Effective Classroom Management

ERIC Educational Resources Information Center

Mansor, Azlin Norhaini; Eng, Wong Kim; Rasul, Mohamad Sattar; Hamzah, Mohd Izham Mohd; Hamid, Aida Hanim A.

2012-01-01

This paper attempts to explore and identify the characteristics of an effective teacher who teaches English as a second language to 10 year old students from different ethnics, various social economic background and multi-level language ability, at a private primary school in Malaysia. The study focused on classroom management using a case study…

Lessons Learned from a Decade of Sudden Oak Death in California: Evaluating Local Management

NASA Astrophysics Data System (ADS)

Alexander, Janice; Lee, Christopher A.

2010-09-01

Sudden Oak Death has been impacting California’s coastal forests for more than a decade. In that time, and in the absence of a centrally organized and coordinated set of mandatory management actions for this disease in California’s wildlands and open spaces, many local communities have initiated their own management programs. We present five case studies to explore how local-level management has attempted to control this disease. From these case studies, we glean three lessons: connections count, scale matters, and building capacity is crucial. These lessons may help management, research, and education planning for future pest and disease outbreaks.

Lessons Learned from a Decade of Sudden Oak Death in California: Evaluating Local Management

PubMed Central

Alexander, Janice

2010-01-01

Sudden Oak Death has been impacting California’s coastal forests for more than a decade. In that time, and in the absence of a centrally organized and coordinated set of mandatory management actions for this disease in California’s wildlands and open spaces, many local communities have initiated their own management programs. We present five case studies to explore how local-level management has attempted to control this disease. From these case studies, we glean three lessons: connections count, scale matters, and building capacity is crucial. These lessons may help management, research, and education planning for future pest and disease outbreaks. PMID:20559634

The Impact of Managerialism on the Strategy Work of University Middle Managers

ERIC Educational Resources Information Center

Davis, Annemarie; Jansen van Rensburg, Mari; Venter, Peet

2016-01-01

In an attempt to understand the effects of managerialism on university managers in a developing country, we set out to gather rich data on the strategy work of middle managers through a single case study at a South African university. Managerialism has the potential to solve inefficiencies in university systems and processes, as it could help to…

Human Resource Management in Australian Registered Training Organisations: Literature Review and Discussion Starter. Support Document

ERIC Educational Resources Information Center

Smith, Andrew

2008-01-01

This project seeks to establish the current state of human resource management practice in RTOs in Australia. The project takes a strategic approach, particularly in the case study phase where the research will attempt to examine the links between human resource management and the strategy of the organisation. The results of the project will…

It Is a Small World after All: Teaching Business Ethics in a Global Environment

ERIC Educational Resources Information Center

Budden, Connie B.; Budden, Michael C.

2011-01-01

Increasingly, managers and employees are facing ethical issues when conducting business in the global marketplace. Business educators attempting to teach appropriate ethical behavior and develop skills for dealing with complex ethical situations need to incorporate realistic case scenarios to challenge students. Such cases should appropriately…

Branding in Higher Education: A Case Study from Turkey

ERIC Educational Resources Information Center

Garipagaoglu, Burçak Çagla

2016-01-01

Drawing upon the brand-building experience of a young and successful Turkish foundation university, this case study attempts to broaden our understanding of branding in Higher Education (HE). Focusing on the diverse brand conceptualizations, brand management principles and brand strategies that are deployed to circumvent barriers to successful…

Management as Ideology: The Case of "New Managerialism" in Higher Education

ERIC Educational Resources Information Center

Deem, Rosemary; Brehony, Kevin J.

2005-01-01

The paper explores ideological conceptions of management, especially "new managerialism", with particular reference to their role in the reform of higher education. It is suggested that attempts to reform public services in general are political as well as technical, though there is no single unitary ideology of "new managerialism". Whilst some…

The Development of Employability Skills in Novice Workers.

ERIC Educational Resources Information Center

Smith, Erica; Comyn, Paul

This research study attempts to determine how teenage workers develop their employability skills in their first formal jobs. Case studies were carried out in 12 Australian enterprises of varying sizes and drawn from different industry areas. In each case study the following staff were interviewed: senior managers and/or human resources management…

Workshop Organization and Management in Adult Education. Case Study of the MOBRAL System.

ERIC Educational Resources Information Center

da Costa, Lamartine Pereira

This case study of the organizational structure of the Brazilian Literacy Movement (MOBRAL) describes the various organizational changes made as the mediating agency attempted to develop a large-scale national program within the existing social structure. Steps in the organization's development are traced from: (1) Beginnings in 1970 under the…

Aeromedical management of U.S. air force aviators who attempt suicide.

PubMed

Patterson, J C; Jones, D R; Marsh, R W; Drummond, F E

2001-12-01

Little has been published about the aeromedical management and disposition of aviators who attempt suicide, and almost no such information about military aviators exists in the open literature. The few available data are scattered and frequently anecdotal. The authors reviewed all case reports of fliers evaluated at the USAF School of Aerospace Medicine's Aeromedical Consultation Service (ACS) between 1981-96 for possible return to flying duties after a suicide attempt, and prepared a representative case report. Between 1981 and 1996, the ACS evaluated 14 trained aviators (pilots and other aircrew members, excluding flight surgeons) who had attempted suicide. Of these, 11 (79%) ultimately received a recommendation for return to flying duties. In most instances the underlying stressors included failed intimate interpersonal relationships, administrative or legal problems, psychiatric disorders, death of spouse, or job conflicts. Evidence of abuse of alcoholor other substances was found in 54% of an earlier, larger data set of attempters. Some data on aircrew suicide completion were available and are reported. The top medical priorities after such attempts should be to diagnose what is wrong, and to treat it. In spite of the common assumption that a suicide attempt inevitably ends a military flying career, some attempters can return to safe and effective flying duty after appropriate psychotherapy. If the flier regains physical and mental health and maintains them for at least 6 mo after treatment, then that flier may be evaluated by an outside aeromedical psychiatric consultant such as the ACS (to avoid transference issues between flier and therapist) for possible return to flying duties. Waiver action should be based on the underlying psychiatric diagnosis, not the suicidal attempt itself. Follow-up may be accomplished through periodic mental health evaluations in conjunction with routine physical examination procedures. Issues involving substance abuse and security clearances must be handled through the appropriate channels.

A Case Study of a "Collaborative Organizational Innovation" Intervention, Combining Action Research and Design-Thinking Methodologies

ERIC Educational Resources Information Center

Wetzler, Jeffrey Richard

2013-01-01

For decades, debates have raged about performance management in education. While it is essential to understand the degree of student learning and the nature of teacher impact in education systems, when attempts at managing outcomes go wrong, the consequences can be problematic. National Education Organization (a pseudonym for the organization…

Moving toward Socially and Environmentally Responsible Management Education--A Case Study of Mumbai

ERIC Educational Resources Information Center

Goyal, Ela; Gupta, Mahendra

2014-01-01

Educational institutions have a vital role to play shaping the future of our environment. Education provides opportunities for students to become environmentally conscious citizens besides being educated. In this study, an attempt has been made to study the perception of management students and teachers in the city of Mumbai, India, to determine…

The case for watchful waiting with Isle Royale's wolf population

USGS Publications Warehouse

Mech, L. David

2013-01-01

In "Should Isle Royale Wolves be Reintroduced? A Case Study on Wilderness Management in a Changing World," Vucetich et al. concluded with the hope that their analysis “motivates broader discussion that deepens understanding of the specifics on Isle Royale and the underlying principles” (2012: 137). This article represents an attempt to continue that discussion.

Managing Resource Dependence Difficulties in African Higher Education: The Case of Multiple Exchange Relationships

ERIC Educational Resources Information Center

Wangenge-Ouma, Gerald

2011-01-01

The paper has a twofold structure and focus. The first part is an examination of the funding challenges facing African universities resulting mainly from public finance difficulties, and the second part is a case study of how some Kenyan and South African public universities have attempted to mitigate resource dependence difficulties through…

[Penetrant injuries of colon--our experience].

PubMed

Lazović, R; Krivokapić, Z; Dobricanin, V

2010-01-01

In attemption to determine the place of primary repair in management of colon injuries, an open, non randomized clinical study was performed. Retrospective (RS) group of 62 patients according to exclusion criteria by Stone (S/F) and Flint (F1) was managed by one or two stage surgical procedure. Prospective (PR) group of 34 patients was managed using one stage repair non-selectively: two stage procedures were performed in 3 cases of advanced peritonitis and multi-segmental lacerations with impaired circulation of colon. In RS group 36 patients were managed by primary repair and in PR group, 31 were managed by primary repair. Both groups were of similar age/sex. Indexes of trauma severity were similar (TS, ISS, PATI). The latent time was shorter in PR group. Associated injuries to other body regions and abdominal organs were similar in both groups. S/F criteria and Flint grading in both (RS vs. PR) groups were similar. Comparison of attempted and successful primary repairs justifies the more liberal use of primary repair in early management of colon injuries.

A Principle-Attribute Matrix for Environmentally Sustainable Management Education and Its Application: The Case for Change-Oriented Service-Learning Projects

ERIC Educational Resources Information Center

Rands, Gordon P.

2009-01-01

The environmental threats humanity faces have led businesses to increasingly commit to improve their environmental performance and to increasing attempts to address environmental issues in management education. This article presents a matrix of (a) principles that can underlie and (b) attributes that can be generated by environmentally focused…

Dynamics of Community Participation, Student Achievement and School Management: The Case of Primary Schools in a Rural Area of Malawi

ERIC Educational Resources Information Center

Taniguchi, Kyoko; Hirakawa, Yukiko

2016-01-01

School management in many sub-Saharan African countries has been enhanced through community participation in an attempt to improve education quality. This study uses field research in a rural district of Malawi to assess how community and parent participation differs between schools, the intentions of communities and parents when carrying out…

Management of complex pediatric laryngotracheal stenosis with skin graft reconstruction.

PubMed

Bowe, Sarah N; Wentland, Carissa J; Sandhu, G S; Hartnick, Christopher J

2018-05-01

For pediatric patients with laryngotracheal stenosis, the ultimate goal is creation of a safe, functional airway. Unfortunately, wound healing in a hollow structure can complicate repair attempts, leading to restenosis. Herein, we present our experience using skin-grafting techniques in two complex pediatric laryngotracheal stenosis cases, leading to successful decannulation or speech production. A chart review was performed examining the evaluation and management of two pediatric patients with laryngotracheal stenosis despite prior reconstructive attempts. Patient history, bronchoscopic evaluation, intra-operative technique, post-operative management, treatment outcomes, and complications were noted. Harvesting and preparation of the split-thickness skin grafts (STSG) proceeded in a similar manner for each case. Stenting material varied based on the clinical scenario. Using this technique, our patient with a Type 3 glottic web achieved substantial improvement in exercise tolerance, as well as vocal strength and quality. In addition, our aphonic patient could vocalize for the first time since her laryngotracheal injury. Temporary endoluminal stenting with skin graft lining can reproduce epithelial continuity and provide "biological inhibition" to enhance the wound healing process. When previous reconstructive efforts have failed, use of STSG can be considered in the management of complex pediatric laryngotracheal stenosis. Copyright © 2018. Published by Elsevier B.V.

A case study on the successful management of Cotard's syndrome in pregnancy: Case Reports.

PubMed

Howe, G; Srinivasan, M

1999-01-01

Cotard's Syndrome is rare and no cases have been reported in pregnancy. We describe a case of a woman in the third trimester who attempted suicide by jumping out of a window, sustaining multiple fractures. Delivery of her baby by Caesarean section and orthopaedic intervention was necessary before electroconvulsive therapy (ECT) could be administered, resulting in a successful outcome for both mother and child. (Int J Psych Clin Pract 1999; 3: 293-295).

[Study protocol of a prevention of recurrent suicidal behaviour program based on case management (PSyMAC)].

PubMed

Sáiz, Pilar A; Rodríguez-Revuelta, Julia; González-Blanco, Leticia; Burón, Patricia; Al-Halabí, Susana; Garrido, Marlen; García-Alvarez, Leticia; García-Portilla, Paz; Bobes, Julio

2014-01-01

Prevention of suicidal behaviour is a public health priority in the European Union. A previous suicide attempt is the best risk predictor for future attempts, as well as completed suicides. The primary aim of this article is to describe a controlled study protocol designed for prevention of recurrent suicidal behaviour that proposes case management, and includes a psychoeducation program, as compared with the standard intervention (PSyMAC). Patients admitted from January 2011 to June 2013 to the emergency room of the Hospital Universitario Central de Asturias were evaluated using a protocol including sociodemographic, psychiatric, and psychosocial assessment. Patients were randomly assigned to either a group receiving continuous case management including participation in a psychoeducation program (experimental group), or a control group receiving standard care. The primary objective is to examine whether or not the period of time until recurrent suicidal behaviour in the experimental group is significantly different from that of the control group. PSyMAC proposes low cost and easily adaptable interventions to the usual clinical setting that can help to compensate the shortcoming of specific action protocols and suicidal behaviour prevention programs in our country. The evaluation of PSyMAC results will determine their real effectivity as a case-magament program to reduce suicidal risk. Copyright © 2013 SEP y SEPB. Published by Elsevier España. All rights reserved.

Is Case Management Effective for Long-Lasting Suicide Prevention?

PubMed

Wang, Liang-Jen; Wu, Ya-Wen; Chen, Chih-Ken

2015-01-01

Case management services have been implemented in suicide prevention programs. To investigate whether case management is an effective strategy for reducing the risks of repeated suicide attempts and completed suicides in a city with high suicide rates in northern Taiwan. The Suicide Prevention Center of Keelung City (KSPC) was established in April 2005. Subjects included a consecutive sample of individuals (N = 2,496) registered in KSPC databases between January 1, 2006, and December 31, 2011, with at least one episode of nonfatal self-harm. Subjects were tracked for the duration of the study. Of all the subjects, 1,013 (40.6%) received case management services; 416 (16.7%) had at least one other deliberate self-harm episode and 52 (2.1%) eventually died by suicide. No significant differences were found in the risks of repeated self-harm and completed suicides between suicide survivors who received case management and those who refused the services. However, a significant reduction in suicide rates was found after KSPC was established. Findings suggest that case management services might not reduce the risks of suicide repetition among suicide survivors during long-term follow-up. Future investigation is warranted to determine factors impacting the downward trend of suicide rates.

Professional relationships and power dynamics between urban community-based nurses and social work case managers: advocacy in action.

PubMed

Young, Staci

2009-01-01

The purpose of this study was to explore how community-based case managers interface with their clients' healthcare providers and other community organizations as a function within their advocacy efforts. Case managers previously defined advocacy as occurring at individual, organizational, and community levels. The relationships they attempt to develop and maintain are consistent with case management ideology, yet this is a complex process to ensure care for vulnerable populations with many medical and socioeconomic needs. Community-based case management settings. In-depth qualitative interviews with a total of 20 nurse and social work case managers working in public housing, university-affiliated community nursing centers, local parishes, and community ministry. The case managers in this study reflected on how they interface with their clients, other healthcare providers, and community organizations on behalf of their clients. They reflect on the importance of trust and communication to facilitate this process. The advocacy work of case managers is influenced by the setting, others' perceptions of their knowledge and expertise, and power dynamics. Their ability to effectively advocate is greatly influenced by the strength of the relationships they forge. Advocacy for vulnerable clients is influenced by the existing relationship between case managers and their clients' healthcare providers. Case managers need to be persistent in their interactions with other providers to ensure that their clients have access to valuable community resources. Clear lines of communication should be established between case managers so that there is clarity around roles and expectations in service provision. Case managers should also participate in the mentoring of future health professions students so they may learn the application of advocacy work in community settings.

Making the case for OWTS management: lessons from case studies and research

NASA Astrophysics Data System (ADS)

Rahm, B.; Woods, F.; Hwang, S.; Walter, M. T.; Grantham, D. G.; Riha, S. J.

2016-12-01

On-site wastewater treatment systems (OWTS) are used in 20-25% of homes in the United States and can be an efficient and cost-effective alternative to conventional centralized systems. However, OWTS also represent a source of non-point nutrient, pathogen, and micro-contaminant pollution to surface and groundwater if they are poorly designed, sited and/or maintained. Despite their ubiquity and potential to negatively impact water resources, the contribution of OWTS to local and regional water contamination issues is poorly understood. There are no federal regulations or uniform standards for the operation, maintenance, and management of these systems. The effectiveness of educational programs and best management practices developed by the US Environmental Protection Agency, along with local and regional governments, remains uncertain. Here we describe attempts to increase our knowledge of the state of OWTS in relation to water resources and their management. Specifically, we summarize 1) efforts to modernize a NY State-wide inventory of residential OWTS using GIS-based tools; 2) research aimed at better understanding the impact of OWTS on surface and ground water in 5 upstate NY counties across a gradient of land uses; 3) lessons learned from 13 case studies of municipal OWTS management programs across the US; and 4) observations on the roles of data, education and policy in creating and evaluating successful municipal OWTS management programs. Initial results show that total numbers of OWTS in NY State continue to grow, particularly in areas associated with ex-urban migration. Research into the relationship between OWTS and nutrient and pathogen contamination in ground and surface waters, respectively, suggests location-specific variation. This has implications for management approaches: preventing failure of any individual OWTS may be just as effective as programs attempting to bring all OWTS up to a high level of performance. Case studies of management programs, which we assess using a set of policy-related criteria, suggest that approaches differ according to local regulations, stakeholder values, and other environmental, economic, and social factors.

Tracheal injury as a sequence of multiple attempts of endotracheal intubation in the course of a preclinical cardiopulmonary resuscitation.

PubMed

Jaeger, K; Ruschulte, H; Osthaus, A; Scheinichen, D; Heine, J

2000-01-01

Management of the difficult airway requires an appropriate approach based on personal clinical experiences. For every physician involved in rescue and emergency medicine, it is important to know the difficult airway algorithm and be familiar with alternative techniques of managing the difficult airway. We report a case of tracheal injury caused by multiple attempts at intubating the trachea. Based on current knowledge, apart from surgical equipment for cricothyroidotomy the laryngeal mask airway (LMA) and the Combitube (ETC) should be available on any ambulance vehicle staffed by an emergency physician. In future, blind intubation through the intubating laryngeal mask airway (ILMA) could offer a new opportunity.

Importance of an intact dura in management of compound elevated fractures; a short series and literature review.

PubMed

Mohindra, Sandeep; Singh, Harnarayan; Savardekar, Amey

2012-01-01

To describe compound elevated fractures (CEFs) of the skull vault, with radiological pictures, management problems and prognosticative factors. The authors describe three cases of CEFs of the cranium, their mode of injury, clinical findings, radiological images and management problems. The authors have reviewed the existing literature regarding epidemiological data, neurological status, dural breech, methods of management and final outcome, in respect of CEFs. The first case had no dural breech, the second case had completely shattered dura, with extruding brain matter from the wound, while the third case had an elevated bone flap in consequence to large extradural haematoma. The patients with intact dura had relatively favourable outcome, when compared to patients with shattered dura. Three cases are added to the existing 10 such cases described in English literature. The major cause of unfavourable outcome remains sepsis and the presence of intact dura places these cases in the relatively safe category, regarding infective complications. The authors attempt at highlighting the importance of intact dura with such an injury. The review of literature supports favourable outcomes in patients having no dural breech.

Aripiprazole augmentation in managing comorbid obsessive-compulsive disorder and bipolar disorder: a case with suicidal attempts.

PubMed

Lai, Jianbo; Lu, Qiaoqiao; Zhang, Peng; Xu, Tingting; Xu, Yi; Hu, Shaohua

2017-01-01

Comorbid obsessive-compulsive disorder (OCD) and bipolar disorder (BD) have long been an intractable problem in clinical practice. The increased risk of manic/hypomanic switch hinders the use of antidepressants for managing coexisting OCD symptoms in BD patients. We herein present a case of a patient with BD-OCD comorbidity, who was successfully treated with mood stabilizers and aripiprazole augmentation. The young female patient reported recurrent depressive episodes and aggravating compulsive behaviors before hospitalization. Of note, the patient repetitively attempted suicide and reported dangerous driving because of intolerable mental sufferings. The preexisting depressive episode and OCD symptoms prompted the use of paroxetine, which consequently triggered the manic switching. Her diagnosis was revised into bipolar I disorder. Minimal response with mood stabilizers prompted the addition of aripiprazole (a daily dose of 10 mg), which helped to achieve significant remission in emotional and obsessive-compulsive symptoms. This case highlights the appealing efficacy of a small dose of aripiprazole augmentation for treating BD-OCD comorbidity. Well-designed clinical trials are warranted to verify the current findings.

Airway management by physician-staffed Helicopter Emergency Medical Services - a prospective, multicentre, observational study of 2,327 patients.

PubMed

Sunde, Geir Arne; Heltne, Jon-Kenneth; Lockey, David; Burns, Brian; Sandberg, Mårten; Fredriksen, Knut; Hufthammer, Karl Ove; Soti, Akos; Lyon, Richard; Jäntti, Helena; Kämäräinen, Antti; Reid, Bjørn Ole; Silfvast, Tom; Harm, Falko; Sollid, Stephen J M

2015-08-07

Despite numerous studies on prehospital airway management, results are difficult to compare due to inconsistent or heterogeneous data. The objective of this study was to assess advanced airway management from international physician-staffed helicopter emergency medical services. We collected airway data from 21 helicopter emergency medical services in Australia, England, Finland, Hungary, Norway and Switzerland over a 12-month period. A uniform Utstein-style airway template was used for collecting data. The participating services attended 14,703 patients on primary missions during the study period, and 2,327 (16 %) required advanced prehospital airway interventions. Of these, tracheal intubation was attempted in 92 % of the cases. The rest were managed with supraglottic airway devices (5 %), bag-valve-mask ventilation (2 %) or continuous positive airway pressure (0.2 %). Intubation failure rates were 14.5 % (first-attempt) and 1.2 % (overall). Cardiac arrest patients showed significantly higher first-attempt intubation failure rates (odds ratio: 2.0; 95 % CI: 1.5-2.6; p < 0.001) compared to non-cardiac arrest patients. Complications were recorded in 13 %, with recognised oesophageal intubation being the most frequent (25 % of all patients with complications). For non-cardiac arrest patients, important risk predictors for first-attempt failure were patient age (a non-linear association) and administration of sedatives (reduced failure risk). The patient's sex, provider's intubation experience, trauma type (patient category), indication for airway intervention and use of neuromuscular blocking agents were not risk factors for first-attempt intubation failure. Advanced airway management in physician-staffed prehospital services was performed frequently, with high intubation success rates and low complication rates overall. However, cardiac arrest patients showed significantly higher first-attempt failure rates compared to non-cardiac arrest patients. All failed intubations were handled successfully with a rescue device or surgical airway. www.clinicaltrials.gov NCT01502111 . Registered 22 December 2011.

Ethical dilemmas among nurses as they transition to hospital case management: implications for organizational ethics, part I.

PubMed

O'Donnell, Lolita T

2007-01-01

To describe the experiences of ethical concerns by clinical nurses as they transitioned into their new role in hospital case management. Through this study, an attempt was made to explore experiences of ethical concerns and identify the implications for organizational ethics. In this study, nurse case managers practicing in the acute hospital setting, military, not-for-profit community, and teaching hospitals were interviewed. The majority of the nurse case manager participants were engaged in hospital discharge planning and utilization review activities. An interpretive phenomenological approach was used to identify the themes inherent in ethical concerns and articulate them within the context of hospital nurse case management. Fifteen participants were interviewed to obtain a qualitative description of the nurse case managers' lived experiences of ethical dilemmas and how they were resolved. Nurse case managers' perceptions of solutions/options to resolve such ethical dilemmas were explored. As nurses transition into the expanded role of case management in the present healthcare delivery system, they frequently face situations demanding ethical choices and judgments to accommodate diverse patient interests and needs. These ethical decisions required in daily practice in case management represent ethical dilemmas to nurses. The insights derived from the analysis of the interviews have implications for nursing practice, education, policy, ethics, and research; recommendations for organizations employing nurse case managers in terms of recruitment, orientation, training, and continued need for educational support are identified. 1. The clinical decisions required in daily practice of case management represented challenges to the nurses. This highlights the critical role of adequate educational orientation to case management for beginning case managers. 2. Nurse case managers should be cognizant of the "disconnect" that could occur between their obligations to the organizations that employ them and the healthcare needs of the patients that they advocate for. 3. Aside from the importance of linking patient care outcomes with accountability, nurse case managers may need to advocate for policy change and system reform.

Does availability of mental health resources prevent recurrent suicidal behavior? An ecological analysis.

PubMed

Cooper, Sara L; Lezotte, Dennis; Jacobellis, Jillian; Diguiseppi, Carolyn

2006-08-01

This study examines whether availability of mental health resources in the county of residence is associated with subsequent suicidal behavior after a previous suicide attempt. Among 10,922 individuals who attempted suicide in Colorado between 1998 and 2002, residence in a county that offered a minimum safety-net of mental health services significantly reduced the risk of suicidal behavior for at least 1 year after the index attempt. Safety-net services included mental health treatment, crisis treatment, and case management. These results suggest one strategy for prevention of suicidal behavior that could inform state-level health policy development and resource allocation.

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

PubMed

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

2013-11-15

Many attempts to implement resource management initiatives in Canadian and international communities have been resisted by stakeholders despite inclusion of their representatives in the decision-making process. Managers' failure to understand stakeholders' perspectives when proposing initiatives is a potential cause of this resistance. Our study uses marketing thought to enhance stakeholder theory by bringing in an audience-centric perspective. We attempt to understand how stakeholders perceive their interests in an organization and consequently decide how to influence that organization. By doing so, we investigate whether a disconnect exists between the perceptions of managers and those of stakeholders. Natural resource managers can utilize this knowledge to garner stakeholder support for the organization and its activities. We support this claim with findings from a water transfer plebiscite held in the Canadian province of Alberta. Sixteen personal interviews employing narrative inquiry were conducted to document voters' (i.e., irrigators') interpretations. Copyright © 2013 Elsevier Ltd. All rights reserved.

An Unusual Case of Suicide Attempt Using Intravenous Injection of Kerosene.

PubMed

Hasan, M N; Sutradhar, S R; Ahmed, S M; Chowdhury, I H

2016-07-01

Kerosene belongs to the hydrocarbon group of compounds, used as a fuel for lamps, as well as heating and cooking in developing countries. Accidental kerosene poisoning and intoxication usually occur by inhalation or by occupational percutaneous absorption. Adults usually ingest kerosene for the purpose of self-harm, and children may ingest accidentally. Suicidal attempt using intravenous kerosene is an extra ordinary and very rare occurrence. A very few data are available regarding effects of intravenous administration of kerosene and its management.

Replacing the Lab Manual with a Learning Management System in Physics Investigations for K-4 Pre-Service Teachers

ERIC Educational Resources Information Center

Sobolewski, Stanley; Numan, Muhammad Z.

2018-01-01

The traditional laboratory investigation uses a procedure written on paper; students then record their responses on a supplied data page or laboratory notebook. In an attempt to make this process more efficient, the use of a Learning Management System (in this case D2L) was used to present the material and collect student feedback. Each student…

Developing purchasing strategy: a case study of a District Health Authority using soft systems methodology.

PubMed

Brown, A D

1997-02-01

This paper examines the attempt by a District Health Authority (DHA) to create structures (called Purchasing Strategy Groups or PSGs) to facilitate the effective development of its purchasing strategy. The paper is based on a case study design conducted using Soft Systems Methodology (SSM). The research contribution the paper makes is twofold. First, it analyses some of the fundamental management-related difficulties that a DHA can experience when attempting to come to terms with its role and responsibilities in the 1990s. Second, it provides a discussion and evaluation of the utility of SSM for qualitative research in the National Health Service (NHS) in the UK.

Rebel with a Cause: A School Board Member Calls for Reform in Miami-Dade County Public Schools

ERIC Educational Resources Information Center

Manning, Tom

2011-01-01

This case describes the experience of a new school board member in Miami-Dade County Public Schools, Marta Perez, as she discovers a wide range of ethical and management problems in the school district and attempts to deal with them. Layered throughout the case are challenges pertaining to the school board's roles and responsibilities,…

Diagnosis and management of maxillary incisors affected by incisal wear: an interdisciplinary case report.

PubMed

Bernardo, Jussara Karina; Maia, Elaine A Vilela; Cardoso, Antônio Carlos; de Araújo Júnior, Edson Medeiros; Monteiro Júnior, Sylvio

2002-01-01

In the attempt to restore anterior teeth affected by erosion and bruxism, many clinicians have been frustrated with the constant restorative failures. Frequently, these failures are attributed to the restorative materials employed, especially in cases in which composite resins are used. However, some flaws of the restorations are related to the oversight of occlusal principles. The purpose of this article is to discuss the etiology, signs, and symptoms of incisal wear, with special attention to that caused by bruxism and chemical erosion. Relatively simple management techniques (e.g., occlusal adjustment, adhesive restorations) are proposed, and the diagnosis and management of a representative clinical case is presented. In some cases of bruxism and/or dental erosion, it is possible to acquire space to recuperate the esthetics and function of maxillary incisors affected by incisal wear through a conservative treatment associated with the control of the etiologic factors.

Massive prolapsed haemorrhoids managed by ablation and correction in a poor resourced area

PubMed Central

Weledji, Elroy Patrick; Enow Orock, George; Aminde, Leopold

2013-01-01

More recently some patients with rectal mucosal prolapse and obstructive defaecation have been treated with the procedure for prolapse and haemorrhoids. We report a case of symptomatic chronic circumferentially prolapsed haemorrhoids that had several failed attempts at surgical repair. This was finally managed by ablation and correction of the associated rectal mucosal prolapse by a modified ‘Delorme's procedure akin to a stapled anopexy. PMID:24968428

Planning and Implementing total Quality Management in an Air Force Service Organization: A Case Study

DTIC Science & Technology

1988-09-01

Quality Management (TQM). Documentation of such implementation methods can provide useful crossfeed to other services organizations attempting similiar efforts. The following research questions were addressed to present the case in a useful context for interpretation: (1) What is TQM and how will it be implemented in AFALC; (2) How can the quality of service organizations be improved and what techniques may be useful for this purpose; (3) How does the environment at AFALC differ from most Air Force organizations implementing TQM and what obstacles must it overcome; (4) How

Penile strangulation by iron metal ring: A novel and effective method of management

PubMed Central

Paonam, Somorendro; Kshetrimayum, Nillachandra; Rana, Indrajit

2017-01-01

Penile strangulation by metal ring is a rare urological emergency situation which requires urgent decompression of the penis to avoid adverse effect. It is usually associated with an attempt to improve sexual act and/or to prolong erection. But sometimes, cutting of the ring to decompress the penis safely is a very difficult task particularly when the strangulating object is a hard metal object as in our case. Here, we present a case which was managed by cutting in a novel way with the help of dental micromotor with wheel shape bur. PMID:28216935

Ethical dilemmas among nurses as they transition to hospital case management: implications for organizational ethics, part II.

PubMed

O'Donnell, Lolita T

2007-01-01

The purpose of this study was to describe the experiences of ethical concerns by clinical nurses as they transitioned into their new role in hospital case management. Through this study, an attempt was made to explore experiences of ethical concerns and identify the implications for organizational ethics. In this study, nurse case managers practicing in the acute care setting, military, not-for-profit community, and teaching hospitals were interviewed. The majority of the nurse case manager participants were engaged in hospital discharge planning and utilization review activities. An interpretive phenomenological approach was used to identify the themes inherent in ethical concerns and articulate them within the context of hospital nurse case management. Fifteen participants were interviewed to obtain a qualitative description of the nurse case managers' lived experiences of ethical dilemmas and how they were resolved. Nurse case managers' perceptions of solutions/options to resolve such ethical dilemmas were explored. As nurses transition into the expanded role of case management in the present healthcare delivery system, they frequently face situations demanding ethical choices and judgments to accommodate diverse patient interests and needs. These ethical decisions required in daily practice of case management represent ethical dilemmas to nurses. The insights derived from the analysis of the interviews have implications for nursing practice, education, policy, ethics, and research; recommendations for organizations employing nurse case managers in terms of recruitment, orientation, training, and continued need for educational support are identified. 1. The clinical decisions required in daily practice of case management represented challenges to the nurses. This highlights the critical role of adequate educational orientation to case management for beginning case managers. 2. Nurse case managers should be cognizant of the "disconnect" that could occur between their obligations to the organizations that employ them and the healthcare needs of the patients that they advocate for. 3. Aside from the importance of linking patient care outcomes with accountability, nurse case managers may need to advocate for policy change and system reform.

The U.S. Army and Doctrine for Weapons of Mass Destruction: Consequence Management Operations.

DTIC Science & Technology

1999-06-04

Forces within section 7 Competency of witnesses 23 Construction Generally 1 With other laws 2 Estoppel 19 Exclusionary rule 22 Execution of laws 8...19. Estoppel Despite ruling in previous case that this section precluded prosecutions under section 231 of this title prohibiting attempts to

Work Restructuring in Post-Apartheid South Africa.

ERIC Educational Resources Information Center

Webster, Edward; Omar, Rahmat

2003-01-01

Case studies of South African companies (mining, manufacturing, and telephone call centers) reveal a mix of management strategies that converge with and diverge from past practices. South Africa is attempting to balance the demands of efficiency, employee rights, and racial equity, a challenge that requires overcoming the legacy of the apartheid…

Not a Dirty Word: Arts Entrepreneurship and Higher Education

ERIC Educational Resources Information Center

Bridgstock, Ruth

2013-01-01

While the majority of creative, performing and literary artists are self-employed, relatively few tertiary arts schools attempt to develop capabilities for venture creation and management (and entrepreneurship more broadly) and still fewer do so effectively. This article asks why this is the case. It addresses underlying conceptual and…

Trends in the Restructuring of German Universities

ERIC Educational Resources Information Center

Pritchard, Rosalind

2006-01-01

What happens when a highly regulated educational system--one featuring academic freedom, a national outlook, and an input-oriented, state-run bureaucracy--attempts to internationalize and introduce management structures that are outcome-oriented, deregulated, and more efficient? In the case of Germany, examined in this article, it has long been…

Planning and Implementing Shared Teaching: An MBA Team-Teaching Case Study

ERIC Educational Resources Information Center

Helms, Marilyn M.; Alvis, John M.; Willis, Marilyn

2005-01-01

Team teaching is a popular trend in business education. In an attempt to integrate seemingly disparate functional disciplines, a number of business programs have combined courses. Regardless of the courses combined (marketing and finance, management and accounting, economics and strategy, or production and cost accounting), the teaching pedagogy…

English-only work rules: balancing fair employment considerations in a multicultural and multilingual healthcare workforce.

PubMed

Fink, R L; Robinson, R K; Wyld, D C

1996-01-01

Most healthcare organizations are currently or will shortly be composed of a multicultural and multilingual workforce. In attempting to manage such diverse workforces. English-only work rules may be necessary to ensure effective communication among workers. However, care must be taken to insure that the employees' rights to free speech and a harassment-free workplace are not infringed by utilizing English-only work rules. This article attempts to assist the healthcare manager in dealing with the legal aspects of English-only work rules. Specifically, an examination of two legal cases is provided to illustrate the various legal aspects of such work rules. Also, suggestions are offered as to how and when, or when not, to implement English-only work rule in order to avoid possible liability.

Retained rectal foreign body with rectal perforation; a complication of the traditional management of haemorrhoids: a case report.

PubMed

Olaoye, Iyiade Olatunde; Adensina, Micheal Dapo

2013-10-01

Retained rectal foreign bodies are most commonly seen in homosexuals and after assault. A few have been reported after self-treatment of anorectal conditions and prostatic massage. Harmful traditional medical practices have been reported in many communities in Africa but therapeutic anal insertion of foreign bodies for the management of haemorrhoids is rare. We present a patient with features of peritonitis following insertion of a wine bottle into his rectum in an attempt to manage his prolapsed haemorrhoids.

Permanent antibiotic impregnated intramedullary nail in diabetic limb salvage: a case report and literature review

PubMed Central

Woods, Jason B.; Lowery, Nicholas J.; Burns, Patrick R.

2012-01-01

Managing complications after attempted hind foot and ankle arthrodesis with intramedullary nail fixation is a challenge. This situation becomes more problematic in the patient with diabetes mellitus and multiple comorbidities. Infection and subsequent osteomyelitis can be a devastating, limb threatening complication associated with these procedures. The surgeon must manage both the infectious process and the skeletal instability concurrently. This article provides a literature review and detailed management strategies for a modified technique of employing antibiotic impregnated polymethylmethacrylate-coated intramedullary nailing. PMID:22396833

Laryngeal Trauma Following an Inhalation Injury: A Review and Case Report.

PubMed

Hogg, Gemma; Goswamy, Jay; Khwaja, Sadie; Khwaja, Nadeem

2017-05-01

The primary concern when managing a patient with inhalation injury is security of the airway. Airflow may be impeded by both edema of the upper airway and reduction of oxygen delivery to the lower respiratory tract. Although there has been much discussion regarding management of the latter, the focus of this article is the management of the former. This review aimed to determine the optimum management in burn victims with upper airway inhalation injury as an attempt to prevent laryngeal trauma leading to long-term voice disorders and upper airway dyspnea. We describe the case of a 57-year-old woman with significant inhalation injury and discuss the natural progression of her injuries and the laryngeal controversies surrounding her care. We conclude with advice on the optimal management of this condition based on our experience, combined with current best evidence. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

Management of breech presentation at term: a retrospective cohort study of 10 years of experience.

PubMed

Burgos, J; Rodríguez, L; Cobos, P; Osuna, C; Del Mar Centeno, M; Larrieta, R; Martínez-Astorquiza, T; Fernández-Llebrez, L

2015-10-01

To evaluate the impact of management of childbirth (external cephalic version (ECV) plus planned vaginal delivery (PVD)) of breech presentation at term (⩾37 weeks of gestation). This retrospective cohort study was based on data collected of singleton breech presentations at term in the Obstetrics and Gynaecology Service, Cruces University Hospital (Biscay, Spain), from January 2003 to December 2012. We attended 2377 singleton breech pregnancies at term. We attended 1684 singleton breech term deliveries, attempting vaginal delivery after selection in 52.9% of cases and were successful in 57.5% of attempts. A total of 1360 ECV were attempted, with a success rate of 50.3% of those attempted. The use of ECV has decreased the rate of breech presentation at delivery by 39.0%, the rate of breech presentation as a caesarean section (CS) indication by 47.1% (CS due to breech presentation/total of CS) and the rate of CS for breech presentation out of the total of deliveries by 39.1% (CS due to breech presentation/total of deliveries). Early postnatal parameters (5-min Apgar score, umbilical cord arterial pH and acid-base analysis) were significantly lower following PVD compared with planned CS for breech presentation. However, we did not find any differences in the rates of admissions to the neonatal unit or neonatal mortality. Management of breech presentation with a protocol that includes ECV, careful selection criteria and active management of vaginal delivery achieve a great decrease in the rate of CS for breech presentation.

Initial treatment of sigmoid volvulous by colonoscopy.

PubMed Central

Starling, J R

1979-01-01

The initial management of acute, nonstrangulated sigmoid volvulous is to attempt proctosigmoidoscopic, rectal tube, or barium enema reduction and evacuation. If unsuccessful emergency surgery is necessary. The flexible colonoscope offers an additional therapeutic modality to effectuate preoperative reduction of the twisted sigmoid colon if attempts with conventional methods fail. Three cases of acute sigmoid volvulous are presented which illustrate for the first time successful reduction of acute sigmoid volvulous by colonoscopy after failure of the usual methods of treatment. Instead of emergency surgery all of these patients had elective resection with primary colocolostomy. Patients with acute sigmoid volvulous refractile to reduction by conventional modalities should have an attempt at flexible colonoscopic reduction. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. PMID:464675

Double lung point in an 18-month-old child: a case report and literature review

PubMed Central

2015-01-01

Objective Double lung point is a rare sign of pneumothorax in clinical practice. In this report I presented an 18-month-old child who presented with bilateral pneumothorax. Data synthesis and case presentation Ultrasonography examination revealed conventional lung point sign on the right and double lung point on the left side. Thoracentesis was attempted and closed thoracic drainage was performed on the right side, but no gas was drawn on the left side. Clinical implication of double lung point sign found in chest ultrasonography is that the size of pneumothorax is limited and conservative treatment is enough. Conclusions To the best of our knowledge, this is the first case of double lung point identified with ultrasonography in child. The strength of the case is that the double lung point sign is supported by computed tomography (CT). Furthermore, we propose that the presence of double lung point indicates limited pneumothorax and conservative management may well be attempted. PMID:25922750

Attempted and completed suicide in primary care: not what we expected?

PubMed

Younes, N; Melchior, M; Turbelin, C; Blanchon, T; Hanslik, T; Chee, C Chan

2015-01-01

General Practitioners (GPs) play a central role in suicide prevention. This study aims to compare the characteristics of individuals who attempt suicide to those who complete suicide in a same primary care setting. We compared the characteristics and GP's management of all patients with attempted (N=498, SA) or completed suicide (N=141, SC) reported to the GPs'French Sentinelles surveillance system (2009-2013). Compared to patients who attempted suicide, those who completed suicide were more likely to be male, older and to have used a more lethal method; for men they were less likely to have a history of previous suicide attempt and prior contacts with their GP. In terms of GPs' management, we found no differences between the SA and SC groups in the identification of psychological difficulties and in the care, but GPs were more likely to provide psychological support to the SA group. During the last consultation, the SC group expressed suicidal ideas more frequently than the SA group (26.7% vs. 14.8%, p<0.01), only for women. The network may have missed cases and selected more serious SA. Individuals who commit suicide differ from those who attempt suicide in terms of demographic characteristics and by sex, of history of suicide attempt, previous contact and expressed suicidal ideas. We show that GPs do not act more intensively with patients who will commit suicide, as if they do not foresee them. Current prevention programs particularly in primary care should be tailored. Copyright © 2014 Elsevier B.V. All rights reserved.

Anterior neck injuries presenting as cut throat emergencies in a tertiary health institution in north western Nigeria.

PubMed

Iseh, K R; Obembe, A

2011-01-01

Anterior neck injuries vary in pattern and aetiology and may pose management challenges ifnot fatal. To describe patterns of anterior neck injuries in a tertiary hospital north western Nigeria. This is a prospective study of all cases of anterior neck injuries presenting as cut throat emergencies that were referred from accident and emergency department to the department of otorhinolaryngology over a nine year period (September 1999 to August 2008). A total number of 19 cases were seen. All were males whose age range was from 5 years to 60 years with a mean age of 21.2 years. About 78.9% of the patients were within the 2nd to 4th decades of life with a peak at the 4th decade (31.6%). Ten (52.6%) patients were cases of attempted suicide with known background of psychiatric illness, Five (26.3%) were homicidal (3 under the influence of illicit drugs), two (10.5%) were from animal assault while one was as a result of road traffic accident and another one from fall on sharp object. Patients with attempted suicide had deep open wounds exposing the pharynx, larynx or both with horizontally positioned incision wounds while homicidal cases had obliquely positioned incision wounds. Restoration of normal neck, pharyngeal and laryngeal architecture was carried out through meticulous surgical repair of various tissue layers with nasogastric tube in situ for 7-9 days. Psychiatric evaluation and treatment were carried out concurrently with patients who attempted suicide and homicide. Two patients required tracheostomy to prevent upper airway obstruction from severe laryngeal trauma. Significant proportion of emergencies from anterior neck cut throat injuries in this study were from suicidal attempts (52.6%) by people with a background history of psychiatric illness, followed by attempted homicide (26.3%) and animal assault (10.5%). Prompt surgical repair and concurrent psychiatric evaluation in attempted suicide and homicide is required.

Videolaryngoscopy versus Fiber-optic Intubation through a Supraglottic Airway in Children with a Difficult Airway: An Analysis from the Multicenter Pediatric Difficult Intubation Registry.

PubMed

Burjek, Nicholas E; Nishisaki, Akira; Fiadjoe, John E; Adams, H Daniel; Peeples, Kenneth N; Raman, Vidya T; Olomu, Patrick N; Kovatsis, Pete G; Jagannathan, Narasimhan; Hunyady, Agnes; Bosenberg, Adrian; Tham, See; Low, Daniel; Hopkins, Paul; Glover, Chris; Olutoye, Olutoyin; Szmuk, Peter; McCloskey, John; Dalesio, Nicholas; Koka, Rahul; Greenberg, Robert; Watkins, Scott; Patel, Vikram; Reynolds, Paul; Matuszczak, Maria; Jain, Ranu; Khalil, Samia; Polaner, David; Zieg, Jennifer; Szolnoki, Judit; Sathyamoorthy, Kumar; Taicher, Brad; Riveros Perez, N Ricardo; Bhattacharya, Solmaletha; Bhalla, Tarun; Stricker, Paul; Lockman, Justin; Galvez, Jorge; Rehman, Mohamed; Von Ungern-Sternberg, Britta; Sommerfield, David; Soneru, Codruta; Chiao, Franklin; Richtsfeld, Martina; Belani, Kumar; Sarmiento, Lina; Mireles, Sam; Bilen Rosas, Guelay; Park, Raymond; Peyton, James

2017-09-01

The success rates and related complications of various techniques for intubation in children with difficult airways remain unknown. The primary aim of this study is to compare the success rates of fiber-optic intubation via supraglottic airway to videolaryngoscopy in children with difficult airways. Our secondary aim is to compare the complication rates of these techniques. Observational data were collected from 14 sites after management of difficult pediatric airways. Patient age, intubation technique, success per attempt, use of continuous ventilation, and complications were recorded for each case. First-attempt success and complications were compared in subjects managed with fiber-optic intubation via supraglottic airway and videolaryngoscopy. Fiber-optic intubation via supraglottic airway and videolaryngoscopy had similar first-attempt success rates (67 of 114, 59% vs. 404 of 786, 51%; odds ratio 1.35; 95% CI, 0.91 to 2.00; P = 0.16). In subjects less than 1 yr old, fiber-optic intubation via supraglottic airway was more successful on the first attempt than videolaryngoscopy (19 of 35, 54% vs. 79 of 220, 36%; odds ratio, 2.12; 95% CI, 1.04 to 4.31; P = 0.042). Complication rates were similar in the two groups (20 vs. 13%; P = 0.096). The incidence of hypoxemia was lower when continuous ventilation through the supraglottic airway was used throughout the fiber-optic intubation attempt. In this nonrandomized study, first-attempt success rates were similar for fiber-optic intubation via supraglottic airway and videolaryngoscopy. Fiber-optic intubation via supraglottic airway is associated with higher first-attempt success than videolaryngoscopy in infants with difficult airways. Continuous ventilation through the supraglottic airway during fiber-optic intubation attempts may lower the incidence of hypoxemia.

A hidden view of wildlife conservation: How camera traps aid science, research and management

USGS Publications Warehouse

O'Connell, Allan F.

2015-01-01

Camera traps — remotely activated cameras with infrared sensors — first gained measurable popularity in wildlife conservation in the early 1990s. Today, they’re used for a variety of activities, from species-specific research to broad-scale inventory or monitoring programs that, in some cases, attempt to detect biodiversity across vast landscapes. As this modern tool continues to evolve, it’s worth examining its uses and benefits for wildlife management and conservation.

Social workers' role in disease management.

PubMed

Claiborne, N; Vandenburgh, H

2001-11-01

This article discusses social work's participation in a new paradigm for health care delivery, disease management. Attempts to improve health care quality havefocused on evidence-based methods of evaluating health care outcomes as well as quality of life issues with which social workers have been traditionally concerned. The fit between social work's ecological perspective and disease management and the needfor social workers to participate as patient case managers on interdisciplinary disease management teams are discussed. Quality and cost benefits can occur when social workers address such issues as adherence, psychosocialfactors, and depression in terms of the patient's global recovery and concurrent enhancement of quality of life. Potential barriers to disease management implementation with social work participation are discussed.

An Alternative View of Quality Assurance and Enhancement

ERIC Educational Resources Information Center

Wong, Viola Yuk-Yue

2012-01-01

This paper attempts to deal with the elusive nature of quality in quality management, using a case study to examine quality control measures implemented in an academic context and to show an emergent framework for quality enhancement. This paper introduces the concept of the ecology of quality assurance and examines efforts to maintain and advance…

Working with a Head Start Population with Asthma: Lessons Learned

ERIC Educational Resources Information Center

Nelson, Belinda W.; Clark, Noreen M.; Valerio, Melissa A.; Houle, Christy R.; Brown, Randall W.; Brown, Clive

2006-01-01

The Early Childhood Asthma Project involved asthma case identification in 35 Head Start centers in Detroit, MI, and attempted implementation of an intervention designed to help families manage a child's asthma more effectively. Surveys were distributed to the parents of all Head Start children (3408), and 2198 complete surveys were returned. Case…

Attaining Visual Literacy Using Simplified Graphics in Industry.

ERIC Educational Resources Information Center

Burton, Terry

In the current milieu of ISO 9000 certification, just-in-time engineering (JIT), demand flow technology (DFT), and total quality management (TQM), industry is attempting to implement available technology for the creation, control, and delivery of documentation. In most cases, their efforts are in need of outside resources to analyze, develop,…

An Enjoyable Learning Experience in Personalising Learning Based on Knowledge Management: A Case Study

ERIC Educational Resources Information Center

Xu, Hao; Song, Donglei; Yu, Tao; Tavares, Adriano

2017-01-01

Many attempts at personalisation have been made in education. They all collect learning data and analyse learning behaviours, and ultimately achieve personalised learning dynamically. However, further research is needed on the ways to effectively access and analyse information about learning within an enjoyable environment and with positive…

Women in Authority: A Sociopsychological Analysis

ERIC Educational Resources Information Center

Bayes, Marjorie; Newton, Peter M.

1978-01-01

A case study of a woman manager and her staff within a mental health center is analyzed in an attempt to interrelate organizational structure, leadership style, and staff group dynamics. The approach to the exercise of authority is sociopsychological. Available from: JAB S Order Dept., NTL Institute for Applied Behavioral Science, P.O. Box 9155,…

[Fentanyl Citrate Sublingual Tablets Were Effective in Relieving Symptoms of Akathisia - A Case Report].

PubMed

Kessoku, Takaomi; Kusakabe, Akihiko; Matsuura, Tetsuya; Honda, Yasushi; Yoshimi, Asuka; Goto, Ayumu; Yoshida, Haruhisa; Sukegawa, Akiko; Hata, Chiaki; Saito, Yukie; Miyashita, Yoko; Yashiro, Ryoko; Komori, Tomoya; Arai, Sachiko; Nakajima, Atsushi; Ichikawa, Yasushi

2018-03-01

Akathisia is a condition wherein sitting calmly and quietly is impossible, with a representative complaint of restless legs. It is generally assumed to be caused by anti-dopamine activity. In severe cases, it has been known to result in suicide attempt. We reported a case of drug-induced akathisia with difficulty in oral intake, in which fentanyl citrate sublingual tablets were found to be effective in relieving symptoms. The patient was a female aged 50's who had a gastric cancer with peritoneal dissemination causing pain and vomiting. Palliative care was requested for management of symptoms. Metoclopramide and haloperidol were administered for vomiting. However, because of the complaints of restless legs, the case was diagnosed as drug-induced akathisia. Fentanyl citrate sublingual tablets were then administered for pain management, resulting in temporary improvement of akathisia symptoms.

“Puestow modified procedure in the era of advanced endoscopic interventions for the management of chronic lithiasic pancreatitis. A two cases report”

PubMed Central

Fragulidis, Georgios P.; Vezakis, Αntonios; Dellaportas, Dionissios; Sotirova, Ira; Koutoulidis, Vassilis; Kontis, Elliseos; Polydorou, Andreas

2015-01-01

Introduction Pancreatic duct calculi in chronic pancreatitis (CP) patients are the main cause of intractable pain which is their main symptom. Decompression options of for the main pancreatic duct are both surgical and advanced endoscopic procedures. Presentation of cases A 64-year-old male with known CP due to alcohol consumption and a 36-year-old female with known idiopathic CP and pancreatic duct calculi were managed recently in our hospital where endoscopic procedures were unsuccessful. A surgical therapy was considered and a longitudinal pancreaticojejunostomy (modified Puestow procedure) in both patients was performed with excellent results. Discussion Over the last 30 years, endoscopic procedures are developed to manage pancreatic duct strictures and calculi of the main pancreatic duct in CP patients. In both of our cases endoscopic therapy was first attempted but failed to extract the pancreatic duct stones, due to their size and speculations. Modified Puestow procedure was performed for both and it was successful for long term pain relief. Conclusion Despite advancement in endoscopic interventions and less invasive therapies for the management of chronic lithiasic pancreatitis we consider that classic surgical management can be appropriate in certain cases. PMID:26318135

Reconstructive Management of Devastating Electrical Injuries to the Face.

PubMed

Janis, Jeffrey E; Khansa, Ibrahim; Lehrman, Craig R; Orgill, Dennis P; Pomahac, Bohdan

2015-10-01

Devastating fourth-degree electrical injuries to the face and head pose significant reconstructive challenges. To date, there have been few peer-reviewed articles in the literature that describe those reconstructive challenges. The authors present the largest case series to date that describes the management of these injuries, including the incorporation of face transplantation. A retrospective case series was conducted of patients with devastating electrical injuries to the face who were managed at two level-1 trauma centers between 2007 and 2011. Data describing patient injuries, initial management, and reconstructive procedures were collected. Five patients with devastating electrical injuries to the face were reviewed. After initial stabilization and treatment of life-threatening injuries, all five underwent burn excision and microsurgical reconstruction using distant flaps. Two of the patients eventually underwent face transplantation. The authors describe differences in management between the two trauma centers, one of which had the availability for composite tissue allotransplantation; the other did not. Also described is how initial attempts at traditional reconstruction affected the eventual face transplantation. The care of patients with complex electrical burns must be conducted in a multidisciplinary fashion. As with all other trauma, the initial priority should be management of the airway, breathing, and circulation. Additional considerations include cardiac arrhythmias and renal impairment attributable to myoglobinuria. Before embarking on aggressive reconstruction attempts, it is advisable to determine early whether the patient is a candidate for face transplantation in order to avoid antigen sensitization, loss of a reconstructive "lifeboat," surgical plane disruption, and sacrifice of potential recipient vessels. Therapeutic, V.

Scavenging high-voltage copper wire, a hazardous petty larceny.

PubMed

Himel, H N; Ahn, L C; Jones, K C; Edlich, R F

1992-01-01

With the current emphasis on recycling and the establishment of markets for sale of used copper wire, scavenging of copper wire from old buildings and equipment has become common. Although scavenging without permission constitutes theft, a more significant risk to the perpetrator is the potential for electrical burn injury in attempting to remove "hot" wire. A severe high-voltage electrical burn injury sustained while attempting to scavenge wire from an old house is reported. The circumstances surrounding the injury, the clinical management of the case, and the long-term consequences to the patient are presented and discussed.

Mental Health, Substance Abuse, and Suicide Among Homeless Adults.

PubMed

Lee, Kyoung Hag; Jun, Jung Sim; Kim, Yi Jin; Roh, Soonhee; Moon, Sung Seek; Bukonda, Ngoyi; Hines, Lisa

2017-01-01

This study explored the role of mental health and substance abuse problems on the suicidal ideation and suicide attempts of 156 homeless adults. The logistic regression results indicated that homeless adults with anxiety were significantly more likely than those without anxiety to have both suicidal ideation and suicide attempts. Also, homeless adults with drug abuse were significantly more likely than those without drug abuse to have suicidal ideation. The study suggests that to reduce the suicide of the homeless, case managers need to screen mental health and substance abuse issues and to provide appropriate treatment services at homeless shelters.

[Airway management in a man with ankylosing spondylitis].

PubMed

Gil, S; Jamart, V; Borrás, R; Miranda, A

2007-02-01

We report a case of difficult airway management in a 41-year-old man with ankylosing spondylitis who was scheduled for total left hip replacement surgery. After several failed attempts to achieve regional anesthesia, we converted to general anesthesia with orotracheal intubation using a fiberoptic bronchoscope. Ankylosing spondylitis leads to fibrosis, ossification, and ankylosis along the spinal column and sacroiliac articulations. Cervical column and atlantooccipital articulation mobility are reduced and in severe cases the cervical vertebrae become fixed in a flexed position. This portion of the spine is also the most susceptible to fracture, particularly in hyperextension, an event that could lead to damage to the cervical spinal cord during maneuvers to manage the airway. Patients with this condition may also have temporomandibular joint involvement, further complicating airway management. We report the case of a patient with ankylosing spondylitis with fixation along the entire spine. The airway was managed by intubation with a fiberoptic bronchoscope. Spontaneous ventilation was maintained during the maneuver, and sedation was achieved with perfusion of remifentanil as the only anesthetic agent following failure of intradural anesthesia.

Case management for the elderly with complex needs: cross-linking the views of their role held by elderly people, their informal caregivers and the case managers.

PubMed

Balard, Frédéric; Gely-Nargeot, Marie-Christine; Corvol, Aline; Saint-Jean, Olivier; Somme, Dominique

2016-11-08

In 2009, case management interventions were a new social service in France implemented within the framework of the PRISMA-France program (2006-2010). People who had benefitted from case management intervention were individuals, over 60 years old living at home in situations deemed complex by professionals. Their informal caregivers were also considered as users of the service. This research accompanied the interventions during the implementation of PRISMA-France attempting to explore the users' (old people and their informal caregivers) and case managers' first experiences of case management. Its aim is to provide a thorough knowledge of the dispositive in order to reveal any initial failings and to ensure optimum conditions for the onset of full implementation. The study had a qualitative explorative design. Cross-linked representations of case-management were obtained through opened-ended and guided interviews with three types of informants: old people (19), their informal caregivers (11) and the case managers (5) who participated in the program during the first 6 months. Thematic analysis of the data was carried out. The analysis revealed that each group of people generated its own representations of the case manager's role, even though the three groups of informants shared the idea that the case manager is first and foremost a helper. The case managers insisted on their proximity to the old people and their role as coordinators. The informal caregivers saw the professional as a partner and potential provider of assistance in accompanying old people. The old people focused on the personal connections established with the case manager. The innovative and experimental dimension of case management in France and the flexible nature of the role generated a broad spectrum of representations by those involved. These different representations are, in part, the fruit of each individual's projected expectations of this social service. Analyzing the first representations of the case manager's role during the implementation phase of the CM service appears as a necessary step before considering the effects of the services. The implementation and the success of a case management model have to be evaluated regarding the previous healthcare context and the expectations of the people involved.

Predictors of suicide-related behaviors during treatment following a first episode of psychosis: the contribution of baseline, past, and recent factors.

PubMed

Fedyszyn, I E; Robinson, J; Harris, M G; Paxton, S J; Francey, S

2012-09-01

Suicide-related behaviors (suicide attempts and suicides) are common in the early phase of psychotic disorders. Studies have examined risk factors among baseline and historical (i.e., past) variables, yet little is known about recent characteristics that increase suicide risk during treatment for first-episode psychosis (FEP). This study had two aims: first, to determine the relative importance of baseline, past, and recent variables to the prediction of suicide-related behaviors in patients with FEP; second, to identify recent characteristics that exert most influence on suicide risk levels and which could become foci of preventive interventions. This was a case-control study of 180 patients from a cohort entering a specialist FEP service between 1/12/2002 and 30/11/2005. Data for 72 cases and 108 matched controls were obtained via medical record audit. Multivariate logistic regression models assessed the contribution of baseline, past, and recent domains. Suicide attempt or suicide during treatment was the outcome variable. The strongest risk factors for suicide-related behaviors were: baseline depressive symptoms, baseline suicidal ideation/intent, past negative events, past non-suicidal self-injurious behavior, recent negative events, recent depressive symptoms, and recent non-suicidal self-injurious behavior. However, when these were entered into a hierarchical logistic regression model, only recent non-suicidal self-injurious behavior (AOR=72.96, p<0.001), and recent negative events (AOR=1.90, p=0.003) remained significant predictors. The final model accurately classified 75.5% of cases and 89.2% of controls, and explained 72.0% of variance in the suicide attempt status. Since recent negative events and recent non-suicidal self-injurious behavior were the strongest predictors of suicide-related behaviors during treatment for FEP, psychiatric services could consider incorporating psychosocial interventions addressing affect regulation, interpersonal effectiveness, stress management and problem solving, alongside case management and pharmacotherapy, to help to reduce the rates of suicide attempts and suicides in first-episode patients. Copyright © 2012 Elsevier B.V. All rights reserved.

The case for undergraduate medical education in healthcare business and management.

PubMed

Hsu, Benson S; Hosokawa, Michael C; Maria, Bernard

2007-01-01

Current undergraduate medical education does notprepare students to approach the intricacies of healthcare business. This absence within medical education creates significant challenges for physicians throughout their careers. The field of academic medicine has clearly documented the need for medical education to prepare students for practice management, yet there exist only a small number of attempts at exposing students to healthcare business and management. The authors argue that this curriculum must start at the level ofundergraduate medical education. Furthermore, this curriculum must possess the basic components of support, integration, practicality, application, and continuation. Fulfilling these requirements will allow for the successful adaptation of the healthcare business and management curriculum.

Dangerous blind tracheal intubation attempt due to fiberscope non-availability in a pediatric patient with retropharyngeal abscess caused by a large fish bone.

PubMed

Li, Bi-Lian; Xu, Ying-Yi; Jiang, Yan-Fang; Liu, Wen-Xing; Kuang, Xiao-Hua; Ni, Jin

2015-01-01

In China, foods containing bones are sometimes fed to young infants. Occasionally, this practice results in bone aspiration and retropharyngeal abscess, a potentially life-threatening infection in the deep space of the neck that can compromise the airway. The main concern in managing patients with retropharyngeal abscess is airway management. In China, not all hospitals and operating rooms are equipped with fiberscopes, particularly pediatric-size fiberscopes. Emergency airway management can be dangerous when a fiberscope is unavailable. We present the case of a 21-month-old baby girl with a retropharyngeal abscess secondary to fish bone ingestion. During an attempted blind tracheal intubation due to fiberscope non-availability, the abscess ruptured, and the pus released from it obstructed the airway. The patient was successfully treated despite the inadequate resources and dangerous complication. We recommend a detailed preoperative airway assessment and preparation for fiberscopic tracheal intubation in such patients to prevent this dangerous complication.

Pemphigus vulgaris – a report of three cases

PubMed Central

Gharote, Harshkant P; Nair, Preeti P; Kasetty, Sowmya; Thomas, Shaji; Kulkarni, Abhay

2012-01-01

Pemphigus vulgaris (PV) is a potentially life-threatening illness that manifests in the mouth and on skin. In a majority of patients it affects the oral mucosa and is sometimes difficult to diagnose when only mucosal involvement is present. In an attempt to highlight the proper treatment plan of this potentially fatal disorder, the authors document a report of three cases. These patients were prescribed conventional steroids which brought about partial relief but early recurrence with discontinuation of the drug. Subsequent management of these patients with azathioprine along with corticosteroids improved the outcome of the disease with longer remission periods. In this case series, the steroid sparing effect of azathioprine was achieved successfully and hence needs to be considered as a primary drug in management of PV. PMID:22605597

CPR-induced consciousness: A cross-sectional study of healthcare practitioners' experience.

PubMed

Olaussen, Alexander; Shepherd, Matthew; Nehme, Ziad; Smith, Karen; Jennings, Paul A; Bernard, Stephen; Mitra, Biswadev

2016-11-01

Consciousness may occur during effective management of cardiac arrest and ranges from eye opening to interfering with rescuers' resuscitation attempts. Reported cases in the medical literature appear scant compared to anecdotal reports. The aim of this study was to evaluate health care providers' experience with consciousness during cardio-pulmonary resuscitation (CPR). A cross-sectional survey of 100 experienced health care professionals, including doctors, nurses and paramedics. Participants were asked about their experience with both CPR-non-interfering consciousness (e.g. eye opening, agonal breaths or mild restlessness) and CPR-interfering consciousness (e.g. purposeful movement, withdrawing from CPR, attempting to pull out airway-securing devices). A third of responders reported attending more than 100 cases of arrests, while another third had attended 20 or less arrests. The responders had a mean of 11 (SD 8.7) years of practice. Most responders (59 of 67) to the question had experienced CPR-non-interfering consciousness and reported experiencing it a median of 3 (IQR 1-5) times. CPR-interfering consciousness had been experienced by 51 of the 63 responders and was experienced overall 1 (IQR 1-3) time. Management of these cases varied widely with varied opinion on ideal management ranging from no action to sedation and/or paralysis. A guideline describing the management of this presentation was considered necessary by 40 out of 57 (70%) responders. Contrasting to a few reports in the medical literature, CPR-induced consciousness appears to be experienced more commonly during resuscitation. Management strategies varied widely and clinician opinion of ideal management was also varied. The desire for consensus guidelines on this topic exists. Acute care nurses are integral members of all resuscitation teams and in conjunction with other clinicians, ideally placed to develop, implement and disseminate such guidelines to delivering evidence based care to this sub-group of patients. Copyright © 2016 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

Exploring motivation for leisure-based physical activity: a case study of college students

Treesearch

Alvin Hung Chih Yu

2007-01-01

The benefits of physical activity have been well documented in recent years. Physical activity may decrease the risk of cardiovascular disease, assist in weight management, improve personal mood, and promote physiological health. In light of this increased activity, it is important to understand the reasons for it. This exploratory study attempted to identify college...

Chylous Ascites: A Rare Complication of Thoracic Duct Embolization for Chylothorax

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

Gaba, Ron C., E-mail: rgaba@uic.edu; Owens, Charles A.; Bui, James T.

2011-02-15

Thoracic duct embolization represents a safe and effective method to treat postsurgical chylothorax. Complications of this procedure are rare despite transabdominal puncture of lymphatic channels for thoracic duct access, and chylous ascites is unreported. Herein, we describe a case of chylous ascites formation after lymphatic puncture and attempted cannulation. Our management approach is also discussed.

Transforming Negative Emotions: A Case Study of Intergroup Conflict among Conflict Resolution Practitioners of Color.

ERIC Educational Resources Information Center

Carvalho, Millicent

2003-01-01

Examined how conflict affected internalized oppression and conflict-handling methods utilized during a facilitated meeting that attempted to resolve or manage intergroup conflict. Data on diverse conflict-resolution practitioners and mentors at a training session on how to overcome the effects of oppression in the writing process illuminated how…

Negative Life Events and Attempted Suicide in Rural China

PubMed Central

Zhang, Wen-Chao; Jia, Cun-Xian; Zhang, Ji-Yu; Wang, Lin-Lin; Liu, Xian-Chen

2015-01-01

Objective This study aimed to examine the association between negative life events (NLEs) and attempted suicide in rural China. Methods Six rural counties were selected from disease surveillance points in Shandong province, China. A total of 409 suicide attempters in rural areas between October 1, 2009, and March 31, 2011, and an equal number of matched controls were interviewed. We compared negative life events experienced within 1 month, 1–3 months, 3–6months, and 6–2 months prior to attempted suicide for cases and prior to interview for controls. We used multivariate logistic regression to examine the association between NLEs and attempted suicide. Results Suicide attempters experienced more NLEs within the last year prior to suicide attempt than controls prior to interview (83.1% vs. 33.5%). There was a significant dose-response relationship between NLEs experienced within the last year and increased risk of attempted suicide. Timing of NLEs analysis showed that NLEs experienced in the last month and 6–12 months prior to suicide attempt were significantly associated with elevated risk of attempted suicide, even after adjusting for mental disorders and demographic factors. Of NLEs, quarrelling with spouse, quarrelling with other family members, conflicting with friends or neighbors, family financial difficulty, and serious illness were independently related to attempted suicide. Conclusion NLEs are significantly associated with increased risk for attempted suicide in rural China. Stress management and intervention may be important to prevent suicidal behavior in rural China. PMID:25611854

VA Suicide Prevention Applications Network

PubMed Central

Stephens, Brady; Morley, Sybil; Thompson, Caitlin; Kemp, Janet; Bossarte, Robert M.

2016-01-01

Objectives: The US Department of Veterans Affairs’ Suicide Prevention Applications Network (SPAN) is a national system for suicide event tracking and case management. The objective of this study was to assess data on suicide attempts among people using Veterans Health Administration (VHA) services. Methods: We assessed the degree of data overlap on suicide attempters reported in SPAN and the VHA’s medical records from October 1, 2010, to September 30, 2014—overall, by year, and by region. Data on suicide attempters in the VHA’s medical records consisted of diagnoses documented with E95 codes from the International Classification of Diseases, Ninth Revision. Results: Of 50 518 VHA patients who attempted suicide during the 4-year study period, data on fewer than half (41%) were reported in both SPAN and the medical records; nearly 65% of patients whose suicide attempt was recorded in SPAN had no data on attempted suicide in the VHA’s medical records. Conclusion: Evaluation of administrative data suggests that use of SPAN substantially increases the collection of data on suicide attempters as compared with the use of medical records alone, but neither SPAN nor the VHA’s medical records identify all suicide attempters. Further research is needed to better understand the strengths and limitations of both systems and how to best combine information across systems. PMID:28123228

VA Suicide Prevention Applications Network: A National Health Care System-Based Suicide Event Tracking System.

PubMed

Hoffmire, Claire; Stephens, Brady; Morley, Sybil; Thompson, Caitlin; Kemp, Janet; Bossarte, Robert M

2016-11-01

The US Department of Veterans Affairs' Suicide Prevention Applications Network (SPAN) is a national system for suicide event tracking and case management. The objective of this study was to assess data on suicide attempts among people using Veterans Health Administration (VHA) services. We assessed the degree of data overlap on suicide attempters reported in SPAN and the VHA's medical records from October 1, 2010, to September 30, 2014-overall, by year, and by region. Data on suicide attempters in the VHA's medical records consisted of diagnoses documented with E95 codes from the International Classification of Diseases, Ninth Revision . Of 50 518 VHA patients who attempted suicide during the 4-year study period, data on fewer than half (41%) were reported in both SPAN and the medical records; nearly 65% of patients whose suicide attempt was recorded in SPAN had no data on attempted suicide in the VHA's medical records. Evaluation of administrative data suggests that use of SPAN substantially increases the collection of data on suicide attempters as compared with the use of medical records alone, but neither SPAN nor the VHA's medical records identify all suicide attempters. Further research is needed to better understand the strengths and limitations of both systems and how to best combine information across systems.

The impact of New Public Management on efficiency: an analysis of Madrid's hospitals.

PubMed

Alonso, José M; Clifton, Judith; Díaz-Fuentes, Daniel

2015-03-01

Madrid has recently become the site of one of the most controversial cases of public healthcare reform in the European Union. Despite the fact that the introduction of New Public Management (NPM) into Madrid hospitals has been vigorous, little scholarship has been done to test whether NPM actually led to technical efficiency. This paper is one of the first attempts to do so. We deploy a bootstrapped data envelopment analysis to compare efficiency scores in traditionally managed hospitals and those operating with new management formulas. We do not find evidence that NPM hospitals are more efficient than traditionally managed ones. Moreover, our results suggest that what actually matters may be the management itself, rather than the management model. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Employing crisis postcards with case management in Kaohsiung, Taiwan: 6-month outcomes of a randomised controlled trial for suicide attempters.

PubMed

Chen, Wei-Jen; Ho, Chi-Kung; Shyu, Shi-Sen; Chen, Cheng-Chung; Lin, Guei-Ging; Chou, Li-Shiu; Fang, Yun-Ju; Yeh, Pin-Yang; Chung, Tieh-Chi; Chou, Frank Huang-Chih

2013-07-17

Suicide attempts constitute a serious clinical problem and have important implications for healthcare resources. The aim of the present study was to evaluate the effectiveness of case management using crisis postcards over a 6-month follow-up period. A randomised controlled trial was conducted in Kaohsiung, Taiwan. Prevention of further suicide attempts was compared between two groups with and without the postcard intervention. The intervention group consisted of 373 participants (139 males, 234 females; age: 39.8 ± 14.0 yrs.). The control group consisted of 388 participants (113 males, 275 females; age: 40.0 ± 16.0 yrs.). A survival analysis was used to test the effectiveness of the crisis postcard intervention for the prevention of suicide reattempts. Per-protocol and intention-to-treat analyses were conducted. The intention-to-treat analysis indicated that the crisis postcard had no effect (hazard ratio = 0.84; 95% CI = 0.56 - 1.29), whereas the per-protocol analysis showed a strong benefit for the crisis postcard (hazard ratio = 0.39; 95% CI = 0.21 - 0.72). Although the results of the present study indicated that the postcard intervention did not reduce subsequent suicide behaviour, our study provides an alteration to the postcard intervention. Further studies need to be conducted to clarify whether this type of intervention can reduce subsequent suicidal behaviour, with a particular focus on reducing the rate of loss to follow-up.

Telemedicine-Assisted Intubation in Rural Emergency Departments: A National Emergency Airway Registry Study.

PubMed

Van Oeveren, Lucas; Donner, Julie; Fantegrossi, Andrea; Mohr, Nicholas M; Brown, Calvin A

2017-04-01

Intubation in rural emergency departments (EDs) is a high-risk procedure, often with little or no specialty support. Rural EDs are utilizing real-time telemedicine links, connecting providers to an ED physician who may provide clinical guidance. We endeavored to describe telemedicine-assisted intubation in rural EDs that are served by an ED telemedicine network. Prospective data were collected on all patients who had an intubation attempt while on the video telemedicine link from May 1, 2014 to April 30, 2015. We report demographic information, indication, methods, number of attempts, operator characteristics, telemedicine involvement/intervention, adverse events, and clinical outcome by using descriptive statistics. Included were 206 intubations. The most common indication for intubation was respiratory failure. First-pass success rate (postactivation) was 71%, and 96% were eventually intubated. Most attempts (66%) used rapid-sequence intubation. Fifty-four percent of first attempts used video laryngoscopy (VL). Telemedicine providers intervened in 24%, 43%, and 55% of first-third attempts, respectively. First-pass success with VL and direct laryngoscopy was equivalent (70% vs. 71%, p = 0.802). Adverse events were reported in 49 cases (24%), which were most frequently hypoxemia. The impact of telemedicine during emergency intubation is not defined. We showed a 71% first-pass rate post-telemedicine linkage (70% of cases had a previous attempt). Our ultimate success rate was 96%, similar to that in large-center studies. Telemedicine support may contribute to success. Telemedicine-supported endotracheal intubation performed in rural hospitals is feasible, with good success rates. Future research is required to better define the impact of telemedicine providers on emergency airway management.

Hospital choice factors: a case study in Turkey.

PubMed

Akinci, Fevzi; Esatoğlu, A Ezel; Tengilimoglu, Dilaver; Parsons, Amy

2004-01-01

In an attempt to test the robustness of the numerous American findings related to hospital choice in the context of another country, this study examines the factors affecting hospital choice decisions of 869 patients in three public and one private hospital policlinics in Ankara, Turkey and attempts to determine their importance levels. Identification of these factors and determining their effect levels is important in concentrating management efforts on these key areas and in formulating effective marketing strategies to retain and expand hospital patient bases in the future. Our findings highlight the importance of accessibility of hospital services to consumers in hospital choice as well as the role of hospital's image, its physical appearance, and technological capabilities in informing such choices. American health care managers can use these findings to further understand how patients make choices related to health care facilities and to develop marketing strategies that may more effectively market their facilities.

Business planning: can the health service move from strategy into action?

PubMed

Bennett, A R

1994-01-01

Advances the case for the use of one particular business planning technique within a National Health Service Trust. At the present time, NHS trusts are required to write strategic direction statements. Evidence suggests that these documents provide an accurate account of past performance and present position of the trust, but do not express the future position intended to be achieved. These documents also tend to be lengthy and lack strategic focus, which means that they are not helpful to managers who want clear organizational goals and objectives to which to work. Attempts to address the difficulties associated with determining how existing skills and resources can be used as the platform for future growth strategies by using the Ansoff Matrix and SWOT Analysis planning tools, given the external changes in the marketplace. Also attempts to shed light on some of the important links between busines strategy and management development by extending planning theory into practice.

Beware Swan-Ganz complications. Perioperative management.

PubMed

Asteri, T; Tsagaropoulou, I; Vasiliadis, K; Fessatidis, I; Papavasi-Liou, E; Spyrou, P

2002-08-01

Since the introduction of the pulmonary artery catheter (PAC) in 1970 by Swan et al., various complications are recognized with the insertion and the use of Swan-Ganz catheter. We present two different cases with rare but life threatening complications which had been successfully managed. The first case is a carotid cannulation with an 8.5 Fr introducer sheath, in an attempt to insert a pulmonary catheter via the right internal jugular vein. Two weeks later, the patient was re-admitted to the hospital and when an arteriovenous fistulae (carotid artery-internal jugular vein) was diagnosed, he was treated surgically. The second case presents the rupture of the right atrium in the conjunction with the superior vena cava. This serious cardiac complication was developed during the floatation of the PAC and the lesion was repaired while the mitral valve replacement was in progress.

Should Let Them Go? Study on the Emergency Department Discharge of Patients Who Attempted Suicide.

PubMed

Shin, Heejun; Kim, Ho Jung; Kim, Shingyeom; Choi, Sunjin; Oh, Heeju; Lee, Bora

2018-06-01

The purpose of this study was to analyze the characteristics and factors of voluntary discharged patients after suicide attempt and analyze the effectiveness of follow-up measures. Total 504 adult patients aged 14 years and over, who visited a local emergency medical center from September 1, 2013 to December 31, 2015 were enrolled and retrospectively reviewed. We analyzed the relationship with voluntary discharge group (VDG) among basic characteristics, suicidal attempt variables, outcome variables related to suicide attempts, and treatment related variables comparing with normal discharge group (NDG). Of the total 504 suicide attempts, three hundred eleven (61.7%) patients were VDG and 193 (38.2%) were NDG. The proportion of patients who completed the community service linkage were 18.7% (36/193) in NDG, compared with 7.7% (24/311) in VDG (p<0.05). In addition, the ratio of the patients who visited psychiatric outpatient department in NDG were 57.0% (110/193), more than four times as likely as 14.5% (45/311) in VDG (p<0.05). Over sixty percent of suicide attempters discharged against medical advice. Further various aspects of national supportive measures including strengthening case management service should be considered.

Hospital closure: Phoenix, Hydra or Titanic?

PubMed

Dunne, T; Davis, S

1996-01-01

Very little has been published about the effects of hospital closure in terms of the service, financial or management issues of the process. Attempts through a case-study format to redress the balance and as such represents the reflections of practitioners who have recently undergone the experience of hospital closure and the often neglected issues arising both during and after the process.

An Analysis of Selected Data Practices: A Case Study of the Purdue College of Agriculture

ERIC Educational Resources Information Center

Pouchard, Line; Bracke, Marianne Stowell

2016-01-01

This paper describes a survey of data practices given to the Purdue College of Agriculture. Data practices are a concern for many researchers with new governmental funding mandates that require data management plans, and for the institution providing resources to comply with these mandates. The survey attempted to answer these questions: What are…

Tracing a Transformation in Industrial Relations. The Case of Xerox Corporation and the Amalgamated Clothing and Textile Workers Union.

ERIC Educational Resources Information Center

Cutcher-Gershenfeld, Joel

A combination of crises and innovative attempts to manage them that began in 1980 transformed the relationship between Xerox Corporation and the Amalgamated Clothing and Textile Workers Union, which represents most of Xerox's manufacturing employees. Eight pivotal episodes were largely responsible for the transformation. The first was a joint…

Evaluative Case Study of the Effectiveness of Professional Development Elements When Implementing a Learning Management System in Elementary Education

ERIC Educational Resources Information Center

Beams, Tara E.

2017-01-01

As school districts across the country attempt to comply with federal and state mandates to effectively integrate technology into today's teaching and learning, they must face the challenge of also developing professional development plans which will adequately and successfully prepare teachers for implementing these new resources and these new…

Inadvertent injection of formalin mistaken for local anesthetic agent: report of a case.

PubMed

Arakeri, Gururaj; Brennan, Peter A

2012-05-01

Chemical facial cellulitis, while commonly seen in domestic accidents or attempted suicide, is uncommon in the dental office and hence rarely addressed in the dental literature. We present an unusual case of chemical facial cellulitis caused by inadvertent injection of formalin into the soft tissues of the oral cavity, which was mistaken for local anesthesia solution. This report comprises the immediate symptoms, possible root cause, and management of the difficult situation. We also provide some guidelines to avoid such unfortunate events. Copyright © 2012 Elsevier Inc. All rights reserved.

Self-Inflicted Nailgun-Induced Penetrating Penile Injury: Case Report and Discussion.

PubMed

Hernandez, Jeremy Mark; Hamilton, David; Upadhye, Suneel

2017-05-01

Penetrating penile injuries occur mostly in industrial/work accidents, automobile accidents, or as a result of sexual curiosity and attempts at self-expression/mutilation. In this case report, the authors describe an accidental nailgun injury to the penis of a 46-year-old man. We discuss the management of such injuries in the emergency department, including the utility of a dorsal penile block for regional anesthesia. Although exceptionally rare, familiarity with penetrating lower urinary tract injuries may reduce their long-term repercussions on genitourinary and sexual health.

Intensive case management for high-risk patients with first-episode psychosis: service model and outcomes.

PubMed

Brewer, Warrick J; Lambert, Timothy J; Witt, Katrina; Dileo, John; Duff, Cameron; Crlenjak, Carol; McGorry, Patrick D; Murphy, Brendan P

2015-01-01

The first episode of psychosis is a crucial period when early intervention can alter the trajectory of the young person's ongoing mental health and general functioning. After an investigation into completed suicides in the Early Psychosis Prevention and Intervention Centre (EPPIC) programme, the intensive case management subprogramme was developed in 2003 to provide assertive outreach to young people having a first episode of psychosis who are at high risk owing to risk to self or others, disengagement, or suboptimal recovery. We report intensive case management model development, characterise the target cohort, and report on outcomes compared with EPPIC treatment as usual. Inclusion criteria, staff support, referral pathways, clinical review processes, models of engagement and care, and risk management protocols are described. We compared 120 consecutive referrals with 50 EPPIC treatment as usual patients (age 15-24 years) in a naturalistic stratified quasi-experimental real-world design. Key performance indicators of service use plus engagement and suicide attempts were compared between EPPIC treatment as usual and intensive case management, and psychosocial and clinical measures were compared between intensive case management referral and discharge. Referrals were predominately unemployed males with low levels of functioning and educational attainment. They were characterised by a family history of mental illness, migration and early separation, with substantial trauma, history of violence, and forensic attention. Intensive case management improved psychopathology and psychosocial outcomes in high-risk patients and reduced risk ratings, admissions, bed days, and crisis contacts. Characterisation of intensive case management patients validated the clinical research focus and identified a first episode of psychosis high-risk subgroup. In a real-world study, implementation of an intensive case management stream within a well-established first episode of psychosis service showed significant improvement in key service outcomes. Further analysis is needed to determine cost savings and effects on psychosocial outcomes. Targeting intensive case management services to high-risk patients with unmet needs should reduce the distress associated with pathways to care for patients, their families, and the community. National Health & Medical Research Council and the Colonial Foundation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Use of orbital floor steroids in the management of patients with uniocular non-necrotising scleritis.

PubMed Central

Hakin, K N; Ham, J; Lightman, S L

1991-01-01

Most cases of non-necrotising scleritis can be successfully treated with non-steroidal anti-inflammatory drugs. If these are ineffective, then high-dose systemic corticosteroids, with all their attendant side-effects, are usually required. We have used orbital floor injections of depot steroid in the management of nine patients with non-necrotising scleritis in an attempt to avoid the use of systemic steroids, or to allow the dose of steroids to be reduced while maintaining disease control. A temporary reduction in inflammation was achieved in all cases, which allowed the use of systemic steroids to be avoided altogether in two patients and delayed in the others. Non-steroidal anti-inflammatory drugs and systemic corticosteroids remain the mainstay of treatment for non-necrotising scleritis, but orbital floor injections may be a useful adjunct in certain cases. Images PMID:2043574

Police officers who commit suicide by cop: a clinical study with analysis.

PubMed

Arias, Elizabeth A; Schlesinger, Louis B; Pinizzotto, Anthony J; Davis, Edward F; Fava, Joanna L; Dewey, Lauren M

2008-11-01

Suicide by cop has become a familiar topic among members of law enforcement, mental health professionals, and the general public. This paper presents two cases where police officers chose to commit suicide by getting other police officers to kill them. The two police officers studied, by examination of closed case files, were found to be similar to civilians who committed suicide by cop on several demographic (gender, age, history of mental illness, and suicide attempts), and situational (stress factors, trigger) variables. The cases help us to understand possible motives and management for individuals who choose to end their life in this manner.

Challenges and lessons learned in the application of autonomy to space operations

NASA Technical Reports Server (NTRS)

Forrest, David J.; Statman, Joseph I.

2001-01-01

NASA's Space Operations Management Office (SOMO) is working toward a goal of providing an integrated infrastructure of mission and data services for space missions undertaken by NASA enterprises. A significant portion of this effort is focused on reducing the cost of these services. We are interested in the potential of autonomy to reduce operations costs. Some attempts have already been made to apply autonomy and automation in these areas in the past with varying degrees of success. We present brief case histories and the lessons inferred from them. Combining this past experience with anticipated future needs, we attempt to clarify the challenges that must be met in order to realize the benefits of autonomy.

Knocked by the shuttlecock: twelve sight-threatening blunt-eye injuries in Australian badminton players.

PubMed

Jao, Kathy K; Atik, Alp; Jamieson, Michael P; Sheales, Mariana P; Lee, Matthew H; Porter, Ashley; Roufas, Athena; Goldberg, Ivan; Zamir, Ehud; White, Andrew; Skalicky, Simon E

2017-07-01

Non-penetrating ocular injuries from badminton shuttlecocks can result in severe damage and life-long complications. This case series highlights the morbidity of such injuries, particularly in regard to post-traumatic glaucoma. This is a retrospective case series of 12 patients with shuttlecock-related blunt eye injuries sustained during badminton play without eye protection. By approaching colleagues through conference presentations and networking, the authors have attempted to gather all known cases of shuttlecock ocular injury managed in tertiary ocular emergency departments or private ophthalmological clinics in Victoria and New South Wales, Australia in 2015. This is the first multicentre case series to describe badminton-related ocular injuries in Australia. Our case series demonstrates, in particular, long-term glaucoma-related morbidity for patients over a large age range (16 to 77 years), with one patient requiring ongoing management 26 years following their initial injury. The cases reported further add to the literature promoting awareness of badminton-related ocular injury. We encourage player education and advocacy on badminton-related eye injuries and appropriate use of eye protection to reduce associated morbidity. © 2016 Optometry Australia.

Unique Approach to Dental Management of Children with Hearing Impairment.

PubMed

Renahan, Navanith; Varma, R Balagopal; Kumaran, Parvathy; Xavier, Arun M

2017-01-01

The number of deaf children has dramatically increased in the past few decades. These children present to the pediatric dentist a unique set of challenges mostly pertaining to the establishment of communication with them. There have been very few attempts in the past to break down these challenges and formulate a strategy on how to manage them effectively. This is a case report of a child who was successfully managed using two different modes of communication. Finally, the advantages and disadvantages are mentioned, and a common strategy incorporating the positives of both the methods has been devised. Renahan N, Varma RB, Kumaran P, Xavier AM. Unique Approach to Dental Management of Children with Hearing Impairment. Int J Clin Pediatr Dent 2017;10(1):107-110.

Including policy and management in socio-hydrology models: initial conceptualizations

NASA Astrophysics Data System (ADS)

Hermans, Leon; Korbee, Dorien

2017-04-01

Socio-hydrology studies the interactions in coupled human-water systems. So far, the use of dynamic models that capture the direct feedback between societal and hydrological systems has been dominant. What has not yet been included with any particular emphasis, is the policy or management layer, which is a central element in for instance integrated water resources management (IWRM) or adaptive delta management (ADM). Studying the direct interactions between human-water systems generates knowledges that eventually helps influence these interactions in ways that may ensure better outcomes - for society and for the health and sustainability of water systems. This influence sometimes occurs through spontaneous emergence, uncoordinated by societal agents - private sector, citizens, consumers, water users. However, the term 'management' in IWRM and ADM also implies an additional coordinated attempt through various public actors. This contribution is a call to include the policy and management dimension more prominently into the research focus of the socio-hydrology field, and offers first conceptual variables that should be considered in attempts to include this policy or management layer in socio-hydrology models. This is done by drawing on existing frameworks to study policy processes throughout both planning and implementation phases. These include frameworks such as the advocacy coalition framework, collective learning and policy arrangements, which all emphasis longer-term dynamics and feedbacks between actor coalitions in strategic planning and implementation processes. A case about longter-term dynamics in the management of the Haringvliet in the Netherlands is used to illustrate the paper.

Management of an oral ingestion of transdermal fentanyl patches: a case report and literature review.

PubMed

Faust, Andrew C; Terpolilli, Ralph; Hughes, Darrel W

2011-01-01

Purpose. Fentanyl is available as a transdermal system for the treatment of chronic pain in opioid-tolerant patients; however, it carries a black box warning due to both the potency of the product and the potential for abuse. In this report, we describe a case of transbuccal and gastrointestinal ingestion of fentanyl patches and the management of such ingestion. Summary. A 32-year-old man was brought to the emergency department (ED) via emergency medical services for toxic ingestion and suicide attempt. The patient chewed and ingested two illegally purchased transdermal fentanyl patches. In the ED, the patient was obtunded, dizzy and drowsy. Initial vital signs showed the patient to be afebrile and normotensive with a heart rate of 63, respiratory rate of 16, and oxygen saturation of 100% on 2 liters nasal cannula after administration of 2 milligrams of intravenous naloxone. The patient was treated with whole bowel irrigation and continuous intravenous naloxone infusion for approximately 48 hours without complications. Conclusion. Despite numerous case reports describing oral ingestion of fentanyl patches, information on the management of such intoxication is lacking. We report successful management of such a case utilizing whole bowel irrigation along with intravenous push and continuous infusion naloxone.

Management of an Oral Ingestion of Transdermal Fentanyl Patches: A Case Report and Literature Review

PubMed Central

Faust, Andrew C.; Terpolilli, Ralph; Hughes, Darrel W.

2011-01-01

Purpose. Fentanyl is available as a transdermal system for the treatment of chronic pain in opioid-tolerant patients; however, it carries a black box warning due to both the potency of the product and the potential for abuse. In this report, we describe a case of transbuccal and gastrointestinal ingestion of fentanyl patches and the management of such ingestion. Summary. A 32-year-old man was brought to the emergency department (ED) via emergency medical services for toxic ingestion and suicide attempt. The patient chewed and ingested two illegally purchased transdermal fentanyl patches. In the ED, the patient was obtunded, dizzy and drowsy. Initial vital signs showed the patient to be afebrile and normotensive with a heart rate of 63, respiratory rate of 16, and oxygen saturation of 100% on 2 liters nasal cannula after administration of 2 milligrams of intravenous naloxone. The patient was treated with whole bowel irrigation and continuous intravenous naloxone infusion for approximately 48 hours without complications. Conclusion. Despite numerous case reports describing oral ingestion of fentanyl patches, information on the management of such intoxication is lacking. We report successful management of such a case utilizing whole bowel irrigation along with intravenous push and continuous infusion naloxone. PMID:21629807

Integrating care for high-risk patients in England using the virtual ward model: lessons in the process of care integration from three case sites

PubMed Central

Lewis, Geraint; Vaithianathan, Rhema; Wright, Lorraine; Brice, Mary R; Lovell, Paul; Rankin, Seth; Bardsley, Martin

2013-01-01

Background Patients at high risk of emergency hospitalisation are particularly likely to experience fragmentation in care. The virtual ward model attempts to integrate health and social care by offering multidisciplinary case management to people at high predicted risk of unplanned hospitalisation. Objective To describe the care practice in three virtual ward sites in England and to explore how well each site had achieved meaningful integration. Method Case studies conducted in Croydon, Devon and Wandsworth during 2011–2012, consisting of semi-structured interviews, workshops, and site visits. Results Different versions of the virtual wards intervention had been implemented in each site. In Croydon, multidisciplinary care had reverted back to one-to-one case management. Conclusions To integrate successfully, virtual ward projects should safeguard the multidisciplinary nature of the intervention, ensure the active involvement of General Practitioners, and establish feedback processes to monitor performance such as the number of professions represented at each team meeting. PMID:24250284

Assessing Commercially Available Personal Health Records for Home Health: Recommendations for Design.

PubMed

Kneale, Laura; Choi, Yong; Demiris, George

2016-01-01

Home health nurses and clients experience unmet information needs when transitioning from hospital to home health. Personal health records (PHRs) support consumer-centered information management activities. Previous work has assessed PHRs associated with healthcare providers, but these systems leave home health nurses unable to access necessary information. To evaluate the ability of publically available PHRs to accept, manage, and share information from a home health case study. Two researchers accessed the publically available PHRs on myPHR.com, and attempted to enter, manage, and share the case study data. We qualitatively described the PHR features, and identified gaps between the case study information and PHR functionality. Eighteen PHRs were identified in our initial search. Seven systems met our inclusion criteria, and are included in this review. The PHRs were able to accept basic medical information. Gaps occurred when entering, managing, and/or sharing data from the acute care and home health episodes. The PHRs that were reviewed were unable to effectively manage the case study information. Therefore, increasing consumer health literacy through these systems may be difficult. The PHRs that we reviewed were also unable to electronically share their data. The gap between the existing functionality and the information needs from the case study may make these PHRs difficult to use for home health environments. Additional work is needed to increase the functionality of the PHR systems to better fit the data needs of home health clients.

The effectiveness of collaborative care for people with memory problems in primary care: results of the CAREDEM case management modelling and feasibility study.

PubMed

Iliffe, Steve; Waugh, Amy; Poole, Marie; Bamford, Claire; Brittain, Katie; Chew-Graham, Carolyn; Fox, Chris; Katona, Cornelius; Livingston, Gill; Manthorpe, Jill; Steen, Nick; Stephens, Barbara; Hogan, Vanessa; Robinson, Louise

2014-08-01

People with dementia and their families need support in different forms, but currently services are often fragmented with variable quality of care. Case management offers a way of co-ordinating services along the care pathway and therefore could provide individualised support; however, evidence of the effectiveness of case management for dementia is inconclusive. To adapt the intervention used in a promising case management project in the USA and test its feasibility and acceptability in English general practice. In work package 1, a design group of varied professionals, with a carer and staff from the voluntary sector, met six times over a year to identify the skills and personal characteristics required for case management; protocols from the US study were adapted for use in the UK. The feasibility of recruiting general practices and patient-carer dyads and of delivering case management were tested in a pilot study (work package 2). An embedded qualitative study explored stakeholder views on study procedures and case management. Four general practices, two in the north-east of England (Newcastle) one in London and one in Norfolk, took part in a feasibility pilot study of case management. Community-dwelling people with dementia and their carers who were not already being case managed by other services. A social worker shared by the two practices in the north-east and practice nurses in the other two practices were trained to deliver case management. We aimed to recruit 11 people with dementia from each practice who were not already being case managed. Numbers of people with dementia and their carers recruited, numbers and content of contacts, needs identified and perceptions of case management among stakeholders. Recruitment of practices and patients was slow and none of the practices achieved its recruitment target. It took more than 6 months to recruit a total of 28 people with dementia. Practice Quality and Outcome Framework registers for dementia contained only 60% of the expected number of people, most living in care homes. All stakeholders were positive about the potential of case management; however, only one of the four practices achieved a level of case management activity that might have influenced patient and carer outcomes. Case managers' activity levels were not related solely to time available for case management. Delivery of case management was hindered by limited clarity about the role, poor integration with existing services and a lack of embeddedness within primary care. There were discrepancies between case manager and researcher judgements about need, and evidence of a high threshold for acting on unmet need. The practice nurses experienced difficulties in ring-fencing case management time. The model of case management developed and evaluated in this feasibility study is unlikely to be sustainable in general practice under current conditions and in our view it would not be appropriate to attempt a definitive trial of this model. This study could inform the development of a case management role with a greater likelihood of impact. Different approaches to recruiting and training case managers, and identifying people with dementia who might benefit from case management, are needed, as is exploration of the scale of need for this type of working. Current Controlled Trials ISRCTN74015152. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 52. See the NIHR Journals Library website for further project information.

In-hospital airway management training for non-anesthesiologist EMS physicians: a descriptive quality control study.

PubMed

Trimmel, Helmut; Beywinkler, Christoph; Hornung, Sonja; Kreutziger, Janett; Voelckel, Wolfgang G

2017-04-26

Pre-hospital airway management is a major challenge for emergency medical service (EMS) personnel. Despite convincing evidence that the rescuer's qualifications determine efficacy of tracheal intubation, in-hospital airway management training is not mandatory in Austria, and often neglected. Thus we sought to prove that airway management competence of EMS physicians can be established and maintained by a tailored training program. In this descriptive quality control study we retrospectively evaluated all in- and pre-hospital airway cases managed by EMS physicians who underwent a structured in-hospital training program in anesthesia at General Hospital Wiener Neustadt. Data was obtained from electronic anesthesia and EMS documentation systems. From 2006 to 2016, 32 EMS physicians with 3-year post-graduate education, but without any prior experience in anesthesia were trained. Airway management proficiency was imparted in three steps: initial training, followed by an ongoing practice schedule in the operating room (OR). Median and interquartile range of number of in-hospital tracheal intubations (TIs) vs. use of supra-glottic airway devices (SGA) were 33.5 (27.5-42.5) vs. 19.0 (15.0-27.0) during initial training; 62.0 (41.8-86.5) vs. 33.5 (18.0-54.5) during the first, and 64.0 (34.5-93.8) vs. 27 (12.5-56.0) during the second year. Pre-hospitaly, every physician performed 9.0 (5.0-14.8) TIs vs. 0.0 (0.0-0.0) SGA cases during the first, and 9.0 (7.0-13.8) TIs vs. 0.0 (0.0-0.3) SGA during the second year. Use of an SGA was mandatory when TI failed after the second attempt, thus accounting for a total of 33 cases. In 8 cases, both TI and SGA failed, but bag mask ventilation was successfully performed. No critical events related to airway management were noted and overall success rate for TI with a max of 2 attempts was 95.3%. Number of TIs per EMS physician is low in the pre-hospital setting. A training concept that assures an additional 60+ TIs per year appears to minimize failure rates. Thus, a fixed amount of working days in anesthesia seems crucial to maintain proficiency. CONCLUSIONS: In-hospital training programs are mandatory for non-anesthetist EMS physicians to gain competence in airway management and emergency anesthesia.Our results might be helpful when discussing the need for regulation and financing with the authorities.

Clinical governance breakdown: Australian cases of wilful blindness and whistleblowing.

PubMed

Cleary, Sonja; Duke, Maxine

2017-01-01

After their attempts to have patient safety concerns addressed internally were ignored by wilfully blind managers, nurses from Bundaberg Base Hospital and Macarthur Health Service felt compelled to 'blow the whistle'. Wilful blindness is the human desire to prefer ignorance to knowledge; the responsibility to be informed is shirked. To provide an account of instances of wilful blindness identified in two high-profile cases of nurse whistleblowing in Australia. Critical case study methodology using Fay's Critical Social Theory to examine, analyse and interpret existing data generated by the Commissions of Inquiry held into Bundaberg Base Hospital and Macarthur Health Service patient safety breaches. All data was publicly available and assessed according to the requirements of unobtrusive research methods and secondary data analysis. Ethical considerations: Data collection for the case studies relied entirely on publicly available documentary sources recounting and detailing past events. Data from both cases reveal managers demonstrating wilful blindness towards patient safety concerns. Concerns were unaddressed; nurses, instead, experienced retaliatory responses leading to a 'social crisis' in the organisation and to whistleblowing. Managers tasked with clinical governance must be aware of mechanisms with the potential to blind them. The human tendency to favour positive news and avoid conflict is powerful. Understanding wilful blindness can assist managers' awareness of the competing emotions occurring in response to ethical challenges, such as whistleblowing.

Severe Refractory Anemia in Primary Intestinal Lymphangiectasia. A Case Report.

PubMed

Balaban, Vasile Daniel; Popp, Alina; Grasu, Mugur; Vasilescu, Florina; Jinga, Mariana

2015-09-01

Primary intestinal lymphangiectasia (Waldmann's disease) is a rare disease characterized by dilated lymphatics in the small bowel leading to an exudative enteropathy with lymphopenia, hypoalbuminemia and hypogammaglobulinemia. We report the case of a 23 year-old male who presented with chronic anemia and in whom primary intestinal lymphangiectasia was diagnosed. A low-fat diet along with nutritional therapy with medium-chain triglyceride supplementation improved the protein-losing enteropathy, but did not solve the anemia. Octreotide was also unsuccessful, and after attempting angiographic embolization therapy, limited small bowel resection together with antiplasmin therapy managed to correct the anemia and control the exudative enteropathy. Although primary intestinal lymphangiectasia is usually adequately managed by nutritional therapy, complications such as anemia can occur and can prove to be a therapeutic challenge.

Asphyxiation Incidents by Hydrogen Sulfide at Manure Storage Facilities of Swine Livestock Farms in Korea.

PubMed

Park, Jihoon; Kang, Taesun; Jin, Suhyun; Heo, Yong; Kim, Kyungran; Lee, Kyungsuk; Tsai, Perngjy; Yoon, Chungsik

2016-01-01

Livestock workers are involved in a variety of tasks, such as caring for animals, maintaining the breeding facilities, cleaning, and manure handling, and are exposed to health and safety risks. Hydrogen sulfide is considered the most toxic by-product of the manure handling process at livestock facilities. Except for several reports in developed countries, the statistics and cause of asphyxiation incidents in farms have not been collected and reported systematically, although the number of these incidents is expected to increase in developing and underdeveloped countries. In this study, the authors compiled the cases of work-related asphyxiation incidents at livestock manure storage facilities and analyzed the main causes. In this survey, a total of 17 incidents were identified through newspapers or online searches and public reports. Thirty workers died and eight were injured due to work-related tasks and rescue attempts from 1998 to 2013 in Korea. Of the 30 fatalities, 18 occurred during manure handling/maintenance tasks and 12 during rescue attempts. All incidents except for one case occurred during the warm season from the late spring (April) to early autumn (September) when manure is likely to decompose rapidly. It is important to train employees involved in the operation of the facilities (i.e., owners, managers, employees) regarding the appropriate prevention strategies for confined space management, such as hazard identification before entry, periodical facility inspection, restriction of unnecessary access, proper ventilation, and health and safety. Sharing information or case reports on previous incidents could also help prevent similar cases from occurring and reduce the number of fatalities and injuries.

A Political Case of Penetrating Cranial Trauma: The Injury of James Scott Brady.

PubMed

Menger, Richard; Kalakoti, Piyush; Hanif, Rimal; Ahmed, Osama; Nanda, Anil; Guthikonda, Bharat

2017-09-01

James Brady, the White House press secretary during President Ronald Reagan's first term in office, was 1 of 4 people (including the President) wounded during an attempted assassination attempt on President Reagan's life on March 30, 1981. John Hinckley, Jr. was found not guilty of this attempt by reason of insanity. The assassination attempt was a ploy by Hinckley, Jr. to impress the actress Jodie Foster. Brady was the most seriously injured of the 4 who were wounded. He suffered a gunshot wound to the left forehead that traveled through the left frontal lobe, corpus callosum, and then into the right frontal and temporal lobes. He initially required a bifrontal craniotomy for evacuation of a right frontotemporal intraparenchymal hemorrhage and debridement of tract. His postoperative course was complicated by seizures, cerebrospinal fluid leakage (necessitating multiple reparative procedures), aspiration pneumonia, and pulmonary emboli. Despite the severity of his injury and perioperative morbidities, Mr. Brady made good recovery. Although permanently left with residual weakness on the left side of his body, making a wheelchair necessary, Brady maintained cognitive and personality traits that were very close to his preinjury baseline. As a result, James Brady and his wife, Sarah, led a call to create legislative reform subsequently known as the "Brady Bill." This bill controversially made mandatory background checks for the purchase of firearms from licensed dealers. Our work aims to describe the assassination attempt, the neurosurgical injury and management of Mr. Brady's case, and the brief historical sequel that followed. Copyright © 2017 by the Congress of Neurological Surgeons.

Environmental problem solving

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

Miller, A.

Human influences create both environmental problems and barriers to effective policy aimed at addressing those problems. In effect, environmental managers manage people as much as they manage the environment. Therefore, they must gain an understanding of the psychological and sociopolitical dimensions of environmental problems that they are attempting to resolve. The author reappraises conventional analyses of environmental problems using lessons from the psychosocial disciplines. The author combines the disciplines of ecology, political sociology and psychology to produce a more adaptive approach to problem-solving that is specifically geared toward the environmental field. Numerous case studies demonstrate the practical application of theorymore » in a way that is useful to technical and scientific professionals as well as to policymakers and planners.« less

Male sexual dysfunction and infertility associated with neurological disorders

PubMed Central

Fode, Mikkel; Krogh-Jespersen, Sheila; Brackett, Nancy L; Ohl, Dana A; Lynne, Charles M; Sønksen, Jens

2012-01-01

Normal sexual and reproductive functions depend largely on neurological mechanisms. Neurological defects in men can cause infertility through erectile dysfunction, ejaculatory dysfunction and semen abnormalities. Among the major conditions contributing to these symptoms are pelvic and retroperitoneal surgery, diabetes, congenital spinal abnormalities, multiple sclerosis and spinal cord injury. Erectile dysfunction can be managed by an increasingly invasive range of treatments including medications, injection therapy and the surgical insertion of a penile implant. Retrograde ejaculation is managed by medications to reverse the condition in mild cases and in bladder harvest of semen after ejaculation in more severe cases. Anejaculation might also be managed by medication in mild cases while assisted ejaculatory techniques including penile vibratory stimulation and electroejaculation are used in more severe cases. If these measures fail, surgical sperm retrieval can be attempted. Ejaculation with penile vibratory stimulation can be done by some spinal cord injured men and their partners at home, followed by in-home insemination if circumstances and sperm quality are adequate. The other options always require assisted reproductive techniques including intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection. The method of choice depends largely on the number of motile sperm in the ejaculate. PMID:22138899

"Puestow modified procedure in the era of advanced endoscopic interventions for the management of chronic lithiasic pancreatitis. A two cases report".

PubMed

Fragulidis, Georgios P; Vezakis, Αntonios; Dellaportas, Dionissios; Sotirova, Ira; Koutoulidis, Vassilis; Kontis, Elliseos; Polydorou, Andreas

2015-01-01

Pancreatic duct calculi in chronic pancreatitis (CP) patients are the main cause of intractable pain which is their main symptom. Decompression options of for the main pancreatic duct are both surgical and advanced endoscopic procedures. A 64-year-old male with known CP due to alcohol consumption and a 36-year-old female with known idiopathic CP and pancreatic duct calculi were managed recently in our hospital where endoscopic procedures were unsuccessful. A surgical therapy was considered and a longitudinal pancreaticojejunostomy (modified Puestow procedure) in both patients was performed with excellent results. Over the last 30 years, endoscopic procedures are developed to manage pancreatic duct strictures and calculi of the main pancreatic duct in CP patients. In both of our cases endoscopic therapy was first attempted but failed to extract the pancreatic duct stones, due to their size and speculations. Modified Puestow procedure was performed for both and it was successful for long term pain relief. Despite advancement in endoscopic interventions and less invasive therapies for the management of chronic lithiasic pancreatitis we consider that classic surgical management can be appropriate in certain cases. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

A mixed-modes approach for estimating hiking on trails through diverse forest landscapes: the case of the Appalachian Trail

Treesearch

Stanley J. Zarnoch; J.M. Bowker; H. Ken Cordell

2011-01-01

Many hiking trails traverse the forests and public lands across North America. It has therefore become important for federal management to gain an understanding of total use on these trails. However, there has never been a formal attempt to estimate hiking on these long, backcountry trails. This paper presents an approach that utilizes two survey instruments (exit-site...

The Strategic Implications of Sustaining and Improving Military Health Care

DTIC Science & Technology

2010-03-01

Soldiers dealing with psychological disorders of their own have been put in charge of others at risk of suicide . Disengaged clerks, unqualified...platoon sergeants, and overworked case managers struggle to provide patient’s with simple needs: feeding soldiers’ families who are close to poverty...require. Suicide attempts and unintentional overdoses from prescription drugs and alcohol have occurred as a direct result of these shortages. No

Work-Based Learning: A Practical Approach for Learning to Work and Working to Learn. A Case Study on Decision-Makers' Professional Development in Iran

ERIC Educational Resources Information Center

Arani, Mohammad Reza Sarkar; Alagamandan, Jafar; Tourani, Heidar

2004-01-01

The work-based learning model of human resource development has captured a great deal of attention and has gained increasing importance in higher education in recent years. Work-based learning is a powerful phenomenon that attempts to help policy-makers, managers and curriculum developers improve the quality of the decision and organizational…

An architecture model for multiple disease management information systems.

PubMed

Chen, Lichin; Yu, Hui-Chu; Li, Hao-Chun; Wang, Yi-Van; Chen, Huang-Jen; Wang, I-Ching; Wang, Chiou-Shiang; Peng, Hui-Yu; Hsu, Yu-Ling; Chen, Chi-Huang; Chuang, Lee-Ming; Lee, Hung-Chang; Chung, Yufang; Lai, Feipei

2013-04-01

Disease management is a program which attempts to overcome the fragmentation of healthcare system and improve the quality of care. Many studies have proven the effectiveness of disease management. However, the case managers were spending the majority of time in documentation, coordinating the members of the care team. They need a tool to support them with daily practice and optimizing the inefficient workflow. Several discussions have indicated that information technology plays an important role in the era of disease management. Whereas applications have been developed, it is inefficient to develop information system for each disease management program individually. The aim of this research is to support the work of disease management, reform the inefficient workflow, and propose an architecture model that enhance on the reusability and time saving of information system development. The proposed architecture model had been successfully implemented into two disease management information system, and the result was evaluated through reusability analysis, time consumed analysis, pre- and post-implement workflow analysis, and user questionnaire survey. The reusability of the proposed model was high, less than half of the time was consumed, and the workflow had been improved. The overall user aspect is positive. The supportiveness during daily workflow is high. The system empowers the case managers with better information and leads to better decision making.

Child sexual abuse: report of 311 cases with review of literature.

PubMed

Essabar, Laila; Khalqallah, Abdenbi; Dakhama, Badr Sououd Benjelloun

2015-01-01

Child sexual abuse (CSA) is a global problem that has significant consequences for public health; it has been a prominent topic of public concern for more than a decade, but many basic facts about the problem remain unclear or in dispute. We conducted a study of 311 cases of CSA in order to highlight the epidemiological features and negative impact on victims' well-being and to emphasize the need for a multidisciplinary approach to the primary prevention and management of CSA. We noted an increase in cases number with male predominance. Most of our patients came from lower socioeconomic classes. The perpetrators were male in 100% of cases; acquaintances in 70% of cases and family members in 22 cases. Physical examination were normal in 61% of cases, however, a range of psychological and physical effects were identified with dramatic health consequences: three cases of attempted suicide, five pregnancies and one case of HIV virus infection.

Case Management Directors

PubMed Central

Bankston White, Cheri; Birmingham, Jackie

2015-01-01

Purpose and Objectives: Case management directors are in a dynamic position to affect the transition of care of patients across the continuum, work with all levels of providers, and support the financial well-being of a hospital. Most importantly, they can drive good patient outcomes. Although the position is critical on many different levels, there is little to help guide a new director in attending to all the “moving parts” of such a complex role. This is Part 2 of a two-part article written for case management directors, particularly new ones. Part 1 covered the first 4 of 7 tracks: (1) Staffing and Human Resources, (2) Compliance and Accreditation, (3) Discharge Planning and (4) Utilization Review and Revenue Cycle. Part 2 addresses (5) Internal Departmental Relationships (Organizational), (6) External Relationships (Community Agency), and (7) Quality and Program Outcomes. This article attempts to answer the following questions: Are case management directors prepared for an expanded role that affects departments and organizations outside of their own?How does a case management director manage the transition of care of patients while managing required relationships outside the department?How does the director manage program outcomes in such a complex department? Primary Practice Setting: The information is most meaningful to those case management directors who work in either stand-alone hospitals or integrated health systems and have frontline case managers (CMs) reporting to them. Findings/Conclusions: Part 1 found that case management directors would benefit from further research and documentation of “best practices” related to their role, particularly in the areas of leadership and management. The same conclusion applies to Part 2, which addresses the director's responsibilities outside her immediate department. Leadership and management skills apply as well to building strong, productive relationships across a broad spectrum of external organizations that include payer, provider, and regulatory agencies. At the same time, they must also develop the skills to positively influence the revenue cycle and financial health of both the organization for which they work and those to whom they transition patients. Implications for Case Management: A director of case management with responsibility for transitions of care has more power and influence over patient safety than is commonly known. Few of the directors who are drawn from clinical case management or other leadership positions and thrust into this role are prepared to navigate within the organization, much less across the whole spectrum of payer, provider, and monitoring organizations. Yet the external focus of the director's role continues to grow in importance as the health care industry evolves and more focus is placed on population management and relationships with payers and community providers. PMID:25700135

Linkage to care among adults being investigated for tuberculosis in South Africa: pilot study of a case manager intervention.

PubMed

Maraba, Noriah; Chihota, Violet; McCarthy, Kerrigan; Churchyard, Gavin J; Grant, Alison D

2018-05-24

We piloted an intervention to determine if support from a case manager would assist adults being investigated for tuberculosis (TB) to link into TB and HIV care. Pilot interventional cohort study. Patients identified by primary healthcare clinic staff in South Africa as needing TB investigations were enrolled. Participants were supported for 3 months by case managers who facilitated the care pathway by promoting HIV testing, getting laboratory results, calling patients to return for results and facilitating treatment initiation. Linkage to TB care was defined as starting TB treatment within 28 days in those with a positive test result; linkage to HIV care, for HIV-positive people, was defined as having blood taken for CD4 count and, for those eligible, starting antiretroviral therapy within 3 months. Intervention implementation was measured by number of attempts to contact participants. Among 562 participants (307 (54.6%) female, median age: 36 years (IQR 29-44)), most 477 (84.8%) had previously tested for HIV; of these, 328/475 (69.1%) self-reported being HIV-positive. Overall, 189/562 (33.6%) participants needed linkage to care (132 HIV care linkage only; 35 TB treatment linkage only; 22 both). Of 555 attempts to contact these 189 participants, 407 were to facilitate HIV care linkage, 78 for TB treatment linkage and 70 for both. At the end of 3-month follow-up, 40 participants had not linked to care (29 of the 132 (22.0%) participants needing linkage to HIV care only, 4 of the 35 (11.4%) needing to start on TB treatment only and 7 of the 22 (31.8%) needing both). Many people testing for TB need linkage to care. Despite case manager support, non-linkage into HIV care remained higher than desirable, suggesting a need to modify this intervention before implementation. Innovative strategies to enable linkage to care are needed. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Occurrence and Recurrence of Attempted Suicide Among People With Epilepsy.

PubMed

Hesdorffer, Dale C; Ishihara, Lianna; Webb, David J; Mynepalli, Lakshmi; Galwey, Nicholas W; Hauser, W Allen

2016-01-01

People with epilepsy have a 5-fold increased risk of suicide. Less is known about attempted suicide and whether psychiatric disorders and antiepileptic drugs modify the risk of attempted suicide. To estimate the magnitude of the association between attempted suicide and epilepsy by comparing a first suicide attempt and a second suicide attempt (hereafter referred to as a recurrent suicide attempt) among people before they received a diagnosis of epilepsy (case patients) with a first suicide attempt and a recurrent suicide attempt among people without epilepsy (control patients), and to evaluate the effect of comorbid psychiatric disorders and the exclusion of antiepileptic drug prescriptions on this association. Population-based retrospective cohort study in the United Kingdom of case patients with incident epilepsy and control patients without a history of epilepsy in a general practice setting using Clinical Practice Research Datalink. The case patients with incident epilepsy were identified between 1987 and 2013 and were 10 to 60 years of age. The control patients for each case patient were 4 randomly selected people who did not receive a diagnosis of epilepsy before the case patient's epilepsy was diagnosed (the index date), matched by year of birth, sex, and general practice for a control to case ratio of 4 to 1. Hazard ratio for incident and recurrent suicide attempts among case patients with epilepsy compared with control patients without. For 14,059 case patients (median age, 36 years [range, 10-60 years]) who later had an onset of epilepsy vs 56,184 control patients (median age, 36 years [range, 10-60 years]), the risk was increased 2.9-fold (95% CI, 2.5- to 3.4-fold) for a first suicide attempt during the time period before the case patients received a diagnosis of epilepsy. For 278 case patients (median age, 37 years [range, 10-61 years]) who later had an onset of epilepsy vs 434 control patients (median age, 35 years [range, 11-61 years]), the risk was increased 1.8-fold (95% CI, 1.3- to 2.5-fold) for a recurrent suicide attempt up to and including the day that epilepsy was diagnosed. Exclusion of antiepileptic drugs prescribed before the index date did not meaningfully alter the findings, nor did separate analyses of patients with and patients without diagnosed psychiatric disorders. Suicide attempts and recurrent suicide attempts are associated with epilepsy even before epilepsy manifests, suggesting a common underlying biology. Our findings indicate that both incident and recurrent suicide attempts are associated with incident epilepsy in the absence of antiepileptic drugs and in the absence of diagnosed psychiatric disorders, further strengthening the evidence for a common underlying etiology with an as-yet-unknown mechanism.

Case management directors: how to manage in a transition-focused world: part 2.

PubMed

Bankston White, Cheri; Birmingham, Jackie

2015-01-01

Case management directors are in a dynamic position to affect the transition of care of patients across the continuum, work with all levels of providers, and support the financial well-being of a hospital. Most importantly, they can drive good patient outcomes. Although the position is critical on many different levels, there is little to help guide a new director in attending to all the "moving parts" of such a complex role.This is Part 2 of a two-part article written for case management directors, particularly new ones.Part 1 covered the first 4 of 7 tracks: (1) Staffing and Human Resources, (2) Compliance and Accreditation, (3) Discharge Planning and (4) Utilization Review and Revenue Cycle. Part 2 addresses (5) Internal Departmental Relationships (Organizational), (6) External Relationships (Community Agency), and (7) Quality and Program Outcomes.This article attempts to answer the following questions: : The information is most meaningful to those case management directors who work in either stand-alone hospitals or integrated health systems and have frontline case managers (CMs) reporting to them. Part 1 found that case management directors would benefit from further research and documentation of "best practices" related to their role, particularly in the areas of leadership and management. The same conclusion applies to Part 2, which addresses the director's responsibilities outside her immediate department. Leadership and management skills apply as well to building strong, productive relationships across a broad spectrum of external organizations that include payer, provider, and regulatory agencies. At the same time, they must also develop the skills to positively influence the revenue cycle and financial health of both the organization for which they work and those to whom they transition patients. A director of case management with responsibility for transitions of care has more power and influence over patient safety than is commonly known. Few of the directors who are drawn from clinical case management or other leadership positions and thrust into this role are prepared to navigate within the organization, much less across the whole spectrum of payer, provider, and monitoring organizations. Yet the external focus of the director's role continues to grow in importance as the health care industry evolves and more focus is placed on population management and relationships with payers and community providers.

Ensuring IT service continuity in the face of increasing threats.

PubMed

Nair, Vishwanath

2014-01-01

How is IT service continuity related to business continuity management? Is it just a glorified disaster recovery procedure? Will IT service continuity help increase the assurance of IT services from the business owner to the customer? This paper is an attempt at answering these and many such questions. It is presented as a case study of IT service continuity management implementation at Emirates Group IT, Dubai. It takes the reader through the need for the process as felt by the business, through the learning acquired during implementation, to the practices deployed for managing the process on an ongoing basis. It provides a detailed view of the kind of pitfalls that could be encountered during implementation of the IT service continuity management process in a large-scale enterprise.

Cardiac missiles. A review of the literature and personal experience.

PubMed Central

Symbas, P N; Picone, A L; Hatcher, C R; Vlasis-Hale, S E

1990-01-01

The management of retained missiles in the heart is still controversial. In an attempt to define the issue more clearly, the reported cases in the English literature from 1940 to 1988 (group 1) and our experience from 1968 to 1988 (group 2) were reviewed. In group 1 there were 222 missiles retained in the hearts of 201 patients. The retained missiles were 45 bullets in 45 patients, 109 shrapnel in 99 patients, 18 pellets in 7 patients, and 50 unidentified missiles in 50 patients. Thirteen of the missiles were completely embedded intramyocardial missiles, 122 were partially intramyocardial, 47 were free in a cardiac chamber, and 40 were intrapericardial. One hundred four of the missiles were removed and 118 were left in place. In group 2 there were 24 missiles, 18 bullets, 1 bullet fragment, and 5 pellets retained in the hearts of 24 patients. Ten missiles were removed, no attempt was made in 13 patients, and an unsuccessful attempt was made to remove one other. From group 1 patients, 6 died, 2 with intracavitary missiles, 3 patients with partially intramyocardial, and 1 patient with an intrapericardial missile, all of whom had either unsuccessful or no attempt to remove the missile. Twenty-seven patients had symptoms, all of whom, except two, had either unsuccessful or no attempt to remove the missile. All group 2 patients did well and had been free of symptoms related to the missiles. This review suggests that the management of missiles in the heart should be individualized according to the patient's clinical course, the site, shape, and size of the missile, and that in selected patients missiles in the heart are tolerated well. PMID:2187422

Cardiac missiles. A review of the literature and personal experience.

PubMed

Symbas, P N; Picone, A L; Hatcher, C R; Vlasis-Hale, S E

1990-05-01

The management of retained missiles in the heart is still controversial. In an attempt to define the issue more clearly, the reported cases in the English literature from 1940 to 1988 (group 1) and our experience from 1968 to 1988 (group 2) were reviewed. In group 1 there were 222 missiles retained in the hearts of 201 patients. The retained missiles were 45 bullets in 45 patients, 109 shrapnel in 99 patients, 18 pellets in 7 patients, and 50 unidentified missiles in 50 patients. Thirteen of the missiles were completely embedded intramyocardial missiles, 122 were partially intramyocardial, 47 were free in a cardiac chamber, and 40 were intrapericardial. One hundred four of the missiles were removed and 118 were left in place. In group 2 there were 24 missiles, 18 bullets, 1 bullet fragment, and 5 pellets retained in the hearts of 24 patients. Ten missiles were removed, no attempt was made in 13 patients, and an unsuccessful attempt was made to remove one other. From group 1 patients, 6 died, 2 with intracavitary missiles, 3 patients with partially intramyocardial, and 1 patient with an intrapericardial missile, all of whom had either unsuccessful or no attempt to remove the missile. Twenty-seven patients had symptoms, all of whom, except two, had either unsuccessful or no attempt to remove the missile. All group 2 patients did well and had been free of symptoms related to the missiles. This review suggests that the management of missiles in the heart should be individualized according to the patient's clinical course, the site, shape, and size of the missile, and that in selected patients missiles in the heart are tolerated well.

Moving from full-time healing work to paid employment: challenges and celebrations.

PubMed

Bergmans, Yvonne; Carruthers, Anne; Ewanchuk, Elizabeth; James, Judy; Wren, Kate; Yager, Christina

2009-01-01

The experiences and barriers associated with the return to paid employment following healing from recurrent suicide attempts related to mental illness have not been addressed in the literature to date. This paper is a collaborative case study between graduates (experts by experience) and facilitators of a psychosocial/psychoeducational group for people with recurrent suicide attempts. The journeys taken by the experts by experience are explored through thematic narrative analysis. Issues of stigma, disclosure, accommodations, maintaining wellness and coming to re-define a sense of self were consistent themes found throughout all narratives. The paper identified key areas of challenge and celebration, suggesting the need for enhanced support from health care providers, workplace managers, supervisors and colleagues for successful transitions into the workplace.

Multiple Attempts for Online Assessments in an Operations Management Course: An Exploration

ERIC Educational Resources Information Center

Orchard, Ryan K.

2016-01-01

In learning management systems, tools for online homework assessments include a number of alternatives for the assessment settings, including the ability to permit students to attempt an assessment multiple times, with options for how the multiple attempts are administered. A specific implementation of online assessments in an introductory…

Modelling a critical infrastructure-driven spatial database for proactive disaster management: A developing country context

PubMed Central

Baloye, David O.

2016-01-01

The understanding and institutionalisation of the seamless link between urban critical infrastructure and disaster management has greatly helped the developed world to establish effective disaster management processes. However, this link is conspicuously missing in developing countries, where disaster management has been more reactive than proactive. The consequence of this is typified in poor response time and uncoordinated ways in which disasters and emergency situations are handled. As is the case with many Nigerian cities, the challenges of urban development in the city of Abeokuta have limited the effectiveness of disaster and emergency first responders and managers. Using geospatial techniques, the study attempted to design and deploy a spatial database running a web-based information system to track the characteristics and distribution of critical infrastructure for effective use during disaster and emergencies, with the purpose of proactively improving disaster and emergency management processes in Abeokuta.

Delayed management of traumatic bilateral cervical facet dislocation: surgical strategy. Report of three cases.

PubMed

Bartels, Ronald H M A; Donk, Roland

2002-10-01

Postinjury cervical spine instability typically requires surgical treatment in the acute or semiacute stage. The authors, however, report on three patients with older (> 8 weeks) untreated bilateral cervical facet dislocation. In two patients they attempted a classic anterior-posterior-anterior approach but failed. The misalignment in the second stage of the procedure could not be corrected, and they had to add a fourth, posterior, stage. To avoid the fourth stage, thereby reducing operating time and risk of neurological damage while turning the patient, they propose the following sequence: 1) a posterior approach to perform a complete facetectomy bilaterally with no attempt to reduce the dislocation; 2) an anterior microscopic discectomy with reduction of the dislocation and anterior fixation; and 3) posterior fixation. This sequence of procedures was successfully performed in the third patient. Based on this experience, they suggest that in cases of nonacute bilateral cervical facet dislocations the operating sequence should be posterior-anterior-posterior.

Innovative Application of a Microlaryngeal Surgery Tube for difficult Airway Management in a Case of Down's Syndrome.

PubMed

Gulabani, Michell; Gupta, Akhilesh; Bannerjee, Neerja Gaur; Sood, Rajesh; Dass, Prashant

2016-04-01

An 11-year-old male child, known case of down's syndrome with congenital oesophageal stricture was posted for oesophageal dilatation. Preoperative airway assessment revealed a high arched palate, receding mandible and Mallampati Score of 2. During surgery, after loss of consciousness which was described as loss of eyelash reflex and adequate jaw relaxation, direct laryngoscopy and endotracheal intubation was attempted with a cuffed endotracheal tube number 5.0mm ID (internal diameter). The endotracheal tube could not be negotiated smoothly, so 5.0mm ID uncuffed endotracheal tube was used which passed through easily, but on auscultation revealed a significant leak. Later, intubation via a Micro Laryngeal Surgery (MLS) cuffed tube 4.0mm ID was attempted. The MLS tube advanced smoothly and there was no associated leak on positive pressure ventilation. Thus by innovative thinking and avant-garde reasoning, a definitive airway device could be positioned with no other suitable alternative at hand.

Efficient Use of Information in Adaptive Management with an Application to Managing Recreation near Golden Eagle Nesting Sites

PubMed Central

Fackler, Paul L.; Pacifici, Krishna; Martin, Julien; McIntyre, Carol

2014-01-01

It is generally the case that a significant degree of uncertainty exists concerning the behavior of ecological systems. Adaptive management has been developed to address such structural uncertainty, while recognizing that decisions must be made without full knowledge of how a system behaves. This paradigm attempts to use new information that develops during the course of management to learn how the system works. To date, however, adaptive management has used a very limited information set to characterize the learning that is possible. This paper uses an extension of the Partial Observable Markov Decision Process (POMDP) framework to expand the information set used to update belief in competing models. This feature can potentially increase the speed of learning through adaptive management, and lead to better management in the future. We apply this framework to a case study wherein interest lies in managing recreational restrictions around golden eagle (Aquila chrysaetos) nesting sites. The ultimate management objective is to maintain an abundant eagle population in Denali National Park while minimizing the regulatory burden on park visitors. In order to capture this objective, we developed a utility function that trades off expected breeding success with hiker access. Our work is relevant to the management of human activities in protected areas, but more generally demonstrates some of the benefits of POMDP in the context of adaptive management. PMID:25098955

Cultural Factors in Managing an FMS Case Program: Saudi Arabian Army Ordnance Corps (SOCP) Program

DTIC Science & Technology

1977-11-01

which included the purchase of large amounts of US;--’,oducee current generation self-Dromelled artillery, personnel earri- ero, tanks, mortar carriers...exores:ecd when attempting, to discuss 13 complex, sophisticated technical material with senior counterparts who possessed relative fluency in...i.ored -:ith ’ mop ity; they crnnot be rvoided; the: can to a rrroat extent be anticipated as critical man- cement factors. Bfy anticipating and preparing

Management of geminated maxillary lateral incisor using cone beam computed tomography as a diagnostic tool.

PubMed

James, Elizabeth Prabha; Johns, Dexton Antony; Johnson, Ki; Maroli, Ramesh Kumar

2014-05-01

Geminated teeth are consequences of developmental anomalies leading to joined elements, due to incomplete attempt of one tooth germ to divide into two. This case report describes successful endodontic treatment of an unaesthetic geminated permanent maxillary lateral incisor tooth and its esthetic rehabilitation using all ceramic crowns. Newer imaging technique like cone beam computed tomography was taken for the better understanding of the complicated root canal morphology.

Genital malodor in women: a modern reappraisal.

PubMed

Subramanian, Chithra; Nyirjesy, Paul; Sobel, Jack D

2012-01-01

Genital malodor is a common distressing complaint that brings a woman to her physician's office. Vaginal infections, primarily bacterial vaginosis and trichomoniasis, still remain the commonest causes and are relatively easy to diagnose and treat. However, in approximately one third of women who present with malodor, no cause is identified. Although data on the management of vaginal discharge are extensive, the management of genital odor beyond common vaginal infections remains poorly studied. This presents a frustrating situation for both the patient and her physician. Often, patients resort to home remedies and over-the-counter preparations, which, while providing short-term relief for some women, almost never address the cause and, in some cases, can exacerbate symptoms. In this review, we have attempted to consolidate the known and documented causes of genital malodor including the nonvaginal causes and provide case studies that will help clinicians understand the possible settings for the various causes. We also provide an algorithm for the management of this symptom beyond vaginal infections.

Exporting the Buyers Health Care Action Group Purchasing Model: Lessons from Other Communities

PubMed Central

Christianson, Jon B; Feldman, Roger

2005-01-01

When first implemented in Minneapolis and St. Paul, Minnesota, the Buyers Health Care Action Group's (BHCAG) purchasing approach received considerable attention as an employer-managed, consumer-driven health care model embodying many of the principles of managed competition. First BHCAG and, later, a for-profit management company attempted to export this model to other communities. Their efforts were met with resistance from local hospitals and, in many cases, apathy by employers who were expected to be supportive. This experience underscores several difficulties that appear to be inherent in implementing purchasing models based on competing care systems. It also, once again, suggests caution in drawing lessons from community-level experiments in purchasing health care. PMID:15787957

Vocational rehabilitation case manager factors associated with vocational rehabilitation service program outcomes for people with disabilities in Taiwan - an exploratory study.

PubMed

Wang, Yun-Tung; Lin, Yi-Jiun

2017-02-01

Purpose The aim of this study is to explore whether/which vocational rehabilitation case manager (VRCMer) factors were significantly associated with the vocational rehabilitation service (VRS) program outcomes in Taiwan. Method This study used the 2011 VRS Program for People with Disabilities Database in a metropolitan city in Taiwan (N = 466) to do a secondary data analysis using hierarchical logistic regression. Results This study found that the employment rate and stable employment rate created by the 2011 VRS program in a metropolitan city in Taiwan were 48.7% and 42.1%, respectively. For the predictors of employment/stable employment, "occurrences of the services provided by the VRCMer" variable was definitely dominant. In addition, "level of the disability" was the second-ranking predictor, and was significantly negatively correlated with both employment and stable employment outcomes. Conclusions Vocational rehabilitation case manager factors in this study were significantly correlated with VRS program outcomes for people with disabilities in Taiwan after controlling for the clients' socio-demographic variables. The results indicate that greater input by VRCMers for people with disabilities equates to better employment outcomes in metropolitan Taiwan. Implications for Rehabilitation This is the first study to build an inferential statistical model in attempt to explain and predict the association between vocational rehabilitation case manager factors and vocational rehabilitation service program outcomes for people with disabilities in Taiwan. In cases of severe disability, a vocational rehabilitation case manager should seek out more in-kind and in-cash resources, and choose a suitable job coach to cooperate in assisting the client to become employed. Based on the findings, government has to continue implementing opportunities for people with disabilities to attain higher and better quality educational levels, for increasing their employment rate. Vocational rehabilitation case managers should raise the referral rate and cooperation with job coaches as this directly affects the quality of services and clients' employment rate.

Nursing students’ attitude towards suicide attempters: A study from rural part of Northern India

PubMed Central

Nebhinani, Mamta; Nebhinani, Naresh; Tamphasana, L.; Gaikwad, Achla D.

2013-01-01

Context: Majority of health professionals have unfavorable attitudes towards patients presenting with self-harm, which further compromises their willingness and outcome of care. Aims: To assess the nursing students’ attitudes toward suicide attempters. Settings and Design: Cross-sectional study was conducted in two nursing colleges of north India. Material and Methods: Three hundred and eight nursing students were recruited through total enumeration method from May to June 2012. ‘Suicide opinion questionnaire’ was administered to assess their attitudes towards suicide attempters. Statistical Analysis Used: Descriptive statistics was employed with Statistical Package for Social Sciences version 14.0 for Windows. Results: Majority were single females, from urban locality, with the mean age of 20 years. Only minority had previous exposure to suicide prevention programs and management of such cases. Majority of students agreed for mental illness, disturbed family life, and depression as major push to attempt suicide. They held favorable attitude for half of the attitudinal statement, but they were uncertain for rest half of the statements. Conclusions: They generally had favorable attitude towards suicide attempters. Their uncertain response highlights the need for enhancing educational exposure of nursing students and new staff at the earliest opportunity, to carve their favorable attitude towards patients presenting with self-harm. PMID:24347946

Strategy in the Surgical Treatment of Primary Spinal Tumors

PubMed Central

Williams, Richard; Foote, Matthew; Deverall, Hamish

2012-01-01

Primary spine tumors are rare, accounting for only 4% of all tumors of the spine. A minority of the more common primary benign lesions will require surgical treatment, and most amenable malignant lesions will proceed to attempted resection. The rarity of malignant primary lesions has resulted in a paucity of historical data regarding optimal surgical and adjuvant treatment and, although we now derive benefit from standardized guidelines of overall care, management of each neoplasm often proceeds on a case-by-case basis, taking into account the individual characteristics of patient operability, tumor resectability, and biological potential. This article aims to provide an overview of diagnostic techniques, staging algorithms and the authors' experience of surgical treatment alternatives that have been employed in the care of selected benign and malignant lesions. Although broadly a review of contemporary management, it is hoped that the case illustrations given will serve as additional “arrows in the quiver” of the treating surgeon. PMID:24353976

Mammalian meat allergy following a tick bite: a case report.

PubMed

Jackson, W Landon

2018-02-01

The alpha-gal allergy is an emerging IgE-mediated reaction against the galactose-alpha-1,3-galactose carbohydrate found in mammalian meats. Patients with this condition will develop anaphylactic symptoms 3-6 h after the ingestion of mammalian meat food products such as beef, pork or lamb. The prevalence of this allergy is drastically increasing and severe reactions including anaphylactic shock have been reported, yet many patients experience symptoms for years before a diagnosis is made. We describe the presentation, diagnosis and management of a patient with the alpha-gal allergy in attempt to improve early recognition and management of patients with this condition.

Mammalian meat allergy following a tick bite: a case report

PubMed Central

2018-01-01

Abstract The alpha-gal allergy is an emerging IgE-mediated reaction against the galactose-alpha-1,3-galactose carbohydrate found in mammalian meats. Patients with this condition will develop anaphylactic symptoms 3–6 h after the ingestion of mammalian meat food products such as beef, pork or lamb. The prevalence of this allergy is drastically increasing and severe reactions including anaphylactic shock have been reported, yet many patients experience symptoms for years before a diagnosis is made. We describe the presentation, diagnosis and management of a patient with the alpha-gal allergy in attempt to improve early recognition and management of patients with this condition. PMID:29492269

The successful use of simple tube duodenostomy in large duodenal perforations from varied etiologies

PubMed Central

Kutlu, Onur C.; Garcia, Steven; Dissanaike, Sharmila

2012-01-01

INTRODUCTION Tube decompression of the duodenum is an old but underutilized technique known to decrease morbidity and mortality in patients with difficult to manage duodenal injuries. Broad arrays of techniques have been described in the literature and are reviewed, but most are complex procedures not appropriate for the management of an unstable patient. PRESENTATION OF CASE In this paper we describe the technique of tube duodenostomy and the successful application in three cases of large defects (>3 cm) which two of these cases had failed previous repair attempts. The defects were caused by very different etiologies, including blunt trauma, peptic ulcer disease and erosion from cancer. All were finally managed by application of tube duodenostomy with success. DISCUSSION Patients with “difficult to manage duodenum” usually present with hemodynamic instability with hostile abdomen. Complex procedures in an unstable patient are associated with adverse outcomes. In patients with significant comorbidities and instability the damage control principle of trauma surgery is gaining popularity. Tube duodenostomy technique described in this paper fits in well with that principle. CONCLUSION Application of tube duodenostomy instead of a complex procedure in an unstable patient provides an opportunity to stabilize the patient, converting an impending catastrophe to a future scheduled surgery. PMID:23357008

Attempted salvage of infected cardiovascular implantable electronic devices: Are there clinical factors that predict success?

PubMed

Peacock, James E; Stafford, Jeanette M; Le, Katherine; Sohail, Muhammad Rizwan; Baddour, Larry M; Prutkin, Jordan M; Danik, Stephan B; Vikram, Holenarasipur R; Hernandez-Meneses, Marta; Miró, José M; Blank, Elisabeth; Naber, Christoph K; Carrillo, Roger G; Greenspon, Arnold J; Tseng, Chi-Hong; Uslan, Daniel Z

2018-03-08

Published guidelines mandate complete device removal in cases of cardiovascular implantable electronic device (CIED) infection. Clinical predictors of successful salvage of infected CIEDs have not been defined. Data from the Multicenter Electrophysiologic Device Infection Collaboration, a prospective, observational, multinational cohort study of CIED infection, were used to investigate whether clinical predictors of successful salvage of infected devices could be identified. Of 433 adult patients with CIED infections, 306 (71%) underwent immediate device explantation. Medical management with device retention and antimicrobial therapy was initially attempted in 127 patients (29%). "Early failure" of attempted salvage occurred in 74 patients (58%) who subsequently underwent device explantation during the index hospitalization. The remaining 53 patients (42%) in the attempted salvage group retained their CIED. Twenty-six (49%) had resolution of CIED infection (successful salvage group) whereas 27 patients (51%) experienced "late" salvage failure. Upon comparing the salvage failure group, early and late (N = 101), to the group experiencing successful salvage of an infected CIED (N = 26), no clinical or laboratory predictors of successful salvage were identified. However, by univariate analysis, coagulase-negative staphylococci as infecting pathogens (P = 0.0439) and the presence of a lead vegetation (P = 0.024) were associated with overall failed salvage. In patients with definite CIED infections, clinical and laboratory variables cannot predict successful device salvage. Until new data are forthcoming, device explantation should remain a mandatory and early management intervention in patients with CIED infection in keeping with existing expert guidelines unless medical contraindications exist or patients refuse device removal. © 2018 Wiley Periodicals, Inc.

Approaches to reduce urinary tract injury during management of placenta accreta, increta, and percreta: a systematic review.

PubMed

Tam Tam, Kiran Babu; Dozier, James; Martin, James Nello

2012-04-01

A systematic review of the literature was conducted to answer the following question: are there enhancements to standard peripartum hysterectomy technique that minimize unintentional urinary tract (UT) injury in pregnancies complicated by invasive placental attachment (INPLAT)? A PubMed search of English language articles on INPLAT published by June 2010 was conducted. Data regarding the following parameters was required for inclusion in the quantitative analysis of the review's objective: (1) type of INPLAT, (2) details pertaining to medical and surgical management of INPLAT, and (3) complications, if any, associated with management. An attempt was made to identify approaches that may lower the risk of unintentional UT injury. Most cases (285 of 292) were managed by hysterectomy. There were 83 (29%) cases of unintentional UT injury. Antenatal diagnosis of INPLAT lowered the rate of UT injury (39% vs. 63%; P = 0.04). Information regarding surgical technique or medical management was available for 90 cases; 14 of these underwent a standard hysterectomy technique. Methotrexate treatment and 11 modifications of the surgical technique were associated with 16% unintentional UT injury rate as opposed to 57% for standard hysterectomy (P = 0.002). The use of ureteral stents reduced risk of urologic injury (P = 0.01). Multiple logistic regression analysis identified antenatal diagnosis as the significant predictor of an intact UT. Antenatal diagnosis of INPLAT is paramount to minimize UT injury. Utilization of management modifications identified in this review may reduce urologic injury due to INPLAT.

Eco-psychiatry and Environmental Conservation: Study from Sundarban Delta, India

PubMed Central

Chowdhury, Arabinda N.; Mondal, Ranajit; Brahma, Arabinda; Biswas, Mrinal K.

2008-01-01

Aims: This study attempts to examine the extent and impact of human-animal conflicts visa-vis psychosocial stressors and mental health of affected people in two villages adjacent to Sundarban Reserve Forest (SRF) in the Gosaba Block, West Bengal, India. Methods: Door to door household survey for incidents of human-animal conflicts, Focus Group Discussions, In-depth Interviews, Case studies, Community Mental health clinics and participatory observation. Results: A total of 3084 households covering a population of 16,999 were surveyed. 32.8% people live on forest-based occupation. During the last 15 years 111 persons (male 83, female 28) became victims of animal attacks, viz, Tiger (82%), Crocodile (10.8%) and Shark (7.2%) of which 73.9% died. In 94.5% cases the conflict took place in and around the SRF during livelihood activities. Tracking of 66 widows, resulted from these conflicts, showed that majority of them (51.%) are either disabled or in a very poor health condition, 40.9% are in extreme economic stress and only 10.6% remarried. 1 widow committed suicide and 3 attempted suicide. A total of 178 persons (male 82, female 96) attended the community mental health clinics. Maximum cases were Major Depressive Disorder (14.6%), followed by Somatoform Pain Disorder (14.0%), Post Traumatic Stress Disorder-animal attack related (9.6%) and Adjustment Disorder (9%). 11.2% cases had history of deliberate self-harm attempt, of which 55% used pesticides. Conclusions: Improvement of quality of life of this deltaic population by appropriate income generation and proper bio-forest management are the key factors to save their life as well as the mangrove environment of the Sundarban region. PMID:21572831

Eco-psychiatry and Environmental Conservation: Study from Sundarban Delta, India.

PubMed

Chowdhury, Arabinda N; Mondal, Ranajit; Brahma, Arabinda; Biswas, Mrinal K

2008-09-12

This study attempts to examine the extent and impact of human-animal conflicts visa-vis psychosocial stressors and mental health of affected people in two villages adjacent to Sundarban Reserve Forest (SRF) in the Gosaba Block, West Bengal, India. Door to door household survey for incidents of human-animal conflicts, Focus Group Discussions, In-depth Interviews, Case studies, Community Mental health clinics and participatory observation. A total of 3084 households covering a population of 16,999 were surveyed. 32.8% people live on forest-based occupation. During the last 15 years 111 persons (male 83, female 28) became victims of animal attacks, viz, Tiger (82%), Crocodile (10.8%) and Shark (7.2%) of which 73.9% died. In 94.5% cases the conflict took place in and around the SRF during livelihood activities. Tracking of 66 widows, resulted from these conflicts, showed that majority of them (51.%) are either disabled or in a very poor health condition, 40.9% are in extreme economic stress and only 10.6% remarried. 1 widow committed suicide and 3 attempted suicide. A total of 178 persons (male 82, female 96) attended the community mental health clinics. Maximum cases were Major Depressive Disorder (14.6%), followed by Somatoform Pain Disorder (14.0%), Post Traumatic Stress Disorder-animal attack related (9.6%) and Adjustment Disorder (9%). 11.2% cases had history of deliberate self-harm attempt, of which 55% used pesticides. Improvement of quality of life of this deltaic population by appropriate income generation and proper bio-forest management are the key factors to save their life as well as the mangrove environment of the Sundarban region.

Failed manual removal of the placenta after vaginal delivery.

PubMed

Bjurström, Johanna; Collins, Sally; Langhoff-Roos, Jens; Sundberg, Karin; Jørgensen, Annemette; Duvekot, Johannes J; Groenbeck, Lene

2018-02-01

A retained placenta after vaginal delivery where manual removal of placenta fails is a clinical challenge. We present six cases that illustrate the heterogeneity of the condition and discuss the etiology and terminology as well as the clinical management. Members of the European Working group on Abnormally Invasive Placenta (EW-AIP) were invited to report all recent cases of retained placenta that were not antenatally suspected to be abnormally adherent or invasive, but could not be removed manually despite several attempts. The six cases from Denmark, The Netherlands and the UK provide examples of various treatment strategies such as ultrasound-guided vaginal removal, removal of the placenta through a hysterotomy and just leaving the placenta in situ. The placentas were all retained, but it was only possible to diagnose abnormal invasion in the one case, which had a histopathological diagnosis of increta. Based on these cases we present a flow chart to aid clinical management for future cases. We need properly defined stringent terminology for the different types of retained placenta, as well as improved tools to predict and diagnose both abnormally invasive and abnormally adherent placenta. Clinicians need to be aware of the options available to them when confronted by the rare case of a retained placenta that cannot be removed manually in a hemodynamically stable patient.

Pediatric Emergency Department Suicidal Patients: Two-Site Evaluation of Suicide Ideators, Single Attempters, and Repeat Attempters

ERIC Educational Resources Information Center

Asarnow, Joan Rosenbaum; Baraff, Larry J.; Berk, Michele; Grob, Charles; Devich-Navarro, Mona; Suddath, Robert; Piacentini, John; Tang, Lingqi

2008-01-01

The study examines ideators, single attempters, and repeats attempters of suicide to clarify optimal strategies for emergency department management and risk assessment to help them in reducing youth suicide and suicide attempts. Depression was found to be a strong predictor of suicide/suicide attempts along with substance use, externalizing…

Estimating the rates of deaths by suicide among adults who attempt suicide in the United States.

PubMed

Han, Beth; Kott, Phillip S; Hughes, Art; McKeon, Richard; Blanco, Carlos; Compton, Wilson M

2016-06-01

In 2012, over 1.3 million U.S. adults reported that they attempted suicide in the past year, and 39,426 adults died by suicide. This study estimated national suicide case fatality rates among adult suicide attempters (fatal and nonfatal cases) and examined how they varied by sociodemographic characteristics. We pooled data on deaths by suicide (n = 147,427, fatal cases in the U.S.) from the 2008-2011 U S. mortality files and data on suicide attempters who survived (n = 2000 nonfatal cases) from the 2008-2012 National Surveys on Drug Use and Health. Descriptive analyses and multivariable logistic regression models were applied. Among adult suicide attempters in the U.S., the overall 12-month suicide case fatality rate was 3.2% (95% confidence interval (CI) = 2.9%-3.5%). It varied significantly by sociodemographic factors. For those aged 45 or older, the adjusted suicide case fatality rate was higher among men (7.6%) than among women (2.6%) (suicide case fatality rate ratio (SCFRR) = 3.0, 95% CI = 1.83-4.79), was higher among non-Hispanic whites (7.9%) than among non-white minorities (0.8-2.5%) (SCFRRs = 3.2-9.9), and was higher among those with less than high school education (16.0%) than among college graduates (1.8%) (SCFRR = 8.8, 95% CI = 3.83-20.16). Across male and female attempters, being aged 45 or older and non-Hispanic white and having less than secondary school were at a higher risk for death by suicide. Focusing on these demographic characteristics can help identify suicide attempters at higher risk for death by suicide, inform clinical assessments, and improve suicide prevention and intervention efforts by increasing high-risk suicide attempters' access to mental health treatment. Published by Elsevier Ltd.

Unconsummated marriage in sub-Saharan Africa: case reports.

PubMed

Lema, Valentino M

2014-09-01

Unconsummated marriage is a condition where newly married couples are unable to achieve penile-vaginal intercourse for variable periods despite desire and several attempts to do so. Its exact cause(s) is/are unknown, but performance anxiety resulting from or leading to other conditions is reportedly the major etiological factor. It is thought to be more prevalent in traditional and conservative religious communities where premarital sexual exposure is strictly prohibited. Most publications on unconsummated marriage have originated from North America, European and Middle Eastern countries. There have not been any such reports from sub-Saharan Africa, which is home to diverse cultures and traditions regarding premarital sex and marriage. This paper presents a sample of four cases with unconsummated marriage managed by the author in his private clinic based in the city of Nairobi Kenya, over the past five years. Possible etiological factors and management approaches are discussed, with a review of relevant literature.

Integrated and adaptive management of water resources: Tensions, legacies, and the next best thing

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

Engle, Nathan L.; Johns, Owen R.; Lemos, Maria Carmen

2011-02-01

Integrated water resources management (IWRM) and adaptive management (AM) are two institutional and management paradigms designed to address shortcomings within water systems governance – the limits of hierarchical water institutional arrangements in the case of IWRM and the challenge of making water management decisions under uncertainty in the case of AM. Recently, there has been a trend to merge these paradigms to address the growing complexity of stressors shaping water management, such as globalization and climate change. However, because many of these joint approaches have received little empirical attention, questions remain about how they might work (or not) in practice.more » Here, we explore a few of these issues using empirical research carried out in Brazil. We focus on highlighting the potentially negative interactions, tensions, and tradeoffs between different institutions/mechanisms perceived as desirable as research and practice attempt to make water systems management simultaneously integrated and adaptive. Our examples pertain mainly on the use of techno-scientific knowledge in water management and governance in Brazil’s IWRM model and how it relates to participation, democracy, deliberation, diversity, and adaptability. We show that a legacy of technical and hierarchical management has shaped the integration of management, and subsequently, the degree to which management might also be adaptive. While integrated systems may be more legitimate and accountable than top-down command and control ones, the mechanisms of IWRM may be at odds with the flexible, experimental, and self-organizing nature of AM.« less

Chronic tinnitus resulting from cerumen removal procedures.

PubMed

Folmer, Robert L; Shi, Baker Yongbing

2004-01-01

This study was undertaken to determine how many cases of chronic tinnitus in a clinic population resulted from cerumen removal procedures and to summarize cerumen management methodologies and recommendations that will reduce the likelihood of such serious complications. Detailed questionnaires were mailed to 2400 consecutive patients (1704 male, 696 female; mean age, 53.3 +/- 11.8 years; age range, 7-87 years) prior to their initial appointment at the Oregon Health & Science University Tinnitus Clinic between 1986 and 2000. These questionnaires requested information about patients' medical, hearing, and tinnitus histories. Records were analyzed to determine how many patients reported that their chronic tinnitus began as a result of cerumen removal procedures. Of 2400 patients, 11 (0.46%) reported that their tinnitus began as a result of cerumen removal procedures performed by clinicians. Three additional patients reported that chronic tinnitus began as a result of their own attempts to clean their ear canals. Chronic and debilitating conditions, such as hearing loss and tinnitus, can occur as results of attempts to remove cerumen. By following the recommendations of experts in cerumen management techniques, clinicians can reduce the likelihood of catastrophic complications and subsequent litigation.

Epidemiological aspects of suicide attempts among Moroccan children.

PubMed

Mekaoui, Nour; Karboubi, Lamiae; Ouadghiri, Fatima Zahra; Dakhama, Badr Sououd Benjelloun

2016-01-01

Suicidal behavior among children has significantly increased in Morocco. We conducted a study on the epidemiological aspect to propose a treatment strategy. Descriptive retrospective study over a period of 3 years (April 2012-April 2015) involving children who visited pediatric medical emergencies of the Children Hospital of Rabat after an autolysis attempt. We observed epidemiological parameters, history, social and family context, the means used, the presumed cause, clinical manifestation, and the management. 66 patients were identified. A female predominance was found (sex =15). The average age was 13 years old. This was a first episode in 97% of cases. Psychiatric history was found in 6 patients. The causes of suicide attempt were unidentified in 65%. The most frequent cause was family conflict (35%). The most frequent method was pharmaceutical drug ingestion (54.4%). Children were asymptomatic (57.6%). Neurological manifestations (30%) were most frequent. Digestive symptoms (12%) and hemodynamic (3%) were also discovered. Patients were hospitalized in a general pediatric service 92.4% of the times, admitted to intensive care 4.5% of the times, and two patients refused to be hospitalized. The treatment consisted of gastric lavage (18%) supplemented by symptomatic measures. The outcome was favorable in 95.4% of cases. We recorded 2 deaths by rat poison poisoning. All patients were advised in writing after leaving to follow up with a psychological treatment. Suicide attempts are the result of an ill being, mostly among children living in a family with conflict. Upstream treatment is essential to identify children at risk. Additionally, a psychiatric care in hospital is essential to avoid recurrences.

Management of ingested foreign bodies in childhood: our experience and review of the literature.

PubMed

Hachimi-Idrissi, S; Corne, L; Vandenplas, Y

1998-09-01

The management of foreign bodies in the gastrointestinal tract is not standardized. Retrospectively, we analysed the management of 174 cases of accidental ingestion of foreign bodies in children. No child had ingested more than one foreign object. The ingested foreign bodies were: coins, toy parts, jewels, batteries, 'sharp' materials such as needles and pins, fish and chicken bone, and 'large' amounts of food. Of the patients 51% had transient symptoms at the moment of ingestion, such as retrosternal pain, cyanosis and dysphasia. Attempts to extract the foreign body either by a magnet tube, endoscopy or McGill forceps was performed in 83 patients. The majority of the extracted foreign bodies were batteries and sharp materials. The outcome of all the patients was excellent. No complications were observed.

Necrotizing Fasciitis

PubMed Central

Sadasivan, Jagdish; Maroju, Nanda Kishore; Balasubramaniam, Anandh

2013-01-01

Necrotizing fasciitis (NF) is among the most challenging surgical infections faced by a surgeon. The difficulty in managing this entity is due to a combination of difficulty in diagnosis, and also of early as well as late management. For the patient, such a diagnosis means prolonged hospital stay, painful dressings, an extended recovery, and in some unfortunate cases even loss of limb or life. Necrotizing fasciitis is a fairly common condition in surgical practice in the Indian context resulting in a fairly large body of clinical experience. This article reviews literature on MEDLINE with the key words “necrotizing,” “fasciitis,” and “necrotizing infections” from 1970, as well as from articles cross referenced therein. The authors attempt to draw comparisons to their own experience in managing this condition to give an Indian perspective to the condition. PMID:24459334

Childhood intussusception: A prospective study of management trend in a developing country.

PubMed

Ogundoyin, Olakayode Olaolu; Olulana, Dare Isaac; Lawal, Taiwo Akeem

2015-01-01

The management of intussusception has evolved universally from the use of hydrostatic reduction through operative reduction to the use of pneumatic reduction for the acute and uncomplicated cases and surgical reduction for the complicated cases. However, the process of evolution has been very slow in the developing countries, especially sub-Saharan Africa, due to lack of requisite facilities and expertise to manage these patients nonoperatively. This study examined the trends in the management of childhood intussusception in a developing country, compared operative and nonoperative modalities of treatment, and assessed the impact of delayed presentation on the outcome of management. This was a prospective study of the management of children with intussusception at the University College Hospital, Ibadan, Nigeria. Fifty-five consecutive cases of intussusception that presented to the Children Emergency Unit of the University College Hospital between January 2005 and December 2011 were prospectively studied. Details of sex, age of the patients, clinical presentation, duration of symptoms, mode of treatment, and incidence of recurrence were recorded and analyzed. The median age was 7 months. Moreover, the duration of symptoms varied from 1 to 21 days with a mean of 4 days. Twenty-two patients (40%) had attempted hydrostatic reduction; this was successful in 14 patients (63.6%), whereas 8 patients (36.4%) had failed reduction. In all, 41 patients (74.6%) had operative management of intussusceptions; primary operative intervention was carried out in 33 patients (60%) and secondary surgical management in 8 patients (14.5%) with failed hydrostatic reduction. At surgery, manual reduction of intussusception was carried out on 17 patients (30.9%) and resection of devitalized bowel with end to end anastomosis was carried out on the remaining 24 patients (43.6%). The incidence of surgical intervention for intussusception was 74.6%, mortality was 3.6%, and recurrence rate was 3.6%. Nonoperative management of intussusception should be adopted in carefully selected cases of intussusception in this subregion as it will help to reduce the financial burden on the parents while surgical management should be reserved for the complicated cases.

A 30-Year Retrospective: Degrees of Difficulty in Decreasing LOS.

PubMed

Zander, Karen

2016-01-01

In an attempt to avoid future revisionist history, the author offers a 30-year retrospective (1986-2016) on the evolution of strategies to reduce length of stay (LOS). She and her colleagues have been involved from the onset by developing tools such as critical paths, roles such as clinical case management, and operational systems for managing measureable outcome-driven care from the bedside to the boardroom. Acute care hospitals. The LOS for all inpatients has changed dramatically from 1970 (average LOS = 7.8 days) through solidly between 2005 and 2012 (average LOS = 4.5 days in 2012) despite a significant increase in the average age of hospital inpatients (; ). For patients 65 years and older, who comprised 38% of all inpatients, the decrease has been more drastic: from 12.6 days in 1970 to 5.5 days in 2005-2010 ().With the exception of hospitalists and case management staff, acute care hospitals have essentially doubled productivity without adding additional direct care full-time equivalents! Described in terms of "low-hanging" to "high-hanging" fruit, this article outlines the classic methods used to reduce LOS and concludes with some implications of LOS for health care reform. The U.S. health system could not have accomplished this feat without case managers and social workers. Acute care services should be very proud of their achievements and use their reputation to empower their work for the next frontier, which will be reducing cost per case, especially in risk contracts. Everything old seems new again.

Innovations in information management and access for assessments

PubMed Central

Champion, Sarah M.; Kunkel, Kenneth E.; Tilmes, Curt

2017-01-01

The third National Climate Assessment (NCA3) included goals for becoming a more timely, inclusive, rigorous, and sustained process, and for serving a wider variety of decision makers. In order to accomplish these goals, it was necessary to deliberately design an information management strategy that could serve multiple stakeholders and manage different types of information - from highly mature government-supported climate science data, to isolated practitioner-generated case study information - and to do so in ways that are consistent and appropriate for a highly influential assessment. Meeting the information management challenge for NCA3 meant balancing relevance and authority, complexity and accessibility, inclusivity and rigor. Increasing traceability of data behind figures and graphics, designing a public-facing website, managing hundreds of technical inputs to the NCA, and producing guidance for over 300 participants on meeting the Information Quality Act were all aspects of a deliberate, multi-faceted, and strategic information management approach that nonetheless attempted to be practical and usable for a variety of participants and stakeholders. PMID:29081560

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

Paci, Enrico; Antico, Ettore; Candelari, Roberto

We report a case of a pseudoaneurysm of the common hepatic artery treated with a stent-graft in a 67-year-old man. The patient presented with severe catheter bleeding through a drain following surgical and interventional procedures performed for therapeutic management of a choledochal cholangiocarcinoma. Selective hepatic arteriography showed a pseudoaneurysm close to the origin of the gastroduodenal artery. After a preliminary attempt at arterial embolization, it was decided to use a stent-graft to bridge the false aneurysm. Complete pseudoaneurysm exclusion was seen after the procedure with preservation of hepatic arterial flow.

Journal of Air Transportation, Volume 10, No. 3

NASA Technical Reports Server (NTRS)

Bowen, Brent D. (Editor); Kabashkin, Igor (Editor)

2005-01-01

The following topics are discussed: The Effects of Safety Information on Aeronautical Decision Making; Design, Development, and Validation of an Interactive Multimedia Training Simulator for Responding to Air Transportation Bomb Threats; Discovering the Regulatory Considerations of the Federal Aviation Administration: Interviewing the Aviation Rulemaking Advisory Committee; How to Control Airline Routes from the Supply Side: The Case of TAP; An Attempt to Measure the Traffic Impact of Airline Alliances; and Study Results on Knowledge Requirements for Entry-level Airport Operations and Management Personnel.

Retroperitoneal Extraskeletal Osteosarcoma: Imaging Findings and Transarterial Chemoembolization

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

Zhang Huojun, E-mail: chyyzhj@hotmail.com; Yang Jijin, E-mail: yangjijin@live.com; Lu Jianping

2010-04-15

Extraskeletal osteosarcoma (EOS) is an uncommon and usually highly aggressive mesenchymal tumor. Retroperitoneal extraskeletal osteosarma (REOS) is exceedingly rare. Due to the rare nature of the disease, both the diagnosis and the management of REOS can be challenging. We present the clinical history, CT findings, angiographic manifestations, and use of transarterial chemoembolization for treatment in a case of REOS. To our knowledge, the angiographic features of and attempt at transarterial treatment of REOS have not been reported in the literature.

Acute iatrogenic dislocation following hip impingement arthroscopic surgery.

PubMed

Matsuda, Dean K

2009-04-01

This is the first case report of an iatrogenic anterior hip dislocation after arthroscopic surgery for femoroacetabular impingement with over 1 year of follow-up. This case report describes the clinical course of a patient with symptomatic cam-pincer femoroacetabular impingement. She underwent arthroscopic rim trimming, labral debridement after a failed attempt at labral refixation from suture cut-through, and femoral head-neck resection osteoplasty. The procedure involved supranormal hip distraction for extraction of an iatrogenic loose body (detached metallic radiofrequency probe tip). The patient had an anterior hip dislocation in the recovery room. Immediate closed reduction under general anesthesia and bracing were performed but failed despite the ability to obtain a concentric but grossly unstable reduction. After 3 failed attempts, a mini-open capsulorrhaphy was performed that successfully restored stability. Her postoperative management and outcome are presented. All of the major static stabilizers of the hip (osseous, labral, and capsuloligamentous) were surgically altered, and a multifactorial causation is proposed. Lessons learned are discussed in hopes of minimizing the occurrence of this rare but dramatic complication.

Surgical management of colorectal injuries: colostomy or primary repair?

PubMed

Papadopoulos, V N; Michalopoulos, A; Apostolidis, S; Paramythiotis, D; Ioannidis, A; Mekras, A; Panidis, S; Stavrou, G; Basdanis, G

2011-10-01

Several factors have been considered important for the decision between diversion and primary repair in the surgical management of colorectal injuries. The aim of this study is to clarify whether patients with colorectal injuries need diversion or not. From 2008 to 2010, ten patients with colorectal injuries were surgically treated by primary repair or by a staged repair. The patients were five men and five women, with median age 40 years (20-55). Two men and two women had rectal injuries, while 6 patients had colon injuries. The mechanism of trauma in two patients was firearm injuries, in two patients was a stab injury, in four patients was a motor vehicle accident, in one woman was iatrogenic injury during vaginal delivery, and one case was the transanal foreign body insertion. Primary repair was possible in six patients, while diversion was necessary in four patients. Primary repair should be attempted in the initial surgical management of all penetrating colon and intraperitoneal rectal injuries. Diversion of colonic injuries should only be considered if the colon tissue itself is inappropriate for repair due to severe edema or ischemia. The role of diversion in the management of unrepaired extraperitoneal rectal injuries and in cases with anal sphincter injuries is mandatory.

Opening the black box in nursing work and management practice: the role of ward managers.

PubMed

Townsend, Keith; Wilkinson, Adrian; Kellner, Ashlea

2015-03-01

This paper aims to identify and explore key obstacles preventing ward managers from effectively performing the human resource management (HRM) responsibilities required in their role. In the context of increasing costs and the decentralisation of responsibility to ward level, the relevance of the ward manager role within the 'black box' between human resource management and firm performance is becoming increasingly pertinent. This paper presents an intensive case study including 37 interviews across all levels of a hospital where senior management attempted to shift to a high performance model of human resource management. The findings indicated that ward managers played a critical role in maintaining and improving employee performance, although they were restricted from effectively performing their responsibilities due to budget pressure and limited managerial skill development. Our findings support the contention that hospitals would benefit from focusing on the critical role of the ward manager as the central locus of influence in high performance human resource management (HPHRM) systems. Investment into high performance human resource management is discouraged if the hospital cannot adequately enable ward managers who are responsible for implementation. Introduction of managerial skills training to potential and existing ward managers is critical. © 2013 John Wiley & Sons Ltd.

Contain or eradicate? Optimizing the management goal for Australian acacia invasions in the face of uncertainty

USGS Publications Warehouse

Moore, J.L.; Runge, M.C.; Webber, B.L.; Wilson, J.R.U.

2011-01-01

Aim To identify whether eradication or containment is expected to be the most cost-effective management goal for an isolated invasive population when knowledge about the current extent is uncertain. Location Global and South Africa. Methods We developed a decision analysis framework to analyse the best management goal for an invasive species population (eradication, containment or take no action) when knowledge about the current extent is uncertain. We used value of information analysis to identify when investment in learning about the extent will improve this decision-making and tested the sensitivity of the conclusions to different parameters (e.g. spread rate, maximum extent, and management efficacy and cost). The model was applied to Acacia paradoxa DC, an Australian shrub with an estimated invasive extent of 310ha on Table Mountain, South Africa. Results Under the parameters used, attempting eradication is cost-effective for infestations of up to 777ha. However, if the invasion extent is poorly known, then attempting eradication is only cost-effective for infestations estimated as 296ha or smaller. The value of learning is greatest (maximum of 8% saving) when infestation extent is poorly known and if it is close to the maximum extent for which attempting eradication is optimal. The optimal management action is most sensitive to the probability that the action succeeds (which depends on the extent), with the discount rate and cost of management also important, but spread rate less so. Over a 20-year time-horizon, attempting to eradicate A. paradoxa from South Africa is predicted to cost on average ZAR 8 million if the extent is known, and if our current estimate is poor, ZAR 33.6 million as opposed to ZAR 32.8 million for attempting containment. Main conclusions Our framework evaluates the cost-effectiveness of attempting eradication or containment of an invasive population that takes uncertainty in population extent into account. We show that incorporating uncertainty in the analysis avoids overly optimistic beliefs about the effectiveness of management enabling better management decisions. For A. paradoxa in South Africa, attempting to eradicate is likely to be cost-effective, particularly if resources are allocated to better understand and improve management efficacy. ?? 2011 Blackwell Publishing Ltd.

The role of waste bank partnership in efforts to decrease waste volume in urban: A case study at a waste bank in Kalibaru, Cilodong, Depok City

NASA Astrophysics Data System (ADS)

Suparmini; Junadi, Purnawan

2018-03-01

Waste Bank is a program that the government uses as one of the efforts to tackle the increasingly growing garbage day. The Waste Bank in Depok City serves as a collection of non-organic waste that still has economic value. This study attempts to examine the factors that make Depok City Waste Bank play its role today and its relationship with the community involved in the activities of the Waste Bank. Through qualitative approach with a case study, the authors make observations on the object and conduct in-depth interviews with some informants. This study found four factors that make a Waste Bank continues to play a role, namely the presence of leaders who are reliable (leadership), good management (management), incentive (incentive) and the involvement of partners (partnership). While the characteristics of community-based on the level of education, income levels also affect the community participation in receiving the Waste Bank as a form of waste management in the city of Depok.

Management of priapism with a trial of exercise in the emergency department.

PubMed

Gravel, Jonathan; LeBlanc, Constance; Varner, Catherine

2018-03-16

Priapism is characterized by persistent penile erection in the absence of sexual arousal or desire that does not subside with orgasm. Although relatively uncommon, it is a genitourinary emergency that necessities prompt work-up and appropriate management, as there is a time-dependent relationship between total duration of erection and an increasing risk of permanent erectile dysfunction. Confirming the type of priapism is key to proper management, but the majority of cases presenting to the emergency department are ischemic in nature. Conservative management strategies for ischemic priapism are sparsely described in the literature but generally include ice pack application to the area, cold showers, masturbation and rarely, exercise. These strategies lack sound evidence, but the risks of attempting them are minimal as long as access to more definitive treatment is not delayed. Lower-limb exercise as a first-line treatment warrants further study in the undifferentiated emergency department priapism population. The case we present and discuss here illustrates the potential benefits of a trial of acute lower-limb exercise, specifically stair climbing, as a treatment for medication-induced priapism. If effective, this simple non-invasive management strategy may decrease the time to effective treatment, requires minimal resource utilization, and ultimately, avoids the need for more invasive treatment.

The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study

PubMed Central

Fitzpatrick, KE; Sellers, S; Spark, P; Kurinczuk, JJ; Brocklehurst, P; Knight, M

2014-01-01

Objective To describe the management and outcomes of placenta accreta, increta, and percreta in the UK. Design A population-based descriptive study using the UK Obstetric Surveillance System (UKOSS). Setting All 221 UK hospitals with obstetrician-led maternity units. Population All women diagnosed with placenta accreta, increta, and percreta in the UK between May 2010 and April 2011. Methods Prospective case identification through the monthly mailing of UKOSS. Main outcome measures Median estimated blood loss, transfusion requirements. Results A cohort of 134 women were identified with placenta accreta, increta, or percreta: 50% (66/133) were suspected to have this condition antenatally. In women with a final diagnosis of placenta increta or percreta, antenatal diagnosis was associated with reduced levels of haemorrhage (median estimated blood loss 2750 versus 6100 ml, P = 0.008) and a reduced need for blood transfusion (59 versus 94%, P = 0.014), possibly because antenatally diagnosed women were more likely to have preventative therapies for haemorrhage (74 versus 52%, P = 0.007), and were less likely to have an attempt made to remove their placenta (59 versus 93%, P < 0.001). Making no attempt to remove any of the placenta, in an attempt to conserve the uterus or prior to hysterectomy, was associated with reduced levels of haemorrhage (median estimated blood loss 1750 versus 3700 ml, P = 0.001) and a reduced need for blood transfusion (57 versus 86%, P < 0.001). Conclusions Women with placenta accreta, increta, or percreta who have no attempt to remove any of their placenta, with the aim of conserving their uterus, or prior to hysterectomy, have reduced levels of haemorrhage and a reduced need for blood transfusion, supporting the recommendation of this practice. PMID:23924326

The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study.

PubMed

Fitzpatrick, K E; Sellers, S; Spark, P; Kurinczuk, J J; Brocklehurst, P; Knight, M

2014-01-01

To describe the management and outcomes of placenta accreta, increta, and percreta in the UK. A population-based descriptive study using the UK Obstetric Surveillance System (UKOSS). All 221 UK hospitals with obstetrician-led maternity units. All women diagnosed with placenta accreta, increta, and percreta in the UK between May 2010 and April 2011. Prospective case identification through the monthly mailing of UKOSS. Median estimated blood loss, transfusion requirements. A cohort of 134 women were identified with placenta accreta, increta, or percreta: 50% (66/133) were suspected to have this condition antenatally. In women with a final diagnosis of placenta increta or percreta, antenatal diagnosis was associated with reduced levels of haemorrhage (median estimated blood loss 2750 versus 6100 ml, P = 0.008) and a reduced need for blood transfusion (59 versus 94%, P = 0.014), possibly because antenatally diagnosed women were more likely to have preventative therapies for haemorrhage (74 versus 52%, P = 0.007), and were less likely to have an attempt made to remove their placenta (59 versus 93%, P < 0.001). Making no attempt to remove any of the placenta, in an attempt to conserve the uterus or prior to hysterectomy, was associated with reduced levels of haemorrhage (median estimated blood loss 1750 versus 3700 ml, P = 0.001) and a reduced need for blood transfusion (57 versus 86%, P < 0.001). Women with placenta accreta, increta, or percreta who have no attempt to remove any of their placenta, with the aim of conserving their uterus, or prior to hysterectomy, have reduced levels of haemorrhage and a reduced need for blood transfusion, supporting the recommendation of this practice. © 2013 RCOG.

Descemet Membrane Endothelial Keratoplasty for Failed Deep Anterior Lamellar Keratoplasty: A Case Series.

PubMed

Einan-Lifshitz, Adi; Sorkin, Nir; Boutin, Tanguy; Mednick, Zale; Kreimei, Mohammad; Chan, Clara C; Rootman, David S

2018-06-01

To suggest a new surgical approach for posterior opacities or persistent Descemet membrane (DM) detachment in failed deep anterior lamellar keratoplasty (DALK) and to report the outcome of Descemet membrane endothelial keratoplasty (DMEK) in a series of patients with DALK failure. In this retrospective case series of patients who underwent DMEK for failed DALK at Toronto Western Hospital, 4 patients with failed DALK who underwent DMEK surgery were included. In all 4 cases, big bubble formation during initial DALK surgery had failed and the surgical technique was converted to manual dissection using the Melles technique. In 2 cases, the descemetorhexis in DMEK surgery was performed manually, and in 2 cases, the descemetorhexis was performed with the assistance of the femtosecond laser. Four eyes of 4 patients aged 70 ± 4 years were included. Average follow-up time was 9 ± 5 months. Indications for DALK surgery were corneal dystrophy in 2 patients and corneal scars in the other 2. DALK failure was due to persistent DM detachment that created a double chamber in 2 patients and due to posterior lamellar haze in the other 2. After DMEK surgery, 2 patients had graft detachment and required rebubbling. In 1 patient, the DMEK scroll was attached after 1 rebubble attempt, and in the other patient, a second rebubble attempt was needed. The final visual acuities were 20/40, 20/50, 20/70, and 20/200 (because of dense cataract). All procedures were uneventful. DMEK surgery may be effective in managing DALK failure.

The NHS--is Scotland different? A case study of the management of health care in the hospital service in the west of Scotland 1947-1987.

PubMed

McTavish, D

2000-10-01

Management of the health service in Scotland and England, has since its creation, shown both divergence and congruence. In the initial decades in Scotland the executive hospital boards (which contained strong medical professional membership) and central government had a clearer relationship than in England. The health service-civil service machinery in Scotland was without doubt more to the forefront with higher status in the Scottish 'polity' than was the case in England. The 1970s reforms also indicated difference: despite the pro managerialist tones of the Farquarson Lang report in Scotland, a managerial emphasis was more apparent in the English reforms. By the 1980s, the government's clear intention that their 'radical' agenda should apply in Scotland and England was implemented in many instances: aspects of the new managerialism were applied as vigorously in the case examined than anywhere in England; the attempt to draw clinicians into resource management (as advocated in the Griffiths report) appeared to have advanced further in Scotland until well into the 1990s. Yet in other aspects, Scotland diverged from parts of England in the implementation of the 1980's agenda most notably in the growth of private practice though the case indicated significant Scottish developments here too. The article concludes by speculating on some Scottish differences in the coming years.

Refeeding syndrome: treatment considerations based on collective analysis of literature case reports.

PubMed

Boateng, Akwasi Afriyie; Sriram, Krishnan; Meguid, Michael M; Crook, Martin

2010-02-01

Refeeding syndrome (RFS) represents a group of clinical findings that occur in severely malnourished individuals undergoing nutritional support. Cardiac arrhythmias, multisystem organ dysfunction, and death are the most severe symptoms observed. As the cachectic body attempts to reverse its adaptation to the starved state in response to the nutritional load, symptoms result from fluid and electrolyte imbalances, with hypophosphatemia playing a central role. Because guidelines for feeding the malnourished patient at risk for refeeding syndrome is scarce, we have provided management recommendations based on the knowledge derived from a collection of reported English literature cases of the RFS. A MEDLINE search using keywords including "refeeding syndrome," "RFS," and "refeeding hypophosphatemia" was performed. References from initial cases were utilized for more literature on the subject. We have emphasized the continued importance of managing patients at risk for RFS, compared how management of the severely malnourished patients have evolved over time, and provided comprehensive clinical guidelines based on the sum of experience documented in the case reports for the purpose of supplementing the guidelines available. Based on our review, the most effective means of preventing or treating RFS were the following: recognizing the patients at risk; providing adequate electrolyte, vitamin, and micronutrient supplementation; careful fluid resuscitation; cautious and gradual energy restoration; and monitoring of critical laboratory indices. 2010 Elsevier Inc. All rights reserved.

Short Hospitalization after Early Intervention in Managing Grade III Pancreatic Injuries in Children: A Possible New Trend

PubMed Central

Al-Jazaeri, Ayman H.

2011-01-01

The presence of ductal disruption in pancreatic trauma is a major indicator of severity leading to higher morbidities and prolonged hospital stay. However, the adoption of early interventional approach in selected cases of documented grade III pancreatic trauma could result in shorter hospitalization and early recovery. We are describing our approach of early presentation-tailored interventions in managing two consecutive children diagnosed with grade III pancreatic injuries, which constitute the two main ends of the presentations’ spectrum. For the early presenter a spleen preserving distal pancreatectomy was performed, while for the late presenter with large symptomatic pseudocyst endoscopic drainage was attempted. Both early and late presenting children had quick and uneventful recoveries leading to 5 and 6 days of hospitalization, respectively. Both cases continued to be asymptomatic at 4 and 12 months post procedure. In the pseudocyst case, the gastro-cystostomy stents were removed after 10 weeks, and 2.5 months later a completely healed pancreas was demonstrated by magnetic resonance cholangio-pancreatography. Unlike other abdominal solid organ injuries in children, adopting early presentation-tailored intervention can be associated with quicker recovery and short hospitalization for grade III pancreatic injuries. While the series is still small, achieving such remarkable outcomes in two consecutive cases is possible and could set a new trend in managing these injuries in children. PMID:21912067

Endovascular Treatment of an Aortoiliac Tuberculous Pseudoaneurysm

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

Villegas, Miguel O.; Mereles, Alberto Perez; Tamashiro, Gustavo A.

2013-04-15

We report a rare case of a tuberculous mycotic aortoiliac pseudoaneurysm treated with an endovascular procedure and follow-up of 36 months. The patient was a white 72-year-old man with pulmonary tuberculosis and a former smoker with hypertension, chronic renal failure, and dyslipidemia. A computed tomographic scan of the abdomen and pelvis revealed a left paravertebral cavity with fluid content and involvement of vertebrae L2-L4. After a surgical repair attempt, the patient was treated with the implant of a bifurcated endoprosthesis. Because it is unlikely that any center has extensive experience in the management of this rare manifestation of the disease,more » we reviewed the literature for similar cases.« less

Use of laparoscopy in the management of malfunctioning peritoneal dialysis catheters.

PubMed

Brandt, C P; Ricanati, E S

1996-01-01

The proper function of peritoneal dialysis (PD) catheters can be compromised by catheter malposition, fibrin clot, or omental wrapping. The purpose of this study was to determine the efficacy of laparoscopy in the treatment of malfunctioning PD catheters. All patients undergoing laparoscopy for catheter dysfunction at MetroHealth Medical Center in Cleveland, Ohio, from 1991 to 1995, were reviewed. Twenty-six laparoscopies were performed in 22 patients, for malfunction occurring an average of 3.9 months following insertion (range 0.5-18 months). Omental and/or small below wrapping as present in all but three cases. Lysis of adhesions was required in 19 of 26 cases, with repositioning only in seven. Eight patients had failed attempts at stiff wire manipulation prior to laparoscopy. Perioperative complications occurred in seven cases, consisting of temporary dialysate leakage (2), enterotomy (1), and early reocclusion (4). Repeat laparoscopy was successful in three of these four reocclusions. The overall success rate (catheter function > 30 days after laparoscopy) was 21/22 (96%). Laparoscopy is highly accurate and effective in the management of peritoneal dialysis catheter dysfunction and results in prolongation of catheter life.

Countering resistance to protected-area extension.

PubMed

Lindenmayer, David; Thorn, Simon; Noss, Reed

2018-04-01

The establishment of protected areas is a critical strategy for conserving biodiversity. Key policy directives like the Aichi targets seek to expand protected areas to 17% of Earth's land surface, with calls by some conservation biologists for much more. However, in places such as the United States, Germany, and Australia, attempts to increase protected areas are meeting strong resistance from communities, industry groups, and governments. We examined case studies of such resistance in Victoria, Australia, Bavaria, Germany, and Florida, United States. We considered 4 ways to tackle this problem. First, broaden the case for protected areas beyond nature conservation to include economic, human health, and other benefits, and translate these into a persuasive business case for protected areas. Second, better communicate the conservation values of protected areas. This should include highlighting how many species, communities, and ecosystems have been conserved by protected areas and the counterfactual (i.e., what would have been lost without protected area establishment). Third, consider zoning of activities to ensure the maintenance of effective management. Finally, remind citizens to think about conservation when they vote, including holding politicians accountable for their environmental promises. Without tackling resistance to expanding the protected estate, it will be impossible to reach conservation targets, and this will undermine attempts to stem the global extinction crisis. © 2017 Society for Conservation Biology.

Operationalizing Sustainable Development Suncor Energy Inc: A critical case

NASA Astrophysics Data System (ADS)

Fergus, Andrew

The concept of Sustainable Development is often understood as a framework within which organizations are able to move forward in a successful and beneficial manner. However, it is also seen as an ambiguous notion with little substance beyond a hopeful dialogue. If we are to base organizational action upon the concepts of Sustainable Development, it is vital that we comprehend the implications of how the concept is understood at a behavioral level. Industry leaders, competitors, shareholders, and stakeholders recognize Suncor Energy Inc as a leading organization within the Oil and Gas energy field. In particular it has a reputation for proactive thinking and action within the areas of environmental and social responsibility. Through attempting to integrate the ideas of Sustainable Development at a foundational level into the strategic plan, the management of Suncor Energy Inc has committed the organization to be a sustainable energy company. To achieve this vision the organization faces the challenge of converting strategic goals into operational behaviors, a process critical for a successful future. This research focuses on understanding the issues found with this conversion process. Through exploring a critical case, this research illuminates the reality of a best-case scenario. The findings thus have implications for both Suncor Energy Inc and more importantly all other organizations attempting to move in a Sustainable Development direction.

Noah’s Ark Conservation Will Not Preserve Threatened Ecological Communities under Climate Change

PubMed Central

Harris, Rebecca Mary Bernadette; Carter, Oberon; Gilfedder, Louise; Porfirio, Luciana Laura; Lee, Greg; Bindoff, Nathaniel Lee

2015-01-01

Background Effective conservation of threatened ecological communities requires knowledge of where climatically suitable habitat is likely to persist into the future. We use the critically endangered Lowland Grassland community of Tasmania, Australia as a case study to identify options for management in cases where future climatic conditions become unsuitable for the current threatened community. Methods We model current and future climatic suitability for the Lowland Themeda and the Lowland Poa Grassland communities, which make up the listed ecological community. We also model climatic suitability for the structurally dominant grass species of these communities, and for closely related grassland and woodland communities. We use a dynamically downscaled regional climate model derived from six CMIP3 global climate models, under the A2 SRES emissions scenario. Results All model projections showed a large reduction in climatically suitable area by mid-century. Outcomes are slightly better if closely related grassy communities are considered, but the extent of suitable area is still substantially reduced. Only small areas within the current distribution are projected to remain climatically suitable by the end of the century, and very little of that area is currently in good condition. Conclusions As the climate becomes less suitable, a gradual change in the species composition, structure and habitat quality of the grassland communities is likely. Conservation management will need to focus on maintaining diversity, structure and function, rather than attempting to preserve current species composition. Options for achieving this include managing related grassland types to maintain grassland species at the landscape-scale, and maximising the resilience of grasslands by reducing further fragmentation, weed invasion and stress from other land uses, while accepting that change is inevitable. Attempting to maintain the status quo by conserving the current structure and composition of Lowland Grassland communities is unlikely to be a viable management option in the long term. PMID:25881302

Noah's Ark conservation will not preserve threatened ecological communities under climate change.

PubMed

Harris, Rebecca Mary Bernadette; Carter, Oberon; Gilfedder, Louise; Porfirio, Luciana Laura; Lee, Greg; Bindoff, Nathaniel Lee

2015-01-01

Effective conservation of threatened ecological communities requires knowledge of where climatically suitable habitat is likely to persist into the future. We use the critically endangered Lowland Grassland community of Tasmania, Australia as a case study to identify options for management in cases where future climatic conditions become unsuitable for the current threatened community. We model current and future climatic suitability for the Lowland Themeda and the Lowland Poa Grassland communities, which make up the listed ecological community. We also model climatic suitability for the structurally dominant grass species of these communities, and for closely related grassland and woodland communities. We use a dynamically downscaled regional climate model derived from six CMIP3 global climate models, under the A2 SRES emissions scenario. All model projections showed a large reduction in climatically suitable area by mid-century. Outcomes are slightly better if closely related grassy communities are considered, but the extent of suitable area is still substantially reduced. Only small areas within the current distribution are projected to remain climatically suitable by the end of the century, and very little of that area is currently in good condition. As the climate becomes less suitable, a gradual change in the species composition, structure and habitat quality of the grassland communities is likely. Conservation management will need to focus on maintaining diversity, structure and function, rather than attempting to preserve current species composition. Options for achieving this include managing related grassland types to maintain grassland species at the landscape-scale, and maximising the resilience of grasslands by reducing further fragmentation, weed invasion and stress from other land uses, while accepting that change is inevitable. Attempting to maintain the status quo by conserving the current structure and composition of Lowland Grassland communities is unlikely to be a viable management option in the long term.

Thyroid nodule management: clinical, ultrasound and cytopathological parameters for predicting malignancy

PubMed Central

Maia, Frederico F. R.; Zantut-Wittmann, Denise Engelbrecht

2012-01-01

Although fine-needle aspiration cytology is considered to be the reference method for evaluating thyroid nodules, the results are inaccurate in approximately 10-30% of cases. Several studies have attempted to predict the risk of malignancy in thyroid nodules based on age, nodularity, thyrotropin values, thyroid autoimmune disease, hot/cold nodule status, and ultrasound parameters. However, no consensus has been found, and none of these parameters has significantly affected patient management. The management of indeterminate thyroid nodules and re-biopsies of nodules with initially benign cytological results remain important and controversial topics of discussion. The Bethesda cytological system and several studies on the use of molecular markers to predict malignancy from cytological samples of thyroid nodules need further clarification. More in-depth discussions among and continuous education of the specialists involved in treating thyroid disease are necessary to improve the management of these patients. This review aims to examine the clinical, laboratory, ultrasound, and scintigraphic parameters that can be used for thyroid nodule management. PMID:22948464

Suicide, hospital-presenting suicide attempts, and criminality in bipolar disorder: examination of risk for multiple adverse outcomes.

PubMed

Webb, Roger T; Lichtenstein, Paul; Larsson, Henrik; Geddes, John R; Fazel, Seena

2014-08-01

To compare risks for suicidality and criminality in a national cohort of people diagnosed with bipolar disorder, and to assess how risk factor profiles differ between these outcomes. We conducted 2 case-cohort studies using interlinked Swedish national registers. Primarily, using International Classification of Diseases (ICD) coding, we identified 15,337 people diagnosed with bipolar disorder, 1973-2009, matched by age and gender to 20 individuals per case sampled randomly from the general population. We estimated risks of suicide and hospital-presenting attempted suicide, and violent and nonviolent criminal offending. We separately assessed these risks among 14,677 unaffected siblings matched to a second general population sample. 22.2% of bipolar disorder cohort members engaged in suicidal or criminal acts after diagnosis. They were at greatly elevated risk for completed suicide (risk ratio = 18.8; 95% CI, 16.0-22.2), attempted suicide (risk ratio = 14.3; 95% CI, 13.5-15.2), violent crime (risk ratio = 5.0; 95% CI, 4.6-5.4), and nonviolent crime (risk ratio = 2.9; 95% CI, 2.8-3.1) compared with the general population. Elevations in risk were far less marked among the unaffected siblings than in the bipolar disorder cohort. Three factors independently predicted raised risk of all 4 adverse outcomes: if the first 2 patient episodes for bipolar disorder required admission, a history of attempted suicide, and a history of diagnosed alcohol/drug disorder. Criminal offending before bipolar diagnosis was an especially strong independent predictor of criminality after diagnosis. The combined risk of suicidality or criminality is substantially elevated in both relative and absolute terms. Clinical prediction rules focusing on multiple vulnerabilities following onset of bipolar disorder, especially when there is history of attempted suicide, substance misuse disorders, or criminal offending, may improve risk management. © Copyright 2014 Physicians Postgraduate Press, Inc.

Suicide, Hospital-Presenting Suicide Attempts, and Criminality in Bipolar Disorder: Examination of Risk for Multiple Adverse Outcomes

PubMed Central

Webb, Roger T.; Lichtenstein, Paul; Larsson, Henrik; Geddes, John R.; Fazel, Seena

2014-01-01

Objective To compare risks for suicidality and criminality in a national cohort of people diagnosed with bipolar disorder, and to assess how risk factor profiles differ between these outcomes. Method We conducted 2 case-cohort studies using interlinked Swedish national registers. Primarily, using International Classification of Diseases (ICD) coding, we identified 15,337 people diagnosed with bipolar disorder, 1973–2009, matched by age and gender to 20 individuals per case sampled randomly from the general population. We estimated risks of suicide and hospital-presenting attempted suicide, and violent and nonviolent criminal offending. We separately assessed these risks among 14,677 unaffected siblings matched to a second general population sample. Results 22.2% of bipolar disorder cohort members engaged in suicidal or criminal acts after diagnosis. They were at greatly elevated risk for completed suicide (risk ratio = 18.8; 95% CI, 16.0–22.2), attempted suicide (risk ratio = 14.3; 95% CI, 13.5–15.2), violent crime (risk ratio = 5.0; 95% CI, 4.6–5.4), and nonviolent crime (risk ratio = 2.9; 95% CI, 2.8–3.1) compared with the general population. Elevations in risk were far less marked among the unaffected siblings than in the bipolar disorder cohort. Three factors independently predicted raised risk of all 4 adverse outcomes: if the first 2 patient episodes for bipolar disorder required admission, a history of attempted suicide, and a history of diagnosed alcohol/drug disorder. Criminal offending before bipolar diagnosis was an especially strong independent predictor of criminality after diagnosis. Conclusions The combined risk of suicidality or criminality is substantially elevated in both relative and absolute terms. Clinical prediction rules focusing on multiple vulnerabilities following onset of bipolar disorder, especially when there is history of attempted suicide, substance misuse disorders, or criminal offending, may improve risk management. PMID:25191918

Feelings of worthlessness during a single complicated major depressive episode predict postremission suicide attempt.

PubMed

Wakefield, J C; Schmitz, M F

2016-04-01

To establish which symptoms of major depressive episode (MDE) predict postremission suicide attempts in complicated single-episode cases. Using the nationally representative two-wave National Epidemiologic Survey on Alcohol and Related Conditions data set, we identified wave 1 lifetime single-episode MDE cases in which the episode remitted by the beginning of the wave 2 three-year follow-up period (N = 2791). The analytic sample was further limited to 'complicated' cases (N = 1872) known to have elevated suicide attempt rates, defined as having two or more of the following: suicidal ideation, marked role impairment, feeling worthless, psychomotor retardation, and prolonged (>6 months) duration. Logistic regression analyses showed that, after controlling for wave 1 suicide attempt which significantly predicted postremission suicide attempt (OR = 10.0), the additional complicated symptom 'feelings of worthlessness' during the wave 1 index episode significantly and very substantially predicted postremission suicide attempt (OR = 6.96). Neither wave 1 psychomotor retardation nor wave 1 suicidal ideation nor any of the other wave 1 depressive symptoms were significant predictors of wave 2 suicide attempt. Among depressive symptoms during an MDE, feelings of worthlessness is the only significant indicator of elevated risk of suicide attempt after the episode has remitted, beyond previous suicide attempts. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Clinical decision-making by midwives: managing case complexity.

PubMed

Cioffi, J; Markham, R

1997-02-01

In making clinical judgements, it is argued that midwives use 'shortcuts' or heuristics based on estimated probabilities to simplify the decision-making task. Midwives (n = 30) were given simulated patient assessment situations of high and low complexity and were required to think aloud. Analysis of verbal protocols showed that subjective probability judgements (heuristics) were used more frequently in the high than low complexity case and predominated in the last quarter of the assessment period for the high complexity case. 'Representativeness' was identified more frequently in the high than in the low case, but was the dominant heuristic in both. Reports completed after each simulation suggest that heuristics based on memory for particular conditions affect decisions. It is concluded that midwives use heuristics, derived mainly from their clinical experiences, in an attempt to save cognitive effort and to facilitate reasonably accurate decisions in the decision-making process.

How do paramedics manage the airway during out of hospital cardiac arrest?

PubMed Central

Voss, Sarah; Rhys, Megan; Coates, David; Greenwood, Rosemary; Nolan, Jerry P.; Thomas, Matthew; Benger, Jonathan

2014-01-01

Aim The best method of initial airway management during resuscitation for out of hospital cardiac arrest (OHCA) is unknown. The airway management techniques used currently by UK paramedics during resuscitation for OHCA are not well documented. This study describes the airway management techniques used in the usual practice arm of the REVIVE-Airways feasibility study, and documents the pathway of interventions to secure and sustain ventilation during OHCA. Method Data were collected from OHCAs attended by paramedics participating in the REVIVE-Airways trial between March 2012 and February 2013. Patients were included if they were enrolled in the usual practice arm of the study, fulfilled the main study eligibility criteria and did not receive either of the intervention supraglottic airway devices during the resuscitation attempt. Results Data from 196 attempted resuscitations were included in the analysis. The initial approach to airway management was bag-mask for 108 (55%), a supraglottic airway device (SAD) for 39 (20%) and tracheal intubation for 49 (25%). Paramedics made further airway interventions in 64% of resuscitations. When intubation was the initial approach, there was no further intervention in 76% of cases; this compares to 16% and 44% with bag-mask and SAD respectively. The most common reason cited by paramedics for changing from bag-mask was to carry out advanced life support, followed by regurgitation and inadequate ventilation. Inadequate ventilation was the commonest reason cited for removing a SAD. Conclusion Paramedics use a range of techniques to manage the airway during OHCA, and as the resuscitation evolves. It is therefore desirable to ensure that a range of techniques and equipment, supported by effective training, are available to paramedics who attend OHCA. PMID:25260723

Does TQM Affect Teaching and Learning?

ERIC Educational Resources Information Center

Mauriel, John J.; And Others

Many schools and school districts are attempting to introduce principles and practices of Total Quality Management (TQM). These attempts take many forms with varying degrees of commitment of resources and management attention. This paper describes the research design of a study intended to identify best current practices in applying TQM concepts…

Human Resource Management, Computers, and Organization Theory.

ERIC Educational Resources Information Center

Garson, G. David

In an attempt to provide a framework for research and theory building in public management information systems (PMIS), state officials responsible for computing in personnel operations were surveyed. The data were applied to hypotheses arising from a recent model by Bozeman and Bretschneider, attempting to relate organization theory to management…

Archiving a Software Development Project

DTIC Science & Technology

2013-04-01

an ongoing monitoring system that identifies attempts and requests for retrieval, and ensures that the attempts and requests cannot proceed without...Intelligence Division Peter Fisher has worked as a consultant, systems analyst, software developer and project manager in Australia, Holland, the USA...4 3.1.3 DRMS – Defence Records Management System

Management of the difficult airway.

PubMed

Schwartz, D E; Wiener-Kronish, J P

1991-09-01

For clinicians involved in airway management, a plan of action for dealing with the difficult airway or a failed intubation should be developed well in advance of encountering a patient in whom intubation is not routine. When difficulty is anticipated, the equipment necessary for performing a difficult intubation should be immediately available. It also is prudent to have a surgeon skilled in performing a tracheotomy and a criothyroidotomy stand by. The intubation should be attempted in the awake state, preferably using the fiberoptic bronchoscope. The more challenging situation is when the difficult airway is confronted unexpectedly. After the first failed attempt at laryngoscopy, head position should be checked and the patient ventilated with oxygen by mask. A smaller styletted tube and possibly a different laryngoscope blade should be selected for a second attempt at intubation. The fiberoptic bronchoscope and other equipment for difficult intubation should be obtained. A second attempt should then be made. If this is unsuccessful, the patient should be reoxygenated, and assistance including a skilled anesthesiologist and surgeon should be summoned. On a third attempt, traction to the tongue can be applied by an assistant, a tube changer could be used to enter the larynx, or one of the other special techniques previously described can be used. If this third attempt fails, it may be helpful to have a physician more experienced in airway management attempt intubation after oxygen has been administered to the patient. If all attempts are unsuccessful, then invasive techniques to secure the airway will have to be performed.

Sleep problems and suicide attempts among adolescents: a case-control study.

PubMed

Koyawala, Neel; Stevens, Jack; McBee-Strayer, Sandra M; Cannon, Elizabeth A; Bridge, Jeffrey A

2015-01-01

This study used a case-control design to compare sleep disturbances in 40 adolescents who attempted suicide with 40 never-suicidal adolescents. Using hierarchical logistic regression analyses, we found that self-reported nighttime awakenings were significantly associated with attempted suicide, after controlling for antidepressant use, antipsychotic use, affective problems, and being bullied. In a separate regression analysis, the parent-reported total sleep problems score also predicted suicide attempt status, controlling for key covariates. No associations were found between suicide attempts and other distinct sleep problems, including falling asleep at bedtime, sleeping a lot during the day, trouble waking up in the morning, sleep duration, and parent-reported nightmares. Clinicians should be aware of sleep problems as potential risk factors for suicide attempts for adolescents.

How to Verify and Manage the Translational Plagiarism?

PubMed

Wiwanitkit, Viroj

2016-09-15

The use of Google translator as a tool for determining translational plagiarism is a big challenge. As noted, plagiarism of the original papers written in Macedonian and translated into other languages can be verified after computerised translation in other languages. Attempts to screen the translational plagiarism should be supported. The use of Google Translate tool might be helpful. Special focus should be on any non-English reference that might be the source of plagiarised material and non-English article that might translate from an original English article, which cannot be detected by simple plagiarism screening tool. It is a hard job for any journal to detect the complex translational plagiarism but the harder job might be how to effectively manage the case.

How to Verify and Manage the Translational Plagiarism?

PubMed Central

Wiwanitkit, Viroj

2016-01-01

The use of Google translator as a tool for determining translational plagiarism is a big challenge. As noted, plagiarism of the original papers written in Macedonian and translated into other languages can be verified after computerised translation in other languages. Attempts to screen the translational plagiarism should be supported. The use of Google Translate tool might be helpful. Special focus should be on any non-English reference that might be the source of plagiarised material and non-English article that might translate from an original English article, which cannot be detected by simple plagiarism screening tool. It is a hard job for any journal to detect the complex translational plagiarism but the harder job might be how to effectively manage the case. PMID:27703588

Is Principled Pragmatism a Viable Framework for Addressing Complex Problems?

NASA Astrophysics Data System (ADS)

Islam, S.

2017-12-01

Complex water problems are connected with many competing and often conflicting values, interests, and tools. These problems can't be addressed through simply applying dogmatic principles or a deal-making pragmatic approach. Because these problems are interconnected and interdependent, a final solution can't be pre-specified. Any intervention to a complex problem requires attention to both principles and pragmatism. Strict adherence to principles without pragmatism is often not actionable; pure pragmatism exercised without guiding principles is not sustainable. In a colloquial sense, pragmatism is often taken to suggest practical, opportunistic, and expedient approaches at the expense of principles. This perception appears to be rooted in the dichotomy between "being pragmatic" and "being ideological". The notion of principled pragmatism attempts to get away from this duality by focusing on how to make ideas clear and actionable. In other words, how to connect our thoughts to action given the context, constraints, and capacity. Principled pragmatism - rooted in equity and sustainability as guiding principles for water management - approach attempts to synthesize symbolic aspirations with realistic assessment to chart a trajectory of actionable subset of implementable solutions. Case studies from the Ganges Basin will show the utility of principled pragmatism for water management in a changing world.

Characterization of suicidal behaviour with self-organizing maps.

PubMed

Leiva-Murillo, José M; López-Castromán, Jorge; Baca-García, Enrique

2013-01-01

The study of the variables involved in suicidal behavior is important from a social, medical, and economical point of view. Given the high number of potential variables of interest, a large population of subjects must be analysed in order to get conclusive results. In this paper, we describe a method based on self-organizing maps (SOMs) for finding the most relevant variables even when their relation to suicidal behavior is strongly nonlinear. We have applied the method to a cohort with more than 8,000 subjects and 600 variables and discovered four groups of variables involved in suicidal behavior. According to the results, there are four main groups of risk factors that characterize the population of suicide attempters: mental disorders, alcoholism, impulsivity, and childhood abuse. The identification of specific subpopulations of suicide attempters is consistent with current medical knowledge and may provide a new avenue of research to improve the management of suicidal cases.

Factors influencing attempted and completed suicide in postnatal women: A population-based study in Taiwan.

PubMed

Weng, Shu-Chuan; Chang, Jung-Chen; Yeh, Ming-Kung; Wang, Shun-Mu; Chen, Yi-Hua

2016-05-12

The aims of study were to investigate risk factors associated with attempted and completed suicide. This nested case-control study was conducted using the medical and death data of nearly all pregnant women for the period 2002-2012 in Taiwan. A total of 139 cases of attempted suicide and 95 cases of completed suicide were identified; for each case, 10 controls were randomly selected and matched to the cases according to age and year of delivery. A conditional logistic regression model was used. The mean attempted and completed suicide rates were 9.91 and 6.86 per 100,000 women with live births, respectively. Never having married and postpartum depression also increased the risk of attempted suicide (OR = 2.06; 95% CI = 1.09-3.88 and OR = 2.51; 95% CI = 1.10-5.75, respectively) and completed suicide (OR = 20.27; 95% CI = 8.99-45.73 and OR = 21.72; 95% CI = 8.08-58.37, respectively). Other factors for attempted suicide included being widowed or divorced, and having a caesarean delivery or suicide history. Other factors for completed suicide included lower education level, low infant birth weight, and diagnosis of anxiety or mood disorder. These results suggest that people should appropriately assess potential risk factors and provide assistance for postnatal women to reduce the occurrence of suicide events.

Could kinesiology taping help mitigate pain, breathlessness and abdominal-related symptoms in cancer?

PubMed

Banerjee, Gourav; Rose, Alison; Briggs, Michelle; Johnson, Mark I

2017-02-24

We present the case of a woman who was an amateur athlete diagnosed with primary breast cancer, and 10 years later with terminal metastatic cancer. This case report was prepared posthumously in co-operation with her next of kin (husband). The patient first presented to a sports physiotherapist (AR) for her pain-management and to help maintain physical fitness so that she could continue with sports and an active lifestyle. The patient continued with physiotherapy for several months to enable her to be active. However, when her health deteriorated significantly due to advancing cancer, the treatment was modified and aimed at improving the patient's general well-being. The physiotherapist applied kinesiology tape over the patient's lower rib cage, diaphragm and abdomen in an attempt to manage pain, breathlessness and abdominal bloating. The patient reported alleviation of pain, breathlessness, abdominal discomfort and nausea, accompanied by improvements in eating, drinking, energy levels and physical function. 2017 BMJ Publishing Group Ltd.

Could kinesiology taping help mitigate pain, breathlessness and abdominal-related symptoms in cancer?

PubMed Central

Banerjee, Gourav; Rose, Alison; Briggs, Michelle; Johnson, Mark I

2017-01-01

We present the case of a woman who was an amateur athlete diagnosed with primary breast cancer, and 10 years later with terminal metastatic cancer. This case report was prepared posthumously in co-operation with her next of kin (husband). The patient first presented to a sports physiotherapist (AR) for her pain-management and to help maintain physical fitness so that she could continue with sports and an active lifestyle. The patient continued with physiotherapy for several months to enable her to be active. However, when her health deteriorated significantly due to advancing cancer, the treatment was modified and aimed at improving the patient's general well-being. The physiotherapist applied kinesiology tape over the patient's lower rib cage, diaphragm and abdomen in an attempt to manage pain, breathlessness and abdominal bloating. The patient reported alleviation of pain, breathlessness, abdominal discomfort and nausea, accompanied by improvements in eating, drinking, energy levels and physical function. PMID:28237944

First-aid algorithms in dental avulsion.

PubMed

Baginska, Joanna; Wilczynska-Borawska, Magdalena

2012-04-01

Almost one fourth of traumatic dental injuries occur at schools or in their surroundings. Prevalence of tooth avulsion varies from 0.5% to 16% of all cases of dental trauma. Children with dental avulsion may seek help from school nurses so they should be able to provide first-aid treatment. However, many studies showed that the general level of knowledge of medical staff concerning tooth avulsion is unsatisfactory and that it could be improved by educational activities. This article attempts to give short algorithms of first-aid management of avulsed tooth.

Biologic restoration: a treatment option for reconstruction of anterior teeth.

PubMed

Babaji, Prashant; Khanna, Priyanka; S, Shankar; Chaurasia, Vishwajit Rampratap; Masamatti, Vinaykumar S

2014-11-01

Several procedures are advised to manage fractured anterior tooth structure using acrylic resin, composite restoration, ceramic or metal crown with ceramic facing. Biologic restoration is a procedure to restore fractured tooth structure with natural tooth material. In this in vitro case we have made an attempt for aesthetic rehabilitation of maxillary central incisor with similar biologic crown taken form extracted maxillary central incisor. It was observed that biologic restoration is an aesthetic, economical, fast and functional procedure which can be used as an alternative method to restore fractured primary or permanent anteriors.

Avascular necrosis of the femoral head post heart-transplantation and steroid dosage.

PubMed

Foley-Nolan, D; Daly, C; Barry, C; Woods, A; Neligan, M; Coughlan, R J

1992-12-01

Avascular necrosis (avn) post heart-transplantation has been considered to be due to the high doses of steroids used to immunosuppress these patients in attempting to prevent transplant rejection. This study shows that avascular necrosis occurs even when low dose steroids regimes are used and demonstrates no significant correlation between steroid dosage and the development of avn. Patients with symptomatic avn benefit from early diagnosis and management of their condition in that the need for total joint arthroplasty can be prevented in many cases.

Theoretical and treatment issues of personality disorders in individualistic and collectivistic societies.

PubMed

Kim, H A

1998-12-01

The author will attempt to equate so-called personality disorders with what used to be called psychoneurosis. Some suggestions for theoretical and technical modifications to apply psychoanalysis and psychotherapy on selective cases within the current managed care environment have been offered. In order to develop a comprehensive and effective psychotherapy system, a collaboration of psychotherapists both in collectivistic and individualistic societies is highly desirable. Furthermore, the differences of personality disorder and neurosis in both social structure are either minimal or insignificant from a psychotherapeutic point of view.

Ancient Approaches to the Age-old Problem of Water - How Archaeology Can Contribute to the Water Management Discourse of Socio-Hydrology

NASA Astrophysics Data System (ADS)

Egerer, Kyle

2017-04-01

As "the study of old things", archaeology is concerned with material remnants of the human past. At first glance, archaeology may not appear to align well with the purpose of socio-hydrology. Archaeologists attempt to understand past society by analyzing the materials and architecture that provide them with evidence of how people lived and organized their lives. One aspiration of doing so is to gain a contextualized perspective of how contemporary society became the way it is. Human interaction with water is recorded - among other forms of material evidence - in forms of infrastructure and architecture that people construct to control water's flow and preserve this life-supporting resource in times of human need. Building structures, such as water canals or reservoirs, represent society's endeavor to reconcile nature's incalculable influence on society while subtly revealing humanity's penetration into the natural hydrological cycle. Thus, a bi-directional - or reciprocal - relationship between society and nature exists. Socio-hydrological approaches to water management also attempt to understand this relationship. This contribution introduces an archaeological example of how to conceptualize the human-nature dynamic that can be used to understand the socio-political aspects that envelope water management. To evaluate how the Hittite civilization of Late Bronze Age Anatolia (ca. 1600-1200 B.C.) controlled water resources, the author adopts a socio-ecological approach informed by theories of socio-cultural memory and geomorphological analysis. Critical assessment of Hittite written and cultural evidence are compared with hydraulic infrastructure installations to determine how the Hittites used knowledge of their physical landscape to their advantage. In doing so, a framework for interpreting water management practices is formulated that indicates that solutions to water collection and storage were case-based and highly contextualized. Furthermore, legitimate congruencies between archaeology, socio-hydrology and methodologies of integrated water resource management (IWRM) are presented. This primary research ultimately attempts to ameliorate the theoretical and methodological incongruences of such a highly interdisciplinary field such as socio-hydrology. This approach will fuel a debate within the IWRM discipline about how an archaeological approach for analyzing water management strategies of the past can be used in modern water-management-related issues that encompass human-infrastructural, human-irrigational and human-agricultural systems. Keywords: Socio-hydrology, Bronze Age Archaeology of Anatolia, Hittites, Water Management, Integrated Water Resource Management, Socio-cultural Memory, Perception, Phenomenology, Vulnerability, Human-environment dynamics

Young people's risk of suicide attempts after contact with a psychiatric department - a nested case-control design using Danish register data.

PubMed

Christiansen, Erik; Larsen, Kim Juul

2012-01-01

There seems to be an increased risk of children and adolescents committing or attempting suicide after contact with a psychiatric department. Children and adolescents living in families with low socio-economic status (SES) might have an especially increased suicide attempt risk. A complete extraction of Danish register data for every individual born in the period 1983-1989 was made. Of these 403,431 individuals, 3,465 had attempted suicide. In order to control for confounder effects from gender, age and calendar-time, a nested case-control study was designed. A total population of 72,765 individuals was used to analyze the risk of suicide attempts after contact with a psychiatric department. The case-control data were analyzed using conditional logistic regression. This study shows that a child/adolescent's risk of suicide attempt peaks immediately after discharge from last contact with a psychiatric department. The risk of suicide attempt is highest for children and adolescents suffering from personality disorders, depression and substance use disorders. Children and adolescents with previous contact with a psychiatric department and parental income in the lowest third have a significantly higher risk of suicide attempt. Suicide attempters were more likely to have been given several different diagnoses and several different psychopharmacological drugs prior to their attempted suicide. The findings in this study highlight the need for psychopathology assessment in every case of attempted suicide. This study also shows that well-known risk factors such as contact with a psychiatric department do not affect all individuals in the same way. Individuals from families with low SES had the highest risk. This suggests that the presence of factors influencing both vulnerability and resiliency, e.g., family level of SES, needs to be included in the assessment. © 2011 The Authors. Journal of Child Psychology and Psychiatry © 2011 Association for Child and Adolescent Mental Health.

Mode Deactivation Therapy (MDT): A Theoretical Case Analysis on a Suicidal Adolescent

ERIC Educational Resources Information Center

Apsche, Jack A.; Siv, Alexander M.

2005-01-01

This case study presents a case study of the effectiveness of Mode deactivation therapy (MDT) (Apsche, Bass, Jennings, Murphy, Hunter, and Siv, 2005) with an adolescent male, with reactive conduct disorder, PTSD and 8 lethal suicide attempts. The youngster was hospitalized four times for suicide attempts, three previous placements in residential…

Challenges for community-based forest management in the KoloAla site Manompana.

PubMed

Urech, Zora Lea; Sorg, Jean-Pierre; Felber, Hans Rudolph

2013-03-01

Following the IUCN 5th World Congress on Protected Areas in 2003, the then-President of Madagascar decided to increase the area of Madagascar's protected areas from 1.7 to 6 million ha. To combine the aims of protection and timber production, a new concept was developed through the establishment of community-based forest management (CBFM) sites, called KoloAla. However, experience shows that similar management transfers to communities in Madagascar have only been successful in a very few cases. We aimed to explore the success to be expected of this new approach in the particular case of the Manompana corridor at Madagascar's eastern coast. In a first step, the readiness of the corridor's resource users for CBFM has been analysed according to the seven resource users' attributes developed by Ostrom that predict an effective self-organized resource management. In a second step, we explored how KoloAla addresses known challenges of Madagascar's CBFM. Analyses lead in a rather sober conclusion. Although KoloAla attempts to address the goals of poverty alleviation, biodiversity conservation and timber production under a single umbrella, it does so in a rather non-innovative way. Challenges with regard to the state's environmental governance, agricultural inefficiency and thus deforestation remain unsolved.

Challenges for Community-Based Forest Management in the KoloAla Site Manompana

NASA Astrophysics Data System (ADS)

Urech, Zora Lea; Sorg, Jean-Pierre; Felber, Hans Rudolph

2013-03-01

Following the IUCN 5th World Congress on Protected Areas in 2003, the then-President of Madagascar decided to increase the area of Madagascar's protected areas from 1.7 to 6 million ha. To combine the aims of protection and timber production, a new concept was developed through the establishment of community-based forest management (CBFM) sites, called KoloAla. However, experience shows that similar management transfers to communities in Madagascar have only been successful in a very few cases. We aimed to explore the success to be expected of this new approach in the particular case of the Manompana corridor at Madagascar's eastern coast. In a first step, the readiness of the corridor's resource users for CBFM has been analysed according to the seven resource users' attributes developed by Ostrom that predict an effective self-organized resource management. In a second step, we explored how KoloAla addresses known challenges of Madagascar's CBFM. Analyses lead in a rather sober conclusion. Although KoloAla attempts to address the goals of poverty alleviation, biodiversity conservation and timber production under a single umbrella, it does so in a rather non-innovative way. Challenges with regard to the state's environmental governance, agricultural inefficiency and thus deforestation remain unsolved.

Retrievable Inferior Vena Cava Filters in Trauma Patients: Prevalence and Management of Thrombus Within the Filter.

PubMed

Pan, Y; Zhao, J; Mei, J; Shao, M; Zhang, J; Wu, H

2016-12-01

The incidence of thrombus was investigated within retrievable filters placed in trauma patients with confirmed DVT at the time of retrieval and the optimal treatment for this clinical scenario was assessed. A technique called "filter retrieval with manual negative pressure aspiration thrombectomy" for management of filter thrombus was introduced and assessed. The retrievable filters referred for retrieval between January 2008 and December 2015 were retrospectively reviewed to determine the incidence of filter thrombus on a pre-retrieval cavogram. The clinical outcomes of different managements for thrombus within filters were recorded and analyzed. During the study 764 patients having Aegisy Filters implanted were referred for filter removal, from which 236 cases (134 male patients, mean age 50.2 years) of thrombus within the filter were observed on initial pre-retrieval IVC venogram 12-39 days after insertion (average 16.9 days). The incidence of infra-filter thrombus was 30.9%, and complete occlusion of the filter bearing IVC was seen in 2.4% (18) of cases. Retrieval was attempted in all 121 cases with small clots using a regular snare and sheath technique, and was successful in 120. A total of 116 cases with massive thrombus and IVC occlusion by thrombus were treated by CDT and/or the new retrieval technique. Overall, 213 cases (90.3%) of thrombus in the filter were removed successfully without PE. A small thrombus within the filter can be safely removed without additional management. CDT for reduction of the clot burden in filters was effective and safe. Filter retrieval with manual negative pressure aspiration thrombectomy seemed reasonable and valuable for management of massive thrombus within filters in some patients. Full assessment of the value and safety of this technique requires additional studies. Copyright © 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Feasibility trial of GP and case-managed support for workplace sickness absence.

PubMed

Rannard, Anne; Gabbay, Mark; Sen, Dil; Riley, Richard; Britt, David

2014-07-01

Aim Our aim was to compare the return-to-work rates between individuals supported by their GP plus workplace health advisers (intervention group) and those supported by their GP alone. Workplace sickness absence places a significant cost burden on individuals and the wider economy. Previous research shows better outcomes for individuals if they are supported while still in employment, or have been on sick leave for four weeks or less. Those helped back to work at an early stage are more likely to remain at work. A non-medicalised case-managed approach appears to have the best outcomes and can prevent or reduce the slide onto out-of-work benefits, but UK literature on its effectiveness is sparse. The design was a feasibility-controlled trial in which participants were sickness absentees, or presentees in employment with work-related health problems. Individuals completed health status measures (SF-36; EQ-5D) and a Job Content Questionnaire at baseline and again at four-month follow-up. Findings In the intervention group, 29/60 participants completed both phases of the trial. GP practices referred two control patients, and, despite various attempts by the research team, GPs failed to engage with the trial. This finding is of concern, although not unique in primary care research. In earlier studies, GPs reported a lack of knowledge and confidence in dealing with workplace health issues. Despite this, we report interesting findings from the case-managed group, the majority of whom returned to work within a month. Age and length of sickness absence at recruitment were better predictors of return-to-work rates than the number of case-managed contacts. The traditional randomised controlled trial approach was unsuitable for this study. GPs showed low interest in workplace sickness absence, despite their pivotal role in the process. This study informed a larger Department for Work and Pensions study of case-managed support.

Breast Imaging Second Opinions Impact Surgical Management.

PubMed

Spivey, Tara Lynn; Carlson, Kjirsten Ayn; Janssen, Imke; Witt, Thomas R; Jokich, Peter; Madrigrano, Andrea

2015-07-01

Breast surgeons often see women for second opinions for abnormalities found on breast imaging. For second opinions, these images are submitted for review and interpretation by dedicated breast imagers. This study evaluated the conformity of results among interpretation of imaging submitted from outside hospitals both from tertiary care centers, as well as community programs, in an attempt to evaluate the utility of this practice for the sake of clinical management and resource utilization. A retrospective chart review was conducted on all breast patients that submitted outside imaging films for the years 2011 to 2013 at Rush University Medical Center (RUMC). The radiologic diagnosis and each patient's proposed management plan was collected and evaluated for concordance between the outside institutions and RUMC. A total of 380 patients who presented for second opinions with an interpretation of outside exams were evaluated. In 47.4 % [95 % confidence interval (CI) 42.4-52.4] of cases there was distinct variance in radiologic impression. For 53.5 % (95 % CI 48.4-58.5) of patients, there was a change in recommended management plan, which included recommendations for either additional imaging or need for additional biopsy. In total, this changed the overall surgical management in 27.1 % (95 % CI 22.8-31.9) of cases. In six patients, the reinterpretation of outside imaging detected new malignancies not previously identified. Overall, 83.7 % (95 % CI 79.7-87.1) of patients who submitted imaging from outside institutions chose to complete the remainder of their treatment at RUMC. The practice of second opinion review changed overall definitive management at our specialty center in more than one in four cases. In addition, the review identified six previously unrecognized malignancies. Given this data, the practice of second opinions and interpretation of outside exams should continue despite the additional resources required.

An analysis of the value of marketing to non-profit organizations: the case of child safety.

PubMed

Razis, V; Razis, N

1993-01-01

This paper considers a broad spectrum of literature concerning the limitations and value of applying marketing management principles from the private sector to public or non-profit organizations. The Child Accident Prevention Foundation of Southern Africa is used as a principle case-study. The authors conclude that there is much to be gained from applying a more systematic approach, providing one adapts business strategies to more complex social environments and objectives. Since both marketing and social issues share the challenge of 'sensitivity serving and satisfying human needs,' (Kotler, 1983 p 272) there are also some instances where business can learn from the experience of social organizations in attempts to influence human behavior.

Complete endoscopic management of a retained bullet in the bladder.

PubMed

Friedman, Ariella A; Trinh, Quoc-Dien; Kaul, Sanjeev; Bhandari, Akshay

2013-01-01

A 25-year-old male gunshot victim presented at our institution with gross hematuria following Foley catheter insertion. Computed tomography and cystogram did not show a bladder perforation, but were notable for a left ischial fracture and the presence of a bullet within the bladder. After failed attempts at retrieving the bullet with a resectoscope and loop, as well as a cystoscope and stone crusher, a 26 French nephroscope was inserted transurethrally, and the bullet was successfully engaged and removed using a Perc NCircle (Cook Medical, Bloomington, IN) grasper. The extra-peritoneal injury was managed conservatively with catheter drainage. To our knowledge, this represents the first case of successful transurethral management of a retained intravesical bullet. Such an approach may benefit patients with retained intravesical bullets or other challenging intravesical foreign bodies and may be helpful in select circumstances to spare patients from more extensive surgeries.

Socioeconomic and clinical characteristics associated with repeat suicide attempts among young people.

PubMed

Chen, Chuan-Yu; Yeh, Hsueh-Han; Huang, Nicole; Lin, Yun-Chen

2014-05-01

Repeat suicidal behaviors in young people are a critical public health concern. The study investigates individual socioeconomic and episode-dependent clinical factors predicting repeat suicide attempts among youth by gender. Using a retrospective cohort study, we identified a total of 4,094 male and 3,219 female youths who had the index suicide episode at the ages of 15-24 years from the 1996-2007 National Health Insurance Research Database in Taiwan. The recurrence of suicide attempt was assessed within 1 year after the index suicide. Information pertaining to suicide management and postsuicide treatment was obtained from healthcare records. Repeated event survival analyses were used to estimate episode-dependent risk of suicide attempt. The occurrence of repeat suicide attempts was more common in males, yet the phenomenon of risk aggravation appears more prominent in females. The estimate for peak hazard of the second repeat attempt was 2-fold higher than that of the first repeat event in males, and approximately 6-fold in females. Socioeconomic (e.g., labor market participation: adjusted Hazard Ratio [aHR] = 1.14, 95% CI = 1.01-1.28) and index suicide management characteristics (e.g., receiving treatment at clinic, aHR = 1.54, 95% CI = 1.19-1.99) were found to play important roles for repeat suicide attempts in males. For females, postsuicide treatment of mental disorders appears more influential. The relationships between socioeconomic and clinical factors with repeat suicide attempts in young people vary by gender. School/workplace-based post suicide attempt consultation and clinical management for youth may be planned and delivered on a gender-appropriate basis. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Prone position craniotomy in pregnancy without fetal heart rate monitoring.

PubMed

Jacob, Jean; Alexander, Ashish; Philip, Shoba; Thomas, Anoop

2016-09-01

A pregnant patient in second trimester scheduled for posterior fossa craniotomy in prone position is a challenge for the anesthesiologist. Things to consider are physiological changes during pregnancy, non-obstetric surgery in pregnant patients, neuroanesthetic principles, effects of prone positioning, and need for fetal heart rate (FHR) monitoring. We have described the anesthetic management of this case and discussed intra-operative FHR monitoring including controversies about its role, indications, and various options available as per fetal gestational age. In our case we attempted intermittent intra-operative FHR monitoring to optimize maternal positioning and fetal oxygenation even though the fetus was pre-viable. However the attempt was abandoned due to practical difficulties with prone positioning. Patient made good neurological recovery following the procedure and delivered a healthy term baby 4 months later. Decisions regarding fetal monitoring should be individualized based on viability of the fetus and feasibility of emergency cesarean delivery. Good communication between a multidisciplinary team involving neurosurgeon, anesthesiologist, obstetrician, and neonatologist is important for a successful outcome for mother and fetus. We conclude that prone position neurosurgery can safely be carried out in a pregnant patient with pre-viable fetus without FHR monitoring. Copyright © 2016 Elsevier Inc. All rights reserved.

Use of endoscopy in diagnosis and management of patients with dysphagia in an African setting.

PubMed

Mudawi, H M Y; Mahmoud, A O A; El Tahir, M A; Suliman, S H; Ibrahim, S Z

2010-04-01

The objectives of this study were to define the utility of esophagogastroduodenoscopy in the diagnosis and management of patients presenting with dysphagia and to determine the relative incidence of the various causes of dysphagia in Sudan. This is a prospective, cross-sectional, descriptive, hospital-based study carried out at the endoscopy unit of Soba University Hospital, Khartoum, Sudan. All patients complaining of dysphagia underwent upper gastrointestinal endoscopy with therapeutic intervention when necessary. A total of 114 patients were enrolled in the study, with a mean age of 47 years SD +/- 19 and a male to female ratio of 1 : 1.04. A benign condition was diagnosed in 56% of the cases; this included esophageal strictures in 21% of the cases and achalasia in 14%. Malignant causes were mainly due to esophageal cancer (40.4%) and cancer of the stomach cardia (3.5%). Therapeutic intervention was attempted in 83% of the cases. Risk factors predictive of a malignant etiology were age over 40 years (P < 0.000), dysphagia lasting between 1 month and 1 year (P < 0.000), and weight loss (P < 0.000). A barium study was performed in 35 cases (31%) prior to endoscopic examination and proved to be inaccurate in three cases (8.6%). Upper gastrointestinal endoscopy in our African setting is an accurate and useful investigation in the diagnosis and management of patients presenting with dysphagia. Patients over the age of 40 years presenting with dysphagia and weight loss are more likely to have a neoplastic disease and should be referred for urgent endoscopy.

Productivity, pesticides, and management of the Peregrine Falcon in Arizona

USGS Publications Warehouse

Ellis, D.H.

1985-01-01

In the decade since research commenced with the Peregrine in Arizona, over 60 sites have been identified which historically or presently are occupied by breeding pairs. Productivity was determined for about 120 breeding attempts from 1975-85. Almost all sites, for which productivity information is available for two or more years, have hatched young. Average values for fledging success were ca. 1.4 young/attempt for all active sites and ca. 2.3 young/attempt for successful sites. Eggshell thickness values were highly varied, but few samples reflect thinning sufficient to cause reproductive failure, and the population appears to be increasing slightly. Management practices which can further benefit the falcon include: controlling pesticide use, habitat protection, and information management.

An accountable fistula management treatment plan.

PubMed

Thompson, Mary Jo; Epanomeritakis, Emanuel

An accountable fistula management treatment plan focuses on combining effective medical and nursing treatment with effective and efficient pouching technique and equipment to ensure patient comfort. Small bowel fistula following abdominal surgery can provide challenges in patients' medical and nursing management. This article describes a case study of the successful medical and nursing management of a patient post-abdominal surgery. Within days of surgery a small bowel fistula formed within an abdominal wound. Medical management involved the use of total parenteral nutrition, electrolyte balance management, nil orally and Sandostatin medication. The nursing interventions comprised accurate intake and output measurement, effective and efficient pouching systems and appropriate psychological care. The medical and nursing interventions provided during the healing process are outlined together with the assessment and evaluation of a new innovative wound management pouch. This system proved invaluable in the successful containment of a high small bowel effluent and skin preservation. In an attempt to share best practice a pictorial guide is provided to demonstrate the correct application of the pouching system and technique. This article provides details of an accountable fistula management treatment plan which resulted in the successful spontaneous closure of the small bowel fistula coupled with excellent cost-effectiveness and patient comfort.

Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery

PubMed Central

2011-01-01

Background There is no consensus on diagnosis and management of ASBO. Initial conservative management is usually safe, however proper timing for discontinuing non operative treatment is still controversial. Open surgery or laparoscopy are used without standardized indications. Methods A panel of 13 international experts with interest and background in ASBO and peritoneal diseases, participated in a consensus conference during the 1st International Congress of the World Society of Emergency Surgery and 9th Peritoneum and Surgery Society meeting, in Bologna, July 1-3, 2010, for developing evidence-based recommendations for diagnosis and management of ASBO. Whenever was a lack of high-level evidence, the working group formulated guidelines by obtaining consensus. Recommendations In absence of signs of strangulation and history of persistent vomiting or combined CT scan signs (free fluid, mesenteric oedema, small bowel faeces sign, devascularized bowel) patients with partial ASBO can be managed safely with NOM and tube decompression (either with long or NG) should be attempted. These patients are good candidates for Water Soluble Contrast Medium (WSCM) with both diagnostic and therapeutic purposes. The appearance of water-soluble contrast in the colon on X-ray within 24 hours from administration predicts resolution. WSCM may be administered either orally or via NGT (50-150 ml) both immediately at admission or after an initial attempt of conservative treatment of 48 hours. The use of WSCM for ASBO is safe and reduces need for surgery, time to resolution and hospital stay. NOM, in absence of signs of strangulation or peritonitis, can be prolonged up to 72 hours. After 72 hours of NOM without resolution surgery is recommended. Patients treated non-operatively have shorter hospital stay, but higher recurrence rate and shorter time to re-admission, although the risk of new surgically treated episodes of ASBO is unchanged. Risk factors for recurrences are age <40 years and matted adhesions. WSCM does not affect recurrence rates or recurrences needing surgery when compared to traditional conservative treatment. Open surgery is the preferred method for surgical treatment of strangulating ASBO as well as after failed conservative management. In selected patients and with appropriate skills, laparoscopic approach can be attempted using open access technique. Access in the left upper quadrant should be safe. Laparoscopic adhesiolysis should be attempted preferably in case of first episode of SBO and/or anticipated single band. A low threshold for open conversion should be maintained. Peritoneal adhesions should be prevented. Hyaluronic acid-carboxycellulose membrane and icodextrin can reduce incidence of adhesions. Icodextrin may reduce the risk of re-obstruction. HA cannot reduce need of surgery. PMID:21255429

Best practices: a review of company activity on HIV / AIDS in South Africa.

PubMed

Michael, K

1999-01-01

This article presents the 1998 survey results conducted by the Health Economics and HIV/AIDS Research Division of the University of Natal in South Africa with the goal of documenting the best practices of managing HIV/AIDS in the workplace. The five key areas of the study are: HIV prevention; managing ill health; human resource development and industrial relations; employee benefits and survivor support; monitoring and planning for change in the workplace. The research comprised 14 companies used during the case studies. A few notable cases were observed among companies attempting to create awareness about HIV/AIDS. The Best Practice Survey highlighted issues about the private sectors in South Africa and their HIV management. First, companies conceptualize AIDS as either a health or poverty problem. Second, the environment is affected by the hazards of economic downturns, labor action, and economic inflation while the AIDS problem is neglected. Third, indirect costs were not considered and most companies feel that the conversion to a defined contribution arrangement compensates against escalating payouts for benefits. Fourth, long-term plans of the companies did not utilize the ill health statistics for the past 5 years.

Arterial hemorrhage from cesarean scar: a rare cause of recurring massive uterine bleeding and successful surgical management.

PubMed

Wang, Chun-Feng; Hu, Min

2015-02-01

Abnormal uterine bleeding and other gynecologic complications associated with a previous cesarean section scar are only recently being identified and described. Herein we report a rare case of a woman with recurring massive uterine bleeding after 2 cesarean sections. Curettage and hormone therapy were unsuccessfully used in an attempt to control the bleeding. After she was transferred to our hospital, she had another episode of vaginal bleeding that was successfully managed with oxytocin and hemostatic. Diagnostic hysteroscopy performed under anesthesia revealed an abnormal transected artery in the cesarean section scar with a thrombus visible. In the treatment at the beginning of laparoscopic management, we adopted temporary bilateral uterine artery occlusion with titanium clips to prevent massive hemorrhage. Secondly, with the aid of hysteroscopy, the bleeding site was opened, and then the cesarean scar was wedge resected and stitched interruptedly with 1-0 absorbable sutures. The postoperative recovery was uneventful. It would seem that the worldwide use of cesarean section delivery may contribute to the risk of gynecologic disturbances including some unrecognized and complex conditions as seen in this case. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

A model for evaluating the social performance of construction waste management.

PubMed

Yuan, Hongping

2012-06-01

It has been determined by existing literature that a lot of research efforts have been made to the economic performance of construction waste management (CWM), but less attention is paid to investigation of the social performance of CWM. This study therefore attempts to develop a model for quantitatively evaluating the social performance of CWM by using a system dynamics (SD) approach. Firstly, major variables affecting the social performance of CWM are identified and a holistic system for assessing the social performance of CWM is formulated in line with feedback relationships underlying these variables. The developed system is then converted into a SD model through the software iThink. An empirical case study is finally conducted to demonstrate application of the model. Results of model validation indicate that the model is robust and reasonable to reflect the situation of the real system under study. Findings of the case study offer helpful insights into effectively promoting the social performance of CWM of the project investigated. Furthermore, the model exhibits great potential to function as an experimental platform for dynamically evaluating effects of management measures on improving the social performance of CWM of construction projects. Copyright © 2012 Elsevier Ltd. All rights reserved.

Strategies used by women workers to reconcile family responsibilities with atypical work schedules in the service sector.

PubMed

Barthe, B; Messing, K; Abbas, L

2011-01-01

Workers' attempts to accommodate family needs may be considered illegitimate in the paid work sphere. Their attempts at work-family balancing (WFB) in that sphere can remain invisible, even when those attempts require considerable energy. Since identification of WFB strategies can potentially lead to suggestions to improve management practices, we report an attempt to find them in the work sphere. 14 care aides in a Québec residence for seniors and 2~schedule managers were recruited. Qualitative ergonomic analysis was employed. 24 hours observation; interviews of nursing and human resources staff; qualitative ergonomic analysis by two researchers; feedback collected from meetings with management and union. Strategies for schedule choice were compared between care aides with heavier vs. lighter family responsibilities. For workers with heavier family responsibilities, choice of work schedules was almost entirely conditioned by family considerations, leaving little leeway to manage workers' own health protection. Family constraints affected activity at work, and strategies for handling family constraints could potentially be affected by changes in work organization. Managers should encourage full discussion of work-family balancing strategies if they wish to adapt their working conditions to the workers, and ergonomists should include this balancing as a facet of work activity, despite possible negative consequences.

Evaluating participatory decision processes: which methods inform reflective practice?

PubMed

Kaufman, Sanda; Ozawa, Connie P; Shmueli, Deborah F

2014-02-01

Evaluating participatory decision processes serves two key purposes: validating the usefulness of specific interventions for stakeholders, interveners and funders of conflict management processes, and improving practice. However, evaluation design remains challenging, partly because when attempting to serve both purposes we may end up serving neither well. In fact, the better we respond to one, the less we may satisfy the other. Evaluations tend to focus on endogenous factors (e.g., stakeholder selection, BATNAs, mutually beneficial tradeoffs, quality of the intervention, etc.), because we believe that the success of participatory decision processes hinges on them, and they also seem to lend themselves to caeteris paribus statistical comparisons across cases. We argue that context matters too and that contextual differences among specific cases are meaningful enough to undermine conclusions derived solely from comparisons of process-endogenous factors implicitly rooted in the caeteris paribus assumption. We illustrate this argument with an environmental mediation case. We compare data collected about it through surveys geared toward comparability across cases to information elicited through in-depth interviews geared toward case specifics. The surveys, designed by the U.S. Institute of Environmental Conflict Resolution, feed a database of environmental conflicts that can help make the (statistical) case for intervention in environmental conflict management. Our interviews elicit case details - including context - that enable interveners to link context specifics and intervention actions to outcomes. We argue that neither approach can "serve both masters." Copyright © 2013 Elsevier Ltd. All rights reserved.

Use of Hemadsorption in a Case of Pediatric Toxic Shock Syndrome

PubMed Central

Berkes, Andrea; Szikszay, Edit; Kerényi, Adrienne; Szabó, Tamás; Ujhelyi, László; Bari, Krisztina; Balla, György

2017-01-01

Background Toxic shock syndrome is a potentially fatal toxin-mediated disease. The role of toxins in this clinical entity made us hypothesize that extracorporeal blood purification with CytoSorb® could play a beneficial role in the clinical management of toxic shock syndrome. This case report describes the successful treatment of toxic shock syndrome using a combination of renal replacement therapy and hemadsorption in a pediatric patient. Case Presentation A 5-year-old girl with Down's syndrome presented with an inflamed area surrounding an insect bite, signs of systemic inflammation, and multiple organ failure. As previous attempts of immune modulation therapy were unsuccessful, renal replacement therapy was supplemented by the cytokine absorber CytoSorb. Treatment using this combination was associated with a rapid and significant stabilization in the hemodynamic situation and a decrease in inflammatory mediators within hours after the initiation of therapy. The application of CytoSorb therapy was simple and safe. Conclusion The use of extracorporeal blood purification with CytoSorb proved potentially beneficial by removing toxins and inflammatory mediators in this case and could therefore play a role in the clinical management of toxic shock syndrome. Whether CytoSorb has the potential to even positively influence mortality in patients with toxic shock syndrome still needs to be confirmed. PMID:28791185

Pregnancy outcome and obstetric management after vaginal radical trachelectomy.

PubMed

Ma, L-K; Cao, D-Y; Yang, J-X; Liu, J-T; Shen, K; Lang, J-H

2014-10-01

Radical vaginal trachelectomy (VRT) is widely prescribed as a surgical procedure to treat early-stage cervical cancer while preserving fertility. However, the ideal obstetric standard of care for patients who have undergone VRT has not yet been established. Aim of this rerport is to analyze pregnancy outcomes and optimal obstetric management during pregnancy and delivery after vaginal radical trachelectomy (VRT). Forty-six cases of VRT from December 2003 to April 2013 in Peking Union Medical College Hospital were analyzed. The mean age of the patients at the time of VRT was 30.6 years and the mean follow-up time was 39.5 months. Of the 32 patients who attempted to conceive, 12 had 16 successful conceptions. There were two miscarriages and two elective abortions. One case of ectopic pregnancy and one case of second trimester loss occurred in this cohort. Ten cases reached the third trimester. Two patients delivered before 32 weeks, and four before 37 weeks. The total preterm delivery rate was 60%. All ten patients delivered by Cesarean section through a high transverse uterine incision. No uterine rupture or postpartum hemorrhage occurred. There is an increased occurrence of preterm delivery after VRT. Cesarean section after full term pregnancy through a high transverse incision should be considered as a suitable and safe procedure.

Treatment Challenges of Prosthetic Hip Infection with Associated Iliacus Muscle Abscess: Report of 5 Cases and Literature Review.

PubMed

Lawrenz, Joshua M; Mesko, Nathan W; Higuera, Carlos A; Molloy, Robert M; Simpfendorfer, Claus; Babic, Maja

2017-01-01

Prosthetic joint infection is an unfortunate though well-recognized complication of total joint arthroplasty. An iliacus and/or iliopsoas muscle abscess is a rarely documented presentation of hip prosthetic joint infection. It is thought an unrecognized retroperitoneal nidus of infection can be a source of continual seeding of the prosthetic hip joint, prolonging attempts to eradicate infection despite aggressive debridement and explant attempts. The current study presents five cases demonstrating this clinical scenario, and discusses various treatment challenges. In each case we report the patient's clinical history, pertinent imaging, management and outcome. Diagnosis of the iliacus muscle abscess was made using computed tomography imaging. In brief, the mean number of total drainage procedures (open and percutaneous) per patient was 4.2, and outcomes consisted of one patient with a hip girdlestone, two patients with delayed revisions, and two patients with retained prosthesis. All patients ended with functional pain and on oral antibiotic suppression with an average follow up of 18 months. This article highlights an iliacus muscle abscess as an unrecognized source of infection to a prosthetic hip. It demonstrates resilience to standard treatment protocols for prosthetic hip infection, and is associated with poor patient outcomes. Aggressive surgical debridement appears to remain critical to treatment success, and early retroperitoneal debridement of the abscess should be considered.

[When a Suicide Attempt is Kid's Stuff].

PubMed

Vásquez-Rojas, Rafael; Quijano-Serrano, Margarita

2013-01-01

Attempted suicide in children and adolescents is a disturbing and painful issue for patients, their families and physicians. Current medical literature provides little information about minors who attempt suicide, possibly because there is under-reporting of this condition as a diagnosis, or maybe because it is sometimes considered as a way for the child to draw attention. To present the experience of the Department of Psychiatry (Universidad Nacional de Colombia) at the Hospital Infantil de La Misericordia, from 2003 to 2013. An observational retrospective study was conducted by reviewing 213 cases of children and adolescents treated for attempted suicide at the Hospital Infantil de La Misericordia from January 1, 2003 to October 31, 2013, and who received hospital or outpatient care in Child Psychiatry. A review was performed of the diagnosis, the number of suicide attempts, the peak months of consultation for this reason, and the methods selected, as well as a detailed description of the group of patients under 12 years old, and those managed with outpatient follow-up. The average patient is a female teenager who becomes intoxicated with drugs. Most often, patients do not return to outpatient follow-up. Those with follow-up have multiple psychopathologies and a high level of suffering. The most common methods, other than poisoning by drugs, are hanging and jumping from heights. Patients under 12 years old generally have their first attempt by drug poisoning. There is a predominance of anxiety disorder and depression, with a strong association with cognitive dysfunction, as a vulnerability factor. Copyright © 2013 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Between hype and veracity; privatization of municipal solid waste management and its impacts on the informal waste sector.

PubMed

Sandhu, Kiran; Burton, Paul; Dedekorkut-Howes, Aysin

2017-01-01

The informal waste recycling sector has been an indispensable but ironically invisible part of the waste management systems in developing countries as India, often completely disregarded and overlooked by decision makers and policy frameworks. The turn towards liberalization of economy since 1991 in India opened the doors for privatization of urban services and the waste sector found favor with private companies facilitated by the local governments. In joining the privatization bandwagon, the local governments aim to create an image of a progressive city demonstrated most visibly through apt management of municipal solid waste. Resultantly, the long important stakeholder, the informal sector has been sidelined and left to face the adverse impacts of privatization. There is hardly any recognition of its contributions or any attempt to integrate it within the formal waste management systems. The study investigates the impacts of privatization on the waste pickers in waste recycling operations. Highlighting the other dimension of waste collection and management in urban India the study focuses on the waste pickers and small time informal scrap dealers and this is done by taking the case study of Amritsar city, which is an important historic centre and a metropolitan city in the state of Punjab, India. The paper develops an analytical framework, drawing from literature review to analyze the impacts. In conclusion, it supports the case for involving informal waste sector towards achieving sustainable waste management in the city. Copyright © 2016 Elsevier Ltd. All rights reserved.

Managing Budd-Chiari syndrome: a retrospective review of percutaneous hepatic vein angioplasty and surgical shunting

PubMed Central

Fisher, N; McCafferty, I; Dolapci, M; Wali, M; Buckels, J; Olliff, S; Elias, E

1999-01-01

BACKGROUND—The role of percutaneous hepatic vein angioplasty in the management of Budd-Chiari syndrome has not been well defined. Over a 10 year period at our unit, we have often used this technique in cases of short length hepatic vein stenosis or occlusion, reserving surgical mesocaval shunting for cases of diffuse hepatic vein occlusion or failed angioplasty. 
AIMS—To review the outcome of angioplasty and surgical shunting to define their respective roles. 
PATIENTS—All patients treated by angioplasty or surgical shunting for non-malignant hepatic vein obstruction over a ten year period from 1987 to 1996. 
METHODS—A case note review of pretreatment features and clinical outcome. 
RESULTS—Angioplasty was attempted in 21 patients with patent hepatic vein branches and was succesful in 18; in three patients treatment was unsuccessful and these patients had surgical shunts. Fifteen patients were treated by surgical shunting only. Mortality according to definitive treatment was 3/18 following angioplasty and 8/18 following surgery; in most cases this reflected high risk status prior to treatment. Venous or shunt reocclusion rates were similar for both groups and were associated with subtherapeutic warfarin in half of these cases. Most surviving patients in both groups are asymptomatic although one surgical patient has chronic hepatic encephalopathy. 
CONCLUSION—With appropriate case selection, many patients with Budd-Chiari syndrome caused by short length hepatic vein stenosis or occlusion may be managed successfully by angioplasty alone. Medium term outcome is good following this procedure provided that anticoagulation is maintained. Further follow up is required to assess for definitive benefits but we suggest that this should be included as a valid initial approach in the algorithm for management of Budd-Chiari syndrome. 

 Keywords: Budd-Chiari syndrome; short length hepatic vein stenosis; hepatic vein occlusion; percutaneous hepatic vein angioplasty; mesocaval shunt PMID:10075967

Commercial Impact and Optimum Capacity Determination of Pumped Storage Hydro Plant for a Practical Power System

NASA Astrophysics Data System (ADS)

Latha, P. G.; Anand, S. R.; Imthias, Ahamed T. P.; Sreejith, P. S., Dr.

2013-06-01

This paper attempts to study the commercial impact of pumped storage hydro plant on the operation of a stressed power system. The paper further attempts to compute the optimum capacity of the pumped storage scheme that can be provided on commercial basis for a practical power system. Unlike the analysis of commercial aspects of pumped storage scheme attempted in several papers, this paper is presented from the point of view of power system management of a practical system considering the impact of the scheme on the economic operation of the system. A realistic case study is presented as the many factors that influence the pumped storage operation vary widely from one system to another. The suitability of pumped storage for the particular generation mix of a system is well explored in the paper. To substantiate the economic impact of pumped storage on the system, the problem is formulated as a short-term hydrothermal scheduling problem involving power purchase which optimizes the quantum of power to be scheduled and the duration of operation. The optimization model is formulated using an algebraic modeling language, AMPL, which is then solved using the advanced MILP solver CPLEX.

Transformational change in healthcare: an examination of four case studies.

PubMed

Charlesworth, Kate; Jamieson, Maggie; Davey, Rachel; Butler, Colin D

2016-04-01

Objectives Healthcare leaders around the world are calling for radical, transformational change of our health and care systems. This will be a difficult and complex task. In this article, we examine case studies in which transformational change has been achieved, and seek to learn from these experiences. Methods We used the case study method to investigate examples of transformational change in healthcare. The case studies were identified from preliminary doctoral research into the transition towards future sustainable health and social care systems. Evidence was collected from multiple sources, key features of each case study were displayed in a matrix and thematic analysis was conducted. The results are presented in narrative form. Results Four case studies were selected: two from the US, one from Australia and one from the UK. The notable features are discussed for each case study. There were many common factors: a well communicated vision, innovative redesign, extensive consultation and engagement with staff and patients, performance management, automated information management and high-quality leadership. Conclusions Although there were some notable differences between the case studies, overall the characteristics of success were similar and collectively provide a blueprint for transformational change in healthcare. What is known about the topic? Healthcare leaders around the world are calling for radical redesign of our systems in order to meet the challenges of modern society. What does this paper add? There are some remarkable examples of transformational change in healthcare. The key factors in success are similar across the case studies. What are the implications for practitioners? Collectively, these key factors can guide future attempts at transformational change in healthcare.

Applying the Paris System for Reporting Urine Cytology Increases the Rate of Atypical Urothelial Cells in Benign Cases: A Need for Patient Management Recommendations.

PubMed

Granados, Rosario; Duarte, Joanny A; Corrales, Teresa; Camarmo, Encarnación; Bajo, Paloma

2017-01-01

The Paris System (TPS) for reporting urinary cytology attempts to unify the terminology in this field. To analyze the impact of adopting TPS by measuring nomenclature agreement and cytohistological correlation. Voided urine liquid-based cytology samples corresponding to 149 biopsy-proven cases (76 high-grade carcinomas, 40 low-grade carcinomas, and 33 benign lesions), were reclassified by the same pathologist using TPS. Diagnostic agreement and sensitivity for both nomenclature systems was measured. When using TPS, the rate of atypical samples increased 8 times (from 3 to 24.2%) in benign cases, 10 times (from 2.5 to 25%) in low-grade carcinomas, and 2.4 times (from 6.6 to 15.8%) in high-grade carcinomas. The false-positive rate (abnormal cytology in negative or low-grade carcinoma cases) increased from 11 to 34.2%. Sensitivity was higher (63 vs. 49%) with TPS at the expense of a lower specificity (73 vs. 91%). The agreement between both nomenclatures was moderate for negative and high-grade carcinoma cases (k = 0.42 and 0.56, respectively) and weak for low-grade tumors (k = 0.35). Adopting TPS for reporting urine cytology results in a considerable increase in atypical diagnoses, improving sensitivity but lowering specificity. Appropriate management recommendations for patients with an atypical cytological diagnosis are required. © 2016 S. Karger AG, Basel.

Floodplain conflicts: regulation and negotiation

NASA Astrophysics Data System (ADS)

Pardoe, J.; Penning-Rowsell, E.; Tunstall, S.

2011-10-01

In the continuing shift from engineered solutions towards more holistic methods of managing flood risk, spatial planning has become the primary focus of a conflict between land and water, water and people. In attempting to strike a balance between making space for water and making space for people, compromises are required. Through five case studies in the UK, this paper analyses the effectiveness of Planning Policy Statement 25 (PPS 25) and the processes of negotiation that it promotes. This assessment allows us to draw conclusions on the nature of the compromises this kind of negotiation can achieve and the implications of this for flood risk management. What emerges is that the beneficial impacts of decisions to develop floodplain areas are given a proper hearing and sensible conditions imposed, rather than arguments to prevent such development remaining unchallenged.

Modal analysis of dislocation vibration and reaction attempt frequency

DOE PAGES

Sobie, Cameron; Capolungo, Laurent; McDowell, David L.; ...

2017-02-04

Transition state theory is a fundamental approach for temporal coarse-graining. It estimates the reaction rate for a transition processes by quantifying the activation free energy and attempt frequency for the unit process. To calculate the transition rate of a gliding dislocation, the attempt frequency is often obtained from line tension estimates of dislocation vibrations, a highly simplified model of dislocation behavior. This work revisits the calculation of attempt frequency for a dislocation bypassing an obstacle, in this case a self-interstitial atom (SIA) loop. First, a direct calculation of the vibrational characteristics of a finite pinned dislocation segment is compared tomore » line tension estimates before moving to the more complex case of dislocation-obstacle bypass. The entropic factor associated with the attempt frequency is calculated for a finite dislocation segment and for an infinite glide dislocation interacting with an SIA loop. Lastly, it is found to be dislocation length independent for three cases of dislocation-self interstitial atom (SIA) loop interactions.« less

Arsenic exposures in Mississippi: A review of cases

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

Park, M.J.; Currier, M.

Arsenic poisonings occur in Mississippi despite public education campaigns to prevent poisonings in the home. We reviewed 44 Mississippi cases of arsenic exposures occurring from January 1986 to May 1990. We compared the epidemiologic differences between unintentional and intentional poisonings. Cases were found and characterized through the two toxicology laboratories and hospital records. Arsenic-based rodenticides were the arsenic source in 23 of the 44 exposures. Other sources were monosodium methylarsenate (4 cases), dodecyl ammonium methane arsonate (5 cases), and other compounds (12 cases). Of the 44 exposures, 27 were unintentional, 7 were suicide attempts, 6 were homicide attempts, and 4more » were of unknown intent. Of the 27 unintentionally exposed patients, 19 were black and 14 were male; their median age was 3 years. Of the 13 intentionally poisoned persons, 9 were male and 10 were black, with a median age of 28 years. Six of the seven patients who attempted suicide were white; four of the six victims of attempted homicide were black. We recommend removal of remaining bottles of arsenic-based rodenticides from store shelves, and we urge practicing physicians to warn patients of the dangers of using such rodenticides.« less

Suicide attempts by deliberate self-poisoning in children and adolescents.

PubMed

Zakharov, Sergey; Navratil, Tomas; Pelclova, Daniela

2013-11-30

The objective of the study was to examine the toxicological characteristics of suicide attempts by deliberate self-poisoning in children and adolescents. From the Toxicological Information Centre's database, the inquiries due to the suicide attempts in children (9-13 years old) and adolescents (14-18 years old) were evaluated. From 10,492 calls concerning suicide attempts, 2393 concerned children and adolescents. Most suicide attempts were attempted in spring (31.3%). Among the toxic agents, drugs were used in 97.8% cases. The most frequent ingestions appeared using drugs affecting the nervous system and anti-inflammatory non-steroids. The dose was evaluated as toxic in 73.4%, severely toxic in 3.0% and unknown in 11.2% cases. Only one in 10 children used a non-toxic dose. Girls, more frequently than boys (13.2% vs. 8.9%), used non-toxic doses. The symptoms of moderate and severe intoxications were present in 10.5% of the cases. Poison centre consultation was accessed within the first hour after the ingestion in one-fifth of the patients. In both age groups, the severity of the intoxication was greater among elder males who reached the medical facilities later than 4 h after the poisoning. The combinations of three or more drugs affecting central nervous system were present in the most severe cases. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Avoidable Technical and Clinical Denial Write-Off Management in Hospitals, Physician Offices, and Clinics.

PubMed

Terra, Sandra Marlene; Byrne, Amanda

2016-01-01

This article reviews the various types of technical and clinical denials that are usually "written off" and proposes strategies to prevent this loss. For purposes of this writing, avoidable technical and clinical denial write-offs are defined as revenue lost from "first-pass" denials rejections. For example, a procedure that requires an authorization is performed without having had an authorization obtained. After appeals and attempts to recoup the revenue, often unsuccessful, the organization ultimately "writes off" the revenue as not collectable. The question to ask is: Are these claims really not collectable or can actionable steps be taken to conserve these dollars and improve the bottom line? Acute care hospitals, physician offices, and clinics. In today's environment, the need to manage costs is ubiquitous. Cost management is on the priority list of all savvy health care executives, even if margins are healthy, revenue is under pressure, and the magnitude of cost reduction needed is greater than what past efforts have achieved. As hospitals and physician clinics prioritize areas for improvement, reduction in lost revenue-especially avoidable lost revenue-should be at the top of the list. Attentively managing claim denial write-offs will significantly reduce lost revenue. There is significant interface between case management and the revenue cycle. Developing core competencies for reducing clinical and technical denials should be a critical imperative in overall cost management strategy. Case managers are well placed to prevent these unnecessary losses through accurate status determination and clinical documentation review. These clinical professionals can also provide insight into work flow and other processes inherent in the preauthorization process.

Suicide attempts by exposure to toxic agents registered in a Toxicological Information and Assistance Center in Fortaleza, Ceará, Brazil, 2013.

PubMed

Gondim, Ana Paula Soares; Nogueira, Rachel Rabay; Lima, João Gabriel Barbosa; Lima, Rayra Aguiar Campos; Albuquerque, Polianna Lemos Moura Moreira; Veras, Maria do Socorro Batista; Ferreira, Maria Augusta Drago

2017-01-01

to describe cases of suicide attempts by exposure to toxic agents registered by the Toxicological Information and Assistance Center in Fortaleza, Ceará, Brazil. this is a descriptive study using secondary data of the cases registered in 2013. 410 cases were registered; 56.2% of the individuals were female and 79.7% were between 12 and 39 years old; most of them (86.4%) lived in urban areas and 67.2%, in Fortaleza; in 94.9% of the cases, the exposure took place in the individual's own home; the toxic agents most commonly used were pesticides (42.9%), especially for agricultural use (30.2%), medicines (39.5%) and house cleaning products (3.4%); of 16 suicide attempts that resulted in death, 15 were caused by agricultural pesticides. the study shows that the intake of toxic agents, especially of agricultural pesticides, is a common method used in suicide attempts; the integration between actions of promotion and prevention are essential.

Frontal Lobe Dysfunction in a Depressed Patient Who Survived a Suicide Attempt by Jumping from the Bridge on the Han River

PubMed Central

Kim, Kiwon

2017-01-01

Suicide attempts at the Han river are rapidly increasing, which are 4.11 times from 2005 to 2015, whereas the rate of completed suicide in South Korea increased 1.07 times during the same period. However, few studies have been conducted on the issue because many suicide attempters were seriously injured after a fall in the Han river. We present a case of a patient with major depressive disorder (MDD) who attempted suicide and minimally injured after jumping from the bridge at the Han river. We could assess his psychological and neurocognitive functions before and immediately after his attempt. From this case, we can identify that higher cognitive aspect of executive dysfunction, especially in the frontal domain of selective attention and inhibition, may be associated with his suicide attempt. In conclusion, we suggest psychiatric treatments for cognitive impulsiveness and safety barriers at the bridge to prevent suicide attempts of patients with MDD. PMID:29209400

Frontal Lobe Dysfunction in a Depressed Patient Who Survived a Suicide Attempt by Jumping from the Bridge on the Han River.

PubMed

Kim, Kiwon; Jeon, Hong Jin

2017-11-01

Suicide attempts at the Han river are rapidly increasing, which are 4.11 times from 2005 to 2015, whereas the rate of completed suicide in South Korea increased 1.07 times during the same period. However, few studies have been conducted on the issue because many suicide attempters were seriously injured after a fall in the Han river. We present a case of a patient with major depressive disorder (MDD) who attempted suicide and minimally injured after jumping from the bridge at the Han river. We could assess his psychological and neurocognitive functions before and immediately after his attempt. From this case, we can identify that higher cognitive aspect of executive dysfunction, especially in the frontal domain of selective attention and inhibition, may be associated with his suicide attempt. In conclusion, we suggest psychiatric treatments for cognitive impulsiveness and safety barriers at the bridge to prevent suicide attempts of patients with MDD.

Risk factors for self-directed violence in US Soldiers: A case-control study.

PubMed

Skopp, Nancy A; Zhang, Ying; Smolenski, Derek J; Reger, Mark A

2016-11-30

Military suicide has escalated in recent years, however almost no research has used military surveillance data to examine suicide risk factors. The aims of the current study were to compare suicide risk factors among US Soldiers who died by suicide, attempted suicide, and controls using a prospective case-control design. Controls were 247 Soldiers completing standard post-deployment assessment procedures. Cases were 276 suicide decedents (n=85) or suicide attempters (n=191), drawn from the Department of Defense Suicide Event Report. Compared to controls, suicide attempters and decedents had greater odds of failed intimate relationships, legal problems, and substance abuse problems in the past 90 days. Suicide attempters and decedents also had greater odds of a history of a mood disorder and prior suicide attempt compared to controls. Suicide decedents had greater odds of exposure to legal problems in the past 90 days and lower odds of ever having an anxiety disorder, compared to suicide attempters. Vigilance toward early detection of modifiable suicide risk factors such as relationship dissolution, mood disorders, substance abuse, and legal problems may help reduce suicide risk among US Soldiers. Published by Elsevier Ireland Ltd.

Lacticemia After Acute Overdose of Metformin in an Adolescent Managed Without Intravenous Sodium Bicarbonate or Extracorporeal Therapy.

PubMed

Bebarta, Vikhyat S; Pead, Joshua; Varney, Shawn M

2015-08-01

Metformin-associated lactic acidosis or lacticemia has been widely reported as an adverse drug effect in diabetic patients with other significant comorbidities and in acute overdose in adults. Lacticemia has been reported twice in a previously healthy pediatric population, both of which were suicide attempts and required hemodialysis. We report a case of a 17-year-old, nondiabetic, healthy adolescent girl with metformin-associated lacticemia who intentionally overdosed on metformin, had no coingestants, and was treated only with crystalloids. Furthermore, she did not require intravenous bicarbonate administration or extracorporeal removal.

Organophosphate poisoning in Rhodesia. A study of the clinical features and management of 105 patients.

PubMed

Hayes, M M; van der Westhuizen, N G; Gelfand, M

1978-08-05

A series of 105 patients with organophosphate poisoning admitted to Harari Hospital during the past 4 years is described. Poisoning with organophosphate compounds is being seen more frequently in hospital practice in Rhodesia. Many of the cases are attempted suicides, but frequently there is no positive history of contact with the poison. The majority of patients exhibit the classic clinical features of parasympathetic overactivity, but diagnosis may be obscured by atypical presentation. Rapid diagnosis and utilization of the treatment regimen outlined in this article should reduce the mortality to less than 15%.

[The respect of the right to freedom of movement, an indicator of good quality patient management].

PubMed

Pothain, Alexandre

Freedom of movement is at the centre of contradictory challenges for the different people working in psychiatry, faced with a society demanding social regulation and safety, and the desire of institutions to provide high quality care. This freedom, and more globally the respect of patients' civil rights, are an indicator of the expected quality of care. Taking these rights into consideration does not mean neglecting safety, but attempts to put it into perspective. This article presents the clinical case of a patient. Copyright © 2017. Published by Elsevier Masson SAS.

Patent ductus arteriosus associated with aberrant right subclavian artery: two cases, one successful interventional closure of PDA.

PubMed

Gomez, Jorge E; Gentile, Jorge I

2011-01-01

Two children were sent to the catheterization laboratory for transcatheter closure of patent ductus arteriosus (PDA). During the intervention, cineangiogram revealed associated aberrant right subclavian artery (ARSA). Both patients had left-sided aortic arch. The first patient was sent to surgery after one unsuccessful attempt to close the PDA due to the proximity of the ARSA and also because of other concomitant cardiac lesions. We successfully treated the second patient by closing the PDA with a Nit-Occlud® PDA occlusion device (Pfm Medical, Carlsbad, California). Similar mirror cases of PDA closure with aberrant left subclavian artery and right aortic arch have been reported. Anatomic features, as well as the technique and management of the procedure, are discussed here.

Risk for attempted suicide in children and youths after contact with somatic hospitals: a Danish register based nested case-control study.

PubMed

Christiansen, E; Stenager, E

2012-03-01

A range of studies have found an association between some somatic diseases and increased risk of suicide and attempted suicide. These studies are mostly analyses of adult populations and illnesses related to adulthood. To study the risk of attempted suicide in children and youths with a somatic diagnosis, and to assess a possible association from a somatic perspective. From a cohort of 403 431 individuals (born 1983-89), 3465 children and youths who had attempted suicide were identified. Each case was matched with 20 population controls. 72 765 children and youths constituted the case-control population. All data were obtained from national population registers and analysed in a nested case-control design. Contact of children and youths with a somatic hospital is correlated with increased risk of attempted suicide; the risk peaks in the time immediately after contact. Risk factors were treatment for injury caused by violence, epilepsy, asthma and malformation for males; and spontaneous and medical abortions, treatment for injury caused by violence, epilepsy, asthma, insulin dependent diabetes mellitus and malformation for females. Not all the mentioned diagnoses were significant in the adjusted model. Based on the results of the study a strategy to minimise the risk of attempted suicide among children and youths must be implemented. The strategy should mainly focus on children at high risk-that is, children from families with low socioeconomic status, and children with a psychiatric history, a history of previous suicide attempts and with an unstable somatic disease subsequently causing many admissions.

Characteristics of suicidal attempts among farmers in rural South India

PubMed Central

Kumar, Ravi S.; Hashim, Uzma

2017-01-01

Background: Globally, farming as an industry is considered a high-risk occupation for suicides. Certain states in India like Karnataka have a suicide rate higher than the national average, and this is generally attributed to the farmers’ suicide. Aims: The aim is to study the characteristics of suicidal attempts among the farmer community in South India, with special emphasis on gender differences, modes used, and the immediate precipitant causes. Materials and Methods: Retrospective, case register-based, explorative-descriptive study of 426 consecutive medicolegal case files of patients whose stated occupation was farming and who were admitted as cases of deliberate self-harm or suicide attempt to a rural tertiary care hospital in rural South India. Results: Out of the 426 farmers who attempted suicide, majority were male (355, 83.3%), in the age group of 21–40 years (318, 75%), married (358, 84%), and belonging to lower socioeconomic status (268, 62.9%). About 54% of them had attempted suicide by consuming pesticides (230). Surprisingly, 183 (43%) and 86 (20.2%) reported the immediate precipitant as being relationship issues and marital conflict, respectively, and only 100 (23.5%) attributed it to financial reasons. Females were significantly associated with a past history of suicidal attempt while males tended to abuse alcohol before an attempt more frequently. Conclusions: Pesticide poisoning was the most common mode for attempting suicide among the farmers. Contrary to public perception and other studies, relationship, and marital issues, not financial reasons were found to be the most common immediate precipitant for the attempters in our study. PMID:29456318

Retaining a Legacy while Avoiding Trademark Infringement: A Case Study of One University's Attempt to Develop a Consistent Athletic Brand Identity

ERIC Educational Resources Information Center

Alessandri, Sue Westcott

2007-01-01

This case study chronicles Syracuse University's athletic department's attempt to achieve consistency in its identity program by changing its identity during 2004, and then again in 2005. The changes were owing to high-level personnel changes on both the academic and athletic sides of the university. This case details the many issues arising from…

Bone metastases of unknown origin: epidemiology and principles of management.

PubMed

Piccioli, Andrea; Maccauro, Giulio; Spinelli, Maria Silvia; Biagini, Roberto; Rossi, Barbara

2015-06-01

Metastases are the most common malignancies involving bone; breast, prostate, lung and thyroid are the main sites of primary cancer. However, up to 30 % of patients present with bone metastases of unknown origin, where the site of the primary neoplasm cannot be identified at the time of diagnosis despite a thorough history, physical examination, appropriate laboratory testing and modern imaging technology (CT, MRI, PET). Sometimes only extensive histopathological investigations on bone specimens from biopsy can suggest the primary malignancy. At other times, a bone lesion can have such a highly undifferentiated histological appearance that a precise pathological classification on routine hematoxylin-eosin-stained section is not possible. The authors reviewed the relevant literature in an attempt to investigate the epidemiology of the histological primaries finally identified in patients with bone metastases from occult cancer, and a strategy of management and treatment of bone metastases from occult carcinomas is suggested. Lung, liver, pancreas and gastrointestinal tract are common sites for primary occult tumors. Adenocarcinoma is the main histological type, accounting for 70 % of all cases, while undifferentiated cancer accounts for 20 %. Over the past 30 years, lung cancer is the main causative occult primary for bone metastases and has a poor prognosis with an average survival of 4-8 months. Most relevant literature focuses on the need for standardized diagnostic workup, as surgery for bone lesions should be aggressive only when they are solitary and/or the occult primaries have a good prognosis; in these cases, identification of the primary tumor may be important and warrants special diagnostic efforts. However, in most cases, the primary site remains unknown, even after autopsy. Thus, orthopedic surgery has a mainly palliative role in preventing or stabilizing pathological fractures, relieving pain and facilitating the care of the patient in an attempt to provide the most appropriate therapy for the primary tumor as soon as possible. 5.

Suicide attempt and melancholic depression in a male with erotomania: case report.

PubMed

Kovács, Attila; Vörös, Viktor; Fekete, Sándor

2005-01-01

Erotomania is a delusional disorder, which is more common among women. A case of erotomania in a 34-year-old male associated with depression and suicidal behavior is presented. At the time he attempted suicide his erotomania fulfilled the diagnostic criteria of "pure" erotomania, described by de Clérambault. A depressive picture with melancholic features emerged four months later. Antidepressant medication was given and two months later he became euthymic. The erotomanic delusion disappeared in the third month of the euthymic state. In this case primary erotomania was associated with a depressive illness, presumably unipolar depression. The patient developed delusional guilt and suicidal ideation before the unequivocal change in his mood. To the authors' knowledge this is the first reported case where the erotomanic symptomatology led to suicidal attempt.

Early warnings for suicide attempt among Chinese rural population.

PubMed

Lyu, Juncheng; Wang, Yingying; Shi, Hong; Zhang, Jie

2018-06-05

This study was to explore the main influencing factors of attempted suicide and establish an early warning model, so as to put forward prevention strategies for attempted suicide. Data came from a large-scale case-control epidemiological survey. A sample of 659 serious suicide attempters was randomly recruited from 13 rural counties in China. Each case was matched by a community control for gender, age, and residence location. Face to face interviews were conducted for all the cases and controls with the same structured questionnaire. Univariate logistic regression was applied to screen the factors and multivariate logistic regression was used to excavate the predictors. There were no statistical differences between suicide attempters and the community controls in gender, age, and residence location. The Cronbach`s coefficients for all the scales used were above 0.675. The multivariate logistic regressions have revealed 12 statistically significant variables predicting attempted suicide, including less education, family history of suicide, poor health, mental problem, aspiration strain, hopelessness, impulsivity, depression, negative life events. On the other hand, social support, coping skills, and healthy community protected the rural residents from suicide attempt. The excavated warning predictors are significant clinical meaning for the clinical psychiatrist. Crisis intervention strategies in rural China should be informed by the findings from this research. Education, social support, healthy community, and strain reduction are all measures to decrease the likelihood of crises. Copyright © 2018. Published by Elsevier B.V.

Are BTS guidelines followed?

PubMed

2002-03-01

In 1993, the British Thoracic Society (BTS) issued guidelines for the management of spontaneous pneumothorax. The study's aim was to determine the level of adherence to these guidelines at a London teaching hospital. A retrospective case note audit of 59 episodes was performed. In patients undergoing intervention, the initial procedure was simple aspiration in 32 (73 per cent) and chest tube insertion in 12 (27 per cent) cases, contrasting with the BTS recommendation that aspiration should be attempted first in all such patients. Simple aspiration was successful on 34 per cent of occasions. Successful aspiration was associated with a significantly shorter hospital stay (median 3, range 1-11 days) than either failed aspiration (7, 3-66 days) or chest tube insertion without aspiration (9, 3-16 days). Other areas where practice differed from the BTS guidelines were clamping of chest tubes and use of a pursestring suture for wound closure. A follow up questionnaire suggested a lack of familiarity with the guidelines. These findings indicate that current management of spontaneous pneumothorax deviates from the BTS guidelines in potentially important respects.

The diversity of case management needs for the care of homeless persons.

PubMed Central

Stephens, D; Dennis, E; Toomer, M; Holloway, J

1991-01-01

Health care providers have been attempting to meet the special needs of homeless people on a national level since 1984. The need to implement strategies specific to serving the diversity of services required by homeless people has been apparent. To devise appropriate strategies, clinical information was drawn from the Health Resources and Services Administration-Health Care for the Homeless (HRSA-HCH) projects, which were created in 1987 primarily to fill such a need. In addition, data gathered by the HCH projects (1984-87) funded by the Robert Wood Johnson and Pew Memorial Trust were used. It is suggested that the past mode of providing health care for the homeless has been found to be inadequate when confronting the complex problems of the homeless person of today. In general, health care providers need to focus more on case management activities, which may include activities not necessarily associated with the provision of health care services (for example, finding and providing food, clothing, shelter, and assessing entitlement eligibility) to achieve the ultimate goal--stabilization--and when possible, reintegration of the homeless person back into society. PMID:1899934

Management of nontraumatic corneal perforation with tectonic drape patch and cyanoacrylate glue.

PubMed

Khalifa, Yousuf M; Bailony, M Rami; Bloomer, Michele M; Killingsworth, Daniel; Jeng, Bennie H

2010-10-01

To report a case of nontraumatic corneal perforation managed with a tectonic drape patch. Interventional case report. A 60-year-old patient with a corneal scar in his left eye likely secondary to herpes simplex virus interstitial keratitis underwent laser peripheral iridotomy for narrow angles. He developed progressive thinning of the cornea overlying the scar that led to a descemetocele and then ultimately a 1.2- × 1.7-mm perforation. Intraoperatively, several attempts were made to seal the perforation with cyanoacrylate glue, but the wound continued to leak. Sterile plastic drape that was on the surgical field was fashioned into a 2-mm-diameter patch, and the peripheral edge of the tectonic drape patch was glued over the perforation, successfully sealing the cornea. One week later, the drape patch was intact without leak, and a penetrating keratoplasty was carried out without complication. Tectonic drape patch technique for nontraumatic corneal perforations in which there is tissue loss is a viable temporizing option when cyanoacrylate glue alone fails and when there is no corneal tissue or amniotic membrane available to close the wound.

Personnel Retention Policy and Force Quality: Twice-Passed Staff Sergeants

DTIC Science & Technology

2015-06-01

addressing a manager’s impact on the success of an organization, which attempts to quantify the value of, and variation between, managers. Goodall and...in measuring the value of a manager ( Goodall & Pogrebna, 2015). Branch, Hanushek, and Rivkin (2013) estimate the standard deviation of school...literature reveals leadership effects varying from 4 to 40 percent across a range of industries ( Goodall & Pogrebna, 2015). Although there is no attempt to

Current Status of Peroral Endoscopic Myotomy

PubMed Central

Cho, Young Kwan; Kim, Seong Hwan

2018-01-01

Peroral endoscopic myotomy (POEM) has been established as an optional treatment for achalasia. POEM is an endoluminal procedure that involves dissection of esophageal muscle fibers followed by submucosal tunneling. Inoue first attempted to use POEM for the treatment of achalasia in humans. Expanded indications of POEM include classic indications such as type I, type II, type III achalasia, failed prior treatments, including Botulinum toxin injection, endoscopic balloon dilation, laparoscopic Heller myotomy, and hypertensive motor disorders such as diffuse esophageal spasm, jackhammer esophagus. Contraindications include prior radiation therapy to the esophagus and prior extensive esophageal mucosal resection/ablation involving the POEM field. Most of the complications are minor and self-limited and can be managed conservatively. As POEM emerged as the main treatment for achalasia, various adaptations to tunnel endoscopic surgery have been attempted. Tunnel endoscopic surgery includes POEM, peroral endoscopic tumor resection, gastric peroral endoscopic pyloromyotomy. POEM has been widely accepted as a treatment for all types of achalasia, even for specific cases such as achalasia with failed prior treatments, and hypertensive motor disorders. PMID:29397656

Current Status of Peroral Endoscopic Myotomy.

PubMed

Cho, Young Kwan; Kim, Seong Hwan

2018-01-01

Peroral endoscopic myotomy (POEM) has been established as an optional treatment for achalasia. POEM is an endoluminal procedure that involves dissection of esophageal muscle fibers followed by submucosal tunneling. Inoue first attempted to use POEM for the treatment of achalasia in humans. Expanded indications of POEM include classic indications such as type I, type II, type III achalasia, failed prior treatments, including Botulinum toxin injection, endoscopic balloon dilation, laparoscopic Heller myotomy, and hypertensive motor disorders such as diffuse esophageal spasm, jackhammer esophagus. Contraindications include prior radiation therapy to the esophagus and prior extensive esophageal mucosal resection/ablation involving the POEM field. Most of the complications are minor and self-limited and can be managed conservatively. As POEM emerged as the main treatment for achalasia, various adaptations to tunnel endoscopic surgery have been attempted. Tunnel endoscopic surgery includes POEM, peroral endoscopic tumor resection, gastric peroral endoscopic pyloromyotomy. POEM has been widely accepted as a treatment for all types of achalasia, even for specific cases such as achalasia with failed prior treatments, and hypertensive motor disorders.

Ecological economics of soil erosion: a review of the current state of knowledge.

PubMed

Adhikari, Bhim; Nadella, Karthik

2011-02-01

The economics of land degradation has received relatively little attention until recent years. Although a number of studies have undertaken valuation of ecosystem services ranging from the global to the micro level, and quite a few studies have attempted to quantify the costs of soil erosion, studies that address the full costs of land degradation are still scarce. In this review, we attempt to analyze different land resource modeling and valuation techniques applied in earlier research and the type of data used in these analyses, and to assess their utility for different forms of land resource and management appraisal. We also report on the strengths and weaknesses of different valuation techniques used in studies on the economics of soil erosion, and the relevance of these valuation techniques. We make a case for the need for more appropriate models that can make the analysis more robust in estimating the economic costs of land degradation while recognizing the spatial heterogeneity in biophysical and economic conditions. © 2011 New York Academy of Sciences.

Globalization, China's Drive for World-Class Universities (211 Project) and the Challenges of Ethnic Minority Higher Education: The Case of Yanbian University

ERIC Educational Resources Information Center

Choi, Sheena

2010-01-01

This case study of Yanbian University, a Korean minority university in China, examines the challenges faced, strategies employed, and resources mobilized by a minority university in its attempt to become a world-class university. Specifically, this case study focuses on how the University is attempting to reach its goals within the context of the…

Obsessive-Compulsive Disorder with Suicide Obsessions in a First Responder without Previous Diagnosis of OCD or History of Suicide Attempts.

PubMed

Rachamallu, Vivekananda; Song, Michael M; Liu, Haiying; Giles, Charles L; McMahon, Terry

2017-01-01

Obsessive-compulsive disorder (OCD) is a distressing and often debilitating disorder characterized by obsessions, compulsions, or both that are time-consuming and cause impairment in social, occupational, or other areas of functioning. There are many published studies reporting higher risk of suicidality in OCD patients, as well as studies describing increased risk of suicidality in OCD patients with other comorbid psychiatric conditions such as major depressive disorder (MDD) and posttraumatic stress disorder (PTSD). Existing case reports on OCD with suicide as the obsessive component describe patients with long standing diagnosis of OCD with suicidal ideations or previous suicide attempts. This report describes the case of a 28-year-old male, who works as a first responder, who presented with new onset symptoms characteristic of MDD and PTSD, with no past history of OCD or suicidality who developed OCD with suicidal obsessions. Differentiating between suicidal ideation in the context of other psychiatric illnesses and suicidal obsessions in OCD is critical to ensuring accurate diagnosis and timely provision of most appropriate treatment. The combination of exposure and response prevention therapy and pharmacotherapy with sertraline and olanzapine was effective in helping the patient manage the anxiety and distress stemming from the patient's OCD with suicidal obsession.

Obsessive-Compulsive Disorder with Suicide Obsessions in a First Responder without Previous Diagnosis of OCD or History of Suicide Attempts

PubMed Central

Song, Michael M.; Liu, Haiying; Giles, Charles L.; McMahon, Terry

2017-01-01

Obsessive-compulsive disorder (OCD) is a distressing and often debilitating disorder characterized by obsessions, compulsions, or both that are time-consuming and cause impairment in social, occupational, or other areas of functioning. There are many published studies reporting higher risk of suicidality in OCD patients, as well as studies describing increased risk of suicidality in OCD patients with other comorbid psychiatric conditions such as major depressive disorder (MDD) and posttraumatic stress disorder (PTSD). Existing case reports on OCD with suicide as the obsessive component describe patients with long standing diagnosis of OCD with suicidal ideations or previous suicide attempts. This report describes the case of a 28-year-old male, who works as a first responder, who presented with new onset symptoms characteristic of MDD and PTSD, with no past history of OCD or suicidality who developed OCD with suicidal obsessions. Differentiating between suicidal ideation in the context of other psychiatric illnesses and suicidal obsessions in OCD is critical to ensuring accurate diagnosis and timely provision of most appropriate treatment. The combination of exposure and response prevention therapy and pharmacotherapy with sertraline and olanzapine was effective in helping the patient manage the anxiety and distress stemming from the patient's OCD with suicidal obsession. PMID:29098105

Coming to terms: a case study of hospice collaboration challenges.

PubMed

Pietroburgo, Julie; Bush, Richard

Recent research has focused on the growing phenomenon of mergers, collaborations, and alliances among nonprofit organizations and what makes such arrangements work. Examination of failed collaborative efforts is perhaps just as instructive. This case study examines recent attempts at collaboration between 2 nonprofit hospice organizations. The study finds that despite compelling reasons for and significant commonalities on which to base collaboration, the organizations were initially unable to forge any ongoing and substantive collaborative arrangement because of insurmountable cultural factors and past history. Furthermore, without imminent external pressures to collaborate, these organizations had insufficient motivation to attempt to move beyond their differences. The case also reviews the changed circumstances and factors that later facilitated partnering attempts.

A case of severe chlorite poisoning successfully treated with early administration of methylene blue, renal replacement therapy, and red blood cell transfusion: case report.

PubMed

Gebhardtova, Andrea; Vavrinec, Peter; Vavrincova-Yaghi, Diana; Seelen, Mark; Dobisova, Anna; Flassikova, Zora; Cikova, Andrea; Henning, Robert H; Yaghi, Aktham

2014-08-01

The case of a 55-year-old man who attempted suicide by ingesting <100 mL of 28% sodium chlorite solution is presented. On arrival in the intensive care unit, the patient appeared cyanotic with lowered consciousness and displayed anuria and chocolate brown serum.Initial laboratory tests revealed 40% of methemoglobin. The formation of methemoglobin was effectively treated with methylene blue (10% after 29 hours).To remove the toxin, and because of the anuric acute renal failure, the patient received renal replacement therapy. Despite these therapeutic measures, the patient developed hemolytic anemia and disseminated intravascular coagulation, which were treated with red blood cell transfusion and intermittent hemodialysis. These interventions led to the improvement of his condition and the patient eventually fully recovered. Patient gave written informed consent.This is the third known case of chlorite poisoning that has been reported. Based upon this case, we suggest the management of sodium chlorite poisoning to comprise the early administration of methylene blue, in addition to renal replacement therapy and transfusion of red blood cells.

Real-Time Pretreatment Review Limits Unacceptable Deviations on a Cooperative Group Radiation Therapy Technique Trial: Quality Assurance Results of RTOG 0933

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

Gondi, Vinai, E-mail: vgondi@chicagocancer.org; University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin; Cui, Yunfeng

2015-03-01

Purpose: RTOG 0933 was a phase II trial of hippocampal avoidance during whole brain radiation therapy for patients with brain metastases. The results demonstrated improvement in short-term memory decline, as compared with historical control individuals, and preservation of quality of life. Integral to the conduct of this trial were quality assurance processes inclusive of pre-enrollment credentialing and pretreatment centralized review of enrolled patients. Methods and Materials: Before enrolling patients, all treating physicians and sites were required to successfully complete a “dry-run” credentialing test. The treating physicians were credentialed based on accuracy of magnetic resonance imaging–computed tomography image fusion and hippocampal andmore » normal tissue contouring, and the sites were credentialed based on protocol-specified dosimetric criteria. Using the same criteria, pretreatment centralized review of enrolled patients was conducted. Physicians enrolling 3 consecutive patients without unacceptable deviations were permitted to enroll further patients without pretreatment review, although their cases were reviewed after treatment. Results: In all, 113 physicians and 84 sites were credentialed. Eight physicians (6.8%) failed hippocampal contouring on the first attempt; 3 were approved on the second attempt. Eight sites (9.5%) failed intensity modulated radiation therapy planning on the first attempt; all were approved on the second attempt. One hundred thirteen patients were enrolled in RTOG 0933; 100 were analyzable. Eighty-seven cases were reviewed before treatment; 5 (5.7%) violated the eligibility criteria, and 21 (24%) had unacceptable deviations. With feedback, 18 cases were approved on the second attempt and 2 cases on the third attempt. One patient was treated off protocol. Twenty-two cases were reviewed after treatment; 1 (4.5%) violated the eligibility criteria, and 5 (23%) had unacceptable deviations. Conclusions: Although >95% of the cases passed the pre-enrollment credentialing, the pretreatment centralized review disqualified 5.7% of reviewed cases, prevented unacceptable deviations in 24% of reviewed cases, and limited the final unacceptable deviation rate to 5%. Thus, pretreatment review is deemed necessary in future hippocampal avoidance trials and is potentially useful in other similarly challenging radiation therapy technique trials.« less

The impact of partial resuscitation attempts on the reported outcomes of out-of-hospital cardiac arrest in Victoria, Australia: implications for Utstein-style outcome reports.

PubMed

Nehme, Z; Andrew, E; Bernard, S; Smith, K

2014-09-01

Success rates from cardiopulmonary resuscitation (CPR) are often quantified by Utstein-style outcome reports in populations who receive an attempted resuscitation. In some cases, evidence of futility is ascertained after a partial resuscitation attempt has been administered, and these cases reduce the overall effectiveness of CPR. We examine the impact of partial resuscitation attempts on the reported outcomes of out-of-hospital cardiac arrest (OHCA) in Victoria, Australia. Between 2002 and 2012, 34,849 adult OHCA cases of presumed cardiac aetiology were included from the Victorian Ambulance Cardiac Arrest Registry. Resuscitation attempts lasting ≤10min in cases which died on scene were defined as a partial resuscitation. We used logistic regression to identify factors associated with a partial resuscitation attempt in the emergency medical service (EMS) treated population. Survival outcomes with and without partial resuscitations were compared across included years. The proportion of partial resuscitations in the overall EMS treated population increased significantly from 8.6% in 2002 to 18.8% in 2012 (p for trend<0.001), and were largely supported by documented evidence of irreversible death. Partial resuscitations were independently associated with older age, female gender, initial non-shockable rhythm, prolonged downtime, and lower skill level of EMS personnel. Selectively excluding partial resuscitations increased event survival by 7.6% (95% CI 4.1-11.2%), and survival to hospital discharge increased by 3.1% (95% CI 0.5-5.7%) in 2012 (p<0.001 for both). In our EMS system, evidence of futility was often identified after the commencement of a partial resuscitation attempt. Excluding these events from OHCA outcome reports may better reflect the overall effectiveness of CPR. Crown Copyright © 2014. Published by Elsevier Ireland Ltd. All rights reserved.

The parakeet protectors: Understanding opposition to introduced species management.

PubMed

Crowley, Sarah L; Hinchliffe, Steve; McDonald, Robbie A

2018-01-02

The surveillance and control of introduced and invasive species has become an increasingly important component of environmental management. However, initiatives targeting 'charismatic' wildlife can be controversial. Opposition to management, and the subsequent emergence of social conflict, present significant challenges for would-be managers. Understanding the substance and development of these disputes is therefore vital for improving the legitimacy and effectiveness of wildlife management. It also provides important insights into human-wildlife relations and the 'social dimensions' of wildlife management. Here, we examine how the attempted eradication of small populations of introduced monk parakeets (Myiopsitta monachus) from England has been challenged and delayed by opposition from interested and affected communities. We consider how and why the UK Government's eradication initiative was opposed, focusing on three key themes: disagreements about justifying management, the development of affective attachments between people and parakeets, and the influence of distrustful and antagonistic relationships between proponents and opponents of management. We draw connections between our UK case and previous management disputes, primarily in the USA, and suggest that the resistance encountered in the UK might readily have been foreseen. We conclude by considering how management of this and other introduced species could be made less conflict-prone, and potentially more effective, by reconfiguring management approaches to be more anticipatory, flexible, sensitive, and inclusive. Copyright © 2017 Elsevier Ltd. All rights reserved.

Acute Precipitants of Physical Elder Abuse: Qualitative Analysis of Legal Records From Highly Adjudicated Cases.

PubMed

Rosen, Tony; Bloemen, Elizabeth M; LoFaso, Veronica M; Clark, Sunday; Flomenbaum, Neal E; Breckman, Risa; Markarian, Arlene; Riffin, Catherine; Lachs, Mark S; Pillemer, Karl

2016-08-01

Elder abuse is a common phenomenon with potentially devastating consequences for older adults. Although researchers have begun to identify predisposing risk factors for elder abuse victims and abusers, little is known about the acute precipitants that lead to escalation to physical violence. We analyzed legal records from highly adjudicated cases to describe these acute precipitants for physical elder abuse. In collaboration with a large, urban district attorney's office, we qualitatively evaluated legal records from 87 successfully prosecuted physical elder abuse cases from 2003 to 2015. We transcribed and analyzed narratives of the events surrounding physical abuse within victim statements, police reports, and prosecutor records. We identified major themes using content analysis. We identified 10 categories of acute precipitants that commonly triggered physical elder abuse, including victim attempting to prevent the abuser from entering or demanding that he or she leave, victim threatening or attempting to leave/escape, threat or perception that the victim would involve the authorities, conflict about a romantic relationship, presence during/intervention in ongoing family violence, issues in multi-generational child rearing, conflict about the abuser's substance abuse, confrontation about financial exploitation, dispute over theft/destruction of property, and disputes over minor household issues. Common acute precipitants of physical elder abuse may be identified. Improved understanding of these acute precipitants for escalation to physical violence and their contribution to elder abuse may assist in the development of prevention and management strategies.

Acute Precipitants of Physical Elder Abuse: Qualitative Analysis of Legal Records From Highly Adjudicated Cases

PubMed Central

Rosen, Tony; Bloemen, Elizabeth M.; LoFaso, Veronica M.; Clark, Sunday; Flomenbaum, Neal E.; Breckman, Risa; Markarian, Arlene; Riffin, Catherine; Lachs, Mark S.; Pillemer, Karl

2016-01-01

Elder abuse is a common phenomenon with potentially devastating consequences for older adults. Although researchers have begun to identify predisposing risk factors for elder abuse victims and abusers, little is known about the acute precipitants that lead to escalation to physical violence. We analyzed legal records from highly adjudicated cases to describe these acute precipitants for physical elder abuse. In collaboration with a large, urban district attorney’s office, we qualitatively evaluated legal records from 87 successfully prosecuted physical elder abuse cases from 2003 to 2015. We transcribed and analyzed narratives of the events surrounding physical abuse within victim statements, police reports, and prosecutor records. We identified major themes using content analysis. We identified 10 categories of acute precipitants that commonly triggered physical elder abuse, including victim attempting to prevent the abuser from entering or demanding that he or she leave, victim threatening or attempting to leave/escape, threat or perception that the victim would involve the authorities, conflict about a romantic relationship, presence during/intervention in ongoing family violence, issues in multi-generational child rearing, conflict about the abuser’s substance abuse, confrontation about financial exploitation, dispute over theft/destruction of property, and disputes over minor household issues. Common acute precipitants of physical elder abuse may be identified. Improved understanding of these acute precipitants for escalation to physical violence and their contribution to elder abuse may assist in the development of prevention and management strategies. PMID:27506228

Investigating the Co-Occurrence of Self-Mutilation and Suicide Attempts among Opioid-Dependent Individuals

ERIC Educational Resources Information Center

Maloney, Elizabeth; Degenhardt, Louisa; Darke, Shane; Nelson, Elliot C.

2010-01-01

The prevalence and risk factors associated with self-mutilation among opioid dependent cases and controls were determined, and the co-occurrence of self-mutilation and attempted suicide was examined. The prevalence of self-mutilation among cases and controls did not differ significantly (25% vs. 23%, respectively), with gender differences…

[Operative laparoscopy in the management of perforated peptic ulcer].

PubMed

Schirru, Angelo; Cavaliere, Davide; Caristo, Ilario; Bianchi, Massimo; Cosce, Umberto; Mariani, Federica; Scarimbolo, Monica; Cavaliere, Paolo

2004-01-01

The aim of this retrospective study was to assess the feasibility, safety and efficacy of the laparoscopic approach in the management of perforated peptic ulcers. From January 1997 to December 2002, all patients referred to our community hospital for abdominal surgical emergencies were routinely managed by laparoscopic surgery. A review was carried out on 39 consecutive patients suffering from perforated peptic ulcers with or without generalised peritonitis. The study population comprised 24 male and 15 female patients, aged 30 to 94 years (mean age: 62 +/- 18). Laparoscopic repair was attempted in all patients. Laparoscopy afforded the correct diagnosis in all cases. Laparoscopic peritoneal washout (irrigation and suction of the entire abdominal cavity) with simple suture of the perforation proved successful in 34 patients. An additional omental patching was performed in 15 of these cases. Conversion to conventional open surgery was necessary in 5 patients. The morbidity and mortality rates were 13% and 10%, respectively. The mean operative time was 77 minutes (range: 40-120) and the mean hospital stay 9 days (range: 3-22). Laparoscopic repair of perforated ulcers is technically feasible but requires sound experience in laparoscopic abdominal emergencies. This study shows that the mini-invasive procedure is safe and effective, offering a valid alternative to traditional laparotomy.

The Process of Prehospital Airway Management: Challenges and Solutions During Paramedic Endotracheal Intubation

PubMed Central

Prekker, Matthew E.; Kwok, Heemun; Shin, Jenny; Carlbom, David; Grabinsky, Andreas; Rea, Thomas D.

2016-01-01

Objective Endotracheal intubation success rates in the prehospital setting are variable. Our objective was to describe the challenges encountered and corrective actions taken during the process of endotracheal intubation by paramedics. Design Analysis of prehospital airway management using a prospective registry that was linked to an emergency medical services (EMS) administrative database. Setting EMS system serving King County, Washington, 2006-2011. Paramedics in this system have the capability to administer neuromuscular blocking agents to facilitate intubation (i.e. rapid sequence intubation). Patients A total of 7,523 patients >12 years old in whom paramedics attempted prehospital endotracheal intubation. Interventions None Measurements and Main Results An intubation attempt was defined as the introduction of the laryngoscope into the patient's mouth, and the attempt concluded when the laryngoscope was removed from the mouth. Endotracheal intubation was successful on the first attempt in 77% and ultimately successful in 99% of patients (7,433 of 7,523). Paramedics used a rapid sequence intubation strategy on 54% of first attempts. Among the subset with a failed first attempt (N=1,715), bodily fluids obstructing the laryngeal view (50%), obesity (28%), patient positioning (17%), and facial or spinal trauma (6%) were identified as challenges to intubation. A variety of adjustments were made to achieve intubation success, including upper airway suctioning (used in 43% of attempts resulting in success), patient repositioning (38%), rescue bougie use (19%), operator change (16%), and rescue rapid sequence intubation (6%). Surgical cricothyrotomy (0.4%, N=27) and bag-valve-mask ventilation (0.8%, N=60) were rarely performed by paramedics as final rescue airway strategies. Conclusions Airway management in the prehospital setting has substantial challenges. Success can require a collection of adjustments that involve equipment, personnel, and medication often in a simultaneous fashion. PMID:24589641

The process of prehospital airway management: challenges and solutions during paramedic endotracheal intubation.

PubMed

Prekker, Matthew E; Kwok, Heemun; Shin, Jenny; Carlbom, David; Grabinsky, Andreas; Rea, Thomas D

2014-06-01

Endotracheal intubation success rates in the prehospital setting are variable. Our objective was to describe the challenges encountered and corrective actions taken during the process of endotracheal intubation by paramedics. Analysis of prehospital airway management using a prospective registry that was linked to an emergency medical services administrative database. Emergency medical services system serving King County, Washington, 2006-2011. Paramedics in this system have the capability to administer neuromuscular blocking agents to facilitate intubation (i.e., rapid sequence intubation). A total of 7,523 patients more than 12 years old in whom paramedics attempted prehospital endotracheal intubation. None. An intubation attempt was defined as the introduction of the laryngoscope into the patient's mouth, and the attempt concluded when the laryngoscope was removed from the mouth. Endotracheal intubation was successful on the first attempt in 77% and ultimately successful in 99% of patients (7,433 of 7,523). Paramedics used a rapid sequence intubation strategy on 54% of first attempts. Among the subset with a failed first attempt (n = 1,715), bodily fluids obstructing the laryngeal view (50%), obesity (28%), patient positioning (17%), and facial or spinal trauma (6%) were identified as challenges to intubation. A variety of adjustments were made to achieve intubation success, including upper airway suctioning (used in 43% of attempts resulting in success), patient repositioning (38%), rescue bougie use (19%), operator change (16%), and rescue rapid sequence intubation (6%). Surgical cricothyrotomy (0.4%, n = 27) and bag-valve-mask ventilation (0.8%, n = 60) were rarely performed by paramedics as final rescue airway strategies. Airway management in the prehospital setting has substantial challenges. Success can require a collection of adjustments that involve equipment, personnel, and medication often in a simultaneous fashion.

Body dysmorphia, self-mutilation and the reconstructive surgeon.

PubMed

Chan, James Kwok-Kwan; Jones, Sophie M; Heywood, Anthony J

2011-01-01

Body dysmorphic disorder (BDD) is a disabling preoccupation with a slight or an imagined defect in appearance. It is recognised in some patients who present to the plastic surgeon requesting multiple cosmetic procedures. Very rarely, BDD patients may wish for amputation of a healthy limb and may even mutilate themselves deliberately in order to necessitate amputation. These patients pose a diagnostic challenge as BDD is uncommon and they are often uncooperative whilst appearing mentally sound. Furthermore, they raise difficult ethical and legal issues for the surgeon. Although there is some guidance for the management of BDD patients seeking elective amputation, there is currently none for the management of those who present in the emergency setting. Illustrated by the case of a man who, having failed to find a complicit surgeon, attempted self-amputation of the hand, we review the relevant ethical, legal and management issues with advice by the British Medical Association and General Medical Council. Copyright © 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Outsourcing: two case studies from the Victorian public hospital sector.

PubMed

Young, Suzanne

2007-02-01

Outsourcing was one process of privatisation used in the Victorian public health sector in the 1990s. However it was used to varying degrees and across a variety of different services. This paper attempts to answer the questions: Why have managers outsourced? What have managers considered when they have decided to outsource? The research was carried out in a rural hospital and a metropolitan network in Victoria. The key findings highlight the factors that decision makers considered to be important and those that led to negative outcomes. Economic factors, such as frequency of exchange, length of relationships between the parties, and information availability, were often ignored. However, other factors such as outcome measurability, technology, risk, labour market characteristics and goal conflict, and political factors such as relative power of management over labour were often perceived as important in the decision-making process. Negative outcomes from outsourcing were due to the short length of relationships and accompanying difficulties with trust, commitment and loyalty; poor quality; and excessive monitoring and the measurement of outcomes.

Management of First Branchial Cleft Anomalies via a Cartilage-Splitting Technique.

PubMed

Schmidt, Richard; Conrad, David; Field, Erin; O'Reilly, Robert

2015-06-01

First branchial cleft anomalies are uncommon lesions that often present as periauricular infections. They have high recurrence rates, due in part to scarring secondary to prior infections and their management. These lesions have a close relationship with the facial nerve, and most authors recommend its identification and dissection because of this relationship. Nonetheless, facial nerve palsy has been reported in up to 15% of cases. We describe a novel technique for the management of first branchial cleft anomalies. Such lesions that presented in an infra- or postauricular location were approached via an incision through the cartilage of the pinna, between the tragus and antitragus. This technique affords direct access to the lesion without the need for facial nerve dissection. Six patients were treated. Five had prior surgery, including 3 with previous attempts at excision. There were no complications. The median follow-up was 35 months. One patient developed a recurrence. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

Insight into novel biomarkers in penile cancer: Redefining the present and future treatment paradigm?

PubMed

Zargar-Shoshtari, Kamran; Sharma, Pranav; Spiess, Philippe E

2017-11-02

Biomarkers are increasingly used in the diagnosis and management of various malignancies. Selected biomarkers may also play a role in management of certain cases of penile carcinoma. In this article, we provide an overview of the clinical role of such markers in the management of penile cancer. This is a nonsystematic review of relevant literature assessing biomarkers in penile carcinoma. Evidence of infections with human papillomavirus and its surrogate markers may have important prognostic value in patients with localized or metastatic penile cancer. Squamous cell carcinoma antigen, p53, C-reactive protein, Ki-67, proliferating cell nuclear antigen, cyclin D1, as well as other markers have been studied with various degree of evidence in support of clinical utility in penile cancer. No single marker may have all the answers, and future research should focus on genomic analysis of individual penile tumors, attempting to identify specific targets for treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

Paradigms and nursing management, analysis of the current organizational structure in a large hospital.

PubMed

Wilson, D

1992-01-01

Hospitals developed over the period of time when positivism become a predominant world view. Positivism was founded by four Western trends: preponderance of hierarchy and autocracy, popularization of bureaucracy, extensive application of a machine orientation to work and predominance of "scientific" inquiry. Organizational theory developed largely from quantitative research findings arising from a positivistic world view. A case study, analyzing a current nursing organizational structure at one large hospital, is presented. Nursing management was found to be based upon the positivistic paradigm. The predominance of a machine orientation, and an autocratic and bureaucratic structure are evidence of this. A change to shared governance had been attempted, indicating a shift to a more modern organizational structure based on a different paradigm. The article concludes by emphasizing that managers are largely responsible for facilitating change; change that will meet internal human resource needs and the cost-effectiveness crises of hospitals today through more effective use of human resources.

Alcohol Abuse and Suicide Attempt in Iran: A Case-Crossover Study

PubMed Central

Ghanbari, Behrooz; Malakouti, Seyed Kazem; Nojomi, Marzieh; Leo, Diego De; Saeed, Khalid

2016-01-01

Alcohol use and its disorders are associated with increased risk of suicidal behaviors Research has shown that 6-8% of those who use alcohol have a history of suicide attempt. Given the prohibition of alcohol use legally, the increased alcohol consumption, and the lack of strong evidence in favor of its use associated with suicide in Iran, this study was conducted to determine the link between suicide attempt and alcohol abuse. The case-crossover method was used in this research. Out of 305 referrals to the emergency room due to a suicide attempt, 100 reported drinking alcohol up to six hours before their attempt. Paired Matching and Usual Frequency were employed to analyze the data with STATA 12.0. The probability of attempting suicide up to six hours after drinking alcohol appeared increased by 27 times (95% CI: 8.1-60.4). Separate analysis for each of these hours from the first to the sixth hour after alcohol use was also performed. Fifty percent of attempted suicides happened one hour after alcohol use. Relative risk for the first and second hour was 10% and 5% respectively. Alcohol use is a strong proximal risk factor for attempted suicide among Iranian subjects. Prevention of alcohol use should be considered in setting up of the national Suicide attempt prevention program. PMID:26925903

Climate change collaboration among natural resource management agencies: lessons learned from two US regions

USGS Publications Warehouse

Lemieux, Christopher J.; Thompson, Jessica; Slocombe, D. Scott; Schuster, Rudy

2015-01-01

It has been argued that regional collaboration can facilitate adaptation to climate change impacts through integrated planning and management. In an attempt to understand the underlying institutional factors that either support or contest this assumption, this paper explores the institutional factors influencing adaptation to climate change at the regional scale, where multiple public land and natural resource management jurisdictions are involved. Insights from two mid-western US case studies reveal that several challenges to collaboration persist and prevent fully integrative multi-jurisdictional adaptation planning at a regional scale. We propose that some of these challenges, such as lack of adequate time, funding and communication channels, be reframed as opportunities to build interdependence, identify issue-linkages and collaboratively explore the nature and extent of organisational trade-offs with respect to regional climate change adaptation efforts. Such a reframing can better facilitate multi-jurisdictional adaptation planning and management of shared biophysical resources generally while simultaneously enhancing organisational capacity to mitigate negative effects and take advantage of potentially favourable future conditions in an era characterised by rapid climate change.

Assessment of management-dependent nutrient losses in tropical industrial tree plantations.

PubMed

Mackensen, Jens; Klinge, Rudolf; Ruhiyat, Daddy; Fölster, Horst

2003-03-01

Industrial tree plantations in the tropics usually follow short rotations and intensive site management including slash and burn, and the use of heavy machinery. We attempt to quantify the implied nutrient losses (harvest export, erosion, slash and burn, leaching) in order to give plantation managers a chance to understand the significance of their planning and decisions. We used the scarce globally available information and a case study plantation in East Kalimantan, Indonesia (Acacia mangium and Eucalyptus deglupta). Adaptation involves problems and is discussed in some detail. Results are approximate only. Assuming a harvest volume of 200 m3 ha(-1), we assessed a loss of 427-680 kg ha(-1) N, 12-13 kg ha(-1) P, 178-252 kg ha(-1) Ca, 276-370 kg ha(-1) K, and 45-57 kg ha(-1) Mg per rotation. Of this overall loss, stand harvest accounted for 18-29% (N), 21-30% (P), 56-26% (K), 48-64% (Ca) and 22-37% (Mg). This means that the cumulative loss by erosion, slash and burn, and leaching exceeds that of the harvest. These losses can be influenced by management.

Excessive force during removal of immigration detainees.

PubMed

Granville-Chapman, Charlotte; Smith, Ellie; Moloney, Neil

2005-08-01

Use of force against immigration detainees during attempts to expel them from the UK must be limited to that which is strictly necessary and proportionate under the circumstances, using accepted methods of restraint designed to minimise injury risk to all concerned. Fourteen cases are reported after failed removal attempts, where there were allegations that excessive force had been employed. Collective analysis of the 14 cases reveals a misuse of handcuffs in 11 cases with resulting nerve injury in 4 cases, the use of inappropriate and unsafe methods of force, such as blows to the head and compression of the trunk and/or neck, and continued use of force even after termination of the deportation attempt, occurring inside security company vehicles out of sight of witnesses. An analysis of the legal implications for the government and recommendations aimed at eradication of abusive practices are given.

Airway management in a bleeding adult following tonsillectomy: a case report.

PubMed

Brar, Manjit Singh

2009-12-01

A 37-year-old morbidly obese man with a history of obstructive sleep apnea underwent elective tonsillectomy. The patient was successfully intubated with an 8.0-mm regular cuffed endotracheal tube. A large video laryngoscope (GlideScope, Verathon Inc, Bothell, Washington) was used for intubation, as airway assessment indicated a potentially difficult airway. The surgery was uneventful, but active bleeding was noticed in the oropharynx after extubation. The patient was reintubated, again with the use of a GlideScope. The bleeding site was cauterized, and the patient was extubated after meeting the criteria for an awake extubation. He was discharged home the following day. Eight days postoperatively, the patient returned to the emergency center with spontaneous bleeding from the oropharynx. He was taken to the operating room and, based on the previous GlideScope use, an attempt was made to intubate the patient with a GlideScope. The attempt failed, as the GlideScope screen was blurred by the presence of blood in the oropharynx, even though the oropharynx was suctioned. Resuctioning and reinsertion of the GlideScope probe did not provide an adequate visual field. After 2 failed attempts, the use of the GlideScope was abandoned. Subsequently, the patient's trachea was successfully intubated with a size 4 Macintosh blade.

Suicide risk reduction in youths with attention-deficit/hyperactivity disorder prescribed methylphenidate: A Taiwan nationwide population-based cohort study.

PubMed

Liang, Sophie Hsin-Yi; Yang, Yao-Hsu; Kuo, Ting-Yu; Liao, Yin-To; Lin, Tzu-Chin; Lee, Yena; McIntyre, Roger S; Kelsen, Brent A; Wang, Tsu-Nai; Chen, Vincent Chin-Hung

2018-01-01

Attention-deficit/hyperactivity disorder (ADHD) youths have increased suicide risk. Nevertheless, the beneficial effects of methylphenidate (MPH) on suicide attempt have received relatively little attention. To investigate the MPH usage and the risk of suicide attempt among ADHD youths. We identified 84,898 youths less than 18 years old with ADHD diagnosis between 1997 and 2013 from National Health Insurance, and examined whether MPH use affected suicide attempt risk using Cox proportional-hazards models. Among ADHD youths, reduction of suicide risk was found in patients prescribed 90-180days of MPH after adjusting for confounding factors (hazard ratio (HR): 0.41, 95% confidence interval (CI): 0.19-0.90) and a greater reduction in those prescribed more than 180days of MPH (HR: 0.28, 95% CI: 0.17-0.48). We observed a 59% suicide attempt risk reduction among ADHD youths prescribed between 90 and 180days and a 72% risk reduction in those prescribed more than 180days of MPH. The protective benefit observed by the group prescribed MPH for longer duration underscores the importance of psychoeducation and compliance enhancement as part of ADHD management. Indication bias is identified as a limitation of this study, and future self-case control study to investigate the association between suicide attempt and ADHD medication is suggested. This nationwide population-based cohort study showed that among ADHD youths, reduction of suicide risk was observed in patients prescribed MPH for duration 90days and longer, underscoring the importance of appropriate ADHD pharmacotherapy and enhancing drug compliance. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Effect of Housing First on Suicidal Behaviour

PubMed Central

Aquin, Joshua P.; Roos, Leslie E.; Distasio, Jino; Katz, Laurence Y.; Bourque, Jimmy; Bolton, James M.; Bolton, Shay-Lee; Wong, Jacquelyne Y.; Chateau, Dan; Somers, Julian M.; Enns, Murray W.; Hwang, Stephen W.; Frankish, James C.

2017-01-01

Objective: This study attempted to determine if Housing First (HF) decreased suicidal ideation and attempts compared to treatment as usual (TAU) amongst homeless persons with mental disorders, a population with a demonstrably high risk of suicidal behaviour. Method: The At Home/Chez Soi project is an unblinded, randomised control trial conducted across 5 Canadian cities (Vancouver, Winnipeg, Toronto, Montreal, Moncton) from 2009 to 2013. Homeless adults with a diagnosed major mental health disorder were recruited through community agencies and randomised to HF (n = 1265) and TAU (n = 990). HF participants were provided with private housing units and received case management support services. TAU participants retained access to existing community supports. Past-month suicidal ideation was measured at baseline and 6, 12, 18, and 21/24 months. A history of suicide attempts was measured at baseline and the 21/24-month follow-up. Results: Compared to baseline, there was an overall trend of decreased past-month suicidal ideation (estimate = –.57, SE = .05, P < 0.001), with no effect of treatment group (i.e., HF vs. TAU; estimate = –.04, SE = .06, P = 0.51). Furthermore, there was no effect of treatment status (estimate = –.10, SE = .16, P = 0.52) on prevalence of suicide attempts (HF = 11.9%, TAU = 10.5%) during the 2-year follow-up period. Conclusion: This study failed to find evidence that HF is superior to TAU in reducing suicidal ideation and attempts. We suggest that HF interventions consider supplemental psychological treatments that have proven efficacy in reducing suicidal behaviour. It remains to be determined what kind of suicide prevention interventions (if any) are specifically effective in further reducing suicidal risk in a housing-first intervention. PMID:28683228

Effect of Housing First on Suicidal Behaviour: A Randomised Controlled Trial of Homeless Adults with Mental Disorders.

PubMed

Aquin, Joshua P; Roos, Leslie E; Distasio, Jino; Katz, Laurence Y; Bourque, Jimmy; Bolton, James M; Bolton, Shay-Lee; Wong, Jacquelyne Y; Chateau, Dan; Somers, Julian M; Enns, Murray W; Hwang, Stephen W; Frankish, James C; Sareen, Jitender

2017-07-01

This study attempted to determine if Housing First (HF) decreased suicidal ideation and attempts compared to treatment as usual (TAU) amongst homeless persons with mental disorders, a population with a demonstrably high risk of suicidal behaviour. The At Home/Chez Soi project is an unblinded, randomised control trial conducted across 5 Canadian cities (Vancouver, Winnipeg, Toronto, Montreal, Moncton) from 2009 to 2013. Homeless adults with a diagnosed major mental health disorder were recruited through community agencies and randomised to HF ( n = 1265) and TAU ( n = 990). HF participants were provided with private housing units and received case management support services. TAU participants retained access to existing community supports. Past-month suicidal ideation was measured at baseline and 6, 12, 18, and 21/24 months. A history of suicide attempts was measured at baseline and the 21/24-month follow-up. Compared to baseline, there was an overall trend of decreased past-month suicidal ideation (estimate = -.57, SE = .05, P < 0.001), with no effect of treatment group (i.e., HF vs. TAU; estimate = -.04, SE = .06, P = 0.51). Furthermore, there was no effect of treatment status (estimate = -.10, SE = .16, P = 0.52) on prevalence of suicide attempts (HF = 11.9%, TAU = 10.5%) during the 2-year follow-up period. This study failed to find evidence that HF is superior to TAU in reducing suicidal ideation and attempts. We suggest that HF interventions consider supplemental psychological treatments that have proven efficacy in reducing suicidal behaviour. It remains to be determined what kind of suicide prevention interventions (if any) are specifically effective in further reducing suicidal risk in a housing-first intervention.

Characteristics of suicide attempts in anorexia and bulimia nervosa: a case-control study.

PubMed

Guillaume, Sébastien; Jaussent, Isabelle; Olié, Emilie; Genty, Catherine; Bringer, Jacques; Courtet, Philippe; Schmidt, Ulrike

2011-01-01

Compared to other eating disorders, anorexia nervosa (AN) has the highest rates of completed suicide whereas suicide attempt rates are similar or lower than in bulimia nervosa (BN). Attempted suicide is a key predictor of suicide, thus this mismatch is intriguing. We sought to explore whether the clinical characteristics of suicidal acts differ between suicide attempters with AN, BN or without an eating disorders (ED). Case-control study in a cohort of suicide attempters (n = 1563). Forty-four patients with AN and 71 with BN were compared with 235 non-ED attempters matched for sex, age and education, using interview measures of suicidal intent and severity. AN patients were more likely to have made a serious attempt (OR = 3.4, 95% CI 1.4-7.9), with a higher expectation of dying (OR = 3.7,95% CI 1.1-13.5), and an increased risk of severity (OR = 3.4,95% CI 1.2-9.6). BN patients did not differ from the control group. Clinical markers of the severity of ED were associated with the seriousness of the attempt. There are distinct features of suicide attempts in AN. This may explain the higher suicide rates in AN. Higher completed suicide rates in AN may be partially explained by AN patients' higher desire to die and their more severe and lethal attempts.

[Management of suicidal orbital gunshot wounds to the temple].

PubMed

Schargus, M; Kawa, D; Elling, M; Kunkel, M

2014-10-01

Orbital gunshot wounds are rarely found after suicide. A gunshot fired at point blank range into the temple has devastating effects on all intraorbital and neighboring structures. This article reports on two cases of gunshot wounds to the lateral orbit in attempted suicides with different weapons from 2012 and 2013 and treated at the Ruhr University Eye Hospital in Bochum. In both cases treatment was carried out in cooperation with the department of oral and maxillofacial surgery, Ruhr University Hospital, Bochum. In the first case a 7.65 mm gun was used. The patient presented with a double penetration of both orbits with total destruction of both globes and a reconstruction was not possible. The second patient presented with multiple shots to the head from a small caliber gun (5.6 mm) where one bullet entered the right orbit behind the globe. The bullet could be localized using computed tomography (CT) and surgically removed with preservation of the globe and with a postoperative visual acuity of 20/60. The preservation of visual function after orbital gunshot wounds depends on both the projectile channel and the characteristics of the gun and bullet. Close collaboration in surgical management between ophthalmologists, maxillofacial surgeons and neurosurgeons in specialized centers is necessary because patients often present with multiple trauma and prompt interdisciplinary treatment is needed.

Use of Hemadsorption in a Case of Pediatric Toxic Shock Syndrome.

PubMed

Berkes, Andrea; Szikszay, Edit; Kappelmayer, János; Kerényi, Adrienne; Szabó, Tamás; Ujhelyi, László; Bari, Krisztina; Balla, György; Balla, József

2017-01-01

Toxic shock syndrome is a potentially fatal toxin-mediated disease. The role of toxins in this clinical entity made us hypothesize that extracorporeal blood purification with CytoSorb® could play a beneficial role in the clinical management of toxic shock syndrome. This case report describes the successful treatment of toxic shock syndrome using a combination of renal replacement therapy and hemadsorption in a pediatric patient. A 5-year-old girl with Down's syndrome presented with an inflamed area surrounding an insect bite, signs of systemic inflammation, and multiple organ failure. As previous attempts of immune modulation therapy were unsuccessful, renal replacement therapy was supplemented by the cytokine absorber CytoSorb. Treatment using this combination was associated with a rapid and significant stabilization in the hemodynamic situation and a decrease in inflammatory mediators within hours after the initiation of therapy. The application of CytoSorb therapy was simple and safe. The use of extracorporeal blood purification with CytoSorb proved potentially beneficial by removing toxins and inflammatory mediators in this case and could therefore play a role in the clinical management of toxic shock syndrome. Whether CytoSorb has the potential to even positively influence mortality in patients with toxic shock syndrome still needs to be confirmed.

Stringency of workplace air contaminant exposure limits: a case study of OSHA risk management.

PubMed

Hakes, J K

1999-12-01

Political context may play a large role in influencing the efficiency of environmental and health regulations. This case study uses data from a 1989 update of the Occupational Safety and Health Administration (OSHA) Permissible Exposure Limits (PELs) program to determine the relative effects of legislative mandates, costly acquisition of information by the agency, and pressure applied by special interest groups upon exposure standards. The empirical analysis suggests that federal agencies successfully thwart legislative attempts to limit agency discretion, and that agencies exercise bounded rationality by placing greater emphasis on more easily obtained information. The 1989 PELs were less significantly related to more costly information, contained "safety factors" for chemicals presenting relatively more ambiguous risks, and the proposed standard stringencies showed evidence of being influenced by vying industry and labor interests.

Anterior fracture dislocation of the sacroiliac joint: A case report and literature review.

PubMed

Xiao, Jianlin; Wang, Yang; Zhang, Minglei; Jiang, Rui; Zhu, Tongtong; Liu, Guangyao; Zuo, Jianlin

2017-08-09

Publications describing the diagnosis and treatment of anterior dislocation of the sacroiliac joint are scarce. We report the case a 19-year-old female at 8 weeks' gestation who presented with anterior fracture dislocation of the right sacroiliac joint, posterior fracture dislocation of the left sacroiliac joint (crescent fracture), and incomplete abortion resulting from high energy trauma. Orthopedic surgery involved standard anterior sacroiliac joint plating using an ilioinguinal approach combined with a modified Stoppa approach. Three attempts at complete abortion failed. Complete abortion was eventually achieved by dilatation and curettage two weeks after orthopedic surgery. Our findings reveal a need to improve techniques for diagnosis and treatment of anterior fracture dislocation of the sacroiliac joint, so greater attention can be paid to the rapid and effective management of associated comorbidities, and those resulting from the initial trauma.

A rare case of hepatic duct injury from blunt abdominal trauma.

PubMed

Hasaniya, Nahidh W; Premaratne, Shyamal; Premaratne, Ishani D; McNamara, J Judson

2013-01-01

A 25 year-old male was brought to the emergency room following an apparent suicide attempt by jumping from the fourth floor. Patient had a large abdominal laceration in the right upper quadrant (RUQ). CT scan showed a sub-scapular hematoma of the liver. Due to the repeated episodes of hypotension, a laporotomy was performed and the left hepatic artery was ligated while the ductal injury was managed with a Roux-en-Y left hepatic jejunostomy and stent. Bile leakage was resolved post-operatively by day 5 and the patient was discharged home on day 13 after clearance from psychiatry. While non-iatrogenic extrahepatic biliary trauma is rare, a high degree of suspicion is essential, especially in cases like the one discussed in this report. Diagnosis can be difficult in patients undergoing observation.

Can efficient supply management in the operating room save millions?

PubMed

Park, Kyung W; Dickerson, Cheryl

2009-04-01

Supply expenses occupy an ever-increasing portion of the expense budget in today's increasingly technologically complex operating rooms. Yet, little has been studied and published in the anesthesia literature. This review attempts to bring the topic of supply management to anesthesiologists, who play a significant role in operating room management. Little investigative work has been performed on supply management. Anecdotal reports suggest the benefits of a perpetual inventory system over a periodic inventory system. A perpetual inventory system uses utilization data to update inventory on hand continually and this information is linked to purchasing and restocking, whereas a periodic inventory system counts inventory at some regular intervals (such as annually) and uses average utilization to set par levels. On the basis of application of operational management concepts, ways of taking advantage of a perpetual inventory system to achieve savings in supply expenses are outlined. These include linking the operating room scheduling and supply order system, distributor-driven just-in-time delivery of case carts, continual updating of preference lists based on utilization patterns, increasing inventory turnovers, standardizing surgical practices, and vendor consignment of high unit-cost items such as implants. In addition, Lean principles of visual management and elimination of eight wastes may be applicable to supply management.

Report to Congress on the U.S. Department of Energy`s Environmental Management Science Program: Research funded and its linkages to environmental cleanup problems, and Environmental Management Science Program research award abstracts. Volume 2 of 3 -- Appendix B

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

NONE

The Department of Energy`s Environmental Management Science Program (EMSP) serves as a catalyst for the application of scientific discoveries to the development and deployment of technologies that will lead to reduction of the costs and risks associated with cleaning up the nation`s nuclear complex. Appendix B provides details about each of the 202 research awards funded by the EMSP. This information may prove useful to researchers who are attempting to address the Department`s environmental management challenges in their work, program managers who are planning, integrating, and prioritizing Environmental Management projects, and stakeholders and regulators who are interested in the Department`smore » environmental challenges. The research award information is organized by the state and institution in which the lead principal investigator is located. In many cases, the lead principal investigator is one of several investigators at a number of different institutions. In these cases, the lead investigator (major collaborator) at each of the additional institutions is listed. Each research award abstract is followed by a list of high cost projects that can potentially be impacted by the research results. High cost projects are Environmental Management projects that have total costs greater than $50 million from the year 2007 and beyond, based on the March 1998 Accelerating Cleanup: Paths to Closure Draft data, and have costs or quantities of material associated with an Environmental Management problem area. High cost projects which must remain active in the year 2007 and beyond to manage high risk are also identified. Descriptions of these potentially related high cost Environmental Management projects can be found in Appendix C. Additional projects in the same problem area as a research award can be located using the Index of High Cost Environmental Management Projects by Problem Area, at the end of Appendices B and C.« less

Case Control Study of Impulsivity, Aggression, Pesticide Exposure and Suicide Attempts Using Pesticides among Farmers.

PubMed

Lyu, Chun Ping; Pei, Jian Ru; Beseler, L Cheryl; Li, Yu Ling; Li, Jian Hui; Ren, Ming; Stallones, Lorann; Ren, Shu Ping

2018-03-01

A case-control study was conducted to investigate associations between organophosphate pesticide (OP) exposure, aggression, impulsivity, and attempted suicide. Questionnaires were used to collect information; impulsivity and aggression were measured by the Barratt Impulsivity Scale (BIS) and the Aggression Inventory (AI). A greater number of OP symptoms was associated with an increased odds of a suicide attempt after adjusting for marital status and income (OR = 1.45; CI 1.14-1.86). Attempted suicide was significantly associated with high impulsivity scores (means: 72.4 vs. 60.6, P < 0.0001) and high aggression scores (means: 38.5 vs. 26.1, P < 0.0001). Suicide attempters had a higher number of OP exposure symptoms than controls and scored higher on scales of impulsivity and aggression. Copyright © 2018 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.

A Case Control Study of Suicide and Attempted Suicide in Older Adults.

ERIC Educational Resources Information Center

Beautrais, Annette L.

2002-01-01

Risk factors for serious suicidal behavior among older adults were examined in a case control study of adults aged 55 and older who died by suicide or made suicide attempts and who were compared with randomly selected comparison subjects. Multivariate analyses suggested that mood disorders were the most significant risk factor for suicidal…

Group counseling: A silver lining in the psychological management of disaster trauma

PubMed Central

Maheshwari, Nidhi; Yadav, Ravinder; Singh, Nirender Pal

2010-01-01

Management of disaster effects, physical or psychological, has been the subject of considerable research. Though physical rehabilitation of the victims of any disaster, whether natural or man-made, receives immediate attention, the management of psychological trauma often remains a challenge for the disaster management machinery, in general, and mental health professionals, in particular. The magnitude of population affected, on the one hand, and lack of sufficient mental health professionals, on the other hand, often hinders the psychological rehabilitation of a cross section of the affected population. We attempt to present an overview of the literature to bring home the understanding of correlates of psychological effects in the mass disaster affected population in this article. It dwells on the efficacy of group counseling as the most appropriate paradigm of primary prevention to check the onset of severe psychological disorders. The article also presents an overview of two case studies: tsunami disaster (Nagapatanam, Tamil Nadu, India) and victims of bomb blast (Dhimajee, Assam, India) to highlight the silver lining in the psychological management of disaster traumas. It is proposed that group counseling can prove to be a most important mental rehabilitation program to further strengthen the efficacy of individual therapeutic interventions. PMID:21829322

Corsair microcatheter for retrograde coronary chronic total occlusion recanalization: Early experience outside the realm of dedicated recanalization specialists

PubMed Central

Joseph, George; Thomson, Viji Samuel; Radhakrishnan, Shanmugasundaram

2012-01-01

Objective To determine the extent to which use of the Corsair microcatheter (CM, Asahi Intecc Co., Japan) improves procedural outcomes when an experienced operator who is not a dedicated recanalization specialist attempts retrograde chronic total occlusion (CTO) recanalization through collateral channels during percutaneous coronary intervention. Background The recently introduced CM has improved success rates of retrograde CTO recanalization to nearly 100% in the hands of dedicated coronary recanalization specialists; however, the impact the CM has on the results of non-specialist operators attempting retrograde CTO recanalization is not known. Methods A non-specialist operator attempted CM-assisted recanalization in seven consecutive CTO cases requiring retrograde recanalization. The results obtained were compared with those achieved by the same operator in eleven consecutive retrograde CTO recanalization procedures during the last 2 years before the CM became available. Results CM-assisted retrograde CTO recanalization was successful in 6 of 7 cases (86%), but failed in one case attempted through a tortuous epicardial collateral; there were no complications. In contrast, during the 2 years before the CM became available, retrograde CTO recanalization was successful in only 3 of 11 attempted cases (27%), and was associated with significant morbidity. Lesions in the two groups were comparable in terms of technical difficulty and procedural risk. Conclusions The non-specialist operator's retrograde CTO recanalization results improve significantly when using the CM. Given the effectiveness and safety of CM-assisted retrograde CTO recanalization, operators should be less aggressive with anterograde recanalization attempts, and should switch to the retrograde approach earlier and more often. PMID:22929822

Business Management in the Catholic School.

ERIC Educational Resources Information Center

Correia, Joan

This manual attempts to clarify appropriate business-management practices for Catholic schools. It addresses relevant financial issues, such as stewardship of property and resources. The volume describes the importance of employing a business manager and explores that person's role, delving into the business manager as manager, leader, and…

Success of Intubation Rescue Techniques after Failed Direct Laryngoscopy in Adults: A Retrospective Comparative Analysis from the Multicenter Perioperative Outcomes Group.

PubMed

Aziz, Michael F; Brambrink, Ansgar M; Healy, David W; Willett, Amy Wen; Shanks, Amy; Tremper, Tyler; Jameson, Leslie; Ragheb, Jacqueline; Biggs, Daniel A; Paganelli, William C; Rao, Janavi; Epps, Jerry L; Colquhoun, Douglas A; Bakke, Patrick; Kheterpal, Sachin

2016-10-01

Multiple attempts at tracheal intubation are associated with mortality, and successful rescue requires a structured plan. However, there remains a paucity of data to guide the choice of intubation rescue technique after failed initial direct laryngoscopy. The authors studied a large perioperative database to determine success rates for commonly used intubation rescue techniques. Using a retrospective, observational, comparative design, the authors analyzed records from seven academic centers within the Multicenter Perioperative Outcomes Group between 2004 and 2013. The primary outcome was the comparative success rate for five commonly used techniques to achieve successful tracheal intubation after failed direct laryngoscopy: (1) video laryngoscopy, (2) flexible fiberoptic intubation, (3) supraglottic airway as part of an exchange technique, (4) optical stylet, and (5) lighted stylet. A total of 346,861 cases were identified that involved attempted tracheal intubation. A total of 1,009 anesthesia providers managed 1,427 cases of failed direct laryngoscopy followed by subsequent intubation attempts (n = 1,619) that employed one of the five studied intubation rescue techniques. The use of video laryngoscopy resulted in a significantly higher success rate (92%; 95% CI, 90 to 93) than other techniques: supraglottic airway conduit (78%; 95% CI, 68 to 86), flexible bronchoscopic intubation (78%; 95% CI, 71 to 83), lighted stylet (77%; 95% CI, 69 to 83), and optical stylet (67%; 95% CI, 35 to 88). Providers most frequently choose video laryngoscopy (predominantly GlideScope [Verathon, USA]) to rescue failed direct laryngoscopy (1,122/1,619; 69%), and its use has increased during the study period. Video laryngoscopy is associated with a high rescue intubation success rate and is more commonly used than other rescue techniques.

Exercise-induced acute compartment syndrome in a young man, occurring after a short race

PubMed Central

Matar, Mousa; Vaitilingham, Siddharthan; Chalise, Shyam; Irooegbu, Nkem; Bang, Jane

2016-01-01

We describe a case of exercise-induced acute compartment syndrome (ACS) in a 23-year-old man who presented to his primary care physician 48 hours after he attempted to run a 5K race. He noticed searing pain in his left leg after the first half mile but had no other symptoms. He was referred to the emergency department and diagnosed with ACS, and a fasciotomy was done. A presentation of limb pain that is out of proportion to a known or suspected injury should prompt consideration of ACS. Early recognition and surgical management are essential to achieving the best possible outcome. PMID:27034546

Exercise-induced acute compartment syndrome in a young man, occurring after a short race.

PubMed

Basnet, Bibhusan; Matar, Mousa; Vaitilingham, Siddharthan; Chalise, Shyam; Irooegbu, Nkem; Bang, Jane

2016-04-01

We describe a case of exercise-induced acute compartment syndrome (ACS) in a 23-year-old man who presented to his primary care physician 48 hours after he attempted to run a 5K race. He noticed searing pain in his left leg after the first half mile but had no other symptoms. He was referred to the emergency department and diagnosed with ACS, and a fasciotomy was done. A presentation of limb pain that is out of proportion to a known or suspected injury should prompt consideration of ACS. Early recognition and surgical management are essential to achieving the best possible outcome.

AN/ASQ-197 provides commonality to Recce systems and avionics upgrades

NASA Astrophysics Data System (ADS)

Regan, Brendan P.

1993-02-01

In an attempt to strike a balance between increases in multi-role tactical air reconnaissance mission tasking and simultaneous decreases in defense spending, many users are evaluating upgrades to existing sensors and reconnaissance systems. At the heart of any cost-effective reconnaissance system upgrade must be a flexible reconnaissance management system, capable of filling multiple rolls in today's film backed reconnaissance system, while enabling successful transition to the Electro-Optical (EO) system of tomorrow. As a case in point this paper describes enhanced effectiveness and growth potential that Fairchild's AN/ASQ-197 Sensor Control-Data Display Set (SC-DDS) can provide.

Potential effects of elevated base flow and midsummer spike flow experiments on riparian vegetation along the Green River

USGS Publications Warehouse

Friedman, Jonathan M.

2018-01-01

needs of other riverine resources. Use of high flows to remove unwanted vegetation is constrained by current operational guidance for Flaming Gorge Dam, which attempts to limit spills (i.e., flows greater than 8600 ft3 /s) that might contribute to cavitation and lead to dam safety concerns. Therefore, reversing vegetation encroachment is more likely to succeed if implemented while plants are still small. Annual monitoring of near-channel vegetation and topography would enable managers to prescribe a timely hydrologic response in case the proposed flow experiments lead to vegetation encroachment and habitat degradation.

BPMN, Toolsets, and Methodology: A Case Study of Business Process Management in Higher Education

NASA Astrophysics Data System (ADS)

Barn, Balbir S.; Oussena, Samia

This chapter describes ongoing action research which is exploring the use of BPMN and a specific toolset - Intalio Designer to capture the “as is” essential process model of part of an overarching large business process within higher education. The chapter contends that understanding the efficacy of the BPMN notation and the notational elements to use is not enough. Instead, the effectiveness of a notation is determined by the notation, the toolset that is being used, and methodological consideration. The chapter presents some of the challenges that are faced in attempting to develop computation independent models in BPMN using toolsets such as Intalio Designer™.

34 CFR 395.36 - Enforcement procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... PROPERTY Federal Property Management § 395.36 Enforcement procedures. (a) The State licensing agency shall attempt to resolve day-to-day problems pertaining to the operation of the vending facility in an informal... instrumentality in an attempt to resolve the issue. ...

Managing weeds in potato rotations without herbicides

USDA-ARS?s Scientific Manuscript database

Managing weeds without herbicides requires an integration of methods and strategies and a change in how weeds are perceived. Weeds should be managed in a holistic, intentional and proactive manner. Successful weed management in organic systems attempts to understand the interactions between the crop...

Parapharyngeal space hemangiopericytoma treated with surgery and postoperative radiation--a case report.

PubMed

Fareed, Muhammad Mohsin; Al Amro, Abdullah Suleiman Mazaed; Akasha, Rashad; Al Assiry, Mansour; Al Asiri, Mushabbab; Tonio, Mutahir; Bayoumi, Yasser

2012-04-05

Hemangiopericytoma (HPC) is a rare tumor of uncertain malignant potential arising from mesenchymal cells with pericytic differentiation. It accounts for 3-5% of soft tissue sarcomas and 1% of vascular tumors. It usually presents in 5th to 6th decade of life. Most common sites are limbs, pelvis and head and neck. About 20% of all hemangiopericytomas are seen in head and neck, mostly in adults. Usually it presents in orbit, nasal cavity, oral cavity, jaw, parotid gland, parapharyngeal space, masticator space and jugular foramen. Long term follow up is important because of imprecise nature of the histological criteria for prediction of biologic behavior.We report herein a case of HPC in 66-year-old man, who presented in our department with headache, nasal obstruction and dysphagia. A neck computer tomography scan and magnetic resonance imaging showed a large left parapharyngeal mass bulging into nasopharynx and oropharynx with extension to pharyngeal mucosal surface and causing narrowing of airways and total obstruction of left posterior nostril. Angiography showed a highly vascular neoplasm. Initially he was managed as a case of schwannoma and embolization was done but with no response. An attempt to do complete surgical resection was made, but due to its critical position, it was not possible. During surgery, highly vascularised tumor was found. The histopathologic examination revealed a vascular tumor consistent with hemangiopericytoma G-II. The patient had normal postoperative course of healing and was given adjuvant radiation. He is on regular follow up without signs of recurrence or metastases.In summary, parapharyngeal space is a rare site of presentation for hemangiopericytoma which is highly vascular tumor, requiring extensive work up including magnetic resonance imaging, computed tomography scan and angiography. Complete surgical excision should be attempted. Postoperative radiation is indicated in cases of incomplete resection.

An interesting case report of vertebral artery dissection following polytrauma.

PubMed

Acharya, Vikas; Chandrasekaran, Suresh; Nair, Sujit

2016-01-01

The authors present an interesting case of a 19-year-old male who presented as a polytrauma patient following a fall from a height. He was initially managed on the intensive care unit with intracranial pressure bolt monitoring after being intubated and sedated and having his other traumatic injuries stabilized. Upon attempting to wean sedation and extubation a repeat CT scan of the head was undertaken and showed a new area suggested of cerebral infarction, this was a new finding. Further imaging found that he had a cervical vertebral artery dissection following this polytrauma mode of injury. The incidence of vertebral artery dissection following generalized or local trauma is rising but routine imaging/screening in these patients is not undertaken. Our report displays select images related to this case report and emphasizes the consideration of routine imaging in head and neck traumatic injuries to diagnose internal carotid and/or vertebral artery dissections much earlier. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Acquired high titre factor VIII inhibitor with underlying polyarteritis nodosa.

PubMed

Snowden, J A; Hutchings, M; Spearing, R; Patton, W N

1997-05-01

We here present the case of a 70-year-old woman referred to our unit for investigation of bleeding. Investigations confirmed a high titre acquired Factor VIII inhibitor. In association there was relapse of systemic illness associated with anti-neutrophil cytoplasmic antibodies (atypical pattern) for which she had been treated five years previously. Immunosuppression was attempted, but it failed to have an impact both on the inhibitor titre and on the underlying disorder. The patient died from multi-organ failure and massive chest hemorrhage. Post-mortem showed necrotizing vasculitis of medium sized vessels at several sites, including the kidney, consistent with a diagnosis of polyarteritis nodosa. Although it is well recognised that Factor VIII inhibitors are found in conjunction with autoimmune disorders, this case is significant in that it is the first associated with histologically proven polyarteritis nodosa type vasculitis. The case illustrates the difficulties in the investigation and management of patients with acquired high titre Factor VIII inhibitors.

Risk-taking behaviors and subgrouping of suicide in Iran: A latent class analysis of national registries data.

PubMed

Hajebi, Ahmad; Abbasi-Ghahramanloo, Abbas; Hashemian, Seyed Sepehr; Khatibi, Seyed Reza; Ghasemzade, Masomeh; Khodadost, Mahmoud

2017-09-01

Suicide is one the most important public health problem which is rapidly growing concerns. The aim of this study was to subgroup suicide using LCA method. This cross-sectional study was conducted in Iran based on 66990 records registered in Ministry of Health in 2014. A case report questionnaire in the form of software was used for case registries. Latent class analysis was used to achieve the research objectives. Four latent classes were identified; (a) Non-lethal attempters without a history of psychiatric disorders, (b) Non-lethal attempters with a history of psychiatric disorders, (c) Lethal attempters without a history of psychiatric disorders, (d) Lethal attempters with a history of psychiatric disorders. The probability of completed/an achieved suicide is high in lethal attempter classes. Being male increases the risk of inclusion in lethal attempters' classes (OR = 4.93). Also, being single (OR = 1.16), having an age lower than 25 years (OR = 1.14) and being a rural citizen (OR = 2.36) associate with lethal attempters classes. The males tend to use more violent methods and have more completed suicide. Majority of the individuals are non-lethal attempters who need to be addressed by implementing preventive interventions and mental support provision. Copyright © 2017. Published by Elsevier B.V.

Analysing water use patterns for demand management: the case of the city of Masvingo, Zimbabwe

NASA Astrophysics Data System (ADS)

Dube, Emmanuel; van der Zaag, Pieter

Water use in urban centres is dynamic, fluctuates, differs between high and low-income users, and tends to increase over time. Supply infrastructure can often hardly keep pace with increased water consumption. Given (a) the high cost of infrastructure development, (b) the recent emphasis on demand management, and (c) the social obligation to provide water services to the poor, urban water providers are faced with an important choice: whether to go the demand management route, or to continue constructing new infrastructure. This paper sheds light on some of the possibilities and constraints of both choices by providing a case study of the city of Masvingo in Zimbabwe. The paper analyses water use patterns in this city with a population of 70,000, located in a drought prone region of average rainfall of 600 mm/a. Water consumption has reached the limits of the water supply capacity. The paper first looks at the long-term water use pattern of the city as a whole and the factors that have caused the observed pattern using multiple linear regression. The paper then analyses the patterns of water use of rich and poor households, and attempts to assess the (im)possibilities of influencing these by means of an appropriate tariff structure. In projecting future demand, the paper then considers a number of interventions that could influence demand, which include leakage control, pressure management, awareness campaigns, free technical advice to water users, as well as a new tariff structure. It also discusses when new supply infrastructure should be available, depending on the various demand management measures taken.

So, You Want to Start a Charter? La Escuela Freire: A Charter School Case Study

ERIC Educational Resources Information Center

Herzog, Anat

2017-01-01

This case study attempts to better understand the nuances of charter school impact by documenting the story of the Board of La Escuela Freire (the Board), a group attempting to open a democratic, social justice charter school in Santa Ana, California. In asking the question: "What has been the development process of La Escuela Freire?",…

Efficacy of video-guided laryngoscope in airway management skills of medical students.

PubMed

Peirovifar, Ali; Mahmoodpoor, Ata; Golzari, Samad Ej; Soleimanpour, Hassan; Eslampour, Yashar; Fattahi, Vahid

2014-10-01

Video-guided laryngoscopy, though unproven in achieving better success rates of laryngoscopy outcome and intubation, seems to provide better glottic visualization compared with direct laryngoscopy. The objective of this study was to compare the efficacy of video-guided laryngoscope (VGL) in the airway management skills of medical students. Medical students throughout their anesthesiology rotations were enrolled in this study. All students received standard training in the airway management during their course and were randomly allocated into two 20 person groups. In Group D, airway management was performed by direct laryngoscopy via Macintosh blade and in Group G intubation was performed via VGL. Time to intubation, number of laryngoscopy attempts and success rate were noted. Successful intubation was considered as the primary outcome. All data were analyzed using SPSS 16 software. Chi-square and Fisher's exact test were used for analysis of categorical variables. For analyzing continuous variables independent t-test was used. P < 0.05 was considered as statistically significant. Number of laryngoscopy attempts was less in Group G in comparison to Group D; this, however, was statistically insignificant (P: 0.18). Time to intubation was significantly less in Group G as compared to Group D (P: 0.02). Successful intubation in Group G was less frequently when compared to Group D (P: 0.66). Need for attending intervention, esophageal intubation and hypoxemic events during laryngoscopy were less in Group G; this, however, was statistically insignificant. The use of video-guided laryngoscopy improved the first attempt success rate, time to intubation, laryngoscopy attempts and airway management ability of medical students compared to direct laryngoscopy.

Persistent frenulum of the epiglottis in four foals.

PubMed

Yarbrough, T B; Voss, E; Herrgesell, E J; Shaw, M

1999-01-01

To report the clinical signs and management of 4 foals with persistent frenulum of the epiglottis. Case report. Four newborn foals. Foals were admitted with a complaint of oronasal reflux after nursing. Variable systemic signs of aspiration pneumonia were evident. Nasal endoscopy confirmed persistent dorsal displacement of the soft palate. Persistent frenulum of the epiglottis, confirmed by oral endoscopic examination, was transected. After surgery, all foals had the epiglottis positioned normally, dorsal to the soft palate. Clinical signs of oronasal reflux resolved by the second nursing attempt in 3 foals, whereas this was difficult to assess in one foal that was nursed intermittently because of the mares behavior. This foal died 2 days later. The other 3 foals have had normal epiglottic function for 2-4 years. Persistent frenulum of the epiglottis should be considered in foals with oronasal reflux from birth. With appropriate medical and surgical management the prognosis for resolution should be good.

Institutional and economic influences on the adoption and extensiveness of managerial innovation in hospitals: The case of reengineering.

PubMed

Walston, S L; Kimberly, J R; Burns, L R

2001-06-01

In the recent past, a number of managerial innovations--including product line management, total quality management, and reengineering--have swept through the hospital industry. Given their pervasiveness and their cost, understanding the mix of factors that influences their adoption is of theoretical interest and practical relevance. The research reported here focuses on this general question by examining influences on the adoption and extensiveness of a particular managerial innovation, hospital reengineering. The results suggest that while economic and institutional factors have influenced the adoption and extensiveness of hospital reengineering, institutional forces play a more important role. The greater influence of institutional forces may be attributed to the high degree of uncertainty in health care, the causal ambiguity of the innovation, and the anticipatory actions of hospitals attempting to position themselves in a rapidly changing environment.

A model for evaluating the social performance of construction waste management

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

Yuan Hongping, E-mail: hpyuan2005@gmail.com

Highlights: Black-Right-Pointing-Pointer Scant attention is paid to social performance of construction waste management (CWM). Black-Right-Pointing-Pointer We develop a model for assessing the social performance of CWM. Black-Right-Pointing-Pointer With the model, the social performance of CWM can be quantitatively simulated. - Abstract: It has been determined by existing literature that a lot of research efforts have been made to the economic performance of construction waste management (CWM), but less attention is paid to investigation of the social performance of CWM. This study therefore attempts to develop a model for quantitatively evaluating the social performance of CWM by using a system dynamicsmore » (SD) approach. Firstly, major variables affecting the social performance of CWM are identified and a holistic system for assessing the social performance of CWM is formulated in line with feedback relationships underlying these variables. The developed system is then converted into a SD model through the software iThink. An empirical case study is finally conducted to demonstrate application of the model. Results of model validation indicate that the model is robust and reasonable to reflect the situation of the real system under study. Findings of the case study offer helpful insights into effectively promoting the social performance of CWM of the project investigated. Furthermore, the model exhibits great potential to function as an experimental platform for dynamically evaluating effects of management measures on improving the social performance of CWM of construction projects.« less

NASA Remote Sensing Observations for Water Resource and Infrastructure Management

NASA Astrophysics Data System (ADS)

Granger, S. L.; Armstrong, L.; Farr, T.; Geller, G.; Heath, E.; Hyon, J.; Lavoie, S.; McDonald, K.; Realmuto, V.; Stough, T.; Szana, K.

2008-12-01

Decision support tools employed by water resource and infrastructure managers often utilize data products obtained from local sources or national/regional databases of historic surveys and observations. Incorporation of data from these sources can be laborious and time consuming as new products must be identified, cleaned and archived for each new study site. Adding remote sensing observations to the list of sources holds promise for a timely, consistent, global product to aid decision support at regional and global scales by providing global observations of geophysical parameters including soil moisture, precipitation, atmospheric temperature, derived evapotranspiration, and snow extent needed for hydrologic models and decision support tools. However, issues such as spatial and temporal resolution arise when attempting to integrate remote sensing observations into existing decision support tools. We are working to overcome these and other challenges through partnerships with water resource managers, tool developers and other stakeholders. We are developing a new data processing framework, enabled by a core GIS server, to seamlessly pull together observations from disparate sources for synthesis into information products and visualizations useful to the water resources community. A case study approach is being taken to develop the system by working closely with water infrastructure and resource managers to integrate remote observations into infrastructure, hydrologic and water resource decision tools. We present the results of a case study utilizing observations from the PALS aircraft instrument as a proxy for NASA's upcoming Soil Moisture Active Passive (SMAP) mission and an existing commercial decision support tool.

Shifts in fisheries management: adapting to regime shifts

PubMed Central

King, Jacquelynne R.; McFarlane, Gordon A.; Punt, André E.

2015-01-01

For many years, fisheries management was based on optimizing yield and maintaining a target biomass, with little regard given to low-frequency environmental forcing. However, this policy was often unsuccessful. In the last two to three decades, fisheries science and management have undergone a shift towards balancing sustainable yield with conservation, with the goal of including ecosystem considerations in decision-making frameworks. Scientific understanding of low-frequency climate–ocean variability, which is manifested as ecosystem regime shifts and states, has led to attempts to incorporate these shifts and states into fisheries assessment and management. To date, operationalizing these attempts to provide tactical advice has met with limited success. We review efforts to incorporate regime shifts and states into the assessment and management of fisheries resources, propose directions for future investigation and outline a potential framework to include regime shifts and changes in ecosystem states into fisheries management.

A Case Report on Management of Father Daughter Incest with Schizophrenia.

PubMed

Soron, Tanjir Rashid

2016-01-01

Incest is a neglected and hidden public health problem. This case is about a patient who was victim of sexual abuse, suffered from schizophrenia and abused his biological daughter. He was physically and sexually abused by seniors and classmates, developed paranoid delusion and auditory hallucination. During the course of the illness, he was hospitalized several times as a case of schizophrenia and sexual dysfunction was his main concern. The patient's illness followed a waxing and waning course. He took medication on on-and-off basis. He abused his biological daughter sexually at the later stage of the illness. Ultimately, the patient attempted suicide after an indecent sexual act with another relative and he was admitted to the hospital. He was treated with risperidone that was titrated to 10 mg per day. After continuing the medication for 2 years he regained a functioning life and remained stable with medication. This case shows the importance of exploring the sexual behavior of the patients and sharing the experience may help in the treatment of schizophrenia patients with incest.

A Case of Severe Chlorite Poisoning Successfully Treated With Early Administration of Methylene Blue, Renal Replacement Therapy, and Red Blood Cell Transfusion

PubMed Central

Gebhardtova, Andrea; Vavrinec, Peter; Vavrincova-Yaghi, Diana; Seelen, Mark; Dobisova, Anna; Flassikova, Zora; Cikova, Andrea; Henning, Robert H.; Yaghi, Aktham

2014-01-01

Abstract The case of a 55-year-old man who attempted suicide by ingesting <100 mL of 28% sodium chlorite solution is presented. On arrival in the intensive care unit, the patient appeared cyanotic with lowered consciousness and displayed anuria and chocolate brown serum. Initial laboratory tests revealed 40% of methemoglobin. The formation of methemoglobin was effectively treated with methylene blue (10% after 29 hours). To remove the toxin, and because of the anuric acute renal failure, the patient received renal replacement therapy. Despite these therapeutic measures, the patient developed hemolytic anemia and disseminated intravascular coagulation, which were treated with red blood cell transfusion and intermittent hemodialysis. These interventions led to the improvement of his condition and the patient eventually fully recovered. Patient gave written informed consent. This is the third known case of chlorite poisoning that has been reported. Based upon this case, we suggest the management of sodium chlorite poisoning to comprise the early administration of methylene blue, in addition to renal replacement therapy and transfusion of red blood cells. PMID:25144325

Microsurgical management of a complicated aneurysmal endovascular embolisation with GDC coil: a case report.

PubMed

Pogády, P; Mustafa, H; Wies, W; Lungenschmid, K; Wurm, G; Tomancok, B; Holl, K; Fischer, J

1998-01-01

We present a case involving a microsurgical approach to solving the problem of a medial cerebral artery (MCA) occlusion occurring after GDC coiling of an internal cerebral artery (ICA) bifurcation aneurysm in a 40 year old woman. We describe the clinical course of the case and discuss technical possibilities and risks of clipping a coiled aneurysm. One key to success is awareness of changes in the aneurysm's properties after coiling. With loss of elasticity the aneurysm had the effect of a tumor fixed on the vessel. The apposition of the aneurysm to the wall of the vessel, as well as the aneurysm's rigidity and increase of intracranial pressure after subarachnoideal hemorrhage (SAH), may lead to occlusion of the vessel. In cases of an mandatory operation due to the occlusion of a main arterial stem after coiling, it is primarily crucial to perforate the aneurysm's fundus, remove the coils, and, finally, to clip the slack neck of the aneurysm. An attempt to precisely prepare and clip the aneurysmal neck without removing the coils could result in the rupture of the aneurysm's neck.

A Case Report on Management of Father Daughter Incest with Schizophrenia

PubMed Central

2016-01-01

Incest is a neglected and hidden public health problem. This case is about a patient who was victim of sexual abuse, suffered from schizophrenia and abused his biological daughter. He was physically and sexually abused by seniors and classmates, developed paranoid delusion and auditory hallucination. During the course of the illness, he was hospitalized several times as a case of schizophrenia and sexual dysfunction was his main concern. The patient's illness followed a waxing and waning course. He took medication on on-and-off basis. He abused his biological daughter sexually at the later stage of the illness. Ultimately, the patient attempted suicide after an indecent sexual act with another relative and he was admitted to the hospital. He was treated with risperidone that was titrated to 10 mg per day. After continuing the medication for 2 years he regained a functioning life and remained stable with medication. This case shows the importance of exploring the sexual behavior of the patients and sharing the experience may help in the treatment of schizophrenia patients with incest. PMID:28050302

Suicide attempts and suicides in Bolivia from 2007 to 2012: pesticides are the preferred method - females try but males commit suicide!

PubMed

Jørs, Erik; Christoffersen, Mette; Veirum, Nikoline Høgsgaard; Aquilar, Guido Condarco; Morant, Rafael Cervantes; Konradsen, Flemming

2014-01-01

Suicide attempts and suicides constitute a significant burden on communities and health systems, especially in low income countries. However, many low income countries lack epidemiological information on which to base future preventive strategies. This study reports on gender and age profiles as well as the likely background and means used for suicide attempts and suicides in Bolivia. This study presents 1124 cases from four different sources of information: (i) emergency ward data with suicide attempts by poisoning from the year 2007, (ii) psychiatric ward data including suicide attempts from July 2011 to July 2012, (iii) newspaper articles reporting attempted suicides and suicides from 2009 to 2011, and (iv) the National Statistics on Crime reporting suicides from the years 2010-2011. Data on age was stratified into three age groups: adolescents aged 10-19 years, young adults aged 20-29 years, and older adults aged above 29 years. Data from the hospital wards and Crime Statistics were pooled to compare characteristics of suicide attempts with suicides concerning age and gender. Data on age, gender, methods used, and reasons were analyzed using IBM SPSS version 21. Hospital data showed that more females (403/657, 61%) than males (254/657, 39%) attempted suicide, and females attempted suicide at a younger age than males (p<0.05). In contrast to this, more males (208/293, 70.5%) than females (85/293, 29.5%) committed suicide, and furthermore it was most prevalent among young adults aged 20-29 years of both genders, as observed from the Crime Statistics. The dominant method was pesticide poisoning varying from 400 out of 657 (70.5%) of the hospital poisoning cases to 65 out of 172 (37.8%) of the newspaper cases. Newspaper data showed a higher mortality rate (65/77, 85.1%) among those using violent methods such as hanging and jumping compared to non-violent methods (43/84, 50.9%) such as ingesting chemicals and drugs (p<0.05). The reasons were related to interpersonal problems, economic problems, depression, and unwanted pregnancies. Many cases of suicide seemed to be hidden due to cultural and religious reasons. More females attempted suicide, whereas more males realized suicide. Suicide attempts were most numerous among adolescents in contrast to suicides being most prevalent in the older age groups. Self-poisoning with pesticides was the most popular method used. Access to potential suicide materials should be restricted and psychosocial interventions initiated to prevent suicides.

Management of acute variceal bleeding.

PubMed

Herrera, Jorge L

2014-05-01

Acute variceal bleeding (AVB) is the most common cause of upper gastrointestinal hemorrhage in patients with cirrhosis. Advances in the management of AVB have resulted in decreased mortality. To minimize mortality, a multidisciplinary approach addressing airway safety, prompt judicious volume resuscitation, vasoactive and antimicrobial pharmacotherapy, and early endoscopy to obliterate varices is necessary. Placement of a transjugular intrahepatic portosystemic shunt (TIPS) has been used as rescue therapy for patients failing initial attempts at hemostasis. Patients who have a high likelihood of failing initial attempts at hemostasis may benefit from a more aggressive approach using TIPS earlier in their management. Copyright © 2014 Elsevier Inc. All rights reserved.

Modifiable Risk Factors for Attempted Suicide in Australian Clinical and Community Samples

ERIC Educational Resources Information Center

Carter, Gregory L.; Page, Andrew; Clover, Kerrie; Taylor, Richard

2007-01-01

Modifiable risk factors for suicide attempt require identification in clinical and community samples. The aim of this study was to determine if similar social and psychiatric factors are associated with suicide attempts in community and clinical settings and whether the magnitude of effect is greater in clinical populations. Two case-control…

Adapting a strategic management model to hospital operating strategies. A model development and justification.

PubMed

Swinehart, K; Zimmerer, T W; Oswald, S

1995-01-01

Industrial organizations have employed the process of strategic management in their attempts to cope effectively with global competitive pressures, while attempting to build and maintain competitive advantage. With health-care organizations presently trying to cope with an increasingly turbulent environment created by the uncertainty as to pending legislation and anticipated reform, the need for such organizational strategic planning is apparent. Presents and discusses a methodology for adapting a business-oriented model of strategic planning to health care.

Examining the effectiveness of municipal solid waste management systems: An integrated cost-benefit analysis perspective with a financial cost modeling in Taiwan

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

Weng, Yu-Chi, E-mail: clyde.weng@gmail.com; Fujiwara, Takeshi

2011-06-15

In order to develop a sound material-cycle society, cost-effective municipal solid waste (MSW) management systems are required for the municipalities in the context of the integrated accounting system for MSW management. Firstly, this paper attempts to establish an integrated cost-benefit analysis (CBA) framework for evaluating the effectiveness of MSW management systems. In this paper, detailed cost/benefit items due to waste problems are particularly clarified. The stakeholders of MSW management systems, including the decision-makers of the municipalities and the citizens, are expected to reconsider the waste problems in depth and thus take wise actions with the aid of the proposed CBAmore » framework. Secondly, focusing on the financial cost, this study develops a generalized methodology to evaluate the financial cost-effectiveness of MSW management systems, simultaneously considering the treatment technological levels and policy effects. The impacts of the influencing factors on the annual total and average financial MSW operation and maintenance (O and M) costs are analyzed in the Taiwanese case study with a demonstrative short-term future projection of the financial costs under scenario analysis. The established methodology would contribute to the evaluation of the current policy measures and to the modification of the policy design for the municipalities.« less

Putative effect of alcohol on suicide attempters: an evaluative study in a tertiary medical college.

PubMed

Bhattacharjee, Subir; Bhattacharya, Amit; Thakurta, Rajarshi Guha; Ray, Paramita; Singh, Om Prakash; Sen, Sreyashi

2012-10-01

Alcohol abuse is a known risk factor for suicide. Alcohol increases aggression and impulsivity, which are strongly related to suicidal behavior. Sociocultural factors influence both alcohol use and suicide rates. Studies, conducted in one population, are not applicable to other and the results cannot be generalized. The aim was to study the putative role of alcohol in suicide cases in the rural Indian population by analysis of various sociodemographic variables. This was a cross-sectional study in conducted in a tertiary medical college. Two hundred consecutive patients who survived a suicide attempt were evaluated by a psychiatrist. The data were recorded for sociodemographic variables, psychiatric disorders, suicide intent, lethality of the suicide attempt, and history of alcohol intake prior to the suicide attempt. Using alcohol intake prior to the suicide attempt as a determining dimension, various sociodemographic variables were analyzed for their statistical significance and the role of alcohol in suicide cases was assessed. Seventeen percent suicide attempt survivors had a history of alcohol intake prior to the suicide attempt. Fifteen percent had a history of alcohol use disorder. Alcohol use affected the suicide rate in the male population in the late twenties to mid-thirties age group, illiterate and people with high school education, semiskilled workers, shop owners, and student population. Alcohol dependence, bipolar II disorder, intermittent explosive disorder, and dysthymic disorder had higher rate of suicide attempt with the use of alcohol prior to the suicide attempt. Alcohol users attempted a more lethal suicide attempt and were found to have problems with primary support group and occupational problem as precipitating stressor for suicide attempt. Alcohol use increases the suicide rate, in the specific rural Indian population.

Rehabilitation of cheatgrass-infested rangelands: applications and practices

USDA-ARS?s Scientific Manuscript database

The challenges that land owners and resource managers face when trying to attempt applications and practices when attempting to rehabilitate rangelands infested with cheatgrass (Bromus tectorum) are over-whelming. Simply purchasing seed and spreading it throughout the rangelands is doomed for failu...

Suspected placenta accreta and cesarean hysterectomy: observational cohort utilizing an intraoperative decision strategy.

PubMed

Weiniger, Carolyn F; Kabiri, Doron; Ginosar, Yehuda; Ezra, Yossef; Shachar, BatZion; Lyell, Deirdre J

2016-03-01

Planned cesarean hysterectomy (CH) is recommended to minimize morbidity for suspected placenta accreta (PA), yet this ends fertility. We examined CH frequency and post-operative morbidities for suspected PA cases when an intra-operative decision strategy to perform CH was used. Suspected PA cases were pre-operatively identified in one tertiary care center. Women were assessed intra-operatively, prior to uterine incision, for immediate CH or for attempted placental separation. We compared outcomes among women with versus without PA (surgical and/or pathologic diagnosis), and examined outcomes following immediate CH versus attempted placental separation. Our cohort, from 2002 to 2012, comprised 99 women with suspected PA; 54 (54.5%) had PA diagnosed by surgery/pathology, and 45 (45.5%) did not. Among women diagnoses surgically or pathologically with PA, CH was performed for 46/54 (85%); 8 women with suspected PA had successful placental separation. 27 of the 46 CH were performed immediately following uterine wall examination and 19 were performed following attempted placental separation. We received histological confirmation of the clinical placenta accreta diagnosis for 24/46 (52.2%) cases, and in 22/46 (47.8%) cases the histology did not confirm the clinical diagnosis. Surgery duration, packed cell transfusion requirement and postoperative outcomes were similar among women with PA regardless of immediate CH versus attempted placental separation, except for a higher cystotomy rates following attempted placental separation. Emergency deliveries were performed at significantly earlier gestational ages. Among women with suspected PA, an intra-operative CH decision allows some women to avoid CH. Consideration of attempted placental separation did not increase blood transfusion or post-operative complications, but was associated with a higher rate of cystotomy. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Corsair microcatheter for retrograde coronary chronic total occlusion recanalization: early experience outside the realm of dedicated recanalization specialists.

PubMed

Joseph, George; Thomson, Viji Samuel; Radhakrishnan, Shanmugasundaram

2012-01-01

To determine the extent to which use of the Corsair microcatheter (CM, Asahi Intecc Co., Japan) improves procedural outcomes when an experienced operator who is not a dedicated recanalization specialist attempts retrograde chronic total occlusion (CTO) recanalization through collateral channels during percutaneous coronary intervention. The recently introduced CM has improved success rates of retrograde CTO recanalization to nearly 100% in the hands of dedicated coronary recanalization specialists; however, the impact the CM has on the results of non-specialist operators attempting retrograde CTO recanalization is not known. A non-specialist operator attempted CM-assisted recanalization in seven consecutive CTO cases requiring retrograde recanalization. The results obtained were compared with those achieved by the same operator in eleven consecutive retrograde CTO recanalization procedures during the last 2 years before the CM became available. CM-assisted retrograde CTO recanalization was successful in 6 of 7 cases (86%), but failed in one case attempted through a tortuous epicardial collateral; there were no complications. In contrast, during the 2 years before the CM became available, retrograde CTO recanalization was successful in only 3 of 11 attempted cases (27%), and was associated with significant morbidity. Lesions in the two groups were comparable in terms of technical difficulty and procedural risk. The non-specialist operator's retrograde CTO recanalization results improve significantly when using the CM. Given the effectiveness and safety of CM-assisted retrograde CTO recanalization, operators should be less aggressive with anterograde recanalization attempts, and should switch to the retrograde approach earlier and more often. Copyright © 2012 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

[Cyberbullying and Suicidal Behavior: What is the Connection? About a Case].

PubMed

Escobar Echavarría, Juliana; Montoya González, Laura Elisa; Restrepo Bernal, Diana; Mejía Rodríguez, David

Social networks have increased in recent decades, and with them the bullying, causing difficulties in young people's mental health expressed through depressive symptoms, suicidal ideation and suicide attempts. Up next, we present a case that exemplifies this situation. To describe a case report that exemplifies this new outlook in young people and how it affects their mental health. Case report and non-systematic literature review. One case report, treated at a hospital in Medellin due to two suicide attempts related to social networks is presented. Currently, there are multiple social media resources, the advent of internet and smartphones is not only a strategy for improving social interactions, but it also contributes to impair mental health of some vulnerable young people. This case sensitize us, about the relationship between the growing social networking and cyberbullying as well as suicidal thoughts / attempts; thanks to this case and the available literature, we can't establish causality but we could deduce that the internet utter a increased risk for young people who are exposed and more vulnerable. Copyright © 2016 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

77 FR 39554 - Self-Regulatory Organizations; NYSE Arca, Inc.; Order Granting Approval of Proposed Rule Change...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-03

... investment objective by implementing a ``top-down'' portfolio management style. This management style begins...'' portfolio management style utilizes a tactical and globally diversified allocation strategy in an attempt to... open-end management investment company.\\4\\ The [[Page 39555

Time Management

ERIC Educational Resources Information Center

Stoilov, Todor, Ed.

2012-01-01

The time management is worthy goal of many human activities. It concerns variety problems related to goals definition, assessment of available resources, control of management policies, scheduling of decisions. This book is an attempt to illustrate the decision making process in time management for different success stories, which can be used as…

Cautious but committed: moving toward adaptive planning and operation strategies for renewable energy's wildlife implications.

PubMed

Köppel, Johann; Dahmen, Marie; Helfrich, Jennifer; Schuster, Eva; Bulling, Lea

2014-10-01

Wildlife planning for renewable energy must cope with the uncertainties of potential wildlife impacts. Unfortunately, the environmental policies which instigate renewable energy and those which protect wildlife are not coherently aligned-creating a green versus green dilemma. Thus, climate mitigation efforts trigger renewable energy development, but then face substantial barriers from biodiversity protection instruments and practices. This article briefly reviews wind energy and wildlife interactions, highlighting the lively debated effects on bats. Today, planning and siting of renewable energy are guided by the precautionary principle in an attempt to carefully address wildlife challenges. However, this planning attitude creates limitations as it struggles to negotiate the aforementioned green versus green dilemma. More adaptive planning and management strategies and practices hold the potential to reconcile these discrepancies to some degree. This adaptive approach is discussed using facets of case studies from policy, planning, siting, and operational stages of wind energy in Germany and the United States, with one case showing adaptive planning in action for solar energy as well. This article attempts to highlight the benefits of more adaptive approaches as well as the possible shortcomings, such as reduced planning security for renewable energy developers. In conclusion, these studies show that adaptive planning and operation strategies can be designed to supplement and enhance the precautionary principle in wildlife planning for green energy.

Cautious but Committed: Moving Toward Adaptive Planning and Operation Strategies for Renewable Energy's Wildlife Implications

NASA Astrophysics Data System (ADS)

Köppel, Johann; Dahmen, Marie; Helfrich, Jennifer; Schuster, Eva; Bulling, Lea

2014-10-01

Wildlife planning for renewable energy must cope with the uncertainties of potential wildlife impacts. Unfortunately, the environmental policies which instigate renewable energy and those which protect wildlife are not coherently aligned—creating a green versus green dilemma. Thus, climate mitigation efforts trigger renewable energy development, but then face substantial barriers from biodiversity protection instruments and practices. This article briefly reviews wind energy and wildlife interactions, highlighting the lively debated effects on bats. Today, planning and siting of renewable energy are guided by the precautionary principle in an attempt to carefully address wildlife challenges. However, this planning attitude creates limitations as it struggles to negotiate the aforementioned green versus green dilemma. More adaptive planning and management strategies and practices hold the potential to reconcile these discrepancies to some degree. This adaptive approach is discussed using facets of case studies from policy, planning, siting, and operational stages of wind energy in Germany and the United States, with one case showing adaptive planning in action for solar energy as well. This article attempts to highlight the benefits of more adaptive approaches as well as the possible shortcomings, such as reduced planning security for renewable energy developers. In conclusion, these studies show that adaptive planning and operation strategies can be designed to supplement and enhance the precautionary principle in wildlife planning for green energy.

Immediate open anterior reduction and antero-posterior fixation/fusion for bilateral cervical locked facets.

PubMed

Payer, M

2005-05-01

Bilateral cervical locked facets is a severe traumatic lesion, most frequently resulting in tetraplegia. The common treatment strategy has been an attempt of awake, closed reduction, adding general anesthesia, muscle relaxation and manual traction in difficult cases. In cases of failed closed reduction, open reduction has most commonly been performed by a posterior approach. Patients in the current series have been managed by immediate open anterior reduction and circumferential fixation/fusion. The technique is described and its potential advantages are discussed. Five consecutive patients with traumatic bilateral cervical locked facets are reported. The injury level was C4/5 in one and C5/6 in four patients. Four patients had initial tetraplegia, one patient was neurogically intact. All patients underwent immediate open anterior reduction by interbody distraction and gentle manual traction, followed by circumferential fixation/fusion. Mean follow-up was 15 months. Immediate anterior open reduction was rapidly and reliably achieved in all five patients. No surgical complication occurred. All patients showed fusion at the three-month follow-up. All four tetraplegic patients regained at least one functional root level, but remained tetraplegic. Immediate open anterior reduction of bilateral cervical locked facets and combined antero-posterior fixation/fusion was safe and reliable. This treatment strategy avoids time loss and patient discomfort from attempted closed reduction by traction, obviates the need for external immobilization, and results in an excellent fusion rate.

Intentional overdose with tinzaparin: management dilemmas.

PubMed

Balla, Iliana; Karafotias, Ioasaf; Christopoulos, Constantinos

2014-02-01

Low-molecular-weight heparin (LMWH) is increasingly being prescribed for prophylaxis and treatment of thromboembolic diseases. Despite the fact that its therapeutic use is considered to be safe, it can be complicated by major hemorrhage and, in contrast to unfractionated heparin, it can only partially be neutralized by protamine. Recent reports of LMWH overdose illustrate the need for a consensus on its management. To describe a case of self-poisoning with a very large dose of tinzaparin and discuss management options in patients with LMWH overdose. A 69-year-old woman was brought to the Emergency Department 2 h after injecting herself with 280,000 IU of tinzaparin subcutaneously in an attempt to commit suicide. Despite an unrecordable activated partial thromboplastin time (APTT > 180 s) and prolonged prothrombin time, there was no evidence of active bleeding. She was given an intravenous infusion of 100 mg protamine sulfate and was admitted to the intensive care unit, where further infusions of protamine were administered. Normalization of the APTT occurred 40-50 h post admission, reflecting normal tinzaparin clearance rather than neutralization by protamine. No hemorrhagic complications occurred during her hospitalization except for prolonged bleeding from venipuncture sites. In this case of massive tinzaparin overdose, conventional doses of protamine failed to rapidly normalize the deranged coagulation parameters. The favorable clinical outcome suggests that, regardless of the LMWH amount injected, no active treatment is needed in the absence of hemorrhage. This is in accordance with the limited published data concerning cases of overdose with other LMWHs. Copyright © 2014 Elsevier Inc. All rights reserved.

Technological Frame Incongruence, Diffusion, and Noncompliance

NASA Astrophysics Data System (ADS)

Sobreperez, Polly

The technological frames of reference strand of social shaping of technology theory is used to overlay the issues arising from a case study looking at noncompliance with information systems. A recent review of the theory suggests that although frame content is often addressed, frame structure, the process of framing, and the characteristics and outcomes of frames are largely overlooked. This paper attempts to address this shortfall by applying the indicators identified by case study research to the frames of different groups and using them to highlight differing perceptions and attitudes. In this way, the author suggests that issues surrounding noncompliance should not be dismissed as resistance but instead should be further studied by managers and developers, leading to accommodation of differing views. Further examination of frame incongruence reveals dependence on inefficient or ineffective organizational situations and thus these indicators can be useful in future studies to identify and address procedural, acceptance and cultural issues leading to acts of noncompliance.

Female children with ambiguous genitalia in awareness-poor subregion.

PubMed

Osifo, Osarumwense D; Amusan, Taiwo I

2009-12-01

Congenital aberrations of female children's external genitalia are common worldwide with varied mode of presentation especially in regions with poor awareness. This prospective experience between July 2004 and June 2008 at two Nigerian healthcare facilities is on the mode of presentation and challenges of management of female children with ambiguous genitalia. Congenital adrenal hyperplasia (CAH) 19 (47.5%), female pseudohermaphroditism 20 (50%) and vaginal atresia 1 (2.5%) manifested as aberrations of external genitalia of 40 female children who presented between the ages of 3 months and 16 years (average 9 years). Cultural influence, lack of awareness, inadequate examination of external genitalia at birth and lack of diagnostic facilities resulted in late presentation and diagnosis with all the cases of CAH and pseudohermaphroditism raised as males. Five cases who developed female secondary sexual characteristics at puberty attempted suicide before presentation. Gender reassignment and feminizing genitoplasty were major challenges, but outcomes were encouraging.

Traumatic aneurysms of the internal carotid artery at the base of the skull. Two cases treated surgically.

PubMed

Magnan, P E; Branchereau, A; Cannoni, M

1992-01-01

Internal carotid aneurysms at the base of the skull after blunt trauma are infrequent but their management is difficult, leading many surgeons to only attempt ligation. We report 2 cases presenting with high traumatic aneurysms, following motorcycle accidents. The 2 aneurysms underwent repair by a venous graft. The petrous portion of the carotid artery was approached and controlled by an ENT surgeon. This "infratemporal" approach was used exposing the facial nerve, combined with temporary anterior sub-luxation of the temporomaxillary joint to expose the lower part of the carotid canal which was opened up with a drill in order to control the carotid artery in the petrous canal. Both patients developed facial nerve palsies which improved within 3 months. Postoperative angiography showed patent vein grafts and the patients were doing well, without any symptoms 18 and 24 months later.

Fish hook injury: removal by ''push through and cut off'' technique: a case report and brief literature review.

PubMed

Ahmad Khan, Hayat; Kamal, Younis; Lone, Ansar Ul Haq

2014-04-01

Fishing is a leisure activity for some people around the world. Accidently the fish hook can get hooked in the hand. If the hook is barbed, removal becomes difficult. We report a case of such a injury in the hand and discuss the technique for its removal with a brief review of the literature. A thirty-two year old male accidently suffered a fishhook injury to his hand. He came to the orthopaedic ward two hours after the incident with pain; the fish hook was hanging from the hand. Unsuccessful attempts to remove it were made by his relatives. A push-through and cut-off technique was used for removal of barbed hook. Barbed hooks are to be removed atraumatically with controlled incision over properly anaesthetised skin. Proper wound management and prophylactic antibiotics suitable for treatment of Aeromonas species should be initiated to prevent complications.

Snake Envenomation Causing Distant Tracheal Myonecrosis

PubMed Central

Khimani, Amina; Mcnierney, Afton; Surani, Sara; Surani, Salim

2013-01-01

Snakebites are often believed to be poisonous. However, this is not always the case. In fact, each bite differs from snake to snake, depending on if the snake is poisonous and if there is envenomation. Venom in pit viper snakebites is often associated with local necrosis. The abundant literature selections and research articles justify local myonecrosis due to envenomation, but there is not much in the literature regarding myonecrosis at a site distant from the snakebite. We hereby present a case of a 42-year-old man who was transferred to our emergency department after a rattlesnake bit him twice. The patient, besides developing local myonecrosis at the site of the snakebite, developed necrosis of the scrotum as well as tracheal pressure myonecrosis at the site of the endotracheal tube balloon. In this review, we will attempt to discuss the myonecrosis pathophysiology and management related to the rattle snakebite. PMID:24083047

A dynamic case-based planning system for space station application

NASA Technical Reports Server (NTRS)

Oppacher, F.; Deugo, D.

1988-01-01

We are currently investigating the use of a case-based reasoning approach to develop a dynamic planning system. The dynamic planning system (DPS) is designed to perform resource management, i.e., to efficiently schedule tasks both with and without failed components. This approach deviates from related work on scheduling and on planning in AI in several aspects. In particular, an attempt is made to equip the planner with an ability to cope with a changing environment by dynamic replanning, to handle resource constraints and feedback, and to achieve some robustness and autonomy through plan learning by dynamic memory techniques. We briefly describe the proposed architecture of DPS and its four major components: the PLANNER, the plan EXECUTOR, the dynamic REPLANNER, and the plan EVALUATOR. The planner, which is implemented in Smalltalk, is being evaluated for use in connection with the Space Station Mobile Service System (MSS).

Endodontic management of middle mesial canal of the mandibular molar

PubMed Central

Sundaresh, K J; Srinivasan, Raghu; Mallikarjuna, Rachappa; Rajalbandi, Sandeep

2013-01-01

Thorough knowledge of root canal morphology and unusual anatomy of the tooth is critical for successful endodontic treatment. Although the most common configuration is two roots and three root canals, mandibular molars might have many different combinations. In the literature, it is less described about three mesial canals and two distal canals in mandibular second molars, indicating a rare anatomical configuration. A case of unusual root canal morphology is presented to demonstrate anatomical variations in mandibular molars. Endodontic therapy was performed in a mandibular second molar with five separate canals, three mesial and two distal. This report points out the importance of looking for additional canals and unusual canal morphology, because knowledge of their existence might occasionally enable clinicians to treat a case successfully that otherwise might have ended in failure. In conclusion, every attempt should be made to find and treat all root canals of a tooth. PMID:23349182

Successful replantation of 2 digits in a patient with thrombocytosis after splenectomy: A case report.

PubMed

Hwang, Jae Ha; Kim, Dong Wan; Kim, Kwang Seog; Lee, Sam Yong

2018-06-01

Thrombosis is the most common complication of thrombocytosis, which can be particularly damaging to reattached digits. We present a guideline about digital replantation when thrombocytosis is expected. We report a case of an 18-year-old man who sustained a traumatic amputation of two fingers and splenic rupture in a traffic accident. He underwent digital replantation the day after splenectomy when life-threatening conditions had been managed. The platelet count increased to over 1,300,000/mm and post-splenectomy reactive thrombocytosis was diagnosed. Hydroxyurea and anagrelide were administered to control the platelet count after consultation with a hematologist. The reattached fingers survived without any complication. In patients with digital amputation, replantation can be attempted, even when thrombocytosis is expected, when requested by the patient. Furthermore, the platelet count should be actively controlled with medication to improve the survival rate of the reattached finger.

Using standardized fishery data to inform rehabilitation efforts

USGS Publications Warehouse

Spurgeon, Jonathan J.; Stewart, Nathaniel T.; Pegg, Mark A.; Pope, Kevin L.; Porath, Mark T.

2016-01-01

Lakes and reservoirs progress through an aging process often accelerated by human activities, resulting in degradation or loss of ecosystem services. Resource managers thus attempt to slow or reverse the negative effects of aging using a myriad of rehabilitation strategies. Sustained monitoring programs to assess the efficacy of rehabilitation strategies are often limited; however, long-term standardized fishery surveys may be a valuable data source from which to begin evaluation. We present 3 case studies using standardized fishery survey data to assess rehabilitation efforts stemming from the Nebraska Aquatic Habitat Plan, a large-scale program with the mission to rehabilitate waterbodies within the state. The case studies highlight that biotic responses to rehabilitation efforts can be assessed, to an extent, using standardized fishery data; however, there were specific areas where minor increases in effort would clarify the effectiveness of rehabilitation techniques. Management of lakes and reservoirs can be streamlined by maximizing the utility of such datasets to work smarter, not harder. To facilitate such efforts, we stress collecting both biotic (e.g., fish lengths and weight) and abiotic (e.g., dissolved oxygen, pH, and turbidity) data during standardized fishery surveys and designing rehabilitation actions with an appropriate experimental design.

A Pilot Study in Cameroon to Understand Safe Uses of Pesticides in Agriculture, Risk Factors for Farmers’ Exposure and Management of Accidental Cases

PubMed Central

Pouokam, Guy Bertrand; Lemnyuy Album, William; Ndikontar, Alice S.; SIDATT, Mohamed El Hady

2017-01-01

Chemical pesticides are widely used in Cameroon for agricultural production. In 2015, more than 600 pesticide products were approved for use in various foodstuffs. Much misuse of these chemicals by farmers has been documented in rural and urban settings. This pilot study aims to contribute to the improvement of the health of the population and the environmental preservation by identifying pesticide-poisoning cases, the most incriminated products and critical risk factors of exposure. Questionnaires were administered to pesticide vendors, farmers and health personnel, and observations made on farmers’ practices at their work places. From July to September 2016, 24 villages from five sites, representing the most important agricultural production areas of the five agro-ecological zones of Cameroon, were visited. In total, 519 people were interviewed: 412 farmers, 69 pesticide vendors and 38 health personnel. A total of 180 pesticide formulations out of 610 registered in 2015 were said to be used by farmers. In the 38 health centers visited, 56 cases of pesticide poisonings and intoxications were reported between 2011 and 2016. Paraquat-, glyphosate-, cypermethrin- and metalaxyl-formulated pesticides were the most incriminated. In total, 78% of poisoning cases were accidental, 12% suicide attempts, 4% criminal. Entry of pesticide products from neighboring countries needs to be better regulated, and the quality of pesticides sold on the market should be monitored periodically. Empty pesticide containers should be recuperated from smallholder farmers. Authorities should set up a harmonized pesticide-poisoning management procedure, and create a toxico-vigilance system for surveillance cases and preventive actions. PMID:29104250

[Evaluation of therapeutic strategies for myocardial infarction: the ESTIM Midi-Pyrénées survey].

PubMed

Charpentier, S; Celse, D; Cambou, J P; Lauque, D; Carrie, D; Galinier, M; Baïxas, C; Ducassé, J L; Puel, J

2005-11-01

The aim of the ESTIM Midi-Pyrénées survey was to monitor the management of acute coronary syndrome with ST segment elevation by cardiologists and emergency departments in the Midi-Pyrénées region. Over a period of 2 years between June 2001 and June 2003, 1287 patients presenting with acute coronary syndrome within the first 24 hours were recruited prospectively. The initial management of these patients was undertaken either by a mobile medical team in the pre-hospital phase, or in a hospital emergency department, non-interventional cardiology department or an interventional cardiology department in 51.8%, 28.8%, 9.6% et 9.9% of cases respectively. Depending on these four modes of initial management, the median time for initial management was 1h30, 2h45, 4h30 et 4h respectively. Emergency coronary reperfusion was proposed in 89.6% of cases. Of the patients in whom reperfusion was attempted within the first 12 hours, 33.7% underwent pre-hospital thrombolysis (median delay of 1h48), 35.8% underwent thrombolysis in hospital (median delay 3h), and 30.4% underwent primary angioplasty (median delay 4h40). Thrombolysis was followed by angioplasty in 80% of cases. A combined approach with thrombolysis and angioplasty was applied in 41% of patients. At one month the rate of major cardiac events, death, and/or subsequent myocardial infarction was 12%. Multivariate analysis revealed that the only significant adverse prognostic features were: not offering reperfusion [Odds ratio (OR) 4, confidence interval (CI) 2.3-3.7] and age [OR 3.8, CI 2.3-6.2]. The method of reperfusion did not influence the subsequent outcome in this regional survey. pre-hospital management allows early revascularisation. In our region there was no significant prognostic difference between pre-hospital thrombolysis and primary angioplasty. It shows that the logistic and therapeutic potentials of prehospital care are not being sufficiently exploited.

5 CFR 835.604 - Reasonable attempt to notify.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Reasonable attempt to notify. 835.604 Section 835.604 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) DEBT COLLECTION Collection of Debts by Federal Tax Refund Offset § 835.604 Reasonable...

Academic Information Management--A New Synthesis.

ERIC Educational Resources Information Center

Drummond, Marshall Edward

The design concept and initial development phases of academic information management (AIM) are discussed. The AIM concept is an attempt to serve three segments of academic management with data and models to support decision making. AIM is concerned with management and evaluation of instructional computing in areas other than direct computing (data…

Management Communication Training: The Need for Long-Term Effectiveness Studies.

ERIC Educational Resources Information Center

Mattox, Robert J.; Smith, Robert L.

Currently, training programs for management are an integral part of most organizations. One of the concerns about training programs has been the lack of research supporting change in management training. Recently, counselors have become involved in Human Resources Management (HRM). Organizations have been criticized for making few attempts to…

Case Report: Use of reinforced buccal mucosa graft over gracilis muscle flap in management of post high intensity focused ultrasound (HIFU) rectourethral fistula.

PubMed

Jai, Shrikant; Ganpule, Arvind; Singh, Abhishek; Vijaykumar, Mohankumar; Bopaiah, Vinod; Sabnis, Ravindra; Desai, Mahesh

2016-01-01

High intensity focused ultrasound (HIFU) has come forward as alternative treatment for carcinoma of the prostate. Though minimally invasive,HIFUhas potential side effects. Urethrorectal fistula is one such rare side effect. Management of these fistulas has been described by Vanni et al. This case report describes points of technique that will help successful management of resilient rectourethral fistula. Urinary and faecal diversion in the form of suprapubic catheter and colostomy is vital. Adequate time between stoma formation, fistula closure and then finally stoma closure is needed. Lithotomy position and perineal approach gives best exposure to the fistula. The rectum should be dissected 2cm above the fistula; this aids in tension free closure of the rectal defect. Similarly buccal mucosal graft was used on the urethra to achieve tension free closure. A good vascular pedicle gracilis muscle flap is used to interpose between the two repairs. This not only provides a physical barrier but also provides a vascular bed for BMG uptake. Perfect haemostasis is essential, as any collection may become a site of infection thus compromising results.  We strongly recommend rectourethral fistula be directly repaired with gracilis muscle flap with reinforced buccal mucosa graft without attempting any less invasive repairs because the "first chance is the best chance".

Case Report: Use of reinforced buccal mucosa graft over gracilis muscle flap in management of post high intensity focused ultrasound (HIFU) rectourethral fistula

PubMed Central

Jai, Shrikant; Ganpule, Arvind; Singh, Abhishek; Vijaykumar, Mohankumar; Bopaiah, Vinod; Sabnis, Ravindra; Desai, Mahesh

2017-01-01

High intensity focused ultrasound (HIFU) has come forward as alternative treatment for carcinoma of the prostate. Though minimally invasive,HIFUhas potential side effects. Urethrorectal fistula is one such rare side effect. Management of these fistulas has been described by Vanni et al. This case report describes points of technique that will help successful management of resilient rectourethral fistula. Urinary and faecal diversion in the form of suprapubic catheter and colostomy is vital. Adequate time between stoma formation, fistula closure and then finally stoma closure is needed. Lithotomy position and perineal approach gives best exposure to the fistula. The rectum should be dissected 2cm above the fistula; this aids in tension free closure of the rectal defect. Similarly buccal mucosal graft was used on the urethra to achieve tension free closure. A good vascular pedicle gracilis muscle flap is used to interpose between the two repairs. This not only provides a physical barrier but also provides a vascular bed for BMG uptake. Perfect haemostasis is essential, as any collection may become a site of infection thus compromising results.  We strongly recommend rectourethral fistula be directly repaired with gracilis muscle flap with reinforced buccal mucosa graft without attempting any less invasive repairs because the “first chance is the best chance”. PMID:28299181

Managing Conflict for Productive Results: A Critical Leadership Skill.

ERIC Educational Resources Information Center

Simerly, Robert G.

1998-01-01

Describes sources of conflict in organizations and five effective management strategies: identify points of view, let parties articulate what they want, buy time, attempt negotiation, and ask parties to agree to arbitration. Provides a conflict management analysis sheet. (SK)

Care of the suicidal pediatric patient in the ED: a case study.

PubMed

Schmid, Alexis M; Truog, Amy W; Damian, Frances J

2011-09-01

The suicide rate among children and adolescents has increased worldwide over the past few decades, and many who attempt suicide are first seen at EDs. At Childrens Hospital Boston (CHB), an algorithm-the Risk of Suicidality Clinical Practice Algorithm-has been developed to ensure evidence-based care supported by best practice guidelines. The authors of this article provide an overview of pediatric suicide and suicide attempts; describe screening, assessment, and interventions used at CHB; and discuss the nursing implications. An illustrative case study is also provided. algorithm, Asperger's syndrome, attempted suicide, bullying, emergency, emergency department, patient safety, pediatrics, pediatric suicide, suicide, suicide screening, triage.

Causality discovery technology

NASA Astrophysics Data System (ADS)

Chen, M.; Ertl, T.; Jirotka, M.; Trefethen, A.; Schmidt, A.; Coecke, B.; Bañares-Alcántara, R.

2012-11-01

Causality is the fabric of our dynamic world. We all make frequent attempts to reason causation relationships of everyday events (e.g., what was the cause of my headache, or what has upset Alice?). We attempt to manage causality all the time through planning and scheduling. The greatest scientific discoveries are usually about causality (e.g., Newton found the cause for an apple to fall, and Darwin discovered natural selection). Meanwhile, we continue to seek a comprehensive understanding about the causes of numerous complex phenomena, such as social divisions, economic crisis, global warming, home-grown terrorism, etc. Humans analyse and reason causality based on observation, experimentation and acquired a priori knowledge. Today's technologies enable us to make observations and carry out experiments in an unprecedented scale that has created data mountains everywhere. Whereas there are exciting opportunities to discover new causation relationships, there are also unparalleled challenges to benefit from such data mountains. In this article, we present a case for developing a new piece of ICT, called Causality Discovery Technology. We reason about the necessity, feasibility and potential impact of such a technology.

Transnational organizing: Issue professionals in environmental sustainability networks.

PubMed

Henriksen, Lasse Folke; Seabrooke, Leonard

2016-09-01

An ongoing question for institutional theory is how organizing occurs transnationally, where institution building occurs in a highly ambiguous environment. This article suggests that at the core of transnational organizing is competition and coordination within professional and organizational networks over who controls issues. Transnational issues are commonly organized through professional battles over how issues are treated and what tasks are involved. These professional struggles are often more important than what organization has a formal mandate over an issue. We highlight how 'issue professionals' operate in two-level professional and organizational networks to control issues. This two-level network provides the context for action in which professionals do their institutional work. The two-level network carries information about professional incentives and also norms about how issues should be treated and governed by organizations. Using network and career sequences methods, we provide a case of transnational organizing through professionals who attempt issue control and network management on transnational environmental sustainability certification. The article questions how transnational organizing happens, and how we can best identify attempts at issue control.

Transnational organizing: Issue professionals in environmental sustainability networks

PubMed Central

Henriksen, Lasse Folke; Seabrooke, Leonard

2015-01-01

An ongoing question for institutional theory is how organizing occurs transnationally, where institution building occurs in a highly ambiguous environment. This article suggests that at the core of transnational organizing is competition and coordination within professional and organizational networks over who controls issues. Transnational issues are commonly organized through professional battles over how issues are treated and what tasks are involved. These professional struggles are often more important than what organization has a formal mandate over an issue. We highlight how ‘issue professionals’ operate in two-level professional and organizational networks to control issues. This two-level network provides the context for action in which professionals do their institutional work. The two-level network carries information about professional incentives and also norms about how issues should be treated and governed by organizations. Using network and career sequences methods, we provide a case of transnational organizing through professionals who attempt issue control and network management on transnational environmental sustainability certification. The article questions how transnational organizing happens, and how we can best identify attempts at issue control. PMID:28490973

Interventional Management of “Balloon-Uncrossable” Coronary Chronic Total Occlusion: Is There Any Way Out?

PubMed Central

2018-01-01

It has been estimated that coronary chronic total occlusion (CTO) is encountered in 15 to 20% patients referred for coronary angiography (CAG). The success of percutaneous coronary intervention (PCI) of CTO can be attributed to the vast array of hardware that has now become available and also to the vastly enhanced operator expertise. It is however realistic to state that despite the tremendous increase in the rate of success, there then comes a subset of CTO where PCI attempts fail. The reason for such failures given that other variables remain constant is the inability to cross the CTO lesion. This can be due to a failure to cross the lesion with a guide wire (despite guide wire escalation). The second cause of failure is the inability to cross the lesion with a balloon (balloon-uncrossable [BU] CTO). This can occur despite the successful placement of a guidewire in the distal true lumen. The BU lesions contribute 2% to 10% of CTO PCI failure cases. The author attempts to present a creative solution to assist crossing such lesions. PMID:29625510

Collectives for Multiple Resource Job Scheduling Across Heterogeneous Servers

NASA Technical Reports Server (NTRS)

Tumer, K.; Lawson, J.

2003-01-01

Efficient management of large-scale, distributed data storage and processing systems is a major challenge for many computational applications. Many of these systems are characterized by multi-resource tasks processed across a heterogeneous network. Conventional approaches, such as load balancing, work well for centralized, single resource problems, but breakdown in the more general case. In addition, most approaches are often based on heuristics which do not directly attempt to optimize the world utility. In this paper, we propose an agent based control system using the theory of collectives. We configure the servers of our network with agents who make local job scheduling decisions. These decisions are based on local goals which are constructed to be aligned with the objective of optimizing the overall efficiency of the system. We demonstrate that multi-agent systems in which all the agents attempt to optimize the same global utility function (team game) only marginally outperform conventional load balancing. On the other hand, agents configured using collectives outperform both team games and load balancing (by up to four times for the latter), despite their distributed nature and their limited access to information.

[Morbidity-mortality review in psychiatry: suicide or suicide attempts].

PubMed

Thomas, A; Combalbert, N; Fay, J; Paquis, J

2010-06-01

Further to the occurrence of three cases of suicide attempts or suicides within a few months, a psychiatric team introduced a method of evaluation of the professional practices on this subject. The objective aimed by the team was to collectively identify the risk factors of the acting out and the strategies to prevent it. The analysis and the treatment of unwanted events require an approach per problem. Because of the obligation for the doctors to perform an evaluation of their professional practices, a proposition to use a method presented by the High Authority of Health was looked for. Considering the necessity of favoring the exchanges between team members, the articulation of two methods was proposed: a morbidity mortality review (MMR) and an analysis of the detailed causes. The objective of the MMR is to analyze the deaths of certain predetermined morbid accidents within a service. The aim of the MMR is to highlight actions for improvement. The analysis of the causes allows the professionals to list all the causes of the problem identified, without limiting themselves to the immediate causes. In this case, a simple method was chosen: the Ishikawa diagram (or fishbone diagram, or also cause-and-effect diagram). A specific Ishikawa diagram for suicide was created by the coordinating physician and was proposed to the team. In the term of the first MMR, the tool was improved by the collective clinical experience and served as support of analysis for the studied events. Three cases related to the evaluation were prepared beforehand by the referent doctor and later presented by him in MMR sessions. For each case, approximately a dozen of professionals were invited to fill in the biography of the patient. A discussion was then engaged by the external doctor on the circumstances of self injuries or suicide attempts. The three detailed analyses of cases were transcribed into a virgin Ishikawa diagram. Furthermore, several points were discussed on the safety aspects (diversion of the possessions with suicidal aim, and importance of the "almost incident") and on the interest in exchanging on the current and\\or local professional practices (exchange on tools possibly used in the other psychiatric health establishments; favor the training). The actions of improvement put in perspective mainly concerned the professional practices. In this particular case, the awareness of professional knowledge was the most sought by the ancillary medical members of the team. We observed an important investment of the team, as far as the MMR bases are concerned, on a shared clinical method. The participants easily got to grips with the tool. The initiation with the MMR tool was time consuming, in particular for the doctor coordinating the project and the referent doctor of the department (30 hours). The exchanges also permitted the assessment of the competence of each professional present, and the common priorities were fast identified and focused on sharing the professional practices. The intervention of an external speaker (doctor, qualitician or other) seems important since it favors the emergence of questionings in the team. When faced with unwanted events such as suicides or suicide attempts, the MMR method allows the care teams to have time to ponder, listen and argument. What is learnt from dealing with unexpected events should enable the collective development of the capacity to react with the right reflexes when a surprising situation occurs. The RMM should find a place in the systems of clinical risk management, as a supplement to the declaration of the incidence. The results make it possible to anticipate on the use of the MMR in other thematic studies or issues of risk management. Copyright (c) 2009 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Non-surgical and non-chemical attempts to treat echinococcosis: do they work?

PubMed Central

Tamarozzi, Francesca; Vuitton, Lucine; Brunetti, Enrico; Vuitton, Dominique Angèle; Koch, Stéphane

2014-01-01

Cystic echinococcosis (CE) and alveolar echinococcosis (AE) are chronic, complex and neglected diseases. Their treatment depends on a number of factors related to the lesion, setting and patient. We performed a literature review of curative or palliative non-surgical, non-chemical interventions in CE and AE. In CE, some of these techniques, like radiofrequency thermal ablation (RFA), were shelved after initial attempts, while others, such as High-Intensity Focused Ultrasound, appear promising but are still in a pre-clinical phase. In AE, RFA has never been tested, however, radiotherapy or heavy-ion therapies have been attempted in experimental models. Still, application to humans is questionable. In CE, although prospective clinical studies are still lacking, therapeutic, non-surgical drainage techniques, such as PAIR (puncture, aspiration, injection, re-aspiration) and its derivatives, are now considered a useful option in selected cases. Finally, palliative, non-surgical drainage techniques such as US- or CT-guided percutaneous biliary drainage, centro-parasitic abscesses drainage, or vascular stenting were performed successfully. Recently, endoscopic retrograde cholangiopancreatography (ERCP)-associated techniques have become increasingly used to manage biliary fistulas in CE and biliary obstructions in AE. Development of pre-clinical animal models would allow testing for AE techniques developed for other indications, e.g. cancer. Prospective trials are required to determine the best use of PAIR, and associated procedures, and the indications and techniques of palliative drainage. PMID:25531730

Deliberating death.

PubMed

Landes, Scott D

2010-01-01

Utilizing a particular case study of a woman attempting to come to terms with her death, this article explores the difficult metaphors of death present within the Christian tradition. Tracing a Christian understanding of death back to the work of Augustine, the case study is utilized to highlight the difficulties presented by past and present theology embracing ideas of punishment within death. Following the trajectory of the case study, alternative understandings of death present in recent Christian theology and within Native American spirituality are presented in an attempt to find room for a fuller meaning of death post-reconciliation, but premortem.

Incorporating plant mortality and recruitment into rangeland management and assessment

Treesearch

Tony Svejcar; Jeremy James; Stuart Hardegree; Roger Sheley

2014-01-01

Rangeland management is largely focused on managing vegetation change. Objectives may include managing against change if the desired vegetation is in place, or attempting to create a shift in vegetation if the desired plant community is not present. There is a rich body of research documenting influences of disturbance and management on rangeland vegetation. However,...

How to reduce turnover by creating a positive work climate.

PubMed

Kushell, R E

1979-08-01

Despite company attempts to reduce employee turnover by offering attractive salaries and benefits, Kushell notes that attrition continues at an alarming rate. He states that more than one of every three employees will change jobs over the next five years, a transition that will take its toll on company morale and productivity. The underlying factor, according to the author, is the quality of the working environment. A 1969 University of Michigan survey of 1,533 workers, at every occupation level, reported that all respondents ranked interesting work and authority to get the job done far ahead of good pay and job security. Sources of employee frustration include a stifling bureaucracy, excessive job expectations, and unsuitable jobs. The author suggests that top managers ask themselves whether they are missing out on or losing talented employees. If this is the case, there are several guidelines management should follow: improve communication between employees and top management; define expectations of the employee; and promote candor in the job interview. Kushell concludes that top executives can have an impact on turnover by paying attention to what employees really want rather than what management thinks they want.

Suicide risk assessment practices: a national survey of generalist drug and alcohol residential rehabilitation services.

PubMed

Ross, Joanne; Darke, Shane; Kelly, Erin; Hetherington, Kate

2012-09-01

Clients of drug and alcohol treatment services represent a high-risk group for attempted and completed suicide. The current study sought to examine suicide risk assessment practices in Australian generalist residential rehabilitation services. Semistructured interviews were conducted with managers of residential rehabilitation services and with volunteers from staff responsible for the case management/treatment of clients. Ninety per cent of services participated. In total, 64 managers and 142 staff were interviewed. One-third of services had no documented policy for the assessment and management of suicide risk, and one-quarter of staff had never received formal training in risk assessment. In more than one-third of agencies staff were not expected to use a structured suicide risk assessment tool when assessing a client's acute risk. To varying degrees agencies were gathering information about psychiatric comorbidity, but this information did not appear to be routinely integrated into the client's suicide risk assessment. The development of clearly documented polices, standardised assessment tools and the provision of annual training for all staff would help to address some of the gaps identified in current practice. © 2012 Australasian Professional Society on Alcohol and other Drugs.

Public health response to striking solid waste management.

PubMed

Murti, Michelle; Ayre, Reg; Shapiro, Howard; de Burger, Ron

2011-10-01

In 2009, the City of Toronto, Ontario, Canada, experienced a six-week labor disruption involving 24,000 city workers that included solid waste and public health employees. In an attempt to control illegal dumping and to manage garbage storage across the city during this period, 24 temporary garbage storage sites were established by the city (mostly in local parks) for residents to dispose of their household waste. No other municipality in North America has attempted to operate this many temporary sites for this long a period. Management and nonunion staff from Healthy Environments in Toronto Public Health performed daily inspections, responded to community questions, issued public health orders, and worked closely with Solid Waste Management and the Ministry of the Environment to actively manage the public health concerns associated with these sites. This intensive oversight mitigated public health risks to the community and facilitated an effective, safe solution to the temporary garbage storage problem.

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

Duodenal perforation following esophagogastroduodenoscopy (EGD) with cautery and epinephrine injection for peptic ulcer disease: An interesting case of nonoperative management in the medical intensive care unit (MICU).

PubMed

Chertoff, Jason; Khullar, Vikas; Burke, Lucas

2015-01-01

The utilization of esophagogastroduodenoscopy (EGD) and related procedures continues to rise. Due to this increase in utilization is an inevitable rise in serious complications such as hemorrhage and perforation. One understudied and dreaded complication of EGD causing significant morbidity and mortality is duodenal perforation. We present the case of a 63-year-old male who presented to our institution's emergency room with dyspepsia, melanic stools, tachycardia, and hypotension. Initial laboratory evaluation was significant for severe anemia, lactic acidosis, and acute kidney injury, while CT scan of the abdomen pelvis did not suggest retroperitoneal hematoma or bowel perforation. An emergent EGD was performed which showed multiple bleeding duodenal ulcers that were cauterized and injected with epinephrine. Post-procedure the patient developed worsening abdominal pain, distension, diaphoresis, and tachypnea, requiring emergent intubation. A CT scan of the abdomen and pelvis with oral contrast confirmed pneumoperitoneum and duodenal perforation. Due to the patient's hemodynamic instability and multiple comorbidities, he was treated non-operatively with strict bowel rest and intravenous antibiotics. The patient ultimately had a 19-day hospital course complicated by renal failure requiring hemodialysis and an ischemic limb necessitating above knee amputation. This case describes an unsuccessful attempt at nonoperative management of duodenal perforation following EGD. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

[Abortion using a bicycle pump on the mistress and unusual suicide of a blind man].

PubMed

Holzer, F J

1973-01-01

In Tyrol a case of fatal air embolism after an abortion attempt with a bicycle pump, performed by a blind man who later committed suicide, is described. The bicycle tube was inserted into the vagina and air and a soapy solution were pumped in. Autopsies revealed internal bleeding, gas embolisms in the veins of the ovaries and heart, a bloody foamy liquid in the lungs, and an intact 14 cm male fetus. 3 similar cases of fatal air embolisms after abortion attempts with bicycle pumps are described. In 1 case a soapy solution had been injected. Abortion attempts with a pipe and a rubber catheter, reported here, also resulted in rapidly fatal air embolisms. In 1 case death occurred a few seconds after a partner blew air with his mouth into his pregnant mistress' vagina. It is concluded that under some conditions filling the vagina with air (tightly) can cause fatal air embolisms.

An Information-Processing Model of Crisis Management.

ERIC Educational Resources Information Center

Egelhoff, William G.; Sen, Falguni

1992-01-01

Develops a contingency model for managing a variety of corporate crises. Views crisis management as an information-processing situation and organizations that must cope with crisis as information-processing systems. Attempts to fit appropriate information-processing mechanisms to different categories of crises. (PRA)

Attempted Serial Neonaticides: Case Report and a Brief Review of the Literature.

PubMed

Barros, Alcina Juliana Soares; Rosa, Regis Goulart; Telles, Lisieux Elaine de Borba; Taborda, José Geraldo Vernet

2016-01-01

Neonaticide is an infant murder occurring on the day of birth. The case reports found in the literature are often focused on the mother as the agent in the context of pregnancy denial, dissociative symptoms, or psychosis. However, this report describes a rare case of attempted serial neonaticides, in which the acts were committed by a nurse at the nursery of a referral hospital in Brazil. The authors describe a forensic psychiatric evaluation for criminal responsibility and correlate the information from this particular case with relevant forensic themes, namely neonaticide, Munchausen by proxy syndrome, and serial healthcare killers. © 2015 American Academy of Forensic Sciences.

Effects of Botulinum Toxin on Reducing the Co-contraction of Antagonists in Birth Brachial Plexus Palsy

PubMed Central

Shin, Yong Beom; Chang, Jae Hyeok; Cha, Young Sun; Ko, Hyun-Yoon

2014-01-01

Birth brachial plexus palsy (BBPP) is usually caused by plexus traction during difficult delivery. Although the possibility of complete recovery is relatively high, 5% to 25% of BBPP cases result in prolonged and persistent disability. In particular, muscle imbalance and co-contraction around the shoulder and elbow cause abnormal motor performance, osseous deformities, and joint contracture. Physical and occupational therapies have most commonly been used, but these conventional therapeutic strategies have often been inadequate, in managing the residual muscle imbalance and muscle co-contraction. Therefore, we attempted to improve the functional movements, by using botulinum toxin type A, to reduce the abnormal co-contraction of the antagonist muscles. PMID:24639937

Adoption of Requirements Engineering Practices in Malaysian Software Development Companies

NASA Astrophysics Data System (ADS)

Solemon, Badariah; Sahibuddin, Shamsul; Ghani, Abdul Azim Abd

This paper presents exploratory survey results on Requirements Engineering (RE) practices of some software development companies in Malaysia. The survey attempted to identify patterns of RE practices the companies are implementing. Information required for the survey was obtained through a survey, mailed self-administered questionnaires distributed to project managers and software developers who are working at software development companies operated across the country. The results showed that the overall adoption of the RE practices in these companies is strong. However, the results also indicated that fewer companies in the survey have use appropriate CASE tools or software to support their RE process and practices, define traceability policies and maintain traceability manual in their projects.

Combining Bayesian Networks and Agent Based Modeling to develop a decision-support model in Vietnam

NASA Astrophysics Data System (ADS)

Nong, Bao Anh; Ertsen, Maurits; Schoups, Gerrit

2016-04-01

Complexity and uncertainty in natural resources management have been focus themes in recent years. Within these debates, with the aim to define an approach feasible for water management practice, we are developing an integrated conceptual modeling framework for simulating decision-making processes of citizens, in our case in the Day river area, Vietnam. The model combines Bayesian Networks (BNs) and Agent-Based Modeling (ABM). BNs are able to combine both qualitative data from consultants / experts / stakeholders, and quantitative data from observations on different phenomena or outcomes from other models. Further strengths of BNs are that the relationship between variables in the system is presented in a graphical interface, and that components of uncertainty are explicitly related to their probabilistic dependencies. A disadvantage is that BNs cannot easily identify the feedback of agents in the system once changes appear. Hence, ABM was adopted to represent the reaction among stakeholders under changes. The modeling framework is developed as an attempt to gain better understanding about citizen's behavior and factors influencing their decisions in order to reduce uncertainty in the implementation of water management policy.

Role of mathematical models in assessment of risk and in attempts to define management strategy.

PubMed

Flamm, W G; Winbush, J S

1984-06-01

Risk assessment of food-borne carcinogens is becoming a common practice at FDA. Actual risk is not being estimated, only the upper limit of risk. The risk assessment process involves a large number of steps and assumptions, many of which affect the numerical value estimated. The mathematical model which is to be applied is only one of the factors which affect these numerical values. To fulfill the policy objective of using the "worst plausible case" in estimating the upper limit of risk, recognition needs to be given to a proper balancing of assumptions and decisions. Interaction between risk assessors and risk managers should avoid making or giving the appearance of making specific technical decisions such as the choice of the mathematical model. The importance of this emerging field is too great to jeopardize it by inappropriately mixing scientific judgments with policy judgments. The risk manager should understand fully the points and range of uncertainty involved in arriving at the estimates of risk which must necessarily affect the choice of the policy or regulatory options available.

A new atraumatic method of removing fractured palatal root using endodontic H-files luted with resin modified glass ionomercement: A pilot study.

PubMed

Kannan, V Sadesh; Narayanan, G R Sathya; Ahamed, A Saneem; Velavan, K; Elavarasi, E; Danavel, C

2014-07-01

The purpose of this study is to evaluate the efficacy of using endodontic H-files luted with Resin modified glass ionomer cement (RMGIC) in removing fractured palatal root. This study consists of 30 patients, of which 16 were males and 14 were females with a mean age of 36 years. In which, 19 were maxillary first molar and 11 were maxillary second molar. In that, 18 were fractured at the level of apical 1/3(rd) and 12 were at the level of apical 2/3(rd). All cases were first tried with endodontic H-files, within few attempts, it was wedged tightly in the remaining pulp chamber with one or two clockwise direction and using sudden jerk with a downward pull the remnant part was removed. The cases, which fail to deliver after several attempts were taken up for study. After sufficient isolation with a rubber dam and the socket was dried using sterile gauze, under good lighting and vision again the same file was introduced, which was now luted with RMGIC, after 5 min of setting time, the same attempt using sudden jerk with a downward pull was given. In those 30 cases, 20 cases were removed in the first few attempts using endodontic H-files. The 10 cases (7 cases were apical 2/3(rd) and 3 cases were of apical 1/3(rd)), which fails to come out were tried using endodontic H-files luted with RMGIC, in which 9 cases were successfully removed (90%) and 1 case of apical 1/3(rd) was again failed to come out. Even though, the number of cases were too small to come to a definitive conclusion, the encouraging result (90%) and technically easy, this is a novel method of removing fractured palatal root atraumatically and devoid of any complication.

A new atraumatic method of removing fractured palatal root using endodontic H-files luted with resin modified glass ionomercement: A pilot study

PubMed Central

Kannan, V. Sadesh; Narayanan, G. R. Sathya; Ahamed, A. Saneem; Velavan, K.; Elavarasi, E.; Danavel, C.

2014-01-01

Purpose: The purpose of this study is to evaluate the efficacy of using endodontic H-files luted with Resin modified glass ionomer cement (RMGIC) in removing fractured palatal root. Materials and Methods: This study consists of 30 patients, of which 16 were males and 14 were females with a mean age of 36 years. In which, 19 were maxillary first molar and 11 were maxillary second molar. In that, 18 were fractured at the level of apical 1/3rd and 12 were at the level of apical 2/3rd. All cases were first tried with endodontic H-files, within few attempts, it was wedged tightly in the remaining pulp chamber with one or two clockwise direction and using sudden jerk with a downward pull the remnant part was removed. The cases, which fail to deliver after several attempts were taken up for study. After sufficient isolation with a rubber dam and the socket was dried using sterile gauze, under good lighting and vision again the same file was introduced, which was now luted with RMGIC, after 5 min of setting time, the same attempt using sudden jerk with a downward pull was given. Results: In those 30 cases, 20 cases were removed in the first few attempts using endodontic H-files. The 10 cases (7 cases were apical 2/3rd and 3 cases were of apical 1/3rd), which fails to come out were tried using endodontic H-files luted with RMGIC, in which 9 cases were successfully removed (90%) and 1 case of apical 1/3rd was again failed to come out. Conclusion: Even though, the number of cases were too small to come to a definitive conclusion, the encouraging result (90%) and technically easy, this is a novel method of removing fractured palatal root atraumatically and devoid of any complication. PMID:25210360

Young People's Risk of Suicide Attempts after Contact with a Psychiatric Department--A Nested Case-Control Design Using Danish Register Data

ERIC Educational Resources Information Center

Christiansen, Erik; Larsen, Kim Juul

2012-01-01

Background: There seems to be an increased risk of children and adolescents committing or attempting suicide after contact with a psychiatric department. Children and adolescents living in families with low socio-economic status (SES) might have an especially increased suicide attempt risk. Methods: A complete extraction of Danish register data…

Managing for climate change on protected areas: An adaptive management decision making framework.

PubMed

Tanner-McAllister, Sherri L; Rhodes, Jonathan; Hockings, Marc

2017-12-15

Current protected area management is becoming more challenging with advancing climate change and current park management techniques may not be adequate to adapt for effective management into the future. The framework presented here provides an adaptive management decision making process to assist protected area managers with adapting on-park management to climate change. The framework sets out a 4 step process. One, a good understanding of the park's context within climate change. Secondly, a thorough understanding of the park management systems including governance, planning and management systems. Thirdly, a series of management options set out as an accept/prevent change style structure, including a systematic assessment of those options. The adaptive approaches are defined as acceptance of anthropogenic climate change impact and attempt to adapt to a new climatic environment or prevention of change and attempt to maintain current systems under new climatic variations. Last, implementation and monitoring of long term trends in response to ecological responses to management interventions and assessing management effectiveness. The framework addresses many issues currently with park management in dealing with climate change including the considerable amount of research focussing on 'off-reserve' strategies, and threats and stress focused in situ park management. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Role of Transcutaneous Electrical Nerve Stimulation in the Management of Temporomandibular Joint Disorder.

PubMed

Awan, Kamran Habib; Patil, Shankargouda

2015-12-01

Temporomandibular joint disorders (TMD) constitutes of a group of diseases that functionally affect the masticatory system, including the muscles of mastication and temporomandibular joint (TMJ). A number of etiologies with specific treatment have been identified, including the transcutaneous electrical nerve stimulation (TENS). The current paper presents a literature review on the use of TENS in the management of TMD patients. Temporomandibular joint disorder is very common disorder with approximately 75% of people showing some signs, while more than quarter (33%) having at least one symptom. An attempt to treat the pain should be made whenever possible. However, in cases with no defined etiology, starting with less intrusive and reversible techniques is prescribed. Transcutaneous electrical nerve stimulation is one such treatment modality, i.e. useful in the management of TMD. It comprises of controlled exposure of electrical current to the surface of skin, causing hyperactive muscles relaxation and decrease pain. Although the value of TENS to manage chronic pain in TMD patients is still controversial, its role in utilization for masticatory muscle pain is significant. However, an accurate diagnosis is essential to minimize its insufficient use. Well-controlled randomized trials are needed to determine the utilization of TENS in the management of TMD patients.

Endoscopic sphenopalatine artery ligation for acute idiopathic epistaxis. Do anatomical variation and a limited evidence base raise questions regarding its place in management?

PubMed

Ellinas, A; Jervis, P; Kenyon, G; Flood, L M

2017-04-01

Endoscopic sphenopalatine artery ligation is widely accepted as effective and safe for acute spontaneous epistaxis that is unresponsive to conservative management. As with many new procedures, it has been progressively adopted as common practice, despite a limited evidence base for its efficacy. Early reviews called for comparative trials to support its adoption, but subsequent literature largely consists of case series and narrative reviews. These have attempted to derive an algorithm to establish its place in management, but consensus is still lacking. Intuitively, although there are theoretical objections, an operation regarded as relatively simple, fast and safe hardly seems to demand high-level evidence of efficacy. Rhinologists may be influenced by years of personal experience and success with the technique. However, estimates of the effect size and the added contribution to traditional surgical management are lacking. If the procedure could be shown to dramatically influence outcome, it should be standard practice and indispensable for all patients requiring operative intervention. This paper systematically examined the literature, appraising the anatomical basis for such an approach and evidence for its efficacy. It questions whether any units unable to consistently offer endoscopic sphenopalatine artery ligation should be undertaking surgical management of acute epistaxis.

Automated Generation of Fault Management Artifacts from a Simple System Model

NASA Technical Reports Server (NTRS)

Kennedy, Andrew K.; Day, John C.

2013-01-01

Our understanding of off-nominal behavior - failure modes and fault propagation - in complex systems is often based purely on engineering intuition; specific cases are assessed in an ad hoc fashion as a (fallible) fault management engineer sees fit. This work is an attempt to provide a more rigorous approach to this understanding and assessment by automating the creation of a fault management artifact, the Failure Modes and Effects Analysis (FMEA) through querying a representation of the system in a SysML model. This work builds off the previous development of an off-nominal behavior model for the upcoming Soil Moisture Active-Passive (SMAP) mission at the Jet Propulsion Laboratory. We further developed the previous system model to more fully incorporate the ideas of State Analysis, and it was restructured in an organizational hierarchy that models the system as layers of control systems while also incorporating the concept of "design authority". We present software that was developed to traverse the elements and relationships in this model to automatically construct an FMEA spreadsheet. We further discuss extending this model to automatically generate other typical fault management artifacts, such as Fault Trees, to efficiently portray system behavior, and depend less on the intuition of fault management engineers to ensure complete examination of off-nominal behavior.

Phases of Recognition and Management of Financial Crisis in Public Organizations.

ERIC Educational Resources Information Center

Jones, L. R.

Based in part on interviews conducted in 32 municipalities, this paper is intended to provide information to public managers, policy analysts, and others on methods for improving the management of retrenchment. A model summarizes how public organizations recognize and attempt to manage financial crises and prolonged financial stress. Some cutback…

Manual of Educational Risk Management.

ERIC Educational Resources Information Center

Cody, Frank J.; Dise, John H., Jr.

This is the first risk management publication for school administrators that attempts to be comprehensive by addressing all potential areas of risk to school districts and offering specific guidelines on how to manage those areas. Chapter 1 gives directions on how to use the manual. Chapter 2 contains a complete overview of risk management,…

Presentation and Analysis of Financial Management Information. 2nd Edition.

ERIC Educational Resources Information Center

Kenton, Jay D.

This book is designed to help financial and other managers of colleges and universities in identifying and responding to the needs of individuals and groups requesting management information. The book attempts to facilitate the communication process through management reports. In addition to guidance on report preparation and data analysis, the…

Bringing climate change into natural resource management: proceedings.

Treesearch

L. Joyce; R. Haynes; R. White; R.J. Barbour

2007-01-01

These are the proceedings of the 2005 workshop titled implications of bringing climate into natural resource management in the Western United States. This workshop was an attempt to further the dialogue among scientists, land managers, landowners, interested stakeholders and the public about how individuals are addressing climate change in natural resource management....

Comparison of Management Practices in Public and Private Universities in Khyber Pakhtunkhwa

ERIC Educational Resources Information Center

Khan, Nasrullah; Aajiz, Niaz Muhammad; Ali, Akber

2018-01-01

This study attempted to compare the management practices in public and private universities in Khyber Pakhtunkhawa, Pakistan. The comparison is based on availability of written rules and regulations, distribution of tasks, availability of managers, access to officers, time management, work load, staff promotion procedure and appraisal system.…

77 FR 29429 - Self-Regulatory Organizations; NYSE Arca, Inc.; Notice of Filing of Proposed Rule Change Relating...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-17

... investment objective by implementing a ``top-down'' portfolio management style. This management style begins...'' portfolio management style utilizes a tactical and globally diversified allocation strategy in an attempt to... open-end management investment company.\\5\\ The investment adviser to the Fund is AdvisorShares...

Medical students’ attitude toward suicide attempters

PubMed Central

Nebhinani, Naresh; Chahal, Savita; Jagtiani, Amit; Nebhinani, Mamta; Gupta, Rajiv

2016-01-01

Background: Majority of health professionals have unfavorable attitudes toward the patients presenting with self-harm, which further compromises their therapeutic endeavors and outcomes. Objectives: This study was aimed to assess the medical students' attitudes toward suicide attempters. Materials and Methods: A cross-sectional study was conducted in a tertiary care medical institute of Haryana, a Northern state of India. Two hundred and five final year medical students were recruited through total enumeration method. “Suicide Opinion Questionnaire” was administered to assess their attitudes toward suicide attempters. Results: Only minority had previous exposure of managing any suicidal patient and attended suicide prevention programs. Majority agreed for suicide attempters being lonely and depressed. Nearly half of the students reported small family, disturbed interpersonal relationship, weak personality, self-punishment approach, cultural inhibitions in emotional expression, national instability, and disbelief in afterlife, as a major push to attempt suicide. Compared to boys, girls reported the greater contribution of weak personality and self-destructive behaviors and lesser contribution of family disturbances and religious convictions as suicide triggers. They held favorable attitude for only one-third of the attitudinal statement, and they were uncertain for two-third of the attitudinal statements. Conclusions: Such a high proportion of uncertain responses imply toward lack of awareness and clinical expertise for managing suicide attempters. It also signifies the urgent need for enhancing their educational and clinical exposure, to improve their attitudes toward patients presenting with self-harm. PMID:28163403

Management Attitudes toward Productivity.

ERIC Educational Resources Information Center

Chamber of Commerce of the United States, Washington, DC.

In an attempt to discover management attitudes toward productivity, including management's views about worker attitudes and their motivation, managerial practices and organization, and possible changes to effect improvements in productivity, the United States Chamber of Commerce surveyed a sample of 1,870 top business executives across the country…

A plea for rational mitigation of poor outcomes in the 'off-label use' of medications for the management of pain.

PubMed

Khursheed, Faraz; Ioffe, Julia; Gould, Harry J

2015-02-15

Neuropathic pain is a common and difficult to manage public health problem characterized by frequent treatment failure and high management costs. The variable presentation and response to treatment among patients make it difficult for physicians to apply a single, standardized approach for management. The physician's role in treating neuropathic pain is complex. Clinical decisions must be drawn from personal and shared experience, case reports, and evidence-based, controlled trials performed on selected populations of patients with common, narrowly-defined conditions. Recent advances in our understanding of the mechanisms that underlie the processing of nociceptive stimuli and the perception of pain have led to the increased 'off-label use' of adjuvant medications in an attempt to provide relief for many patients who heretofore have suffered unnecessarily with intractable neuropathic pain. Unfortunately, as with any treatment, sound clinical decisions can occasionally result in an untoward adverse response. It is therefore imperative that potential adverse effects inherent to all medications be considered and weighed against the untoward consequences of withholding treatment prior to incorporating their use in any course of management. This commentary presents a case report that illustrates a particularly devastating consequence that was encountered when a medication was selected for 'off-label use' in the treatment of intractable pain and presents an opinion for consideration in developing guidelines for determining acceptable risk and standard of care based upon rational adherence or deviation from the approved indications offered for the use of a medication at the time of its introduction into practice is granted. Copyright © 2014 Elsevier B.V. All rights reserved.

[Tracheal Intubation by Paramedics in a Local Community: Current Situation and Future Challenges].

PubMed

Takinami, Yoshikazu

2016-03-01

As of April 2013, 164 paramedics are certified to perform tracheal intubation in Fukui Prefecture. This study investigated the current situation surrounding tracheal intubation performed by paramedics in prehospital care. Subjects were 58 paramedics who completed practical training at our hospital. Post-training duration, number of tracheal intubation cases, number of attempts before successful tracheal intubation, disease involved, rate of return of spontaneous circulation, and prognosis were examined. Tracheal intubation was successful on the first attempt in 92% of cases. Rate of return of spontaneous circulation was high in paramedics whose post-training duration was short. No return of spontaneous circulation occurred after a second attempt. Four patients survived asphyxia or aspiration. It is important to perform successful tracheal intubation on the first attempt, to recognize the probability of successful resuscitation in patients with exogenous disease, and to strengthen the medical control system.

Collecting and Using Student Information for School Improvement.

ERIC Educational Resources Information Center

Riegel, N. Blyth

1989-01-01

Describes a Texas school district's attempt to determine highly effective and valid data for management decision-making and to increase managers' access to this data. Common sense and planning expertise helped immeasurably. (MLH)

Adaptive harvest management of North American waterfowl populations - recent successes and future prospects

USGS Publications Warehouse

Nichols, J.D.; Runge, M.C.; Johnson, F.A.; Williams, B.K.; Schodde, Richard; Hannon, Susan; Scheiffarth, Gregor; Bairlein, Franz

2006-01-01

The history of North American waterfowl harvest management has been characterized by attempts to use population monitoring data to make informed harvest management decisions. Early attempts can be characterized as intuitive decision processes, and later efforts were guided increasingly by population models and associated predictions. In 1995, a formal adaptive management process was implemented, and annual decisions about duck harvest regulations in the United States are still based on this process. This formal decision process is designed to deal appropriately with the various forms of uncertainty that characterize management decisions, environmental uncertainty, structural uncertainty, partial controllability and partial observability. The key components of the process are (1) objectives, (2) potential management actions, (3) model(s) of population response to management actions, (4) credibility measures for these models, and (5) a monitoring program. The operation of this iterative process is described, and a brief history of a decade of its use is presented. Future challenges range from social and political issues such as appropriate objectives and management actions, to technical issues such as multispecies management, geographic allocation of harvest, and incorporation of actions that include habitat acquisition and management.

International trade standards for commodities and products derived from animals: the need for a system that integrates food safety and animal disease risk management.

PubMed

Thomson, G R; Penrith, M-L; Atkinson, M W; Thalwitzer, S; Mancuso, A; Atkinson, S J; Osofsky, S A

2013-12-01

A case is made for greater emphasis to be placed on value chain management as an alternative to geographically based disease risk mitigation for trade in commodities and products derived from animals. The geographic approach is dependent upon achievement of freedom in countries or zones from infectious agents that cause so-called transboundary animal diseases, while value chain-based risk management depends upon mitigation of animal disease hazards potentially associated with specific commodities or products irrespective of the locality of production. This commodity-specific approach is founded on the same principles upon which international food safety standards are based, viz. hazard analysis critical control points (HACCP). Broader acceptance of a value chain approach enables animal disease risk management to be combined with food safety management by the integration of commodity-based trade and HACCP methodologies and thereby facilitates 'farm to fork' quality assurance. The latter is increasingly recognized as indispensable to food safety assurance and is therefore a pre-condition to safe trade. The biological principles upon which HACCP and commodity-based trade are based are essentially identical, potentially simplifying sanitary control in contrast to current separate international sanitary standards for food safety and animal disease risks that are difficult to reconcile. A value chain approach would not only enable more effective integration of food safety and animal disease risk management of foodstuffs derived from animals but would also ameliorate adverse environmental and associated socio-economic consequences of current sanitary standards based on the geographic distribution of animal infections. This is especially the case where vast veterinary cordon fencing systems are relied upon to separate livestock and wildlife as is the case in much of southern Africa. A value chain approach would thus be particularly beneficial to under-developed regions of the world such as southern Africa specifically and sub-Saharan Africa more generally where it would reduce incompatibility between attempts to expand and commercialize livestock production and the need to conserve the subcontinent's unparalleled wildlife and wilderness resources. © 2013 Blackwell Verlag GmbH.

Quality Management for Schools.

ERIC Educational Resources Information Center

Mulligan, Dorothy

1992-01-01

W. Edwards Deming introduced management principles that helped Japan become a world economic power. Virginia is attempting to adapt these techniques to education with a grant that provides training and support for school personnel in several school districts. Describes a quality management program at Christa McAuliffe Elementary School that has…

Towards 2000 and Beyond: Preparation of Educational Managers in India.

ERIC Educational Resources Information Center

Sapra, C. L.

1993-01-01

Discusses challenges facing educational management in India resulting from demographic change, social demand for education, economic need for trained manpower. Attempts to develop social model for year 2000, reflecting concerns for strength of India's democracy and secularization. Educational managers will be challenged to achieve universalization…

Work Teams that Work.

ERIC Educational Resources Information Center

Galagan, Patricia

1986-01-01

Describes a line manager's successful attempt to design an autonomously run plant. The author discusses the assembly of a team of workers to develop the plant, product design, characteristics of the team members, the employee reward system, role of the plant manager, and the manager's evaluation of the plant's success. (CT)

Impression Management Training: Conceptualization and Application to Personal Selling.

ERIC Educational Resources Information Center

Leathers, Dale G.

1988-01-01

Discusses the importance of impression management, an individual's conscious attempt to exercise control over selected communicative behaviors and cues for purposes of making a desired impression. Provides a comprehensive conceptualization of the impression-management process, and demonstrates how this process can facilitate effective training of…

[Are near-death experiences following attempted suicide important for suicide risk assessment? A case report].

PubMed

Kralovec, Karl; Plöderl, Martin; Aistleiner, Ursula; Fartacek, Clemens; Fartacek, Reinhold

2009-01-01

We describe a 59-year old patient who reported a near-death experience following attempted suicide. The near-death experience induced reduction of suicidality. Previous studies suggested a high prevalence of near-death experiences following attempted suicide and that near-death experiences may decrease rather than increase subsequent suicide risk. Implications for suicide risk assessment are discussed.

[Risk factors found in suicide attempters].

PubMed

Villa-Manzano, Alberto Iram; Robles-Romero, Miguel Angel; Gutiérrez-Román, Elsa Armida; Martínez-Arriaga, María Guadalupe; Valadez-Toscano, Francisco Javier; Cabrera-Pivaral, Carlos E

2009-01-01

A better understanding of risk factors for suicide in general population is crucial for the design of suicide prevention programs. Our objective was to identify personal and family risk factors in suicide attempters. Case-control design. We searched in patients with an acute intoxication, those subjects with and intoxication attributable to suicide attempt. These patients were matched with controls by gender and the date of intoxication. We use a structured questionnaire to identify personal characteristics, family features and network support. Odds ratio (OR) and 95 % confidence interval were obtained. 25 cases and 25 controls were evaluated. The risk factors associated with suicide attempt adjusted by age, were being a student and smoking habits. Family violence background showed OR = 3.8 (IC 95 % = 1.1-13), family disintegration a OR = 8.5 (IC 95 % = 2.1-35), critical events background OR = 8.8 (IC 95 % = 2.1-36), poor self-esteem OR = 8.2 (IC 95 % 2-35), depression OR = 22 (IC 95 % = 3-190), anxiety OR = 9 (IC 95 % = 2-47), family dysfunction OR = 25 (IC 95 % = 4-151). The principal risk factor for suicide attempt was family dysfunction and psychological traits.

Information security risk management for computerized health information systems in hospitals: a case study of Iran.

PubMed

Zarei, Javad; Sadoughi, Farahnaz

2016-01-01

In recent years, hospitals in Iran - similar to those in other countries - have experienced growing use of computerized health information systems (CHISs), which play a significant role in the operations of hospitals. But, the major challenge of CHIS use is information security. This study attempts to evaluate CHIS information security risk management at hospitals of Iran. This applied study is a descriptive and cross-sectional research that has been conducted in 2015. The data were collected from 551 hospitals of Iran. Based on literature review, experts' opinion, and observations at five hospitals, our intensive questionnaire was designed to assess security risk management for CHISs at the concerned hospitals, which was then sent to all hospitals in Iran by the Ministry of Health. Sixty-nine percent of the studied hospitals pursue information security policies and procedures in conformity with Iran Hospitals Accreditation Standards. At some hospitals, risk identification, risk evaluation, and risk estimation, as well as risk treatment, are unstructured without any specified approach or methodology. There is no significant structured approach to risk management at the studied hospitals. Information security risk management is not followed by Iran's hospitals and their information security policies. This problem can cause a large number of challenges for their CHIS security in future. Therefore, Iran's Ministry of Health should develop practical policies to improve information security risk management in the hospitals of Iran.

Examining the effectiveness of municipal solid waste management systems: an integrated cost-benefit analysis perspective with a financial cost modeling in Taiwan.

PubMed

Weng, Yu-Chi; Fujiwara, Takeshi

2011-06-01

In order to develop a sound material-cycle society, cost-effective municipal solid waste (MSW) management systems are required for the municipalities in the context of the integrated accounting system for MSW management. Firstly, this paper attempts to establish an integrated cost-benefit analysis (CBA) framework for evaluating the effectiveness of MSW management systems. In this paper, detailed cost/benefit items due to waste problems are particularly clarified. The stakeholders of MSW management systems, including the decision-makers of the municipalities and the citizens, are expected to reconsider the waste problems in depth and thus take wise actions with the aid of the proposed CBA framework. Secondly, focusing on the financial cost, this study develops a generalized methodology to evaluate the financial cost-effectiveness of MSW management systems, simultaneously considering the treatment technological levels and policy effects. The impacts of the influencing factors on the annual total and average financial MSW operation and maintenance (O&M) costs are analyzed in the Taiwanese case study with a demonstrative short-term future projection of the financial costs under scenario analysis. The established methodology would contribute to the evaluation of the current policy measures and to the modification of the policy design for the municipalities. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

Temporary placement of covered self-expandable metallic stents in the management of benign biliary strictures.

PubMed

Yasuda, Ichiro; Mukai, Tsuyoshi; Doi, Shinpei; Tomita, Eiichi; Moriwaki, Hisataka

2012-05-01

Currently, endoscopic intervention is widely attempted as the first-line treatment of benign biliary strictures because of its convenience and low morbidity. Plastic tube stents (PS) are usually used for such treatment; however, covered self-expandable metallic stents (C-SEMS) are becoming more commonly used at some institutions. The temporary placement of C-SEMS may lead to better outcomes because of their larger diameter and, therefore, better dilation of the stricture, especially in refractory cases. The aim of the present study was to evaluate the efficacy of the temporary placement of C-SEMS in the management of benign biliary strictures. We retrospectively reviewed our endoscopic retrograde cholangiopancreatography (ERCP) database (May 1996 to December 2010), and extracted the data of patients who underwent endoscopic treatment for benign biliary strictures. Then, the follow-up data from patient charts were reviewed to determine the long-term outcomes of those procedures. All patients (n = 56) initially had a PS placed, with or without balloon dilation. However, C-SEMS placement was later attempted in 12 patients because the stricture was refractory to placement of the PS. During their follow-up periods, two patients died of unrelated diseases after 15 and 17 months, and another two still had the C-SEMS in place after 9 and 50 months. In the remaining eight patients, the C-SEMS was removed after a median placement period of 6 months (range, 2-15). Seven patients in this group have not experienced a recurrence at a median follow-up time of 48 months. However, in one patient, stenosis did recur 8 months after the C-SEMS was removed. Temporary placement of C-SEMS can be a treatment option for benign biliary strictures, especially in refractory cases. © 2012 The Authors. Digestive Endoscopy © 2012 Japan Gastroenterological Endoscopy Society.

Understanding food webs in the Chesapeake Bay

USGS Publications Warehouse

Keough, J.R.; Haramis, G.M.; Perry, M.C.; Perry, M.C.

2002-01-01

Approaches to predictive modeling and to management of the Chesapeake Bay ecosystem are 'bottom up' (i.e., approaches involve the control of nutrient inputs in attempts to manage plankton productivity) and 'top down' (i.e., approaches involve controls on harvest of fisheries and wildlife in attempts to manage vertebrate populations). Both approaches are limited by a lack of understanding of trophic connections between nutrient inputs, primary producers, and higher trophic level consumers. This project is aimed at identifying trophic structure for the submersed aquatic vegetation habitat of the Chesapeake Bay. We are employing analysis of stable isotope ratios of plant and animal tissues to identify trophic levels and traditional food habits analysis to identify the foods of a number of species of waterfowl.

[Clinical analysis of 104 cases of overdose in suicide attempts].

PubMed

Ozaki, Yoshimi; Nakata, Yasuki; Kameoka, Masafumi; Hayashi, Nobuhiro; Nakayama, Yusuke; Yagi, Keiichi

2007-10-01

Patients who have attempted suicide by taking medicines are frequently admitted to emergency and critical care medical centers. These patients usually have both physical and mental problems. Some try repeatedly to commit suicide. In this study, to ascertain how to prevent repeated attempts of suicide, we investigated the clinical characteristics of patients attempting suicide by taking overdoses of medicine. One hundred and four cases of suicide attempted by taking an overdose of medicine, seen at The Emergency and Critical Care Medical Center, Tottori University Hospital, Tottori from April 2005 to March 2006, were investigated in this retrospective study. Patients were 25 males (24%), and 79 females (76%). Eighty one patients (77.9%) had regularly been receiving psychiatric care, with neurotic disorders being the most common psychiatric condition. Thirty eight patients (36.5%) had repeated suicide attempts by taking an overdose of medicine. In 2005, there were 9 patients (9.4%) who had repeatedly consulted our critical care medical center. Most of these patients were females who had previously consulted a psychiatric clinic and had diagnoses of stress-related or personality disorders. In this study, we demonstrated that it is important to build a good relationship between psychiatrists and emergency doctors. As well, to prevent repeated incidents of taking an overdose of medicines in a suicide attempt, it is important to ensure that medical and psychosocial support are positively applied to patients with such tendencies.

The strategic function of attempted suicide.

PubMed

Katschnig, H; Steinert, H

1975-01-01

Attempting suicide is regarded as a strategy for getting out of emotionally troublesome situations. This strategy is a bodily and risky 'cry for help', but also a cry for help with almost certain success as the bodily self-damage forces significant others to show indulgent behaviour. As this indulgent behaviour has the actual function to relieve significant others from feelings of guilt and from real social pressures, it very often diminishes with time, so that the effect of the 'attempted suicide strategy' proves to be very short. The relation between this concept and some epidemiological findings is discussed and the consequences of this approach for the management of attempted suicides are pointed out.

Greek-Turkish Crises since 1955. Implications for Greek-Turkish Conflict Management

DTIC Science & Technology

1997-03-01

NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA THESIS GREEK-TURKISH CRISES SINCE 1955. IMPLICATIONS FOR GREEK-TURKISH CONFLICT MANAGEMENT by...EU, WEU) have only to gain from a Greek-Turkish rapprochement. 14. SUBJECT TERMS GrEek-Turkish RElATiONS, CRiSiS MANAgEMENT, CONfLICT management 15...crises, because the intended outcome of mediation attempts has been regional stability instead of Greek-Turkish conflict management . Power mediation

Weight management behaviors in a sample of Iranian adolescent girls.

PubMed

Garousi, S; Garrusi, B; Baneshi, Mohammad Reza; Sharifi, Z

2016-09-01

Attempts to obtain the ideal body shape portrayed in advertising can result in behaviors that lead to an unhealthy reduction in weight. This study was designed to identify contributing factors that may be effective in changing the behavior of a sample of Iranian adolescents. Three hundred fifty adolescent girls from high schools in Kerman, Iran participated in a cross-sectional study based on a self-administered questionnaire. Multifactorial logistic regression modeling was used to identify the factors influencing each of the contributing factors for body management methods, and a decision tree model was constructed to identify individuals who were more or less likely to change their body shape. Approximately one-third of the adolescent girls had attempted dieting, and 37 % of them had exercised to lose weight. The logistic regression model showed that pressure from their mother and the media; father's education level; and body mass index (BMI) were important factors in dieting. BMI and perceived pressure from the media were risk factors for attempting exercise. BMI and perceived pressure from relatives, particularly mothers, and the media were important factors in attempts by adolescent girls to lose weight.

A theory-based approach to understanding suicide risk in shelter-seeking women.

PubMed

Wolford-Clevenger, Caitlin; Smith, Phillip N

2015-04-01

Women seeking shelter from intimate partner violence are at an increased risk for suicide ideation and attempts compared to women in the general population. Control-based violence, which is common among shelter-seeking women, may play a pivotal role in the development of suicide ideation and attempts. Current risk assessment and management practices for shelter-seeking women are limited by the lack of an empirically grounded understanding of increased risk in this population. We argue that in order to more effectively promote risk assessment and management, an empirically supported theory that is sensitive to the experiences of shelter-seeking women is needed. Such a theory-driven approach has the benefits of identifying and prioritizing targetable areas for intervention. Here, we review the evidence for the link between coercive control and suicide ideation and attempts from the perspective of Baumeister's escape theory of suicide. This theory has the potential to explain the role of coercive control in the development of suicide ideation and eventual attempts in shelter-seeking women. Implications for suicide risk assessment and prevention in domestic violence shelters are discussed. © The Author(s) 2014.

Association of Brain-Derived Neurotrophic Factor G196A and Attempted Suicide: A Case-Control Study in Rural China.

PubMed

Wang, Jin-Yu; Wang, Xin-Ting; Wang, Lin-Lin; Jia, Cun-Xian

2015-01-01

Suicide is an important public problem, the mechanism of which has not been clarified. Many studies have focused on the molecular, biological and genetic mechanisms of suicide. Brain-derived neurotrophic factor (BDNF) G196A is one of the most leading loci in recent studies, but the results are inconsistent. We conducted a 1:1 age- and sex-matched case-control study in rural areas of Shandong Province, China. A total of 365 pairs of cases and controls were finally recruited into our study. The adjusted odds ratios (AORs) of BDNF 196G/G and their 95% confidence intervals (CIs) were calculated by multivariate conditional logistic regression models. No association between BDNF polymorphisms and attempted suicide was found in the overall population. However, the BDNF 196G/G genotype was significantly related to attempted suicide in the elderly population (AOR = 7.85, 95% CI: 1.12-54.90, p = 0.038), while the associations were not significant in young and middle-aged groups. Our study suggests that the BDNF 196G/G genotype increases the risk of attempted suicide in elderly people. © 2015 S. Karger AG, Basel.

Internal versus External Quality Management

ERIC Educational Resources Information Center

Hofman, Roelande H.; Dijkstra, Nynke J.; Hofman, W. H. Adriaan

2008-01-01

This article presents the findings of research into quality management in Dutch elementary schools using theories of school accountability and school improvement as fundamentals. The study is based on data gathered from almost 1000 school leaders. It attempts to determine whether different types of quality management exist in primary schools.…

Strategic Management and Evaluation: Rivals, Partners, or Just Fellow Travelers?

ERIC Educational Resources Information Center

Klay, William Earle

1991-01-01

Evaluation and strategic management are related in that each attempts to improve the quality of policy decisions and each has evolved from a product-centered focus to one in which implementation and utilization are vital. Evaluators should understand strategic management theory to evaluate its applications appropriately. (SLD)

Report: Follow-Up Report: EPA Proposes to Streamline the Review, Management and Disposal of Hazardous Waste Pharmaceuticals

EPA Pesticide Factsheets

Report #15-P-0260, August 19, 2015. EPA states that it intends to issue a proposed rule, Management Standards for Hazardous Waste, which will attempt to streamline the approach to managing and disposing of hazardous and nonhazardous pharmaceutical waste.

Relationships between Time-Management Skills, Facebook Interpersonal Skills and Academic Achievement among Junior High School Students

ERIC Educational Resources Information Center

Tsai, Hsien-Chang; Liu, Shih-Hsiung

2015-01-01

Effective time-management skills and interpersonal interactions with familiar friends for learning matters on Facebook are desired characteristics for adolescents attempting to improve their academic achievements. This study identifies the relationships between time-management skills and Facebook interpersonal skills with the academic achievement…

Highly Integrated Quality Assurance – An Empirical Case

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

Drake Kirkham; Amy Powell; Lucas Rich

2011-02-01

Highly Integrated Quality Assurance – An Empirical Case Drake Kirkham1, Amy Powell2, Lucas Rich3 1Quality Manager, Radioisotope Power Systems (RPS) Program, Idaho National Laboratory, P.O. Box 1625 M/S 6122, Idaho Falls, ID 83415-6122 2Quality Engineer, RPS Program, Idaho National Laboratory 3Quality Engineer, RPS Program, Idaho National Laboratory Contact: Voice: (208) 533-7550 Email: Drake.Kirkham@inl.gov Abstract. The Radioisotope Power Systems Program of the Idaho National Laboratory makes an empirical case for a highly integrated Quality Assurance function pertaining to the preparation, assembly, testing, storage and transportation of 238Pu fueled radioisotope thermoelectric generators. Case data represents multiple campaigns including the Pluto/New Horizons mission,more » the Mars Science Laboratory mission in progress, and other related projects. Traditional Quality Assurance models would attempt to reduce cost by minimizing the role of dedicated Quality Assurance personnel in favor of either functional tasking or peer-based implementations. Highly integrated Quality Assurance adds value by placing trained quality inspectors on the production floor side-by-side with nuclear facility operators to enhance team dynamics, reduce inspection wait time, and provide for immediate, independent feedback. Value is also added by maintaining dedicated Quality Engineers to provide for rapid identification and resolution of corrective action, enhanced and expedited supply chain interfaces, improved bonded storage capabilities, and technical resources for requirements management including data package development and Certificates of Inspection. A broad examination of cost-benefit indicates highly integrated Quality Assurance can reduce cost through the mitigation of risk and reducing administrative burden thereby allowing engineers to be engineers, nuclear operators to be nuclear operators, and the cross-functional team to operate more efficiently. Applicability of this case extends to any high-value, long-term project where traceability and accountability are determining factors.« less

A controlled trial of implementing a complex mental health intervention for carers of vulnerable young people living in out-of-home care: the ripple project.

PubMed

Herrman, Helen; Humphreys, Cathy; Halperin, Stephen; Monson, Katherine; Harvey, Carol; Mihalopoulos, Cathrine; Cotton, Susan; Mitchell, Penelope; Glynn, Tony; Magnus, Anne; Murray, Lenice; Szwarc, Josef; Davis, Elise; Havighurst, Sophie; McGorry, Patrick; Tyano, Sam; Kaplan, Ida; Rice, Simon; Moeller-Saxone, Kristen

2016-12-07

Out-of-home care (OoHC) refers to young people removed from their families by the state because of abuse, neglect or other adversities. Many of the young people experience poor mental health and social function before, during and after leaving care. Rigorously evaluated interventions are urgently required. This publication describes the protocol for the Ripple project and notes early findings from a controlled trial demonstrating the feasibility of the work. The Ripple project is implementing and evaluating a complex mental health intervention that aims to strengthen the therapeutic capacities of carers and case managers of young people (12-17 years) in OoHC. The study is conducted in partnership with mental health, substance abuse and social services in Melbourne, with young people as participants. It has three parts: 1. Needs assessment and implementation of a complex mental health intervention; 2. A 3-year controlled trial of the mental health, social and economic outcomes; and 3. Nested process evaluation of the intervention. Early findings characterising the young people, their carers and case managers and implementing the intervention are available. The trial Wave 1 includes interviews with 176 young people, 52% of those eligible in the study population, 104 carers and 79 case managers. Implementing and researching an affordable service system intervention appears feasible and likely to be applicable in other places and countries. Success of the intervention will potentially contribute to reducing mental ill-health among these young people, including suicide attempts, self-harm and substance abuse, as well as reducing homelessness, social isolation and contact with the criminal justice system. Australian New Zealand Clinical Trials Registry ACTRN12615000501549 . Retrospectively registered 19 May 2015.

From the Red Ball Express to the Objective Force: A Quest for Logistics Transformation

DTIC Science & Technology

2007-03-30

not support. In order to streamline materiel management to the force, Army Sustainment Command developed their Distribution Management Center...material management mission and the establishment and transfer of efforts to the Distribution Management Center, the Army Sustainment Command...attempt to bridge the capability gap. As the Distribution Management Center stands up at Rock Island Arsenal, they will assume responsibility for each

Joint issues – conflicts of interest, the ASR hip and suggestions for managing surgical conflicts of interest

PubMed Central

2014-01-01

Background Financial and nonfinancial conflicts of interest in medicine and surgery are troubling because they have the capacity to skew decision making in ways that might be detrimental to patient care and well-being. The recent case of the Articular Surface Replacement (ASR) hip provides a vivid illustration of the harmful effects of conflicts of interest in surgery. Discussion We identify financial and nonfinancial conflicts of interest experienced by surgeons, hospitals and regulators in the ASR case. These conflicts may have impacted surgical advice, decision-making and evidence gathering with respect to the ASR prosthesis, and contributed to the significant harms experienced by patients in whom the hip was implanted. Drawing on this case we explore shortcomings in the standard responses to conflicts of interest – disclosure and recusal. We argue disclosure is necessary but by no means sufficient to address conflicts of interest. Using the concept of recusal we develop remedies including second opinions and third party consent which may be effective in mitigating conflicts, but their implementation introduces new challenges. Summary Deployment of the ASR hip is a case of surgical innovation gone wrong. As we show, there were multiple conflicts of interest involved in the introduction of the ASR hip into practice and subsequent attempts to gloss over the mounting body of evidence about its lack of safety and effectiveness. Conflicts of interest in surgery are often not well managed. We suggest strategies in this paper which can minimise the conflicts of interest associated with surgical innovation. PMID:25128372

Hyperreactio Luteinalis: Maternal and Fetal Effects.

PubMed

Malinowski, Ann Kinga; Sen, Jonathan; Sermer, Mathew

2015-08-01

Hyperreactio luteinalis is a rare condition in which there is massive cystic enlargement of the ovaries, mimicking malignancy, during pregnancy. When confronted with this condition, the fear of missing a cancer diagnosis often leads the physician to react with unnecessary surgical intervention, potentially resulting in impaired future fertility. The literature on the subject contains mainly case reports and one small case series. A recent review attempted to summarize what is currently known, but there has not yet been a pervasive change in the approach to the management of this condition. In order to define the natural history of the condition and its maternal and fetal effects, we examined all case reports available in the English literature from 1993 to 2014, in addition to another as yet unpublished case report. Our analysis suggests that, despite its impressive presentation with ovarian enlargement and hyperandrogenism, hyperreactio luteinalis tends to be self-limiting, with spontaneous postpartum resolution and without untoward maternal or fetal sequelae. In particular, fetal virilization is rare, and dependent on the timing of hyperandrogenism. Adverse pregnancy outcomes are likely a consequence of the abnormally high hCG levels observed in many of these gestations, and the subset of women with these abnormal values should be considered for enhanced surveillance. Vaginal delivery is preferred, and strategies to sustain the potential for breastfeeding must be introduced while maternal androgen levels fall, allowing lactation to be established. Considering its benign nature and postpartum resolution, management of HL must be conservative, and continued education of health care professionals who may encounter this entity is vital.

A resilience perspective to water risk management: case-study application of the adaptation tipping point method

NASA Astrophysics Data System (ADS)

Gersonius, Berry; Ashley, Richard; Jeuken, Ad; Nasruddin, Fauzy; Pathirana, Assela; Zevenbergen, Chris

2010-05-01

In a context of high uncertainty about hydrological variables due to climate change and other factors, the development of updated risk management approaches is as important as—if not more important than—the provision of improved data and forecasts of the future. Traditional approaches to adaptation attempt to manage future water risks to cities with the use of the predict-then-adapt method. This method uses hydrological change projections as the starting point to identify adaptive strategies, which is followed by analysing the cause-effect chain based on some sort of Pressures-State-Impact-Response (PSIR) scheme. The predict-then-adapt method presumes that it is possible to define a singular (optimal) adaptive strategy according to a most likely or average projection of future change. A key shortcoming of the method is, however, that the planning of water management structures is typically decoupled from forecast uncertainties and is, as such, inherently inflexible. This means that there is an increased risk of under- or over-adaptation, resulting in either mal-functioning or unnecessary costs. Rather than taking a traditional approach, responsible water risk management requires an alternative approach to adaptation that recognises and cultivates resiliency for change. The concept of resiliency relates to the capability of complex socio-technical systems to make aspirational levels of functioning attainable despite the occurrence of possible changes. Focusing on resiliency does not attempt to reduce uncertainty associated with future change, but rather to develop better ways of managing it. This makes it a particularly relevant perspective for adaptation to long-term hydrological change. Although resiliency is becoming more refined as a theory, the application of the concept to water risk management is still in an initial phase. Different methods are used in practice to support the implementation of a resilience-focused approach. Typically these approaches start the identification and analysis of adaptive strategies at the end of PSIR scheme: impact and examine whether, and for how long, current risk management strategies will continue to be effective under different future conditions. The most noteworthy application of this approach is the adaptation tipping point method. Adaptation tipping points (ATP) are defined as the points where the magnitude of change is such that the current risk management strategy can no longer meet its objectives. In the ATP method, policy objectives, determining aspirational functioning, are taken as the starting point. Also, the current measures to achieve these objectives are described. This is followed by a sensitivity analysis to determine the optimal and critical boundary conditions (state). Lastly, the state is related to pressures in terms of future change. It should be noted that in the ATP method the driver for adopting a new risk management strategy is not future change as such, but rather failing to meet the policy objectives. In the current paper, the ATP method is applied to the case study of an existing stormwater system in Dordrecht (the Netherlands). This application shows the potential of the ATP method to reduce the complexity of implementing a resilience-focused approach to water risk management. It is expected that this will help foster greater practical relevance of resilience as a perspective for the planning of water management structures.

Population-based outreach versus care as usual to prevent suicide attempt: study protocol for a randomized controlled trial.

PubMed

Simon, Gregory E; Beck, Arne; Rossom, Rebecca; Richards, Julie; Kirlin, Beth; King, Deborah; Shulman, Lisa; Ludman, Evette J; Penfold, Robert; Shortreed, Susan M; Whiteside, Ursula

2016-09-15

Suicide remains the 10th-ranked most frequent cause of death in the United States, accounting for over 40,000 deaths per year. Nonfatal suicide attempts lead to over 200,000 hospitalizations and 600,000 emergency department visits annually. Recent evidence indicates that responses to the commonly used Patient Health Questionnaire (PHQ9) can identify outpatients who are at risk of suicide attempt and suicide death and that specific psychotherapy or Care Management programs can prevent suicide attempts in high-risk patients. Motivated by these developments, the NIMH-funded Mental Health Research Network has undertaken a multisite trial of two outreach programs to prevent suicide attempts among outpatients identified by routinely administered PHQ9 questionnaires. Outpatients who are at risk of suicide attempt are automatically identified using data from electronic health records (EHRs). Following a modified Zelen design, all those identified are assigned to continued usual care (i.e., no contact) or to be offered one of two population-based outreach programs. A Care Management intervention includes systematic outreach to assess suicide risk, EHR-based tools to implement risk-based care pathways, and care management to facilitate recommended follow-up. A Skills Training intervention includes interactive online training in Dialectical Behavior Therapy skills, supported by reminder and reinforcement messages from a skills coach. Each intervention supplements, rather than replaces, usual care; participants may receive any other services normally available. Interventions are delivered primarily by secure messaging through EHR patient portals. Suicide attempts and deaths following randomization are identified using state vital statistics data and health system EHR and insurance claim data. Primary evaluation will compare risk of suicide attempt or death over 18 months according to the initial assignment, regardless of intervention participation. Recruitment is underway in three health systems (Group Health Cooperative, HealthPartners, and Kaiser Permanente Colorado). Over 2500 participants have been randomized as of 1 March 2016, with enrollment averaging approximately 100 per week. Assessing the effectiveness of population-based suicide prevention requires adherence to the principles of pragmatic trials: population-based enrollment, accepting variable treatment participation, assessing outcomes using health record data, and analyses based on intent-to-treat. ClinicalTrials.gov registration # NCT02326883 , registered on 23 December 2014.

Preventing recurrent suicidal behaviour.

PubMed Central

Links, P. S.; Balchand, K.; Dawe, I.; Watson, W. J.

1999-01-01

OBJECTIVE: To highlight recent empirical evidence for effective interventions that can guide family physicians in managing patients after suicide attempts. QUALITY OF EVIDENCE: Randomized control trials of psychosocial interventions for people after suicide attempts have provided some evidence for effective interventions. MAIN MESSAGE: Suicide attempts are more common than suicides; the number of attempts seen in a family practice is estimated to be 10 to 15 yearly. Up to two thirds of patients who take their lives by suicide have seen a family physician in the month before their death. Principles of care after a suicide attempt include actively engaging the patient, involving the family, restricting access to means of suicide, and developing intervention plans to deal with the psychopathology that has placed the patient at risk. CONCLUSIONS: Family physicians have a crucial role in preventing suicide through aftercare and ongoing monitoring of patients who have attempted suicide. PMID:10587773

A meta-analysis of acute alcohol use and the risk of suicide attempt

PubMed Central

Borges, Guilherme; Bagge, Courtney; Cherpitel, Cheryl J.; Conner, Kenneth; Orozco, Ricardo; Rossow, Ingeborg

2016-01-01

Background While there are reviews reporting on the prevalence of acute use of alcohol (AUA) prior to suicide attempts, no review has used a meta-analytic approach to estimate common odds ratios (OR) of the effect of AUA on suicide attempts. We aim to report the results of the first meta-analysis of controlled epidemiological studies on acute alcohol use and suicide attempt. Methods The English language literature on Medline, PsychInfo, Google Scholar, and public-use databases was searched for original articles and critical review reports on acute alcohol use and suicide attempt for the period ranging from 1996–2015. Studies had to report an OR estimate for this association. Common odds ratios and 95% Confidence Intervals (95%CI) from random effects in meta-analyses for any acute alcohol use and 2 levels of alcohol use on suicide attempt were calculated. Results We gathered 7 studies that provided OR estimates for the likelihood of suicide attempt by acute alcohol use, compared to those who did not drink alcohol. Studies used case-control (3) and case-crossover design (4). All studies found increased ORs for acute alcohol use on suicide attempt. Meta-analysis revealed a common OR of 6.97 (95%CI=4.77, 10.17) for any acute alcohol use. Evidence from 4 studies suggests that «low levels of acute drinking» resulted in an OR of 2.71 (95%CI=1.56, 4.71) and «high levels» had much greater odds of suicide attempt, OR of 37.18 (95%CI=17.38, 79.53). Conclusions Acute use of alcohol is associated with increased likelihood of a suicide attempt, particularly at high doses. Such data should be incorporated into estimates of the burden of disease associated with alcohol use, which are currently limited by a consideration of only alcohol’s chronic effects. Future research should focus on the mechanisms through which acute use of alcohol confers risk for attempt. PMID:27928972

A possible case of natalizumab-dependent suicide attempt: A brief review about drugs and suicide

PubMed Central

Mumoli, Laura; Ciriaco, Miriam; Gambardella, Antonio; Bombardiere, Giuseppe Nicodemo; Valentino, Paola; Palleria, Caterina; Labate, Angelo; Russo, Emilio

2013-01-01

β-Interferon therapy is known to be a potential trigger of suicidal behavior, but this effect has not been previously reported for other multiple sclerosis (MS) treatments, such as, natalizumab. Here we report the case history of a 32-year-old woman affected by relapsing-remitting MS, who attempted suicide during natalizumab treatment. This case suggests that a suicidal ideation might be a rare side effect of natalizumab. Nevertheless, this case represents the first evidence of the new adverse drug reaction related to natalizumab treatment. We should alert clinicians to be aware of the possibility of paradoxical activation of suicidality during its therapeutic use. The main purpose of the present article is to use this case to review the possible relationship between suicidal behavior and drugs. PMID:24347991

A possible case of natalizumab-dependent suicide attempt: A brief review about drugs and suicide.

PubMed

Mumoli, Laura; Ciriaco, Miriam; Gambardella, Antonio; Bombardiere, Giuseppe Nicodemo; Valentino, Paola; Palleria, Caterina; Labate, Angelo; Russo, Emilio

2013-12-01

β-Interferon therapy is known to be a potential trigger of suicidal behavior, but this effect has not been previously reported for other multiple sclerosis (MS) treatments, such as, natalizumab. Here we report the case history of a 32-year-old woman affected by relapsing-remitting MS, who attempted suicide during natalizumab treatment. This case suggests that a suicidal ideation might be a rare side effect of natalizumab. Nevertheless, this case represents the first evidence of the new adverse drug reaction related to natalizumab treatment. We should alert clinicians to be aware of the possibility of paradoxical activation of suicidality during its therapeutic use. The main purpose of the present article is to use this case to review the possible relationship between suicidal behavior and drugs.

[Recent life events preceding suicide attempt by drug overdose].

PubMed

Kubiak, Małgorzata; Musikowska, Barbara; Sein Anand, Jacek

2013-01-01

Recent stressful life events (ASLE) are considered to be one of the factors precipitating suicidal behavior. They precede a suicide attempt in most cases and according to research occur more often during the month or week before the suicide attempt. Interpersonal events are most common. The article presents an analysis of ASLE timing and incidence of events from specific categories during the month preceding suicide attempt by drug overdose. 124 patients admitted to the hospital because of suicidal intoxication were included in the study. Data regarding ASLE were collected with the use of a structured interview. Majority of patients attempting suicide by drug overdose experience a stressful event during the month prior to the suicide attempt. Nearly 4 out of 10 study subjects experience a stressful event on the day of the attempt or on the preceding day. Most common events that occur during the month prior to the attempt and immediately before the attempt are interpersonal events and most of them are related to relationships with spouses or partners.

Intestinal complications following irradiation for gynecologic cancer

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

Ashbaugh, D G; Owens, J C

1963-07-01

Intestinal injury following irradiation for gynecologic cancer is discussed with reference to 49 cases. These cases could be divided into three groups on the basis of the severity of the damage: group 1, (8 cases), those with mild injury and littie or no residual damage and symptoms; group II (9 cases), those with moderate injury and some permanent changes with or without symptoms; and group III (32 cases), those with severe injury who were incapacitated or required surgery. Group III includes seven patients who were cured of their malignancies but who died of the complications of radiation injury and themore » subsequent attempts to correct this damage. In group I the symptoms consisted mainly of rectal pain, diarrhea, tenesmus, and constipation, and in two instances, mild rectal stricture. All patients became asymptomatic with nonoperative management. In group II the initial symptoms were also pain, diarrhea, constipation, tenesmus, and rectal bleeding, persistent in varying degrees. Five patients developed stricture or narrowing of the rectum and sigmoid, but none required operation. In group III there were 19 bowel strictures and 32 fistulss, and 84 operations were performed in attempts to correct these problems. In the seven patients who died from complications of radiation therapy no tumor was found at postmortem examination. A review of other reports shows an incidence of intestinal complications following pelvic irradiation ranging from 2.4% to 17%, with one estimate as high as 50 to 75%. The problem here was not and overdosage of radiation, but the necessity in treating carcinoma, the primary aim of which is eradication of the malignancy, in using adequate dosage. It is suggested that with prompt recognition and early, vigorous treatment, many of the more severe cases could probably have been greatly modified. Treatment is generally nonoperative in the acute stsge, which is best mansged by supportive measures and the cessation of radiation therapy. The chronic stage frequently requires operative intervention for the relief of stricture or fistula, and and initial diverting colostomy is the operation of choice. Subsequently, additional procedures may be performed, but these sometimes lead to increased morbidity and even mortality.« less

Disrupting seasonality to control disease outbreaks: the case of koi herpes virus.

PubMed

Omori, Ryosuke; Adams, Ben

2011-02-21

Common carp accounts for a substantial proportion of global freshwater aquaculture production. Koi herpes virus (KHV), a highly virulent disease affecting carp that emerged in the late 1990s, is a serious threat to this industry. After a fish is infected with KHV, there is a temperature dependent delay before it becomes infectious, and a further delay before mortality. Consequently, KHV epidemiology is driven by seasonal changes in water temperature. Also, it has been proposed that outbreaks could be controlled by responsive management of water temperature in aquaculture setups. We use a mathematical model to analyse the effect of seasonal temperature cycles on KHV epidemiology, and the impact of attempting to control outbreaks by disrupting this cycle. We show that, although disease progression is fast in summer and slow in winter, total mortality over a 2-year period is similar for outbreaks that start in either season. However, for outbreaks that start in late autumn, mortality may be low and immunity high. A single bout of water temperature management can be an effective outbreak control strategy if it is started as soon as dead fish are detected and maintained for a long time. It can also be effective if the frequency of infectious fish is used as an indicator for the beginning of treatment. In this case, however, there is a risk that starting the treatment too soon will increase mortality relative to the case when no treatment is used. This counterproductive effect can be avoided if multiple bouts of temperature management are used. We conclude that disrupting normal seasonal patterns in water temperature can be an effective strategy for controlling koi herpes virus. Exploiting the seasonal patterns, possibly in combination with temperature management, can also induce widespread immunity to KHV in a cohort of fish. However, employing these methods successfully requires careful assessment to ensure that the treatment is started, and finished, at the correct time. Copyright © 2010 Elsevier Ltd. All rights reserved.

New re-entry device for revascularization of chronic coronary total occlusions: preliminary single Japanese center experience.

PubMed

Tsuchikane, Etsuo; Kimura, Masashi; Suzuki, Takahiko; Habara, Maoto; Kurita, Tairo; Tanaka, Nobuyoshi; Nasu, Kenya; Ito, Tatsuya; Kinoshita, Yoshihisa; Wyman, R Michael

2012-08-01

Although retrograde approach for coronary chronic total occlusion (CTO) has been introduced, the procedure is still time and resource consuming. A simplified antegrade approach mightbe another resort. The aim of this study was to evaluate a new device designed to facilitate guidewire re-entry into the true lumen of a CTO from the adjacent subintimal space. Patients with CTO were entered into a prospective registry regardless of lesion characteristics. A new metal-tip catheter was used initially in primary use cases. If it created subintimal tracking, a new re-entry tool (a flat balloon with 2 exit ports offset by 180 degrees) was used as a platform to attempt guidewire penetration into the distal true lumen. In rescue use cases after unsuccessful conventional wiring, the re-entry procedure was subsequently attempted. In 11 CTO lesions attempted, device success was achieved in 8 cases (72.7%). Re-entry procedure success rate was higher in primary use cases (80%) compared to rescue use cases (33.3%). Retrograde approach was conducted immediately after unsuccessful antegrade procedure using this device in the other 3 cases and successful recanalization was achieved in all cases. All lesions were stented, resulting in TIMI 3 flow without major complications. A new coronary re-entry device may provide another strategic option in the antegrade approach to recanalize CTOs.

"Rabbit ear" scalp deformity caused by massive subdural effusion in infant following bilateral bur-hole drainage failure: successfully managed with subduro-peritoneal shunt.

PubMed

Satyarthee, Guru Dutta; Dawar, Pankaj; Sharma, Bhawani Shanker

2013-11-01

Subdural effusion in an infant is a rare clinical scenario which may be secondary to a variety of etiologies. Massive subdural effusion is an extremely rare complication of head injury. Authors report a rare case of progressive massive subdural effusion which, despite bilateral bur-hole placement and drainage, failed and presented with visual deterioration and massive bulge of the scalp at bur-hole sites, producing a rabbit ear appearance in a 10-month-old infant. Ultimately, cystoperitoneal shunt was carried out in a desperate attempt to prevent impending rupture of scalp sutures at sites of previous bur-hole placement. This was followed by not only complete resolution of hygroma but also visual recovery. The patient is doing well at 6 months following shunt, regaining normal vision and appropriate developmental milestones. A MRI scan of the brain was carried out at last follow-up, which revealed mild ventriculomegaly with the rest of the brain being unremarkable, and subduro-peritoneal shunt in situ. Such a case has not been reported in the literature till date. Subdural effusion usually runs a self-limiting course. Though neurosurgical intervention is occasionally needed, different methods of surgical procedure for management include bur hole alone, bur holes with subdural drain placement, twist drill craniotomy with drain, and even craniotomy. Various methods of management are discussed along with a review of pertinent literature.

The Contribution of Earth Observation Technologies to Monitoring Strategies of Cultural Landscapes and Sites

NASA Astrophysics Data System (ADS)

Cuca, B.

2017-08-01

Coupling of Climate change effects with management and protection of cultural and natural heritage has been brought to the attention of policy makers since several years. On the worldwide level, UNESCO has identified several phenomena as the major geo-hazards possibly induced by climate change and their possible hazardous impact to natural and cultural heritage: Hurricane, storms; Sea-level rise; Erosion; Flooding; Rainfall increase; Drought; Desertification and Rise in temperature. The same document further referrers to satellite Remote Sensing (EO) as one of the valuable tools, useful for development of "professional monitoring strategies". More recently, other studies have highlighted on the impact of climate change effects on tourism, an economic sector related to build environment and traditionally linked to heritage. The results suggest that, in case of emergency the concrete threat could be given by the hazardous event itself; in case of ordinary administration, however, the threat seems to be a "hazardous attitude" towards cultural assets that could lead to inadequate maintenance and thus to a risk of an improper management of cultural heritage sites. This paper aims to illustrate potential benefits that advancements of Earth Observation technologies can bring to the domain of monitoring landscape heritage and to the management strategies, including practices of preventive maintenance. The attempt here is to raise awareness on the importance of integrating satellite remote sensing imagery and the deriving products with other geospatial information (even geo-referenced historic maps) for a more complete insight on the environmental dynamics of landscapes.

Towards a balanced performance measurement system in a public health care organization.

PubMed

Yuen, Peter P; Ng, Artie W

2012-01-01

This article attempts to devise an integrated performance measurement framework to assess the Hong Kong Hospital Authority (HA) management system by harnessing previous performance measurement systems. An integrated evaluative framework based on the balanced score card (BSC) was developed and applied using the case study method and longitudinal data to evaluate the HA's performance management system. The authors unveil evolving HA performance indicators (P1). Despite the HA staffs explicit quality emphasis, cost control remains the primary focus in their performance measurements. RESEARCH LHNITATIONS/IMPLICATIONS: Data used in this study are from secondary sources, disclosed mostly by HA staff. This study shows public sector staff often attach too much importance to cost control and easily measurable activities at the expense of quality and other less easily measurable attributes'. A balanced performance measurement system, linked to health targets, with a complementary budgeting process that supports pertinent resource allocation is yet to be implemented in Hong Kong's public hospitals.

Applying Formal Methods to NASA Projects: Transition from Research to Practice

NASA Technical Reports Server (NTRS)

Othon, Bill

2009-01-01

NASA project managers attempt to manage risk by relying on mature, well-understood process and technology when designing spacecraft. In the case of crewed systems, the margin for error is even tighter and leads to risk aversion. But as we look to future missions to the Moon and Mars, the complexity of the systems will increase as the spacecraft and crew work together with less reliance on Earth-based support. NASA will be forced to look for new ways to do business. Formal methods technologies can help NASA develop complex but cost effective spacecraft in many domains, including requirements and design, software development and inspection, and verification and validation of vehicle subsystems. To realize these gains, the technologies must be matured and field-tested so that they are proven when needed. During this discussion, current activities used to evaluate FM technologies for Orion spacecraft design will be reviewed. Also, suggestions will be made to demonstrate value to current designers, and mature the technology for eventual use in safety-critical NASA missions.

"Someone's rooting for you": continuity, advocacy and street-level bureaucracy in UK maternal healthcare.

PubMed

Finlay, Susanna; Sandall, Jane

2009-10-01

Continuity and advocacy are widely held to be important elements in maternal healthcare, yet they are often lacking from the care women receive. In order to understand this disparity, we draw upon interviews and ethnographic observational findings from The One-to-One Caseload Project, a study exploring the impacts of a caseload model of maternity care within an urban National Health Service provider in Britain. Drawing on Lipsky's (1980) and Prottas's (1979) theories of street-level bureaucracy, this paper attempts to understand how midwives, working on the frontline within caseload and standard care models, manage the competing demands of delivering a personalised service within a bureaucratic organisation. The caseload care model serves as a case study for how a client-centred model of working can assist street-level bureaucrats to manage the administrative pressures of public service organisations and provide their clients with a personalised, responsive service. Nevertheless, despite such benefits, client-centred models of working may have unintended consequences for both health carers and healthcare systems.

The politics of participation in watershed modeling.

PubMed

Korfmacher, K S

2001-02-01

While researchers and decision-makers increasingly recognize the importance of public participation in environmental decision-making, there is less agreement about how to involve the public. One of the most controversial issues is how to involve citizens in producing scientific information. Although this question is relevant to many areas of environmental policy, it has come to the fore in watershed management. Increasingly, the public is becoming involved in the sophisticated computer modeling efforts that have been developed to inform watershed management decisions. These models typically have been treated as technical inputs to the policy process. However, model-building itself involves numerous assumptions, judgments, and decisions that are relevant to the public. This paper examines the politics of public involvement in watershed modeling efforts and proposes five guidelines for good practice for such efforts. Using these guidelines, I analyze four cases in which different approaches to public involvement in the modeling process have been attempted and make recommendations for future efforts to involve communities in watershed modeling. Copyright 2001 Springer-Verlag

Atrial fibrillation management in a breeding stallion.

PubMed

Heliczer, N; Mitchell, K; Lorello, O; Dauvillier, J; Burger, D; Schwarzwald, C C; Navas de Solis, C

2017-06-01

A 20-year-old warmblood breeding stallion presented to a University practice for semen collection and evaluation was incidentally diagnosed with atrial fibrillation (AF). Electrocardiogram recordings during breeding revealed inappropriately rapid tachycardia and occasional ventricular premature depolarizations/aberrant ventricular conduction. Transvenous electrical cardioversion was performed. After successful cardioversion the horse displayed supraventricular ectopy and atrial contractile dysfunction and was administered sotalol hydrochloride in an attempt to decrease the risk of AF recurrence. Supraventricular ectopy and echocardiographic evidence of atrial dysfunction gradually improved and normalized over 6 months. No direct adverse effects of the chronic anti-arrhythmic treatment were observed and libido and semen quality were unaffected. AF recurred 6 months after cardioversion and sotalol therapy was continued to control the ventricular ectopy/aberrant ventricular conduction during semen collection. Considerations regarding pathologic arrhythmias and inappropriately high heart rates in breeding stallions with AF may be similar to those in riding horses. Sotalol hydrochloride was a safe anti-arrhythmic drug in the management of this case. Copyright © 2017 Elsevier B.V. All rights reserved.

Portfolio Management Decision Support Tools Analysis Relating to Management Value Metrics

DTIC Science & Technology

2007-03-01

creative activities that have been labeled “management dark matter ” (Housel and Kanevsky, 2007). Further, this new source of data can be used, not...organization. “The idea of management dark matter is introduced in this literature as the use of manager’s creative insights when they attempt to...we account for the dark matter or intuitive (i.e., non-algorithmically definable) heuristics that allow a manager to make creative management

Lakes and ponds recreation management: a state-wide application of the visitor impact management process

Treesearch

Jerry J. Vaske; Rodney R. Zwick; Maureen P. Donnelly

1992-01-01

The Visitor Impact Management (VIM) process is designed to identify unacceptable changes occurring as a result of visitor use and to develop management strategies to keep visitor impacts within acceptable levels. All previous attempts to apply the VIM planning framework have concentrated on specific resources. This paper expands this focus to an entire state. Based on...

Riparian and aquatic habitats of the Pacific Northwest and southeast Alaska: ecology, management history, and potential management strategies.

Treesearch

Fred H. Everest; Gordon H. Reeves

2007-01-01

Management of riparian habitats is controversial because land use policies have historically emphasized economic values (e.g., timber production) at the expense of ecological and social values. Attempting to manage these valuable resources to attain the greatest combination of benefits has created a long-term controversy that continues to the present. Our analysis...

Case series: Bladder clot evacuation using a prostate morcellation device.

PubMed

Doersch, Karen M; Navetta, Andrew F; Bird, Erin T; El Tayeb, Marawan M

2017-07-01

We sought to provide a technical update on the use of a prostate morcellator device (PMD) to manage organized blood clots of the bladder following laser prostatectomy. Herein, we describe our experience in using the Wolf Piranha morcellator in managing organized bladder blood clots supplemented with a retrospective chart review of the patients in whom this procedure was performed. Six patients, all male with a mean age of 75 ± 8.9 years, had organized bladder clots following either holmium laser enucleation or photoselective vaporization of the prostate managed with a PMD. Clots were recognized based on hematuria or urinary retention a median of 3.5 days following the aforementioned procedures. Initial management was attempted with more conservative measures, including a three-way Foley catheter, followed by cystoscopy with an Ellik evacuator, or a glass Tommey syringe. Morcellation times were a mean of 10.2 ± 6.15 minutes (range 2-18). This technique was able to manage clots that were an average of 173.3 ± 115.9 cc in size. The procedure was well-tolerated. No patients experienced intraoperative or morcellator-related complications. Benign prostatic hypertrophy frequently requires surgical endoscopic management and can be complicated by hematuria and bladder blood clot formation. When these clots become organized, this can lead to urinary retention and the required management, evacuation, may be difficult. The use of a Wolf Piranha PMD is a safe, well-tolerated, and effective in evacuating organized blood clots of the bladder.

Knowledge Management: A Skeptic's Guide

NASA Technical Reports Server (NTRS)

Linde, Charlotte

2006-01-01

A viewgraph presentation discussing knowledge management is shown. The topics include: 1) What is Knowledge Management? 2) Why Manage Knowledge? The Presenting Problems; 3) What Gets Called Knowledge Management? 4) Attempts to Rethink Assumptions about Knowledgs; 5) What is Knowledge? 6) Knowledge Management and INstitutional Memory; 7) Knowledge Management and Culture; 8) To solve a social problem, it's easier to call for cultural rather than organizational change; 9) Will the Knowledge Management Effort Succeed? and 10) Backup: Metrics for Valuing Intellectural Capital i.e. Knowledge.

Endoscopic management of massive mercury ingestion

PubMed Central

Zag, Levente; Berkes, Gábor; Takács, Irma F; Szepes, Attila; Szabó, István

2017-01-01

Abstract Rationale: Ingestion of a massive amount of metallic mercury was thought to be harmless until the last century. After that, in a number of cases, mercury ingestion has been associated with appendicitis, impaired liver function, memory deficits, aspiration leading to pneumonitis and acute renal failure. Treatment includes gastric lavage, giving laxatives and chelating agents, but rapid removal of metallic mercury with gastroscopy has not been used. Patient concerns: An 18-year-old man was admitted to our emergency department after drinking 1000 g of metallic mercury as a suicide attempt. Diagnosis: Except from mild umbilical tenderness, he had no other symptoms. Radiography showed a metallic density in the area of the stomach. Intervention: Gastroscopy was performed to remove the mercury. One large pool and several small droplets of mercury were removed from the stomach. Outcomes: Blood and urine mercury levels of the patient remained low during hospitalization. No symptoms of mercury intoxication developed during the follow-up period. Lessons: Massive mercury ingestion may cause several symptoms, which can be prevented with prompt treatment. We used endoscopy to remove the mercury, which shortened the exposure time and minimized the risk of aspiration. This is the first case where endoscopy was used for the management of mercury ingestion. PMID:28562544

Implementing Information and Communication Technology to Support Community Aged Care Service Integration: Lessons from an Australian Aged Care Provider.

PubMed

Douglas, Heather E; Georgiou, Andrew; Tariq, Amina; Prgomet, Mirela; Warland, Andrew; Armour, Pauline; Westbrook, Johanna I

2017-04-10

There is limited evidence of the benefits of information and communication technology (ICT) to support integrated aged care services. We undertook a case study to describe carelink+, a centralised client service management ICT system implemented by a large aged and community care service provider, Uniting. We sought to explicate the care-related information exchange processes associated with carelink+ and identify lessons for organisations attempting to use ICT to support service integration. Our case study included seventeen interviews and eleven observation sessions with a purposive sample of staff within the organisation. Inductive analysis was used to develop a model of ICT-supported information exchange. Management staff described the integrated care model designed to underpin carelink+. Frontline staff described complex information exchange processes supporting coordination of client services. Mismatches between the data quality and the functions carelink+ was designed to support necessitated the evolution of new work processes associated with the system. There is value in explicitly modelling the work processes that emerge as a consequence of ICT. Continuous evaluation of the match between ICT and work processes will help aged care organisations to achieve higher levels of ICT maturity that support their efforts to provide integrated care to clients.

Implementing Information and Communication Technology to Support Community Aged Care Service Integration: Lessons from an Australian Aged Care Provider

PubMed Central

Georgiou, Andrew; Tariq, Amina; Prgomet, Mirela; Warland, Andrew; Armour, Pauline; Westbrook, Johanna I

2017-01-01

Introduction: There is limited evidence of the benefits of information and communication technology (ICT) to support integrated aged care services. Objectives: We undertook a case study to describe carelink+, a centralised client service management ICT system implemented by a large aged and community care service provider, Uniting. We sought to explicate the care-related information exchange processes associated with carelink+ and identify lessons for organisations attempting to use ICT to support service integration. Methods: Our case study included seventeen interviews and eleven observation sessions with a purposive sample of staff within the organisation. Inductive analysis was used to develop a model of ICT-supported information exchange. Results: Management staff described the integrated care model designed to underpin carelink+. Frontline staff described complex information exchange processes supporting coordination of client services. Mismatches between the data quality and the functions carelink+ was designed to support necessitated the evolution of new work processes associated with the system. Conclusions: There is value in explicitly modelling the work processes that emerge as a consequence of ICT. Continuous evaluation of the match between ICT and work processes will help aged care organisations to achieve higher levels of ICT maturity that support their efforts to provide integrated care to clients. PMID:29042851

An overview of history, pathogenesis and treatment of perforated peptic ulcer disease with evaluation of prognostic scoring in adults.

PubMed

Prabhu, V; Shivani, A

2014-01-01

Peptic ulcer disease including both gastric and duodenal ulcer form a substantial part of patients seeking surgical opinion world-wide. The concept of acid in peptic ulcer disease, which was the basis of treatment of peptic ulcer was revolutionized by the discovery of H2-receptor antagonists, that led to the principle of acid suppression therapy for duodenal ulcer which followed decades of preference for surgical interventions in the form of gastric resections, vagotomy etc., After the discovery of Helicobacter pylori organism as the causative factor a triple drug regime was identified to treat peptic disease which was further modified to sequential therapy to avoid antibiotic resistance. This recognition has not concluded the chapter on peptic ulcers. The management of ulcer disease and its complications remain a surgical challenge. All the materials for this review have been accessed from various internet search engines. The references have been narrowed down to 34 by excluding cross references, duplicated citations, pediatric studies, case reports, iatrogenic and malignant perforations and including microbiological, immunohistochemistry references and studies with more than a sample size of ten. Case control, cohort studies, prospective/retrospective, metaanalytical studies were preferred in that order. This article attempts to take an overview of all aspects of the management of peptic ulcer.

The Emergence of `Power with': The Case of a Born Global Organization

NASA Astrophysics Data System (ADS)

Yan, Lin; Panteli, Niki

Thanks to the advancement of Information and Communications Technologies, the past decade has seen the rise of Born Global organizations (Rennie, 1993; Oviatt and McDougall, 1994; Karra and Philips, 2004; Zahra, 2005). Broadly defined as ‘business organizations that, right from inception, seek to derive significant competitive advantages from the use of resources and the sales of outputs in multiple countries’ (Oviatt and McDougall, 1994: 49), Born Global organizations are small, young, and internationally dispersed. While sharing the characteristics of ‘smallness’ and ‘newness’ of Small- and Medium-sized Enterprises (SMEs), Born Global organizations also bear ‘foreignness’, similar to that of Multinational Corporations (Zahra, 2005). Born Globals therefore need to strike a balance between ‘global reach’ and ‘local touch’ as in Multinational Corporations (Bartlett and Ghoshal, 1989); yet they have to do so with scare resources and organizational uncertainty similar to SMEs, and with ‘lean’ and ‘mean’ communications afforded by ICT (e.g. Sproull and Kiesler, 1986). This study is an initial attempt to untangle the combined challenges in Born Globals’ innovative way of management. Through a longitudinal case study, we aim to explore the issue of power in a Born Global’s endeavour to manage its global knowledge via technology mediation.

An Overview of History, Pathogenesis and Treatment of Perforated Peptic Ulcer Disease with Evaluation of Prognostic Scoring in Adults

PubMed Central

Prabhu, V; Shivani, A

2014-01-01

Peptic ulcer disease including both gastric and duodenal ulcer form a substantial part of patients seeking surgical opinion world-wide. The concept of acid in peptic ulcer disease, which was the basis of treatment of peptic ulcer was revolutionized by the discovery of H2-receptor antagonists, that led to the principle of acid suppression therapy for duodenal ulcer which followed decades of preference for surgical interventions in the form of gastric resections, vagotomy etc., After the discovery of Helicobacter pylori organism as the causative factor a triple drug regime was identified to treat peptic disease which was further modified to sequential therapy to avoid antibiotic resistance. This recognition has not concluded the chapter on peptic ulcers. The management of ulcer disease and its complications remain a surgical challenge. All the materials for this review have been accessed from various internet search engines. The references have been narrowed down to 34 by excluding cross references, duplicated citations, pediatric studies, case reports, iatrogenic and malignant perforations and including microbiological, immunohistochemistry references and studies with more than a sample size of ten. Case control, cohort studies, prospective/retrospective, metaanalytical studies were preferred in that order. This article attempts to take an overview of all aspects of the management of peptic ulcer. PMID:24669326

Technology to improve quality and accountability.

PubMed

Kay, Jonathan

2006-01-01

A body of evidence has been accumulated to demonstrate that current practice is not sufficiently safe for several stages of central laboratory testing. In particular, while analytical and perianalytical steps that take place within the laboratory are subjected to quality control procedures, this is not the case for several pre- and post-analytical steps. The ubiquitous application of auto-identification technology seems to represent a valuable tool for reducing error rates. A series of projects in Oxford has attempted to improve processes which support several areas of laboratory medicine, including point-of-care testing, blood transfusion, delivery and interpretation of reports, and support of decision-making by clinicians. The key tools are auto-identification, Internet communication technology, process re-engineering, and knowledge management.

Reconstruction of War Damaged Buildings - A Problem that Still Stands. The Case of the National Economy Bank in Warsaw Restored During the Second World War

NASA Astrophysics Data System (ADS)

Łotysz, Sławomir

2016-12-01

The Polish national historiography remains silent on the reconstruction of damaged towns and cities that was undertaken by the German administration after capturing Poland in September 1939. This paper, on the war-time restoration of the National Economy Bank's headquarters in Warsaw, is an attempt to at least partially fill the gap. Designed by celebrated architect Rudolf Świerczyński in the late 1920s in accordance with contemporary air raid defence regulations, it was bombed and nevertheless seriously damaged during the September Campaign. Under the German management of the bank, the building was reconstructed and even modernized by commissioned Polish engineers.

Surgical stabilization of shoulder luxation in a pot-bellied pig.

PubMed

Rubio-Martínez, Luis M; Rioja, Eva; Shakespeare, A S

2013-03-15

Case Description-A 4.6-month-old pot-bellied pig was evaluated because of non-weight-bearing lameness (grade 5/5) in the right forelimb of 4 days' duration. Clinical Findings-Clinical and radiographic examination revealed a closed, lateral luxation of the right shoulder joint. Treatment and Outcome-Initial attempts at closed reduction failed to provide adequate stability of the shoulder joint. Open reduction and internal fixation by placement of 2 lateral tension sutures with a system designed for canine cranial cruciate ligament repair provided adequate joint stability and a successful outcome. Conclusions and Clinical Relevance-Stabilization of the shoulder joint with lateral tension sutures after open reduction should be considered for management of lateral shoulder luxation in pot-bellied pigs.

Attempting to detect and record brushland in the northeastern United States using MSS data - Schoharie County, N.Y., as a case study

NASA Technical Reports Server (NTRS)

Baumann, Paul R.

1990-01-01

Before county and local governments will utilize satellite data extensively for landcover inventories, digital image processing techniques must be developed to identify transitional land-use conditions and create large-scale, readable land-cover maps. This study examines a satellite-based land-cover inventory done for Schoharie County, New York and reviews the problems encountered in identifying and mapping brushland - a significant transitional land use - within the county and region. Brushland throughout the Northeast represents a barometer for measuring the shift away from agricultural land use to second-home property. Detecting and locating brushland on a regular basis can greatly assist county and local government officials in planning and managing a county's future.

Attempted suicide by snake bite: A case study.

PubMed

Mallik, Subhendu; Singh, Sudipta Ranjan; Mohanty, Manoj Kumar; Padhy, Niranjan

2016-07-14

Snake bite is an important public health issue in India and is almost always accidental in manner. Suicide by snake bite or injection of snake venom is extremely rare. Suicidal ideation and behavior is known to be influenced by various socio-economic and psychological factors. The method employed for suicide is also influenced by the occupation of the victim. We report a case where a snake charmer had attempted suicide by inflicting a bite by a monocled cobra. © The Author(s) 2016.

The Work-Life Balance Pursuit: Challenges, Supports, and Strategies of Successful Women Senior Student Affairs Officers

ERIC Educational Resources Information Center

Stirling, Carolyn C.

2012-01-01

Women educational leaders struggle to achieve and sustain success in senior positions due to their attempts to manage societal expectations for balancing work and family. Societal expectations of being the primary caregivers result in working women attempting to navigate multiple professional and personal roles. Those who have attained the highest…

Managed care. Shifts health care from an altruistic model to a business framework.

PubMed

Kersbergen, A L

2000-01-01

The term managed care, as used throughout the scientific and lay literature, has become a generic label without a clear, universally accepted definition. The many definitions and descriptions of managed care are usually directly related to the model under discussion. Nevertheless, as nurse educators attempt to align curricula with the evolving health care environment, it is imperative that students gain an understanding of the concept of managed care and the skills needed to practice in the managed care environment. Schools of nursing must prepare students to deal with the consequences of managed care, namely, the changing base of power, conflicts, and ethical dilemmas across settings. The drive to control health care costs in the 1990s brought about unprecedented change for nurses. Regardless of the strategies implemented in the name of managing care, the evolving health care environment has changed where and how nurses practice. To aid faculty in the revision of the nursing curriculum, an attempt was made to arrive at an empirically based definition of managed care that will provide a conceptual foundation for future research and theoretical discussions. Other goals were to identify consequences of managed care across disciplines and models implemented in the name of managing care, and to identify skills needed by nurses today.

Why do parents enrol in a childhood obesity management program?: a qualitative study with parents of overweight and obese children.

PubMed

Davidson, Kamila; Vidgen, Helen

2017-02-02

Despite the high prevalence of childhood overweight and obesity enrolment to weight management programs remains difficult, time consuming, costly and has limited effectiveness. The aim of this paper was to explore parents' perspectives on factors that influence their decision to enrol in a program to address their child's weight. Semi-structured qualitative telephone interviews were undertaken with 21 parents of primary school aged children above the healthy weight range who had enrolled in a healthy lifestyle program. Questions were developed and analysed using the Theory of Planned Behaviour. They addressed parental reasons for enrolment, expectations of the program and apprehensions regarding enrolling. Prior to deciding to enrol, parents tended to be aware of the child's weight status, had attempted to address it themselves and had sought help from a number of people including health professionals. Parental decision to enrol was influenced by their evaluation of their previous attempts and their child's emotional state. Awareness of their child's weight status is an important first step in parents taking action at this health issue however it is unlikely to be sufficient on its own. Parental decision to join a childhood obesity management program can be complex and is likely to be made after numerous and unsuccessful attempts to address the child's weight. Strategies to encourage parents to enrol in programs should include activities beyond awareness of weight status. Health professionals should use contact time with parents to raise awareness of the child's weight status and to provide encouragement to address overweight and obesity. Parents must be supported in their attempts to address their child's overweight and obesity whether they choose to manage it themselves or within a program.

A Continuous Quality Improvement Airway Program Results in Sustained Increases in Intubation Success.

PubMed

Olvera, David J; Stuhlmiller, David F E; Wolfe, Allen; Swearingen, Charles F; Pennington, Troy; Davis, Daniel P

2018-02-21

Airway management is a critical skill for air medical providers, including the use of rapid sequence intubation (RSI) medications. Mediocre success rates and a high incidence of complications has challenged air medical providers to improve training and performance improvement efforts to improve clinical performance. The aim of this research was to describe the experience with a novel, integrated advanced airway management program across a large air medical company and explore the impact of the program on improvement in RSI success. The Helicopter Advanced Resuscitation Training (HeART) program was implemented across 160 bases in 2015. The HeART program includes a novel conceptual framework based on thorough understanding of physiology, critical thinking using a novel algorithm, difficult airway predictive tools, training in the optimal use of specific airway techniques and devices, and integrated performance improvement efforts to address opportunities for improvement. The C-MAC video/direct laryngoscope and high-fidelity human patient simulation laboratories were implemented during the study period. Chi-square test for trend was used to evaluate for improvements in airway management and RSI success (overall intubation success, first-attempt success, first-attempt success without desaturation) over the 25-month study period following HeART implementation. A total of 5,132 patients underwent RSI during the study period. Improvements in first-attempt intubation success (85% to 95%, p < 0.01) and first-attempt success without desaturation (84% to 94%, p < 0.01) were observed. Overall intubation success increased from 95% to 99% over the study period, but the trend was not statistically significant (p = 0.311). An integrated advanced airway management program was successful in improving RSI intubation performance in a large air medical company.

Cost benefit of privatizing wall barrier.

DOT National Transportation Integrated Search

2007-08-01

This project began as an attempt to perform a formal comparative cost benefit analysis of privatized wall barrier purchase/management and NMDOT wall barrier purchase/management in order to answer the question "What are the costs and benefits of priva...

Staff Planning in a Time of Recession.

ERIC Educational Resources Information Center

Moore, Nick

1979-01-01

Examines staff management problems within British public libraries, one example of which is the unsuccessful attempt to introduce participative management. The effect of trade unions is noted and three levels of personnel planning (national, professional, and local) are discussed. (SW)

Brazilian and Mexican experiences in the study of incipient domestication.

PubMed

Lins Neto, Ernani Machado de Freitas; Peroni, Nivaldo; Casas, Alejandro; Parra, Fabiola; Aguirre, Xitlali; Guillén, Susana; Albuquerque, Ulysses Paulino

2014-04-02

Studies of domestication enables a better understanding of human cultures, landscape changes according to peoples' purposes, and evolutionary consequences of human actions on biodiversity. This review aimed at discussing concepts, hypotheses, and current trends in studies of domestication of plants, using examples of cases studied in regions of Mesoamerica and Brazil. We analyzed trends of ethnobiological studies contributing to document processes of domestication and to establish criteria for biodiversity conservation based on traditional ecological knowledge. Based on reviewing our own and other authors' studies we analyzed management patterns and evolutionary trends associated to domestication occurring at plant populations and landscape levels. Particularly, we systematized information documenting: ethnobotanical aspects about plant management and artificial selection mechanisms, morphological consequences of plant management, population genetics of wild and managed plant populations, trends of change in reproduction systems of plants associated to management, and other ecological and physiological aspects influenced by management and domestication. Based on the analysis of study cases of 20 native species of herbs, shrubs and trees we identified similar criteria of artificial selection in different cultural contexts of Mexico and Brazil. Similar evolutionary trends were also identified in morphology (selection in favor of gigantism of useful and correlated parts); organoleptic characteristics such as taste, toxicity, color, texture; reproductive biology, mainly breeding system, phenological changes, and population genetics aspects, maintenance or increasing of genetic diversity in managed populations, high gene flow with wild relatives and low structure maintained by artificial selection. Our review is a first attempt to unify research methods for analyzing a high diversity of processes. Further research should emphasize deeper analyses of contrasting and diverse cultural and ecological contexts for a better understanding of evolution under incipient processes of domestication. Higher research effort is particularly required in Brazil, where studies on this topic are scarcer than in Mexico but where diversity of human cultures managing their also high plant resources diversity offer high potential for documenting the diversity of mechanisms of artificial selection and evolutionary trends. Comparisons and evaluations of incipient domestication in the regions studied as well as the Andean area would significantly contribute to understanding origins and diffusion of the experience of managing and domesticating plants.

Association of Toxoplasma gondii infection with schizophrenia and its relationship with suicide attempts in these patients.

PubMed

Ansari-Lari, Maryam; Farashbandi, Hassan; Mohammadi, Fahimeh

2017-10-01

To investigate the association between schizophrenia and Toxoplasma gondii, and to assess the association of infection with suicide attempts and age of onset of schizophrenia in these patients. Case-control study Fars Province, southern Iran. Cases were individuals with psychiatric diagnosis of schizophrenia as per Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Controls were healthy blood donors, frequency-matched with patients according to age and sex. For the detection of IgG antibodies, enzyme-linked immunosorbent assay (ELISA) was used. Data about demographic information in all subjects and duration of illness and history of suicide attempts in patients with schizophrenia were collected using a brief questionnaire and hospital records. Chi-square test and multivariable logistic regression were used for statistical analyses. Among 99 cases, 42 individuals (42%) were positive for T. gondii antibody, vs. 41 (27%) among 152 controls (OR = 2, 95% CI: 1.2-3.4, P = 0.012). We compared the suicide attempts in patients with schizophrenia based on their T. gondii serologic status. There was a lower rate of suicide attempts in seropositive male patients than seronegative ones (OR = 0.3, 95% CI: 0.1-0.97, P = 0.04). Age of onset of schizophrenia did not differ between T. gondii-infected and non-infected patients. These findings may have implications for schizophrenia and suicide prevention programmes. However, clearly further studies are required to confirm them. © 2017 John Wiley & Sons Ltd.

Soil Management for Hardwood Production

Treesearch

W. M. Broadfoot; B. G. Blackmon; J. B. Baker

1971-01-01

Soil management is the key to successful hardwood management because soil properties are probably the most important determinants of forest productivity. Because of the lack of soil uniformity, however, many foresters have become frustrated with attempts to relate soil to satisfactory growth. Since soil scientists have been unable to predict site quality for trees in...

Planning for management information systems in drug treatment organizations.

PubMed

Zalkind, D; Zelon, H; Moore, M; Kaluzny, A

1979-02-01

An attempt to set up a management information system for individual drug abuse programs throughout a state is described. The principles upon which the system is based are discussed along with the problems encountered in its implementation. A series of guidelines for establishing management information systems in operating human services agencies is included.

Proceedings of the Sierra Nevada Science Symposium

Treesearch

Dennis D. Murphy; Peter A. Stine

2004-01-01

Land and resource management issues in the Sierra Nevada are becoming increasingly complex and controversial. The objective of the Sierra Nevada Science Symposium was to provide a synoptic overview of the current state of scientific knowledge related to key management issues. Attempts were made to tie recent scientific findings to applications in land management and...

Boys' Boarding School Management: Understanding the Choice Criteria of Parents

ERIC Educational Resources Information Center

Vigar-Ellis, Debbie

2013-01-01

The South African secondary boarding school sector has become more competitive as schools attempt to attract and retain pupils. Management of such schools must not only address the educational and boarding needs of pupils, but also apply appropriate management and marketing principles to compete effectively with boarding schools throughout the…

Preparing Students for Front-Line Management: Non-Routine Day-to-Day Decisions

ERIC Educational Resources Information Center

Clydesdale, Greg; Tan, John

2009-01-01

Purpose: This paper attempts to reduce the gap between management education and practice. It emphasises day-to-day decisions that middle and lower level managers make. The purpose is to provide an education framework embodying a flexible approach to interpretation and solution creation, suitable for situations of ambiguity and uncertainty.…

'People-Work': Emotion Management, Stress and Coping

ERIC Educational Resources Information Center

Mann, Sandi

2004-01-01

Workers involved in 'people-work' are expected to engage in a great deal of emotion management as they attempt to convey the appropriate emotions (which they may not genuinely feel) to their clients or customers whilst perhaps suppressing inappropriate ones. Should this emotion management be unsuccessful within some industries, a customer may be…

Development of an Effective Special Therapy Bed Management System at Walter Reed Army Medical Center.

DTIC Science & Technology

1991-12-01

Patillo, 1990). The administrative support element attempted to pattern itself after the clinical model, hoping to better manage shortages of personnel...Material ManaQement Quarterly, 11(3), 36-48. Thomas, C. (1989). Specialty beds: Decision making made easy. Ostomy -Wound Management, 23, 51-59. Thomson

Healthy Eating and Exercise: Strategies for Weight Management in the Rural Midwest

ERIC Educational Resources Information Center

Nothwehr, Faryle; Peterson, N. Andrew

2005-01-01

Obesity prevalence has increased dramatically in the United States. Rural areas have been especially affected, yet few weight management studies have been conducted in these populations. This study was designed to assess weight management attitudes and strategies used when rural adults in particular attempt to lose weight, employing measures that…

How much habitat management is needed to meet mallard production objectives?

USGS Publications Warehouse

Cowardin, L.M.; Shaffer, T.L.; Kraft, K.M.

1995-01-01

We used results from simulation models to demonstrate the benefit-cost ratios of habitat management to increase the number of mallard (Anas platyrhynchos) recruits produced. The models were applied to hypothetical 2-habitat landscapes comprised of managed and unmanaged habitat. Managed habitats were predator barrier fencing and CRP cover; unmanaged habitat was grassland. As the amount of managed cover increased, the production curve rose rapidly and leveled off. If 2 managed habitats are added to a landscape, the cover can compete for available nesting hens, thus negating the benefits of 1 of the covers. After converting benefits and costs to dollars, we determined the point at which maximum net benefit occurs. We present an equation that can be used to determine the maximum net benefit of a management treatment given the size of the breeding population and the values of costs and benefits. Our examples demonstrate that, on local areas, it is inefficient to spend money for habitat management once maximum net benefit has been attained. If desired production can not be attained efficiently on an area, the manager can invest effort on alternative areas with greater management potential. If recruitment is inadequate to maintain a stable population, managers should manage to increase recruitment before attempting to attract additional breeding pairs. If recruitment more than maintains the breeding population, managers should attempt to attract additional breeding pairs to the area.

The case of Ohio v. Robinson. An 1870 bite mark case.

PubMed

Pierce, L J; Strickland, D J; Smith, E S

1990-06-01

In 1870, Ansil L. Robinson was charged with the murder of his mistress, Mary Lunsford, in Mansfield, Ohio, U.S.A. Evidence against Robinson included an attempt to match his teeth to bite marks on the victim's arm. Robinson was acquitted after a 3-week trial despite the evidence linking his teeth to the wounds. This trial represents an early and perhaps the first attempt to admit bite-mark evidence in a court of law in the United States. The acquittal resulted in the obscurity that prevented this case from coming to the awareness of the forensic dental and legal communities sooner.

Influential third party on water right conflict: A Game Theory approach to achieve the desired equilibrium (case study: Ilam dam, Iran).

PubMed

Zanjanian, Hossein; Abdolabadi, Hamid; Niksokhan, Mohammad Hossein; Sarang, Amin

2018-05-15

Allocating water to organizational stakeholders poses a vital challenge to water managers. Organizations which benefit from water as the primary factor input attempt to achieve their objectives using cost-effective and quick-return strategies, such as increasing the water rights. In such circumstances, lack of water probably results in the conflict. Recognizing the management approaches, organizational priorities, and the stakeholders' influence power can play a dominant role in analyzing the future of such conflicts. In this paper, we analyzed the conflict of water allocation in Ilam dam among organizational stakeholders. We defined the strategies based on the background of the game and organizational objectives. The influence power of stakeholders and the numerical weights of strategies were quantified based on the expert judgment method. The relative priorities of strategies were then calculated for each state of the conflict. We used the GMCR + model to study the actions of stakeholders. Results suggest that the Jihad Agriculture Organization and the Water and Wastewater Company withdraw more water; hence, there exists no water to meet the environmental water right. In this case, the participation of the third party, such as the Governorship and the Justice can change the future of the conflict, and result in moving to the optimal state. However, results from Inverse GMCR analysis demonstrate that Justice is the most influential third party that can move the conflict towards a desired equilibrium (optimal case). Copyright © 2018 Elsevier Ltd. All rights reserved.

Post-traumatic pseudomyopia.

PubMed

London, Richard; Wick, Bruce; Kirschen, David

2003-02-01

Many clinicians have noted that patients demonstrate a myopic refractive change following Traumatic Brain Injury (TBI). This apparent myopic shift disappears with cycloplegia, yet stubbornly reappears as soon as the pharmaceutical effect wears off. We propose that this shift is secondary to an irritative lesion that affects the parasympathetic innervation, resulting in ciliary body contracture. The dilemma for the clinician is whether to provide the immediate relief of clear distance vision by prescribing additional minus lenses, or to work toward attempting to re-establish the baseline refractive error. The natural history of post-traumatic pseudomyopia in our experience involves one of the following three courses: (1) a transient condition that will occasionally resolve; (2) the typical case, a recalcitrant condition that will resolve under cycloplegic intervention, but immediately return as the cycloplegic wears off; or (3) a less-common subgroup of patients who continue to show an increase in myopia over time. Our description of these cases demonstrates management strategies (including atropinization) to relax accommodative spasm, traditional vision therapy techniques aimed at loosening the accommodative system, and refractive corrections. Pseudomyopia is one of many ocular and behavioral sequelae following TBI. By understanding the natural course and potential management options for post-traumatic pseudomyopia, the clinician will be better prepared to deal with these challenging cases. Flexibility is required, since options that work with one patient may prove ineffective with another. Counseling the patient as to potential outcomes given the natural history of this condition helps establish more-realistic expectations by the patients being treated.

Quality assessment and improvement of "Unsatisfactory" liquid-based cervicovaginal papanicolaou smears.

PubMed

Mirzamani, Neda; Chau, Karen; Rafael, Oana; Shergill, Uday; Sajjan, Sujata; Sumskaya, Irina; Gimenez, Cecilia; Klein, Melissa; Das, Kasturi

2017-10-01

The quality of cervicovaginal smears determines the success of cytology in screening programs for cervical cancer. Bethesda 2014 revisited the adequacy criteria for atrophic smears and redefined the squamous cell count in the "unsatisfactory" category. In this study, we evaluated the smear quality of Thinprep liquid-based cervicovaginal Papanicolaou cytology slides (TPS) that were previously deemed unsatisfactory, to determine reasons for such categorization. In addition, we attempted to establish the impact of the new adequacy criteria on the rate and management of unsatisfactory diagnosis. About 234 unsatisfactory TPS were examined. The reasons for unsatisfactory were noted. The number of squamous cells was recounted, as per the new Bethesda criteria, in borderline adequacy cases that showed an atrophic pattern. The leading cause for unsatisfactory TPS was lubricating gel, followed by blood, as observed in older and younger age groups, respectively (Figure 1). Eleven borderline cases were reclassified as "satisfactory" using the new Bethesda cell count, with 27% above 60 years of age. About 82% of these borderline cases were negative for intraepithelial lesion or malignancy on repeat testing. There was no difference of management or change in rate of unsatisfactory when patients above 60 were reclassified into the satisfactory category using the new Bethesda count. However, a larger study is needed to evaluate whether the new recommendation for minimum cellularity can be implemented in patients above a certain age cut-off. The study highlights the need for improvement in collection practices and education of practitioners. © 2017 Wiley Periodicals, Inc.

Trauma airway management in emergency departments: a multicentre, prospective, observational study in Japan.

PubMed

Nakao, Shunichiro; Kimura, Akio; Hagiwara, Yusuke; Hasegawa, Kohei

2015-02-04

Although successful airway management is essential for emergency trauma care, comprehensive studies are limited. We sought to characterise current trauma care practice of airway management in the emergency departments (EDs) in Japan. Analysis of data from a prospective, observational, multicentre registry-the Japanese Emergency Airway Network (JEAN) registry. 13 academic and community EDs from different geographic regions across Japan. 723 trauma patients who underwent emergency intubation from March 2010 through August 2012. ED characteristics, patient and operator demographics, methods of airway management, intubation success or failure at each attempt and adverse events. A total of 723 trauma patients who underwent emergency intubation were eligible for the analysis. Traumatic cardiac arrest comprised 32.6% (95% CI 29.3% to 36.1%) of patients. Rapid sequence intubation (RSI) was the initial method chosen in 23.9% (95% CI 21.0% to 27.2%) of all trauma patients and in 35.5% (95% CI 31.4% to 39.9%) of patients without cardiac arrest. Overall, intubation was successful in ≤3 attempts in 96% of patients (95% CI 94.3% to 97.2%). There was a wide variation in the initial methods of intubation; RSI as the initial method was performed in 0-50.9% of all trauma patients among 12 EDs. Similarly, there was a wide variation in success rates and adverse event rates across the EDs. Success rates varied between 35.5% and 90.5% at the first attempt, and 85.1% and 100% within three attempts across the 12 EDs. In this multicentre prospective study in Japan, we observed a high overall success rate in airway management during trauma care. However, the methods of intubation and success rates were highly variable among hospitals. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

What limits tool use in nonhuman primates? Insights from tufted capuchin monkeys (Sapajus spp.) and chimpanzees (Pan troglodytes) aligning three-dimensional objects to a surface

PubMed Central

la Cour, L. T.; Stone, B. W.; Hopkins, W.; Menzel, C.; Fragaszy, D.

2013-01-01

Perceptuomotor functions that support using hand tools can be examined in other manipulation tasks, such as alignment of objects to surfaces. We examined tufted capuchin monkeys’ and chimpanzees’ performance at aligning objects to surfaces while managing one or two spatial relations to do so. We presented 6 subjects of each species with a single stick to place into a groove, two sticks of equal length to place into two grooves, or two sticks joined as a T to place into a T-shaped groove. Tufted capuchins and chimpanzees performed equivalently on these tasks, aligning the straight stick to within 22.5° of parallel to the groove in approximately half of their attempts to place it, and taking more attempts to place the T stick than two straight sticks. The findings provide strong evidence that tufted capuchins and chimpanzees do not reliably align even one prominent axial feature of an object to a surface, and that managing two concurrent allocentric spatial relations in an alignment problem is significantly more challenging to them than managing two sequential relations. In contrast, humans from two years of age display very different perceptuomotor abilities in a similar task: they align sticks to a groove reliably on each attempt, and they readily manage two allocentric spatial relations concurrently. Limitations in aligning objects and in managing two or more relations at a time significantly constrain how nonhuman primates can use hand tools. PMID:23820935

A case study on the feasibility and performance of an UWB-AoA real time location system for resources management of civil construction projects

NASA Astrophysics Data System (ADS)

Mok, Esmond; Xia, Linyuan; Retscher, Guenther; Tian, Hui

2010-06-01

The application of integrated satellite and modern wireless positioning technologies for ubiquitous real-time resources management in large scale civil engineering projects can greatly optimize the time and cost in the construction process, and is now the trend for modern construction project management. As the outdoor conditions of most civil construction sites are open to sky, satellite positioning with the popularly used Global Positioning System (GPS) has been proved to be very efficient and effective. However, the condition in indoor and underground construction site is very complicated due to the fact that different construction activities would be carried out in different congested areas, involving heavy construction plant, equipment, professionals and technical personnel. Nowadays different emerging technologies such as Wi-Fi and ZigBee can be adopted for position and tracking in indoor environments. Nevertheless, under the very complicated construction site conditions these technologies may fail due to movement of human resources and construction plant, variation of metrological conditions, and serious multipath effects of signals. It is considered that Ultra Wide Band (UWB) technology is more suitable for indoor construction site environments. In this paper, a case study on the attempt of integrating GPS with Ubisense Real-time Location System (RTLS) for resources management in an underground railway construction site is discussed. Laboratory and field tests have shown that the RTLS can provide better resources management capability in terms of positioning accuracy and stability than Wi-Fi and ZigBee technologies under complicated construction environments. The test results show that the system can normally achieve better than 15 cm accuracy, and better than 1 m under adverse geometrical site condition. However, the high instrumental set up cost and the requirement for high quality data transmission cable for high precision time synchronization between sensors may deter wide application of similar system for resources management in construction sites.

[Maternal morbidity and mortality associated with conservative management for placenta morbidly adherent (accreta) diagnosed during pregnancy. Report of 15 cases].

PubMed

Daney de Marcillac, F; Lecointre, L; Guillaume, A; Sananes, N; Fritz, G; Viville, B; Boudier, E; Nisand, I; Gaudineau, A; Langer, B; Akladios, C Y

2016-10-01

High risk of morbidly adherent placenta increased during past years. Their management is controversial. Cesarean hysterectomy, considered the gold standard treatment by American Society, is associated with high risk of maternal morbimortality. Conservative management has been sought to reduce maternal morbidity associated with caesarean hysterectomy while maintaining fertility. It consists of leaving the placenta in place but long-term monitoring. Our main objective was to determine advantage/disadvantage of conservative management on patient with an antenatal diagnosis of placenta accreta, increta or percreta. This retrospective study included all patients with an antenatal diagnosis of placenta accreta, increta or percreta between 2007 and 2014. Conservative treatment was systematically attempted according to our protocol. The primary outcome was defined as uterine conservation and the secondary outcome as maternal morbimortality defined as any medical or surgical condition occurring after childbirth. Fifteen patients (0.07 % of all living childbirths) were included. Conservative management was successful in 80 % of patients. There was no case of maternal death. Severe post-partum hemorrhage occurred in 4 patients (33.3 %) requiring uterine arteries embolization in one patient and hysterectomy in the 3 others. They underwent immediate blood transfusion of 13.5±4.5 average of red blood cell units. No severe septic condition occurred but 4 patients suffered from endometritis, 2.6±0.5 months after birth requiring intravenous antibiotics treatment in conventional hospitalization. Mean duration for spontaneous abortion of the placenta was 23.0±7.2 weeks. Three spontaneous pregnancies occurred in 2 patients after 19±16.9 months. Conservative management seems encouraging but is associated with a non-insignificant risk of secondary complication requiring long-term monitoring in conciliant patients. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Successful surgical management of ruptured umbilical hernias in cirrhotic patients

PubMed Central

Chatzizacharias, Nikolaos A; Bradley, J Andrew; Harper, Simon; Butler, Andrew; Jah, Asif; Huguet, Emmanuel; Praseedom, Raaj K; Allison, Michael; Gibbs, Paul

2015-01-01

Acute umbilical hernia rupture in patients with hepatic cirrhosis and ascites is an unusual, but potentially life-threatening complication, with postoperative morbidity about 70% and mortality between 60%-80% after supportive care and 6%-20% after urgent surgical repair. Management options include primary surgical repair with or without concomitant portal venous system decompression for the control of the ascites. We present a retrospective analysis of our centre’s experience over the last 6 years. Our cohort consisted of 11 consecutive patients (median age: 53 years, range: 36-63 years) with advanced hepatic cirrhosis and refractory ascites. Appropriate patient resuscitation and optimisation with intravenous fluids, prophylactic antibiotics and local measures was instituted. One failed attempt for conservative management was followed by a successful primary repair. In all cases, with one exception, a primary repair with non-absorbable Nylon, interrupted sutures, without mesh, was performed. The perioperative complication rate was 25% and the recurrence rate 8.3%. No mortality was recorded. Median length of hospital stay was 14 d (range: 4-31 d). Based on our experience, the management of ruptured umbilical hernias in patients with advanced hepatic cirrhosis and refractory ascites is feasible without the use of transjugular intrahepatic portosystemic shunt routinely in the preoperative period, provided that meticulous patient optimisation is performed. PMID:25780312

Back-to-the-future: a fresh policy initiative for fisheries and a restoration ecology for ocean ecosystems

PubMed Central

Pitcher, Tony J.

2005-01-01

‘Back-to-the-future’ (BTF) is an integrative approach to a restoration ecology of the oceans that attempts to solve the fisheries crisis. To this end, it harnesses the latest understanding of ecosystem processes, developments in whole ecosystem simulation modelling, and insight into the human dimension of fisheries management. BTF includes new methods for describing past ecosystems, designing fisheries that meet criteria for sustainability and responsibility, and evaluating the costs and benefits of fisheries in restored ecosystems. Evaluation of alternative policy choices, involving trade-offs between conservation and economic values, employs a range of economic, social and ecological measures. Automated searches maximize values of objective functions, and the methodology includes analyses of model parameter uncertainty. Participatory workshops attempt to maximize compliance by fostering a sense of ownership among all stakeholders. Some challenges that have still to be met include improving methods for quantitatively describing the past, reducing uncertainty in ecosystem simulation techniques and in making policy choices robust against climate change. Critical issues include whether past ecosystems make viable policy goals, and whether desirable goals may be reached from today’s ecosystem. Examples from case studies in British Columbia, Newfoundland and elsewhere are presented. PMID:15713591