therapies for relapsing MS, progressive MS remains comparatively disappointing. Our objective, in this paper, is to review the current challenges in developing therapies for progressive MS and identify key priority areas for research. A collaborative was convened by volunteer and staff leaders from several MS societies with the mission to expedite the development of effective disease-modifying and symptom management therapies for progressive forms of multiple sclerosis. Through a series of scientific and strategic planning meetings, the collaborative identified and developed new perspectives on five key priority areas for research: experimental models, identification and validation of targets and repurposing opportunities, proof-of-concept clinical trial strategies, clinical outcome measures, and symptom management and rehabilitation. Our conclusions, tackling the impediments in developing therapies for progressive MS will require an integrated, multi-disciplinary approach to enable effective translation of research into therapies for progressive MS. Engagement of the MS research community through an international effort is needed to address and fund these research priorities with the ultimate goal of expediting the development of disease-modifying and symptom-relief treatments for progressive MS.

Designing a new cropping system for high productivity and sustainable water usage under climate change

NASA Astrophysics Data System (ADS)

Meng, Qingfeng; Wang, Hongfei; Yan, Peng; Pan, Junxiao; Lu, Dianjun; Cui, Zhenling; Zhang, Fusuo; Chen, Xinping

2017-02-01

The food supply is being increasingly challenged by climate change and water scarcity. However, incremental changes in traditional cropping systems have achieved only limited success in meeting these multiple challenges. In this study, we applied a systematic approach, using model simulation and data from two groups of field studies conducted in the North China Plain, to develop a new cropping system that improves yield and uses water in a sustainable manner. Due to significant warming, we identified a double-maize (M-M; Zea mays L.) cropping system that replaced the traditional winter wheat (Triticum aestivum L.) -summer maize system. The M-M system improved yield by 14-31% compared with the conventionally managed wheat-maize system, and achieved similar yield compared with the incrementally adapted wheat-maize system with the optimized cultivars, planting dates, planting density and water management. More importantly, water usage was lower in the M-M system than in the wheat-maize system, and the rate of water usage was sustainable (net groundwater usage was ≤150 mm yr-1). Our study indicated that systematic assessment of adaptation and cropping system scale have great potential to address the multiple food supply challenges under changing climatic conditions.

Setting a research agenda for progressive multiple sclerosis: The International Collaborative on Progressive MS

PubMed Central

Thompson, Alan; Baker, David; Baneke, Peer; Brown, Doug; Browne, Paul; Chandraratna, Dhia; Ciccarelli, Olga; Coetzee, Timothy; Comi, Giancarlo; Feinstein, Anthony; Kapoor, Raj; Lee, Karen; Salvetti, Marco; Sharrock, Kersten; Toosy, Ahmed; Zaratin, Paola; Zuidwijk, Kim

2012-01-01

Despite significant progress in the development of therapies for relapsing MS, progressive MS remains comparatively disappointing. Our objective, in this paper, is to review the current challenges in developing therapies for progressive MS and identify key priority areas for research. A collaborative was convened by volunteer and staff leaders from several MS societies with the mission to expedite the development of effective disease-modifying and symptom management therapies for progressive forms of multiple sclerosis. Through a series of scientific and strategic planning meetings, the collaborative identified and developed new perspectives on five key priority areas for research: experimental models, identification and validation of targets and repurposing opportunities, proof-of-concept clinical trial strategies, clinical outcome measures, and symptom management and rehabilitation. Our conclusions, tackling the impediments in developing therapies for progressive MS will require an integrated, multi-disciplinary approach to enable effective translation of research into therapies for progressive MS. Engagement of the MS research community through an international effort is needed to address and fund these research priorities with the ultimate goal of expediting the development of disease-modifying and symptom-relief treatments for progressive MS. PMID:22917690

Hierarchical Marginal Land Assessment for Land Use Planning

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

Kang, Shujiang; Post, Wilfred M; Wang, Dali

2013-01-01

Marginal land provides an alternative potential for food and bioenergy production in the face of limited land resources; however, effective assessment of marginal lands is not well addressed. Concerns over environmental risks, ecosystem services and sustainability for marginal land have been widely raised. The objective of this study was to develop a hierarchical marginal land assessment framework for land use planning and management. We first identified major land functions linking production, environment, ecosystem services and economics, and then classified land resources into four categories of marginal land using suitability and limitations associated with major management goals, including physically marginal land,more » biologically marginal land, environmental-ecological marginal land, and economically marginal land. We tested this assessment framework in south-western Michigan, USA. Our results indicated that this marginal land assessment framework can be potentially feasible on land use planning for food and bioenergy production, and balancing multiple goals of land use management. We also compared our results with marginal land assessment from the Conservation Reserve Program (CRP) and land capability classes (LCC) that are used in the US. The hierarchical assessment framework has advantages of quantitatively reflecting land functions and multiple concerns. This provides a foundation upon which focused studies can be identified in order to improve the assessment framework by quantifying high-resolution land functions associated with environment and ecosystem services as well as their criteria are needed to improve the assessment framework.« less

Creation and implementation of SAMPRO™: A school-based asthma management program.

PubMed

Lemanske, Robert F; Kakumanu, Sujani; Shanovich, Kathleen; Antos, Nicholas; Cloutier, Michelle M; Mazyck, Donna; Phipatanakul, Wanda; Schantz, Shirley; Szefler, Stanley; Vandlik, Renee; Williams, Paul

2016-09-01

Clinicians who care for children with asthma have an obligation to coordinate asthma care with the schools. Aside from routine clinical care of asthmatic children, providers must educate the family and child about the need for an asthma treatment plan in school and support the school nurse meeting the needs of the student requiring school-based asthma care. The following article was developed by multiple stakeholders to address this need. It describes the 4 components of the School-based Asthma Management Program (SAMPRO™). SAMPRO™ details elements necessary for the education of children, families, clinicians, and school-based personnel based on a "circle of support" that would enhance multidirectional communication and promote better care for children with asthma within the school setting. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Acute and emergency care for thyrotoxicosis and thyroid storm.

PubMed

Idrose, Alzamani Mohammad

2015-07-01

Thyroid hormones affect all organ systems and, in excess, can cause increased metabolic rate, heart rate, ventricle contractility, and gastrointestinal motility as well as muscle and central nervous system excitability. Thyroid storm is the extreme manifestation of thyrotoxicosis with an estimated incidence of 0.20 per 100,000 per year among hospitalized patients in Japan. The mortality of thyroid storm without treatment ranges from 80% to 100%; but with treatment, the mortality rate is between 10% and 50%. The diagnostic strategy for thyroid storm may take into consideration Burch-Wartofsky scoring or Akamizu's diagnostic criteria. Multiple treatment aims need to be addressed in managing thyroid storm effectively. This paper puts together all aspects to be considered for the management of hyperthyroidism and thyroid storm during the acute and emergency phase as well as consideration of special populations.

Acute and emergency care for thyrotoxicosis and thyroid storm

PubMed Central

2015-01-01

Thyroid hormones affect all organ systems and, in excess, can cause increased metabolic rate, heart rate, ventricle contractility, and gastrointestinal motility as well as muscle and central nervous system excitability. Thyroid storm is the extreme manifestation of thyrotoxicosis with an estimated incidence of 0.20 per 100,000 per year among hospitalized patients in Japan. The mortality of thyroid storm without treatment ranges from 80% to 100%; but with treatment, the mortality rate is between 10% and 50%. The diagnostic strategy for thyroid storm may take into consideration Burch–Wartofsky scoring or Akamizu's diagnostic criteria. Multiple treatment aims need to be addressed in managing thyroid storm effectively. This paper puts together all aspects to be considered for the management of hyperthyroidism and thyroid storm during the acute and emergency phase as well as consideration of special populations. PMID:29123713

Sustainability. Systems integration for global sustainability.

PubMed

Liu, Jianguo; Mooney, Harold; Hull, Vanessa; Davis, Steven J; Gaskell, Joanne; Hertel, Thomas; Lubchenco, Jane; Seto, Karen C; Gleick, Peter; Kremen, Claire; Li, Shuxin

2015-02-27

Global sustainability challenges, from maintaining biodiversity to providing clean air and water, are closely interconnected yet often separately studied and managed. Systems integration—holistic approaches to integrating various components of coupled human and natural systems—is critical to understand socioeconomic and environmental interconnections and to create sustainability solutions. Recent advances include the development and quantification of integrated frameworks that incorporate ecosystem services, environmental footprints, planetary boundaries, human-nature nexuses, and telecoupling. Although systems integration has led to fundamental discoveries and practical applications, further efforts are needed to incorporate more human and natural components simultaneously, quantify spillover systems and feedbacks, integrate multiple spatial and temporal scales, develop new tools, and translate findings into policy and practice. Such efforts can help address important knowledge gaps, link seemingly unconnected challenges, and inform policy and management decisions. Copyright © 2015, American Association for the Advancement of Science.

The Ophidia Stack: Toward Large Scale, Big Data Analytics Experiments for Climate Change

NASA Astrophysics Data System (ADS)

Fiore, S.; Williams, D. N.; D'Anca, A.; Nassisi, P.; Aloisio, G.

2015-12-01

The Ophidia project is a research effort on big data analytics facing scientific data analysis challenges in multiple domains (e.g. climate change). It provides a "datacube-oriented" framework responsible for atomically processing and manipulating scientific datasets, by providing a common way to run distributive tasks on large set of data fragments (chunks). Ophidia provides declarative, server-side, and parallel data analysis, jointly with an internal storage model able to efficiently deal with multidimensional data and a hierarchical data organization to manage large data volumes. The project relies on a strong background on high performance database management and On-Line Analytical Processing (OLAP) systems to manage large scientific datasets. The Ophidia analytics platform provides several data operators to manipulate datacubes (about 50), and array-based primitives (more than 100) to perform data analysis on large scientific data arrays. To address interoperability, Ophidia provides multiple server interfaces (e.g. OGC-WPS). From a client standpoint, a Python interface enables the exploitation of the framework into Python-based eco-systems/applications (e.g. IPython) and the straightforward adoption of a strong set of related libraries (e.g. SciPy, NumPy). The talk will highlight a key feature of the Ophidia framework stack: the "Analytics Workflow Management System" (AWfMS). The Ophidia AWfMS coordinates, orchestrates, optimises and monitors the execution of multiple scientific data analytics and visualization tasks, thus supporting "complex analytics experiments". Some real use cases related to the CMIP5 experiment will be discussed. In particular, with regard to the "Climate models intercomparison data analysis" case study proposed in the EU H2020 INDIGO-DataCloud project, workflows related to (i) anomalies, (ii) trend, and (iii) climate change signal analysis will be presented. Such workflows will be distributed across multiple sites - according to the datasets distribution - and will include intercomparison, ensemble, and outlier analysis. The two-level workflow solution envisioned in INDIGO (coarse grain for distributed tasks orchestration, and fine grain, at the level of a single data analytics cluster instance) will be presented and discussed.

Anesthetic management of spontaneous cervical epidural hematoma during pregnancy: a case report.

PubMed

Samali, Mehdi; Elkoundi, Abdelghafour; Tahri, Achraf; Bensghir, Mustapha; Haimeur, Charki

2017-06-26

Spontaneous spinal epidural hematoma during pregnancy is a quite rare event requiring emergent decompressive surgery in the majority of cases to prevent permanent neurological damage. Therefore, there is little data in the literature regarding anesthetic management of cervical localization during pregnancy. The potential for difficult airway management with the patient under general anesthesia is one of the major concerns that needs to be addressed to prevent further cord compression. Anesthetic management should also include measures to maintain the mean arterial pressure to improve spinal cord perfusion. Furthermore, spine surgery in pregnant patients needs special consideration in terms of positioning and in the postoperative period. We present a case of a 35-year-old white woman at 21 weeks of gestation with a spontaneous cervical epidural hematoma. Fiberoptic bronchoscope-guided nasal intubation was a safe option to ensure a higher rate of successful endotracheal intubation while minimizing the risk of aggravating the injury. Her care posed other multiples challenges that required a multidisciplinary team approach. The case of our patient serves as a reminder of this rare condition and its implications regarding anesthesia.

Method of managing interference during delay recovery on a train system

DOEpatents

Gordon, Susanna P.; Evans, John A.

2005-12-27

The present invention provides methods for preventing low train voltages and managing interference, thereby improving the efficiency, reliability, and passenger comfort associated with commuter trains. An algorithm implementing neural network technology is used to predict low voltages before they occur. Once voltages are predicted, then multiple trains can be controlled to prevent low voltage events. Further, algorithms for managing inference are presented in the present invention. Different types of interference problems are addressed in the present invention such as "Interference During Acceleration", "Interference Near Station Stops", and "Interference During Delay Recovery." Managing such interference avoids unnecessary brake/acceleration cycles during acceleration, immediately before station stops, and after substantial delays. Algorithms are demonstrated to avoid oscillatory brake/acceleration cycles due to interference and to smooth the trajectories of closely following trains. This is achieved by maintaining sufficient following distances to avoid unnecessary braking/accelerating. These methods generate smooth train trajectories, making for a more comfortable ride, and improve train motor reliability by avoiding unnecessary mode-changes between propulsion and braking. These algorithms can also have a favorable impact on traction power system requirements and energy consumption.

Magnets, children and the bowel: a dangerous attraction?

PubMed

George, Anil Thomas; Motiwale, Sandeep

2012-10-14

Reports of magnet ingestion are increasing rapidly globally. However, multiple magnet ingestion, the subsequent potential complications and the importance of the early identification and proper management remain both under-recognized and underestimated. Published literature on such cases could possibly represent only the tip of an iceberg with press reports, web blogs and government documents highlighting further occurrence of many more such incidents. The increasing number of complications worldwide being reported secondary to magnet ingestion point not only to an acute lack of awareness about this condition among the medical profession but also among parents and carers who will be in most cases the first to pick up on magnet ingestion. There still seems to be no consensus on the management of magnet ingestion with several algorithms being proposed for management. Prevention of this condition remains a much better option than cure. Proper education and improved awareness among parents and carers and frontline medical staff is key in addressing this rapidly emerging problem. The goal of managing such cases of suspected magnet ingestion should be aimed at reducing delays between ingestion time, diagnosis time and intervention time.

Magnets, children and the bowel: A dangerous attraction?

PubMed Central

George, Anil Thomas; Motiwale, Sandeep

2012-01-01

Reports of magnet ingestion are increasing rapidly globally. However, multiple magnet ingestion, the subsequent potential complications and the importance of the early identification and proper management remain both under-recognized and underestimated. Published literature on such cases could possibly represent only the tip of an iceberg with press reports, web blogs and government documents highlighting further occurrence of many more such incidents. The increasing number of complications worldwide being reported secondary to magnet ingestion point not only to an acute lack of awareness about this condition among the medical profession but also among parents and carers who will be in most cases the first to pick up on magnet ingestion. There still seems to be no consensus on the management of magnet ingestion with several algorithms being proposed for management. Prevention of this condition remains a much better option than cure. Proper education and improved awareness among parents and carers and frontline medical staff is key in addressing this rapidly emerging problem. The goal of managing such cases of suspected magnet ingestion should be aimed at reducing delays between ingestion time, diagnosis time and intervention time. PMID:23082048

Taguchi's off line method and Multivariate loss function approach for quality management and optimization of process parameters -A review

NASA Astrophysics Data System (ADS)

Bharti, P. K.; Khan, M. I.; Singh, Harbinder

2010-10-01

Off-line quality control is considered to be an effective approach to improve product quality at a relatively low cost. The Taguchi method is one of the conventional approaches for this purpose. Through this approach, engineers can determine a feasible combination of design parameters such that the variability of a product's response can be reduced and the mean is close to the desired target. The traditional Taguchi method was focused on ensuring good performance at the parameter design stage with one quality characteristic, but most products and processes have multiple quality characteristics. The optimal parameter design minimizes the total quality loss for multiple quality characteristics. Several studies have presented approaches addressing multiple quality characteristics. Most of these papers were concerned with maximizing the parameter combination of signal to noise (SN) ratios. The results reveal the advantages of this approach are that the optimal parameter design is the same as the traditional Taguchi method for the single quality characteristic; the optimal design maximizes the amount of reduction of total quality loss for multiple quality characteristics. This paper presents a literature review on solving multi-response problems in the Taguchi method and its successful implementation in various industries.

Configuration of multiple human stressors and their impacts on fish assemblages in Alpine river basins of Austria.

PubMed

Schinegger, Rafaela; Pucher, Matthias; Aschauer, Christiane; Schmutz, Stefan

2018-03-01

This work addresses multiple human stressors and their impacts on fish assemblages of the Drava and Mura rivers in southern Austria. The impacts of single and multiple human stressors on riverine fish assemblages in these basins were disentangled, based on an extensive dataset. Stressor configuration, i.e. various metrics of multiple stressors belonging to stressor groups hydrology, morphology, connectivity and water quality were investigated for the first time at river basin scale in Austria. As biological response variables, the Fish Index Austria (FIA) and its related single as well as the WFD biological- and total state were investigated. Stressor-response analysis shows divergent results, but a general trend of decreasing ecological integrity with increasing number of stressors and maximum stressor is observed. Fish metrics based on age structure, fish region index and biological status responded best to single stressors and/or their combinations. The knowledge gained in this work provides a basis for advanced investigations in Alpine river basins and beyond, supports WFD implementation and helps prioritizing further actions towards multi-stressor restoration- and management. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

AgMIP Training in Multiple Crop Models and Tools

NASA Technical Reports Server (NTRS)

Boote, Kenneth J.; Porter, Cheryl H.; Hargreaves, John; Hoogenboom, Gerrit; Thornburn, Peter; Mutter, Carolyn

2015-01-01

The Agricultural Model Intercomparison and Improvement Project (AgMIP) has the goal of using multiple crop models to evaluate climate impacts on agricultural production and food security in developed and developing countries. There are several major limitations that must be overcome to achieve this goal, including the need to train AgMIP regional research team (RRT) crop modelers to use models other than the ones they are currently familiar with, plus the need to harmonize and interconvert the disparate input file formats used for the various models. Two activities were followed to address these shortcomings among AgMIP RRTs to enable them to use multiple models to evaluate climate impacts on crop production and food security. We designed and conducted courses in which participants trained on two different sets of crop models, with emphasis on the model of least experience. In a second activity, the AgMIP IT group created templates for inputting data on soils, management, weather, and crops into AgMIP harmonized databases, and developed translation tools for converting the harmonized data into files that are ready for multiple crop model simulations. The strategies for creating and conducting the multi-model course and developing entry and translation tools are reviewed in this chapter.

From sequencer to supercomputer: an automatic pipeline for managing and processing next generation sequencing data.

PubMed

Camerlengo, Terry; Ozer, Hatice Gulcin; Onti-Srinivasan, Raghuram; Yan, Pearlly; Huang, Tim; Parvin, Jeffrey; Huang, Kun

2012-01-01

Next Generation Sequencing is highly resource intensive. NGS Tasks related to data processing, management and analysis require high-end computing servers or even clusters. Additionally, processing NGS experiments requires suitable storage space and significant manual interaction. At The Ohio State University's Biomedical Informatics Shared Resource, we designed and implemented a scalable architecture to address the challenges associated with the resource intensive nature of NGS secondary analysis built around Illumina Genome Analyzer II sequencers and Illumina's Gerald data processing pipeline. The software infrastructure includes a distributed computing platform consisting of a LIMS called QUEST (http://bisr.osumc.edu), an Automation Server, a computer cluster for processing NGS pipelines, and a network attached storage device expandable up to 40TB. The system has been architected to scale to multiple sequencers without requiring additional computing or labor resources. This platform provides demonstrates how to manage and automate NGS experiments in an institutional or core facility setting.

Addressing the conundrum of multimorbidity in heart failure: Do we need a more strategic approach to improve health outcomes?

PubMed

Stewart, Simon; Riegel, Barbara; Thompson, David R

2016-02-01

There is clear evidence across the globe that the clinical complexity of patients presenting to hospital with the syndrome of heart failure is increasing - not only in terms of the presence of concurrent disease states, but with additional socio-demographic risk factors that complicate treatment. Management strategies that treat heart failure as the main determinant of health outcomes ignores the multiple and complex issues that will inevitably erode the efficacy and efficiency of current heart failure management programmes. This complex problem (or conundrum) requires a different way of thinking around the complex interactions that underpin poor outcomes in heart failure. In this context, we present the COordinated NUrse-led inteNsified Disease management for continuity of caRe for mUltiMorbidity in Heart Failure (CONUNDRUM-HF) matrix that may well inform future research and models of care to achieve better health outcomes in this rapidly increasing patient population. © The European Society of Cardiology 2015.

Sharing Overdose Data Across State Agencies to Inform Public Health Strategies: A Case Study.

PubMed

Cherico-Hsii, Sara; Bankoski, Andrea; Singal, Pooja; Horon, Isabelle; Beane, Eric; Casey, Meghan; Rebbert-Franklin, Kathleen; Sharfstein, Joshua

2016-01-01

Data sharing and analysis are important components of coordinated and cost-effective public health strategies. However, legal and policy barriers have made data from different agencies difficult to share and analyze for policy development. To address a rise in overdose deaths, Maryland used an innovative and focused approach to bring together data on overdose decedents across multiple agencies. The effort was focused on developing discrete intervention points based on information yielded on decedents' lives, such as vulnerability upon release from incarceration. Key aspects of this approach included gubernatorial leadership, a unified commitment to data sharing across agencies with memoranda of understanding, and designation of a data management team. Preliminary results have yielded valuable insights and have helped inform policy. This process of navigating legal and privacy concerns in data sharing across multiple agencies may be applied to a variety of public health problems challenging health departments across the country.

Volcano warning systems: Chapter 67

USGS Publications Warehouse

Gregg, Chris E.; Houghton, Bruce F.; Ewert, John W.

2015-01-01

Messages conveying volcano alert level such as Watches and Warnings are designed to provide people with risk information before, during, and after eruptions. Information is communicated to people from volcano observatories and emergency management agencies and from informal sources and social and environmental cues. Any individual or agency can be both a message sender and a recipient and multiple messages received from multiple sources is the norm in a volcanic crisis. Significant challenges to developing effective warning systems for volcanic hazards stem from the great diversity in unrest, eruption, and post-eruption processes and the rapidly advancing digital technologies that people use to seek real-time risk information. Challenges also involve the need to invest resources before unrest to help people develop shared mental models of important risk factors. Two populations of people are the target of volcano notifications–ground- and aviation-based populations, and volcano warning systems must address both distinctly different populations.

Shared Authentic Leadership in Research Teams: Testing a Multiple Mediation Model.

PubMed

Guenter, Hannes; Gardner, William L; Davis McCauley, Kelly; Randolph-Seng, Brandon; Prabhu, Veena P

2017-12-01

Research teams face complex leadership and coordination challenges. We propose shared authentic leadership (SAL) as a timely approach to addressing these challenges. Drawing from authentic and functional leadership theories, we posit a multiple mediation model that suggests three mechanisms whereby SAL influences team effectiveness: shared mental models (SMM), team trust, and team coordination. To test our hypotheses, we collected survey data on leadership and teamwork within 142 research teams that recently published an article in a peer-reviewed management journal. The results indicate team coordination represents the primary mediating mechanism accounting for the relationship between SAL and research team effectiveness. While teams with high trust and SMM felt more successful and were more satisfied, they were less successful in publishing in high-impact journals. We also found the four SAL dimensions (i.e., self-awareness, relational transparency, balanced processing, and internalized moral perspective) to associate differently with team effectiveness.

The impact of drugs for multiple sclerosis on sleep.

PubMed

Lanza, Giuseppe; Ferri, Raffaele; Bella, Rita; Ferini-Strambi, Luigi

2017-01-01

Although there is a growing literature on the presence of sleep disorders in multiple sclerosis (MS), few studies have specifically addressed the impact of drugs on sleep of these patients. Moreover, even when sleep is considered, quantitative assessment by standardized questionnaires or polysomnography is lacking. The studies that have been done highlight that interferon-beta and some symptomatic medications may affect sleep, thus contributing to fatigue, depression, and poor quality of life; conversely, natalizumab and cannabinoids may improve sleep. Common limitations of the literature reviewed here are small sample size, selection bias, and often a lack of objective outcome measures. Clinicians need to remember to ask about sleep in all MS patients and intervene when appropriate. A systematic approach that takes sleep into account is recommended to enhance recognition and appropriate management of sleep disruption, including disorders related to medication. Consideration of the impact on sleep should also be part of the design of trials of new therapies.

Shared Authentic Leadership in Research Teams: Testing a Multiple Mediation Model

PubMed Central

Guenter, Hannes; Gardner, William L.; Davis McCauley, Kelly; Randolph-Seng, Brandon; Prabhu, Veena P.

2017-01-01

Research teams face complex leadership and coordination challenges. We propose shared authentic leadership (SAL) as a timely approach to addressing these challenges. Drawing from authentic and functional leadership theories, we posit a multiple mediation model that suggests three mechanisms whereby SAL influences team effectiveness: shared mental models (SMM), team trust, and team coordination. To test our hypotheses, we collected survey data on leadership and teamwork within 142 research teams that recently published an article in a peer-reviewed management journal. The results indicate team coordination represents the primary mediating mechanism accounting for the relationship between SAL and research team effectiveness. While teams with high trust and SMM felt more successful and were more satisfied, they were less successful in publishing in high-impact journals. We also found the four SAL dimensions (i.e., self-awareness, relational transparency, balanced processing, and internalized moral perspective) to associate differently with team effectiveness. PMID:29187779

Reducing Nurses’ Stress: A Randomized Controlled Trial of a Web-Based Stress Management Program for Nurses

PubMed Central

Hersch, Rebekah K.; Cook, Royer F.; Deitz, Diane K.; Kaplan, Seth; Hughes, Daniel; Friesen, Mary Ann; Vezina, Maria

2016-01-01

Background Nursing is a notoriously high-stress occupation emotionally taxing and physically draining, with a high incidence of burnout. In addition to the damaging effects of stress on nurses’ health and well being, stress is also a major contributor to attrition and widespread shortages in the nursing profession. Although there exist promising in-person interventions for addressing the problem of stress among nurses, the experience of our group across multiple projects in hospitals has indicated that the schedules and workloads of nurses can pose problems for implementing in-person interventions, and that web-based interventions might be ideally suited to addressing the high levels of stress among nurses. Purpose The purpose of this study was to evaluate the effectiveness of the web-based BREATHE: Stress Management for Nurses program. Methods The randomized controlled trial was conducted with 104 nurses in five hospitals in Virginia and one hospital in New York. The primary outcome measure was perceived nursing-related stress. Secondary measures included symptoms of distress, coping, work limitations, job satisfaction, use of substances to relieve stress, alcohol consumption, and understanding depression and anxiety. Results Program group participants experienced significantly greater reductions than the control group on the full Nursing Stress Scale, and six of the seven subscales. No other significant results were found. Moderator analysis found that nurses with greater experience benefitted more. Conclusion Using a web-based program holds tremendous promise for providing nurses with the tools they need to address nursing related stress. PMID:27969025

Interdisciplinary rehabilitation for a patient with incomplete cervical spinal cord injury and multimorbidity: A case report.

PubMed

Vining, Robert D; Gosselin, Donna M; Thurmond, Jeb; Case, Kimberlee; Bruch, Frederick R

2017-08-01

This report describes interdisciplinary rehabilitation for a 51-year-old male recovering from incomplete cervical spinal cord injury (SCI) and multiple comorbidities following an automobile accident. The patient was admitted to a rehabilitation specialty hospital approximately 2 months post SCI and 2 separate surgical fusion procedures (C3-C6). Clinical presentation at the rehabilitation hospital included moderate to severe motor strength loss in both upper and lower extremities, a percutaneous endoscopic gastronomy tube (PEG), dysphagia, bowel/bladder incontinence, dependence on a mechanical lift and tilting wheelchair due to severe orthostatic hypotension, and pre-existing shoulder pain from bilateral joint degeneration. The interdisciplinary team formally coordinated rehabilitative care from multiple disciplines. Internal medicine managed medications, determined PEG removal, monitored co-morbid conditions, and overall progress. Chiropractic care focused on alleviating shoulder and thoracic pain and improving spinal and extremity mobility. Physical therapy addressed upright tolerance, transfer, gait, and strength training. Occupational therapy focused on hand coordination and feeding/dressing activities. Psychology assisted with coping strategies. Nursing ensured medication adherence, nutrient intake, wound prevention, and incontinence management, whereas physiatry addressed abnormal muscle tone. Eleven months post-admission the patient's progress allowed discharge to a long-term care facility. At this time he was without dysphagia or need for a PEG. Orthostatic hypotension and bilateral shoulder pain symptoms were also resolved while bowel/bladder incontinence and upper and lower extremity motor strength loss remained. He was largely independent in transferring from bed to wheelchair and in upper body dressing. Lower body dressing/bathing required maximal assistance. Gait with a 2-wheeled walker was possible up to 150 feet with verbal cues and occasional stabilizing assistance. Several specialties functioning within an interdisciplinary team fulfilled complementary roles to support rehabilitation for a patient with SCI.

Landscape Conservation Cooperatives: Creating a Collaborative Conservation Vision in the Face of Climate Change Uncertainty

NASA Astrophysics Data System (ADS)

Athearn, N.; Schlafmann, D.

2015-12-01

The 22 Landscape Conservation Cooperatives (LCCs) form a "network of networks," each defined by the characteristics of its ecoregion and its unique community of conservation managers, practitioners, and scientists. As self-directed partnerships, LCCs are strongly influenced not only by the landscape but by the evolving cultures and values that define the multi-faceted relationships between people and place. LCCs maintain an ecologically connected network across these diverse landscapes by transcending borders and leveraging resources. Natural resource managers are challenged to make decisions in the face of multiple uncertainties, and several partners across the network have recognized that climate change is one important uncertainty that spans boundaries - both across the conservation community and beyond. The impacts of climate change across the LCC Network are likely to be as diverse as the network itself - manifesting as, for example, sea level rise, ocean acidification, loss of sea ice, and shifts in climate patterns and timing - but synergies are being leveraged within and between LCCs and national climate-focused programs to systematically address the needs of the network to support a collaborative conservation vision that addresses multiple landscape-scale stressors in the face of climate uncertainties. This vision is being achieved by leveraging the convening power of the LCCs and collaborating with DOI Climate Science Centers and others. Selected case studies will demonstrate how the network finds strength in its differences, but also reveals powerful collaborative opportunities through integrated science, shared conservation strategies, and strategic approaches for translating targeted science to conservation action. These examples exemplify past successes as well as ongoing efforts as the network continues to bring about effective application of climate science to achieve conservation outcomes across the LCC Network in an uncertain future climate.

Comprehending the multiple 'values' of green infrastructure - Valuing nature-based solutions for urban water management from multiple perspectives.

PubMed

Wild, T C; Henneberry, J; Gill, L

2017-10-01

The valuation of urban water management practices and associated nature-based solutions (NBS) is highly contested, and is becoming increasingly important to cities seeking to increase their resilience to climate change whilst at the same time facing budgetary pressures. Different conceptions of 'values' exist, each being accompanied by a set of potential measures ranging from calculative practices (closely linked to established market valuation techniques) - through to holistic assessments that seek to address wider concerns of sustainability. Each has the potential to offer important insights that often go well beyond questions of balancing the costs and benefits of the schemes concerned. However, the need to address - and go beyond - economic considerations presents policy-makers, practitioners and researchers with difficult methodological, ethical and practical challenges, especially when considered without the benefit of a broader theoretical framework or in the absence of well-established tools (as might apply within more traditional infrastructural planning contexts, such as the analysis of transport interventions). Drawing on empirical studies undertaken in Sheffield over a period of 10 years, and delivered in partnership with several other European cities and regions, we compare and examine different attempts to evaluate the benefits of urban greening options and future development scenarios. Comparing these different approaches to the valuation of nature-based solutions alongside other, more conventional forms of infrastructure - and indeed integrating both 'green and grey' interventions within a broader framework of infrastructures - throws up some surprising results and conclusions, as well as providing important sign-posts for future research in this rapidly emerging field. Copyright © 2017 Elsevier Inc. All rights reserved.

Mitigating road mortality of diamond-backed terrapins (Malaclemy's terrapin) with hybrid barriers at crossing hot spots

USGS Publications Warehouse

Crawford, Brian A.; Moore, Clinton; Norton, Terry M.; Maerz, John C.

2017-01-01

Roads represent a pervasive feature on most landscapes that can pose multiple threats to wildlife populations and substantial challenges for management. To be effective, management strategies must often target where threats are most concentrated. Road mortality and nest predation are well-documented threats to Diamond-backed Terrapins (Malaclemys terrapin) across the majority of their range, including the 8.7-km causeway to Jekyll Island, Georgia, USA, where both are predicted to contribute to population declines if left unmitigated. From 2009 to 2014, we used intensive road surveying to identify spatial peaks (hot spots) of terrapin crossing activity and road mortality and exploit these as targets for management. In 2011, we deployed a hybrid barrier composed of nest boxes, which were designed to prevent terrapins from accessing the road and mitigate nest predation, at one hot spot while leaving two other hot spots unmanaged. We evaluated the impact of the barrier on terrapin emergences on the causeway under a Before-After-Control-Impact (BACI) design, and a companion study evaluated the effects of nest boxes on nest predation rates. We estimated a 57% reduction in annual terrapin emergences at the barrier site compared to no measurable change at control hot spots. Our findings support the use of hybrid barriers for simultaneously addressing road mortality and nest predation for other terrapin populations at risk to these threats. Our approach highlights the need to design feasible but robust management strategies that target spatial peaks of road mortality while addressing additional threats contributing to population declines of terrapins and other species.

The pluralistic water research concept - a new human-water system research approach

NASA Astrophysics Data System (ADS)

Evers, Mariele; Höllermann, Britta; Almoradie, Adrian; Taft, Linda; Garcia-Santos, Glenda

2017-04-01

Sustainable water resources management has been and still is a main challenge for decision makers even though for the past number of decades integrative approaches and concepts (e.g. Integrated Water Resources Management - IWRM) have been developed to address problems on floods, droughts, water quality, water quantity, environment and ecology. Although somehow these approaches are aiming to address water related problems in an integrative approach and to some extent include or involve society in the planning and management, they still lack some of the vital components in including the social dimensions and their interaction with water. Understanding these dynamics in a holistic way and how they are shaped by time and space may tackle these shortcomings and provide more effective and sustainable management solutions with respect to a set of potential present social actions and values as well as possible futures. This paper aims to discuss challenges to coherently and comprehensively integrate the social dimensions of different human-water concepts like IWRM, socio-hydrology and waterscape. Against this background it will develop criteria for an integrative approach and present a newly developed concept termed pluralistic water research (PWR) concept. PWR is not only a pluralistic but also an integrative and interdisciplinary approach to acknowledge the social and water dimensions and their interaction and dynamics by considering more than one perspective of a water-related issue, hereby providing a set of multiple (future) developments. Our PWR concept will be illustrated by a case study application of the Canary island La Gomera. Furthermore an outlook on further possible developments of the PWR concept will be presented and discussed.

Geodata Modeling and Query in Geographic Information Systems

NASA Technical Reports Server (NTRS)

Adam, Nabil

1996-01-01

Geographic information systems (GIS) deal with collecting, modeling, man- aging, analyzing, and integrating spatial (locational) and non-spatial (attribute) data required for geographic applications. Examples of spatial data are digital maps, administrative boundaries, road networks, and those of non-spatial data are census counts, land elevations and soil characteristics. GIS shares common areas with a number of other disciplines such as computer- aided design, computer cartography, database management, and remote sensing. None of these disciplines however, can by themselves fully meet the requirements of a GIS application. Examples of such requirements include: the ability to use locational data to produce high quality plots, perform complex operations such as network analysis, enable spatial searching and overlay operations, support spatial analysis and modeling, and provide data management functions such as efficient storage, retrieval, and modification of large datasets; independence, integrity, and security of data; and concurrent access to multiple users. It is on the data management issues that we devote our discussions in this monograph. Traditionally, database management technology have been developed for business applications. Such applications require, among other things, capturing the data requirements of high-level business functions and developing machine- level implementations; supporting multiple views of data and yet providing integration that would minimize redundancy and maintain data integrity and security; providing a high-level language for data definition and manipulation; allowing concurrent access to multiple users; and processing user transactions in an efficient manner. The demands on database management systems have been for speed, reliability, efficiency, cost effectiveness, and user-friendliness. Significant progress have been made in all of these areas over the last two decades to the point that many generalized database platforms are now available for developing data intensive applications that run in real-time. While continuous improvement is still being made at a very fast-paced and competitive rate, new application areas such as computer aided design, image processing, VLSI design, and GIS have been identified by many as the next generation of database applications. These new application areas pose serious challenges to the currently available database technology. At the core of these challenges is the nature of data that is manipulated. In traditional database applications, the database objects do not have any spatial dimension, and as such, can be thought of as point data in a multi-dimensional space. For example, each instance of an entity EMPLOYEE will have a unique value corresponding to every attribute such as employee id, employee name, employee address and so on. Thus, every Employee instance can be thought of as a point in a multi-dimensional space where each dimension is represented by an attribute. Furthermore, all operations on such data are one-dimensional. Thus, users may retrieve all entities satisfying one or more constraints. Examples of such constraints include employees with addresses in a certain area code, or salaries within a certain range. Even though constraints can be specified on multiple attributes (dimensions), the search for such data is essentially orthogonal across these dimensions.

Cultural Heritage in Smart City Environments

NASA Astrophysics Data System (ADS)

Angelidou, M.; Karachaliou, E.; Angelidou, T.; Stylianidis, E.

2017-08-01

This paper investigates how the historical and cultural heritage of cities is and can be underpinned by means of smart city tools, solutions and applications. Smart cities stand for a conceptual technology-and-innovation driven urban development model. By becoming `smart', cities seek to achieve prosperity, effectiveness and competitiveness on multiple socio-economic levels. Although cultural heritage is one of the many issues addressed by existing smart city strategies, and despite the documented bilateral benefits, our research about the positioning of urban cultural heritage within three smart city strategies (Barcelona, Amsterdam, and London) reveals fragmented approaches. Our findings suggest that the objective of cultural heritage promotion is not substantially addressed in the investigated smart city strategies. Nevertheless, we observe that cultural heritage management can be incorporated in several different strategic areas of the smart city, reflecting different lines of thinking and serving an array of goals, depending on the case. We conclude that although potential applications and approaches abound, cultural heritage currently stands for a mostly unexploited asset, presenting multiple integration opportunities within smart city contexts. We prompt for further research into bridging the two disciplines and exploiting a variety of use cases with the purpose of enriching the current knowledge base at the intersection of cultural heritage and smart cities.

Population-based analysis of patients with COPD in Catalonia: a cohort study with implications for clinical management

PubMed Central

Vela, Emili; Tényi, Ákos; Cano, Isaac; Monterde, David; Cleries, Montserrat; Garcia-Altes, Anna; Hernandez, Carme; Escarrabill, Joan; Roca, Josep

2018-01-01

Background Clinical management of patients with chronic obstructive pulmonary disease (COPD) shows potential for improvement provided that patients’ heterogeneities are better understood. The study addresses the impact of comorbidities and its role in health risk assessment. Objective To explore the potential of health registry information to enhance clinical risk assessment and stratification. Design Fixed cohort study including all registered patients with COPD in Catalonia (Spain) (7.5 million citizens) at 31 December 2014 with 1-year (2015) follow-up. Methods A total of 264 830 patients with COPD diagnosis, based on the International Classification of Diseases (Ninth Revision) coding, were assessed. Performance of multiple logistic regression models for the six main dependent variables of the study: mortality, hospitalisations (patients with one or more admissions; all cases and COPD-related), multiple hospitalisations (patients with at least two admissions; all causes and COPD-related) and users with high healthcare costs. Neither clinical nor forced spirometry data were available. Results Multimorbidity, assessed with the adjusted morbidity grouper, was the covariate with the highest impact in the predictive models, which in turn showed high performance measured by the C-statistics: (1) mortality (0.83), (2 and 3) hospitalisations (all causes: 0.77; COPD-related: 0.81), (4 and 5) multiple hospitalisations (all causes: 0.80; COPD-related: 0.87) and (6) users with high healthcare costs (0.76). Fifteen per cent of individuals with highest healthcare costs to year ratio represented 59% of the overall costs of patients with COPD. Conclusions The results stress the impact of assessing multimorbidity with the adjusted morbidity grouper on considered health indicators, which has implications for enhanced COPD staging and clinical management. Trial registration number NCT02956395. PMID:29511004

Neglected diseases of neglected populations: Thinking to reshape the determinants of health in Latin America and the Caribbean

PubMed Central

2005-01-01

Background People living in poverty throughout the developing world are heavily burdened with neglected communicable diseases and often marginalized by the health sector. These diseases are currently referred to as Neglected Diseases of Neglected Populations. The neglected diseases create social and financial burdens to the individual, the family, the community, and the nation. Discussion Numerous studies of successful individual interventions to manage communicable disease determinants in various types of communities have been published, but few have applied multiple interventions in an integrated, coordinated manner. We have identified a series of successful interventions and developed three hypothetical scenarios where such interventions could be applied in an integrated, multi-disease, inter-programmatic, and/or inter-sectoral approach for prevention and control of neglected diseases in three different populations: a slum, an indigenous community, and a city with a mix of populations. Summary The objective of this paper is to identify new opportunities to address neglected diseases, improve community health and promote sustainable development in neglected populations by highlighting examples of key risk and protective factors for neglected diseases which can be managed and implemented through multi-disease-based, integrated, inter-programmatic, and/or inter-sectoral approaches. Based on a literature review, analysis and development of scenarios we visualize how multiple interventions could manage multiple disease problems and propose these as possible strategies to be tested. We seek to stimulate intra- and inter-sectoral dialogue which will help in the construction of new strategies for neglected diseases (particularly for the parasitic diseases) which could benefit the poor and marginalized based on the principle of sustainability and understanding of key determinants of health, and lead to the establishment of pilot projects and activities which can contribute to the achievement of the Millennium Development Goals. PMID:16283932

State-of-the-lagoon reports as vehicles of cross-disciplinary integration.

PubMed

Zaucha, Jacek; Davoudi, Simin; Slob, Adriaan; Bouma, Geiske; van Meerkerk, Ingmar; Oen, Amy Mp; Breedveld, Gijs D

2016-10-01

An integrative approach across disciplines is needed for sustainable lagoon and estuary management as identified by integrated coastal zone management. The ARCH research project (Architecture and roadmap to manage multiple pressures on lagoons) has taken initial steps to overcome the boundaries between disciplines and focus on cross-disciplinary integration by addressing the driving forces, challenges, and problems at various case study sites. A model was developed as a boundary-spanning activity to produce joint knowledge and understanding. The backbone of the model is formed by the interaction between the natural and human systems, including economy and governance-based subsystems. The model was used to create state-of-the-lagoon reports for 10 case study sites (lagoons and estuarine coastal areas), with a geographical distribution covering all major seas surrounding Europe. The reports functioned as boundary objects to build joint knowledge. The experiences related to the framing of the model and its subsequent implementation at the case study sites have resulted in key recommendations on how to address the challenges of cross-disciplinary work required for the proper management of complex social-ecological systems such as lagoons, estuarine areas, and other land-sea regions. Cross-disciplinary integration is initially resource intensive and time consuming; one should set aside the required resources and invest efforts at the forefront. It is crucial to create engagement among the group of researchers by focusing on a joint, appealing overall concept that will stimulate cross-sectoral thinking and focusing on the identified problems as a link between collected evidence and future management needs. Different methods for collecting evidence should be applied including both quantitative (jointly agreed indicators) and qualitative (narratives) information. Cross-disciplinary integration is facilitated by functional boundary objects. Integration offers important rewards in terms of developing a better understanding and subsequently improved management of complex social-ecological systems. Integr Environ Assess Manag 2016;12:690-700. © 2016 SETAC. © 2016 SETAC.

Neonatal management and outcome in alloimmune hemolytic disease.

PubMed

Ree, Isabelle M C; Smits-Wintjens, Vivianne E H J; van der Bom, Johanna G; van Klink, Jeanine M M; Oepkes, Dick; Lopriore, Enrico

2017-07-01

Hemolytic disease of the fetus and newborn (HDFN) occurs when fetal and neonatal erythroid cells are destroyed by maternal erythrocyte alloantibodies, it leads to anemia and hydrops in the fetus, and hyperbilirubinemia and kernicterus in the newborn. Postnatal care consists of intensive phototherapy and exchange transfusions to treat severe hyperbilirubinemia and top-up transfusions to treat early and late anemia. Other postnatal complications have been reported such as thrombocytopenia, iron overload and cholestasis requiring specific management. Areas covered: This review focusses on the current neonatal management and outcome of hemolytic disease and discusses postnatal treatment options as well as literature on long-term neurodevelopmental outcome. Expert commentary: Despite major advances in neonatal management, multiple issues have to be addressed to optimize postnatal management and completely eradicate kernicterus. Except for strict adherence to guidelines, improvement could be achieved by clarifying the epidemiology and pathophysiology of HDFN. Several pharmacotherapeutic agents should be further researched as alternative treatment options in hyperbilirubinemia, including immunoglobulins, albumin, phenobarbital, metalloporphyrins, zinc, clofibrate and prebiotics. Larger trials are warranted to evaluate EPO, folate and vitamin E in neonates. Long-term follow-up studies are needed in HDFN, especially on thrombocytopenia, iron overload and cholestasis.

A methodological framework to support the initiation, design and institutionalization of participatory modeling processes in water resources management

NASA Astrophysics Data System (ADS)

Halbe, Johannes; Pahl-Wostl, Claudia; Adamowski, Jan

2018-01-01

Multiple barriers constrain the widespread application of participatory methods in water management, including the more technical focus of most water agencies, additional cost and time requirements for stakeholder involvement, as well as institutional structures that impede collaborative management. This paper presents a stepwise methodological framework that addresses the challenges of context-sensitive initiation, design and institutionalization of participatory modeling processes. The methodological framework consists of five successive stages: (1) problem framing and stakeholder analysis, (2) process design, (3) individual modeling, (4) group model building, and (5) institutionalized participatory modeling. The Management and Transition Framework is used for problem diagnosis (Stage One), context-sensitive process design (Stage Two) and analysis of requirements for the institutionalization of participatory water management (Stage Five). Conceptual modeling is used to initiate participatory modeling processes (Stage Three) and ensure a high compatibility with quantitative modeling approaches (Stage Four). This paper describes the proposed participatory model building (PMB) framework and provides a case study of its application in Québec, Canada. The results of the Québec study demonstrate the applicability of the PMB framework for initiating and designing participatory model building processes and analyzing barriers towards institutionalization.

Consensus guidelines for the investigation and management of encephalitis in adults and children in Australia and New Zealand.

PubMed

Britton, P N; Eastwood, K; Paterson, B; Durrheim, D N; Dale, R C; Cheng, A C; Kenedi, C; Brew, B J; Burrow, J; Nagree, Y; Leman, P; Smith, D W; Read, K; Booy, R; Jones, C A

2015-05-01

Encephalitis is a complex neurological syndrome caused by inflammation of the brain parenchyma. The management of encephalitis is challenging because: the differential diagnosis of encephalopathy is broad; there is often rapid disease progression; it often requires intensive supportive management; and there are many aetiologic agents for which there is no definitive treatment. Patients with possible meningoencephalitis are often encountered in the emergency care environment where clinicians must consider differential diagnoses, perform appropriate investigations and initiate empiric antimicrobials. For patients who require admission to hospital and in whom encephalitis is likely, a staged approach to investigation and management is preferred with the potential involvement of multiple medical specialties. Key considerations in the investigation and management of patients with encephalitis addressed in this guideline include: Which first-line investigations should be performed?; Which aetiologies should be considered possible based on clinical features, risk factors and radiological features?; What tests should be arranged in order to diagnose the common causes of encephalitis?; When to consider empiric antimicrobials and immune modulatory therapies?; and What is the role of brain biopsy? © 2015 Royal Australasian College of Physicians.

Advanced data management design for autonomous telerobotic systems in space using spaceborne symbolic processors

NASA Technical Reports Server (NTRS)

Goforth, Andre

1987-01-01

The use of computers in autonomous telerobots is reaching the point where advanced distributed processing concepts and techniques are needed to support the functioning of Space Station era telerobotic systems. Three major issues that have impact on the design of data management functions in a telerobot are covered. It also presents a design concept that incorporates an intelligent systems manager (ISM) running on a spaceborne symbolic processor (SSP), to address these issues. The first issue is the support of a system-wide control architecture or control philosophy. Salient features of two candidates are presented that impose constraints on data management design. The second issue is the role of data management in terms of system integration. This referes to providing shared or coordinated data processing and storage resources to a variety of telerobotic components such as vision, mechanical sensing, real-time coordinated multiple limb and end effector control, and planning and reasoning. The third issue is hardware that supports symbolic processing in conjunction with standard data I/O and numeric processing. A SSP that currently is seen to be technologically feasible and is being developed is described and used as a baseline in the design concept.

Conservative management of neuromuscular scoliosis: personal experience and review of literature.

PubMed

Kotwicki, Tomasz; Jozwiak, Marek

2008-01-01

The principles of conservative management of neuromuscular scoliosis in childhood and adolescence are presented. Analysis of personal experience and literature review. The topic is discussed separately for patients with flaccid or spastic paresis. These demonstrate that conservative management might be proposed for patients with neuromuscular scoliosis in many clinical situations. In spastic disorders, it maintains the symmetry around the hip joints. Bracing is technically difficult and often is not tolerated well by cerebral palsy children. In patients with flaccid paresis, the fitting and the use of brace is easier than in spastic patients. The flexibility of the spinal curvature is more important. Functional benefits of conservative management of neuromuscular scoliosis comprise stable sitting, easier use of upper limbs, discharge of the abdomen from the collapsing trunk, increased diaphragm excursion, and, not always, prevention of curve progression. Specific natural history and multiple medical problems associated with the disease make the treatment of children with neuromuscular scoliosis an extremely complex issue, best addressed when a team approach is applied. Continuously improving techniques of conservative management, comprising bracing and physiotherapy, together with correctly timed surgery incorporated in the process of rehabilitation, provide the optimal care for patients.

Evaluating Threats in Multinational Marine Ecosystems: A Coast Salish First Nations and Tribal Perspective.

PubMed

Gaydos, Joseph K; Thixton, Sofie; Donatuto, Jamie

2015-01-01

Despite the merit of managing natural resources on the scale of ecosystems, evaluating threats and managing risk in ecosystems that span multiple countries or jurisdictions can be challenging. This requires each government involved to consider actions in concert with actions being taken in other countries by co-managing entities. Multiple proposed fossil fuel-related and port development projects in the Salish Sea, a 16,925 km2 inland sea shared by Washington State (USA), British Columbia (Canada), and Indigenous Coast Salish governments, have the potential to increase marine vessel traffic and negatively impact natural resources. There is no legal mandate or management mechanism requiring a comprehensive review of the potential cumulative impacts of these development activities throughout the Salish Sea and across the international border. This project identifies ongoing and proposed energy-related development projects that will increase marine vessel traffic in the Salish Sea and evaluates the threats each project poses to natural resources important to the Coast Salish. While recognizing that Coast Salish traditions identify all species as important and connected, we used expert elicitation to identify 50 species upon which we could evaluate impact. These species were chosen because Coast Salish depend upon them heavily for harvest revenue or as a staple food source, they were particularly culturally or spiritually significant, or they were historically part of Coast Salish lifeways. We identified six development projects, each of which had three potential impacts (pressures) associated with increased marine vessel traffic: oil spill, vessel noise and vessel strike. Projects varied in their potential for localized impacts (pressures) including shoreline development, harbor oil spill, pipeline spill, coal dust accumulation and nearshore LNG explosion. Based on available published data, impact for each pressure/species interaction was rated as likely, possible or unlikely. Impacts are likely to occur in 23 to 28% of the possible pressure/species scenarios and are possible in another 15 to 28% additional pressure/species interactions. While it is not clear which impacts will be additive, synergistic, or potentially antagonistic, studies that manipulate multiple stressors in marine ecosystems suggest that threats associated with these six projects are likely to have an overall additive or even synergistic interaction and therefore impact species of major cultural importance to the Coast Salish, an important concept that would be lost by merely evaluating each project independently. Failure to address multiple impacts will affect the Coast Salish and the 7 million other people that also depend on this ecosystem. These findings show the value of evaluating multiple threats, and ultimately conducting risk assessments at the scale of ecosystems and highlight the serious need for managers of multinational ecosystems to actively collaborate on evaluating threats, assessing risk, and managing resources.

Evaluating Threats in Multinational Marine Ecosystems: A Coast Salish First Nations and Tribal Perspective

PubMed Central

Gaydos, Joseph K.; Thixton, Sofie; Donatuto, Jamie

2015-01-01

Despite the merit of managing natural resources on the scale of ecosystems, evaluating threats and managing risk in ecosystems that span multiple countries or jurisdictions can be challenging. This requires each government involved to consider actions in concert with actions being taken in other countries by co-managing entities. Multiple proposed fossil fuel-related and port development projects in the Salish Sea, a 16,925 km2 inland sea shared by Washington State (USA), British Columbia (Canada), and Indigenous Coast Salish governments, have the potential to increase marine vessel traffic and negatively impact natural resources. There is no legal mandate or management mechanism requiring a comprehensive review of the potential cumulative impacts of these development activities throughout the Salish Sea and across the international border. This project identifies ongoing and proposed energy-related development projects that will increase marine vessel traffic in the Salish Sea and evaluates the threats each project poses to natural resources important to the Coast Salish. While recognizing that Coast Salish traditions identify all species as important and connected, we used expert elicitation to identify 50 species upon which we could evaluate impact. These species were chosen because Coast Salish depend upon them heavily for harvest revenue or as a staple food source, they were particularly culturally or spiritually significant, or they were historically part of Coast Salish lifeways. We identified six development projects, each of which had three potential impacts (pressures) associated with increased marine vessel traffic: oil spill, vessel noise and vessel strike. Projects varied in their potential for localized impacts (pressures) including shoreline development, harbor oil spill, pipeline spill, coal dust accumulation and nearshore LNG explosion. Based on available published data, impact for each pressure/species interaction was rated as likely, possible or unlikely. Impacts are likely to occur in 23 to 28% of the possible pressure/species scenarios and are possible in another 15 to 28% additional pressure/species interactions. While it is not clear which impacts will be additive, synergistic, or potentially antagonistic, studies that manipulate multiple stressors in marine ecosystems suggest that threats associated with these six projects are likely to have an overall additive or even synergistic interaction and therefore impact species of major cultural importance to the Coast Salish, an important concept that would be lost by merely evaluating each project independently. Failure to address multiple impacts will affect the Coast Salish and the 7 million other people that also depend on this ecosystem. These findings show the value of evaluating multiple threats, and ultimately conducting risk assessments at the scale of ecosystems and highlight the serious need for managers of multinational ecosystems to actively collaborate on evaluating threats, assessing risk, and managing resources. PMID:26691860

The Changing Role of Data Stewardship in Creating Trustworthy, Interdisciplinary High Performance Data Platforms for the Future.

NASA Astrophysics Data System (ADS)

Richards, C. J.; Evans, B. J. K.; Wyborn, L. A.; Wang, J.; Trenham, C. E.; Druken, K. A.

2016-12-01

The Australian National Computational Infrastructure (NCI) has ingested over 10PB of national and international environmental, Earth systems science and geophysics reference data onto a single platform to advance high performance data (HPD) techniques that enable interdisciplinary Data-intensive Science. Improved Data Stewardship is critical to evolve both data and data services that support the increasing need for programmatic usability and that prioritises interoperability rather than just traditional data download or portal access. A data platform designed for programmatic access requires quality checked collections that better utilise interoperable data formats and standards. Achieving this involves strategies to meet both the technical and `social' challenges. Aggregating datasets used by different communities and organisations requires satisfying multiple use cases for the broader research community, whilst addressing existing BAU requirements. For NCI, this requires working with data stewards to manage the process of replicating data to the common platform, community representatives and developers to confirm their requirements, and with international peers to better enable globally integrated data communities. It is particularly important to engage with representatives from each community who can work collaboratively to a common goal, as well as capture their community needs, apply quality assurance, determine any barriers to change and to understand priorities. This is critical when managing the aggregation of data collections from multiple producers with different levels of stewardship maturity, technologies and standards, and where organisational barriers can impact the transformation to interoperable and performant data access. To facilitate the management, development and operation of the HPD platform, NCI coordinates technical and domain committees made up of user representatives, data stewards and informatics experts to provide a forum to discuss, learn and advise NCI's management. This experience has been a useful collaboration and suggests that in the age of interdisciplinary HPD research, Data Stewardship is evolving from a focus on the needs of a single community to one which helps balance priorities and navigates change for multiple communities.

Umbrellas can work under water: Using threatened species as indicator and management surrogates can improve coastal conservation

NASA Astrophysics Data System (ADS)

Gilby, Ben L.; Olds, Andrew D.; Connolly, Rod M.; Yabsley, Nicholas A.; Maxwell, Paul S.; Tibbetts, Ian R.; Schoeman, David S.; Schlacher, Thomas A.

2017-12-01

Species surrogates, the use of particular species to index habitat condition or to represent ecological assemblages are commonly identified in many ecosystems, but are less tested, and therefore less employed in estuaries. Estuaries provide important ecosystem goods (e.g. harvestable species) and services (e.g. carbon processing, coastal armouring), but require protection from multiple human activities, meaning that finding surrogates for estuarine condition or faunal assemblages is a significant knowledge gap. In this study, we test the efficacy of the threatened estuary ray Hemitrygon fluviorum, as a suitable indicator of ecosystem condition and management umbrella surrogate species for conservation prioritisation and monitoring purposes within estuaries. We surveyed fish assemblages and ray presence at ten sites within each of 22 estuaries in southeast Queensland, Australia, using one hour deployments of baited video arrays. We then tested for correlations between ray presence, a series of environmental variables considered important to ecosystem management within estuaries (i.e. testing rays as indicator species), and the co-occurring fish species (i.e. testing rays as umbrella species). Estuary rays function as both umbrella species and ecological indicators of habitat status in subtropical Australian estuaries. As umbrellas, ray occurrence concords with elevated species richness. As ecological indicators, ray distribution concords with habitats of good water quality (especially low turbidity) and more natural vegetation remaining in the catchment. These results highlight the potential for other threatened aquatic vertebrates that are both readily detectable and that are reliable proxies for ecosystems status to be become useful management tools in estuaries. The protection of such large, threatened species in coastal seascapes allows managers to address multiple targets for conservation, especially; (1) protecting species of conservation concern; (2) maintaining diversity; and (3) protecting optimal habitats by better placing reserves.

Charge-Control Unit for Testing Lithium-Ion Cells

NASA Technical Reports Server (NTRS)

Reid, Concha M.; Mazo, Michelle A.; Button, Robert M.

2008-01-01

A charge-control unit was developed as part of a program to validate Li-ion cells packaged together in batteries for aerospace use. The lithium-ion cell charge-control unit will be useful to anyone who performs testing of battery cells for aerospace and non-aerospace uses and to anyone who manufacturers battery test equipment. This technology reduces the quantity of costly power supplies and independent channels that are needed for test programs in which multiple cells are tested. Battery test equipment manufacturers can integrate the technology into their battery test equipment as a method to manage charging of multiple cells in series. The unit manages a complex scheme that is required for charging Li-ion cells electrically connected in series. The unit makes it possible to evaluate cells together as a pack using a single primary test channel, while also making it possible to charge each cell individually. Hence, inherent cell-to-cell variations in a series string of cells can be addressed, and yet the cost of testing is reduced substantially below the cost of testing each cell as a separate entity. The unit consists of electronic circuits and thermal-management devices housed in a common package. It also includes isolated annunciators to signal when the cells are being actively bypassed. These annunciators can be used by external charge managers or can be connected in series to signal that all cells have reached maximum charge. The charge-control circuitry for each cell amounts to regulator circuitry and is powered by that cell, eliminating the need for an external power source or controller. A 110-VAC source of electricity is required to power the thermal-management portion of the unit. A small direct-current source can be used to supply power for an annunciator signal, if desired.

Assess and Adapt: Coordinated Ecoregional Forest Vulnerability Assessments Covering the Upper Midwest and Northeast in Support of Climate-informed Decision-making

NASA Astrophysics Data System (ADS)

Swanston, C.; Janowiak, M.; Handler, S.; Butler, P.; Brandt, L.; Iverson, L.; Thompson, F.; Ontl, T.; Shannon, D.

2016-12-01

Forest ecosystem vulnerability assessments are rapidly becoming an integral component of forest management planning, in which there is increasing public expectation that even near-term activities explicitly incorporate information about anticipated climate impacts and risks. There is a clear desire among forest managers for targeted assessments that address critical questions about species and ecosystem vulnerabilities while delivering this information in an accessible format. We developed the Ecosystem Vulnerability Assessment Approach (EVAA), which combines multiple quantitative models, expert elicitation from scientists and land managers, and a templated report structure oriented to natural resource managers. The report structure includes relevant information on the contemporary landscape, past climate, future climate projections, impact model results, and a transparent vulnerability assessment of species and ecosystems. We have used EVAA in seven ecoregional assessments covering 246 million acres of forestland across the upper Midwest and Northeast (www.forestadaptation.org; five published, two in review). We convened a panel of local forest ecology and management experts in each assessment area to examine projected climate effects on system drivers, stressors, and dominant species, as well as the current adaptive capacity of the major ecoregional forest ecosystems. The panels provided a qualitative assessment of the vulnerability of forest ecosystems to climate change over the next century. Over 130 authors from dozens of organizations collaborated on these peer-reviewed assessment publications, which are delivered to thousands of stakeholders through live and recorded webinars, online briefs, and in-person trainings and seminars. The assessments are designed to be used with the Adaptation Workbook (www.adaptationworkbook.org), a planning tool that works at multiple scales and has generated more than 200 real-world forest adaptation demonstration projects.

Climate change, coral reef ecosystems, and management options for marine protected areas.

PubMed

Keller, Brian D; Gleason, Daniel F; McLeod, Elizabeth; Woodley, Christa M; Airamé, Satie; Causey, Billy D; Friedlander, Alan M; Grober-Dunsmore, Rikki; Johnson, Johanna E; Miller, Steven L; Steneck, Robert S

2009-12-01

Marine protected areas (MPAs) provide place-based management of marine ecosystems through various degrees and types of protective actions. Habitats such as coral reefs are especially susceptible to degradation resulting from climate change, as evidenced by mass bleaching events over the past two decades. Marine ecosystems are being altered by direct effects of climate change including ocean warming, ocean acidification, rising sea level, changing circulation patterns, increasing severity of storms, and changing freshwater influxes. As impacts of climate change strengthen they may exacerbate effects of existing stressors and require new or modified management approaches; MPA networks are generally accepted as an improvement over individual MPAs to address multiple threats to the marine environment. While MPA networks are considered a potentially effective management approach for conserving marine biodiversity, they should be established in conjunction with other management strategies, such as fisheries regulations and reductions of nutrients and other forms of land-based pollution. Information about interactions between climate change and more "traditional" stressors is limited. MPA managers are faced with high levels of uncertainty about likely outcomes of management actions because climate change impacts have strong interactions with existing stressors, such as land-based sources of pollution, overfishing and destructive fishing practices, invasive species, and diseases. Management options include ameliorating existing stressors, protecting potentially resilient areas, developing networks of MPAs, and integrating climate change into MPA planning, management, and evaluation.

Managing protected areas under climate change: challenges and priorities.

PubMed

Rannow, Sven; Macgregor, Nicholas A; Albrecht, Juliane; Crick, Humphrey Q P; Förster, Michael; Heiland, Stefan; Janauer, Georg; Morecroft, Mike D; Neubert, Marco; Sarbu, Anca; Sienkiewicz, Jadwiga

2014-10-01

The implementation of adaptation actions in local conservation management is a new and complex task with multiple facets, influenced by factors differing from site to site. A transdisciplinary perspective is therefore required to identify and implement effective solutions. To address this, the International Conference on Managing Protected Areas under Climate Change brought together international scientists, conservation managers, and decision-makers to discuss current experiences with local adaptation of conservation management. This paper summarizes the main issues for implementing adaptation that emerged from the conference. These include a series of conclusions and recommendations on monitoring, sensitivity assessment, current and future management practices, and legal and policy aspects. A range of spatial and temporal scales must be considered in the implementation of climate-adapted management. The adaptation process must be area-specific and consider the ecosystem and the social and economic conditions within and beyond protected area boundaries. However, a strategic overview is also needed: management at each site should be informed by conservation priorities and likely impacts of climate change at regional or even wider scales. Acting across these levels will be a long and continuous process, requiring coordination with actors outside the "traditional" conservation sector. To achieve this, a range of research, communication, and policy/legal actions is required. We identify a series of important actions that need to be taken at different scales to enable managers of protected sites to adapt successfully to a changing climate.

Centrally managed unified shared virtual address space

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

Wilkes, John

Systems, apparatuses, and methods for managing a unified shared virtual address space. A host may execute system software and manage a plurality of nodes coupled to the host. The host may send work tasks to the nodes, and for each node, the host may externally manage the node's view of the system's virtual address space. Each node may have a central processing unit (CPU) style memory management unit (MMU) with an internal translation lookaside buffer (TLB). In one embodiment, the host may be coupled to a given node via an input/output memory management unit (IOMMU) interface, where the IOMMU frontendmore » interface shares the TLB with the given node's MMU. In another embodiment, the host may control the given node's view of virtual address space via memory-mapped control registers.« less

Effort to Accelerate MBSE Adoption and Usage at JSC

NASA Technical Reports Server (NTRS)

Wang, Lui; Izygon, Michel; Okron, Shira; Garner, Larry; Wagner, Howard

2016-01-01

This paper describes the authors' experience in adopting Model Based System Engineering (MBSE) at the NASA/Johnson Space Center (JSC). Since 2009, NASA/JSC has been applying MBSE using the Systems Modeling Language (SysML) to a number of advanced projects. Models integrate views of the system from multiple perspectives, capturing the system design information for multiple stakeholders. This method has allowed engineers to better control changes, improve traceability from requirements to design and manage the numerous interactions between components. As the project progresses, the models become the official source of information and used by multiple stakeholders. Three major types of challenges that hamper the adoption of the MBSE technology are described. These challenges are addressed by a multipronged approach that includes educating the main stakeholders, implementing an organizational infrastructure that supports the adoption effort, defining a set of modeling guidelines to help engineers in their modeling effort, providing a toolset that support the generation of valuable products, and providing a library of reusable models. JSC project case studies are presented to illustrate how the proposed approach has been successfully applied.

Systems and methods to control multiple peripherals with a single-peripheral application code

DOEpatents

Ransom, Ray M.

2013-06-11

Methods and apparatus are provided for enhancing the BIOS of a hardware peripheral device to manage multiple peripheral devices simultaneously without modifying the application software of the peripheral device. The apparatus comprises a logic control unit and a memory in communication with the logic control unit. The memory is partitioned into a plurality of ranges, each range comprising one or more blocks of memory, one range being associated with each instance of the peripheral application and one range being reserved for storage of a data pointer related to each peripheral application of the plurality. The logic control unit is configured to operate multiple instances of the control application by duplicating one instance of the peripheral application for each peripheral device of the plurality and partitioning a memory device into partitions comprising one or more blocks of memory, one partition being associated with each instance of the peripheral application. The method then reserves a range of memory addresses for storage of a data pointer related to each peripheral device of the plurality, and initializes each of the plurality of peripheral devices.

Core principles of assessment in competency-based medical education.

PubMed

Lockyer, Jocelyn; Carraccio, Carol; Chan, Ming-Ka; Hart, Danielle; Smee, Sydney; Touchie, Claire; Holmboe, Eric S; Frank, Jason R

2017-06-01

The meaningful assessment of competence is critical for the implementation of effective competency-based medical education (CBME). Timely ongoing assessments are needed along with comprehensive periodic reviews to ensure that trainees continue to progress. New approaches are needed to optimize the use of multiple assessors and assessments; to synthesize the data collected from multiple assessors and multiple types of assessments; to develop faculty competence in assessment; and to ensure that relationships between the givers and receivers of feedback are appropriate. This paper describes the core principles of assessment for learning and assessment of learning. It addresses several ways to ensure the effectiveness of assessment programs, including using the right combination of assessment methods and conducting careful assessor selection and training. It provides a reconceptualization of the role of psychometrics and articulates the importance of a group process in determining trainees' progress. In addition, it notes that, to reach its potential as a driver in trainee development, quality care, and patient safety, CBME requires effective information management and documentation as well as ongoing consideration of ways to improve the assessment system.

SOMOS: Evaluation of an HIV Prevention Intervention for Latino Gay Men

ERIC Educational Resources Information Center

Vega, Miriam Y.; Spieldenner, Andrew R.; DeLeon, Dennis; Nieto, Bolivar X.; Stroman, Carolyn A.

2011-01-01

Latino gay men face multiple barriers to human immunodeficiency virus (HIV) prevention, in particular a lack of intervention programs that integrate prevention messages with cultural norms and address issues of social marginalization from multiple communities (gay community and Latino community), homophobia and racism. In order to address these…

76 FR 45724 - Clearing Member Risk Management

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-01

... Management AGENCY: Commodity Futures Trading Commission. ACTION: Notice of proposed rulemaking. SUMMARY: The... proposed rules address risk management for cleared trades by futures commission merchants, swap dealers... Commission has proposed extensive regulations addressing open access and risk management at the derivatives...

Experimental Watershed Study Designs: A Tool for Advancing Process Understanding and Management of Mixed-Land-Use Watersheds

NASA Astrophysics Data System (ADS)

Hubbart, J. A.; Kellner, R. E.; Zeiger, S. J.

2016-12-01

Advancements in watershed management are both a major challenge, and urgent need of this century. The experimental watershed study (EWS) approach provides critical baseline and long-term information that can improve decision-making, and reduce misallocation of mitigation investments. Historically, the EWS approach was used in wildland watersheds to quantitatively characterize basic landscape alterations (e.g. forest harvest, road building). However, in recent years, EWS is being repurposed in contemporary multiple-land-use watersheds comprising a mosaic of land use practices such as urbanizing centers, industry, agriculture, and rural development. The EWS method provides scalable and transferrable results that address the uncertainties of development, while providing a scientific basis for total maximum daily load (TMDL) targets in increasing numbers of Clean Water Act 303(d) listed waters. Collaborative adaptive management (CAM) programs, designed to consider the needs of many stakeholders, can also benefit from EWS-generated information, which can be used for best decision making, and serve as a guidance tool throughout the CAM program duration. Of similar importance, long-term EWS monitoring programs create a model system to show stakeholders how investing in rigorous scientific research initiatives improves decision-making, thereby increasing management efficiencies through more focused investments. The evolution from classic wildland EWS designs to contemporary EWS designs in multiple-land-use watersheds will be presented while illustrating how such an approach can encourage innovation, cooperation, and trust among watershed stakeholders working to reach the common goal of improving and sustaining hydrologic regimes and water quality.

Solar cell circuit and method for manufacturing solar cells

NASA Technical Reports Server (NTRS)

Mardesich, Nick (Inventor)

2010-01-01

The invention is a novel manufacturing method for making multi-junction solar cell circuits that addresses current problems associated with such circuits by allowing the formation of integral diodes in the cells and allows for a large number of circuits to readily be placed on a single silicon wafer substrate. The standard Ge wafer used as the base for multi-junction solar cells is replaced with a thinner layer of Ge or a II-V semiconductor material on a silicon/silicon dioxide substrate. This allows high-voltage cells with multiple multi-junction circuits to be manufactured on a single wafer, resulting in less array assembly mass and simplified power management.

Lung Cancer Screening with Low-Dose Computed Tomography for Primary Care Providers

PubMed Central

Richards, Thomas B.; White, Mary C.; Caraballo, Ralph S.

2015-01-01

This review provides an update on lung cancer screening with low-dose computed tomography (LDCT) and its implications for primary care providers. One of the unique features of lung cancer screening is the potential complexity in patient management if an LDCT scan reveals a small pulmonary nodule. Additional tests, consultation with multiple specialists, and follow-up evaluations may be needed to evaluate whether lung cancer is present. Primary care providers should know the resources available in their communities for lung cancer screening with LDCT and smoking cessation, and the key points to be addressed in informed and shared decision-making discussions with patients. PMID:24830610

Health and Safety Benefits of Small Pressurized Suitport Rovers as EVA Surface Support Vehicles

NASA Technical Reports Server (NTRS)

Gernhardt, Michael L.; Abercromby, Andrew F. J.

2008-01-01

Pressurized safe-haven providing SPE protection and decompression sickness (DCS) treatment capabilities within 20 mins at all times. Up to 50% reduction in time spent in EVA suits (vs. Unpressurized Rovers) for equal or greater Boots-on-Surface EVA exploration time. Reduces suit-induced trauma and provides improved options for nutrition, hydration, and waste-management. Time spent inside SPR during long translations may be spent performing resistive and cardiovascular exercise. Multiple shorter EVAs versus single 8 hr EVAs increases DCS safety and decreases prebreathe requirements. SPRs also offer many potential operational, engineering and exploration benefits not addressed here.

Analgesic Techniques in Hip and Knee Arthroplasty: From the Daily Practice to Evidence-Based Medicine

PubMed Central

Anastase, Denisa Madalina; Cionac Florescu, Simona; Munteanu, Ana Maria; Ursu, Traian; Stoica, Cristian Ioan

2014-01-01

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are major orthopedic surgery models, addressing mainly ageing populations with multiple comorbidities and treatments, ASA II–IV, which may complicate the perioperative period. Therefore effective management of postoperative pain should allow rapid mobilization of the patient with shortening of hospitalization and social reintegration. In our review we propose an evaluation of the main analgesics models used today in the postoperative period. Their comparative analysis shows the benefits and side effects of each of these methods and guides us to how to use evidence-based medicine in our daily practice. PMID:25484894

Superstorm Sandy's forgotten patient: a lesson in emergency preparedness in severe obesity.

PubMed

Ramme, Austin J; Vira, Shaleen; McLaurin, Toni M

2015-02-01

Superstorm Sandy gained national attention in late 2012 after its impact on the Northeastern US. In New York City, thousands of residents lost power, and multiple hospitals were forced to evacuate. Bellevue Hospital Center (BHC), the nation's oldest public hospital, was forced to close for the first time in over 275 years. Two patients remained in BHC three days after the primary evacuation without water service and minimal power. Herein, we describe the challenges associated with evacuating a severely obese patient. Obesity management is challenging and at an institutional level must be addressed in emergency preparedness plans. © 2014 The Obesity Society.

A Brokering Protocol for Agent-Based Grid Resource Discovery

NASA Astrophysics Data System (ADS)

Kang, Jaeyong; Sim, Kwang Mong

Resource discovery is one of the basic and key aspects in grid resource management, which aims at searching for the suitable resources for satisfying the requirement of users' applications. This paper introduces an agent-based brokering protocol which connects users and providers in grid environments. In particular, it focuses on addressing the problem of connecting users and providers. A connection algorithm that matches advertisements of users and requests from providers based on pre-specified multiple criteria is devised and implemented. The connection algorithm mainly consists of four stages: selection, evaluation, filtering, and recommendation. A series of experiments that were carried out in executing the protocol, and favorable results were obtained.

Cooperative Learning through Team-Based Projects in the Biotechnology Industry †

PubMed Central

Luginbuhl, Sarah C.; Hamilton, Paul T.

2013-01-01

We have developed a cooperative-learning, case studies project model that has teams of students working with biotechnology professionals on company-specific problems. These semester-long, team-based projects can be used effectively to provide students with valuable skills in an industry environment and experience addressing real issues faced by biotechnology companies. Using peer-evaluations, we have seen improvement in students’ professional skills such as time-management, quality of work, and level of contribution over multiple semesters. This model of team-based, industry-sponsored projects could be implemented in other college and university courses/programs to promote professional skills and expose students to an industry setting. PMID:24358386

Cooperative Learning through Team-Based Projects in the Biotechnology Industry.

PubMed

Luginbuhl, Sarah C; Hamilton, Paul T

2013-01-01

We have developed a cooperative-learning, case studies project model that has teams of students working with biotechnology professionals on company-specific problems. These semester-long, team-based projects can be used effectively to provide students with valuable skills in an industry environment and experience addressing real issues faced by biotechnology companies. Using peer-evaluations, we have seen improvement in students' professional skills such as time-management, quality of work, and level of contribution over multiple semesters. This model of team-based, industry-sponsored projects could be implemented in other college and university courses/programs to promote professional skills and expose students to an industry setting.

Refractory Depression, Fatigue, Irritable Bowel Syndrome, and Chronic Pain: A Functional Medicine Case Report.

PubMed

Plotnikoff, Gregory; Barber, Melissa

2016-01-01

Single-disorder or single-organ-system clinical practice guidelines are often of limited usefulness in guiding effective management of patients with chronic multidimensional signs and symptoms. The presence of multiple long-standing medical problems in a given patient despite intensive medical effort suggests that addressing systemic core imbalances could complement more narrowly focused approaches. A 72-year-old man experiencing longstanding depression, fatigue, irritable bowel syndrome, and chronic pain in the context of additional refractory illnesses was assessed and treated, guided by a system-oriented approach to underlying core imbalances termed functional medicine. This patient was referred from a team of clinicians representing primary care, cardiology, gastroenterology, hematology, and psychology. Prior treatment had been unsuccessful in managing multiple chronic comorbidities. Diagnostic assessment included comprehensive stool and nutritional/metabolic laboratory testing. The blood-, urine-, or stool-based measurements of relevant markers for multiple systemic issues, including digestion/absorption, inflammation, oxidative stress, and methylation, identified previously unrecognized root causes of his constellation of symptoms. These functional measurements guided rational recommendations for dietary choices and supplementation. The patient experienced steady and significant improvement in his mental health, fatigue, chronic pain, and irritable bowel syndrome-as well as the unexpected resolution of his chronic idiopathic pancytopenia. The success in this case suggests that other patients with chronic, complex, and treatment-refractory illness may benefit from a system-oriented assessment of core imbalances guided by specialized nutritional/metabolic and digestive laboratory testing.

Memory Compression Techniques for Network Address Management in MPI

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

Guo, Yanfei; Archer, Charles J.; Blocksome, Michael

MPI allows applications to treat processes as a logical collection of integer ranks for each MPI communicator, while internally translating these logical ranks into actual network addresses. In current MPI implementations the management and lookup of such network addresses use memory sizes that are proportional to the number of processes in each communicator. In this paper, we propose a new mechanism, called AV-Rankmap, for managing such translation. AV-Rankmap takes advantage of logical patterns in rank-address mapping that most applications naturally tend to have, and it exploits the fact that some parts of network address structures are naturally more performance criticalmore » than others. It uses this information to compress the memory used for network address management. We demonstrate that AV-Rankmap can achieve performance similar to or better than that of other MPI implementations while using significantly less memory.« less

Swimming against the tide: A Canadian qualitative study examining the implementation of a province-wide public health initiative to address health equity.

PubMed

McPherson, Charmaine; Ndumbe-Eyoh, Sume; Betker, Claire; Oickle, Dianne; Peroff-Johnston, Nancy

2016-08-19

Effectively addressing the social determinants of health and health equity are critical yet still-emerging areas of public health practice. This is significant for contemporary practice as the egregious impacts of health inequities on health outcomes continue to be revealed. More public health organizations seek to augment internal organizational capacity to address health equity while the evidence base to inform such leadership is in its infancy. The purpose of this paper is to report on findings of a study examining key factors influencing the development and implementation of the social determinants of health public health nurse (SDH-PHN) role in Ontario, Canada. A descriptive qualitative case study approach examined the first Canadian province-wide initiative to add SDH-PHNs to each public health unit. Data sources were documents and staff from public health units (i.e., SDH-PHNs, Managers, Directors, Chief Nursing Officers, Medical Officers of Health) as well as external stakeholders. Data were collected through 42 individual interviews and 226 documents. Interview data were analyzed using framework analysis methods; Prior's approach guided document analysis. Three themes related to the SDH-PHN role implementation were identified: (1) 'Swimming against the tide' to lead change as staff navigated ideological tensions, competency development, and novel collaborations; (2) Shifting organizational practice environments impacted by initial role placement and action to structurally embed health equity priorities; and (3) Bridging policy implementation gaps related to local-provincial implementation and reporting expectations. This study extends our understanding of the dynamic interplay among leadership, change management, ideological tensions, and local-provincial public health policy impacting health equity agendas. Given that the social determinants of health lie outside public health, collaboration with communities, health partners and non-health partners is essential to public health practice for health equity. The study findings have implications for increasing our knowledge and capacity for effective system-wide intervention towards health equity as a critical strategic priority for public health and for broader public policy and community engagement. Appropriate and effective public health leadership at multiple levels and by multiple actors is tantamount to adequately making inroads for health equity.

Optimizing multiple reliable forward contracts for reservoir allocation using multitime scale streamflow forecasts

NASA Astrophysics Data System (ADS)

Lu, Mengqian; Lall, Upmanu; Robertson, Andrew W.; Cook, Edward

2017-03-01

Streamflow forecasts at multiple time scales provide a new opportunity for reservoir management to address competing objectives. Market instruments such as forward contracts with specified reliability are considered as a tool that may help address the perceived risk associated with the use of such forecasts in lieu of traditional operation and allocation strategies. A water allocation process that enables multiple contracts for water supply and hydropower production with different durations, while maintaining a prescribed level of flood risk reduction, is presented. The allocation process is supported by an optimization model that considers multitime scale ensemble forecasts of monthly streamflow and flood volume over the upcoming season and year, the desired reliability and pricing of proposed contracts for hydropower and water supply. It solves for the size of contracts at each reliability level that can be allocated for each future period, while meeting target end of period reservoir storage with a prescribed reliability. The contracts may be insurable, given that their reliability is verified through retrospective modeling. The process can allow reservoir operators to overcome their concerns as to the appropriate skill of probabilistic forecasts, while providing water users with short-term and long-term guarantees as to how much water or energy they may be allocated. An application of the optimization model to the Bhakra Dam, India, provides an illustration of the process. The issues of forecast skill and contract performance are examined. A field engagement of the idea is useful to develop a real-world perspective and needs a suitable institutional environment.

Comparing the effects of different land management strategies across several land types on California's landscape carbon and associated greenhouse gas budgets

NASA Astrophysics Data System (ADS)

Di Vittorio, A. V.; Simmonds, M.; Nico, P. S.

2017-12-01

Land-based carbon sequestration and GreenHouse Gas (GHG) reduction strategies are often implemented in small patches and evaluated independently from each other, which poses several challenges to determining their potential benefits at the regional scales at which carbon/GHG targets are defined. These challenges include inconsistent methods, uncertain scalability to larger areas, and lack of constraints such as land ownership and competition among multiple strategies. To address such challenges we have developed an integrated carbon and GHG budget model of California's entire landscape, delineated by geographic region, land type, and ownership. This empirical model has annual time steps and includes net ecosystem carbon exchange, wildfire, multiple forest management practices including wood and bioenergy production, cropland and rangeland soil management, various land type restoration activities, and land cover change. While the absolute estimates vary considerably due to uncertainties in initial carbon densities and ecosystem carbon exchange rates, the estimated effects of particular management activities with respect to baseline are robust across these uncertainties. Uncertainty in land use/cover change data is also critical, as different rates of shrubland to grassland conversion can switch the system from a carbon source to a sink. The results indicate that reducing urban area expansion has substantial and consistent benefits, while the effects of direct land management practices vary and depend largely on the available management area. Increasing forest fuel reduction extent over the baseline contributes to annual GHG costs during increased management, and annual benefits after increased management ceases. Cumulatively, it could take decades to recover the cost of 14 years of increased fuel reduction. However, forest carbon losses can be completely offset within 20 years through increases in urban forest fraction and marsh restoration. Additionally, highly uncertain black carbon estimates dominate the overall GHG budget due to wildfire, forest management, and bioenergy production. Overall, this tool is well suited for exploring suites of management options and extents throughout California in order to quantify potential regional carbon sequestration and GHG emission benefits.

Exploring Stakeholder Definitions within the Aerospace Industry: A Qualitative Case Study

NASA Astrophysics Data System (ADS)

Hebert, Jonathan R.

A best practice in the discipline of project management is to identify all key project stakeholders prior to the execution of a project. When stakeholders are properly identified, they can be consulted to provide expert advice on project activities so that the project manager can ensure the project stays within the budget and schedule constraints. The problem addressed by this study is that managers fail to properly identify key project stakeholders when using stakeholder theory because there are multiple conflicting definitions for the term stakeholder. Poor stakeholder identification has been linked to multiple negative project outcomes such as budget and schedules overruns, and this problem is heightened in certain industries such as aerospace. The purpose of this qualitative study was to explore project managers' and project stakeholders' perceptions of how they define and use the term stakeholder within the aerospace industry. This qualitative exploratory single-case study had two embedded units of analysis: project managers and project stakeholders. Six aerospace project managers and five aerospace project stakeholders were purposively selected for this study. Data were collected through individual semi-structured interviews with both project managers and project stakeholders. All data were analyzed using Yin's (2011) five-phased cycle approach for qualitative research. The results indicated that the aerospace project managers and project stakeholder define the term stakeholder as "those who do the work of a company." The participants build upon this well-known concept by adding that, "a company should list specific job titles" that correspond to their company specific-stakeholder definition. Results also indicated that the definition of the term stakeholder is used when management is assigning human resources to a project to mitigate or control project risk. Results showed that project managers tended to include the customer in their stakeholder definitions while project stakeholders included a wider range of stakeholders from young employees to union workers. Practical application recommendations, based on the study's findings, include that companies start to develop company-specific definitions of the term stakeholder. Recommendations for future research should focus on exploring how CEOs, executive members, new hires, and hourly workers define and use the term stakeholder in the aerospace industry.

Supported self-management for cancer survivors to address long-term biopsychosocial consequences of cancer and treatment to optimize living well.

PubMed

Howell, Doris D

2018-03-01

As individuals are living longer with cancer as a chronic disease, they face new health challenges that require the application of self-management behaviors and skills that may not be in their usual repertoire of self-regulatory health behaviors. Increasing attention is focused on supported self-management (SSM) programs to enable survivors in managing the long-term biopsychosocial consequences and health challenges of survivorship. This review explores current directions and evidence for SSM programs that enable survivors to manage these consequences and optimize health. Cancer survivors face complex health challenges that affect daily functioning and well being. Multiple systematic reviews show that SSM programs have positive effects on health outcomes in typical chronic diseases. However, the efficacy of these approaches in cancer survivors are in their infancy; and the 'one-size' fits all approach for chronic disease self-management may not be adequate for cancer as a complex chronic illness. This review suggests that SSM has promising potential for improving health and well being of cancer survivors, but there is a need for standardizing SSM for future research. Although there is increasing enthusiasm for SSM programs tailored to cancer survivors, there is a need for further research of their efficacy on long-term health outcomes.

Training doctors to manage patients with multimorbidity: a systematic review.

PubMed

Lewis, Cliona; Wallace, Emma; Kyne, Lorraine; Cullen, Walter; Smith, Susan M

2016-01-01

Patients with multimorbidity (two or more chronic conditions) are now the norm in clinical practice, and place an increasing burden on the healthcare system. Management of these patients is challenging, and requires doctors who are skilled in the complexity of multiple chronic diseases. To perform a systematic review of the literature to ascertain whether there are education and training formats which have been used to train postgraduate medical doctors in the management of patients with multimorbidity in primary and/or secondary care, and which have been shown to improve knowledge, skills, attitudes, and/or patient outcomes. Overall, 75,110 citations were screened, of which 65 full-text articles were then independently assessed for eligibility by two reviewers, and two studies met the inclusion criteria for the review. The two included studies implemented and evaluated multimorbidity workshops, and highlight the need for further research addressing the learning needs of doctors tasked with managing patients with multimorbidity in their daily practice. While much has been published about the challenges presented to medical staff by patients with multimorbidity, published research regarding education of doctors to manage these problems is lacking. Further research is required to determine whether there is a need for, or benefit from, specific training for doctors to manage patients with multimorbidity. PROSPERO registration number: CRD42013004010.

Proceedings of the AMCP Partnership Forum: Breaking the Link Between Pain Management and Opioid Use Disorder.

PubMed

2015-12-01

Prescription drug misuse and abuse, especially with opioid analgesics, is the fastest growing drug problem in the United States. Addressing this public health crisis demands the coordinated efforts and actions of all stakeholders to establish a process of improving patient care and decreasing misuse and abuse. On September 9, 2014, the Academy of Managed Care Pharmacy (AMCP) convened a meeting of multiple stakeholders to recommend activities and programs that AMCP can promote to improve pain management, prevent opioid use disorder (OUD), and improve medication-assisted treatment outcomes. The speakers and panelists recommended that efforts to improve pain management outcomes and reduce the potential for OUD should rely on demonstrated evidence and best practices. It was recommended that AMCP promote a more holistic and evidence-based approach to pain management and OUD treatment that actively engages the patient in the decision-making process and includes care coordination with medical, pharmacy, behavioral, and mental health aspects of organizations, all of which is seamlessly supported by a technology infrastructure. To accomplish this, it was recommended that AMCP work to collaborate with organizations representing these stakeholders. Additionally, it was recommended that AMCP conduct continuing pharmacy education programs, develop a best practices toolkit on pain management, and actively promote quality standards for OUD prevention and treatment.

Examining the impact of succession management practices on organizational performance: A national study of U.S. hospitals.

PubMed

Groves, Kevin S

2017-08-03

Spearheaded by the industry's transition from volume- to value-based care, the health care reform movement has spurred both unprecedented challenges and opportunities for developing more effective and sustainable health care delivery organizations. Whereas the formidable challenges of leading hospitals and health systems have been widely discussed, including reimbursement degradation, the rapidly aging workforce, and the imminent wave of executive retirements, the opportunity to leverage succession management and talent development capabilities to overcome these challenges has been largely overlooked. To address this key research and practice need, this multiphase study develops and validates an assessment of succession management practices for health care organizations. Utilizing data collected from two national samples of hospital organizations, the results provide a 32-item succession management assessment comprising seven distinct sets of succession management practices. The results indicate that succession management practices are strongly associated with multiple hospital performance metrics, including patient satisfaction and Medicare Spending per Beneficiary, leadership bench strength, and internal/external placement rate for executive level positions. The author concludes this article with a discussion of several practical implications for health care executives and boards, including employing the succession management assessment for diagnosing development opportunities, benchmarking succession planning and talent development practices against similar hospitals or health systems, and elevating the profile of succession management as a strategic priority in today's increasingly uncertain health care landscape.

How widely applicable is river basin management? An analysis of wastewater management in an arid transboundary case.

PubMed

Dombrowsky, Ines; Almog, Ram; Becker, Nir; Feitelson, Eran; Klawitter, Simone; Lindemann, Stefan; Mutlak, Natalie

2010-05-01

The basin scale has been promoted universally as the optimal management unit that allows for the internalization of all external effects caused by multiple water uses. However, the basin scale has been put forward largely on the basis of experience in temperate zones. Hence whether the basin scale is the best scale for management in other settings remains questionable. To address these questions this paper analyzes the economic viability and the political feasibility of alternative management options in the Kidron/Wadi Nar region. The Kidron/Wadi Nar is a small basin in which wastewater from eastern Jerusalem flows through the desert to the Dead Sea. Various options for managing these wastewater flows were analyzed ex ante on the basis of both a cost benefit and a multi-criteria analysis. The paper finds that due to economies of scale, a pure basin approach is not desirable from a physical and economic perspective. Furthermore, in terms of political feasibility, it seems that the option which prompts the fewest objections from influential stakeholder groups in the two entities under the current asymmetrical political setting is not a basin solution either, but a two plant solution based on an outsourcing arrangement. These findings imply that the river basin management approach can not be considered the best management approach for the arid transboundary case at hand, and hence is not unequivocally universally applicable.

How Widely Applicable is River Basin Management? An Analysis of Wastewater Management in an Arid Transboundary Case

NASA Astrophysics Data System (ADS)

Dombrowsky, Ines; Almog, Ram; Becker, Nir; Feitelson, Eran; Klawitter, Simone; Lindemann, Stefan; Mutlak, Natalie

2010-05-01

The basin scale has been promoted universally as the optimal management unit that allows for the internalization of all external effects caused by multiple water uses. However, the basin scale has been put forward largely on the basis of experience in temperate zones. Hence whether the basin scale is the best scale for management in other settings remains questionable. To address these questions this paper analyzes the economic viability and the political feasibility of alternative management options in the Kidron/Wadi Nar region. The Kidron/Wadi Nar is a small basin in which wastewater from eastern Jerusalem flows through the desert to the Dead Sea. Various options for managing these wastewater flows were analyzed ex ante on the basis of both a cost benefit and a multi-criteria analysis. The paper finds that due to economies of scale, a pure basin approach is not desirable from a physical and economic perspective. Furthermore, in terms of political feasibility, it seems that the option which prompts the fewest objections from influential stakeholder groups in the two entities under the current asymmetrical political setting is not a basin solution either, but a two plant solution based on an outsourcing arrangement. These findings imply that the river basin management approach can not be considered the best management approach for the arid transboundary case at hand, and hence is not unequivocally universally applicable.

Developing a Behavioral Model for Mobile Phone-Based Diabetes Interventions

PubMed Central

Nundy, Shantanu; Dick, Jonathan J.; Solomon, Marla C.; Peek, Monica E.

2013-01-01

Objectives Behavioral models for mobile phone-based diabetes interventions are lacking. This study explores the potential mechanisms by which a text message-based diabetes program affected self-management among African-Americans. Methods We conducted in-depth, individual interviews among 18 African-American patients with type 2 diabetes who completed a 4-week text message-based diabetes program. Each interview was audio- taped, transcribed verbatim, and imported into Atlas.ti software. Coding was done iteratively. Emergent themes were mapped onto existing behavioral constructs and then used to develop a novel behavioral model for mobile phone-based diabetes self-management programs. Results The effects of the text message-based program went beyond automated reminders. The constant, daily communications reduced denial of diabetes and reinforced the importance of self-management (Rosenstock Health Belief Model). Responding positively to questions about self-management increased mastery experience (Bandura Self-Efficacy). Most surprisingly, participants perceived the automated program as a “friend” and “support group” that monitored and supported their self-management behaviors (Barrera Social Support). Conclusions A mobile phone-based diabetes program affected self-management through multiple behavioral constructs including health beliefs, self-efficacy, and social support. Practice implications: Disease management programs that utilize mobile technologies should be designed to leverage existing models of behavior change and can address barriers to self-management associated with health disparities. PMID:23063349

Information Management: Records Management: Official Mail and Distribution Management

DTIC Science & Technology

1992-11-30

Official Mail Cost Control Program and the Department of the Army Official Mail and Distribution Management Program. It addresses the use of postage meters...mailing permits, special mail services, postage stamps, correspondence distribution management , mailing procedures for certain U.S. Army activities and U.S. citizens overseas, and street addressing of correspondence.

Collaborative Research for Water Resource Management under Climate Change Conditions

NASA Astrophysics Data System (ADS)

Brundiers, K.; Garfin, G. M.; Gober, P.; Basile, G.; Bark, R. H.

2010-12-01

We present an ongoing project to co-produce science and policy called Collaborative Planning for Climate Change: An Integrated Approach to Water-Planning, Climate Downscaling, and Robust Decision-Making. The project responds to motivations related to dealing with sustainability challenges in research and practice: (a) state and municipal water managers seek research that addresses their planning needs; (b) the scientific literature and funding agencies call for more meaningful engagement between science and policy communities, in ways that address user needs, while advancing basic research; and (c) empirical research contributes to methods for the design and implementation of collaborative projects. To understand how climate change might impact water resources and management in the Southwest US, our project convenes local, state, and federal water management practitioners with climate-, hydrology-, policy-, and decision scientists. Three areas of research inform this collaboration: (a) the role of paleo-hydrology in water resources scenario construction; (b) the types of uncertainties that impact decision-making beyond climate and modeling uncertainty; and (c) basin-scale statistical and dynamical downscaling of climate models to generate hydrologic projections for regional water resources planning. The project engages all participants in the research process, from research design to workshops that build capacity for understanding data generation and sources of uncertainty to the discussion of water management decision contexts. A team of “science-practice translators” facilitates the collaboration between academic and professional communities. In this presentation we contextualize the challenges and opportunities of use-inspired science-policy research collaborations by contrasting the initial project design with the process of implementation. We draw from two sources to derive lessons learned: literature on collaborative research, and evaluations provided by participating scientists and water managers throughout the process. Lessons learned include: RESULTS: The research process needs to generate academic (peer-reviewed publications, grant proposals) and applied (usable dataset, communication support) products. Additionally, the project also strives for intangible products, e.g., the research currently continues to support efforts to predict future regional hydroclimatology, whereas management requires a paradigm shift toward anticipation of needs for adapting to multiple possible futures. APPROACH: Collaborative research is not a one-off event or consultation, but a process of mutual engagement that needs to allow for adaptive evolution of the project and its organization. TOPICS: With the acceptance of hydroclimatic non-stationarity, the focus of water managers shifts from reducing scientific uncertainty to enhancing their ability to present academically and politically defensible scenarios to their constituencies. This requires addressing the related need for exploring how to deal with political and institutional uncertainties in decision-making.

FluxSuite: a New Scientific Tool for Advanced Network Management and Cross-Sharing of Next-Generation Flux Stations

NASA Astrophysics Data System (ADS)

Burba, G. G.; Johnson, D.; Velgersdyk, M.; Beaty, K.; Forgione, A.; Begashaw, I.; Allyn, D.

2015-12-01

Significant increases in data generation and computing power in recent years have greatly improved spatial and temporal flux data coverage on multiple scales, from a single station to continental flux networks. At the same time, operating budgets for flux teams and stations infrastructure are getting ever more difficult to acquire and sustain. With more stations and networks, larger data flows from each station, and smaller operating budgets, modern tools are needed to effectively and efficiently handle the entire process. This would help maximize time dedicated to answering research questions, and minimize time and expenses spent on data processing, quality control and station management. Cross-sharing the stations with external institutions may also help leverage available funding, increase scientific collaboration, and promote data analyses and publications. FluxSuite, a new advanced tool combining hardware, software and web-service, was developed to address these specific demands. It automates key stages of flux workflow, minimizes day-to-day site management, and modernizes the handling of data flows: Each next-generation station measures all parameters needed for flux computations Field microcomputer calculates final fully-corrected flux rates in real time, including computation-intensive Fourier transforms, spectra, co-spectra, multiple rotations, stationarity, footprint, etc. Final fluxes, radiation, weather and soil data are merged into a single quality-controlled file Multiple flux stations are linked into an automated time-synchronized network Flux network manager, or PI, can see all stations in real time, including fluxes, supporting data, automated reports, and email alerts PI can assign rights, allow or restrict access to stations and data: selected stations can be shared via rights-managed access internally or with external institutions Researchers without stations could form "virtual networks" for specific projects by collaborating with PIs from different actual networks This presentation provides detailed examples of FluxSuite currently utilized by two large flux networks in China (National Academy of Sciences & Agricultural Academy of Sciences), and smaller networks with stations in the USA, Germany, Ireland, Malaysia and other locations around the globe.

Managing Tomorrow's University.

ERIC Educational Resources Information Center

Michalak, Craig L., Ed.

The issues addressed in this conference report concern budgeting, the resourceful manager, extramural funding, employer-employee interaction, management information systems, and management of the university in the future. Contents include: the keynote address by F. E. Balderston; "University Budgeting in an Era of Scarce Resources," by F. M. Bowen…

41 CFR 109-26.203 - Activity address codes.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Activity address codes. 109-26.203 Section 109-26.203 Public Contracts and Property Management Federal Property Management Regulations System (Continued) DEPARTMENT OF ENERGY PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26...

Care management role in end-of-life discussions.

PubMed

Meyer, Star

2012-01-01

How do we prepare our patients for decisions that will need to be made for end-of-life care? End-of-life care discussions should occur early on in the patient's disease process and often requires a great deal of coordination between multiple caregivers. There are also ethical, cultural social and spiritual considerations during this very important time in the disease process. Research suggests that we are not doing an adequate job of addressing end-of-life care with our patients and that a great deal of money and resources are being spent in the last days of life when there may be no clinical indication to do so. Registered nurse case managers have a unique knowledge base to serve in the role of coordinating care and leading the multidisciplinary care team in an effort to use resources responsibly while providing patients and families with options for end-of-life care.

Improving the delivery of care and reducing healthcare costs with the digitization of information.

PubMed

Noffsinger, R; Chin, S

2000-01-01

In the coming years, the digitization of information and the Internet will be extremely powerful in reducing healthcare costs while assisting providers in the delivery of care. One example of healthcare inefficiency that can be managed through information digitization is the process of prescription writing. Due to the handwritten and verbal communication surrounding prescription writing, as well as the multiple tiers of authorizations, the prescription drug process causes extensive financial waste as well as medical errors, lost time, and even fatal accidents. Electronic prescription management systems are being designed to address these inefficiencies. By utilizing new electronic prescription systems, physicians not only prescribe more accurately, but also improve formulary compliance thereby reducing pharmacy utilization. These systems expand patient care by presenting proactive alternatives at the point of prescription while reducing costs and providing additional benefits for consumers and healthcare providers.

Monoclonal Gammopathy Associated Peripheral Neuropathy: Diagnosis and Management

PubMed Central

Chaudhry, Hafsa M.; Mauermann, Michelle L.; Rajkumar, S. Vincent

2017-01-01

Monoclonal gammopathies consist of a spectrum of clonal plasma cell disorders that includes monoclonal gammopathy of undetermined significance (MGUS), multiple myeloma (MM) and Waldenstrom Macroglobulinemia (WM). In this review, we outline the epidemiology, etiology, classification, diagnosis, and treatment of monoclonal gammopathy associated peripheral neuropathy. Monoclonal gammopathy of undetermined significance (MGUS) is relatively common in the general population, with a prevalence of 3–4% among those over the age of 50. Therefore, the presence of M protein in a patient with neuropathy does not automatically indicate a causal relationship. Monoclonal gammopathy associated peripheral neuropathy is often a difficult diagnosis with limited treatment options. Studies addressing the optimal approach to diagnosis and management of this entity are limited. In addition to a review of the literature, we present a diagnostic approach to patients with monoclonal gammopathy associated peripheral neuropathy and discuss available data and options for treatment. PMID:28473042

Integrality: life principle and right to health.

PubMed

Viegas, Selma Maria Fonseca; Penna, Cláudia Maria de Mattos

2015-01-01

To understand the health integrality in the daily work of Family Health Strategy (FHS) and its concept according to the managers in Jequitinhonha Valley, Minas Gerais, Brazil. This is a multiple case study of holistic and qualitative approach based on the Quotidian Comprehensive Sociology. The subjects were workers of the Family Health Strategy teams, the support team and managers in a total of 48. The results show the integrality as a principle of life and right to health and to contemplate it in the quotidian of doings in health, others principles of the Unified Health System may be addressed consecutively. The universal right to health care needs is declared in contemplation of integrity of being, the idealization of a subject-centered care, one that is our aim in health care, which signals a step towards a change of attitude in seeking comprehensive care. It is considered that the principle of integrality is a difficult accomplishment in its dimensions.

Frail elderly patients. New model for integrated service delivery.

PubMed Central

Hébert, Rejean; Durand, Pierre J.; Dubuc, Nicole; Tourigny, André

2003-01-01

PROBLEM BEING ADDRESSED: Given the complex needs of frail older people and the multiplicity of care providers and services, care for this clientele lacks continuity. OBJECTIVE OF PROGRAM: Integrated service delivery (ISD) systems have been developed to improve continuity and increase the efficacy and efficiency of services. PROGRAM DESCRIPTION: The Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA) is an innovative ISD model based on coordination. It includes coordination between decision makers and managers of different organizations and services; a single entry point; a case-management process; individualized service plans; a single assessment instrument based on clients' functional autonomy, coupled with a case-mix classification system; and a computerized clinical chart for communicating between institutions and professionals for client monitoring. CONCLUSION: Preliminary results on the efficacy of this model showed a decreased incidence of functional decline, a decreased burden for caregivers, and a smaller proportion of older people wishing to enter institutions. PMID:12943358

The Case for Dual Training in Geriatric Medicine and Palliative Care: The Time is Now.

PubMed

Gabbard, Jennifer; McNabney, Matthew

2018-02-01

The majority of older adults die from chronic illnesses which are preceded by years of progressive decline and increasing symptom burden. Delivery of high-quality care cannot take place without sufficient numbers of health professionals with appropriate training and skills in both geriatric and palliative care medicine. Despite the surge in aging population and the majority of deaths being attributed to patients with multiple comorbidities, very few health-care providers undergo dual training in these areas. Thus, the nation is facing a health-care crisis as the number of geriatric patients with chronic disease increasingly outpaces the number of physicians with adequate skills to manage them. Joint training in palliative care and geriatric medicine could prepare physicians to better manage our aging population by addressing all their health-care needs irrespective of their stage of disease emphasizing patient-directed care.

Advanced multiple access concepts in mobile satellite systems

NASA Technical Reports Server (NTRS)

Ananasso, Fulvio

1990-01-01

Some multiple access strategies for Mobile Satellite Systems (MSS) are discussed. These strategies were investigated in the context of three separate studies conducted for the International Maritime Satellite Organization (INMARSAT) and the European Space Agency (ESA). Satellite-Switched Frequency Division Multiple Access (SS-FDMA), Code Division Multiple Access (CDMA), and Frequency-Addressable Beam architectures are addressed, discussing both system and technology aspects and outlining advantages and drawbacks of either solution with associated relevant hardware issues. An attempt is made to compare the considered option from the standpoint of user terminal/space segment complexity, synchronization requirements, spectral efficiency, and interference rejection.

Air traffic surveillance and control using hybrid estimation and protocol-based conflict resolution

NASA Astrophysics Data System (ADS)

Hwang, Inseok

The continued growth of air travel and recent advances in new technologies for navigation, surveillance, and communication have led to proposals by the Federal Aviation Administration (FAA) to provide reliable and efficient tools to aid Air Traffic Control (ATC) in performing their tasks. In this dissertation, we address four problems frequently encountered in air traffic surveillance and control; multiple target tracking and identity management, conflict detection, conflict resolution, and safety verification. We develop a set of algorithms and tools to aid ATC; These algorithms have the provable properties of safety, computational efficiency, and convergence. Firstly, we develop a multiple-maneuvering-target tracking and identity management algorithm which can keep track of maneuvering aircraft in noisy environments and of their identities. Secondly, we propose a hybrid probabilistic conflict detection algorithm between multiple aircraft which uses flight mode estimates as well as aircraft current state estimates. Our algorithm is based on hybrid models of aircraft, which incorporate both continuous dynamics and discrete mode switching. Thirdly, we develop an algorithm for multiple (greater than two) aircraft conflict avoidance that is based on a closed-form analytic solution and thus provides guarantees of safety. Finally, we consider the problem of safety verification of control laws for safety critical systems, with application to air traffic control systems. We approach safety verification through reachability analysis, which is a computationally expensive problem. We develop an over-approximate method for reachable set computation using polytopic approximation methods and dynamic optimization. These algorithms may be used either in a fully autonomous way, or as supporting tools to increase controllers' situational awareness and to reduce their work load.

Merits and potential downsides of the 2013 ACC/AHA cholesterol management guidelines.

PubMed

Gotto, A M; Moon, J E

2014-06-01

New guidelines from the American College of Cardiology and the American Heart Association on cholesterol management introduced substantial changes from the previous Adult Treatment Panel III guidelines and generated an immediate storm of controversy upon their release in November 2013. Four categories of individuals that can benefit from statin therapy, including three high-risk groups, have been identified. The fourth category of primary prevention has proven to be the most contentious, with criticism centering on the algorithm used to estimate ten-year risk for atherosclerotic cardiovascular disease and the optimal threshold for statin therapy. Although the risk assessment algorithm can be further refined, it represents an improvement from the previous calculator since it better captures risk in women and African Americans. However, the elimination of lipid targets in the new guidelines discounts a wealth of clinical trial and epidemiological evidence indicating that, with regards to low-density lipoprotein cholesterol, "lower is better." Recommendations regarding the use of nonstatin drugs, while appropriate, could potentially be revised in the future. In general, the new guidelines stress the necessity of addressing the multiple factors that contribute to cardiovascular risk, and they provide a valuable opportunity for physicians to address the importance of lifestyle modifications to lower a patient's overall risk. Copyright © 2014 Elsevier B.V. All rights reserved.

The Lorenzini Foundation in a changing scenario of patient management.

PubMed

Peracino, A; Paoletti, R

2009-06-10

The loss of life, disability, and economic burden attributed to cardiovascular disease (CVD) in Europe has created an urgent need for all stakeholders in CVD prevention to partner together to address the barriers in local health policy and produce effective programs in individual and population risk reduction and rational use of health services. Countries have a legal and moral obligation to achieve the highest standard of CV health care for citizens and to improve national health care systems accordingly. As part of a vision for future potential opportunities in CVD prevention, the Lorenzini Foundation would like to raise awareness of several key areas among the European authorities: Integration of interventions aimed at several risk factors within an individual country's health care system; implementation of a comprehensive approach combining policy development, capacity building, partnership and information support at all levels; promotion of transversal health policies, including coordinated action outside of the health sector to address major determinants of ill health; a combination of health policy and high-risk strategies to link health promotion, public health services, primary care, and hospital care; and, finally, reduction in ethnic, cultural, socioeconomic, and gender inequalities to multiple risk factor management among and within countries through use of cost-effective medications and medical technologies.

Patient Privacy, Consent, and Identity Management in Health Information Exchange: Issues for the Military Health System.

PubMed

Hosek, Susan D; Straus, Susan G

2013-01-01

The Military Health System (MHS) and the Veterans Health Administration (VHA) have been among the nation's leaders in health information technology (IT), including the development of health IT systems and electronic health records that summarize patients' care from multiple providers. Health IT interoperability within MHS and across MHS partners, including VHA, is one of ten goals in the current MHS Strategic Plan. As a step toward achieving improved interoperability, the MHS is seeking to develop a research roadmap to better coordinate health IT research efforts, address IT capability gaps, and reduce programmatic risk for its enterprise projects. This article contributes to that effort by identifying gaps in research, policy, and practice involving patient privacy, consent, and identity management that need to be addressed to bring about improved quality and efficiency of care through health information exchange. Major challenges include (1) designing a meaningful patient consent procedure, (2) recording patients' consent preferences and designing procedures to implement restrictions on disclosures of protected health information, and (3) advancing knowledge regarding the best technical approaches to performing patient identity matches and how best to monitor results over time. Using a sociotechnical framework, this article suggests steps for overcoming these challenges and topics for future research.

DISPOSITION PATHS FOR ROCKY FLATS GLOVEBOXES: EVALUATING OPTIONS

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

Lobdell, D.; Geimer, R.; Larsen, P.

2003-02-27

The Kaiser-Hill Company, LLC has the responsibility for closure activities at the Rocky Flats Environmental Technology Site (RFETS). One of the challenges faced for closure is the disposition of radiologically contaminated gloveboxes. Evaluation of the disposition options for gloveboxes included a detailed analysis of available treatment capabilities, disposal facilities, and lifecycle costs. The Kaiser-Hill Company, LLC followed several processes in determining how the gloveboxes would be managed for disposition. Currently, multiple disposition paths have been chosen to accommodate the needs of the varying styles and conditions of the gloveboxes, meet the needs of the decommissioning team, and to best managemore » lifecycle costs. Several challenges associated with developing a disposition path that addresses both the radiological and RCRA concerns as well as offering the most cost-effective solution were encountered. These challenges included meeting the radiological waste acceptance criteria of available disposal facilities, making a RCRA determination, evaluating treatment options and costs, addressing void requirements associated with disposal, and identifying packaging and transportation options. The varying disposal facility requirements affected disposition choices. Facility conditions that impacted decisions included radiological and chemical waste acceptance criteria, physical requirements, and measurement for payment options. The facility requirements also impacted onsite activities including management strategies, decontamination activities, and life-cycle cost.« less

Generation of Priority Research Questions to Inform Conservation Policy and Management at a National Level

PubMed Central

Rudd, Murray A; Beazley, Karen F; Cooke, Steven J; Fleishman, Erica; Lane, Daniel E; Mascia, Michael B; Roth, Robin; Tabor, Gary; Bakker, Jiselle A; Bellefontaine, Teresa; Berteaux, Dominique; Cantin, Bernard; Chaulk, Keith G; Cunningham, Kathryn; Dobell, Rod; Fast, Eleanor; Ferrara, Nadia; Findlay, C Scott; Hallstrom, Lars K; Hammond, Thomas; Hermanutz, Luise; Hutchings, Jeffrey A; Lindsay, Kathryn E; Marta, Tim J; Nguyen, Vivian M; Northey, Greg; Prior, Kent; Ramirez-Sanchez, Saudiel; Rice, Jake; Sleep, Darren J H; Szabo, Nora D; Trottier, Geneviève; Toussaint, Jean-Patrick; Veilleux, Jean-Philippe

2011-01-01

Integrating knowledge from across the natural and social sciences is necessary to effectively address societal tradeoffs between human use of biological diversity and its preservation. Collaborative processes can change the ways decision makers think about scientific evidence, enhance levels of mutual trust and credibility, and advance the conservation policy discourse. Canada has responsibility for a large fraction of some major ecosystems, such as boreal forests, Arctic tundra, wetlands, and temperate and Arctic oceans. Stressors to biological diversity within these ecosystems arise from activities of the country's resource-based economy, as well as external drivers of environmental change. Effective management is complicated by incongruence between ecological and political boundaries and conflicting perspectives on social and economic goals. Many knowledge gaps about stressors and their management might be reduced through targeted, timely research. We identify 40 questions that, if addressed or answered, would advance research that has a high probability of supporting development of effective policies and management strategies for species, ecosystems, and ecological processes in Canada. A total of 396 candidate questions drawn from natural and social science disciplines were contributed by individuals with diverse organizational affiliations. These were collaboratively winnowed to 40 by our team of collaborators. The questions emphasize understanding ecosystems, the effects and mitigation of climate change, coordinating governance and management efforts across multiple jurisdictions, and examining relations between conservation policy and the social and economic well-being of Aboriginal peoples. The questions we identified provide potential links between evidence from the conservation sciences and formulation of policies for conservation and resource management. Our collaborative process of communication and engagement between scientists and decision makers for generating and prioritizing research questions at a national level could be a model for similar efforts beyond Canada. Generación de Preguntas de Investigación Prioritarias para Informar a las Políticas y Gestión de la Conservación a Nivel Nacional PMID:21175828

Adapting to a changing world: Implications for water management.

NASA Astrophysics Data System (ADS)

Loucks, Daniel

2010-05-01

Everyone is aware that the world is changing, and that many of these changes will impact our water resource supplies and how they are used and managed. It's always a challenge to try to predict the future, especially the very uncertain distant future. But one thing is certain, the future environment our descendants will experience will differ from the economic, social, technological and natural conditions we experience today. Some aspects of the changes that are happening may not be under human control, but many are. And to the extent they are, we can influence that future. In this paper I attempt to speculate about a future some 40 to 50 years from now, and how water will need to be managed then. My goal is to motivate some thinking and discussion about how we as water managers can influence and prepare ourselves (or our successors) for that future. It will require collaboration among multiple disciplines to determine how best we as a profession can help society adapt to these changes, and this in turn will require all of us to learn how to work together more effectively than we do now. This theme fits in with the current interest in sustainability, for no matter how it is defined, sustainability makes us think about the long-term future. How do we develop and manage our natural and cultural resources in ways that benefit both us and future generations of people living on this earth? What will their needs and goals be? We don't know and that is the major challenge in deciding what decisions we might make today on their behalf. Here I attempt to identify the challenges and issues water managers could be addressing some 40 to 50 years from now, and what we in each of our disciplines, and together, can begin to do now to address them.

Initiating the 2002 Mars Science Laboratory (MSL) Focused Technology Program

NASA Technical Reports Server (NTRS)

Caffrey, Robert T.; Udomkesmalee, Gabriel; Hayati, Samad A.

2004-01-01

The Mars Science Laboratory (MSL) Project is an aggressive mission launching in 2009 to deliver a new generation of rover safely to the surface of Mars and conduct comprehensive in situ investigations using a new generation of instruments. This system will be designed to land with precision and be capable of operating over a large percentage on the surface of Mars. It will have capabilities that will support NASA's scientific goals into the next decade of exphation. The MSL Technology program is developing a wide-range of technologies needed for this Mission and potentially other space missions. The MSL Technology Program reports to both the MSL Project and the Mars Technology Program (MTP). The dual reporting process creates a challenging management situation, but ensures the new technology meets both the specific MSL requirements and the broader Mars Program requirements. MTP is a NASA-wide technology development program managed by the Jet Propulsion Laboratory (JPL) and is divided into a Focused Program and a Base Program. The Focused Technology Program addresses technologies that are specific and critical to near-term missions, while the Base Technology Program addresses those technologies that are applicable to multiple missions and which can be characterized as longer term, higher risk, and high payoff technologies. The MSL Technology Program is under the Focused Program and is tightly coupled to MSL's mission milestones and deliverables. The technology budget is separate from the flight Project budget, but the technology s requirements and the development process are tightly coordinated with the Project. The Technology Program combines proven management techniques of flight projects with commercial and academic technology management strategies, to create a technology management program that meets the near-term requirements of MSL and the long-term requirements of MTP. This paper examines the initiation of 2002 MSL Technology program. Some of the areas discussed in this paper include technology definition, task selection, technology management, and technology assessment.

Name-Based Address Mapping for Virtual Private Networks

NASA Astrophysics Data System (ADS)

Surányi, Péter; Shinjo, Yasushi; Kato, Kazuhiko

IPv4 private addresses are commonly used in local area networks (LANs). With the increasing popularity of virtual private networks (VPNs), it has become common that a user connects to multiple LANs at the same time. However, private address ranges for LANs frequently overlap. In such cases, existing systems do not allow the user to access the resources on all LANs at the same time. In this paper, we propose name-based address mapping for VPNs, a novel method that allows connecting to hosts through multiple VPNs at the same time, even when the address ranges of the VPNs overlap. In name-based address mapping, rather than using the IP addresses used on the LANs (the real addresses), we assign a unique virtual address to each remote host based on its domain name. The local host uses the virtual addresses to communicate with remote hosts. We have implemented name-based address mapping for layer 3 OpenVPN connections on Linux and measured its performance. The communication overhead of our system is less than 1.5% for throughput and less than 0.2ms for each name resolution.

An Adaptive Management Approach for Summer Water Level Reductions on the Upper Mississippi River System

USGS Publications Warehouse

Johnson, B.L.; Barko, J.W.; Clevenstine, R.; Davis, M.; Galat, D.L.; Lubinski, S.J.; Nestler, J.M.

2010-01-01

The primary purpose of this report is to provide an adaptive management approach for learning more about summer water level reductions (drawdowns) as a management tool, including where and how drawdowns can be applied most effectively within the Upper Mississippi River System. The report reviews previous drawdowns conducted within the system and provides specific recommendations for learning more about the lesser known effects of drawdowns and how the outcomes can be influenced by different implementation strategies and local conditions. The knowledge gained can be used by managers to determine how best to implement drawdowns in different parts of the UMRS to help achieve management goals. The information and recommendations contained in the report are derived from results of previous drawdown projects, insights from regional disciplinary experts, and the experience of the authors in experimental design, modeling, and monitoring. Modeling is a critical part of adaptive management and can involve conceptual models, simulation models, and empirical models. In this report we present conceptual models that express current understanding regarding functioning of the UMRS as related to drawdowns and highlight interactions among key ecological components of the system. The models were developed within the constraints of drawdown timing, magnitude (depth), and spatial differences in effects (longitudinal and lateral) with attention to ecological processes affected by drawdowns. With input from regional experts we focused on the responses of vegetation, fish, mussels, other invertebrates, and birds. The conceptual models reflect current understanding about relations and interactions among system components, the expected strength of those interactions, potential responses of system components to drawdowns, likelihood of the response occurring, and key uncertainties that limit our ability to make accurate predictions of effects (Table 1, Fig. 4-10). Based on this current understanding, the main questions still associated with drawdowns include (1) the effects of frequency of drawdowns (from once every few years to multiple years in succession); (2) timing of the beginning of drawdowns (follow the descending arm of the flood pulse versus always beginning in early summer); (3) long-term benefits (greater than 5-6 years), especially as compared to known short-term loses (e.g., mortality of mussels in exposed areas, loss of submersed vegetation in exposed areas, cost of advanced dredging); and (4) the effects in northern (above pool 14) versus southern pools (pool 14 and below, and the Illinois River). An adaptive management design should address these questions to reduce uncertainty in predictions of drawdown effects and help determine if different implementation strategies are needed in different parts of the system. Given that drawdowns will continue to be used as a management tool on the UMRS, we suggest that some drawdowns be conducted in an adaptive management context that helps meet management objectives, but also provides efficient learning about the questions listed above. We propose two different, but interrelated, experimental designs to address these questions. Both designs call for conducting multiple drawdowns in multiple pools (2-4 pools) to allow direct comparison of results and produce rapid learning. However, the report does not provide a detailed scope of work for carrying out the designs. If managers choose to implement one of the experimental designs, specifics of choosing appropriate pools and developing a monitoring plan will need to be determined through collaboration among managers, researchers, and statisticians. We suggest characteristics to consider in selecting treatment and reference pools (study sites) and also provide guidance for developing a monitoring plan. Some aspects of these two designs could be implemented individually, but by implementing individual elements, direct comparisons of some design features

Total Quality Management Implementation Plan.

DTIC Science & Technology

1989-06-01

Quality Management Implementation Plan 6. AUTHOR(S) 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION Defense General...E 14. SUBJECT TERMS 15. NUMBER OF PAGES TOM (Total Quality Management ), Continuous Process Improvement,_________ Depot Operations, Supply Support 16

Introducing the CERT (Trademark) Resiliency Engineering Framework: Improving the Security and Sustainability Processes

DTIC Science & Technology

2007-05-01

business processes and services. 4. Security operations management addresses the day-to-day activities that the organization performs to protect the...Management TM – Technology Management Security Operations Management SOM – Security Operations Management 5.7.2 Important Operations Competency...deals with the provision of access rights to informa- tion and technical assets SOM – Security Operations Management , which addresses the fundamental

Management of Human Immunodeficiency Virus Infection in Advanced Age

PubMed Central

Greene, Meredith; Justice, Amy C.; Lampiris, Harry W.; Valcour, Victor

2013-01-01

Importance Human immunodeficiency virus (HIV)-positive patients treated with antiretroviral therapy now have increased life expectancy and develop chronic illnesses that are often seen in older HIV-negative patients. Objective To address emerging issues related to aging with HIV. Screening older adults for HIV, diagnosis of concomitant diseases, management of multiple comorbid medical illnesses, social isolation, polypharmacy, and factors associated with end-of-life care are reviewed. Evidence Acquisition Published guidelines and consensus statements were reviewed. PubMed and PsycINFO were searched between January 2000 and February 2013. Articles not appearing in the search that were referenced by reviewed articles were also evaluated. Findings The population of older HIV-positive patients is rapidly expanding. It is estimated that by 2015 one-half of the individuals in the United States with HIV will be older than age 50. Older HIV-infected patients are prone to having similar chronic diseases as their HIV-negative counterparts, as well as illnesses associated with co-infections. Medical treatments associated with these conditions, when added to an antiretroviral regimen, increase risk for polypharmacy. Care of aging HIV-infected patients involves a need to balance a number of concurrent comorbid medical conditions. Conclusions and Relevance HIV is no longer a fatal disease. Management of multiple comorbid diseases is a common feature associated with longer life expectancy in HIV-positive patients. There is a need to better understand how to optimize the care of these patients. PMID:23549585

The Dust Management Project: Final Report

NASA Technical Reports Server (NTRS)

Hyatt, Mark J.; Straka, Sharon

2011-01-01

A return to the Moon to extend human presence, pursue scientific activities, use the Moon to prepare for future human missions to Mars, and expand Earth s economic sphere, will require investment in developing new technologies and capabilities to achieve affordable and sustainable human exploration. From the operational experience gained and lessons learned during the Apollo missions, conducting longterm operations in the lunar environment will be a particular challenge, given the difficulties presented by the unique physical properties and other characteristics of lunar regolith, including dust. The Apollo missions and other lunar explorations have identified significant lunar dust-related problems that will challenge future mission success. Comprised of regolith particles ranging in size from tens of nanometers to microns, lunar dust is a manifestation of the complex interaction of the lunar soil with multiple mechanical, electrical, and gravitational effects. The environmental and anthropogenic factors effecting the perturbation, transport, and deposition of lunar dust must be studied in order to mitigate it s potentially harmful effects on exploration systems and human explorers. The Dust Management Project (DMP) is tasked with the evaluation of lunar dust effects, assessment of the resulting risks, and development of mitigation and management strategies and technologies related to Exploration Systems architectures. To this end, the DMP supports the overall goal of the Exploration Technology Development Program (ETDP) of addressing the relevant high priority technology needs of multiple elements within the Constellation Program (CxP) and sister ETDP projects. Project scope, approach, accomplishments, summary of deliverables, and lessons learned are presented.

LHCb Conditions database operation assistance systems

NASA Astrophysics Data System (ADS)

Clemencic, M.; Shapoval, I.; Cattaneo, M.; Degaudenzi, H.; Santinelli, R.

2012-12-01

The Conditions Database (CondDB) of the LHCb experiment provides versioned, time dependent geometry and conditions data for all LHCb data processing applications (simulation, high level trigger (HLT), reconstruction, analysis) in a heterogeneous computing environment ranging from user laptops to the HLT farm and the Grid. These different use cases impose front-end support for multiple database technologies (Oracle and SQLite are used). Sophisticated distribution tools are required to ensure timely and robust delivery of updates to all environments. The content of the database has to be managed to ensure that updates are internally consistent and externally compatible with multiple versions of the physics application software. In this paper we describe three systems that we have developed to address these issues. The first system is a CondDB state tracking extension to the Oracle 3D Streams replication technology, to trap cases when the CondDB replication was corrupted. Second, an automated distribution system for the SQLite-based CondDB, providing also smart backup and checkout mechanisms for the CondDB managers and LHCb users respectively. And, finally, a system to verify and monitor the internal (CondDB self-consistency) and external (LHCb physics software vs. CondDB) compatibility. The former two systems are used in production in the LHCb experiment and have achieved the desired goal of higher flexibility and robustness for the management and operation of the CondDB. The latter one has been fully designed and is passing currently to the implementation stage.

Use of sediment quality guidelines and related tools for the asssessment of contaminated sediments: Executive summary sooklet of a SETAC Pellston Workshop

USGS Publications Warehouse

Wenning, R. J.; Ingersoll, Christopher G.

2002-01-01

This publication summarizes the results of a Pellston Workshop sponsored by the Society of Environmental Toxicology and Chemistry (SETAC), held 17-22 August 2002 in Fairmont, Montana, USA. The full technical proceedings of the workshop will be published separately by SET AC in 2003. Previous SETAC workshops have focused on sediment ecological risk assessment (ERA) (Dickson et al. 1987; Ingersoll et al. 1997) and porewater toxicity testing (Carr and Nipper 2003). Another recent workshop addressed the application of weight-of-evidence (WOE) methods in ERA (Burton et al. 2002). These previous workshops focused on how, when, and why ERAs are needed in sediment assessments. However, more focused discussion among scientists, environmental regulators, and environmental managers is now needed to build on this previous work. Specifically, additional guidance is needed on procedures that can be used to integrate the information derived from multiple chemical and biological lines of evidence (LOE). These LOE, which are developed through the application of different assessment tools, often include the use of chemically based sediment quality guidelines (SQGs) to evaluate sediment contamination and to help practitioners in sediment assessment and management formulate risk management decisions. This workshop focused on evaluation of the scientific foundations supporting different chemically based numeric SQGs and methods to improve the integration of SQGs into different sediment quality assessment frameworks that include information derived from multiple chemical and biological LOE.

Exploring the need for interventions to manage weight and stress during interconception.

PubMed

Huberty, Jennifer; Leiferman, Jenn A; Kruper, Abbey R; Jacobson, Lisette T; Waring, Molly E; Matthews, Jeni L; Wischenka, Danielle M; Braxter, Betty; Kornfield, Sara L

2017-02-01

Interventions to manage weight and stress during the interconception period (i.e., time immediately following childbirth to subsequent pregnancy) are needed to promote optimal maternal and infant health outcomes. To address this gap, we summarize the current state of knowledge, critically evaluate the research focused on weight and stress management during the interconception period, and provide future recommendations for research in this area. Evidence supports the importance of weight and stress management during the reproductive years and the impact of weight on maternal and child health outcomes. However, evidence-based treatment models that address postpartum weight loss and manage maternal stress during the interconception period are lacking. This problem is further compounded by inconsistent definitions and measurements of stress. Recommendations for future research include interventions that address weight and stress tailored for women in the interconception period, interventions that address healthcare providers' understanding of the significance of weight and stress management during interconception, and long-term follow-up studies that focus on the public health implications of weight and stress management during interconception. Addressing obesity and stress during the interconception period via a reproductive lens will be a starting point for women and their families to live long and healthy lives.

How is shrimp aquaculture transforming coastal livelihoods and lagoons in Estero Real, Nicaragua? The need to integrate social-ecological research and ecosystem-based approaches.

PubMed

Benessaiah, Karina; Sengupta, Raja

2014-08-01

Ecosystem-based approaches to aquaculture integrate environmental concerns into planning. Social-ecological systems research can improve this approach by explicitly relating ecological and social dynamics of change at multiple scales. Doing so requires not only addressing direct effects of aquaculture but also considering indirect factors such as changes in livelihood strategies, governance dynamics, and power relations. We selected the community of Puerto Morazán, Nicaragua as a case study to demonstrate how the introduction of small-scale aquaculture radically transformed another key livelihood activity, lagoon shrimp fishing, and the effects that these changes have had on lagoons and the people that depend on them. We find that shrimp aquaculture played a key role in the collapse, in the 1990s, of an existing lagoon common-property management. Shrimp aquaculture-related capital enabled the adoption of a new fishing technique that not only degraded lagoons but also led to their gradual privatization. The existence of social ties between small-scale shrimp farmers and other community members mitigated the impacts of privatization, illustrating the importance of social capital. Since 2008, community members are seeking to communally manage the lagoons once again, in response to degraded environmental conditions and a consolidation of the shrimp industry at the expense of smaller actors. This research shows that shrimp aquaculture intersects with a complex set of drivers, affecting not only how ecosystems are managed but also how they are perceived and valued. Understanding these social-ecological dynamics is essential to implement realistic policies and management of mangrove ecosystems and address the needs of resource-dependent people.

Incorporating Social System Dynamics into the Food-Energy-Water System Resilience-Sustainability Modeling Process

NASA Astrophysics Data System (ADS)

Givens, J.; Padowski, J.; Malek, K.; Guzman, C.; Boll, J.; Adam, J. C.; Witinok-Huber, R.

2017-12-01

In the face of climate change and multi-scalar governance objectives, achieving resilience of food-energy-water (FEW) systems requires interdisciplinary approaches. Through coordinated modeling and management efforts, we study "Innovations in the Food-Energy-Water Nexus (INFEWS)" through a case-study in the Columbia River Basin. Previous research on FEW system management and resilience includes some attention to social dynamics (e.g., economic, governance); however, more research is needed to better address social science perspectives. Decisions ultimately taken in this river basin would occur among stakeholders encompassing various institutional power structures including multiple U.S. states, tribal lands, and sovereign nations. The social science lens draws attention to the incompatibility between the engineering definition of resilience (i.e., return to equilibrium or a singular stable state) and the ecological and social system realities, more explicit in the ecological interpretation of resilience (i.e., the ability of a system to move into a different, possibly more resilient state). Social science perspectives include but are not limited to differing views on resilience as normative, system persistence versus transformation, and system boundary issues. To expand understanding of resilience and objectives for complex and dynamic systems, concepts related to inequality, heterogeneity, power, agency, trust, values, culture, history, conflict, and system feedbacks must be more tightly integrated into FEW research. We identify gaps in knowledge and data, and the value and complexity of incorporating social components and processes into systems models. We posit that socio-biophysical system resilience modeling would address important complex, dynamic social relationships, including non-linear dynamics of social interactions, to offer an improved understanding of sustainable management in FEW systems. Conceptual modeling that is presented in our study, represents a starting point for a continued research agenda that incorporates social dynamics into FEW system resilience and management.

Evaluation of clinical pharmacy services in a hematology/oncology outpatient setting.

PubMed

Shah, Sachin; Dowell, Jonathan; Greene, Shane

2006-09-01

The Veterans Affairs North Texas Health Care System in Dallas, TX, provides a unique opportunity for clinical pharmacists to work as providers. Even though clinical pharmacists are actively involved in patient care, many of their efforts remain undocumented, resulting in an underestimation of the importance of their services and missed opportunities for improvements and new directions. To document and evaluate the services of a hematology/oncology clinical pharmacy in the outpatient setting. Pendragon Forms 3.2 software was used to design the documentation template. The template was designed to collect diagnoses, supportive care issues, drug-specific interventions, and prescriptions written. This template was uploaded to the personal digital assistant (PDA) for documentation. Patient-specific information was documented in a password-protected PDA. Data collected from November 1, 2002, to October 31, 2003, were retrospectively analyzed. Clinical pharmacists were involved in 423 patient visits for chemotherapy follow-up or disease management. Cancer diagnoses included colorectal (n = 99), multiple myeloma (59), non-small cell lung (56), chronic lymphocytic leukemia (44), myelodysplastic syndromes (22), and chronic myelogenous leukemia (19). During the 423 patient visits, 342 supportive care issues were addressed including anemia (34%), pain management (22%), constipation/diarrhea (15%), and nausea/vomiting (8%). Major drug-specific interventions included drug addition (41%), discontinuation (23%), and adjustment (21%). Four hundred forty-five prescriptions were filled, of which 181 were new and 150 were refilled. This is the first study, as of July 25, 2006, to document considerable contribution of an outpatient clinical pharmacist in direct cancer patient care. Although the disease management and supportive care issues addressed here may differ based on institution and patient population, the results of our study show that clinical pharmacists have ever-growing roles in the management of these patients.

Climate Change Resilience Planning at the Department of Energy's Savannah River Site

NASA Astrophysics Data System (ADS)

Werth, D. W.; Johnson, A.

2015-12-01

The Savannah River National Laboratory (SRNL) is developing a site sustainability plan for the Department of Energy's Savannah River Site (SRS) in South Carolina in accordance with Executive Order 13693, which charges each DOE agency with "identifying and addressing projected impacts of climate change" and "calculating the potential cost and risk to mission associated with agency operations". The plan will comprise i) projections of climate change, ii) surveys of site managers to estimate the effects of climate change on site operations, and iii) a determination of adaptive actions. Climate change projections for SRS are obtained from multiple sources, including an online repository of downscaled global climate model (GCM) simulations of future climate and downscaled GCM simulations produced at SRNL. Taken together, we have projected data for temperature, precipitation, humidity, and wind - all variables with a strong influence on site operations. SRNL is working to engage site facility managers and facilitate a "bottom up" approach to climate change resilience planning, where the needs and priorities of stakeholders are addressed throughout the process. We make use of the Vulnerability Assessment Scoring Tool, an Excel-based program designed to accept as input various climate scenarios ('exposure'), the susceptibility of assets to climate change ('sensitivity'), and the ability of these assets to cope with climate change ('adaptive capacity'). These are combined to produce a series of scores that highlight vulnerabilities. Working with site managers, we have selected the most important assets, estimated their expected response to climate change, and prepared a report highlighting the most endangered facilities. Primary risks include increased energy consumption, decreased water availability, increased forest fire danger, natural resource degradation, and compromised outdoor worker safety in a warmer and more humid climate. Results of this study will aid in driving future management decisions and promoting sustainable practices at SRS.

Note: Toward multiple addressable optical trapping

PubMed Central

Faustov, Alexei R.; Webb, Michael R.; Walt, David R.

2010-01-01

We describe a setup for addressable optical trapping in which a laser source is focused on a digital micromirror device and generates an optical trap in a microfluidic cell. In this paper, we report a proof-of-principle single beam∕single micromirror∕single three-dimensional trap arrangement that should serve as the basis for a multiple-trap instrument. PMID:20192526

A Scoping Review to Address the Culture of Concussion in Youth and High School Sports.

PubMed

Sarmiento, Kelly; Donnell, Zoe; Hoffman, Rosanne

2017-10-01

In 2013, the National Academy of Sciences emphasized the need to develop, implement, and evaluate effective large-scale educational strategies to improve the culture of concussion in youth and high school sports. In support of this recommendation, in this article we summarize research on factors that contribute to the culture of concussion. We conducted the literature search using 7 electronic databases. We used a scoping review method to identify studies that addressed knowledge, attitudes, behaviors, use of educational resources, and interventions related to concussion among young athletes, coaches, and parents. Of the 33 articles identified, most focused on concussion education (N = 15), followed by knowledge (N = 13), behaviors (N = 13), and attitudes (N = 5). Three studies addressed multiple study populations. The rapid spread of concussion education and awareness efforts has outpaced research on effective strategies to improve knowledge, attitudes, and behaviors that contribute to the culture of concussion. Further research is critical to inform the development and implementation of large-scale educational efforts. This research should incorporate rigorous study designs; be inclusive of diverse ages, socioeconomic status, and racial/ethnic groups; and examine opportunities to improve behavioral outcomes around concussion prevention, reporting, and management. © 2017, American School Health Association.

Enabling information management systems in tactical network environments

NASA Astrophysics Data System (ADS)

Carvalho, Marco; Uszok, Andrzej; Suri, Niranjan; Bradshaw, Jeffrey M.; Ceccio, Philip J.; Hanna, James P.; Sinclair, Asher

2009-05-01

Net-Centric Information Management (IM) and sharing in tactical environments promises to revolutionize forward command and control capabilities by providing ubiquitous shared situational awareness to the warfighter. This vision can be realized by leveraging the tactical and Mobile Ad hoc Networks (MANET) which provide the underlying communications infrastructure, but, significant technical challenges remain. Enabling information management in these highly dynamic environments will require multiple support services and protocols which are affected by, and highly dependent on, the underlying capabilities and dynamics of the tactical network infrastructure. In this paper we investigate, discuss, and evaluate the effects of realistic tactical and mobile communications network environments on mission-critical information management systems. We motivate our discussion by introducing the Advanced Information Management System (AIMS) which is targeted for deployment in tactical sensor systems. We present some operational requirements for AIMS and highlight how critical IM support services such as discovery, transport, federation, and Quality of Service (QoS) management are necessary to meet these requirements. Our goal is to provide a qualitative analysis of the impact of underlying assumptions of availability and performance of some of the critical services supporting tactical information management. We will also propose and describe a number of technologies and capabilities that have been developed to address these challenges, providing alternative approaches for transport, service discovery, and federation services for tactical networks.

The Perceived Medical Condition Self-Management Scale can be applied to patients with chronic kidney disease.

PubMed

Wild, Marcus G; Wallston, Kenneth A; Green, Jamie A; Beach, Lauren B; Umeukeje, Ebele; Wright Nunes, Julie A; Ikizler, T Alp; Steed, Julia; Cavanaugh, Kerri L

2017-10-01

Chronic Kidney Disease (CKD) is a major burden on patients and the health care system. Treatment of CKD requires dedicated involvement from both caretakers and patients. Self-efficacy, also known as perceived competence, contributes to successful maintenance of patient's CKD self-management behaviors such as medication adherence and dietary regulations. Despite a clear association between self-efficacy and improved CKD outcomes, there remains a lack of validated self-report measures of CKD self-efficacy. To address this gap, the Perceived Kidney/Dialysis Self-Management Scale (PKDSMS) was adapted from the previously validated Perceived Medical Condition Self-Management Scale. We then sought to validate this using data from two separate cohorts: a cross-sectional investigation of 146 patients with end-stage renal disease receiving maintenance hemodialysis and a longitudinal study of 237 patients with CKD not receiving dialysis. The PKDSMS was found to be positively and significantly correlated with self-management behaviors and medication adherence in both patient cohorts. The PKDSMS had acceptable reliability, was internally consistent, and exhibited predictive validity between baseline PKDSMS scores and self-management behaviors across multiple time points. Thus, the PKDSMS is a valid and reliable measure of CKD patient self-efficacy and supports the development of interventions enhancing perceived competence to improve CKD self-management. Copyright © 2017 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Managing Nitrogen in Croplands: Implications for Increasing Ecosystem Services in Agricultural Landscapes

NASA Astrophysics Data System (ADS)

Jackson, L.

2011-12-01

Many agricultural landscapes in the temperate zone are dominated by agroecosystems that are managed with high inputs of agrochemicals, including synthetic nitrogen (N) fertilizers. The process of agricultural intensification increases crop production per unit area, but also often results in loss of environmental quality (such as N contamination of waters, eutrophication, atmospheric N deposition, and emissions of nitrous oxide (N2O), a potent greenhouse gas). Loss of biodiversity and its 'functional homogenization' is another concern. Not only does little land in these landscapes remain in natural ecosystems, but there are negative off-site impacts of intensive agriculture on non-target organisms. Segregating agroecosystems with high-input agricultural production from natural ecosystems (land sparing) is one view to support both food security and biodiversity conservation. But proponents of land sparing rarely address the loss of other ecosystem services, such as those related to environmental quality, health, and human well-being (e.g., livelihoods and cultural values). An emerging view is that increased reliance on ecological processes in agroecosystems ('ecological intensification') is more feasible when the landscape mosaic includes planned and unplanned biodiversity. This requires research on how to support multiple ecosystem services through the integration of agricultural production and biodiversity conservation in the same landscape, and how ecological and physico-chemical processes at various spatial scales are interlinked. It is an enormous challenge to increase reliance on ecological processes for N availability for crop productivity. There are skeptics who think that this will be detrimental for food security, despite benefits for other types of ecosystem services. Using examples from agricultural landscapes in California, mechanisms for ecologically-based N cycling will be discussed, such as: 1) increasing the reservoir of soil organic N and the dynamic turnover and supply of N via soil microbial N transformations and root symbioses; 2) developing farming systems that rely on crop rotations and functional groups that increase N supply and retention; 3) minimizing N losses through better understanding of agroecosystem biogeochemistry; and 4) overcoming the problems associated with open N cycles in agroecosystems with landscape features such buffer strips, managed riparian corridors, and patchy land use types. The capacity to compensate for high non-renewable inputs in specific farming situations will be addressed, along with factors that increase the capacity for different types of farmers to adopt N management practices that enhance the provision of multiple types of ecosystem services.

Integrating Multiple Social Statuses in Health Disparities Research: The Case of Lung Cancer

PubMed Central

Williams, David R; Kontos, Emily Z; Viswanath, K; Haas, Jennifer S; Lathan, Christopher S; MacConaill, Laura E; Chen, Jarvis; Ayanian, John Z

2012-01-01

Objective To illustrate the complex patterns that emerge when race/ethnicity, socioeconomic status (SES), and gender are considered simultaneously in health care disparities research and to outline the needed research to understand them by using disparities in lung cancer risks, treatment, and outcomes as an example. Principal Findings SES, gender, and race/ethnicity are social categories that are robust predictors of variations in health and health services utilization. These are usually considered separately, but intersectionality theory indicates that the impact of each depends on the others. Each reflects historically and culturally contingent variations in social, economic, and political status. Distinct patterns of risk and resilience emerge at the intersections of multiple social categories and shape the experience of health, health care access, utilization, quality, and outcomes where these categories intersect. Intersectional approaches call for greater attention to understand social processes at multiple levels of society and require the collection of relevant data and utilization of appropriate analytic approaches to understand how multiple risk factors and resources combine to affect the distribution of disease and its management. Conclusions Understanding how race/ethnicity, gender, and SES are interactive, interdependent, and social identities can provide new knowledge to enhance our efforts to effectively address health disparities. PMID:22568674

Applying a cloud computing approach to storage architectures for spacecraft

NASA Astrophysics Data System (ADS)

Baldor, Sue A.; Quiroz, Carlos; Wood, Paul

As sensor technologies, processor speeds, and memory densities increase, spacecraft command, control, processing, and data storage systems have grown in complexity to take advantage of these improvements and expand the possible missions of spacecraft. Spacecraft systems engineers are increasingly looking for novel ways to address this growth in complexity and mitigate associated risks. Looking to conventional computing, many solutions have been executed to solve both the problem of complexity and heterogeneity in systems. In particular, the cloud-based paradigm provides a solution for distributing applications and storage capabilities across multiple platforms. In this paper, we propose utilizing a cloud-like architecture to provide a scalable mechanism for providing mass storage in spacecraft networks that can be reused on multiple spacecraft systems. By presenting a consistent interface to applications and devices that request data to be stored, complex systems designed by multiple organizations may be more readily integrated. Behind the abstraction, the cloud storage capability would manage wear-leveling, power consumption, and other attributes related to the physical memory devices, critical components in any mass storage solution for spacecraft. Our approach employs SpaceWire networks and SpaceWire-capable devices, although the concept could easily be extended to non-heterogeneous networks consisting of multiple spacecraft and potentially the ground segment.

Using exercises to identify Veterans Health Administration priorities for disaster response: findings from the New Madrid Earthquake training exercise.

PubMed

Gin, June L; Chan, Edward W; Brewster, Pete; Mitchell, Michael N; Ricci, Karen A; Afable, Melissa K; Dobalian, Aram

2013-01-01

Emergency managers are often charged with prioritizing the relative importance of key issues and tasks associated with disaster response. However, little work has been done to identify specific ways that the decision-making process can be improved. This exercise was conducted with 220 employees of the US Department of Veterans Affairs, who were asked to assign priority rankings to a list of possible options of the most important issues to address after a hypothetical disaster scenario impacting a Veterans Affairs Medical Center. We found that groups that were assigned to represent perspectives farther from the impacted site had less agreement in their identification of the top priorities than those assigned to the impacted facility. These findings suggest that greater geographic and administrative proximity to the impacted site may generate greater clarity and certainty about priority setting. Given the complex structure of many organizations, and the multiple levels of group decision making and coordination likely to be needed during disasters, research to better understand training needs with respect to decision making is essential to improve preparedness. Relatively simple modifications to exercises, as outlined here, could provide valuable information to better understand emergency management decision making across multiple organizational levels.

Monitoring Wildlife Interactions with Their Environment: An Interdisciplinary Approach

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

Charles-Smith, Lauren E.; Domnguez, Ignacio X.; Fornaro, Robert J.

In a rapidly changing world, wildlife ecologists strive to correctly model and predict complex relationships between animals and their environment, which facilitates management decisions impacting public policy to conserve and protect delicate ecosystems. Recent advances in monitoring systems span scientific domains, including animal and weather monitoring devices and landscape classification mapping techniques. The current challenge is how to combine and use detailed output from various sources to address questions spanning multiple disciplines. WolfScout wildlife and weather tracking system is a software tool capable of filling this niche. WolfScout automates integration of the latest technological advances in wildlife GPS collars, weathermore » stations, drought conditions, and severe weather reports, and animal demographic information. The WolfScout database stores a variety of classified landscape maps including natural and manmade features. Additionally, WolfScout’s spatial database management system allows users to calculate distances between animals’ location and landscape characteristics, which are linked to the best approximation of environmental conditions at the animal’s location during the interaction. Through a secure website, data are exported in formats compatible with multiple software programs including R and ArcGIS. The WolfScout design promotes interoperability in data, between researchers, and software applications while standardizing analyses of animal interactions with their environment.« less

Are care plans suitable for the management of multiple conditions?

PubMed Central

Young, Charlotte E.; Boyle, Frances M.; Mutch, Allyson J.

2016-01-01

Background Care plans have been part of the primary care landscape in Australia for almost two decades. With an increasing number of patients presenting with multiple chronic conditions, it is timely to consider whether care plans meet the needs of patients and clinicians. Objectives To review and benchmark existing care plan templates that include recommendations for comorbid conditions, against four key criteria: (i) patient preferences, (ii) setting priorities, (iii) identifying conflicts and synergies between conditions, and (iv) setting dates for reviewing the care plan. Design Document analysis of Australian care plan templates published from 2006 to 2014 that incorporated recommendations for managing comorbid conditions in primary care. Results Sixteen templates were reviewed. All of the care plan templates addressed patient preference, but this was not done comprehensively. Only three templates included setting priorities. None assisted in identifying conflicts and synergies between conditions. Fifteen templates included setting a date for reviewing the care plan. Conclusions Care plans are a well-used tool in primary care practice, but their current format perpetuates a single-disease approach to care, which works contrary to their intended purpose. Restructuring care plans to incorporate shared decision-making and attention to patient preferences may assist in shifting the focus back to the patient and their care needs. PMID:29090181

Designing a new cropping system for high productivity and sustainable water usage under climate change

PubMed Central

Meng, Qingfeng; Wang, Hongfei; Yan, Peng; Pan, Junxiao; Lu, Dianjun; Cui, Zhenling; Zhang, Fusuo; Chen, Xinping

2017-01-01

The food supply is being increasingly challenged by climate change and water scarcity. However, incremental changes in traditional cropping systems have achieved only limited success in meeting these multiple challenges. In this study, we applied a systematic approach, using model simulation and data from two groups of field studies conducted in the North China Plain, to develop a new cropping system that improves yield and uses water in a sustainable manner. Due to significant warming, we identified a double-maize (M-M; Zea mays L.) cropping system that replaced the traditional winter wheat (Triticum aestivum L.) –summer maize system. The M-M system improved yield by 14–31% compared with the conventionally managed wheat-maize system, and achieved similar yield compared with the incrementally adapted wheat-maize system with the optimized cultivars, planting dates, planting density and water management. More importantly, water usage was lower in the M-M system than in the wheat-maize system, and the rate of water usage was sustainable (net groundwater usage was ≤150 mm yr−1). Our study indicated that systematic assessment of adaptation and cropping system scale have great potential to address the multiple food supply challenges under changing climatic conditions. PMID:28155860

Knowledge-driven institutional change: an empirical study on combating desertification in northern China from 1949 to 2004.

PubMed

Yang, Lihua; Wu, Jianguo

2012-11-15

Understanding institutional changes is crucial for environmental management. Here we investigated how institutional changes influenced the process and result of desertification control in northern China between 1949 and 2004. Our analysis was based on a case study of 21 field sites and a meta-analysis of additional 29 sites reported in the literature. Our results show that imposed knowledge-driven institutional change was often perceived as a more progressive, scientific, and rational type of institutional change by entrepreneurs, scholars, experts, and technicians, while voluntary, knowledge-driven institutional change based on indigenous knowledge and experiences of local populations was discouraged. Our findings also demonstrate that eight working rules of imposed knowledge-driven institutional change can be applied to control desertification effectively. These rules address the issues of perception of potential gains, entrepreneurs' appeals and support, coordination of multiple goals, collaboration among multiple organizations, interest distribution and conflict resolution, incremental institutional change, external intervention, and coordination among the myriad institutions involved. Imposed knowledge-driven institutional change tended to be more successful when these rules were thoroughly implemented. These findings provide an outline for implementing future institutional changes and policy making to combat desertification and other types of ecological and environmental management. Copyright © 2012 Elsevier Ltd. All rights reserved.

Science advancements key to increasing management value of life stage monitoring networks for endangered Sacramento River winter-run Chinook salmon in California

USGS Publications Warehouse

Johnson, Rachel C.; Windell, Sean; Brandes, Patricia L.; Conrad, J. Louise; Ferguson, John; Goertler, Pascale A. L.; Harvey, Brett N.; Heublein, Joseph; Isreal, Joshua A.; Kratville, Daniel W.; Kirsch, Joseph E.; Perry, Russell W.; Pisciotto, Joseph; Poytress, William R.; Reece, Kevin; Swart, Brycen G.

2017-01-01

A robust monitoring network that provides quantitative information about the status of imperiled species at key life stages and geographic locations over time is fundamental for sustainable management of fisheries resources. For anadromous species, management actions in one geographic domain can substantially affect abundance of subsequent life stages that span broad geographic regions. Quantitative metrics (e.g., abundance, movement, survival, life history diversity, and condition) at multiple life stages are needed to inform how management actions (e.g., hatcheries, harvest, hydrology, and habitat restoration) influence salmon population dynamics. The existing monitoring network for endangered Sacramento River winterrun Chinook Salmon (SRWRC, Oncorhynchus tshawytscha) in California’s Central Valley was compared to conceptual models developed for each life stage and geographic region of the life cycle to identify relevant SRWRC metrics. We concluded that the current monitoring network was insufficient to diagnose when (life stage) and where (geographic domain) chronic or episodic reductions in SRWRC cohorts occur, precluding within- and among-year comparisons. The strongest quantitative data exist in the Upper Sacramento River, where abundance estimates are generated for adult spawners and emigrating juveniles. However, once SRWRC leave the upper river, our knowledge of their identity, abundance, and condition diminishes, despite the juvenile monitoring enterprise. We identified six system-wide recommended actions to strengthen the value of data generated from the existing monitoring network to assess resource management actions: (1) incorporate genetic run identification; (2) develop juvenile abundance estimates; (3) collect data for life history diversity metrics at multiple life stages; (4) expand and enhance real-time fish survival and movement monitoring; (5) collect fish condition data; and (6) provide timely public access to monitoring data in open data formats. To illustrate how updated technologies can enhance the existing monitoring to provide quantitative data on SRWRC, we provide examples of how each recommendation can address specific management issues.

Training in Good Psychiatric Management for Borderline Personality Disorder in Residency: An Aide to Learning Supportive Psychotherapy for Challenging-to-Treat Patients.

PubMed

Bernanke, Joel; McCommon, Benjamin

2018-01-01

Given many competing demands, psychotherapy training to competency is difficult during psychiatric residency. Good Psychiatric Management for borderline personality disorder (GPM) offers an evidence-based, simplified, psychodynamically informed framework for the outpatient management of patients with borderline personality disorder, one of the most challenging disorders psychiatric residents must learn to treat. In this article, we provide an overview of GPM, and show that training in GPM meets a requirement for training in supportive psychotherapy; builds on psychodynamic psychotherapy training; and applies to other severe personality disorders, especially narcissistic personality disorder. We describe the interpersonal hypersensitivity model used in GPM as a straightforward way for clinicians to collaborate with patients in organizing approaches to psychoeducation, treatment goals, case management, use of multiple treatment modalities, and safety. A modification of the interpersonal hypersensitivity model that includes intra-personal hypersensitivity can be used to address narcissistic problems often present in borderline personality disorder. We argue that these features make GPM ideally suited for psychiatry residents in treating their most challenging patients, provide clinical examples to illustrate these points, and report the key lessons learned by a psychiatry resident after a year of GPM supervision.

Managing complex, high-output, enterocutaneous fistulas: a case study.

PubMed

Hahler, Barbara; Schassberger, Debra; Novakovic, Rachel; Lang, Stephanie

2009-10-15

Gastrointestinal (GI) fistulas are an uncommon but serious complication. Following diagnosis, management strategies may have to be adapted frequently to address changes in fistula output, surrounding skin or wound condition, overall patient clinical and nutritional status, mobility level, and body contours. Following a motor vehicle accident, a 49-year-old man with a body mass index of 36.8 and a history of multiple previous surgeries, including gastric bypass, experienced excessive output from a fistula within a large open abdominal wound measuring 45 cm x 40 cm x 5 cm. Abdominal creases and the need to protect a split-thickness skin graft of the wound surrounding his fistula complicated wound management. During his prolonged 4-month hospital stay, the patient underwent several surgical procedures, repeated wound debridement, and various nutritional support interventions; a wide variety of wound and fistula management systems were utilized. One year after the initial trauma, the fistula was surgically closed. One week later, the patient died from a cardiac event. This case study confirms that GI fistulas increase costs of care and hospital length of stay and require the experience and expertise of a wide array of patient support staff members and clinicians.

Cardio-Facio-Cutaneous Syndrome: Clinical Features, Diagnosis, and Management Guidelines

PubMed Central

Magoulas, Pilar L.; Adi, Saleh; Kavamura, Maria Ines; Neri, Giovanni; Noonan, Jacqueline; Pierpont, Elizabeth I.; Reinker, Kent; Roberts, Amy E.; Shankar, Suma; Sullivan, Joseph; Wolford, Melinda; Conger, Brenda; Santa Cruz, Molly; Rauen, Katherine A.

2014-01-01

Cardio-facio-cutaneous syndrome (CFC) is one of the RASopathies that bears many clinical features in common with the other syndromes in this group, most notably Noonan syndrome and Costello syndrome. CFC is genetically heterogeneous and caused by gene mutations in the Ras/mitogen-activated protein kinase pathway. The major features of CFC include characteristic craniofacial dysmorphology, congenital heart disease, dermatologic abnormalities, growth retardation, and intellectual disability. It is essential that this condition be differentiated from other RASopathies, as a correct diagnosis is important for appropriate medical management and determining recurrence risk. Children and adults with CFC require multidisciplinary care from specialists, and the need for comprehensive management has been apparent to families and health care professionals caring for affected individuals. To address this need, CFC International, a nonprofit family support organization that provides a forum for information, support, and facilitation of research in basic medical and social issues affecting individuals with CFC, organized a consensus conference. Experts in multiple medical specialties provided clinical management guidelines for pediatricians and other care providers. These guidelines will assist in an accurate diagnosis of individuals with CFC, provide best practice recommendations, and facilitate long-term medical care. PMID:25180280

What can complexity do for diabetes management? Linking theory to practice.

PubMed

Cooper, Helen C; Geyer, Robert

2009-08-01

Diabetes presents a multifaceted picture with its rapidly rising prevalence associated with changing demographics and increasing levels of obesity in the developed world. Deaths from diabetes are predicted to rise by 25% over the next 10 years. The enormity of this public health challenge has been recognized the world over, but little attention has been paid to the theoretical frameworks underpinning practical management. This paper aims to introduce complexity theory and discuss its practical application to diabetes, focusing on a single 'tool' to provide an example of how theory can be linked to practice. Critics have questioned the all inclusive nature of complexity seeing it as an intangible concept that fails to offer anything new to health care. However, few have appraised its practical application to a chronic disease that is currently managed using an outdated, linear, reduce and resolve model which fails to address the multiple interacting systems inherent within this condition. This article proposes that complexity theory provides an interprofessional perspective for describing and understanding the processes involved, and provides working 'tools' for patients, carers and practitioners that capture the reality of managing this chronic disease in modern life.

Preprocessing Structured Clinical Data for Predictive Modeling and Decision Support

PubMed Central

Oliveira, Mónica Duarte; Janela, Filipe; Martins, Henrique M. G.

2016-01-01

Summary Background EHR systems have high potential to improve healthcare delivery and management. Although structured EHR data generates information in machine-readable formats, their use for decision support still poses technical challenges for researchers due to the need to preprocess and convert data into a matrix format. During our research, we observed that clinical informatics literature does not provide guidance for researchers on how to build this matrix while avoiding potential pitfalls. Objectives This article aims to provide researchers a roadmap of the main technical challenges of preprocessing structured EHR data and possible strategies to overcome them. Methods Along standard data processing stages – extracting database entries, defining features, processing data, assessing feature values and integrating data elements, within an EDPAI framework –, we identified the main challenges faced by researchers and reflect on how to address those challenges based on lessons learned from our research experience and on best practices from related literature. We highlight the main potential sources of error, present strategies to approach those challenges and discuss implications of these strategies. Results Following the EDPAI framework, researchers face five key challenges: (1) gathering and integrating data, (2) identifying and handling different feature types, (3) combining features to handle redundancy and granularity, (4) addressing data missingness, and (5) handling multiple feature values. Strategies to address these challenges include: cross-checking identifiers for robust data retrieval and integration; applying clinical knowledge in identifying feature types, in addressing redundancy and granularity, and in accommodating multiple feature values; and investigating missing patterns adequately. Conclusions This article contributes to literature by providing a roadmap to inform structured EHR data preprocessing. It may advise researchers on potential pitfalls and implications of methodological decisions in handling structured data, so as to avoid biases and help realize the benefits of the secondary use of EHR data. PMID:27924347

Methodology Development for Passive Component Reliability Modeling in a Multi-Physics Simulation Environment

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

Aldemir, Tunc; Denning, Richard; Catalyurek, Umit

Reduction in safety margin can be expected as passive structures and components undergo degradation with time. Limitations in the traditional probabilistic risk assessment (PRA) methodology constrain its value as an effective tool to address the impact of aging effects on risk and for quantifying the impact of aging management strategies in maintaining safety margins. A methodology has been developed to address multiple aging mechanisms involving large numbers of components (with possibly statistically dependent failures) within the PRA framework in a computationally feasible manner when the sequencing of events is conditioned on the physical conditions predicted in a simulation environment, suchmore » as the New Generation System Code (NGSC) concept. Both epistemic and aleatory uncertainties can be accounted for within the same phenomenological framework and maintenance can be accounted for in a coherent fashion. The framework accommodates the prospective impacts of various intervention strategies such as testing, maintenance, and refurbishment. The methodology is illustrated with several examples.« less

Pollution exposure on marine protected areas: A global assessment.

PubMed

Partelow, Stefan; von Wehrden, Henrik; Horn, Olga

2015-11-15

Marine protected areas (MPAs) face many challenges in their aim to effectively conserve marine ecosystems. In this study we analyze the extent of pollution exposure on the global fleet of MPAs. This includes indicators for current and future pollution and the implications for regionally clustered groups of MPAs with similar biophysical characteristics. To cluster MPAs into characteristic signature groups, their bathymetry, baseline biodiversity, distance from shore, mean sea surface temperature and mean sea surface salinity were used. We assess the extent at which each signature group is facing exposure from multiple pollution types. MPA groups experience similar pollution exposure on a regional level. We highlight how the challenges that MPAs face can be addressed through governance at the appropriate scale and design considerations for integrated terrestrial and marine management approaches within regional level networks. Furthermore, we present diagnostic social-ecological indicators for addressing the challenges facing unsuccessful MPAs with practical applications. Copyright © 2015 Elsevier Ltd. All rights reserved.

Constraining Upper Troposphere/Lower Stratosphere Aerosol Physical Processes with High-Altitude Aircraft Measurements

NASA Technical Reports Server (NTRS)

Jensen, Eric; Rosenlof, Karen H.; Thornberry, Troy

2018-01-01

Interest in a more complete understanding of the sources, composition and microphysics of stratospheric aerosol particles has intensified during recent years for several reasons: (1) small volcanic eruptions have been recognized as a driver of short-term changes in climate forcing; (2) emissions of sulfur dioxide (SO2) and other aerosol precursors have shifted to south Asia and other low latitude regions with intense vertical transport; (3) organic material has been recognized as a key contributor to lower stratospheric aerosol mass; and (4) interest in possible solar radiation management (geoengineering) through significant enhancements in stratospheric aerosols has intensified. To address stratospheric aerosol science issues, we are proposing a NASA Earth Ventures mission to NASA to provide extensive high-altitude aircraft measurements of critical gas-phase and aerosol properties at multiple locations across the planet. In this presentation, we will discuss the objectives of the proposed campaign, the measurements provided, the sampling strategy, and the modeling and analysis approaches that would be used to address specific science questions.

Pain assessment and management in end of life care: a survey of assessment and treatment practices of hospice music therapy and nursing professionals.

PubMed

Groen, Kara Mills

2007-01-01

The primary focus of this paper is to describe current trends in pain assessment in end of life care with a secondary focus on music therapy techniques commonly used to address pain for hospice patients. These trends were determined through a survey of 72 board certified music therapists and 92 hospice and palliative nurses. Survey results indicate that most music therapists in the hospice setting incorporate formal pain assessment into their practice; both nursing professionals and music therapists surveyed utilize multiple assessment tools to assess patient pain. Although there are currently a variety of pain assessment tools used, this study indicates that nursing professionals most frequently use the Numerical Rating Scale (NRS) and FACES scales, and identified them as appropriate for use by nonnursing members of the interdisciplinary hospice team. This paper also describes music therapy techniques most often utilized by music therapists with hospice patients to address acute and chronic pain symptoms.

Water Management Decisions within a Changing Hydrologic Environment

NASA Astrophysics Data System (ADS)

Wegner, D. L.

2013-12-01

Across the United States and around the world we are facing unprecedented demands on our surface and ground water. Increasing population demands coupled with maintaining water quality, supporting species and ecosystem services, distribution of supply, hydrologic variability associated with changing climatic conditions - all require us to look more rigorously at the intersection of policy, management and science. The water supply and hydroelectric constituencies has embraced the concept of Adaptive Management in balancing the needs of resources, people, economies and providing ecosystem support. In its infancy Adaptive Management was employed as a way to move forward on dam operation and reservoir management decisions while recognizing the unknowns of how up or downstream physical and biological elements of freshwater systems would respond. River science at the time was not mature or expansive enough to address the interrelated and complex impacts of the nuances of changing operations of dams. Adaptive Management, the concept, made good sense and has provided a framework to inform management and policy decisions while keeping the door open for integrating new knowledge into a management matrix - the essence of adaptation. The application of Adaptive Management principles has continued to expand as water management demands increase. The application and reality of the use of Adaptive Management has had variable success. In the United States we have over 25 federal agencies that have water in their mission statements. Combine this with 50 states with their own water management requirements, Native American Tribes, and countless watershed and local water supply constraints and you get a sense of the challenge associated with collaborating and addressing water management issues. Without having a set of national water objectives and goals (a National Water Policy) it is up to the collaboration and integration of the multiple water silos with appropriate science. It is within this context that river restoration and management case studies will be explored to evaluate opportunities, challenges, the process of integrating science-policy-management, and some perspectives on the possible options for building a water future. A water future that embraces the essence of Adaptive Management without using the concept as a convenient mechanism for avoiding having to make difficult decisions on water management. The review will include assessing the application of various tools including hydrologic and ecosystem models, experimental floods, channel-cleansing flows, manipulation of habitats, and seasonal allocation of water to provide flooding of estuary habitats and river mouths for water volume and water quality purposes.

Managing Human Resources. Greater OPM Leadership Needed To Address Critical Challenges. Report to the Congress.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. General Government Div.

The General Accounting Office examined the Office of Personnel Management's (OPM's) leadership role in addressing critical human resource problems and preparing the government to meet future challenges. Federal managers, OPM employees, and federal personnel officials were surveyed to study federal government problems in hiring, managing, and…

Reconfigurable optical interconnections via dynamic computer-generated holograms

NASA Technical Reports Server (NTRS)

Liu, Hua-Kuang (Inventor); Zhou, Shaomin (Inventor)

1994-01-01

A system is proposed for optically providing one-to-many irregular interconnections, and strength-adjustable many-to-many irregular interconnections which may be provided with strengths (weights) w(sub ij) using multiple laser beams which address multiple holograms and means for combining the beams modified by the holograms to form multiple interconnections, such as a cross-bar switching network. The optical means for interconnection is based on entering a series of complex computer-generated holograms on an electrically addressed spatial light modulator for real-time reconfigurations, thus providing flexibility for interconnection networks for largescale practical use. By employing multiple sources and holograms, the number of interconnection patterns achieved is increased greatly.

Adaptive management for a turbulent future

USGS Publications Warehouse

Allen, Craig R.; Fontaine, J.J.; Pope, K.L.; Garmestani, A.S.

2011-01-01

The challenges that face humanity today differ from the past because as the scale of human influence has increased, our biggest challenges have become global in nature, and formerly local problems that could be addressed by shifting populations or switching resources, now aggregate (i.e., "scale up") limiting potential management options. Adaptive management is an approach to natural resource management that emphasizes learning through management based on the philosophy that knowledge is incomplete and much of what we think we know is actually wrong. Adaptive management has explicit structure, including careful elucidation of goals, identification of alternative management objectives and hypotheses of causation, and procedures for the collection of data followed by evaluation and reiteration. It is evident that adaptive management has matured, but it has also reached a crossroads. Practitioners and scientists have developed adaptive management and structured decision making techniques, and mathematicians have developed methods to reduce the uncertainties encountered in resource management, yet there continues to be misapplication of the method and misunderstanding of its purpose. Ironically, the confusion over the term "adaptive management" may stem from the flexibility inherent in the approach, which has resulted in multiple interpretations of "adaptive management" that fall along a continuum of complexity and a priori design. Adaptive management is not a panacea for the navigation of 'wicked problems' as it does not produce easy answers, and is only appropriate in a subset of natural resource management problems where both uncertainty and controllability are high. Nonetheless, the conceptual underpinnings of adaptive management are simple; there will always be inherent uncertainty and unpredictability in the dynamics and behavior of complex social-ecological systems, but management decisions must still be made, and whenever possible, we should incorporate learning into management. ?? 2010 .

Adaptive Management for a Turbulent Future

USGS Publications Warehouse

Allen, Craig R.; Fontaine, Joseph J.; Pope, Kevin L.; Garmestani, Ahjond S.

2011-01-01

The challenges that face humanity today differ from the past because as the scale of human influence has increased, our biggest challenges have become global in nature, and formerly local problems that could be addressed by shifting populations or switching resources, now aggregate (i.e., "scale up") limiting potential management options. Adaptive management is an approach to natural resource management that emphasizes learning through management based on the philosophy that knowledge is incomplete and much of what we think we know is actually wrong. Adaptive management has explicit structure, including careful elucidation of goals, identification of alternative management objectives and hypotheses of causation, and procedures for the collection of data followed by evaluation and reiteration. It is evident that adaptive management has matured, but it has also reached a crossroads. Practitioners and scientists have developed adaptive management and structured decision making techniques, and mathematicians have developed methods to reduce the uncertainties encountered in resource management, yet there continues to be misapplication of the method and misunderstanding of its purpose. Ironically, the confusion over the term "adaptive management" may stem from the flexibility inherent in the approach, which has resulted in multiple interpretations of "adaptive management" that fall along a continuum of complexity and a priori design. Adaptive management is not a panacea for the navigation of 'wicked problems' as it does not produce easy answers, and is only appropriate in a subset of natural resource management problems where both uncertainty and controllability are high. Nonetheless, the conceptual underpinnings of adaptive management are simple; there will always be inherent uncertainty and unpredictability in the dynamics and behavior of complex social-ecological systems, but management decisions must still be made, and whenever possible, we should incorporate learning into management. Published by Elsevier Ltd.

Integrating science into management of ecosystems in the Greater Blue Mountains.

PubMed

Chapple, Rosalie S; Ramp, Daniel; Bradstock, Ross A; Kingsford, Richard T; Merson, John A; Auld, Tony D; Fleming, Peter J S; Mulley, Robert C

2011-10-01

Effective management of large protected conservation areas is challenged by political, institutional and environmental complexity and inconsistency. Knowledge generation and its uptake into management are crucial to address these challenges. We reflect on practice at the interface between science and management of the Greater Blue Mountains World Heritage Area (GBMWHA), which covers approximately 1 million hectares west of Sydney, Australia. Multiple government agencies and other stakeholders are involved in its management, and decision-making is confounded by numerous plans of management and competing values and goals, reflecting the different objectives and responsibilities of stakeholders. To highlight the complexities of the decision-making process for this large area, we draw on the outcomes of a recent collaborative research project and focus on fire regimes and wild-dog control as examples of how existing knowledge is integrated into management. The collaborative research project achieved the objectives of collating and synthesizing biological data for the region; however, transfer of the project's outcomes to management has proved problematic. Reasons attributed to this include lack of clearly defined management objectives to guide research directions and uptake, and scientific information not being made more understandable and accessible. A key role of a local bridging organisation (e.g., the Blue Mountains World Heritage Institute) in linking science and management is ensuring that research results with management significance can be effectively transmitted to agencies and that outcomes are explained for nonspecialists as well as more widely distributed. We conclude that improved links between science, policy, and management within an adaptive learning-by-doing framework for the GBMWHA would assist the usefulness and uptake of future research.

Integrating Science into Management of Ecosystems in the Greater Blue Mountains

NASA Astrophysics Data System (ADS)

Chapple, Rosalie S.; Ramp, Daniel; Bradstock, Ross A.; Kingsford, Richard T.; Merson, John A.; Auld, Tony D.; Fleming, Peter J. S.; Mulley, Robert C.

2011-10-01

Effective management of large protected conservation areas is challenged by political, institutional and environmental complexity and inconsistency. Knowledge generation and its uptake into management are crucial to address these challenges. We reflect on practice at the interface between science and management of the Greater Blue Mountains World Heritage Area (GBMWHA), which covers approximately 1 million hectares west of Sydney, Australia. Multiple government agencies and other stakeholders are involved in its management, and decision-making is confounded by numerous plans of management and competing values and goals, reflecting the different objectives and responsibilities of stakeholders. To highlight the complexities of the decision-making process for this large area, we draw on the outcomes of a recent collaborative research project and focus on fire regimes and wild-dog control as examples of how existing knowledge is integrated into management. The collaborative research project achieved the objectives of collating and synthesizing biological data for the region; however, transfer of the project's outcomes to management has proved problematic. Reasons attributed to this include lack of clearly defined management objectives to guide research directions and uptake, and scientific information not being made more understandable and accessible. A key role of a local bridging organisation (e.g., the Blue Mountains World Heritage Institute) in linking science and management is ensuring that research results with management significance can be effectively transmitted to agencies and that outcomes are explained for nonspecialists as well as more widely distributed. We conclude that improved links between science, policy, and management within an adaptive learning-by-doing framework for the GBMWHA would assist the usefulness and uptake of future research.

Nutrition-based interventions to address metabolic syndrome in the Navajo: a systematic review.

PubMed

Nava, Lorenzo T; Zambrano, Jenelle M; Arviso, Karen P; Brochetti, Denise; Becker, Kathleen L

2015-11-01

The objective of this systematic review is to identify nutrition-based interventions that may be effective for the prevention and treatment of metabolic syndrome in the Navajo. Metabolic syndrome, a major risk factor for cardiovascular disease, affects almost half of the Navajo population. The diet of the Navajo, heavy in fat and refined carbohydrates, has been identified as an important contributing factor to the high rates of metabolic syndrome in this population. A search was conducted on PubMed, EMBASE and CINAHL to identify studies published before October, 2013, involving nutrition-based interventions in adult populations similar to the Navajo targeting at least one measure of metabolic syndrome. Data on efficacy and participation were gathered and synthesised qualitatively. Out of 19 studies included in this systematic review, 11 interventions were identified to be effective at improving at least one measure of metabolic syndrome. Level of exposure to the intervention, frequency of intervention activities, family and social support, cultural adaptation and case management were identified as factors that may improve the efficacy of an intervention. Multiple nutrition-based interventions have been found to be effective in populations similar to the Navajo. Development of a strategy to address metabolic syndrome in the Navajo may involve aspects from multiple interventions to increase efficacy and maximise participation. © 2015 John Wiley & Sons Ltd.

Assessment of system reliability for a stochastic-flow distribution network with the spoilage property

NASA Astrophysics Data System (ADS)

Lin, Yi-Kuei; Huang, Cheng-Fu; Yeh, Cheng-Ta

2016-04-01

In supply chain management, satisfying customer demand is the most concerned for the manager. However, the goods may rot or be spoilt during delivery owing to natural disasters, inclement weather, traffic accidents, collisions, and so on, such that the intact goods may not meet market demand. This paper concentrates on a stochastic-flow distribution network (SFDN), in which a node denotes a supplier, a transfer station, or a market, while a route denotes a carrier providing the delivery service for a pair of nodes. The available capacity of the carrier is stochastic because the capacity may be partially reserved by other customers. The addressed problem is to evaluate the system reliability, the probability that the SFDN can satisfy the market demand with the spoilage rate under the budget constraint from multiple suppliers to the customer. An algorithm is developed in terms of minimal paths to evaluate the system reliability along with a numerical example to illustrate the solution procedure. A practical case of fruit distribution is presented accordingly to emphasise the management implication of the system reliability.

Voltage control on a train system

DOEpatents

Gordon, Susanna P.; Evans, John A.

2004-01-20

The present invention provides methods for preventing low train voltages and managing interference, thereby improving the efficiency, reliability, and passenger comfort associated with commuter trains. An algorithm implementing neural network technology is used to predict low voltages before they occur. Once voltages are predicted, then multiple trains can be controlled to prevent low voltage events. Further, algorithms for managing inference are presented in the present invention. Different types of interference problems are addressed in the present invention such as "Interference During Acceleration", "Interference Near Station Stops", and "Interference During Delay Recovery." Managing such interference avoids unnecessary brake/acceleration cycles during acceleration, immediately before station stops, and after substantial delays. Algorithms are demonstrated to avoid oscillatory brake/acceleration cycles due to interference and to smooth the trajectories of closely following trains. This is achieved by maintaining sufficient following distances to avoid unnecessary braking/accelerating. These methods generate smooth train trajectories, making for a more comfortable ride, and improve train motor reliability by avoiding unnecessary mode-changes between propulsion and braking. These algorithms can also have a favorable impact on traction power system requirements and energy consumption.

Efficient high density train operations

DOEpatents

Gordon, Susanna P.; Evans, John A.

2001-01-01

The present invention provides methods for preventing low train voltages and managing interference, thereby improving the efficiency, reliability, and passenger comfort associated with commuter trains. An algorithm implementing neural network technology is used to predict low voltages before they occur. Once voltages are predicted, then multiple trains can be controlled to prevent low voltage events. Further, algorithms for managing inference are presented in the present invention. Different types of interference problems are addressed in the present invention such as "Interference. During Acceleration", "Interference Near Station Stops", and "Interference During Delay Recovery." Managing such interference avoids unnecessary brake/acceleration cycles during acceleration, immediately before station stops, and after substantial delays. Algorithms are demonstrated to avoid oscillatory brake/acceleration cycles due to interference and to smooth the trajectories of closely following trains. This is achieved by maintaining sufficient following distances to avoid unnecessary braking/accelerating. These methods generate smooth train trajectories, making for a more comfortable ride, and improve train motor reliability by avoiding unnecessary mode-changes between propulsion and braking. These algorithms can also have a favorable impact on traction power system requirements and energy consumption.

Urban Stormwater Governance: The Need for a Paradigm Shift.

PubMed

Dhakal, Krishna P; Chevalier, Lizette R

2016-05-01

Traditional urban stormwater management involves rapid removal of stormwater through centralized conveyance systems of curb-gutter-pipe networks. This results in many adverse impacts on the environment including hydrological disruption, groundwater depletion, downstream flooding, receiving water quality degradation, channel erosion, and stream ecosystem damage. In order to mitigate these adverse impacts, urban stormwater managers are increasingly using green infrastructure that promote on-site infiltration, restore hydrological functions of the landscape, and reduce surface runoff. Existing stormwater governance, however, is centralized and structured to support the conventional systems. This governance approach is not suited to the emerging distributed management approach, which involves multiple stakeholders including parcel owners, government agencies, and non-governmental organizations. This incongruence between technology and governance calls for a paradigm shift in the governance from centralized and technocratic to distributed and participatory governance. This paper evaluates how five US cities have been adjusting their governance to address the discord. Finally, the paper proposes an alternative governance model, which provides a mechanism to involve stakeholders and implement distributed green infrastructure under an integrative framework.

Screensaver: an open source lab information management system (LIMS) for high throughput screening facilities

PubMed Central

2010-01-01

Background Shared-usage high throughput screening (HTS) facilities are becoming more common in academe as large-scale small molecule and genome-scale RNAi screening strategies are adopted for basic research purposes. These shared facilities require a unique informatics infrastructure that must not only provide access to and analysis of screening data, but must also manage the administrative and technical challenges associated with conducting numerous, interleaved screening efforts run by multiple independent research groups. Results We have developed Screensaver, a free, open source, web-based lab information management system (LIMS), to address the informatics needs of our small molecule and RNAi screening facility. Screensaver supports the storage and comparison of screening data sets, as well as the management of information about screens, screeners, libraries, and laboratory work requests. To our knowledge, Screensaver is one of the first applications to support the storage and analysis of data from both genome-scale RNAi screening projects and small molecule screening projects. Conclusions The informatics and administrative needs of an HTS facility may be best managed by a single, integrated, web-accessible application such as Screensaver. Screensaver has proven useful in meeting the requirements of the ICCB-Longwood/NSRB Screening Facility at Harvard Medical School, and has provided similar benefits to other HTS facilities. PMID:20482787

Focusing management in implementing a smoking ban in a university hospital in Sweden.

PubMed

Ullén, H; Höijer, Y; Ainetdin, T; Tillgren, P

2002-04-01

To explore the impact of various steps when introducing a smoking ban at the Karolinska Hospital (1000 beds; 6000 employees) in Stockholm, Sweden, a multiple evaluation strategy was performed over 5 years. All heads of clinical departments (N = 41) and a random sample of employees (n = 517) and a convenience sample of hospital labour managers (n = 17) were separately addressed through questionnaire surveys at different time intervals after the introduction of the ban in 1992. An observational and interview study completed the follow-up. The implementation process was supplemented by a comprehensive information strategy over 5 years. The two most important steps during implementation were management support and focus on environmental tobacco. The ban was well known at introduction. Heads of clinical departments reported a third of staff to be satisfied with the restrictions. In contrast, the staff survey revealed 62% to be positive. A shift in favour of a radical tobacco-free hospital was perceived during follow-up. Co-operation between hospital board, heads of clinical departments and local labour managers proved successful. The consecutive evaluations served as tools in labour management and contributed to staff compliance. A total ban, including the selling of tobacco and smoking in the hospital grounds is still to be achieved.

The well-being of laboratory non-human primates.

PubMed

Baker, Kate C; Dettmer, Amanda M

2017-01-01

The well-being of non-human primates in captivity is of joint concern to scientists, veterinarians, colony managers, caretakers, and researchers working with non-human primates in biomedical research. With increased regulatory, accreditation, and research focus on optimizing the use of social housing for laboratory primates, as well as the advent of techniques to assess indices of chronic stress and related measures of well-being, there is no better time to present the most current advances in the field of non-human primate behavioral management. The collective body of research presented here was inspired in part by a 2014 symposium entitled, "Chronic Hormones and Demographic Variables: Center-Wide Studies on Non-Human Primate Well-Being" held at the American Society of Primatologists' 37th Annual Meeting in Decatur, GA. By aiming to target readership with scientific and/or management oversight of captive primate behavioral management programs, this special issue provides badly-needed guidance for implementing social housing programs in a research environment and leverages collaboration across multiple facilities to address key components of behavioral management, explore refinements in how well-being can be measured, and identify the interrelationships between varying indices. Am. J. Primatol. 79:e22520, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

The addition of E (Empowerment and Economics) to the ABCD algorithm in diabetes care.

PubMed

Khazrai, Yeganeh Manon; Buzzetti, Raffaella; Del Prato, Stefano; Cahn, Avivit; Raz, Itamar; Pozzilli, Paolo

2015-01-01

The ABCD (Age, Body weight, Complications, Duration of disease) algorithm was proposed as a simple and practical tool to manage patients with type 2 diabetes. Diabetes treatment, as for all chronic diseases, relies on patients' ability to cope with daily problems concerning the management of their disease in accordance with medical recommendations. Thus, it is important that patients learn to manage and cope with their disease and gain greater control over actions and decisions affecting their health. Healthcare professionals should aim to encourage and increase patients' perception about their ability to take informed decisions about disease management and to improve patient self-esteem and feeling of self-efficacy to become agents of their own health. E for Empowerment is therefore an additional factor to take into account in the management of patients with type 2 diabetes. E stands also for Economics to be considered in diabetes care. Attention should be paid to public health policies as well as to the physician faced with the dilemma of delivering the best possible care within the problem of limited resources. The financial impact of the new treatment modalities for diabetes represents an issue that needs to be addressed at multiple strata both globally and nationally. Copyright © 2015 Elsevier Inc. All rights reserved.

Synthesis of common management concerns associated with dam removal

USGS Publications Warehouse

Tullos, Desiree D.; Collins, Mathias J.; Bellmore, J. Ryan; Bountry, Jennifer A.; Connolly, Patrick J.; Shafroth, Patrick B.; Wilcox, Andrew C.

2016-01-01

Managers make decisions regarding if and how to remove dams in spite of uncertainty surrounding physical and ecological responses, and stakeholders often raise concerns about certain negative effects, regardless of whether or not these concerns are warranted at a particular site. We used a dam-removal science database supplemented with other information sources to explore seven frequently-raised concerns, herein Common Management Concerns (CMCs). We investigate the occurrence of these concerns and the contributing biophysical controls. The CMCs addressed are: degree and rate of reservoir sediment erosion, excessive channel incision upstream of reservoirs, downstream sediment aggradation, elevated downstream turbidity, drawdown impacts on local water infrastructure, colonization of reservoir sediments by non-native plants, and expansion of invasive fish. Biophysical controls emerged for some of the concerns, providing managers with information to assess whether a given concern is likely to occur at a site. To fully assess CMC risk, managers should concurrently evaluate site conditions and identify the ecosystem or human uses that will be negatively affected if the biophysical phenomenon producing the CMC occurs. We show how many CMCs have one or more controls in common, facilitating the identification of multiple risks at a site, and demonstrate why CMC risks should be considered in the context of other factors like natural watershed variability and disturbance history.

Screensaver: an open source lab information management system (LIMS) for high throughput screening facilities.

PubMed

Tolopko, Andrew N; Sullivan, John P; Erickson, Sean D; Wrobel, David; Chiang, Su L; Rudnicki, Katrina; Rudnicki, Stewart; Nale, Jennifer; Selfors, Laura M; Greenhouse, Dara; Muhlich, Jeremy L; Shamu, Caroline E

2010-05-18

Shared-usage high throughput screening (HTS) facilities are becoming more common in academe as large-scale small molecule and genome-scale RNAi screening strategies are adopted for basic research purposes. These shared facilities require a unique informatics infrastructure that must not only provide access to and analysis of screening data, but must also manage the administrative and technical challenges associated with conducting numerous, interleaved screening efforts run by multiple independent research groups. We have developed Screensaver, a free, open source, web-based lab information management system (LIMS), to address the informatics needs of our small molecule and RNAi screening facility. Screensaver supports the storage and comparison of screening data sets, as well as the management of information about screens, screeners, libraries, and laboratory work requests. To our knowledge, Screensaver is one of the first applications to support the storage and analysis of data from both genome-scale RNAi screening projects and small molecule screening projects. The informatics and administrative needs of an HTS facility may be best managed by a single, integrated, web-accessible application such as Screensaver. Screensaver has proven useful in meeting the requirements of the ICCB-Longwood/NSRB Screening Facility at Harvard Medical School, and has provided similar benefits to other HTS facilities.

Toward sustainable environmental quality: Identifying priority research questions for Latin America

PubMed Central

Furley, Tatiana Heid; Brodeur, Julie; Silva de Assis, Helena C; Carriquiriborde, Pedro; Chagas, Katia R; Corrales, Jone; Denadai, Marina; Fuchs, Julio; Mascarenhas, Renata; Miglioranza, Karina SB; Miguez Caramés, Diana Margarita; Navas, José Maria; Nugegoda, Dayanthi; Planes, Estela; Rodriguez‐Jorquera, Ignacio Alejandro; Orozco‐Medina, Martha; Boxall, Alistair BA; Rudd, Murray A

2018-01-01

ABSTRACT The Global Horizon Scanning Project (GHSP) is an innovative initiative that aims to identify important global environmental quality research needs. Here we report 20 key research questions from Latin America (LA). Members of the Society of Environmental Toxicology and Chemistry (SETAC) LA and other scientists from LA were asked to submit research questions that would represent priority needs to address in the region. One hundred questions were received, then partitioned among categories, examined, and some rearranged during a workshop in Buenos Aires, Argentina. Twenty priority research questions were subsequently identified. These research questions included developing, improving, and harmonizing across LA countries methods for 1) identifying contaminants and degradation products in complex matrices (including biota); 2) advancing prediction of contaminant risks and effects in ecosystems, addressing lab‐to‐field extrapolation challenges, and understanding complexities of multiple stressors (including chemicals and climate change); and 3) improving management and regulatory tools toward achieving sustainable development. Whereas environmental contaminants frequently identified in these key questions were pesticides, pharmaceuticals, endocrine disruptors or modulators, plastics, and nanomaterials, commonly identified environmental challenges were related to agriculture, urban effluents, solid wastes, pulp and paper mills, and natural extraction activities. Several interesting research topics included assessing and preventing pollution impacts on conservation protected areas, integrating environment and health assessments, and developing strategies for identification, substitution, and design of less hazardous chemicals (e.g., green chemistry). Finally, a recurrent research need included developing an understanding of differential sensitivity of regional species and ecosystems to environmental contaminants and other stressors. Addressing these critical questions will support development of long‐term strategic research efforts to advance more sustainable environmental quality and protect public health and the environment in LA. Integr Environ Assess Manag 2018;14:344–357. © 2018 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC) PMID:29469193

Total Quality Management Implementation Plan: Defense Depot, Ogden

DTIC Science & Technology

1989-07-01

NUMBERS Total Quality Management Implementation Plan Defense Depot Ogden 6. AUTHOR(S) 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING...PAGES TQM (Total Quality Management ), Continuous Process Improvement, Depot Operations, Process Action Teams 16. PRICE CODE 17. SECURITY...034 A Message From The Commander On Total Quality Management i fully support the DLA aoproacii to Total Quality Management . As stated by General

Breast Cancer: Exploring the Facts and Holistic Needs during and beyond Treatment

PubMed Central

Ng, Zhi Xuan; Ong, Mei Shan; Jegadeesan, Tamilarasi; Deng, Shuo; Yap, Celestial T.

2017-01-01

Breast cancer patients face challenges throughout the journey of diagnosis, treatment, post-treatment, and recovery. The breast cancer patient is exposed to a multidisciplinary team including doctors, nurses, therapists, counselors, and psychologists. While the team assembled together aims to address multiple facets in breast cancer care, the sub-specialized nature of individual professional practices may constrain the overview of patients’ holistic needs and a comprehensive approach to cancer management. This paper aims to provide an overview of the holistic needs of breast cancer patients at each stage of their cancer journey, addressing their complex physical, psychological, and social needs. As every patient is different, cancer care has to be tailored to each patient based on a holistic needs assessment. This paper also explores how support can be provided from the perspectives of the healthcare providers, family members and caretakers. Examples of general practices at healthcare institutions worldwide as well as supportive care provided by support groups are discussed. The needs of breast cancer patients extend beyond the resolution of cancer as a disease, and the restoration of health as far as possible is a critical component of healing. Understanding the complex issues involved in the journey of breast cancer will aid healthcare providers to be better equipped to sensitively address their concerns and focus on healing the patient holistically. Methodology: This paper provides a literature review of validated practices in different countries and elaborates on the holistic needs of patients at various stages of recovery. This review is based on more than a decade of publications sourced from multiple resources including PubMed journal articles; books and official websites of breast cancer organizations. PMID:28538673

Breast Cancer: Exploring the Facts and Holistic Needs during and beyond Treatment.

PubMed

Ng, Zhi Xuan; Ong, Mei Shan; Jegadeesan, Tamilarasi; Deng, Shuo; Yap, Celestial T

2017-05-24

Breast cancer patients face challenges throughout the journey of diagnosis, treatment, post-treatment, and recovery. The breast cancer patient is exposed to a multidisciplinary team including doctors, nurses, therapists, counselors, and psychologists. While the team assembled together aims to address multiple facets in breast cancer care, the sub-specialized nature of individual professional practices may constrain the overview of patients' holistic needs and a comprehensive approach to cancer management. This paper aims to provide an overview of the holistic needs of breast cancer patients at each stage of their cancer journey, addressing their complex physical, psychological, and social needs. As every patient is different, cancer care has to be tailored to each patient based on a holistic needs assessment. This paper also explores how support can be provided from the perspectives of the healthcare providers, family members and caretakers. Examples of general practices at healthcare institutions worldwide as well as supportive care provided by support groups are discussed. The needs of breast cancer patients extend beyond the resolution of cancer as a disease, and the restoration of health as far as possible is a critical component of healing. Understanding the complex issues involved in the journey of breast cancer will aid healthcare providers to be better equipped to sensitively address their concerns and focus on healing the patient holistically. This paper provides a literature review of validated practices in different countries and elaborates on the holistic needs of patients at various stages of recovery. This review is based on more than a decade of publications sourced from multiple resources including PubMed journal articles; books and official websites of breast cancer organizations.

Addressing Gender-Based Violence at Schools for Learners with Intellectual Disability in Gauteng, South Africa: A Multiple Case Study

ERIC Educational Resources Information Center

Phasha, T. N.; Nyokangi, D.

2012-01-01

This paper reports part of the findings of the study which investigated sexual violence at two schools catering specifically for learners with mild intellectual disability in Gauteng Province. It looks particularly on participants' suggestions for addressing sexual violence in such school. A multiple case study within the qualitative research…

Adaptation of a Counseling Intervention to Address Multiple Cancer Risk Factors among Overweight/Obese Latino Smokers

ERIC Educational Resources Information Center

Castro, Yessenia; Fernández, Maria E.; Strong, Larkin L.; Stewart, Diana W.; Krasny, Sarah; Hernandez Robles, Eden; Heredia, Natalia; Spears, Claire A.; Correa-Fernández, Virmarie; Eakin, Elizabeth; Resnicow, Ken; Basen-Engquist, Karen; Wetter, David W.

2015-01-01

More than 60% of cancer-related deaths in the United States are attributable to tobacco use, poor nutrition, and physical inactivity, and these risk factors tend to cluster together. Thus, strategies for cancer risk reduction would benefit from addressing multiple health risk behaviors. We adapted an evidence-based intervention grounded in social…