Business Continuity Management Plan

DTIC Science & Technology

2014-12-01

organization ( Shaw , 2004). Navy Supply Systems Command (NAVSUP) does not have a framework that can help develop a business continuity management (BCM...cites two case studies that demonstrate how an organization mitigated issues during catastrophic events that led to disruptions to their business ...www.uschamber.com/sites/default/files/legacy/ issues /defense/files/guideli nesbc.pdf Comprehensive Emergency Management Associates. (2006). Business continuity

Using foresight methods to anticipate future threats: the case of disease management.

PubMed

Ma, Sai; Seid, Michael

2006-01-01

We describe a unique foresight framework for health care managers to use in longer-term planning. This framework uses scenario-building to envision plausible alternate futures of the U.S. health care system and links those broad futures to business-model-specific "load-bearing" assumptions. Because the framework we describe simultaneously addresses very broad and very specific issues, it can be easily applied to a broad range of health care issues by using the broad framework and business-specific assumptions for the particular case at hand. We illustrate this method using the case of disease management, pointing out that although the industry continues to grow rapidly, its future also contains great uncertainties.

The duty of care 2: risk assessment and risk management.

PubMed

Fullbrook, Suzanne

In this second article in the series, the issue of risk assessment and management, in the context of a recent case, is revisited. The case in question is outlined in the previous article 'Compliance with directives and protocols'.

Issues of human rabies immunoglobulin and vaccine: policy versus practice.

PubMed

Folb, Jonathan E; Cooke, Richard P D

2007-03-01

A retrospective audit was conducted of all issues of rabies vaccine or human rabies immunoglobulin (HRIG) from the Clinical Microbiology Department at University Hospital Aintree for post-exposure prophylaxis. The appropriateness of management was reviewed by a blinded panel, which used guidelines issued by the Health Protection Agency (HPA) as a standard. Thirty-six enquiries, on average 9 days following exposure, led to issues of HRIG, rabies vaccine or both. Dog bites accounted for the majority of incidents. In no cases was the biting animal recorded as having been observed for signs of rabies. Management was judged to have been inappropriate in 9 cases, and documentation was judged to have been unsatisfactory in 13 cases. This study has highlighted several areas of ambiguity in the current guidelines, and a number of deficiencies in the information prompted by the standardized proformas used to deal with post-exposure queries.

Case management of persons with acquired immunodeficiency syndrome in San Francisco

PubMed Central

Benjamin, A. E.; Lee, Philip R.; Solkowitz, Sharon N.

1988-01-01

The acquired immunodeficiency syndrome (AIDS) epidemic represents a growing challenge for the health care system and for case management models applied to persons with AIDS. The experience of San Francisco highlights some of the issues involved in developing a case management system appropriate to the needs of persons with AIDS, as well as providers, and payers. Dramatic growth in the size and complexity of the AIDS caseload and the involvement of public, health maintenance organization, and community providers has required the increasing formalization and centralization of case management roles. Persistent questions about the definition and goals of case management complicate development of these services. PMID:10312974

A CASE STUDY IN RISK MANAGEMENT ISSUES: PERCHLORATE IN POTABLE WATER

EPA Science Inventory

Risk management brings together many issues. While some of these are scientific in nature, many come down to policy and even emotion. As a result, striking a balance among competing objectives can be difficult. This is especially true when problems are localized or solutions are ...

Issue Management by School Superintendents: Final Report. Part II.

ERIC Educational Resources Information Center

Huff, Anne S.; Pondy, Louis R.

Four papers generated by a broader study of issues management in three suburban Chicago school districts are collected here. "Achieving Routine" focuses on the effective routinization of organizational change, in this case a curriculum decision, through the use of administrative mechanisms and the conceptual linkage of the new to…

Using intensive case management to reduce violence by mentally ill persons in the community.

PubMed

Dvoskin, J A; Steadman, H J

1994-07-01

Aggressive and intensive case management and a comprehensive array of community support services are the keys to reducing the risk of violence by people with serious mental illness in the community. The authors describe the elements of intensive case management for potentially violent clients, including use of individual case managers responsible for small caseloads, 24-hour availability of case managers, and strong linkages to agencies providing mental health services, substance abuse treatment, and social services as well as to the criminal justice system. They summarize the results of three recent studies of intensive case management programs suggesting that this intervention is effective in reducing clients' dangerousness in the community. They discuss cultural and human resource issues that affect planning of intensive case management services. Intensive case managers need to be "boundary spanners" with the training, experience, and personality to bridge the often-broad gap between human service and criminal justice systems.

Forecasting landscape-scale, cumulative effects of forest management on vegetation and wildlife habitat: a case study of issues, limitations, and opportunities

Treesearch

Stephen R. Shifley; Frank R. Thompson; William D. Dijak; Zhaofei F. Fan

2008-01-01

Forest landscape disturbance and succession models have become practical tools for large-scale, long-term analyses of the cumulative effects of forest management on real landscapes. They can provide essential information in a spatial context to address management and policy issues related to forest planning, wildlife habitat quality, timber harvesting, fire effects,...

Clinical management issues vary by specialty in the Victorian Audit of Surgical Mortality: a retrospective observational study

PubMed Central

Vinluan, Jessele; Retegan, Claudia; Chen, Andrew; Beiles, Charles Barry

2014-01-01

Objective Clinical management issues are contributory factors to mortality. The aim of this study was to use data from the Victorian Audit of Surgical Mortality (VASM), an educational peer-review process for surgeons, to discover differences in the incidence of these issues between surgical specialties in order to focus attention to areas of care that might be improved. Design This study used retrospectively analysed observational data from VASM. Clinical management issues between eight specialties were assessed using χ2 analysis. Data sources VASM data were reported by participating public and private health services, the Coroner and self-reporting surgeons across Victoria. Results A total of 2946 specific clinical issues as deficiencies of care were reported. 15% of cases had significant issues of care. The most common clinical management issue was the delay in delivery of treatment. Other clinical issues included the quality of communication and documentation, preoperative and postoperative care, adverse events and protocol issues. There were significant differences in issues between specialties. Conclusions The clinical management issues presented across surgical specialties were similar; however, five issues of clinical care differed significantly in frequency across surgical specialties. The three main issues varying among specialties were complications after operation, communication and postoperative care. Addressing these clinical management issues via the peer-review process may impact positively on patient care. PMID:24980043

The corporate impact of addressing social issues: a financial case study of a project in Peru.

PubMed

Dabbs, Alan; Bateson, Matthew

2002-05-01

Large, multinational resource development projects can affect many aspects, including social, economic and ecological realities, in the regions where they operate. Social and environmental issues that are usually ignored in such projects are increasingly affecting the financial future of multinational corporations in negative ways. In this article, we advance the argument that corporations can successfully manage these issues and that if they choose to view these management efforts as an investment rather than an expense, they may well acquire a competitive advantage over companies that do not. We describe as a case study the Camisea natural gas and condensates development project in Peru, operated by Shell Prospecting and Development Peru (SPDP). Camisea is one of the first projects anywhere in the world to conduct a detailed analysis of key industry-related social issues and the processes, required investment and financial impact of managing them. The Camisea example supports the argument that addressing social and environmental concerns makes financial sense. In present value terms, the benefit of managing these concerns was expected to surpass the cost investment by approximately US$50 million.

Strategies for waste management in small and medium towns of developing countries: a case study of India.

PubMed

Sundaravadivel, M; Vigneswaran, S

2003-01-01

This paper evaluates the issues of waste management in small and medium towns (SMTs) (with population in the range of 10,000-100,000) of India, and identifies the need for a multi-disciplinary approach encompassing technological, economic and financial aspects of the issues to effect improvements. A comprehensive set of cross-disciplinary strategies is suggested to improve the prevailing conditions with environmentally appropriate, economically efficient and financially self-sustaining waste management services. Based on a case study of four SMTs in the State of Tamil Nadu in India, this paper evaluates the application of the suggested strategies and offers policy recommendations.

Understanding the economics of succeeding in disease management.

PubMed

Shulkin, D J

1999-04-01

If implemented with the proper resource commitment, disease management can have a significant effect on the health of an organization's patient population. However, it is unlikely that even the noblest of strategic initiatives will survive long without a compelling business imperative. After analyzing the business case, many organizations have committed large amounts of resources to building disease management programs. Yet these issues are still being formulated. The author discusses five issues that are key to understanding the economics of disease management.

Epidemiological Data Management during an Outbreak of Ebola Virus Disease: Key Issues and Observations from Sierra Leone.

PubMed

Owada, Kei; Eckmanns, Tim; Kamara, Kande-Bure O'Bai; Olu, Olushayo Oluseun

2016-01-01

Sierra Leone experienced intense transmission of Ebola virus disease (EVD) from May 2014 to November 2015 during which a total of 8,704 confirmed cases and over 3,589 confirmed deaths were reported. Our field observation showed many issues in the EVD data management system, which may have contributed to the magnitude and long duration of the outbreak. In this perspective article, we explain the key issues with EVD data management in the field, and the resulting obstacles in analyzing key epidemiological indicators during the outbreak response work. Our observation showed that, during the latter part of the EVD outbreak, surveillance and data management improved at all levels in the country as compared to the earlier stage. We identified incomplete filling and late arrival of the case investigation forms at data management centers, difficulties in detecting double entries and merging identified double entries in the database, and lack of clear process of how death of confirmed cases in holding, treatment, and community care centers are reported to the data centers as some of challenges to effective data management. Furthermore, there was no consolidated database that captured and linked all data sources in a structured way. We propose development of a new application tool easily adaptable to new occurrences, regular data harmonization meetings between national and district data management teams, and establishment of a data quality audit system to assure good quality data as ways to improve EVD data management during future outbreaks.

An Analysis of Technological Issues Emanating from Faculty Transition to a New Learning Management System

ERIC Educational Resources Information Center

Sanga, Mapopa William

2016-01-01

This case study investigated the process 119 faculty members underwent as they transitioned from using Desire to Learn (D2L) learning management system (LMS), to using Canvas LMS. Other than analyzing technological issues faculty members encountered while navigating various aspects of the Canvas interface, the study also analyzed technological…

The Literature on Military Families, 1980: An Annotated Bibliography.

DTIC Science & Technology

1980-08-01

re- search results are useful in planning. Principles to be considered in the future planning, management , and dissemination of family research in the...Derr, C. B. Managing marriage/ family issues across career stages: the case of the U.S. Naval officers. Unpublished manuscript, Depart- ment...Report No. 2, NP554-79-003. Arlington VA: Office of Naval Research (Code 454), 1979. See: Derr, C. B. Managing marriage/ family issues across career stages

Another look at roles and functions: has hospital case management lost its way?

PubMed

Reynolds, John J

2013-01-01

The purpose of this study was to identify the roles, functions, and types of activities that hospital case managers engage in on a day-to-day basis and that leverage the most amounts of time. Previous studies superimpose a priori categories on research tools. Hospital case management. This study analyzes 4,064 spontaneous, unstructured list serve postings from the American Case Management Association Learning Link list serve from August 15, 2011, to August 18, 2012. The study group was a cross section of 415 case management professionals. The data suggest that hospital case managers' time is inordinately leveraged by issues related to observation status/leveling of patients and the Centers for Medicare and Medicaid Services compliance. The data also suggest that hospital case management has taken a conceptual trajectory that has deviated significantly from what was initially conceived (quality, advocacy, and care coordination) and what is publicly purported. Case management education and practical orientation will need to be commensurate with this emerging emphasis. Case management leadership will need to be adept at mitigating the stresses of role confusion, role conflict, and role ambiguity.

Problems and Issues in Using Emerging Computer Technologies To Manage and Evaluate Instructional Programs 1, 2, 3.

ERIC Educational Resources Information Center

Atwood, Nancy K.

School districts have begun examining the feasibility of, and in some cases are developing and implementing automated systems for, managing and evaluating instructional programs. This paper describes and analyzes the issues and problems that emerged over the course of three projects--a large suburban school in the West, a consortium of five small…

Ethics in an operations management course.

PubMed

Rudnicka, Ewa A

2005-10-01

Graduates of the management major at the University of Pittsburgh at Greensburg find employment in a variety of organizations. As future managers with employees from different professions, students expressed an interest in discussing ethics cases in the operations management class. The semester starts with students familiarizing themselves with various professional and corporate codes of ethics. Throughout the semester a number of short ethics' cases in operations' areas such as inventory management, scheduling, facility location, and product design are introduced to illustrate ethical issues that a manager and his/her employees might face. Students prepare individual responses before the in-class discussions. The semester ends with a long group ethics case discussion and formal case presentations. In the end-of-semester survey, students responded very favorably to an ethics component in the operations management class.

17 CFR 230.460 - Distribution of preliminary prospectus.

Code of Federal Regulations, 2011 CFR

2011-04-01

... issued by a face-amount certificate company or a redeemable security issued by an open-end management... the effective date of the registration statement in the same fashion as is required in the case of...

17 CFR 230.460 - Distribution of preliminary prospectus.

Code of Federal Regulations, 2010 CFR

2010-04-01

... issued by a face-amount certificate company or a redeemable security issued by an open-end management... the effective date of the registration statement in the same fashion as is required in the case of...

The Effect of Administering a Boundary Course to Third-Year Medical Students During Their Psychiatry Clerkship.

PubMed

Kunaparaju, Sindhura; Hidalgo, Michael Sposito; Bennett, David S; Sedky, Karim

2018-06-01

Due to lack of experience, third-year medical students (MS3) may be vulnerable to boundary violations. Investigators aimed to increase awareness regarding boundary issues among MS3s and assess the effect of using videotaped scenarios and case-based discussion on medical students' comfort in managing boundary issues. A nine-question pre-course survey was administered to MS3s enrolled at Cooper Medical School of Rowan University that asked students to rate their comfort in managing various boundary challenges. MS3s then viewed seven pre-recorded boundary-related cases followed by a 10-15-min discussion after each case. A post-course survey reassessed comfort in managing boundary challenges using the same nine questions, with three additional questions assessing satisfaction with the course. Change in pre- and post-course scores were analyzed using paired t tests and effect sizes. Internal consistency was assessed using Cronbach's alpha. There was a significant difference between pre- and post-course total scores as well as seven of the nine individual scores. Effect sizes were large (d > .08). These findings indicate that students became more comfortable managing boundary issues following the course. In addition, satisfaction ratings were high indicating the course was perceived favorably. Medical students perceived the course to be beneficial and reported that it increased their awareness of boundary issues. A boundary course at the beginning of the psychiatry clerkship can improve MS3s' comfort in managing boundary challenges. With increased comfort in managing boundary, students can better focus on other aspects of their psychiatry education and on building therapeutic alliances with their patients.

The occupational safety and health scorecard--a business case example for strategic management.

PubMed

Köper, Birgit; Möller, Klaus; Zwetsloot, Gerard

2009-12-01

Human resources and health issues are crucial in terms of corporate competitiveness. However, systematic, continuous and strategically aligned occupational safety and health (OSH) management is scarcely applied in companies. One major reason for this could be the lack of generally accepted and standardised OSH control methods. Our objective was thus to conceptualize a method by which qualitative factors such as human resources and OSH aspects contribute to the performance or value-added layer of an organization. We developed a business case based on the well-known and accepted Balanced Scorecard approach, which we adapted and applied to the management of OSH issues. The concept was implemented in the course of a comprehensive case study at a German automobile manufacturer. We gathered health as well as finance data in order to test which health-related indicators had an impact on financial performance. The demonstration of, and reporting on, how the promotion of workplace health contributes strategically to the organization is crucial for both health and human resource managers. Based on multivariate regression analyses, our main finding was that the Balanced Scorecard approach is an adequate means to control OSH issues in terms of strategic health management. Our analyses demonstrated that health-related interventions contribute significantly to performance aspects such as quality, productivity, absenteeism, and cost reduction. Therefore, the financial impact of health-related aspects / interventions could be demonstrated by means of the OSH scorecard. The availability and quality of health data within the context of overall corporate performance data needs to be improved in order to bridge OSH-related and performance issues of an organization.

Educating Managers with Tomorrow's Technologies. Research in Management Education and Development Series.

ERIC Educational Resources Information Center

Wankel, Charles, Ed.; DeFillippi, Robert, Ed.

This volume demonstrates how technology is impacting management education and learning in a variety of educational contexts. Some of the issues and trends in management education addressed include: technotrends; web-based management learning; the changing nature of the web as a context for learning; online simulations; web-format case studies;…

Ecological Knowledge Among Communities, Managers and Scientists: Bridging Divergent Perspectives to Improve Forest Management Outcomes

NASA Astrophysics Data System (ADS)

Rist, Lucy; Shackleton, Charlie; Gadamus, Lily; Chapin, F. Stuart; Gowda, C. Made; Setty, Siddappa; Kannan, Ramesh; Shaanker, R. Uma

2016-04-01

Multiple actors are typically involved in forest management, namely communities, managers and researchers. In such cases, suboptimal management outcomes may, in addition to other factors, be symptomatic of a divergence in perspectives among these actors driven by fundamental differences in ecological knowledge. We examine the degree of congruence between the understandings of actors surrounding key issues of management concern in three case studies from tropical, subtropical and boreal forests. We identify commonly encountered points of divergence in ecological knowledge relating to key management processes and issues. We use these to formulate seven hypotheses about differences in the bodies of knowledge that frequently underlie communication and learning failures in forest management contexts where multiple actors are involved and outcomes are judged to be suboptimal. Finally, we present a set of propositions to acknowledge and narrow these differences. A more complete recognition of the full triangulation between all actors involved, and of the influence that fundamental differences in ecological knowledge can exert, may help lead to a more fruitful integration between local knowledge and practice, manager knowledge and practice, and contemporary science in forest management.

Case managers and the use of Medicare, Part D.

PubMed

Hensley, Melissa Anne

2011-01-01

The purpose of this study was to examine the experiences and opinions of community-based mental health case managers with the Medicare prescription drug benefit. A qualitative approach, consisting of analysis of data from 3 case manager focus groups, was used to achieve an understanding of the role that case managers played in beneficiaries' access to and use of prescription medicines. Two urban nonprofit community-based mental health agencies. Adults who are disabled by mental illness depend on case managers for information about their prescription drug insurance, help with formulary and plan switching information, and assistance with tasks related to medication adherence in the community. Common themes in the case managers' discussion were managing beneficiary problems, stress for beneficiaries, information and paperwork issues, and cynicism regarding health care reform. The critical role of case managers in the use of Medicare Part D is not well understood or appreciated. Case managers need to be informed about Medicare Part D and ready to advocate for their clients in the community. In addition, it is important for case managers to understand how Medicare Part D affects not only older adults, but also adults living with serious and persistent mental illness.

Health assessments for Indigenous Australians at Orange Aboriginal Medical Service: health problems identified and subsequent follow up.

PubMed

Dutton, Tegan; Stevens, Wendy; Newman, Jamie

2016-01-01

This study aimed to document the types, management and follow up of health issues identified by all Aboriginal Health Assessments (AHA) performed at Orange Aboriginal Medical Service from 1 January 2011 to 31 December 2012. This was done with a retrospective audit of clinical records. In total, 1169 AHAs were performed: 41% child, 53% adult and 6% older person AHAs. Newly identified health issues were documented in 85% (984). Being overweight (41%; 476) and smoking (26%; 301) were the common risk factors identified. As a result of the AHA, most children who were not up-to-date with their vaccinations received catch-up immunisations; 11% (36) of adult women (n=314) received a Pap smear, although Pap smear status was unknown or not up-to-date for 61% (192); 27% (311) of cases were prescribed new medication; and 1239 referrals were made but only 40% were attended. At 6 months following the AHA, 26% (240) of cases with newly identified health issues were completely managed and followed up, whereas 25% (226) received no follow up. The AHAs are useful for identifying new health issues; however, follow up of the identified health issues should be improved. If AHAs are to improve health outcomes, appropriate management and follow up of the identified health issues are essential.

Statistical and methodological issues in the evaluation of case management studies.

PubMed

Lesser, M L; Robertson, S; Kohn, N; Cooper, D J; Dlugacz, Y D

1996-01-01

For the past 3 years, the nursing case management team at North Shore University Hospital in Manhasset, NY, has been involved in a project to implement more than 50 clinical pathways, which provide a written "time line" for clinical events that should occur during a patient's hospital stay. A major objective of this project was to evaluate the efficacy of these pathways with respect to a number of important outcomes, such as length of stay, hospital costs, quality of patient care, and nursing and patient satisfaction. This article discusses several statistics-related issues in the design and evaluation of such case management studies. In particular, the role of a research approach in implementing and evaluating hospital programs, the choice of a comparison (control) group, the exclusion of selected patients from analysis, and the problems of equating pathways with diagnosis-related groups are addressed.

The Business of Internationalisation: Emerging Issues for the Entrepreneurial University. AIR 1999 Annual Forum Paper.

ERIC Educational Resources Information Center

Poole, David; Pratt, Graham

This paper analyzes various strategic management models for international programs from an Australian perspective. It presents the results of a qualitative case study of one Australian university faculty of business in the context of the relevance of chaos and complexity theories to strategic management. The case study is organized around the…

Arbitration Intervention Worker (AIW) Services: Case Management Overlay in a Juvenile Diversion Program

ERIC Educational Resources Information Center

Poythress, Norman G.; Dembo, Richard; DuDell, Gary; Wareham, Jennifer

2006-01-01

In this issue we describe a clinical trials study of the impact of adding specific case manager overlay services to "treatment as usual" services for youths in a Juvenile Arbitration Program. In this first article we describe the experimental intervention, the Arbitration Intervention Worker (AIW) service, which was provided to a randomly selected…

Health Services for Management of Chronic Non-Cancer Pain in Kuwait: A Case Study Review

PubMed Central

Lakha, S. Fatima; Pennefather, Peter; Badr, Hanan E.; Mailis-Gagnon, Angela

2016-01-01

The experience of chronic pain is universal, yet pain management services delivered by health professionals vary substantially, depending on the context and patient. This review is a part of a series that has examined the issue of chronic non-cancer pain services and management in different global cities. The review is structured as a case study of the availability of management services for people living with chronic non-cancer pain within the context of the Kuwaiti health systems, and the cases are built from evidence in the published literature identified through a comprehensive review process. The evolution of the organizational structure of the public and private health systems in Kuwait is described. These are discussed in terms of their impact on the delivery of comprehensive chronic pain management service by health professionals in Kuwait. This review also includes a description of chronic pain patient personas to highlight expected barriers as well as compliance issues with services likely to be encountered in Kuwait. The case study analysis and persona descriptions illustrate a need to move beyond pain symptom management towards considering the entire person and his/her individual experience of pain such that health care success is judged by enhancement of patient well-being rather than access to services. A road map for improving integrative chronic pain management in Kuwait is discussed. PMID:26595816

Health Services for Management of Chronic Non-Cancer Pain in Kuwait: A Case Study Review.

PubMed

Lakha, S Fatima; Pennefather, Peter; Badr, Hanan E; Mailis-Gagnon, Angela

2016-01-01

The experience of chronic pain is universal, yet pain management services delivered by health professionals vary substantially, depending on the context and patient. This review is a part of a series that has examined the issue of chronic non-cancer pain services and management in different global cities. The review is structured as a case study of the availability of management services for people living with chronic non-cancer pain within the context of the Kuwaiti health systems, and the cases are built from evidence in the published literature identified through a comprehensive review process. The evolution of the organizational structure of the public and private health systems in Kuwait is described. These are discussed in terms of their impact on the delivery of comprehensive chronic pain management service by health professionals in Kuwait. This review also includes a description of chronic pain patient personas to highlight expected barriers as well as compliance issues with services likely to be encountered in Kuwait. The case study analysis and persona descriptions illustrate a need to move beyond pain symptom management towards considering the entire person and his/her individual experience of pain such that health care success is judged by enhancement of patient well-being rather than access to services. A road map for improving integrative chronic pain management in Kuwait is discussed. © 2015 S. Karger AG, Basel.

Leadership development and succession planning in case management.

PubMed

Miodonski, Kathleen; Hines, Patricia

2013-01-01

The director of case management is one of health care's leadership positions most frequently in demand. The lack of qualified and effective case management leaders will continue to be an issue for organizations for years to come, influenced by increasing pressures on health care reimbursement and the aging case management workforce. Organizations have an opportunity to create a program to develop future case management leaders from their internal talent. The proposed strategies are designed for the acute care hospital but also have applicability in other health care settings where there are case managers and a need for case management leadership. The business community offers leadership research and leadership development models with relevance to case management. Identifying and developing internal talent for leadership roles has been proven to be effective in preparation for advanced responsibilities, has a positive effect on staff morale, and minimizes the impact of vacant leadership positions during recruitment and onboarding activities. Creating a case management leadership development program for an organization can be an alternative to the process of external recruitment for case management department leaders. Such a program can be undertaken even in today's budget conscious environment by accessing existing resources in an organization in a creative and organized manner. The authors outline an approach for case management leaders to accept responsibility for succession planning and for case managers to accept responsibility for promoting their own career development through creation of a leadership development program.

Ethical issues when using social media for health outside professional relationships.

PubMed

DeCamp, Matthew

2015-04-01

Social media have the potential to revolutionize health and healthcare, but fulfilling this potential requires attention to the ethical issues social media may raise. This article reviews the major ethical issues arising when social media are used for research, public health, mobile health applications, and global health. It focuses on social media use outside fiduciary relationships between healthcare professionals and patients. Emphasis is given to the potential of social media in these contexts, the ethical issues relatively unique to each, and where possible how existing ethical principles and frameworks could help navigate these issues. In some cases social media create the circumstance for particular ethical issues but also facilitate managing them, such as in informed consent for research. In other cases, disagreement exists about whether social media - despite their potential - should be used for certain purposes, such as in public health surveillance (where confidentiality represents a significant ethical concern). In still others, ethical uncertainty exists about how social media will affect ethical issues, such as inequality in global health. As social media technologies continue to develop, identifying and managing the ethical issues they raise will be critical to their success in improving health while preserving fundamental ethical values.

Identification of Management Information System (MIS) Strategies Barriers in Higher Education Institutions through Multi-Criteria Decision Making (MCDM) Approach: Case Study of Ferdowsi University of Mashhad

ERIC Educational Resources Information Center

Hosseini, Mirza Hasan; Karimzadegan, Davood; Sazvar, Azam

2012-01-01

Each organization or company, regardless to its restrictions, purposes, and type of the activity, in order to fulfill and manage the duties is in need of various data and pieces of information. The aforesaid cases are generated by managers and employees and used by all the staffs. The manifest issue of current days is that organizations and…

Gaps in Management Education: A Case Study of University of Management and Technology

ERIC Educational Resources Information Center

Abdur-Raouf; Kalim, Rukhsana; Siddiqi, Ahmed F.

2010-01-01

This paper aims to identify the gaps in management education highlighted by 3 primary stakeholders: students, faculty and alumni. The study tries to address the issue of relevance and compatibility of management education and investigates areas of improvement perceived by respondents. The paper assumes that business departments of universities…

Managing pets with behavior problems: realistic expectations.

PubMed

Horwitz, Debra F

2008-09-01

Management solutions offer a useful tool for owners faced with behavior issues in their pets. In some cases management will improve the behavior and allow control. In other situations it may be only the first step in treatment. By offering management solutions, veterinarians can help owners with problem pets and begin the road to recovery.

The HSE management system in practice-implementation

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

Primrose, M.J.; Bentley, P.D.; Sykes, R.M.

1996-11-01

This paper sets out the necessary strategic issues that must be dealt with when setting up a management system for HSE. It touches on the setting of objectives using a form of risk matrix and the establishment of corporate risk tolerability levels. Such issue management is vital but can be seen as yet another corporate HQ initiative. It must therefore be linked, and made relevant to those in middle management tasked with implementing the system and also to those at risk {open_quote}at the sharp end{close_quote} of the business. Setting acceptance criteria is aimed at demonstrating a necessary and sufficient levelmore » of control or coverage for those hazards considered as being within the objective setting of the Safety or HSE Case. Critical risk areas addressed via the Safety Case, within Shell companies at least, must show how this coverage is extended to critical health and environmental issues. Methods of achieving this are various ranging from specific Case deliverables (like the Hazard Register and Accountability Matrices) through to the incorporation of topics from the hazard analysis in toolbox talks and meetings. Risk analysis techniques are increasingly seen as complementary rather than separate with environmental assessments, health risk assessment sand safety risk analyses taking place together and results being considered jointly. The paper ends with some views on the way ahead regarding the linking of risk decisions to target setting at the workplace and views on how Case information may be retrieved and used on a daily basis.« less

Practical Project Management for Education and Training.

ERIC Educational Resources Information Center

Lockitt, Bill

This booklet provides a succinct guide to effective management procedures, including whether and how to take on projects, estimation of costs prior to project bids, project management tools, case studies, and practical exercises for staff development activities. Chapter 1 investigates why institutions take on projects, issues involved, benefits…

Central Hypoventilation: A Case Study of Issues Associated with Travel Medicine and Respiratory Infection.

PubMed

Hon, Kam Lun; Leung, Alexander K C; Li, Albert M C; Ng, Daniel K K

2015-01-01

Aim. We presented the case of a child with central hypoventilation syndrome (CHS) to highlight issues that need to be considered in planning long-haul flight and problems that may arise during the flight. Case. The pediatric intensive care unit (PICU) received a child with central hypoventilation syndrome (Ondine's curse) on nocturnal ventilatory support who travelled to Hong Kong on a make-a-wish journey. He was diagnosed with central hypoventilation and had been well managed in Canada. During a long-haul aviation travel, he developed respiratory symptoms and desaturations. The child arrived in Hong Kong and his respiratory symptoms persisted. He was taken to a PICU for management. The child remained well and investigations revealed no pathogen to account for his respiratory infection. He went on with his make-a-wish journey. Conclusions. Various issues of travel medicine such as equipment, airline arrangement, in-flight ventilatory support, travel insurance, and respiratory infection are explored and discussed. This case illustrates that long-haul air travel is possible for children with respiratory compromise if anticipatory preparation is timely arranged.

School Nurse Case Management for Children with Chronic Illness: Health, Academic, and Quality of Life Outcomes

ERIC Educational Resources Information Center

Engelke, Martha Keehner; Guttu, Martha; Warren, Michelle B.; Swanson, Melvin

2008-01-01

More children with chronic illnesses are attending school, and some of them struggle academically because of issues related to their health. School-based case management has been suggested as one strategy to improve the academic success of these children. This study tracked the academic, health, and quality of life outcomes for 114 children with…

Executive Programs for Brazilian Mid-Career Public Managers: Pitfalls and Challenges

ERIC Educational Resources Information Center

Pacheco, Regina Silvia; Franzese, Cibele

2017-01-01

This paper discusses the challenges of professional education for mid-career public managers at graduate level, pointing out pitfalls to avoid and obstacles to face. Analyzing the Brazilian case, the goal is to raise issues that may also be present in other cases. The main argument developed here is that the puzzle faced by graduate programs on…

Munchausen syndrome: Playing sick or sick player

PubMed Central

Prakash, Jyoti; Das, R. C.; Srivastava, K.; Patra, P.; Khan, S. A.; Shashikumar, R.

2014-01-01

Munchausen syndrome is rare factitious disorder which entails frequent hospitalization, pathological lying and intentional production of symptoms for sick role. Management requires collateral history taking, sound clinical approach, exclusion of organicity and addressing psychological issues. A case which presented with unusual symptoms of similar dimension is discussed here. The case brings out finer nuances in evaluation and management of this entity. PMID:25535450

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.

Trends in managed care contracting among U.S. hospitals.

PubMed

Gautam, K; Campbell, C; Arrington, B

1995-01-01

This article describes the changing profile of hospitals initiating managed care contracts as of 1992. Based on statistical tests, early contractors rank higher on profitability, case mix, bed size, affiliation, and urban location. In contrast, recent and noncontractors are predominantly rural, freestanding hospitals with low case mix, low profitability, high subacute services, and government ownership. A number of lessons for the future are drawn and a stage-by-stage approach to studying managed care issues is proposed.

Using a personal digital assistant to document clinical pharmacy services in an intensive care unit.

PubMed

Lau, A; Balen, R M; Lam, R; Malyuk, D L

2001-07-01

Management Case Studies describe approaches to real-life management problems in health systems. Each installment is a brief description of a problem and how it was dealt with. The cases are intended to help readers deal with similar experiences in their own work sites. Problem solving, not hypothesis testing, is emphasized. Successful resolution of the management issue is not a criterion for publication--important lessons can be learned from failures, too.

Closing unprofitable services: ethical issues and management responses.

PubMed

Summers, James W

1985-01-01

Closing unprofitable services often requires as much analysis, public relations, marketing, and planning as any expansion. Further, issues about ethics, indigents, and the hospital mission force the consideration of values explicitly if a marketing fiasco is to be avoided. By integrating values analysis with more traditional management tasks, the challenges of service closure can be converted into opportunities to demonstrate how your institution has met or exceeded its ethical obligations. A case involving OB is developed to show how ethical and management issues blend into one another. Specific strategies for consensus building and marketing of the legitimacy of the hospital's position are given. Institutional ethics committees are one primary mechanism for developing a plan to benefit from unpleasant decisions.

Examining the Role of Voluntary Associations in Environmental Management: The Case of the Sam Houston National Forest

NASA Astrophysics Data System (ADS)

Lu, Jiaying; Schuett, Michael A.

2012-02-01

The purpose of this study was to gain a better understanding of voluntary associations involved in forest management. The specific areas examined in this study include organizational attributes, membership profile, attitudes toward forest-management priorities, and concerns about forest-management issues. To achieve this purpose, data were collected using a case study approach with mixed-methods (document reviews, personal interviews, and a Web survey) at a national forest in Texas, USA. Overall, the voluntary associations in this study can be described as place-based, small to moderate in scale, activity-oriented, and active groups that are adaptive to sociopolitical and environmental changes. General group members placed high importance on aesthetic, ecological, and recreation management of the national forest. In addition, this study showed five key forest management issues: (1) limited recreation access; (2) financial challenges for forest management; (3) conflict among recreation user groups; (4) inadequate communication by the United States Forest Service to the general public, and (5) sustainability of the forest. Theoretical and managerial implications of the results are discussed.

IVHS Institutional Issues And Case Studies: Advantage I-75 Case Study

DOT National Transportation Integrated Search

1999-01-01

This brochure describes how cost-effective incident management technologies can be in handling traffic congestion. Embedded sensors, closed circuit television cameras, and variable message signs are examples of existing technologies that can be enhan...

Topical Backgrounder: Evaluating Chemical Hazards in the Community: Using RMP's Offsite Consequence Analysis

EPA Pesticide Factsheets

Part of a May 1999 series on the Risk Management Program Rule and issues related to chemical emergency management. Explains hazard versus risk, worst-case and alternative release scenarios, flammable endpoints and toxic endpoints.

Aims and harvest of moral case deliberation.

PubMed

Weidema, Froukje C; Molewijk, Bert A C; Kamsteeg, Frans; Widdershoven, Guy A M

2013-09-01

Deliberative ways of dealing with ethical issues in health care are expanding. Moral case deliberation is an example, providing group-wise, structured reflection on dilemmas from practice. Although moral case deliberation is well described in literature, aims and results of moral case deliberation sessions are unknown. This research shows (a) why managers introduce moral case deliberation and (b) what moral case deliberation participants experience as moral case deliberation results. A responsive evaluation was conducted, explicating moral case deliberation experiences by analysing aims (N = 78) and harvest (N = 255). A naturalistic data collection included interviews with managers and evaluation questionnaires of moral case deliberation participants (nurses). From the analysis, moral case deliberation appeals for cooperation, team bonding, critical attitude towards routines and nurses' empowerment. Differences are that managers aim to foster identity of the nursing profession, whereas nurses emphasize learning processes and understanding perspectives. We conclude that moral case deliberation influences team cooperation that cannot be controlled with traditional management tools, but requires time and dialogue. Exchanging aims and harvest between manager and team could result in co-creating (moral) practice in which improvements for daily cooperation result from bringing together perspectives of managers and team members.

In-home behavioral health case management: an integrated model for high-risk populations.

PubMed

Theis, Gerald A; Kozlowski, Deirdre; Behrens, Jenna

2006-01-01

The escalating health care costs attributed to high-risk populations have fueled a need for a proactive approach to deal with people affected by complex mental health issues that often coexist with chronic medical conditions. Through an in-home behavioral health case management (CM) program, patients with mental illnesses (some with coexisting medical conditions) receive integrated medical and mental health services through a disease-management approach that has proven effective in treating high-risk patients.

Case analysis online: a strategic management case model for the health industry.

PubMed

Walsh, Anne; Bearden, Eithne

2004-01-01

Despite the plethora of methods and tools available to support strategic management, the challenge for health executives in the next century will relate to their ability to access and interpret data from multiple and intricate communication networks. Integrated digital networks and satellite systems will expand the scope and ease of sharing information between business divisions, and networked systems will facilitate the use of virtual case discussions across universities. While the internet is frequently used to support clinical decisions in the healthcare industry, few executives rely upon the internetfor strategic analysis. Although electronic technologies can easily synthesize data from multiple information channels, research as well as technical issues may deter their application in strategic analysis. As digital models transform access to information, online models may become increasingly relevant in designing strategic solutions. While there are various pedagogical models available to support the strategic management process, this framework was designed to enhance strategic analysis through the application of technology and electronic research. A strategic analysis framework, which incorporated internet research and case analysis in a strategic managementcourse, is described alongwith design and application issues that emerged during the case analysis process.

Case formulation and management using pattern-based formulation (PBF) methodology: clinical case 1.

PubMed

Fernando, Irosh; Cohen, Martin

2014-02-01

A tool for psychiatric case formulation known as pattern-based formulation (PBF) has been recently introduced. This paper presents an application of this methodology in formulating and managing complex clinical cases. The symptomatology of the clinical presentation has been parsed into individual clinical phenomena and interpreted by selecting explanatory models. The clinical presentation demonstrates how PBF has been used as a clinical tool to guide clinicians' thinking, that takes a structured approach to manage multiple issues using a broad range of management strategies. In doing so, the paper also introduces a number of patterns related to the observed clinical phenomena that can be re-used as explanatory models when formulating other clinical cases. It is expected that this paper will assist clinicians, and particularly trainees, to better understand PBF methodology and apply it to improve their formulation skills.

A Case for Advanced Skills and Employability in Higher Education.

ERIC Educational Resources Information Center

Holmes, Alison; Miller, Stuart

2000-01-01

Case Studies to Advance Skills and Employability is a project designed to introduce a vocational dimension into academic curriculum. Key employability skills are developed as students work on real-life case situations in such areas as public sculpture, waste management, human organizations, and environmental issues. (SK)

[Hypertrophic cardiomyopathy: an intraoperative death case analysis and substantiation of the standards of perioperative anesthetic management in a non-cardiosurgery clinic].

PubMed

Fedosiuk, Roman N; Shchupachynska, Liliia O

2018-01-01

The article is based on the case analysis of a sudden and unexpected intraoperative death of a 51-year-old female patient with hypertrophic cardiomyopathy, who was undergoing a non-cardiac operation in a non-cardiosurgery clinic, from acute precipitation of left ventricular outflow tract obstruction provoked by surgery and anesthesia. It emphasizes the importance of raising non-cardiac anesthesiologists' awareness of the issue and having clear standards of pre-operative evaluation and perioperative management of patients with hypertrophic cardiomyopathy in order to avoid fatal medical errors. A literature review on the disease with an accent on anesthesia-related issues is also given, and four standards of perioperative anesthetic management of patients with hypertrophic cardiomyopathy presenting for non-cardiac surgery in general hospital settings are developed and offered.

Enrollment Management Issue Analysis: Operating in a Post-Katrina Higher Education Environment

ERIC Educational Resources Information Center

Jones, Jacqueline; Das, Nabakrishna; Huggins, Desiree'; McNeely, Stanton, III

2008-01-01

A definition and brief history of enrollment management are presented. The challenges represented by Hurricane Katrina for enrollment management at one community technical college and a private 4-year college are identified along with three cases that illuminate the challenges. The need for rapid response planning is articulated. (Contains 1…

Analysis of Risk Management in Adapted Physical Education Textbooks

ERIC Educational Resources Information Center

Murphy, Kelle L.; Donovan, Jacqueline B.; Berg, Dominck A.

2016-01-01

Physical education teacher education (PETE) programs vary on how the topics of safe teaching and risk management are addressed. Common practices to cover such issues include requiring textbooks, lesson planning, peer teaching, videotaping, reflecting, and reading case law analyses. We used a mixed methods design to examine how risk management is…

On the relation between trust and fairness in environmental risk management.

PubMed

Earle, Timothy C; Siegrist, Michael

2008-10-01

In this study, we empirically examine the relations between trust, fairness, and cooperation within two environmental risk management contexts, one in which the focal issue is of high personal moral importance and the other in which the focal issue is of low moral importance. Using an experimental design embedded in two parallel survey questionnaires, one mailed to residents of Washington State, the other to German-speaking residents of Switzerland, we either manipulated or constructed three factors, issue importance (high/low), procedural fairness (fair/unfair), and policy outcome (risk averse/risk accepting). This design enabled us to compare the predictions of the standard account of procedural fairness, that trust and cooperation are determined by judgments of fairness, with the predictions of an alternative account, that trust and cooperation will be determined by judgments of procedural fairness only when the issue involved is not morally important. Results for the American case showed that under conditions of high issue importance, policy outcome affected judged fairness, trust, and cooperation. Under conditions of low issue importance, policy outcome had no effect on judged fairness or trust but did have a moderate impact on cooperation. Analyses also showed that when issue importance was high, procedural fairness had no effects. When issue importance was low, procedural fairness had moderate effects on judged fairness and trust. Results for the Swiss case replicated the main findings for the American case. Together, these results support the alternative model of the relation between trust and fairness, suggesting that the efficacy of fair procedures is strictly limited.

Legal Liabilities of Administrators.

ERIC Educational Resources Information Center

Underwood, Julie

This chapter of "Principles of School Business Management" discusses the implications of several court cases for legal issues affecting the role of the school business official. The issues addressed include civil rights, negligence, contracts, criminal liability, tuition and fees, and student records. The chapter opens with a brief overview of…

The hierarchy of work pursuits of public health managers.

PubMed

Braithwaite, Jeffrey; Luft, Sabine; Bender, Wolfgang; Callen, Joanne; Westbrook, Johanna I; Westbrook, Mary T; Mallock, Nadine A; Iedema, Rick; Hindle, Donald; Jochelson, Tanya

2007-05-01

How public health is managed in various settings is an important but under-examined issue. We examine themes in the management literature, contextualize issues facing public health managers and investigate the relative importance placed on their various work pursuits using a 14-activity management model empirically derived from studies of clinician-managers in hospitals. Ethnographic case studies of 10 managers in nine diverse public health settings were conducted. The case study accounts of managers' activities were content analysed, and substantive words encapsulating their work were categorized using the model. Managerial activities of the nine public health managers were ranked according to the number of words describing each activity. Kendall's coefficient of concordance yielded W = 0.710, P < 0.000, revealing significant similarity between the activity patterns of the public health managers. A rank order correlation between the activity patterns of the average ranks for the public health sample and for the hospital clinician-managers (n = 52) was R = 0.420, P = 0.131, indicating no significant relationship between relative activity priorities of the two groups. Public health managers put less emphasis on pursuits associated with structure, hierarchy and education, and more on external relations and decision-making. The model of hospital clinician-managers' managerial activities is applicable to public health managers while identifying differences in the way the two groups manage. The findings suggest that public health management work is more managerialist than previously thought.

Assessment and Management of Professionalism Issues in Pathology Residency Training: Results From Surveys and a Workshop by the Graduate Medical Education Committee of the College of American Pathologists.

PubMed

Domen, Ronald E; Talbert, Michael L; Johnson, Kristen; Post, Miriam D; Brissette, Mark D; Conran, Richard Michael; Hoffman, Robert D; McCloskey, Cindy B; Raciti, Patricia M; Roberts, Cory Anthony; Rojiani, Amyn M; Tucker, J Allan; Powell, Suzanne Zein-Eldin

2015-01-01

Professionalism issues are common in residency training and can be very difficult to recognize and manage. Almost one-third of the milestones for pathology recently instituted by the Accreditation Council for Graduate Medical Education encompass aspects of professionalism. Program directors are often unsure of how and when to remediate residents for unprofessional behavior. We used a case-based educational approach in a workshop setting to assist program directors in the management of unprofessional behavior in residents. Eight case scenarios highlighting various aspects of unprofessional behavior by pathology residents were developed and presented in an open workshop forum at the annual pathology program director's meeting. Prior to the workshop, 2 surveys were conducted: (1) to collect data on program directors' experience with identifying, assessing, and managing unprofessional behavior in their residents and (2) to get feedback from workshop registrants on how they would manage each of the 8 case scenarios. A wide range of unprofessional behaviors have been observed by pathology program directors. Although there is occasionally general agreement on how to manage specific behaviors, there remains wide variation in how to manage many of the presented unprofessional behaviors. Remediation for unprofessional behavior in pathology residents remains a difficult and challenging process. Additional education and research in this area are warranted.

School Planning and Management Buyer's Guide 2000.

ERIC Educational Resources Information Center

School Planning and Management, 1999

1999-01-01

Presents product information and a suppliers' directory for school purchasing managers for the year 2000, including a detailed product showcase and case histories and a section on descriptions of free brochures, pamphlets, and guides from key suppliers. An advertiser index concludes the issue. (GR)

Building Research Relationships With Managed Care Organizations: Issues and Strategies.

PubMed

Lein, Catherine; Collins, Clare; Lyles, Judith S; Hillman, Donald; Smith, Robert C

2003-06-01

Managed care is now the dominant form of healthcare in the United States. The need for clinical research about the organization, delivery, and outcomes of primary care services in managed care models is high, yet access to managed care organizations as sites for clinical research may be problematic. The purpose of this article is to describe issues involved in obtaining access to managed care settings for clinical research and practical strategies for successful collaboration using literature review and case description. Three steps for developing collaborative relationships with managed care organizations (MCOs) are presented: 1) assessment of organizational structure, history, and culture; 2) finding common ground; and 3) project implementation. These steps are discussed within the context of MCO systems issues and a relationship-centered approach to communication between researchers and individuals from the MCO. Successful relationships with MCOs for clinical research are possible when careful attention is paid to inclusion of MCOs as collaborators in the development of the research questions and design, and as partners in the research implementation process.

Tapering and discontinuation of methadone for chronic pain.

PubMed

Breivik, Harald

2015-06-01

How to taper and discontinue methadone therapy for chronic pain management is illustrated through a case report. This report is adapted from paineurope 2014; Issue 4, ©Haymarket Medical Publications Ltd, and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, LTD and is distributed free of charge to healthcare professionals in Europe. Archival issues can be viewed via the website: www.paineurope.com at which health professionals can find links to the original articles and request copies of the quarterly publication and access additional pain education and pain management resources.

Evolution from safety management system (SMS) to HSE MS: Incorporating health aspects into the HSE management system

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

Jong, G. de

1996-12-31

There is increasing recognition within the E&P industry that protection and promotion of the health of people at work is more than taking care of individual health. It is an organizational issue which can be managed using the same principles as for safety and environment. The synergy`s with safety and environmental management provide the link with the management system. However line managers need to under the critical Health issues: what are they are they relevant? How do we manage them? what are the standards? What are the management tools to be used? How do we monitor performance? What is themore » role of the line? What is the role of the health advisers? What training and competencies are needed for health management? What are the benefits? These questions have to be clarified before acceptance can be achieved for full integration of Health aspects into the HSE Management System. Health Risk Assessment was developed as a tool for systematic identification and assessment of health hazards and risks. It specifies the need for and type of controls and recovery measures, which can subsequently be incorporated in HSE Management System and HSE Cases. Our experience to date indicates that Health can successfully be integrated in HSE Management Systems and HSE Cases by using the same principles as developed for Safety Management Systems and Safety Cases. There are still many problems which need to be addressed but the methodology used appears to be sound and will eventually enhance line management understanding of the health management aspects relevant to the E&P Industry.« less

The Growing Concerns Regarding School Resource Officers

ERIC Educational Resources Information Center

Ryan, Joseph B.; Katsiyannis, Antonis; Counts, Jennifer M.; Shelnut, Jill C.

2018-01-01

There have been an increasing number of incidents in which school resource officers (SRO) have been used to manage student disciplinary issues with disastrous results. Court cases brought by parents and advocacy groups claim SROs have traumatized and injured students. This article addresses several critical issues concerning SROs being used to…

Achieving Quality Learning in Higher Education.

ERIC Educational Resources Information Center

Nightingale, Peggy; O'Neil, Mike

This volume on quality learning in higher education discusses issues of good practice particularly action learning and Total Quality Management (TQM)-type strategies and illustrates them with seven case studies in Australia and the United Kingdom. Chapter 1 discusses issues and problems in defining quality in higher education. Chapter 2 looks at…

Internet Telehealth for Pediatric Asthma Case Management: Integrating Computerized and Case Manager Features for Tailoring a Web-Based Asthma Education Program

PubMed Central

Wise, Meg; Gustafson, David H.; Sorkness, Christine A.; Molfenter, Todd; Staresinic, Anthony; Meis, Tracy; Hawkins, Robert P.; Shanovich, Kathleen Kelly; Walker, Nola P.

2008-01-01

This article reports on the development of a personalized, Web-based asthma-education program for parents whose 4- to 12-year-old children have moderate to severe asthma. Personalization includes computer-based tailored messages and a human coach to build asthma self-management skills. Computerized features include the Asthma Manager, My Calendar/Reminder, My Goals, and a tailored home page. These are integrated with monthly asthma-education phone calls from an asthmanurse case manager. The authors discuss the development process and issues and describe the current randomized evaluation study to test whether the yearlong integrated intervention can improve adherence to a daily asthma controller medication, asthma control, and parent quality of life to reduce asthma-related healthcare utilization. Implications for health education for chronic disease management are raised. PMID:16928987

Case-Based Learning: Educating Future Human Service Managers

ERIC Educational Resources Information Center

Austin, Michael J.; Packard, Thomas

2009-01-01

Using teaching cases in professional education programs has gained increased attention in the past several decades. While the use of teaching cases has been an important part of social work education, the majority of current casebooks focus on micro or direct practice issues and settings. Over the past forty years only four major casebooks have…

The Microcomputerization of Business Schools. Part I: General Strategies, Lessons, and Issues. Part II: A Case Study of the UCLA Graduate School of Management.

ERIC Educational Resources Information Center

Frand, Jason L.

Part I (General Strategies, Lessons and Issues) of this two-part analysis of the microcomputerization process describes strategies schools have followed in their microcomputerization efforts and the lessons and issues that have emerged. Part I covers the following: strategies for introducing microcomputers into the curriculum (the saturation,…

Applying the ED QUEST Planning Model in a School of Management: A Case Study.

ERIC Educational Resources Information Center

Ptaszynski, James Garner; Morrison, James L.

1990-01-01

The Strategic Planning Committee at the Graduate School of Management, Wake Forest University, identified what issues, trends, and possible events might affect the school in the future. The implementation of the ED QUEST planning model is described. (MLW)

Managing Leadership in the UK University: A Case for Researching the Missing Professoriate?

ERIC Educational Resources Information Center

Rayner, Steve; Fuller, Mary; McEwen, Lindsey; Roberts, Hazel

2010-01-01

This article offers a critical review of literature dealing with the topic of educational management and academic leadership as applied to the role of the professor or professoriate in the UK. The review identified a range of leadership issues and associated contemporary developments in the "management" of higher education. The subject…

Essays on the Effect of Radio Frequency Identification (RFID) on the Management of Healthcare Supply Chain Performance

ERIC Educational Resources Information Center

Cakici, Ozden Engin

2012-01-01

This dissertation examines three issues on the effect of Radio Frequency Identification (RFID) on the management of healthcare supply chain performance within the context of inventory management. Motivated by a case study conducted in a radiology practice, the second chapter analyzes the incremental benefits of RFID over barcodes for managing…

Leadership in School-Based Management: A Case Study in Selected Schools

ERIC Educational Resources Information Center

Botha, Nico

2006-01-01

According to the literature on school-based management, there are two clear schools of thought on this issue. One school views school-based management as a positive and successful vehicle of school improvement. The other argues that it has been minimally successful in school improvement. The leadership role of the school principal is widely…

Career Management in Transition: HRD Themes from the Estonian Civil Service

ERIC Educational Resources Information Center

Rees, Christopher J.; Jarvalt, Jane; Metcalfe, Beverley

2005-01-01

Purpose: To explore, through a case study, some of the key career-related HRD issues that senior managers are currently facing in the Estonian civil service. Design/methodology/approach: Presents primary empirical research into career management in the Estonian civil service since 1991, that is, in the post-Soviet era. The research involved…

Public Management Reform without Managers: The Case of German Public Schools

ERIC Educational Resources Information Center

Mintrop, Rick

2015-01-01

Purpose: The purpose of this paper is to discuss the role of principals in light of public management reforms taking place in the German educational system and in reference to the empirical patterns uncovered by the papers contained in the Special Issue. Policy makers have created new expectations and new technologies that seem to suggest to…

Revolutionizing Child Welfare with Outcomes Management

PubMed Central

Toche-Manley, Linda L.; Dietzen, Laura; Nankin, Jesse; Beigel, Astrid

2013-01-01

Outcomes management technology holds great promise for improving the quality of services provided to youth in the child welfare system. Advantages include better detection of behavioral health and trauma-related issues, early indicators of case progress or risk of failure and program- and system-level learning. Yet organizational barriers to implementation persist. Attention is spent in this paper on addressing these barriers so the use of outcomes management technology becomes a common practice. A model for predicting resiliency is presented, along with case examples demonstrating its potential use for treatment planning and monitoring progress. PMID:23460130

Self-amputation of the hand: issues in diagnosis and general hospital management.

PubMed

Crawford, Alison; Wand, Anne Pf; Smith, Michelle A

2016-04-01

To detail a diagnostic dilemma of intentional hand amputation in a man with a history of substance misuse and associated psychosis, depression and traumatic brain injury and to highlight issues in joint psychiatric and surgical management of such a complex patient in a general hospital setting. Deliberate limb self-amputation is a rare event with the majority of reported cases occurring during an episode of psychosis. This case illustrates the diagnostic utility of the literature supporting that a person who has self-inflicted amputation of a limb should be treated as psychotic until proven otherwise. The presence of a traumatic brain injury, with associated cognitive and psychosocial sequelae, affected diagnosis and management. Early and ongoing involvement of consultation-liaison psychiatry collaborating with a multidisciplinary general hospital team may improve mental and physical health outcomes for such patients. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Shifting from presumptive to test-based management of malaria - technical basis and implications for malaria control in Ghana.

PubMed

Baiden, F; Malm, K; Bart-Plange, C; Hodgson, A; Chandramohan, D; Webster, J; Owusu-Agyei, S

2014-06-01

The presumptive approach was the World Health Organisation (WHO) recommended to the management of malaria for many years and this was incorporated into syndromic guidelines such as the Integrated Management of Childhood Illnesses (IMCI). In early 2010 however, WHO issued revised treatment guidelines that call for a shift from the presumptive to the test-based approach. Practically, this implies that in all suspected cases, the diagnosis of uncomplicated malaria should be confirmed using rapid test before treatment is initiated. This revision effectively brings to an end an era of clinical practice that span several years. Its implementation has important implications for the health systems in malaria-endemic countries. On the basis of research in Ghana and other countries, and evidence from program work, the Ghana National Malaria Control Program has issued revised national treatment guidelines that call for implementation of test-based management of malaria in all cases, and across all age groups. This article reviews the evidence and the technical basis for the shift to test-based management and examines the implications for malaria control in Ghana.

Chronic disease management in Sub-Saharan Africa: whose business is it?

PubMed

Bischoff, Alexander; Ekoe, Tetanye; Perone, Nicolas; Slama, Slim; Loutan, Louis

2009-08-01

Public health specialists and clinicians alike agree that Humanity faces a global pandemic of chronic diseases in the 21(st) century. In this article we discuss the implications of this pandemic on another global issue, the health workforce. Because both issues are particularly acute in Sub-Saharan Africa (SSA), we will focus on this region and use Cameroon as a case in point. We first gauge the epidemic of chronic conditions in SSA. We then discuss the implications of chronic conditions for the reshaping of health systems and the health workforce. We conclude by making a strong case for the building up and strengthening the health workforce, insisting on the crucial role of nurses, their training, and involvement in chronic disease management.

Chronic Disease Management in Sub-Saharan Africa: Whose Business Is It?

PubMed Central

Bischoff, Alexander; Ekoe, Tetanye; Perone, Nicolas; Slama, Slim; Loutan, Louis

2009-01-01

Public health specialists and clinicians alike agree that Humanity faces a global pandemic of chronic diseases in the 21st century. In this article we discuss the implications of this pandemic on another global issue, the health workforce. Because both issues are particularly acute in Sub-Saharan Africa (SSA), we will focus on this region and use Cameroon as a case in point. We first gauge the epidemic of chronic conditions in SSA. We then discuss the implications of chronic conditions for the reshaping of health systems and the health workforce. We conclude by making a strong case for the building up and strengthening the health workforce, insisting on the crucial role of nurses, their training, and involvement in chronic disease management. PMID:19742159

77 FR 33195 - Western Pacific Fishery Management Council; Public Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-05

... Workshop A. Introduction and Overview of FAD Issues in the Western Pacific Region B. Case Study of Local... Management Council; Public Meetings AGENCY: National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA), Commerce. ACTION: Notice of public meetings and hearings. SUMMARY: The...

A case of bilateral lower cranial nerve palsies after base of skull trauma with complex management issues: case report and review of the literature.

PubMed

Lehn, Alexander Christoph; Lettieri, Jennie; Grimley, Rohan

2012-05-01

Fractures of the skull base can cause lower cranial nerve palsies because of involvement of the nerves as they traverse the skull. A variety of syndromes have been described, often involving multiple nerves. These are most commonly unilateral, and only a handful of cases of bilateral cranial nerve involvement have been reported. We describe a 64-year-old man with occipital condylar fracture complicated by bilateral palsies of IX and X nerves associated with dramatic physiological derangement causing severe management challenges. Apart from debilitating postural hypotension, he developed dysphagia, severe gastrointestinal dysmotility, issues with airway protection as well as airway obstruction, increased oropharyngeal secretions and variable respiratory control. This is the first report of a patient with traumatic bilateral cranial nerve IX and X nerve palsies. This detailed report and the summary of all 6 previous case reports of traumatic bilateral lower cranial nerve palsies illustrate clinical features, treatment strategies, and outcomes of these rare events.

Discursive construction of polyphony in healthcare management.

PubMed

Hujala, Anneli; Rissanen, Sari

2012-01-01

The aim of the paper is to understand and define how the polyphony of management is constructed in interaction and to describe this through concrete management meeting cases. Polyphony refers to the diverse voices of various organization members, and how these voices are present, disclosed and utilized in management. The study is based on the social constructionist and discursive perspectives of management, which question the traditional, individualistic approaches of management. The issue was examined through a qualitative case study by analysing the micro-level management discourse in three healthcare organizations. Discursive practices that enhance or inhibit polyphony are often unnoticed and unconscious. Key moments of management discourse are an example of unconscious mundane practices through which members of organizations construct the reality of management. The empirical results are locally contextual. In the future, research will be able to apply the approach to diverse contexts as well as link micro-level discourses to the construction of broader health and social management discourses. The paper increases the understanding of how to enhance participation and staff contribution, and how to utilize the knowledge of all members of the organization. Both managers and other staff members are fully involved in the social construction of management. Micro-level discourse should be paid attention to in management work as well as in the education of managers and staff. The study increases the understanding of micro-level issues of management and challenges the conventional, taken-for-granted assumptions behind organization and management theories.

Therapist concerns and process issues in grappling with functional autobiographical amnesia.

PubMed

Tripathi, Ravikesh; Bharath, Srikala; Desai, Geetha; Mehrotra, Seema

2013-07-01

Dissociative amnesia is relatively rare form of the dissociative disorder. This paper aims at describing the salient features of a case of functional autobiographical amnesia in a young adult and the approach adopted in the psychological management of this case. The case highlights concerns of the therapist at various stages of the therapy process.

The Management of Student Affairs Programs in Community Colleges: Revamping Processes and Structures. Horizons Issues Monograph Series.

ERIC Educational Resources Information Center

Deegan, William L.

Based on a review of the management literature in the fields of business and education and on case studies, interviews, and discussions, this monograph identifies the prerequisites for the successful management of student affairs programs. Chapter 1 presents perspectives on the student affairs profession, summarizes the problems facing the field,…

Is It Ethical for Patents to Be Issued for the Computer Algorithms that Affect Course Management Systems for Distance Learning?

ERIC Educational Resources Information Center

Moreau, Nancy

2008-01-01

This article discusses the impact of patents for computer algorithms in course management systems. Referring to historical documents and court cases, the positive and negative aspects of software patents are presented. The key argument is the accessibility to algorithms comprising a course management software program such as Blackboard. The…

Crisis management with applicability on fire fighting plants

NASA Astrophysics Data System (ADS)

Panaitescu, M.; Panaitescu, F. V.; Voicu, I.; Dumitrescu, L. G.

2017-08-01

The paper presents a case study for a crisis management analysis which address to fire fighting plants. The procedures include the steps of FTA (Failure tree analysis). The purpose of the present paper is to describe this crisis management plan with tools of FTA. The crisis management procedures have applicability on anticipated and emergency situations and help to describe and planning a worst-case scenario plan. For this issue must calculate the probabilities in different situations for fire fighting plants. In the conclusions of paper is analised the block diagram with components of fire fighting plant and are presented the solutions for each possible risk situations.

Resettlement: A Cultural and Psychological Crisis.

ERIC Educational Resources Information Center

Hulewat, Phyllis

1996-01-01

The stages of resettlement and need to integrate past cultural experience into their new life are similar for all immigrants. Describes stages of resettlement and basic elements needed to manage the resettlement process. Three specific groups of clients are identified, and case management methods are presented for dealing with issues raised by…

Tax Exemption Issues Facing Academic Health Centers in the Managed Care Environment.

ERIC Educational Resources Information Center

Jones, Darryll K.

1997-01-01

Traditional characteristics of academic health centers are outlined, and conflicts with managed care are identified. Operating strategies designed to resolve the conflicts are discussed in light of tax statutes and regulations, Internal Revenue Service interpretations, and case law. Detailed references are included to provide a complete resource…

A public utility model for managing public land recreation enterprises.

Treesearch

Tom Quinn

2002-01-01

Through review of relevant economic principles and judicial precedent, a case is made that public-land recreation enterprises are analogous to traditionally recognized public utilities. Given the historical concern over the societal value of recreation and associated pricing issues, public-land management policies failing to acknowledge these utility-like...

Call It Trash, Garbage or Refuse: Four Case Studies Illustrate Community Waste Management Options.

ERIC Educational Resources Information Center

Kazzi, John W.

1990-01-01

Describes four successful community programs dealing with waste management issues, developed with assistance from Keep America Beautiful System: litter prevention (Beatrice, Nebraska); composting yard waste (Centralia, Illinois); recycling (Lake Jackson, Texas); and waste-to-energy incineration (Gastonia, North Carolina). Notes related education…

The Case for Creative Abrasion: Experts Speak Out on Knowledge Management.

ERIC Educational Resources Information Center

Cowley-Durst, Barbara; Christensen, Hal D.; Degler, Duane; Weidner, Douglas; Feldstein, Michael

2001-01-01

Five knowledge management (KM) experts discuss answers to six fundamental issues of KM that address: a definition of knowledge and KM; relationship between business and KM; whether technology has helped the knowledge worker; relationship between learning, performance, knowledge, and community; the promise of knowledge ecology or ecosystem and…

Musical Instrument-Associated Health Issues and Their Management.

PubMed

Okoshi, Kae; Minami, Taro; Kikuchi, Masahiro; Tomizawa, Yasuko

2017-09-01

Playing musical instruments can bring joy to people, but can also cause a wide variety of health issues that range from mild disorders to potentially fatal conditions. Although sports medicine is an established medical subspecialty, relatively few studies have investigated the health issues associated with musical instruments. Here we present an overview of these health issues. These include infections due to microorganisms, allergic reactions, as well as mechanical injuries from sustained high pressures within the oral, mediastinal, thoracic, and abdominal cavities. For example, wind instruments can potentially harbor thousands of pathogenic organisms. If several players share the same instrument, these instruments present potential hazards in the spread of infections. A fatal case of hypersensitivity pneumonitis in a bagpiper is particularly noteworthy. Similarly, a case of gastrointestinal anthrax in an animal-hide drummer is a reminder of this rare but highly fatal disease. Although not fatal, hearing-related disorders, neuromuscular issues, musculoskeletal problems, and contact dermatitis are also very common among instrumentalists. This review aims to illuminate these under-recognized health issues by highlighting both the common conditions and the rare but fatal cases.

Traumatic brain injury rehabilitation: case management and insurance-related issues.

PubMed

Pressman, Helaine Tobey

2007-02-01

Traumatic brain injury (TBI) cases are medically complex, involving the physical, cognitive, behavioral, social, and emotional aspects of the survivor. Often catastrophic, these cases require substantial financial resources not only for the patient's survival but to achieve the optimal outcome of a functional life with return to family and work responsibilities for the long term. TBI cases involve the injured person, the family, medical professionals such as treating physicians, therapists, attorneys, the employer, community resources, and the funding source, usually an insurance company. Case management is required to facilitate achievement of an optimal result by collaborating with all parties involved, assessing priorities and options, coordinating services, and educating and communicating with all concerned.

Solid waste management in Thailand: an overview and case study (Tha Khon Yang sub-district).

PubMed

Yukalang, Nachalida; Clarke, Beverley Dawn; Ross, Kirstin Elizabeth

2017-09-26

Due to rapid urbanization, solid waste management (SWM) has become a significant issue in several developing countries including Thailand. Policies implemented by the Central Thai Government to manage SWM issues have had only limited success. This article reviews current municipal waste management plans in Thailand and examines municipal waste management at the local level, with focus on the Tha Khon Yang sub-district surrounding Mahasarakham University in Mahasarakham Province. Within two decades this area has been converted from a rural to an urban landscape featuring accommodation for over 45,000 university students and a range of business facilities. This development and influx of people has outpaced the government's ability to manage municipal solid waste (MSW). There are significant opportunities to improve local infrastructure and operational capacity; but there are few mechanisms to provide and distribute information to improve community participation in waste management. Many community-based waste management projects, such as waste recycling banks, the 3Rs (reduce, reuse and recycle), and waste-to-biogas projects have been abandoned. Additionally, waste from Tha Kon Yang and its surrounding areas has been transferred to unsanitary landfills; there is also haphazard dumping and uncontrolled burning of waste, which exacerbate current pollution issues.

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…

Teaching Communication with Ethics-Based Cases.

ERIC Educational Resources Information Center

Stevens, Betsy

1996-01-01

Argues the importance of presenting ethics and communication as twin concepts in the management communication class. Presents two cases useful in the classroom that address two contemporary issues (harassment in the workplace and the consumption of alcohol by pregnant women) that have implications for business professionals and allow students to…

Social Services: The Navajo Way.

ERIC Educational Resources Information Center

Belone, Cecilia; Gonzalez-Santin, Edwin; Gustavsson, Nora; MacEachron, Ann E.; Perry, Timothy

2002-01-01

Explores the Navajo Nation Division of Social Services' efforts to transform the Bureau of Indian Affairs service delivery paradigm into a more holistic case management paradigm for child and family services congruent with Navajo culture and rural location. Discusses a composite case to illustrate issues experienced by many Navajo clients.…

The Technology Principal: To Be or Not to Be?

ERIC Educational Resources Information Center

Anthony, Anika Ball; Patravanich, Supawaree

2014-01-01

This case provides principal licensure candidates a strategic perspective on leading and managing educational technology initiatives. It presents issues related to vision setting, planning, implementation, organizational structure, and decision making. The case narrative is presented from the perspective of a principal, but it can also be used to…

Challenging issues of urban biodiversity related to ecohydrology.

PubMed

Mendiondo, E M

2008-11-01

This paper aims to outline challenging issues of urban biodiversity in order to address yardsticks related to ecohydrology, and with a complementary approach to eutrophication impacts. The vision of environmental services, urbanization's consequences and management aspects of water governance are also depicted. Factors of river restoration, environmental tradeoffs and socio-cultural constrains are envisaged through concept questions towards emerging aspects that figure out methodological guides, strategic challenges for stakeholders and inter-disciplinary opportunities. Examples from case studies on restoration and management, from experiences and lessons learned, are enclosed, with brief discussions and literature citation.

Medical Big Data Warehouse: Architecture and System Design, a Case Study: Improving Healthcare Resources Distribution.

PubMed

Sebaa, Abderrazak; Chikh, Fatima; Nouicer, Amina; Tari, AbdelKamel

2018-02-19

The huge increases in medical devices and clinical applications which generate enormous data have raised a big issue in managing, processing, and mining this massive amount of data. Indeed, traditional data warehousing frameworks can not be effective when managing the volume, variety, and velocity of current medical applications. As a result, several data warehouses face many issues over medical data and many challenges need to be addressed. New solutions have emerged and Hadoop is one of the best examples, it can be used to process these streams of medical data. However, without an efficient system design and architecture, these performances will not be significant and valuable for medical managers. In this paper, we provide a short review of the literature about research issues of traditional data warehouses and we present some important Hadoop-based data warehouses. In addition, a Hadoop-based architecture and a conceptual data model for designing medical Big Data warehouse are given. In our case study, we provide implementation detail of big data warehouse based on the proposed architecture and data model in the Apache Hadoop platform to ensure an optimal allocation of health resources.

Collaborative Procurement within Enterprise Networks: A Literature Review, a Reference Framework and a Case Study

NASA Astrophysics Data System (ADS)

Cagnazzo, Luca; Taticchi, Paolo; Bidini, Gianni; Sameh, Mohamed

Collaboration among companies is nowadays a success leverage from those involved, especially for SMEs. The networking advantages are several and among them, reducing costs is a critical one. Costs reduction due to the possibility of Collaborative Procurement (CP) among partners is one of the most important achievements in a network. While the literature available offers good bases for managing single contractor procurement issues, little research addresses the case of CP within Enterprise Networks (ENs). This paper explore the mentioned issue and proposes a general framework for managing CP in ENs, those with the Virtual Development Office (VDO) structure. The findings from the application of the framework proposed in an Italian network are highlighted so as to provide preliminary results and drive future research.

Violence at School: Global Issues and Interventions. Studies in Comparative Education.

ERIC Educational Resources Information Center

Ohsako, Toshio, Ed.

The case studies in this collection explore issues of violence in schools and what can be done to reduce these events. A number of national experiences in violence management, principally from developing countries, are brought together as a step toward improving the quality of education. The following are included: (1) "Tackling School Violence…

Case Study: University of Anyplace: Strategic Legal Risk Review.

ERIC Educational Resources Information Center

Hall, John T.; Ferguson, Rowan

2000-01-01

Considers legal issues and risks faced by a fictional American university as it seeks to establish an operation based in London. Addresses the first step in the process of risk management, the risk review exercise, and provides an explanation of the legal issues involved to allow progression to the second stage in the process (evaluation of the…

Investigation of Geobase Implementation Issues: Case Study of Information Resource Management

DTIC Science & Technology

2004-03-01

case study , ethnography , phenomenological study , and grounded theory . “Of...all the research designs [described] … a grounded theory study is the one that is least likely to begin from a 40 Use this approach if...the treatments explained, the case study method best matches the objectives of this research (Leedy & Ormrod, 2001). Yin’s criteria for

A technical investigation on tools and concepts for sustainable management of the subsurface in The Netherlands.

PubMed

Griffioen, Jasper; van Wensem, Joke; Oomes, Justine L M; Barends, Frans; Breunese, Jaap; Bruining, Hans; Olsthoorn, Theo; Stams, Alfons J M; van der Stoel, Almer E C

2014-07-01

In response to increasing use of the subsurface, there is a need to modernise policies on sustainable use of the subsurface. This holds in particular for the densely populated Netherlands. We aimed to analyse current practice of subsurface management and the associated pressure points and to establish a conceptual overview of the technical issues related to sustainable management of the subsurface. Case studies on the exploitation of subsurface resources (including spatial use of the subsurface) were analysed, examining social relevance, environmental impact, pressure points and management solutions. The case studies ranged from constructing underground garages to geothermal exploitation. The following issues were identified for the technological/scientific aspects: site investigation, suitability, risk assessment, monitoring and measures in the event of failure. Additionally, the following general issues were identified for the administrative aspects: spatial planning, option assessment, precaution, transparency, responsibility and liability. These issues were explored on their technological implications within the framework of sustainable management of the subsurface. This resulted into the following key aspects: (1) sustainability assessment, (2) dealing with uncertainty and (3) policy instruments and governance. For all three aspects, different options were identified which might have a legal, economic or ethical background. The technological implications of these backgrounds have been identified. A set of recommendations for sustainable management of the subsurface resources (incl. space) was established: (1) management should be driven by scarcity, (2) always implement closed loop monitoring when the subsurface activities are high-risk, (3) when dealing with unknown features and heterogeneity, apply the precautionary principle, (4) responsibility and liability for damage must be set out in legislation and (5) sustainability should be incorporated in all relevant legislation and not only in environmental legislation. Other aspects to be considered are the reversibility of the impacts from subsurface activities and the abandonment of installations. Copyright © 2014 Elsevier B.V. All rights reserved.

Processing of intended and unintended strategic issues and integration into the strategic agenda.

PubMed

Ridder, Hans-Gerd; Schrader, Jan Simon

2017-11-01

Strategic change is needed in hospitals due to external and internal pressures. However, research on strategic change, as a combination of management and medical expertise in hospitals, remains scarce. We analyze how intended strategic issues are processed into deliberate strategies and how unintended strategic issues are processed into emergent strategies in the management of strategy formation in hospitals. This study empirically investigates the integration of medical and management expertise in strategy formation. The longitudinal character of the case study enabled us to track patterns of intended and unintended strategic issues over 2 years. We triangulated data from interviews, observations, and documents. In accordance with the quality standards of qualitative research procedures, we analyzed the data by pattern matching and provided analytical generalization regarding strategy formation in hospitals. Our findings suggest that strategic issues are particularly successful within the strategy formation process if interest groups are concerned with the strategic issue, prospective profits are estimated, and relevant decisions makers are involved early on. Structure and interaction processes require clear criteria and transparent procedures for effective strategy formation. There is systematic neglect of medical expertise in processes of generating strategies. Our study reveals that the decentralized structure of medical centers is an adequate template for both the operationalization of intended strategic issues and the development of unintended strategic issues. However, tasks, roles, responsibility, resources, and administrative support are necessary for effective management of strategy formation. Similarly, criteria, procedures, and decision-making are prerequisites for effective strategy formation.

The primary health care physician and the cancer patient: tips and strategies for managing sexual health

PubMed Central

Zhou, Eric S.; Nekhlyudov, Larissa

2015-01-01

There is a large and growing population of long-term cancer survivors. Primary care physicians (PCPs) are playing an increasingly greater role in the care of these patients across the continuum of cancer survivorship. In this role, PCPs are faced with the responsibility of managing a range of medical and psychosocial late effects of cancer treatment. In particular, the sexual side effects of treatment which are common and have significant impact on quality of life for the cancer survivor, often go unaddressed. This is an area of clinical care and research that has received increasing attention, highlighted by the presentation of this special issue on Cancer and Sexual Health. The aims of this review are 3-fold. First, we seek to overview common presentations of sexual dysfunction related to major cancer diagnoses in order to give the PCP a sense of the medical issues that the survivor may present with. Barriers to communication about sexual health issues between patient/PCPs in order are also described in order to emphasize the importance of PCPs initiating this important conversation. Next, we provide strategies and resources to help guide the PCP in the management of sexual dysfunction in cancer survivors. Finally, we discuss case examples of survivorship sexual health issues and highlight the role that a PCP can play in each of these case examples. PMID:26816826

Time Management in Higher Education Administration: A Case Study

ERIC Educational Resources Information Center

Lewis, Darrell R.; Dahl, Tor

1976-01-01

Drawing on data from a staff development project for administrators in a college at a major American university, it was determined that there is considerable commonality across individuals and that it is possible to deal with such issues as time management, job stress, and enjoyment on an organizational level. (Editor/JT)

Contracting for Facilities Services. Critical Issues in Facilities Management. No. 9.

ERIC Educational Resources Information Center

APPA: Association of Higher Education Facilities Officers, Alexandria, VA.

This book has been designed to provide practical information to managers on how to work with outside contractors in the higher education facilities area, and provides "real world" advice on the opportunities and pitfalls of privatization. Overviews and detailed case studies of contracting-out for services such as custodial services and…

40 CFR 123.63 - Criteria for withdrawal of State programs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... withdrawal of State programs. (a) In the case of a sewage sludge management program, references in this... under this part, including failure to issue permits; (ii) Repeated issuance of permits which do not... sludge management program, § 501.14 of this chapter). (5) Where the State fails to develop an adequate...

Integrating Six Sigma Concepts in an MBA Quality Management Class

ERIC Educational Resources Information Center

Weinstein, Larry B.; Petrick, Joseph; Castellano, Joseph; Vokurka, Robert J.

2008-01-01

Instructors face enormous challenges in presenting effective instruction on concepts and tools of quality management. Most textbooks focus on presenting individual concepts or tools and fail to address complex issues confronted in real-world problem-solving situations. The supplementary use of cases does not help students to understand the dynamic…

A Coalitional View of Site-Based Management: Implications for School Administrators in Collective Bargaining Environments.

ERIC Educational Resources Information Center

Conley, Sharon C.; And Others

1991-01-01

Analyzes site-based management structures, using specific case of teacher unions and collective bargaining. From coalitional perspective, interview data suggest that teacher union leaders may be in a quandary, shifting between traditional "bread and butter" issues and professional/collegial concerns. A struggle exists involving the…

Insights and participatory actions driven by a socio-hydrogeological approach for groundwater management: the Grombalia Basin case study (Tunisia)

NASA Astrophysics Data System (ADS)

Tringali, C.; Re, V.; Siciliano, G.; Chkir, N.; Tuci, C.; Zouari, K.

2017-08-01

Sustainable groundwater management strategies in water-scarce countries need to guide future decision-making processes pragmatically, by simultaneously considering local needs, environmental problems and economic development. The socio-hydrogeological approach named `Bir Al-Nas' has been tested in the Grombalia region (Cap Bon Peninsula, Tunisia), to evaluate the effectiveness of complementing hydrogeochemical and hydrogeological investigations with the social dimension of the issue at stake (which, in this case, is the identification of groundwater pollution sources). Within this approach, the social appraisal, performed through social network analysis and public engagement of water end-users, allowed hydrogeologists to get acquainted with the institutional dimension of local groundwater management, identifying issues, potential gaps (such as weak knowledge transfer among concerned stakeholders), and the key actors likely to support the implementation of the new science-based management practices resulting from the ongoing hydrogeological investigation. Results, hence, go beyond the specific relevance for the Grombaila basin, showing the effectiveness of the proposed approach and the importance of including social assessment in any given hydrogeological research aimed at supporting local development through groundwater protection measures.

Case management after long-term absence from work in China: a case report.

PubMed

Tang, Dan; Yu, Ignatius Tak Sun; Luo, Xiaoyuan; Liang, Youxin; He, Yonghua

2011-03-01

Return-to-work (RTW) after occupational injuries is an important and challenging issue. Case managers are expected to play a vital role in successful RTW. In China, RTW intervention is in its early phase and requires further research and practice. This case report describes Mr. H's RTW process for illustrating the work of a case management team in China. Suggestions on developing and optimizing the process in China are given. After 9 years of absence from work due to severe burn injuries at work, Mr. H was referred for RTW interventions. Mr. H received social and occupational rehabilitation services of 3 months, and the following workplace visits and work trials. After the job placement, the case manager continued the liaison with the worker and employer. Mr. H showed positive changes in occupational and social adjustment after the case management interventions. This was reflected from the shift from the contemplation to action stage on the Lam Assessment of Stages of Employment Readiness. Despite he did not show significant changes on functional capacity and fear avoidance beliefs, Mr. H passed the job credential test and was offered a maintenance technician position at a new company. Both the worker and the employer were satisfied with the outcome of the case management. The RTW interventions carried out by the case managers appeared to be effective within the Chinese system. The results suggested that professional training of case managers, RTW-related policies and technological standards, early integrated interventions should be further developed in China. Disability Adjustment Group Therapy and RTW Support Groups perhaps are useful approaches in workers' returning to work.

Making intelligent systems team players: Case studies and design issues. Volume 1: Human-computer interaction design

NASA Technical Reports Server (NTRS)

Malin, Jane T.; Schreckenghost, Debra L.; Woods, David D.; Potter, Scott S.; Johannesen, Leila; Holloway, Matthew; Forbus, Kenneth D.

1991-01-01

Initial results are reported from a multi-year, interdisciplinary effort to provide guidance and assistance for designers of intelligent systems and their user interfaces. The objective is to achieve more effective human-computer interaction (HCI) for systems with real time fault management capabilities. Intelligent fault management systems within the NASA were evaluated for insight into the design of systems with complex HCI. Preliminary results include: (1) a description of real time fault management in aerospace domains; (2) recommendations and examples for improving intelligent systems design and user interface design; (3) identification of issues requiring further research; and (4) recommendations for a development methodology integrating HCI design into intelligent system design.

Primary care management of patients following bariatric surgery.

PubMed

Doolen, Jessica L; Miller, Sally K

2005-11-01

To evaluate the nutritional, psychosocial, and other primary care issues faced by nurse practitioners (NPs) and their patients in the long-term management of the increasing population of patients who have had bariatric surgery. An extensive review of the literature provides the foundation for development of assessment and management strategies highlighted in a case study. Management of the patient after bariatric surgery does not end with successful surgical healing. Numerous long-term implications, including significant psychosocial and nutritional issues, require the informed attention of the primary care provider for the rest of the life span. Each year an increasing number of obese patients pursue a surgical solution to obesity, up to an estimated 100,000 in 2004. Numerous long-term health implications are specific to this population. NPs can improve the quality of primary care to these patients by being informed regarding the different procedures and their impact on physiologic phenomena, and the psychosocial issues inherent to extreme weight loss.

Reflections on lymphoedema, fungating wounds and the power of touch in the last weeks of life.

PubMed

Fenton, Suzy

2011-02-01

Terminal care is a significant chapter of life in which each individual has the right to expect dignity, compassion, holistic care, and quality of life. The case of 'Sally', a 57-year-old woman with a diagnosis of inflammatory breast cancer, left arm lymphoedema, and a fungating chest wound, gave palliative care nurses a multitude of distressing and complex challenges to manage. Management of lymphoedema is often put into the 'too hard basket', especially in the palliative care setting. Similarly, fungating wounds are hard to confront, and the power of touch is often underestimated. The aim of this case study is to explore and reflect on how these issues entwine, and how vital it is for nurses to feel comfortable in providing the most appropriate care. As a result of reflection on Sally's care management many issues were highlighted, including the crucial need to relieve her symptoms with timely, appropriate, dignified, and respectful care, optimizing her sense of worth and quality of life.

Managing the Quality of Cross-Border Higher Education in Zimbabwe

ERIC Educational Resources Information Center

Garwe, Evelyn Chiyevo

2015-01-01

A study on investigating the issues of quality associated with cross-border higher education was carried out using the case study approach focusing on Zimbabwe. The methodology involved document analysis of the cases of regulation and accreditation of cross-border higher education providers and assessment of qualifications acquired from foreign…

MILS in a general surgery unit: learning curve, indications, and limitations.

PubMed

Patriti, Alberto; Marano, Luigi; Casciola, Luciano

2015-06-01

Minimally invasive liver surgery (MILS) is going to be a method with a wide diffusion even in general surgery units. Organization, learning curve effect, and the environment are crucial issues to evaluate before starting a program of minimally invasive liver resections. Analysis of a consecutive series of 70 patients has been used to define advantages and limits of starting a program of MILS in a general surgery unit. Seventeen MILS have been calculated with the cumulative sum method as the number of cases to complete the learning curve. Operative times [270 (60-480) vs. 180 (15-550) min; p 0.01] and rate of conversion (6/17 vs. 5/53; p 0.018) decrease after this number of cases. More complex cases can be managed after a proper optimization of all steps of liver resection. When a high confidence of the medical and nurse staff with MILS is reached, economical and strategic issues should be evaluated in order to establish a multidisciplinary hepatobiliary unit independent from the general surgery unit to manage more complex cases.

Eco-efficiency for greenhouse gas emissions mitigation of municipal solid waste management: a case study of Tianjin, China.

PubMed

Zhao, Wei; Huppes, Gjalt; van der Voet, Ester

2011-06-01

The issue of municipal solid waste (MSW) management has been highlighted in China due to the continually increasing MSW volumes being generated and the limited capacity of waste treatment facilities. This article presents a quantitative eco-efficiency (E/E) analysis on MSW management in terms of greenhouse gas (GHG) mitigation. A methodology for E/E analysis has been proposed, with an emphasis on the consistent integration of life cycle assessment (LCA) and life cycle costing (LCC). The environmental and economic impacts derived from LCA and LCC have been normalized and defined as a quantitative E/E indicator. The proposed method was applied in a case study of Tianjin, China. The study assessed the current MSW management system, as well as a set of alternative scenarios, to investigate trade-offs between economy and GHG emissions mitigation. Additionally, contribution analysis was conducted on both LCA and LCC to identify key issues driving environmental and economic impacts. The results show that the current Tianjin's MSW management system emits the highest GHG and costs the least, whereas the situation reverses in the integrated scenario. The key issues identified by the contribution analysis show no linear relationship between the global warming impact and the cost impact in MSW management system. The landfill gas utilization scenario is indicated as a potential optimum scenario by the proposed E/E analysis, given the characteristics of MSW, technology levels, and chosen methodologies. The E/E analysis provides an attractive direction towards sustainable waste management, though some questions with respect to uncertainty need to be discussed further. Copyright © 2011 Elsevier Ltd. All rights reserved.

Satellites for Commonwealth Education: Some Policy Issues. Case Studies: AUSSAT, Australia; Knowledge Network, Canada; INSAT, India; University of the South Pacific; University of the West Indies.

ERIC Educational Resources Information Center

Bates, A. W.

This report presents case studies on the use of satellites for education in five Commonwealth countries: Australia, Canada, India, Fiji, and Jamaica. Information provided in each of the case studies includes geography, production, the distribution system, regulation and management, and costs. Additional information given for the Australian…

Integrating natural and social sciences to inspire public confidence in radioactive waste policy case study - Committee on radioactive waste management

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

Usher, Sam

2007-07-01

Integrating Natural and Social Sciences to Inspire Public Confidence in Radioactive Waste Policy Case Study: Committee on Radioactive Waste Management Implementing effective long-term radioactive waste management policy is challenging, and both UK and international experience is littered with policy and programme failures. Policy must not only be underpinned by sound science and technical rationale, it must also inspire the confidence of the public and other stakeholders. However, in today's modern society, communities will not simply accept the word of scientists for setting policy based purely on technical grounds. This is particularly so in areas where there are significant social andmore » ethical issues, such as radioactive waste disposal. To develop and implement effective policy, governments, waste owners and implementing bodies must develop processes which effectively integrate both complex technical and scientific issues, with equally challenging social and ethical concerns. These integrating processes must marry often intricate technical issues with broad public and stakeholder engagement programmes, in programmes which can expect the highest levels of public scrutiny, and must invariably be delivered within challenging time and budget constraints. This paper considers a model for how such integrating processes can be delivered. The paper reviews, as a case study, how such challenges were overcome by the Committee on Radioactive Waste Management (CoRWM), which, in July 2006, made recommendations to the UK government for the establishment of a long-term radioactive waste policy. Its recommendations were underpinned by sound science, but also engendered public confidence through undertaking the largest and most significant deliberative public and stakeholder engagement programme on a complex policy issue in the UK. Effective decision-making was enabled through the integration of both proven and bespoke methodologies, including Multi-criteria Decision Analysis and Holistic assessments, coupled with an overarching deliberative approach. How this was managed and delivered to programme demonstrates how important effective integration of different issues, interests and world views can be achieved, and the paper looks forward to how the continued integration of both natural and social sciences is essential if public confidence is to be maintained through implementation stages. This paper will be particularly relevant to governments, waste owners and implementing bodies who are responsible for developing and implementing policy. (author)« less

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.

Military Retention and Retirement. Reciprocal Family/Organization Effects,

DTIC Science & Technology

1981-06-30

the Chief of Naval Operations, 1978. Derr, C.B. Managing marriage/ family issues across career stages: the case of the U.S. Naval officers. Unpublished...Jeffers-, Davis Highway University of Maryland Arlingtcn VA , #02 College of Business and Management and Department of Psychology Dr. Larry Cummings...Institution 801 N. Pitt Street, Suite 120 Alexandria VA 22314 Dr. Richard Steers Graduate School of Management and Business University of Oregon Eugene

Why issues emerge

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

Coates, J.F.; Jarrett, J.; Decker, C.

1989-10-01

For those analysts and managers responsible for anticipating issues that may become important to their organizations, the origin of such issues is an important question. This study looks at how, and why, an issue may emerge from a situation, or an event. The full development of an issue, and its resolution may take from five to 30 years or more. The earlier it can be anticipated, the more opportunity for its stakeholders to develop positions and options for addressing it. Three approaches to examining the origins of issues are employed; the invention of ten models as metaphors for the formationmore » and growth of issues; the test of these models against 12 well-known, and fully developed issues; and the analysis of three case studies of issue development. This analysis assesses the readiness at different times for cultural, institutional and situational factors to allow or promote a situation to transition into an issue. Six of the ten conceptual models prove to be more powerful metaphors of issue development than the others. Analysis of the case studies shows that a readiness assessment of an unfolding situation may yield clues to a new issue. A readiness checklist is provided. 6 figs., 4 tabs.« less

Malaysia’s First Transplanted Case of Chronic Granulomatous Disease: The Journey of Overcoming Obstacles

PubMed Central

Ismail, Intan Hakimah; Jamli, Faizah Mohamed; Othman, Ida Shahnaz; Noh, Lokman Mohd; Abdul Latiff, Amir Hamzah

2016-01-01

The awareness of primary immunodeficiency (PID) in Malaysia is still not forthcoming. Certain practical issues such as lack of clinical immunologists and specialized laboratory diagnostic facilities remain to be addressed. However, great efforts taken by passionate clinicians and scientists in the immunology networking have ascertained some prevalence. Despite the limitation, all suspected cases of PID are being properly investigated and competently managed. In this case report we highlighted the obstacles we faced in managing PID patients, particularly preparing for bone marrow transplant. This is the first transplanted case of chronic granulomatous disease in Malaysia, which emphasizes the importance of collaborative work to ensure further morbidities or mortalities are prevented. PMID:27417247

Malaysia's First Transplanted Case of Chronic Granulomatous Disease: The Journey of Overcoming Obstacles.

PubMed

Ismail, Intan Hakimah; Jamli, Faizah Mohamed; Othman, Ida Shahnaz; Noh, Lokman Mohd; Abdul Latiff, Amir Hamzah

2016-05-17

The awareness of primary immunodeficiency (PID) in Malaysia is still not forthcoming. Certain practical issues such as lack of clinical immunologists and specialized laboratory diagnostic facilities remain to be addressed. However, great efforts taken by passionate clinicians and scientists in the immunology networking have ascertained some prevalence. Despite the limitation, all suspected cases of PID are being properly investigated and competently managed. In this case report we highlighted the obstacles we faced in managing PID patients, particularly preparing for bone marrow transplant. This is the first transplanted case of chronic granulomatous disease in Malaysia, which emphasizes the importance of collaborative work to ensure further morbidities or mortalities are prevented.

Managing length of stay using patient flow--part 1.

PubMed

Cesta, Toni

2013-02-01

This month we have discussed the fundamentals of patient flow and its related theories. We reviewed the concepts of demand and capacity management as they apply to the hospital setting. Patient flow requires daily diligence and attention. It should not be something focused on only on busy days, but should be managed each and every day. By taking a proactive approach to patient flow, the number of days your hospital will be bottlenecked can be reduced. Patient flow needs to be part of the daily activities of every case management department and should be factored in as a core role and function in a contemporary case management department. Patient flow needs to be addressed at the patient, departmental, and hospital level. In next month's issue we will continue our discussion on patient flow with a detailed review of specific examples that any case management department can use. We will also review all the departments and disciplines that contribute to patient flow and their role in it.

Challenges of managing disease in tall orchard trees – pecan scab, a case study

USDA-ARS?s Scientific Manuscript database

Managing disease in tall orchard trees presents unique issues not found in relatively shorter horticultural and agronomic crops, simply due to height. Pecan scab (caused by Fusicladium effusum [G. Winter] Seyran et al.) is used as an example of a major disease of one of the tallest orchard crops in ...

Management of a river recreation resource: the Lower Kananaskis River--a case study

Treesearch

Kimberley Rae; Paul F.J. Eagles

2008-01-01

This study examined recreational use of the Lower Kananaskis River in Southwestern Alberta, Canada. Surveys and participant observations helped develop a better understanding of current use levels and interviews with key policy leaders explored management issues and concerns. Users suggested the need for improvements to river infrastructure both on and off the river....

A Business Case Analysis to Determine the Feasibility of a Scrub Management System at Brooke Army Medical Center

DTIC Science & Technology

2009-03-07

Designated Areas lor Scrub Issue i : FHSI 2. I West ?. Cardiac Cath Lab> 4. Cardiology Radiology 5. Centralized Materiel Services 6. CCUs...Scrub Management System 37 BAMC Memo 52-2 4-. Neiirosnrgciy Clinic 15. Bum Tinuma Unit 46 Cinq Rullis -4". 9J V School -IS. Veterinary Clinic

Students with Learning Disabilities within the Context of Inclusive Education: Issues of Identification and School Management

ERIC Educational Resources Information Center

Sakiz, Halis

2018-01-01

This paper reports findings of a case study carried out in two elementary mainstream schools in Turkey. The main aim of the study was to investigate the role of identification and school management within the process of educating students with learning disabilities in mainstream schools. Interviews with stakeholders, observations and documentary…

Role of Ketamine and Methadone as Adjunctive Therapy in Complex Pain Management: A Case Report and Literature Review

PubMed Central

Faisal, Wasek; Jacques, Judith

2017-01-01

Assessment and management of complex cancer pain always remains a major challenge for any palliative care team, given its heterogeneity of underlying pathophysiology and limitations of any pharmacotherapy. Here, we present a case of complex pain management in a young patient with a life-limiting illness, highlighting the issues of organic and nonorganic contributors of pain and provide some insight into the role of ketamine and methadone as adjunctive therapy to opioid analgesics. A brief literature review is also done to provide the context of use of these adjunctive drugs in this setting. PMID:28216871

Methadone Management of Withdrawal Associated With Loperamide-related Opioid Use Disorder.

PubMed

Leo, Raphael J; Ghazi, Muhammad A; Jaziri, Kelly S

: Loperamide hydrochloride is an over-the-counter anti-diarrheal agent, acting via mu-opioid receptor agonist effects in the intestinal myenteric plexus. Although preclinical investigations suggested that abuse liability associated with loperamide use is low, there are increasing numbers of cases reported to the US Food and Drug Administration, of abuse, dependence, and withdrawal associated with loperamide use. A case of a patient with opioid use disorder, that is, in the form of protracted loperamide excess use, requiring management of withdrawal with methadone is presented. Management of withdrawal from abrupt loperamide discontinuation has not been discussed in the literature. Long-term treatment issues are also described.

Endourologic management of malignant ureteral obstruction: indications, results, and quality-of-life issues.

PubMed

Sountoulides, Petros; Pardalidis, Nikolaos; Sofikitis, Nikolaos

2010-01-01

Obstruction of the upper urinary tract is a problem commonly faced by practicing urologists. The constant evolution in endourology has effectively facilitated minimally invasive management of upper-tract obstruction. In a case in which malignancy is the cause of obstruction, however, the situation significantly changes. Questions arise regarding the need for relieving the obstruction, the means to accomplish this, and the benefits and drawbacks of each technique regarding both their efficacy and their impact on the patients well-being and the crucial issue of quality of life in the face of malignancy.

Implementing programs for chronic illness management: the case of hypertension services.

PubMed

Christianson, J B; Pietz, L; Taylor, R; Woolley, A; Knutson, D J

1997-11-01

This article describes the process by which HealthSystem Minnesota (a vertically integrated health care organization), functioning in a competitive managed care environment, has been implementing a hypertension services program. The program involves a team approach to care, with emphasis on patient participation in treatment; decentralized care delivery by nurse coordinators at primary care practice sites; ongoing training and education for patients and providers; and the continuous monitoring and evaluation of patient outcomes and satisfaction. JOB-LEVEL ISSUES: A variety of issues, such as the role and responsibilities of the nurse coordinator, became evident as the program moved towards operational status at four primary care practice sites, which prolonged the implementation period. PROCESS-LEVEL ISSUES: Issues relating to work process changes were more complicated to resolve and required, in some cases, changes in the proposed model. The most significant process-level issues related to educating physicians about the program to secure their participation and support. ORGANIZATION-LEVEL ISSUES: Such issues, which were the most difficult for program implementors to anticipate and resolve, included an organizational culture that emphasized decision making autonomy at primary practice sites. In part, the difficulty encountered in resolving organization-level issues reflected the implementors' lack of awareness of the strength or complexity of the environmental pressures facing the organization, as well as a lack of sensitivity to nuances relating to organizational culture. Two groups of hypertensive patients--at the implementation and comparison sites--will be compared with respect to satisfaction with care, clinical outcomes, and costs. Expansion of the model to patients with other chronic conditions is under consideration.

Psychiatric Case Management in the Emergency Department.

PubMed

Turner, Stephanie B; Stanton, Marietta P

2015-01-01

The care of the mentally ill has reached a real crisis in the United States. There were more than 6.4 million visits to emergency departments (EDs) in 2010, or about 5% of total visits, involved patients whose primary diagnosis was a mental health condition or substance abuse (). That is up 28% from just 4 years earlier, according to the latest figures available from the Agency for Healthcare Research and Quality in Rockville, MD. Using a method called scoping, the purpose of this article is to examine the range, extent, and evidence available regarding case management as an intervention in the ED to manage mental health patients, to determine whether there is sufficient quantity and quality of evidence on this topic to conduct a meta-analysis, and to identify relevant studies that balance comprehensiveness with reasonable limitations. One solution for ensuring that the costs are contained, efficiency is maintained, and quality outcomes are achieved is the placement of a case manager in the ED. According to , because the majority of hospital admissions come through the ED, it makes sense to have case managers located there to act as gatekeepers and ensure that patients who are admitted meet criteria and are placed in the proper bed with the proper status. From the scoping techniques implemented in this study, the authors came to the conclusion that case management has been and can be used to effectively treat mental health patients in the emergency room. A good number of patients with psych mental health issues are frequent visitors and repeat visitors. Case management has not been used very often as a strategy for managing patients through the ED or for follow-up after the visit. Hospitals that have developed a protocol for managing these patients outside the main patient flow have had successful results. Staff training and development on psych mental health issues have been helpful in the ED. While there are not a large number of studies available on this topic, there is sufficient evidence to warrant further examination of this research topic. The findings in this scoping study have broader implications for research, policy, and practice. The framework of this study involved an outcomes-based approach. Clinical outcomes that positively enhance patient care and save the hospital money are necessary in the current health care environment.

Managers' views on and experiences with moral case deliberation in nursing teams.

PubMed

Weidema, Froukje C; Molewijk, A C Bert; Kamsteeg, Frans; Widdershoven, Guy A M

2015-11-01

Providing management insights regarding moral case deliberation (MCD) from the experiential perspective of nursing managers. MCD concerns systematic group-wise reflection on ethical issues. Attention to implementing MCD in health care is increasing, and managers' experiences regarding facilitating MCD's implementation have not yet been studied. As part of an empirical qualitative study on implementing MCD in mental health care, a responsive evaluation design was used. Using former research findings (iterative procedures), a managers' focus group was organised. Managers appreciated MCD, fostering nurses' empowerment and critical reflection - according to managers, professional core competences. Managers found MCD a challenging intervention, resulting in dilemmas due to MCD's confidential and egalitarian nature. Managers value MCD's process-related outcomes, yet these are difficult to control/regulate. MCD urges managers to reflect on their role and (hierarchical) position both within MCD and in the nursing team. MCD is in line with transformative and participatory management, fostering dialogical interaction between management and nursing team. © 2015 John Wiley & Sons Ltd.

Legal Aspects: Civilians/Contractors in the War Zone And Disaster Relief Support Joint Center for Operational Analysis Journal, Volume 10, Issue 2, June 2008

DTIC Science & Technology

2008-06-01

operations . The JSC, however, has analyzed the new legislation and their JCOA Journal, June 2008 13 recommendations for managing how these cases are...CBRNE) consequence management operations . 4 While the Department of Homeland Security’s (DHS) Federal Emergency Management Agency (FEMA) 5 is...affect the Department of Defense’s consequence management operations in support of a primary federal agency. Although the U.S. Constitution’s Supremacy

A hybrid simulation approach for integrating safety behavior into construction planning: An earthmoving case study.

PubMed

Goh, Yang Miang; Askar Ali, Mohamed Jawad

2016-08-01

One of the key challenges in improving construction safety and health is the management of safety behavior. From a system point of view, workers work unsafely due to system level issues such as poor safety culture, excessive production pressure, inadequate allocation of resources and time and lack of training. These systemic issues should be eradicated or minimized during planning. However, there is a lack of detailed planning tools to help managers assess the impact of their upstream decisions on worker safety behavior. Even though simulation had been used in construction planning, the review conducted in this study showed that construction safety management research had not been exploiting the potential of simulation techniques. Thus, a hybrid simulation framework is proposed to facilitate integration of safety management considerations into construction activity simulation. The hybrid framework consists of discrete event simulation (DES) as the core, but heterogeneous, interactive and intelligent (able to make decisions) agents replace traditional entities and resources. In addition, some of the cognitive processes and physiological aspects of agents are captured using system dynamics (SD) approach. The combination of DES, agent-based simulation (ABS) and SD allows a more "natural" representation of the complex dynamics in construction activities. The proposed hybrid framework was demonstrated using a hypothetical case study. In addition, due to the lack of application of factorial experiment approach in safety management simulation, the case study demonstrated sensitivity analysis and factorial experiment to guide future research. Copyright © 2015 Elsevier Ltd. All rights reserved.

TQM and lean strategy deployment in Italian hospitals.

PubMed

Chiarini, Andrea; Baccarani, Claudio

2016-10-03

Purpose This paper aims to contribute to the debate concerning total quality management (TQM)-Lean strategy in public healthcare by analyzing the deployment path for implementation, the possible benefits that can be achieved and the encountered pitfalls. Design/methodology/approach Three case studies are drawn from three large Italian hospitals with more than 500 beds each and structured with many departments. The hospitals are located in Tuscany, Italy. These three hospitals have embraced TQM and Lean, starting from strategic objectives and their deployment. At the same time, they have also implemented many TQM-Lean tools. The case studies are based on interviews held with four managers in each of these three public hospitals. Findings Results from the interviews show that there is a specific deployment path for TQM-Lean implementation. The hospitals have also achieved benefits linked to patient satisfaction and improved organizational performances. Problems related to organizational and cultural issues, such as senior managers' commitment, staff management, manufacturing culture and tools adaptation, could affect the benefits. Research limitations/implications The research has been carried out in just three Italian public hospitals. Hence, similar investigations could be managed in other countries. Researchers could also use a larger sample and investigate these issues by means of quantitative inquiry. Practical implications Practitioners could try to apply the deployment path revealed by these case studies in other public and private hospitals. Originality/value The results of this research show that there is a specific, new deployment path for implementing TQM-Lean strategy in some public hospitals.

Using Crisis Simulations in Public Relations Education

ERIC Educational Resources Information Center

Veil, Shari R.

2010-01-01

Objectives: Students will demonstrate research, decision making, team building, and public speaking skills, while applying issues management and crisis communication concepts in a realistic setting. Courses: Introduction to Public Relations, Public Relations Cases, Crisis Communication.

Water Resources Management and Hydrologic Design Under Uncertain Climate Change Scenarios

NASA Astrophysics Data System (ADS)

Teegavarapu, R. S.

2008-05-01

The impact of climate change on hydrologic design and management of water resource systems could be one of the important challenges faced by future practicing hydrologists and water resources managers. Many water resources managers currently rely on the historical hydrological data and adaptive real-time operations without consideration of the impact of climate change on major inputs influencing the behavior of hydrologic systems and the operating rules. Issues such as risk, reliability and robustness of water resources systems under different climate change scenarios were addressed in the past. However, water resources management with the decision maker's preferences attached to climate change has never been dealt with. This presentation discusses issues related to impacts of climate change on water resources management and application of a soft-computing approach, fuzzy set theory, for climate-sensitive management of water resources systems. A real-life case study example is presented to illustrate the applicability of soft-computing approach for handling the decision maker's preferences in accepting or rejecting the magnitude and direction of climate change.

Embracing the Open-Source Movement for the Management of Spatial Data: A Case Study of African Trypanosomiasis in Kenya

PubMed Central

Langley, Shaun A.; Messina, Joseph P.

2011-01-01

The past decade has seen an explosion in the availability of spatial data not only for researchers, but the public alike. As the quantity of data increases, the ability to effectively navigate and understand the data becomes more challenging. Here we detail a conceptual model for a spatially explicit database management system that addresses the issues raised with the growing data management problem. We demonstrate utility with a case study in disease ecology: to develop a multi-scale predictive model of African Trypanosomiasis in Kenya. International collaborations and varying technical expertise necessitate a modular open-source software solution. Finally, we address three recurring problems with data management: scalability, reliability, and security. PMID:21686072

Embracing the Open-Source Movement for the Management of Spatial Data: A Case Study of African Trypanosomiasis in Kenya.

PubMed

Langley, Shaun A; Messina, Joseph P

2011-01-01

The past decade has seen an explosion in the availability of spatial data not only for researchers, but the public alike. As the quantity of data increases, the ability to effectively navigate and understand the data becomes more challenging. Here we detail a conceptual model for a spatially explicit database management system that addresses the issues raised with the growing data management problem. We demonstrate utility with a case study in disease ecology: to develop a multi-scale predictive model of African Trypanosomiasis in Kenya. International collaborations and varying technical expertise necessitate a modular open-source software solution. Finally, we address three recurring problems with data management: scalability, reliability, and security.

Case Mix Management Systems: An Opportunity to Integrate Medical Records and Financial Management System Data Bases

PubMed Central

Rusnak, James E.

1987-01-01

Due to previous systems selections, many hospitals (health care facilities) are faced with the problem of fragmented data bases containing clinical, demographic and financial information. Projects to select and implement a Case Mix Management System (CMMS) provide an opportunity to reduce the number of separate physical files and to migrate towards systems with an integrated data base. The number of CMMS candidate systems is often restricted due to data base and system interface issues. The hospital must insure the CMMS project provides a means to implement an integrated on-line hospital information data base for use by departments in operating under a DRG-based Prospective Payment System. This paper presents guidelines for use in selecting a Case Mix Mangement System to meet the hospital's financial and operations planning, budgeting, marketing, and other management needs, while considering the data base implications of the implementation.

Perceptions of Cyberbullying Management within Southern California Independent Middle Schools: A Multiple Case Study

ERIC Educational Resources Information Center

Lyons, Suzanne Shaw

2013-01-01

Cyberbullying among students has become a serious issue for school communities, partly due to ubiquitous Internet access, instant messaging, and a myriad of social media websites that provide infinite ways to abuse, threaten, and insult others. In some cases, students have been cyberbullied so brutally that adolescent victims even contemplate or…

Creating Regional Futures: A Scenario-Based Inter- and Transdisciplinary Case Study as a Model for Applied Student-Centred Learning in Geography

ERIC Educational Resources Information Center

Fromhold-Eisebith, Martina; Freyer, Bernhard; Mose, Ingo; Muhar, Andreas; Vilsmaier, Ulli

2009-01-01

Human geography students face changing qualification requirements due to a shift towards new topics, educational tasks and professional options regarding issues of spatial development. This "practical turn" raises the importance of inter- and transdisciplinary work, management and capability building skills, with case study projects and…

A Case of Sexual Abuse by a Traditional Faith Healer: Are There Potential Preventions?

ERIC Educational Resources Information Center

Chan, Lai Fong; Tan, Susan Mooi Koon; Ang, Jin Kiat; Kamal Nor, Norazlin; Sharip, Shalisah

2012-01-01

Adolescent sexual abuse is not an uncommon phenomenon in Malaysia. It is a traumatic experience that complicates the psychosocial development of young people on the threshold of adulthood. This case report highlights the psychosocial sequelae of adolescent sexual abuse by a traditional healer and discusses management issues in the context of…

50 CFR 18.118 - What are the mitigation, monitoring, and reporting requirements?

Code of Federal Regulations, 2010 CFR

2010-10-01

... availability of these marine mammals for subsistence uses. Dynamic management approaches, such as temporal or... emergency, should any vessel approach within a 805-m (0.5-mi) radius of walruses or polar bears observed on... issued by the Service on a case-by-case basis, based upon a review of seasonal ice conditions and...

50 CFR 18.118 - What are the mitigation, monitoring, and reporting requirements?

Code of Federal Regulations, 2011 CFR

2011-10-01

... availability of these marine mammals for subsistence uses. Dynamic management approaches, such as temporal or... emergency, should any vessel approach within a 805-m (0.5-mi) radius of walruses or polar bears observed on... issued by the Service on a case-by-case basis, based upon a review of seasonal ice conditions and...

50 CFR 18.118 - What are the mitigation, monitoring, and reporting requirements?

Code of Federal Regulations, 2012 CFR

2012-10-01

... availability of these marine mammals for subsistence uses. Dynamic management approaches, such as temporal or... emergency, should any vessel approach within a 805-m (0.5-mi) radius of walruses or polar bears observed on... issued by the Service on a case-by-case basis, based upon a review of seasonal ice conditions and...

Introduction to the Wetland Book 1: Wetland structure and function, management, and nethods

USGS Publications Warehouse

Davidson, Nick C.; Middleton, Beth A.; McInnes, Robert J.; Everard, Mark; Irvine, Kenneth; Van Dam, Anne A.; Finlayson, C. Max; Finlayson, C. Max; Everard, Mark; Irvine, Kenneth; McInnes, Robert J.; Middleton, Beth A.; Van Dam, Anne A.; Davidson, Nick C.

2016-01-01

The Wetland Book 1 is designed as a ‘first port-of-call’ reference work for information on the structure and functions of wetlands, current approaches to wetland management, and methods for researching and understanding wetlands. Contributions by experts summarize key concepts, orient the reader to the major issues, and support further research on such issues by individuals and multidisciplinary teams. The Wetland Book 1 is organized in three parts - Wetland structure and function; Wetland management; and Wetland methods - each of which is divided into a number of thematic Sections. Each Section starts with one or more overview chapters, supported by chapters providing further information and case studies on different aspects of the theme.

Case management training needs to support vocational rehabilitation for case managers and general practitioners: a survey study

PubMed Central

2014-01-01

Background The use of the biopsychosocial model of health and case management for effective vocational rehabilitation (VR) has been confirmed for many health conditions. While Case and Condition Managers (CCMPs) use this approach in their everyday work, little is known about their views on training needs. A review of the training curriculum for General Practitioners’ (GPs) revealed little training in VR and the biopsychosocial model of care. This study aims to identify Case and Condition Managers and GPs perceptions of their training needs in relation to employability and VR. Methods 80 Case and Condition Managers and 304 GPs working in NHS Lanarkshire, providing a comparison group, were invited to participate in this study. A self-completion questionnaire was developed and circulated for online completion with a second round of hardcopy questionnaires distributed. Results In total 45 responses were obtained from CCMPs, 5 from occupational health nurses (62% response rate) and 60 from GPs (20% response rate). CCMPs and the nursing group expressed a need for training but to a lesser extent than GP’s. The GP responses demonstrated a need for high levels of training in case/condition management, the biopsychosocial model, legal and ethical issues associated with employment and VR, and management training. Conclusions This survey confirms a need for further training of CCMPs and that respondent GPs in one health board are not fully equipped to deal with patients employability and vocational needs. GPs also reported a lack of understanding about the role of Case and Condition managers. Training for these professional groups and others involved in multidisciplinary VR could improve competencies and mutual understanding among those advising patients on return-to-work. PMID:24884477

Erosion Control Management Plan for Army Training Lands

DTIC Science & Technology

1990-07-01

Functional Appropriateness of Control Appropriateness of Control for Natural Conditions Environmental Impact Considerations Appropriateness of Control...construction, maintenance, and repair projects are often related to environmental protection standards and natural resource guidelines. In such cases...SEP 17 90" The Army faces major land management issues in SEP 1 9O maintaining its training areas to be environmentally sound and support the mission

Gatineau Park: a case study of managing recreation in the wildland-urban interface

Treesearch

Paul Heintzman

2007-01-01

Gatineau Park, a few kilometers from the Parliament Buildings in Ottawa, is a classic example of a park confronted by management issues related to the wildland-urban interface. The park, comprising 36,300 hectares of forested and hilly Canadian Shield terrain stretching 50 kilometres in length, extends into the National Capital region, which has a population of over...

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…

Tour NASA’s Kennedy Space Center LIVE with Director Bob Cabana and GSDO Associate Program Manager Shawn Quinn

NASA Image and Video Library

2017-05-23

We experienced some technical issues during our live stream of Behind The Scenes at NASA’s Kennedy Space Center. In case you missed it, please enjoy the show with Director Bob Cabana, and an exclusive tour inside the Vehicle Assembly Building (VAB) with Ground Systems Development Office (GSDO) Associate Program Manager Shawn Quinn

Media Choice in Environmental Information Dissemination for Solid Waste Management among Policy Formulators and Implementors: A Case Study of Oyo State, Nigeria

ERIC Educational Resources Information Center

Akintola, B. A.; Temowo, O. O.; Ajiboye, J. O.

2009-01-01

Environmental information has been described as central to the issues of solid waste management and disposal. This study investigated the availability and accessibility of environmental information to the solid waste policy formulators and implementors with regard to the media/channels used for disseminating environmental information to the…

Curriculum Issues in the Relationship between Language, Culture and Learning: The Case of Food and Beverage Management Teaching.

ERIC Educational Resources Information Center

Sutton, John; Tse, Peter S. M.

1997-01-01

Hotel management students in Hong Kong (n=65) reported that foundation courses were essential to their careers, but 61% had problems understanding the curriculum. Causes were cultural differences in food styles and/or the fact that most Cantonese-speaking students were learning in their second language (English) and most of the multicultural…

Preparing students for the ethical challenges on international health electives: A systematic review of the literature on educational interventions.

PubMed

Rahim, Anika; Knights Née Jones, Felicity; Fyfe, Molly; Alagarajah, Janagan; Baraitser, Paula

2016-09-01

International health electives pose specific ethical challenges for students travelling from to low and middle income countries. We undertook a systematic review of the literature on interventions to prepare students to identify ethical issues addressed, educational approaches and to collate evidence on the effectiveness of different strategies. We searched nine electronic databases of peer-reviewed literature and identified grey literature through key word searches; supplemented through citation mapping and expert consultation. Articles that described ethical training conducted by universities or professional bodies were included for review. We reviewed forty-four full text articles. Ten sources of published literature and seven sources of grey literature met our inclusion criteria. We identified thirteen ethical situations that students should be prepared to manage and eight generic skills to support this process. Most interventions were delivered before the elective, used case studies or guidelines. Some suggested ethical principles or a framework for analysis of ethical issues. Only two papers evaluated the intervention described. Our paper collates a small but growing body of work on education to prepare students to manage ethical issues. Ethical training should have elements that are delivered before, during and after the elective. Interventions should include case studies covering thirteen ethical issues identified here, linked to ethical principles and a process for responding to ethical issues. We suggest that evaluations of interventions are an important area for future research.

Penetrating abdominal injuries: management controversies

PubMed Central

Butt, Muhammad U; Zacharias, Nikolaos; Velmahos, George C

2009-01-01

Penetrating abdominal injuries have been traditionally managed by routine laparotomy. New understanding of trajectories, potential for organ injury, and correlation with advanced radiographic imaging has allowed a shift towards non-operative management of appropriate cases. Although a selective approach has been established for stab wounds, the management of abdominal gunshot wounds remains a matter of controversy. In this chapter we describe the rationale and methodology of selecting patients for non-operative management. We also discuss additional controversial issues, as related to antibiotic prophylaxis, management of asymptomatic thoracoabdominal injuries, and the use of colostomy vs. primary repair for colon injuries. PMID:19374761

Mother-infant home care drives quality in a managed care environment.

PubMed

Malnory, M

1997-04-01

Advocates of inpatient managed care employing clinical pathways are confident that this patient management strategy reduces cost while promoting equivalent patient outcomes. Other health care professionals are concerned that cost reductions place patients at higher risk for adverse health events. Research is needed to demonstrate the true impact of cost-containment strategies on clinical outcomes. The article describes a study in progress comparing patients conventionally managed by their physicians with similar patients whose overall management involved a nurse case manager. This study explores the issue of resource costs that can be linked to clinical and financial outcome measures.

Organisational performance and business continuity management: a theoretical perspective and a case study.

PubMed

Sawalha, Ihab Hanna Salman

2013-01-01

This paper seeks to extend the research relating to the strategic view of business continuity management (BCM) to the context of organisational performance (OP). It discusses potential performance consequences resulting from applying BCM aspects/elements within an organisation. The paper contributes to the understanding of the role of BCM in OP by discussing how deployment of BCM key aspects/elements can improve OP. Two main issues are discussed: first, background to performance and the elements of OP; and secondly, the role of BCM in achieving optimised OP. These issues are significant, as they go further than the extant literature relating to the significance of BCM and its potential influence on OP. The study focuses on Jordanian banks as a case study and as a way of illustrating how BCM helps improve OP for those organisations facing performance shortcomings or difficulties.

Case-based clinical reasoning in feline medicine: 2: Managing cognitive error.

PubMed

Canfield, Paul J; Whitehead, Martin L; Johnson, Robert; O'Brien, Carolyn R; Malik, Richard

2016-03-01

This is Article 2 of a three-part series on clinical reasoning that encourages practitioners to explore and understand how they think and make case-based decisions. It is hoped that, in the process, they will learn to trust their intuition but, at the same time, put in place safeguards to diminish the impact of bias and misguided logic on their diagnostic decision-making. Article 1, published in the January 2016 issue of JFMS, discussed the relative merits and shortcomings of System 1 thinking (immediate and unconscious) and System 2 thinking (effortful and analytical). This second article examines ways of managing cognitive error, particularly the negative impact of bias, when making a diagnosis. Article 3, to appear in the May 2016 issue, explores the use of heuristics (mental short cuts) and illness scripts in diagnostic reasoning. © The Author(s) 2016.

Reducing chronic obstructive pulmonary disease readmissions: the role of the durable medical equipment provider.

PubMed

Messenger, Robert W

2012-01-01

Exacerbation and frequent rehospitalization in chronic obstructive pulmonary disease exacts a heavy toll on the US health care system. To address these issues, new initiatives have been proposed that are largely based on financial penalties to promote patient education and postdischarge care. However, as laudable as these goals are, improving outcomes in the chronic obstructive pulmonary disease population is more confounding than it may first appear. Chronic hypoxia, cognitive dysfunction, poor nutrition, and economic disadvantage are just a few of the challenges that require creative solutions and ongoing support. Case managers need to utilize all the potential products and services that can assist in improving outcomes for these patients. Durable medical equipment providers are often viewed as purveyors of medical equipment that offer little in the form of clinical support. However, in many cases these providers represent an overlooked resource that provides individualized, highly structured patient education and ongoing support programs. The challenge is in identifying those durable medical equipment providers that offer patients contemporary technology, and have both the resources and the commitment to provide patient support that is amenable to the goals of the hospital. This article reviews many of the confounding issues that contribute to the frequent rehospitalization of chronic obstructive pulmonary disease patients. Recommendations to improve patient education and oxygen therapy outcomes are provided along with suggestions to aid in the vetting of durable medical equipment providers. Acute care hospitals, long-term acute care hospitals, extended care facilities, integrated delivery systems. 1. An understanding of the complex variables that play in the management of chronic obstructive pulmonary disease will help the case manager to plan an effective course of care. 2. Case managers need to ensure that patients receive long-term oxygen technology that supports their lifestyle, promotes compliance, and ultimately achieves the desired outcomes. 3. Case managers must advocate for coordinated, ongoing patient education and stress the need for continuing reinforcement. 4. Case managers must ensure that patients under their care be matched with durable medical equipment providers that provide the technology and support that favors positive clinical outcomes.

Late recurrent urothelial carcinoma in the Studer neobladder: conversion to continent reservoir

PubMed Central

Kotb, AF; Alkosiry, M; AbdElkawy, N; Atta, MA

2012-01-01

Bladder cancer represents a considerable issue in Egypt and the Middle East. Radical cystectomy and orthotopic neobladder represent the standard of care for managing cases with invasive bladder tumour. There are few cases reported in the literature considering the urothelial recurrence in the urethra, connected to neobladder. We are presenting a rare case of a young female patient, with an aggressive urothelial tumour, recurring 13-year post-radical cystectomy, and the Studer neobladder. Our case was managed by urethrectomy and conversion of the neobladder into continent reservoir, with good short-term oncological and functional outcomes. We can conclude that bladder cancer cases should be followed thoroughly throughout their life. Follow-up urethroscopy and cytology should be done for all cases of post-radical cystectomy, regardless of patients’ symptoms. Key message Late urothelial recurrence of post-radical cystectomy is possible and, in our case, happened 13 years following surgery. The Studer neobladder can be safely converted into continent reservoir, allowing good functional outcomes. Also, recurrence in the Studer neobladder can be safely managed, allowing good oncological outcomes, without the need for any ureteroileal interventions. PMID:22973413

Synthesis and review: delivering on conservation promises: the challenges of managing and measuring conservation outcomes

NASA Astrophysics Data System (ADS)

Adams, Vanessa M.; Game, Edward T.; Bode, Michael

2014-08-01

Growing threats and limited resources have always been the financial realities of biodiversity conservation. As the conservation sector has matured, however, the accountability of conservation investments has become an increasingly debated topic, with two key topics being driven to the forefront of the discourse: understanding how to manage the risks associated with our conservation investments and demonstrating that our investments are making a difference through evidence-based analyses. A better understanding of the uncertainties associated with conservation decisions is a central component of managing risks to investments that is often neglected. This focus issue presents both theoretical and applied approaches to quantifying and managing risks. Furthermore, transparent and replicable approaches to measuring impacts of conservation investments are noticeably absent in many conservation programs globally. This focus issue contains state of the art conservation program impact evaluations that both demonstrate how these methods can be used to measure outcomes as well as directing future investments. This focus issue thus brings together current thinking and case studies that can provide a valuable resource for directing future conservation investments.

Developing a health information network within an integrated delivery system: a case study.

PubMed

Wager, K A; Heda, S; Austin, C J

1997-05-01

Changes in the health care environment, such as the growth of integrated delivery systems and the proliferation of managed care, are having a profound impact on the way in which health care organizations manage both clinical and financial information. Health information networks (HINs) are emerging to support the goals and internal needs of integrated delivery systems. In this environment, health care managers must assume a leadership role in planning for the development of HINs. The article provides an overview of the principal issues that should be addressed in an organization's information systems plan when a HIN is being developed and includes a case study that illustrates the key points discussed.

A developmental approach to the treatment of bipolar disorder: IPSRT with an adolescent.

PubMed

Crowe, Marie; Inder, Maree; Joyce, Peter; Moor, Stephanie; Carter, Janet; Luty, Sue

2009-01-01

This case study explains how a psychotherapy previously used with adults can be used with adolescents by focusing on the specific developmental issues associated with adolescence. Bipolar disorder is a damaging disorder to experience during the developmental phase of adolescence. Interpersonal social rhythm psychotherapy has been developed as an adjunct to medication for managing bipolar disorder and shows some promising outcomes in adults. This is a single case study design drawn from a larger randomised control trial of two psychotherapies for bipolar disorder. The case study addressed the question: How can Interpersonal social rhythm therapy be applied with adolescents who have bipolar disorder? This study used a purposeful sampling process by selecting the youngest adolescent participating in the randomised control trial. All the subject's sessions of Interpersonal social rhythm therapy were taped, transcribed and analysed. The analysis involved describing the process of psychotherapy as it occurred over time, mapping the process as a trajectory across the three phases of psychotherapy experience and focusing the analysis around the impact of bipolar disorder and IPSRT on adolescent developmental issues, specifically the issue of identity development. Interpersonal social rhythm therapy allowed the therapist to address developmental issues within its framework. As a result of participation in the psychotherapy the adolescent was able to manage her mood symptoms and develop a sense of identity that was age-appropriate. Interpersonal social rhythm therapy provided the adolescent in the case study the opportunity to consider what it meant to have bipolar disorder and to integrate this meaning into her sense of self. Bipolar disorder is a chronic and recurring disorder that can have a serious impact on development and functioning. Interpersonal social rhythm therapy provides an approach to nursing care that enables adolescents to improve social functioning.

A case of sexual abuse by a traditional faith healer: are there potential preventions?

PubMed

Chan, Lai Fong; Tan, Susan Mooi Koon; Ang, Jin Kiat; Kamal Nor, Norazlin; Sharip, Shalisah

2012-01-01

Adolescent sexual abuse is not an uncommon phenomenon in Malaysia. It is a traumatic experience that complicates the psychosocial development of young people on the threshold of adulthood. This case report highlights the psychosocial sequelae of adolescent sexual abuse by a traditional healer and discusses management issues in the context of unique cultural and belief systems.

Utilizing the Multidisciplinary Team for Planning and Monitoring Care and Quality Improvement

PubMed Central

Patel, A.; Franko, Edward R.; Fleshman, James W.

2015-01-01

Multidisciplinary team management of patients with rectal cancer requires a dedicated group of surgeons, medical and radiation oncologists, pathologists, radiologists, and mid-level providers who meet to discuss every patient with rectal cancer. The data from that meeting is collected prospectively, recommendations made for case, follow-up obtained, and quality issues monitored. Improved case is the result. PMID:25733969

Using International Accreditation in Higher Education to Effect Changes in Organisational Culture: A Case Study from a Turkish University

ERIC Educational Resources Information Center

Collins, Ian

2015-01-01

International accreditation is now a significant yet controversial issue in global higher education. This case study looked at the experience of an intensive English language preparatory programme within a university in Turkey going through an accreditation by a foreign institution, and assessed to what extent the project managed to foster changes…

Community mental health nursing: keeping pace with care delivery?

PubMed

Henderson, Julie; Willis, Eileen; Walter, Bonnie; Toffoli, Luisa

2008-06-01

The National Mental Health Strategy has been associated with the movement of service delivery into the community, creating greater demand for community services. The literature suggests that the closure of psychiatric beds and earlier discharge from inpatient services, have contributed to an intensification of the workload of community mental health nurses. This paper reports findings from the first stage of an action research project to develop a workload equalization tool for community mental health nurses. The study presents data from focus groups conducted with South Australian community mental health nurses to identify issues that impact upon their workload. Four themes were identified, relating to staffing and workforce issues, clients' characteristics or needs, regional issues, and the impact of the health-care system. The data show that the workload of community mental health nurses is increased by the greater complexity of needs of community mental health clients. Service change has also resulted in poor integration between inpatient and community services and tension between generic case management and specialist roles resulting in nurses undertaking tasks for other case managers. These issues, along with difficulties in recruiting and retaining staff, have led to the intensification of community mental health work and a crisis response to care with less time for targeted interventions.

'Implementation deficit' and 'street-level bureaucracy': policy, practice and change in the development of community nursing issues.

PubMed

Bergen, Ann; While, Alison

2005-01-01

The present paper examines the mechanisms by which health and social care policies put forward by the Government may be translated into community nursing practice. Data from a research project on community nurse case managers were re-examined in the light of two classic theories often cited by policy analysts (i.e. implementation theory and 'street-level bureaucracy'). It was found that the extent to which nurses adopted the case management role, and the model of choice, depended on four major interrelated variables, namely: (1) the clarity of policy guidance; (2) the extent to which it coincided with professional (nursing) values; (3) local practices and policies; and (4) the personal vision of the community nurse. It is argued that this framework may have wider relevance, and this was tested out in two ways. First, major change in one of these variables (Government policy) over time was analysed for its effect on case management practice via the remaining variables. Secondly, an unrelated, but policy-initiated, nursing issue (nurse prescribing) was briefly examined in the light of the framework. It is suggested that this framework may be of some use when considering the likely practice response to policy-related changes in community nursing.

Community Partnerships Can Be Risky Business.

ERIC Educational Resources Information Center

Schirick, Ed

2001-01-01

Considers risk management and liability issues in cases of camp partnerships with schools, camp alternatives to incarceration for juvenile offenders, and elder hostel programs. Discusses making contracts, hiring attorneys, identifying risks and responsibilities, insuring volunteers, governmental immunity, liability waivers, additional insured…

Case Study of 'Engineering Peer Meetings' in JPL's ST-6 Project

NASA Technical Reports Server (NTRS)

Chao, Lawrence P.; Tumer, Irem

2004-01-01

This design process error-proofing case study describes a design review practice implemented by a project manager at NASA Jet Propulsion Laboratory. There are many types of reviews at NASA: required and not, formalized and informal, programmatic and technical. Standing project formal reviews such as the Preliminary Design Review (PDR) and Critical Design Review (CDR) are a required part of every project and mission development. However, the engineering peer reviews that support teams technical work on such projects are often informal, ad hoc, and inconsistent across the organization. This case study discusses issues and innovations identified by a project manager at JPL and implemented in 'engineering peer meetings' for his group.

Case Study of "Engineering Peer Meetings" in JPL's ST-6 Project

NASA Technical Reports Server (NTRS)

Tumer, Irem Y.; Chao, Lawrence P.

2003-01-01

This design process error-proofing case study describes a design review practice implemented by a project manager at NASA Jet Propulsion Laboratory. There are many types of reviews at NASA: required and not, formalized and informal, programmatic and technical. Standing project formal reviews such as the Preliminary Design Review (PDR) and Critical Design Review (CDR) are a required part of every project and mission development. However, the engineering peer reviews that support teams technical work on such projects are often informal, ad hoc, and inconsistent across the organization. This case study discusses issues and innovations identified by a project manager at JPL and implemented in "engineering peer meetings" for his group.

Major technology issues in surgical data collection.

PubMed

Kirschenbaum, I H

1995-10-01

Surgical scheduling and data collection is a field that has a long history as well as a bright future. Historically, surgical cases have always involved some amount of data collection. Surgical cases are scheduled and then reviewed. The classic method, that large black surgical log, actually still exists in many hospitals. In fact, there is nothing new about the recording or reporting of surgical cases. If we only needed to record the information and produce a variety of reports on the data, then modern electronic technology would function as a glorified fast index card box--or, in computer database terms, a simple flat file database. But, this is not the future of technology in surgical case management. This article makes the general case for integrating surgical data systems. Instead of reviewing specific software, it essentially addresses the issues of strategic planning related to this important aspect of medical information systems.

The Evolution of End-of-Life Care: Ethical Implications for Case Management.

PubMed

Fink-Samnick, Ellen

2016-01-01

This article: : Applicable to all health care sectors where case management is practiced. Few topics are more intimate and multifaceted for case managers than engaging with today's culturally diverse patient populations around end-of-life processes. The already prominent focus of this issue has been further elevated by a series of events to receive public attention. These include the Institute of Medicine's 2014 report-Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, rising numbers of patients around the globe requesting to end life on their own terms, and corresponding death with dignity initiatives and legislation.Another vital factor in the end-of-life equation involves how the latest generation of shared decision making influences the management of treatment dialogues among practitioners, patients, as well as insurance companies. Case managers are at the intersection of these complex interactions, working to achieve ethical, as well as legal accountability to the patient, employer, and profession while balancing personal perspectives. Professionals strive to effectively intervene with patients and their support systems facing end-of-life care decisions. It is essential case managers actively consider the intricacies of ethical practice and current contexts including death with dignity legislation, shared decision making, and shifts in regulations and reimbursement for end-of-life care.Case management's ethical envelope will continue to be pushed. To that end amid shifting societal constructs, professionals must have mastery of applicable codes, standards, principles, and rules essential for adherence to ethical practice.

Ecosystem Based Management in Transition: From Ocean Policy to Application

NASA Astrophysics Data System (ADS)

Saumweber, W. J.; Goldman, E.

2016-02-01

Ecosystem-based management (EBM) has been proposed as a means to improve resource management and stewardship for more than two decades. Over this history, its exact goals and approaches have evolved in concert with advances in science and policy, including a greater understanding of ecosystem function, valuation, and thresholds for change, along with direct reference to EBM principles in statute, regulation, and other Executive Actions. Most recently, and explicitly, the Administration's National Ocean Policy (NOP) called for the development of a Federal EBM framework that would outline principles and guidelines for implementing EBM under existing authorities. This cross-agency framework has yet to be developed, but, the NOP, and related Administration initiatives, have resulted in the practical application of EBM principles in several issue-specific policy initiatives ranging from fisheries and marine protected area management to coastal adaptation and water resource infrastructure investment. In each case, the application of EBM principles uses apparently unique policy mechanisms (e.g. marine planning, ecosystem services assessment, adaptive management, dynamic ocean management, etc.). Despite differences in terminology and policy context, each of these policy initiatives is linked at its core to concepts of integrated and adaptive management that consider broad ecosystem function and services. This practical history of EBM implementation speaks to both the challenges and opportunities in broad incorporation of EBM across diverse policy initiatives and frameworks. We suggest that the continued growth of EBM as a practical policy concept will require a move away from broad frameworks, and towards the identification of specific resource management issues and accompanying policy levers with which to address those issues. In order to promote this progression, Federal policy should recognize and articulate the diverse set of policy mechanisms encompassed under the rubric of EBM and seek to require similar approaches across the spectra of resource management issues.

Ecosystem Based Management in Transition: From Ocean Policy to Application

NASA Astrophysics Data System (ADS)

Saumweber, W. J.; Goldman, E.

2016-12-01

Ecosystem-based management (EBM) has been proposed as a means to improve resource management and stewardship for more than two decades. Over this history, its exact goals and approaches have evolved in concert with advances in science and policy, including a greater understanding of ecosystem function, valuation, and thresholds for change, along with direct reference to EBM principles in statute, regulation, and other Executive Actions. Most recently, and explicitly, the Administration's National Ocean Policy (NOP) called for the development of a Federal EBM framework that would outline principles and guidelines for implementing EBM under existing authorities. This cross-agency framework has yet to be developed, but, the NOP, and related Administration initiatives, have resulted in the practical application of EBM principles in several issue-specific policy initiatives ranging from fisheries and marine protected area management to coastal adaptation and water resource infrastructure investment. In each case, the application of EBM principles uses apparently unique policy mechanisms (e.g. marine planning, ecosystem services assessment, adaptive management, dynamic ocean management, etc.). Despite differences in terminology and policy context, each of these policy initiatives is linked at its core to concepts of integrated and adaptive management that consider broad ecosystem function and services. This practical history of EBM implementation speaks to both the challenges and opportunities in broad incorporation of EBM across diverse policy initiatives and frameworks. We suggest that the continued growth of EBM as a practical policy concept will require a move away from broad frameworks, and towards the identification of specific resource management issues and accompanying policy levers with which to address those issues. In order to promote this progression, Federal policy should recognize and articulate the diverse set of policy mechanisms encompassed under the rubric of EBM and seek to require similar approaches across the spectra of resource management issues.

The Contemporary Setting for Water Management in the West: An Overview

NASA Astrophysics Data System (ADS)

Cummings, Ronald G.

1985-11-01

The socioeconomic, legal, and institutional settings for water resources management and use in the United States have undergone dramatic changes over recent years. The resulting confusion and uncertainties in terms of the structure of water rights, the prerogatives of sovereign states, and the limitations of state-federal interfaces provide the raison d'être for the collection of papers in this special section of Water Resources Research. This special issue is intended to serve several purposes: to inform, to provoke, and to invite. Thus many readers may find new and informative Tarlock's [this issue] overview of the evolution of groundwater law from English Common Law to laws based on notions of "reasonable use" and "sharing"; of particular importance is the readers appreciation of the changes and uncertainties in water law associated with the 1982 decision in Sporhase and in the later El Paso case. These cases, marking an end of the "immunity theory" wherein states were immune, in cases involving resources use, from challenges under the Commerce Clause, give rise to Tarlock's concern with the question, Might current conditions give rise to federal control of groundwater?

Veterinary teaching hospitals: current challenges and pathways for the future.

PubMed

Hubbell, John A E

2008-01-01

University-based veterinary teaching hospitals must change to maintain their viability. A number of factors both internal and external to universities and the veterinary profession have contributed to the need for change. A task force formed by the Association of American Veterinary Medical Colleges and the American Association of Veterinary Clinicians was convened to identify the issues and propose individual and collective strategies for the future. Primary issues include a shortage of faculty and staff, the nature of the case load, the need for fiscal management strategies, and the need to manage stakeholder expectations. The majority of the proposed strategies for the future will be managed individually by the colleges. Proposed collective strategies center on increasing the number of specialists and improving recruitment and retention of faculty and staff.

Proving that less is more: linking resources to outcomes.

PubMed

Ebener, M K; Baugh, K; Formella, N M

1996-01-01

Advocates of inpatient managed care employing clinical pathways are confident that this patient management strategy reduces cost while promoting optimal patient outcomes. Other health care professionals are concerned that cost reductions place patients at higher risk for adverse health events. Research is needed to demonstrate the true impact of cost-containment strategies on clinical outcomes. The article describes a study in progress comparing patients conventionally managed by their physicians with similar patients whose overall management involved a nurse case manager. This study explores the issue of resource costs that can be linked to clinical and financial outcome measures.

Management of pregnancy in woman with suspected malignant deep infiltrating endometriosis fistulised to the uterine cervix.

PubMed

Richard, Frederic; Canlorbe, Geoffroy; Bazot, Marc; Daraï, Emile

2014-06-04

Deep infiltrating endometriosis (DIE) is a well-known cause of pelvic pain and infertility. Malignant transformation of DIE is rare but can be suggested by MRI. We report a case of a spontaneous pregnancy in a woman with suspicion of malignant transformation of DIE with fistulisation to the posterior uterine isthmus through to the cervical canal. The pregnancy was closely monitored and an uneventful caesarian section was performed at 34 weeks of gestation. This case raises the issue of the relevance of imaging techniques and management of pregnancy. 2014 BMJ Publishing Group Ltd.

U.S. National Security Strategy - The Magnitude of Second and Third-Order Effects on Smaller Nations: The Cases of Lebanon During the Cold War and Pakistan During the Global War on Terrorism

DTIC Science & Technology

2004-03-19

informal management style used during the war years was not suited to the longer-term security issues of the post-war era. As US grand strategy became...Eisenhower Doctrine in 1957. THE CASE OF LEBANON Each of the above mentioned security policies were products of American diplomacy aimed at managing the...consisting of its East and West entities, found itself a principle player in the American-led security alliance structure designed to check Soviet

Overview of Contemporary Issues of Forest Research and Management in China

NASA Astrophysics Data System (ADS)

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

2011-12-01

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

The implications of new forest tenure reforms and forestry property markets for sustainable forest management and forest certification in China.

PubMed

Chen, Juan; Innes, John L

2013-11-15

This study examines issues existing in the southern collective forests in China, particularly prior to the implementation of new forest tenure reforms, such as continued illegal logging and timber theft, inadequate availability of finance and inconsistent forest-related policies. Such problems are believed to be hindering the adoption of sustainable forest management (SFM) and forest certification by forest farmers in China. Two strategies were introduced by the Chinese government with the purpose of addressing these issues, namely forest tenure reforms and their associated supporting mechanism, forestry property markets. Through two case studies in southern China, we investigated the effectiveness of the two strategies as well as their implications for the adoption of SFM and forest certification. The two cases were Yong'an in Fujian province and Tonggu in Jiangxi province. Personal interviews with open-ended questions were conducted with small-scale forest farmers who had already benefited from the two strategies as well as market officers working for the two selected forestry property markets. The study identified eight issues constraining the potential adoption of SFM and certification in China, including limited finance, poorly developed infrastructure and transport systems, insecure forest tenures, inconsistent forest policies, low levels of awareness, illegal forest management practices, lack of local cooperative organizations, and inadequate knowledge and technical transfer. We found that the new forest tenure reforms and forestry property markets had generally fulfilled their original objectives and had the capacity to assist in addressing many of the issues facing forests prior to the reforms. Copyright © 2013 Elsevier Ltd. All rights reserved.

Synchronous papillary thyroid carcinoma and primary hyperparathyroidism: diagnosis and management issues.

PubMed

Vysetti, Suneetha; Sridhar, Preethi; Theckedath, Boby; Gilden, Janice L; Morawiecki, Peter

2012-10-01

The occurrence of a papillary thyroid carcinoma in a patient with primary hyperparathyroidism is rare. Awareness of this condition will enable clinicians to evaluate for possible thyroid pathology in patients with primary hyperparathyroidism. Both of these endocrine conditions could then be managed with a single surgery involving concomitant resection of the thyroid and parathyroid glands. We report a case of a 53-year-old woman with a parathyroid adenoma and a unilateral papillary thyroid carcinoma, and detail the clinical features, diagnosis, and management.

Enabling and enacting 'practical action' in catchments: responding to the 'wicked problem' of nonpoint source pollution in coastal subtropical Australia.

PubMed

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

2015-02-01

Enabling and enacting 'practical action' (i.e., purposeful and concerted collective action) in catchments is a key challenge in responding to a wide range of pressing catchment and natural resource management (NRM) issues. It is particularly a challenge in responding to 'wicked problems,' where generating action is not straightforward and cannot be brought about solely by any single actor, policy or intervention. This paper responds to the critical need to better understand how practical action can be generated in catchments, by conducting an in-depth empirical case study of efforts to manage nonpoint source (NPS) pollution in South East Queensland (SEQ), Australia. SEQ has seen substantial concerted efforts to manage waterway and catchment issues over two decades, yet NPS pollution remains a major problem for waterway health. A novel framework was applied to empirically analyze practical action in three local catchment cases embedded within the broader SEQ region. The analysis focuses on 'enabling capacities' underpinning practical action in catchments. Findings reveal that capacities manifested in different ways in different cases, yet many commonalities also occurred across cases. Interplay between capacities was critical to the emergence of adaptive and contextual forms of practical action in all cases. These findings imply that in order to enable and enact practical action in catchments, it is vital to recognize and support a diversity of enabling capacities across both local and regional levels of decision making and action. This is likely to have relevance for other 'wicked' catchment and NRM problems requiring local responses within broader multiscalar regional problem situations.

Metastatic basal cell carcinoma: case series and review of the literature.

PubMed

Tang, Simon; Thompson, Stephen; Smee, Robert

2017-05-01

Metastatic basal cell carcinoma is exceedingly uncommon, with a poorly defined natural history, and its incidence, risk factors, patterns of spread, prognosis and potential treatment options are not well understood. This retrospective single institution case series aims to shed light on these issues. Aggressive local management in patients with locoregional disease may result in long-term survivors. © 2016 The Australasian College of Dermatologists.

Earth Observation Data Quality Monitoring and Control: A Case Study of STAR Central Data Repository

NASA Astrophysics Data System (ADS)

Han, W.; Jochum, M.

2017-12-01

Earth observation data quality is very important for researchers and decision makers involved in weather forecasting, severe weather warning, disaster and emergency response, environmental monitoring, etc. Monitoring and control earth observation data quality, especially accuracy, completeness, and timeliness, is very useful in data management and governance to optimize data flow, discover potential transmission issues, and better connect data providers and users. Taking a centralized near real-time satellite data repository, STAR (Center for Satellite Applications and Research of NOAA) Central Data Repository (SCDR), as an example, this paper describes how to develop new mechanism to verify data integrity, check data completeness, and monitor data latency in an operational data management system. Such quality monitoring and control of large volume satellite data help data providers and managers improve data transmission of near real-time satellite data, enhance its acquisition and management, and overcome performance and management issues to better serve research and development activities.

An ontological case base engineering methodology for diabetes management.

PubMed

El-Sappagh, Shaker H; El-Masri, Samir; Elmogy, Mohammed; Riad, A M; Saddik, Basema

2014-08-01

Ontology engineering covers issues related to ontology development and use. In Case Based Reasoning (CBR) system, ontology plays two main roles; the first as case base and the second as domain ontology. However, the ontology engineering literature does not provide adequate guidance on how to build, evaluate, and maintain ontologies. This paper proposes an ontology engineering methodology to generate case bases in the medical domain. It mainly focuses on the research of case representation in the form of ontology to support the case semantic retrieval and enhance all knowledge intensive CBR processes. A case study on diabetes diagnosis case base will be provided to evaluate the proposed methodology.

Using integrated research and interdisciplinary science: Potential benefits and challenges to managers of parks and protected areas

USGS Publications Warehouse

van Riper, Charles; Powell, Robert B.; Machlis, Gary; van Wagtendonk, Jan W.; van Riper, Carena J.; von Ruschkowski, Eick; Schwarzbach, Steven E.; Galipeau, Russell E.

2012-01-01

Our purpose in this paper is to build a case for utilizing interdisciplinary science to enhance the management of parks and protected areas. We suggest that interdisciplinary science is necessary for dealing with the complex issues of contemporary resource management, and that using the best available integrated scientific information be embraced and supported at all levels of agencies that manage parks and protected areas. It will take the commitment of park managers, scientists, and agency leaders to achieve the goal of implementing the results of interdisciplinary science into park management. Although such calls go back at least several decades, today interdisciplinary science is sporadically being promoted as necessary for supporting effective protected area management(e.g., Machlis et al. 1981; Kelleher and Kenchington 1991). Despite this history, rarely has "interdisciplinary science" been defined, its importance explained, or guidance provided on how to translate and then implement the associated research results into management actions (Tress et al. 2006; Margles et al. 2010). With the extremely complex issues that now confront protected areas (e.g., climate change influences, extinctions and loss of biodiversity, human and wildlife demographic changes, and unprecedented human population growth) information from more than one scientific discipline will need to be brought to bear in order to achieve sustained management solutions that resonate with stakeholders (Ostrom 2009). Although interdisciplinary science is not the solution to all problems, we argue that interdisciplinary research is an evolving and widely supported best practice. In the case of park and protected area management, interdisciplinary science is being driven by the increasing recognition of the complexity and interconnectedness of human and natural systems, and the notion that addressing many problems can be more rapidly advanced through interdisciplinary study and analysis.

[Transferring palliative-care patients from hospital to community care: A qualitative study].

PubMed

Correa-Casado, Matías; Granero-Molina, José; Hernández-Padilla, José Manuel; Fernández-Sola, Cayetano

To know the experience of case-manager nurses with regard to transferring palliative-care patients from the hospital to their homes. Qualitative phenomenological study carried out in 2014-2015. Poniente and Almería health districts, which referral hospitals are Poniente Hospital and Torrecárdenas Hospital, respectively. A purposive sample comprised of 12 case-manager nurses was recruited from the aforementioned setting. Theoretical data saturation was achieved after performing 7 in-depth individual interviews and 1 focus group. Data analysis was performed following Colaizzi's method. Three themes emerged: (1) 'Case-management nursing as a quality, patient-centred service' (2) 'Failures of the information systems', with the subthemes "patients" insufficient and inadequate previous information" and "ineffective between-levels communication channels for advanced nursing"; (3) 'Deficiencies in discharge planning', with the subthemes "deficient management of resources on admission", "uncertainty about discharge" and "insufficient human resources to coordinate the transfer". Case-manager nurses consider themselves a good-quality service. However, they think there are issues with coordination, information and discharge planning of palliative patients from hospital. It would be useful to review the communication pathways of both care and discharge reports, so that resources needed by palliative patients are effectively managed at the point of being transferred home. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Making intelligent systems team players: Additional case studies

NASA Technical Reports Server (NTRS)

Malin, Jane T.; Schreckenghost, Debra L.; Rhoads, Ron W.

1993-01-01

Observations from a case study of intelligent systems are reported as part of a multi-year interdisciplinary effort to provide guidance and assistance for designers of intelligent systems and their user interfaces. A series of studies were conducted to investigate issues in designing intelligent fault management systems in aerospace applications for effective human-computer interaction. The results of the initial study are documented in two NASA technical memoranda: TM 104738 Making Intelligent Systems Team Players: Case Studies and Design Issues, Volumes 1 and 2; and TM 104751, Making Intelligent Systems Team Players: Overview for Designers. The objective of this additional study was to broaden the investigation of human-computer interaction design issues beyond the focus on monitoring and fault detection in the initial study. The results of this second study are documented which is intended as a supplement to the original design guidance documents. These results should be of interest to designers of intelligent systems for use in real-time operations, and to researchers in the areas of human-computer interaction and artificial intelligence.

30 CFR 250.1405 - When is a case file developed?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 250.1405 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Outer Continental Shelf (OCS) Civil... Officer may administer oaths and issue subpoenas requiring witnesses to attend meetings, submit...

Challenges of Digital Preservation for Cultural Heritage Institutions

ERIC Educational Resources Information Center

Evens, Tom; Hauttekeete, Laurence

2011-01-01

This article elaborates four major issues hampering the sustainability of digital preservation within cultural heritage institutions: digitization, metadata indexes, intellectual property rights management and business models. Using a case-study approach, the digitization of audiovisual collections within the performing arts institutions in…

Juvenile Arrest: A Cross-Cultural Comparison

ERIC Educational Resources Information Center

Vermeiren, Robert; Jones, Stephanie M.; Ruchkin, Vladislav; Deboutte, Dirk; Schwab-Stone, Mary

2004-01-01

Background: Cross-national studies describing the psychopathological characteristics of arrested adolescents are virtually non-existent. Such studies are important because they have implications for national policy on arrest, case-management, and future research. Method: To address this issue, self-report surveys administered to representative…

An eco-sustainable green approach for heavy metals management: two case studies of developing industrial region.

PubMed

Rai, Prabhat Kumar

2012-01-01

Multifaceted issues or paradigm of sustainable development should be appropriately addressed in the discipline of environmental management. Pollution of the biosphere with toxic metals has accelerated dramatically since the beginning of the Industrial Revolution. In present review, comparative assessment of traditional chemical technologies and phytoremediation has been reviewed particularly in the context of cost-effectiveness. The potential of phytoremediation and green chemicals in heavy metals management has been described critically. Further, the review explores our work on phytoremediation as green technology during the last 6 years and hand in hand addresses the various ecological issues, benefits and constraints pertaining to heavy metal pollution of aquatic ecosystems and its phytoremediation as first case study. Second case study demonstrates the possible health implications associated with use of metal contaminated wastewater for irrigation in peri-urban areas of developing world. Our researches revealed wetland plants/macrophytes as ideal bio-system for heavy metals removal in terms of both ecology and economy, when compared with chemical treatments. However, there are several constraints or limitations in the use of aquatic plants for phytoremediation in microcosm as well as mesocosm conditions. On the basis of our past researches, an eco-sustainable model has been proposed in order to resolve the certain constraints imposed in two case studies. In relation to future prospect, phytoremediation technology for enhanced heavy metal accumulation is still in embryonic stage and needs more attention in gene manipulation area. Moreover, harvesting and recycling tools needs more extensive research. A multidisciplinary research effort that integrates the work of natural sciences, environmental engineers and policy makers is essential for greater success of green technologies as a potent tool of heavy metals management.

Business continuity management in emerging markets: the case of Jordan.

PubMed

Sawalha, Ihab H; Anchor, John R

2012-01-01

Despite their considerable growth in last few decades, emerging markets (EM) face numerous risks that have the potential to slow down or obstruct their development. Three main issues are discussed in this paper: first, the risks facing organisations operating in emerging markets and Jordan in particular; secondly, the role of business continuity management (BCM) in emerging markets; and thirdly, potential factors that underpin the role of BCM in emerging markets. These issues are significant, as they represent the role of BCM in highly dynamic and fast changing business environments. The paper provides a discussion of the significance of BCM in reducing or preventing risks facing organisations operating in emerging markets, especially those in Jordan.

Pain management discussion forum: prevention of chronic postoperative pain.

PubMed

Breivik, Harald

2014-09-01

ABSTRACT A case of a 35-year-old woman scheduled for removal of a painful breast tumor is discussed. Ways to reduce risk of chronic pain developing postoperatively are described. Preoperative medications, nerve blocks, local anesthetics, and postoperative epidural pharmacotherapy are described. This report is adapted from paineurope 2014; Issue 1, Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be accessed via the Web site: http://www.paineurope.com, at which European health professionals can register online to receive copies of the quarterly publication.

Towards adaptive and integrated management paradigms to meet the challenges of water governance.

PubMed

Halbe, J; Pahl-Wostl, C; Sendzimir, J; Adamowski, J

2013-01-01

Integrated Water Resource Management (IWRM) aims at finding practical and sustainable solutions to water resource issues. Research and practice have shown that innovative methods and tools are not sufficient to implement IWRM - the concept needs to also be integrated in prevailing management paradigms and institutions. Water governance science addresses this human dimension by focusing on the analysis of regulatory processes that influence the behavior of actors in water management systems. This paper proposes a new methodology for the integrated analysis of water resources management and governance systems in order to elicit and analyze case-specific management paradigms. It builds on the Management and Transition Framework (MTF) that allows for the examination of structures and processes underlying water management and governance. The new methodology presented in this paper combines participatory modeling and analysis of the governance system by using the MTF to investigate case-specific management paradigms. The linking of participatory modeling and research on complex management and governance systems allows for the transfer of knowledge between scientific, policy, engineering and local communities. In this way, the proposed methodology facilitates assessment and implementation of transformation processes towards IWRM that require also the adoption of adaptive management principles. A case study on flood management in the Tisza River Basin in Hungary is provided to illustrate the application of the proposed methodology.

A case study of polypharmacy management in nine European countries: Implications for change management and implementation.

PubMed

McIntosh, Jennifer; Alonso, Albert; MacLure, Katie; Stewart, Derek; Kempen, Thomas; Mair, Alpana; Castel-Branco, Margarida; Codina, Carles; Fernandez-Llimos, Fernando; Fleming, Glenda; Gennimata, Dimitra; Gillespie, Ulrika; Harrison, Cathy; Illario, Maddalena; Junius-Walker, Ulrike; Kampolis, Christos F; Kardas, Przemyslaw; Lewek, Pawel; Malva, João; Menditto, Enrica; Scullin, Claire; Wiese, Birgitt

2018-01-01

Multimorbidity and its associated polypharmacy contribute to an increase in adverse drug events, hospitalizations, and healthcare spending. This study aimed to address: what exists regarding polypharmacy management in the European Union (EU); why programs were, or were not, developed; and, how identified initiatives were developed, implemented, and sustained. Change management principles (Kotter) and normalization process theory (NPT) informed data collection and analysis. Nine case studies were conducted in eight EU countries: Germany (Lower Saxony), Greece, Italy (Campania), Poland, Portugal, Spain (Catalonia), Sweden (Uppsala), and the United Kingdom (Northern Ireland and Scotland). The workflow included a review of country/region specific polypharmacy policies, key informant interviews with stakeholders involved in policy development and implementation and, focus groups of clinicians and managers. Data were analyzed using thematic analysis of individual cases and framework analysis across cases. Polypharmacy initiatives were identified in five regions (Catalonia, Lower Saxony, Northern Ireland, Scotland, and Uppsala) and included all care settings. There was agreement, even in cases without initiatives, that polypharmacy is a significant issue to address. Common themes regarding the development and implementation of polypharmacy management initiatives were: locally adapted solutions, organizational culture supporting innovation and teamwork, adequate workforce training, multidisciplinary teams, changes in workflow, redefinition of roles and responsibilities of professionals, policies and legislation supporting the initiative, and data management and information and communication systems to assist development and implementation. Depending on the setting, these were considered either facilitators or barriers to implementation. Within the studied EU countries, polypharmacy management was not widely addressed. These results highlight the importance of change management and theory-based implementation strategies, and provide examples of polypharmacy management initiatives that can assist managers and policymakers in developing new programs or scaling up existing ones, particularly in places currently lacking such initiatives.

Integrating Landscape Ecology into Natural Resource Management - Series: Cambridge Studies in Landscape Ecology

NASA Astrophysics Data System (ADS)

Jianguo Liu, Edited By; Taylor, William W.

2002-08-01

The rapidly increasing global population has dramatically increased the demands for natural resources and has caused significant changes in quantity and quality of natural resources. To achieve sustainable resource management, it is essential to obtain insightful guidance from emerging disciplines such as landscape ecology. This text addresses the links between landscape ecology and natural resource management. These links are discussed in the context of various landscape types, a diverse set of resources and a wide range of management issues. A large number of landscape ecology concepts, principles and methods are introduced. Critical reviews of past management practices and a number of case studies are presented. This text provides many guidelines for managing natural resources from a landscape perspective and offers useful suggestions for landscape ecologists to carry out research relevant to natural resource management. In addition, it will be an ideal supplemental text for graduate and advanced undergraduate ecology courses. Written, and rigorously reviewed, by many of the world's leading landscape ecologists and natural resource managers Contains numerous case studies and insightful guidelines for landscape ecologists and natural resource managers

Management of space networks

NASA Technical Reports Server (NTRS)

Markley, R. W.; Williams, B. F.

1993-01-01

NASA has proposed missions to the Moon and Mars that reflect three areas of emphasis: human presence, exploration, and space resource development for the benefit of Earth. A major requirement for such missions is a robust and reliable communications architecture. Network management--the ability to maintain some degree of human and automatic control over the span of the network from the space elements to the end users on Earth--is required to realize such robust and reliable communications. This article addresses several of the architectural issues associated with space network management. Round-trip delays, such as the 5- to 40-min delays in the Mars case, introduce a host of problems that must be solved by delegating significant control authority to remote nodes. Therefore, management hierarchy is one of the important architectural issues. The following article addresses these concerns, and proposes a network management approach based on emerging standards that covers the needs for fault, configuration, and performance management, delegated control authority, and hierarchical reporting of events. A relatively simple approach based on standards was demonstrated in the DSN 2000 Information Systems Laboratory, and the results are described.

Self-Efficacy and Academic Achievement--A Case from Turkey

ERIC Educational Resources Information Center

Köseoglu, Yaman

2015-01-01

The issues of motivational inclinations, cognitive and meta-cognitive approaches and resource management abilities of university students are considered in predicting academic achievement. First-year university students filled in the Motivated Strategies Learning Questionnaire, completed the Implicit Theories of Intelligence Scale, answered the…

Legal, Social, Ethical, and Medical Perspectives on the Care of the Statutory Rape Adolescent in the Emergency Department.

PubMed

Tsai, Shiu-Lin; Acosta, Elvira; Cardenas, Toni; Sigall, Jeremy K; Van Geem, Kevin

2017-07-01

Rapes involving adolescents who present to the emergency department (ED) are fraught with ethical and legal complexities and are often emotionally turbulent for patients, their families, and medical providers. Management requires a thoughtful approach from multiple standpoints, including legal, psychosocial, ethical, and medical ones. However, there is no standardized sexual assault education for emergency medicine residents, and management practices vary widely. 1,2 We present a hypothetical statutory rape case based on real cases that occurred in New York City and bring together the perspectives of an attorney on the legal parameters, two social workers on the psychosocial issues, an ethicist on the moral considerations, and a pediatric emergency physician-who is also a sexual assault forensic examiner-on the medical treatments. We aim to provide a framework for physicians to navigate issues of patient-physician privilege involving minors, privacy rules, and mandatory reporting laws. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Disclosure of psychosocial stressors affecting diabetes care among uninsured young adults with Type 1 diabetes.

PubMed

Pyatak, E A; Sequeira, P; Peters, A L; Montoya, L; Weigensberg, M J

2013-09-01

To determine the disclosure rates of psychosocial issues affecting routine diabetes care. A total of 20 young adults were interviewed regarding the impact of psychosocial stressors on their diabetes care. The interviewer, endocrinologist and case manager reported the prevalence rates of psychosocial stressors. Disclosure rates were compared to determine the prevalence of psychosocial issues and the different patterns of disclosure. Participants reported a high number of psychosocial stressors, which were associated with poorer glycaemic control (r = 0.60, P = 0.005). Approximately half of all disclosed stressors (50.9%) were identified in routine care; other stressors were identified only through intensive case management and/or in-depth interviews. Identifying psychosocial stressors in routine care, and providing referrals to psychological or social services, is a significant unmet need and may improve glycaemic control among certain populations with diabetes. Systematic mechanisms of capturing this information, such as by screening surveys, should be considered. © 2013 The Authors. Diabetic Medicine © 2013 Diabetes UK.

Software Defined Networking challenges and future direction: A case study of implementing SDN features on OpenStack private cloud

NASA Astrophysics Data System (ADS)

Shamugam, Veeramani; Murray, I.; Leong, J. A.; Sidhu, Amandeep S.

2016-03-01

Cloud computing provides services on demand instantly, such as access to network infrastructure consisting of computing hardware, operating systems, network storage, database and applications. Network usage and demands are growing at a very fast rate and to meet the current requirements, there is a need for automatic infrastructure scaling. Traditional networks are difficult to automate because of the distributed nature of their decision making process for switching or routing which are collocated on the same device. Managing complex environments using traditional networks is time-consuming and expensive, especially in the case of generating virtual machines, migration and network configuration. To mitigate the challenges, network operations require efficient, flexible, agile and scalable software defined networks (SDN). This paper discuss various issues in SDN and suggests how to mitigate the network management related issues. A private cloud prototype test bed was setup to implement the SDN on the OpenStack platform to test and evaluate the various network performances provided by the various configurations.

The role of Indigenous knowledge in environmental health risk management in Yukon, Canada

PubMed Central

Friendship, Katelyn A.; Furgal, Chris M.

2012-01-01

Objectives This project aimed to gain better understandings of northern Indigenous risk perception related to food safety and to identify the role that Indigenous knowledge (IK) plays in risk management processes to support more effective and culturally relevant benefit-risk (B-R) management strategies. Study design The project used an exploratory qualitative case study design to investigate the role and place of IK in the management of environmental contaminants exposure via consumption of traditional foods in Yukon First Nations (YFNs). Methods Forty-one semi-directive interviews with Traditional Food Knowledge Holders and Health and Environment Decision-makers were conducted. A review and analysis of organizational documents related to past risk management events for the issue was conducted. Thematic content analysis was used to analyze transcripts and documents for key themes related to the research question. Results There was a recognized need by all participants for better collaboration between scientists and YFN communities. YFNs have been involved in identifying and defining community concerns about past risk issues, setting a local context, and participating in communications strategies. Interviewees stressed the need to commit adequate time for building relationships, physically being in the community, and facilitating open communication. Conducting community-based projects was identified as critical for collaboration and for cooperative learning and management of these issues. Conclusions The perception of “effective” benefit-risk management is significantly influenced by the efforts made to include local communities in the process. A set of common guiding principles within a process that brings together people and knowledge systems may provide a more effective way forward in cross-cultural, multiple knowledge system contexts for complex benefit-risk issues than a prescriptive rigid framework. PMID:22868192

The impact of CMSA's case management adherence guidelines and guidelines training on case manager-reported behavior change.

PubMed

Aliotta, Sherry L; Boling, Jeanne; Commander, Connie; Day, David; Greenberg, Liza; Lattimer, Cheri; Marshall, Danielle; Rogers, Susan A

2007-01-01

The Case Management Society of America (CMSA) developed evidence-based guidelines (Case Management Adherence Guidelines, CMAG) for case managers to support increased efficacy of case managers in helping patients become more adherent to medication regimens. The effort was in response to documented high levels of nonadherence, and evidence demonstrating that lack of adherence negatively impacts patient health status. The CMSA engaged in a massive training program to support case manager adoption of the CMAG tools and approaches to improve patient knowledge and motivation. This article reports on findings of a follow-up survey that evaluated case manager's use of the tools and strategies discussed in the CMAG. Seven hundred fifty case managers from all settings were trained in the use of the CMAG. In a follow-up survey, 42% of respondents reported that there has been a very, or fairly, significant impact of using their new skills to increase their effectiveness in helping patients reach their outcome improvement goals. In addition, 43% reported that there has been a very, or fairly, big improvement in patient adherence since they took the training, while 39% did not see a major impact. At the time of the survey (up to 1 year after training), 43% of respondents indicated that the training was very valuable; another 39% reported that it was fairly valuable. Participants continue to use the skills and information adopted in the training sessions: 26% report that they currently use at least some of the information and skills very often, while another 49% use them fairly often. Sixty-six percent of respondents indicated that they specifically use motivational interviewing to help address patient knowledge and motivation regarding medication adherence. Medication adherence is a key issue in case management practice; efforts to positively impact low patient knowledge and motivation can be frustration for case managers. The CMAG offer evidence-based assessment tools to evaluate patient knowledge of medications and their motivation to adhere, and recommend the strategy of motivational interviewing to help case managers address adherence more effectively with patients. A 1-time training on the CMAG and motivational interviewing had some effect on self-reported case manager effectiveness in addressing medication adherence. Case managers appreciated the training; many reported that they continue to use skills and that they have observed changes in patient outcomes. Additional training, skill building, and reinforcement may help case managers apply CMAG and motivational interviewing effectively to support patients' adherence to medication regimens. The CMSA may continue to evaluate the impact of the CMAG and CMAG training to refine the tools and the training approach.

Sexual harassment in the workplace: guidelines for educating healthcare managers.

PubMed

Robinson, Robert K; Franklin, Geralyn Mcclure; Tinney, Cathie H; Crow, Stephen M; Hartman, Sandra J

2005-01-01

Actionable sexual harassment is defined as a violation of Title VII of the Civil Rights Act of 1964. In recent years, there have been a number of significant developments in sexual harassment case law and litigation including: (1) nationwide legal recognition for same-sex sexual harassment; (2) increased standards on employer liability for sexual harassment perpetrated by supervisory and managerial personnel; and (3) guidelines for mitigating damages when employers are found liable. These developments are of particular concern in those professions such as healthcare in which women historically have been represented as a significant portion of the workforce. Moreover, because management and supervisory relationships in healthcare are often cloudy, harassment by "supervisors" in healthcare settings can be an issue of special concern. In this article, we review relevant issues related to sexual harassment and provide guidance in dealing with the issue in the workplace.

Evidence-based treatment of attention deficit/hyperactivity disorder in a preschool-age child: a case study.

PubMed

Verduin, Timothy L; Abikoff, Howard; Kurtz, Steven M S

2008-04-01

This case study illustrates a behavioral treatment of "Peter," a 4-year-old male with attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder. Multiple evidence-based treatment procedures were implemented, affording the opportunity to explore issues common to the clinical application of empirically supported interventions. Among the strategies utilized were behavioral parent training, school consultation and behavioral training of educators, school-based contingency management, and a behavioral daily report card. Numerous issues are discussed, including the limited evidence regarding interventions for preschool-age children with ADHD, factors influencing treatment planning and sequencing, collaboration with schools and parents, and evidence-based assessment of treatment gains.

Batch Model for Batched Timestamps Data Analysis with Application to the SSA Disability Program

PubMed Central

Yue, Qingqi; Yuan, Ao; Che, Xuan; Huynh, Minh; Zhou, Chunxiao

2016-01-01

The Office of Disability Adjudication and Review (ODAR) is responsible for holding hearings, issuing decisions, and reviewing appeals as part of the Social Security Administration’s disability determining process. In order to control and process cases, the ODAR has established a Case Processing and Management System (CPMS) to record management information since December 2003. The CPMS provides a detailed case status history for each case. Due to the large number of appeal requests and limited resources, the number of pending claims at ODAR was over one million cases by March 31, 2015. Our National Institutes of Health (NIH) team collaborated with SSA and developed a Case Status Change Model (CSCM) project to meet the ODAR’s urgent need of reducing backlogs and improve hearings and appeals process. One of the key issues in our CSCM project is to estimate the expected service time and its variation for each case status code. The challenge is that the systems recorded job departure times may not be the true job finished times. As the CPMS timestamps data of case status codes showed apparent batch patterns, we proposed a batch model and applied the constrained least squares method to estimate the mean service times and the variances. We also proposed a batch search algorithm to determine the optimal batch partition, as no batch partition was given in the real data. Simulation studies were conducted to evaluate the performance of the proposed methods. Finally, we applied the method to analyze a real CPMS data from ODAR/SSA. PMID:27747132

Multidisciplinary analysis of invasive meningococcal disease as a framework for continuous quality and safety improvement in regional Australia

PubMed Central

Taylor, Kathryn A; Durrheim, David N; Merritt, Tony; Massey, Peter; Ferguson, John; Ryan, Nick; Hullick, Carolyn

2018-01-01

Background System factors in a regional Australian health district contributed to avoidable care deviations from invasive meningococcal disease (IMD) management guidelines. Traditional root cause analysis (RCA) is not well-suited to IMD, focusing on individual cases rather than system improvements. As IMD requires complex care across healthcare silos, it presents an opportunity to explore and address system-based patient safety issues. Context Baseline assessment of IMD cases (2005–2006) identified inadequate triage, lack of senior clinician review, inconsistent vital sign recording and laboratory delays as common issues, resulting in antibiotic administration delays and inappropriate or premature discharge. Methods Clinical governance, in partnership with clinical and public health services, established a multidisciplinary Meningococcal Reference Group (MRG) to routinely review management of all IMD cases. The MRG comprised representatives from primary care, acute care, public health, laboratory medicine and clinical governance. Baseline data were compared with two subsequent evaluation points (2011–2012 and 2013–2015). Interventions Phase I involved multidisciplinary process mapping and development of a standardised audit tool from national IMD management guidelines. Phase II involved formalisation of group processes and advocacy for operational change. Phase III focused on dissemination of findings to clinicians and managers. Results Greatest care improvements were observed in the final evaluation. Median antibiotic delay decreased from 72 to 42 min and proportion of cases triaged appropriately improved from 38% to 75% between 2013 and 2015. Increasing fatal outcomes were attributed to the emergence of more virulent meningococcal serotypes. Conclusions The MRG was a key mechanism for identifying system gaps, advocating for change and enhancing communication and coordination across services. Employing IMD case review as a focus for district-level process reflection presents an innovative patient safety approach, combining the strengths of prospective hazard analysis with more traditional RCA methodologies. PMID:29527576

Approaches to child protection case management for cases involving people with disabilities.

PubMed

Lightfoot, Elizabeth B; LaLiberte, Traci L

2006-04-01

This exploratory study examines the delivery of child protection services by county child protection agencies involving cases with a family member with a disability. Telephone surveys were conducted with the directors or their designees of 89% of the child protection agencies in a Midwestern state. Respondents were asked about the policies and/or procedures for approaching cases involving a person with a disability and the barriers and strengths agencies have in serving people with disabilities. Only 6.7% of respondents reported their agency had a written policy related to serving persons with a disability. There were 18 different approaches to serving clients with a disability within child protection, with the most common being informally teaming for information, dual case assignment, and teaming with an outside consultant. Five counties had specialty workers who were experts in both child protection and disability. Barriers reported varied between rural and non-rural counties, with the most important barriers being lack of resources, lack of knowledge regarding disabilities, systems conflicts, and rural issues, such as lack of providers and lack of transportation. Strengths included accessing and coordinating services, individualizing services, good collaboration and creativity. While few county agencies had any written policies, both formal and informal collaboration is happening at the individual level. The lack of standardization in providing services indicates a need for more attention to issues regarding disability within child protection, including more training for workers, the development of models of collaborative case management and the removal of systemic barriers.

Economic and Environmental Analysis for Advancing Sustainable Management of Livestock Waste: A Wisconsin Case Study

EPA Science Inventory

Livestock waste may cause air quality degradation from ammonia and methane emissions, soil quality detriment from the in-excess nutrients and acidification, and water pollution issues from nutrient and pathogens runoff to the water bodies, leading to eutrophication, algal blooms,...

AIDS and the Older Adult.

ERIC Educational Resources Information Center

Allers, Christopher T.

1990-01-01

Older adults are finding themselves the neighbors of Acquired Immunodeficiency Syndrome (AIDS) patients as well as the primary caregivers of infected adult children. Focuses on roles, issues, and conflicts older adults face in dealing with relatives or neighbors with AIDS. Case management and educational intervention strategies are also offered.…

An Approach to Ethical Practice in Management and Trainer Training.

ERIC Educational Resources Information Center

Johnston, Rita

1992-01-01

Concern with ethics has given rise to two educational approaches, one derived from philosophical principles of social ethics, the other based on case studies of practical issues. A combination of these is necessary to ensure situational applicability and to avoid moral relativism and expediency. (SK)

Langley Communications: Socializing and Snooping on E-mail.

ERIC Educational Resources Information Center

Rymer, Jone

1998-01-01

Presents a case study for use in business communication classes to help students understand and learn both the context and the strategies for the communication with business management. Deals with a business problem revolving around issues of appropriate e-mail use and privacy. Includes five assignments. (SR)

Sentry Assurance: Bringing Outsiders "In."

ERIC Educational Resources Information Center

Lease, Judy E.

1998-01-01

Presents a case study for use in business communication classes to help students understand and learn both the context and the strategies for communication with business and management. Deals with multiple problems caused by the rapid expansion of an insurance brokerage, including gender issues, clarification of responsibilities and roles, and…

Human Resource Development: An Examination of Perceived Training Needs of Certified Rehabilitation Counselors.

ERIC Educational Resources Information Center

Szymanski, Edna Mora; And Others

1993-01-01

Investigated human resource development needs of certified rehabilitation counselors (n=1,535). Counselors reported development needs in vocational services; medical/psychosocial aspects; case management/services; and social, cultural, and environmental issues. Significant differences in development needs were found across job levels, job…

Pregnancy in inherited hypokalemic salt-losing renal tubular disorder.

PubMed

Mascetti, Laura; Bettinelli, Alberto; Simonetti, Giacomo D; Tagliabue, Alessandro; Syrén, Marie Lousie; Nordio, Francesco; Bianchetti, Mario G

2011-02-01

The management of inherited hypokalemia has improved and the issue of pregnancy has become important. Between 1992 and 2010, five Italian women with the clinical diagnosis of Gitelman syndrome gave birth to a total of six newborns. Pregnancy was uneventful in four women but was complicated by tiredness and tetanic seizures in the fifth woman. Drug management included potassium chloride in four cases and magnesium and amiloride in one case each. The six neonates were born at term (n=4) or near term (n=2), with a body weight that was appropriate for gestational age. The children, aged between 6 weeks and 18 years, were healthy and neurodevelopmentally and somatically normal at the last follow-up. Women with hypokalemia can become pregnant and the disorder may be managed without negative effect on the fetus.

Collaboration of hospital case managers and home care liaisons when transitioning patients.

PubMed

Kelly, Margaret M; Penney, Erika D

2011-01-01

Hospital case managers frequently collaborate with home care liaisons when coordinating special discharge plans. This article focuses on the collaborative relationship between the hospital case manager and on-site liaison whose primary role centers around care coordination and patient teaching. Ineffective collaboration between hospital case managers and these clinical on-site liaisons can lead to serious lapses in care and services for patients, families, and the health care team when transitioning from hospital to home care. In a review of literature, little detail was found about the collaborative practice between hospital case managers and home care liaisons. This article discusses how collegiality, collaboration, and role clarification between hospital case managers and on-site home care liaisons can improve coordination of care and services for patients and their families in the transition from hospital to home care. Included is a set of guidelines developed by case managers at a major metropolitan acute care hospital to inform and improve their practice with home care liaisons. The authors are nursing case managers who practice in a major metropolitan teaching hospital. They met by telephone and in person with case managers from 3 metropolitan medical centers as well as on-site liaisons from 2 skilled nursing facilities and 5 home care agencies to develop practice recommendations for their department regarding work with home care liaisons. Conversations between hospital case managers and on-site home care liaisons revealed that all had experiences in which suboptimal collaboration negatively impacted home care coordination for patients and their families. Furthermore, outcomes in similar patient scenarios varied widely based on the individual practices of the case managers and liaisons involved in discharge coordination. Multiple issues were discussed, including blurred role and responsibility delineations, variations in communication styles and practices, and different levels of experience and training. Consensus regarding the implementation of the hospital's guidelines was achieved through a series of discussions within the workgroup in developing practice guidelines. Multiple revisions and secondary reviews by colleagues and directors took place before the guidelines were accepted and implemented. Recommendations for improving collaboration with liaisons included (1) taking time to become familiar with one another's practices and backgrounds; (2) ensuring clear discussions of roles, responsibilities, and expectations with liaisons related to individual cases and organizational requirements and limitations; (3) providing time and forums for ongoing communication and follow-up; and (4) recognizing that responsibility for certain aspects of the discharge planning process may be shared but that the case manager, in partnership with the multidisciplinary team, is ultimately accountable for the effectiveness and outcomes of the discharge plan.

Hanford Site Environmental Safety and Health Fiscal Year 2001 Budget-Risk management summary

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

REEP, I.E.

1999-05-12

The Hanford Site Environment, Safety and Health (ES&H) Budget-Risk Management Summary report is prepared to support the annual request to sites in the U.S. Department of Energy (DOE) Complex by DOE, Headquarters. The request requires sites to provide supplementary crosscutting information related to ES&H activities and the ES&H resources that support these activities. The report includes the following: (1) A summary status of fiscal year (FY) 1999 ES&H performance and ES&H execution commitments; (2)Status and plans of Hanford Site Office of Environmental Management (EM) cleanup activities; (3) Safety and health (S&H) risk management issues and compliance vulnerabilities of FY 2001more » Target Case and Below Target Case funding of EM cleanup activities; (4) S&H resource planning and crosscutting information for FY 1999 to 2001; and (5) Description of indirect-funded S&H activities.« less

If the face is familiar, the patient may be overusing healthcare.

PubMed

2014-01-01

Patients who use the healthcare system excessively, and often for avoidable issues, create a burden for hospitals and consume a significant portion of healthcare expenditures. Many frequent users have complex medical and psychosocial needs, are uninsured, or have behavioral health issues. Case managers should identify patients who are potential frequent utilizers and make sure they are connected with a primary care provider. Take the time to find out barriers to care and call in a social worker to help line up community resources.

Risk Management and Medico-Legal Issues in Breast Cancer.

PubMed

Ward, Charles J; Green, Victoria L

2016-06-01

Breast cancer is a leading source of malpractice claims for radiologists and gynecologists. Delay in or failure to diagnosis was the second most common cause for allegations of malpractice and failure to diagnosis breast cancer accounted for the majority of these claims. The amount paid in indemnity for such claims was only second to claims paid for neurologically impaired newborns. Issues involved in documentation and communication are reviewed with a focus on specific medical legal cases. Obstetrician gynecologists must remain cognizant of the potential for liability.

[Difficulties for the medical and legal forensic evaluation in cases of sexual abuse].

PubMed

Romi, Juan Carlos

2005-01-01

The forensic evaluation of sexual offenders and their victims are a very complex task. This concern becomes even more relevant when children have to be assessed. The evaluation process should consider: children's motivation to deceive during forensic assessment; their perception of the assessment process and its influence on their deceptive tendencies; parental issues related to dissimulation among children and the induction of false memories. The article summarize these problems and gives physicians a practical guide for managing this issue.

Knowledge management strategies: Enhancing knowledge transfer to clinicians and patients.

PubMed

Roemer, Lorrie K; Rocha, Roberto A; Del Fiol, Guilherme; Bradshaw, Richard L; Hanna, Timothy P; Hulse, Nathan C

2006-01-01

At Intermountain Healthcare (Intermountain), executive clinical content experts are responsible for disseminating consistent evidence-based clinical content throughout the enterprise at the point-of-care. With a paper-based system it was difficult to ensure that current information was received and was being used in practice. With electronic information systems multiple applications were supplying similar, but different, vendor-licensed and locally-developed content. These issues influenced the consistency of clinical practice within the enterprise, jeopardized patient and clinician safety, and exposed the enterprise and its employees to potential financial penalties. In response to these issues Intermountain is developing a knowledge management infrastructure providing tools and services to support clinical content development, deployment, maintenance, and communication. The Intermountain knowledge management philosophy includes strategies guiding clinicians and consumers of health information to relevant best practice information with the intention of changing behaviors. This paper presents three case studies describing different information management problems identified within Intermountain, methods used to solve the problems, implementation challenges, and the current status of each project.

A critical look at persistent problems in the diagnosis, staging and treatment of temporal bone carcinoma.

PubMed

Zanoletti, Elisabetta; Lovato, Andrea; Stritoni, Paola; Martini, Alessandro; Mazzoni, Antonio; Marioni, Gino

2015-12-01

Temporal bone squamous cell carcinoma (TBSCC) is an uncommon malignancy with a distinctly poor prognosis in advanced cases. There is still much controversy surrounding the rational diagnostic/therapeutic approach to TBSCC. Diagnostic differences are due mainly to: the small number of cases reported (even in the largest available series); the inappropriate histological heterogeneity of several case series; the lack of an internationally-accepted staging system for TBSCC; the frequent absence of adequate radiological imaging to enable a malignancy's local, regional and distant extension to be studied in detail; and a non-standardized approach to final histological assessment of the surgical margins. As for the therapeutic approaches, several issues are still debated, including the choice between en bloc and piecemeal primary surgery for the tumor's removal, and the role of elective neck dissection. Although radiotherapy seems to be an effective adjuvant therapy in advanced cases, its role in low-stage tumors or as a primary treatment has yet to be established. The value of chemotherapy is also still unclear. The treatment strategy for TBSCC is often based on the combined experience of a given surgeon and institution, bearing the results reportedly achieved by other oncology centers in mind. To date, the optimal management of TBSCC is still elusive. We aimed to critically review the ongoing crucial issues concerning the management of TBSCC, analyzing how it is diagnosed, staged and treated, the management of recurrences, rational follow-up schedules, and prognostic factors for this disease. Copyright © 2015 Elsevier Ltd. 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.

Using an Interdisciplinary Approach to Teach About Climate Change

NASA Astrophysics Data System (ADS)

Schafer, K.; Spenner, C.

2017-12-01

The traditional methods of teaching science, or any particular discipline, are not necessarily well suited for preparing students to solve big messy problems like sustainable development, climate change and resource management. We have developed a summer course entitled, "Human Ecology: Our Place in Nature," with the goal of addressing such issues through a series of case studies. The goal of these case studies is to explore how people interact with nature through Agriculture, Fisheries and Energy Use issues and could easily be adapted to specific geographical regions with different land use challenges. The course was divided into two segments: the first took place at locations near our school in San Jose, California and the second piece at various locations in Southeastern Alaska. Students learned about the interdisciplinary nature of these issues and developed an individual project of their choosing to explore some aspect of the course in greater depth.

The management of pneumonia in internal medicine.

PubMed

Bouza, E; Giannella, M; Pinilla, B; Pujol, R; Capdevila, J A; Muñoz, P

2013-01-01

Pneumonia generates a high workload for internal medicine departments. Management of this disease is challenging, because patients are usually elderly and have multiple comorbid conditions. Furthermore, the interpretation and adherence to guidelines are far from clear in this setting. We report the opinion of 43 internists especially interested in infectious diseases that were questioned at the 2011 XXXII National Conference of Spanish Society of Internal Medicine about the main issues involved in the management of pneumonia in the internal medicine departments, namely, classification, admission criteria, microbiological workup, therapeutic management, discharge policy, and prevention of future episodes. Participants were asked to choose between 2 options for each statement by 4 investigators. Consensus could not be reached in many cases. The most controversial issues concerned recognition and management of healthcare-associated pneumonia (HCAP). Most participants were aware of the differences in terms of underlying diseases, etiological distribution, and outcome of HCAP compared with community-acquired pneumonia, but only a minority agreed to manage HCAP as hospital-acquired pneumonia, as suggested by some guidelines. A clinical patient-to-patient approach proved to be the option preferred by internists in the management of HCAP. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Rare cases of disorders of sex development (DSD) in adolescents with female phenotype.

PubMed

Kristesashvili, Jenara; Chipashvili, Mariam; Jorbenadze, Teimuraz; Greydanus, Donald E

2012-01-01

Disorders of sex development (DSD) belong to uncommon pathologies; in addition, there are especially rare forms, such are ovotesticular disorders (OT), Turner syndrome and early malignisation of intraabdominal located gonads in the cases of androgen insensitivity syndrome. In this article we present four rare cases of DSD in female phenotype adolescents: two cases of ovotesticular DSD with 46,XX and 46,XY karyotypes; one familial case of androgen insensitivity syndrome (AIS) with early malignancy (19-year-old) of intra-abdominally-located testicle in older siblings, and a case of spontaneous menstruation in a patient with Turner syndrome and mosaic karyotype 45,X/47,XXX. Rare cases of DSD are connected with diagnostic and management difficulties and so description of each such case and collection of data in this field is very important from a scientific, as well as a practical, point of view. Determination of prognosis and adequate management of each individual patient are also essential. Study of this issue is especially sensitive in the case of adolescent patients in order to avoid physiological stress, to reduce health risks and to improve quality of life.

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

PubMed

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

2011-12-01

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

Haemophilia at various stages of life: design of new therapeutic strategies through an interactive course - the Kogeniale project

PubMed Central

Santagostino, Elena; Messina, Maria; Tagliaferri, Annarita; Iorio, Alfonso; Morfini, Massimo

2013-01-01

Background High-quality evidence is lacking in several areas of haemophilia treatment, in part because little time is allocated to the treatment and care of haemophilia in university education in Italy. Physicians caring for patients with haemophilia must, therefore, rely on their information on background pathophysiology and more experienced colleagues. This makes diagnostic and therapeutic choices difficult, especially when the patient has concomitant disorders or psychological issues. Material and methods This article describes a course to educate young physicians who were already engaged in the management of haemophilia on the emerging and unmet issues of haemophilia care and to implement existing guidelines. Physicians (n=53) already caring for patients with haemophilia in their haematology, internal medicine, or paediatric practices in Italy attended the course. Problem-solving group activity and open discussion were the methods chosen to formulate consensus statements. During the specifically designed interactive course, three clinical cases were simulated: a young child with congenital dislocation of the hip, an adolescent refusing prophylactic treatment, and an elderly man with cardiovascular disorders. The physicians were asked questions during the course and, through a Wi-Fi console, were able to answer and discuss each case interactively. Results Following discussion of each case, agreement was reached regarding general statements on the management of patients with severe haemophilia A in the three different age ranges considered. Discussion This project helped to outline useful decision-making tools for handling diagnostic and treatment issues in the field of haemophilia. PMID:23399360

Groundwater contamination from waste management sites: The interaction between risk-based engineering design and regulatory policy: 2. Results

NASA Astrophysics Data System (ADS)

Massmann, Joel; Freeze, R. Allan

1987-02-01

The risk-cost-benefit analysis developed in the companion paper (J. Massmann and R. A. Freeze, this issue) is here applied to (1) an assessment of the relative worth of containment-construction activities, site-exploration activities, and monitoring activities as components of a design strategy for the owner/operator of a waste management facility; (2) an assessment of alternative policy options available to a regulatory agency; and (3) a case history. Sensitivity analyses designed to address the first issue show that the allocation of resources by the owner/operator is sensitive to the stochastic parameters used to describe the hydraulic conductivity field at a site. For the cases analyzed, the installation of a dense monitoring network is of less value to the owner/operator than a more conservative containment design. Sensitivity analyses designed to address the second issue suggest that from a regulatory perspective, design standards should be more effective than performance standards in reducing risk, and design specifications on the containment structure should be more effective than those on the monitoring network. Performance bonds posted before construction have a greater potential to influence design than prospective penalties to be imposed at the time of failure. Siting on low-conductivity deposits is a more effective method of risk reduction than any form of regulatory influence. Results of the case history indicate that the methodology can be successfully applied at field sites.

Surrogacy in modern obstetric practice.

PubMed

Burrell, Celia; Edozien, Leroy C

2014-10-01

Surrogacy is rising in profile and prevalence, which means that perinatal care providers face an increasing likelihood of encountering a case in their clinical practice. Rapidly expanding scientific knowledge (for example, fetal programming) and technological advances (for example, prenatal screening and diagnosis) pose challenges in the management of the surrogate mother; in particular, they could exacerbate conflict between the interests of the baby, the surrogate mother, and the intending parent(s). Navigating these often-tranquil-but-sometimes-stormy waters is facilitated if perinatal care providers are aware of the relevant ethical, legal, and service delivery issues. This paper describes the ethical and legal context of surrogacy, and outlines key clinical practice issues in management of the surrogate mother. Copyright © 2014 Elsevier Ltd. All rights reserved.

Liability issues in managed care.

PubMed

Ellis, M S

1997-05-01

The explosive growth in Managed Care Organizations as a mechanism for providing health care in the United States has generated an equal explosion in litigation and new legislation related to problems within this delivery system. Abuses have included the "gagging" of physicians from providing full disclosure of medical options for their patients, inappropriate denial of care, denial of specialty referral, false claims data, insurer insolvency, economic credentialling, deselection, financial disincentives to render care, and lack of appeal or grievance mechanisms. These issues and others have resulted in injuries to patients and damage to the patient/physician relationship. This article discusses some of the more dramatic litigated cases and endeavors to alert both physicians and patients to potential legal matters that should be considered before becoming involved within this structure.

Considerations in pharmaceutical conversion: focus on antihistamines.

PubMed

Garbus, S B; Moulton, B W; Meltzer, E O; Reich, P R; Weinreb, L F; Friedman, J A; Orland, B I

1997-04-01

The practice of pharmaceutical conversion, which encompasses three types of drug interchange (generic, brand, and therapeutic substitution), is increasing in managed care settings. Pharmaceutical conversion has numerous implications for managed care organizations, their healthcare providers, and their customers. Although drug cost may be a driving consideration in pharmaceutical conversion, a number of other considerations are of equal or greater importance in the decision-making process may affect the overall cost of patient care. Among these considerations are clinical, psychosocial, and safety issues; patient adherence; patient satisfaction; and legal implications of pharmaceutical conversion. Patient-centered care must always remain central to decisions about pharmaceutical conversion. This article discusses the issues related to, and implications of, pharmaceutical conversion utilizing the antihistamines class of drugs as the case situation.

Herpes Zoster Immunization in Older Adults Has Big Benefits.

PubMed

Breivik, Harald

2015-09-01

A case of acute herpes zoster neuralgia (shingles) in a 78-year-old patient is described. The value and importance of immunizing against herpes zoster to decrease the incidence and severity of both acute herpes zoster neuralgia and postherpetic neuralgia are described. --This report is adapted from paineurope 2015: Issue 1, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be viewed via the Web site: www.paineurope.com , at which health professionals can find links to the original articles and request copies of the quarterly publication and access additional pain education and pain management resources.

Fundamentals of Collection Development and Management. Second Edition

ERIC Educational Resources Information Center

Johnson, Peggy

2009-01-01

In this fully updated revision, expert instructor and librarian Peggy Johnson addresses the art in controlling and updating your library's collection. Each chapter offers complete coverage of one aspect of collection development, including suggestions for further reading and a narrative case study exploring the issue. Johnson also integrates…

Fundraising and Values: When Do You Say "No" to Money

ERIC Educational Resources Information Center

Hunsaker, Johanna S.

2010-01-01

Larimor University entered a relationship with a donor during a time of continuous leadership changes. The case study had many issues: questionable ethics in fundraising and donor relations, leadership failing to uphold the values by which the institution was founded, leadership transition and succession planning, ineffective management policies,…

The Management of Independent Learning. Staff and Educational Development Series.

ERIC Educational Resources Information Center

Tait, Jo, Ed.; Knight, Peter, Ed.

The development of key competencies through higher education is of increasing interest in government, industry, and academics. The contributors to this collection of research analyses and case studies focus on the competencies associated with self-motivated autonomous lifelong learning. Examining a variety of issues from a British perspective, the…

Providing for Student Voice in Classroom Management: Teachers' Views

ERIC Educational Resources Information Center

Lewis, Ramon; Burman, Eva

2008-01-01

Recent research indicates that teachers would prefer to allow for more student voice in classroom discipline decision-making than is currently the case. This paper identifies factors that teachers suggest inhibit them from implementing their ideas of best disciplinary practice. It also examines which classroom discipline issues teachers are…

77 FR 45663 - James William Eisenberg, M.D.; Decision and Order

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-01

... failed to consider any non-opioid management other than cannabis, and failed to review the Controlled... noticed and alleged in its prehearing statement and documentary evidence that Respondent issued controlled..., (Gov't Ex. 11).\\1\\ \\1\\ I find in this case that the Government's prehearing statements and documentary...

Common diseases of black bass: implications for conservation and management

USDA-ARS?s Scientific Manuscript database

Disease issues relevant to black bass populations arise from infectious as well as noninfectious etiologies. While disease outbreaks can occur via direct means, as is the case with primary pathogens, mortality events can also be linked to factors that disrupt the delicate balance between the enviro...

Michigan Physicians' Conference on Elder Abuse. Final Report.

ERIC Educational Resources Information Center

Sengstock, Mary C.; O'Brien, James G.

The final report describes the Michigan Physicians' Conference on Elder Abuse project. The project conference had four major content areas, including: a general introduction to the problem of elder abuse; clinical symptoms of abuse; legal issues; and referral and case management techniques. Training techniques included lectures, group discussion,…

Systems Engineering and Integration for Advanced Life Support System and HST

NASA Technical Reports Server (NTRS)

Kamarani, Ali K.

2005-01-01

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

14 CFR 91.1017 - Amending program manager's management specifications.

Code of Federal Regulations, 2014 CFR

2014-01-01

... proposed amendment. (2) The Flight Standards District Office that issued the program manager's management... presented, the Flight Standards District Office that issued the program manager's management specifications... Standards District Office that issued the program manager's management specifications issues an amendment of...

14 CFR 91.1017 - Amending program manager's management specifications.

Code of Federal Regulations, 2012 CFR

2012-01-01

... proposed amendment. (2) The Flight Standards District Office that issued the program manager's management... presented, the Flight Standards District Office that issued the program manager's management specifications... Standards District Office that issued the program manager's management specifications issues an amendment of...

Mental health issues in the workplace: a case for a new managerial approach.

PubMed

Dunnagan, T; Peterson, M; Haynes, G

2001-12-01

Anger, stress, and depression in the workplace are growing concerns among management. Traditionally, health outcomes have functioned under the realm of workplace health professionals. This study assessed whether a traditional worksite health promotion program had an impact on mental health factors. The results suggested that worksite health promotion programs play a limited role in ameliorating work-related mental health outcomes. Rather, management must play a greater role in addressing workplace stress, anger, and depression.

Ecological and political issues surrounding decommissioning of offshore oil facilities in the Southern California Bight

USGS Publications Warehouse

Schroeder, Donna M.; Love, Milton S.

2004-01-01

To aid legislators, resource managers, and the general public, this paper summarizes and clarifies some of the issues and options that the federal government and the state of California face in decommissioning offshore oil and gas production platforms, particularly as these relate to platform ecology. Both local marine ecology and political climate play a role in decommissioning offshore oil production platforms. Compared to the relatively supportive political climate in the Gulf of Mexico for “rigs-to-reefs” programs, conflicting social values among stakeholders in Southern California increases the need for understanding ecological impacts of various decommissioning alternatives (which range from total removal to allowing some or all of platform structure to remain in the ocean). Additional scientific needs in the decommissioning process include further assessment of platform habitat quality, estimation of regional impacts of decommissioning alternatives to marine populations, and determination of biological effects of any residual contaminants. The principal management need is a ranking of environmental priorities (e.g. species-of-interest and marine habitats). Because considerable numbers of economically important species reside near oil platforms, National Oceanic and Atmospheric Administration Fisheries should consider the consequences of decommissioning alternatives in their overall management plans. Management strategies could include designating reefed platforms as marine protected areas. The overarching conclusion from both ecological and political perspectives is that decommissioning decisions should be made on a case-by-case basis.

[Lean logistics management in healthcare: a case study].

PubMed

Aguilar-Escobar, V G; Garrido-Vega, P

2013-01-01

To study the applicability of the principles of Lean Production to manage the supply chain of a hospital. In particular, to determine which Lean practices and principles are applicable, the benefits obtained and the main barriers for its implementation. Managing the hospital supply chain is an important issue, both for its effect on the quality of care and its impact on costs. This study is based on a case study. 2005-10. Hospital Virgen Macarena in Seville. Process of implementing a comprehensive logistics management plan based on Lean principles and technological investments. The implementation of the comprehensive plan has reduced inventory, decreased lead times and improved service quality. Also, there have been other important improvements: enhanced employee satisfaction and increased staff productivity, both dedicated to health and the logistics. The experience analysed has shown the applicability and appropriateness of Lean principles and some of its techniques in managing the logistics of hospitals. It also identifies some of the main difficulties that may arise. Copyright © 2011 SECA. Published by Elsevier Espana. All rights reserved.

General concepts in the management of a kidney transplant.

PubMed

Ortiz-Heredia, Luis; Cangiano, Jose L

2011-01-01

The management of a kidney transplant patient is, in most cases, challenging and requires a multidisciplinary approach. For the physician caring for the patient it is imperative to have a broad knowledge regarding several concepts on their management, as they are increasingly faced with long-term care. Baseline rapport and accessibility provides a pivotal role in the treatment, monitoring and preventive measures in the kidney transplant patient. Currently, most aspects regarding patient management vary according to each transplant center. This article describes the importance of several medical issues directed towards the clinician aiming to improve awareness and expand knowledge, with the development of a systematic approach.

Experience with an extended-release opioid formulation designed to reduce abuse liability in a community-based pain management clinic

PubMed Central

Rubino, Daniel

2011-01-01

Context With the growing public health concern over rising rates of opioid abuse, physicians have a responsibility to incorporate safeguards into their practice to minimize the potential for opioid misuse, abuse, and diversion. Patient-specific treatment regimens should include steps to monitor treatment success with regard to optimal pain management as well as inappropriate use of opioids and other substances. Opioid formulations designed to be less attractive for abuse are also being developed. While future studies are needed to determine the impact of such formulations in addressing the issue of opioid misuse in the community as a whole, the experience of practitioners who have utilized these formulations can highlight the practical steps to incorporate such formulations into the everyday patient-care setting. Purpose The purpose of this report is to describe experience in managing patients with chronic, moderate-to-severe pain using morphine sulfate and naltrexone hydrochloride extended release capsules (MS-sNT) (EMBEDA®, King Pharmaceuticals® Inc, Bristol, TN, which was acquired by Pfizer Inc, New York, NY, in March 2011), a formulation designed with features to deter abuse/misuse, in a community-based pain management clinic. Case presentations Case reports demonstrating a clinical management plan for assessment, initial interview procedures, explanation/discussion of proposed therapies, patients’ treatment goals, conversion to MS-sNT, and titration and treatment outcomes are provided. Results The management approach yielded successful outcomes including pain relief, improved quality of life, treatment satisfaction, and patient acceptance of a formulation designed to deter abuse/misuse. Discussion The cases presented demonstrate that the communication accompanying complete pretreatment assessment, goal-setting and expectations, and attention to individual patient needs can enable optimization of pain-related outcomes, resulting in improved quality of life for patients and fostering patient acceptance of formulations designed to help address opioid abuse/misuse issues in the community at large. PMID:22069367

Overall comparative analysis of management and outcomes of cardiac cases reported on board merchant ships.

PubMed

Apostolatos, Charalampos; Andria, Vivian; Licari, Julie

Telemedical assistance has always been the cornerstone of medical care on board. Significant technological progress has provided improved scientific tools and equipment for high-quality communication and prompt management of either minor incidents or major emergencies on board. Med Solutions International is a medical management company, offering services exclusively to the maritime industry. Registered vessels contact the medical team and healthcare professionals provide immediate guidelines for onboard management as well as necessary action thereafter, i.e. examination ashore or urgent medical evacuation. Since cardiac conditions or diseases are potentially the most dangerous when traveling at sea, it is of major importance to analyse and evaluate the overall management and outcomes of cases reporting symptoms of possible heart disease so as to improve telemedical assistance services in future. The study included cases reporting cardiac symptoms from 5 major shipping companies during the year 2016. Data was collected from telecommunication, emails and seafarers' final medical reports. A descriptive analysis of overall management and outcomes was performed. The study showed that the number of confirmed cardiovascular cases on board was very low. Among 551 total cases and 44 cases with reported cardiac symptoms there was only one heart attack, one pulmonary oedema and one suspected myocarditis. In the majority of cases, chest pain was musculoskeletal or due to respiratory infection. Symptoms resulting from issues such as stress or anxiety often present as potential cardiac conditions. Stress may also amplify the severity of symptoms. Language barriers between the seafarer, the master and the doctor often make communication very difficult. According to our findings there are grounds to intensify the prevention process through more efficient pre-employment medical examinations and improve management on board through more intensive training. Communication problems often complicate medical management on board. Effective communication and knowledge of patient's medical history and risk profile is very important to reviewing physician. Effective diagnosis depends on accurate and objective description of symptoms and clinical condition.

The Role of Integrated Modelling and Assessment for Decision-Making: Lessons from Water Allocation Issues in Australia

NASA Astrophysics Data System (ADS)

Jakeman, A. J.; Guillaume, J. H. A.; El Sawah, S.; Hamilton, S.

2014-12-01

Integrated modelling and assessment (IMA) is best regarded as a process that can support environmental decision-making when issues are strongly contested and uncertainties pervasive. To be most useful, the process must be multi-dimensional and phased. Principally, it must be tailored to the problem context to encompass diverse issues of concern, management settings and stakeholders. This in turn requires the integration of multiple processes and components of natural and human systems and their corresponding spatial and temporal scales. Modellers therefore need to be able to integrate multiple disciplines, methods, models, tools and data, and many sources and types of uncertainty. These dimensions are incorporated into iteration between the various phases of the IMA process, including scoping, problem framing and formulation, assessing options and communicating findings. Two case studies in Australia are employed to share the lessons of how integration can be achieved in these IMA phases using a mix of stakeholder participation processes and modelling tools. One case study aims to improve the relevance of modelling by incorporating stakeholder's views of irrigated viticulture and water management decision making. It used a novel methodology with the acronym ICTAM, consisting of Interviews to elicit mental models, Cognitive maps to represent and analyse individual and group mental models, Time-sequence diagrams to chronologically structure the decision making process, an All-encompassing conceptual model, and computational Models of stakeholder decision making. The second case uses a hydro-economic river network model to examine basin-wide impacts of water allocation cuts and adoption of farm innovations. The knowledge exchange approach used in each case was designed to integrate data and knowledge bearing in mind the contextual dimensions of the problem at hand, and the specific contributions that environmental modelling was thought to be able to make.

Project delivery in HIV/AIDS and TB in Southern Africa: the cross-cultural management imperative.

PubMed

Claeyé, Frederik; Jackson, Terence

2011-01-01

The purpose of this paper is to report the findings of a broad-based study that initially investigated a possible gap in global inputs into the fight against HIV/AIDS and TB co-infection, and outputs in terms of results achieved. It is proposed that such a gap may be hypothesized to be due, at least in part, to inappropriate management regimes within the global health governance structure. The research does not simply question the effectiveness of the management of programs and projects, but rather the inappropriateness resulting from the lack of addressing cross-cultural issues. The factors facilitating or hampering project service delivery were examined, by looking at 12 case studies in Botswana and South Africa. These data were complemented with seven semi-structured interviews with donor organizations and NGOs, conducted in the North. Cultural interactions were investigated by using the concept of "interfaces". The results suggest that there is a disjuncture between the global and local level that affects project delivery. The main issues hampering project outcomes can be summarized as systemic, structural and cultural. The article's main contributions are both theoretical, looking at global project delivery from a cross-cultural management perspective, as well as to development praxis by highlighting the need to focus more critically on cross-cultural management issues within the global health governance structure, and indeed within international development as a whole.

Compendium of meteorology scientific issues of 1950 still outstanding

NASA Technical Reports Server (NTRS)

Vaughan, W. W.

1986-01-01

The Compendium of Meteorology was published in 1951 by the American Meteorological Society. A review was made of the Compendium of Meteorology to identify the studies and future needs which the authors expressed in their papers. The needs as seen by the authors are organized into sections and papers following the format of the Compendium of Meteorology. In some cases the needs they identified are as valid today as they were in 1951. In other cases one will easily be able to identify examples where significant progress has been made. It is left to the individual scientists and scientific program managers to assess whether significant progress has been made over the past thirty-five years on these outstanding scientific issues.

Orthotic management of the neuropathic foot: an interdisciplinary care perspective.

PubMed

Robinson, Christopher; Major, Matthew J; Kuffel, Charles; Hines, Kevin; Cole, Pamela

2015-02-01

Clinical management of the patient with neuropathic foot is becoming commonplace in orthotic clinics worldwide. The presentations that can result from neuropathic foot are diverse, requiring clinicians to understand the pathomechanics of ulceration, infection, and Charcot joint arthropathy to provide effective interventions. The purpose of this clinical perspective is to provide a review of the literature regarding clinical concepts associated with orthotic management of neuropathic foot. Literature review and clinical case study. Relevant literature were reviewed and summarized, and a clinical case study synthesizing reviewed concepts was presented. Given the multifactorial nature of the neuropathic foot, treatments must be multifaceted and patient-specific to effectively address the underlying disease processes. While systemic issues such as peripheral arterial disease are treated by physicians, local issues such as foot deformity are managed by orthotists. Orthotic interventions commonly include custom footwear to reduce the risk of ulceration through creation of a protective environment or targeted plantar offloading. Patient and caregiver education to encourage management compliance is equally as important to ensure successful treatment. Patients with neuropathic foot benefit from an interdisciplinary care approach which engages physicians, wound care practitioners, and orthotists to treat and manage systemic and local problems. Addressing this pathology through interdisciplinary care may positively affect the patient's health status while lowering associated healthcare costs through improved treatment efficacy. The commonality of neuropathic foot and associated complications including ulceration, infection, and Charcot joint arthropathy requires that the patient care team have a fundamental understanding of these pathologies and common treatment modalities. We review orthotic treatment modalities to assist clinicians with the management of patients with neuropathic foot. © The International Society for Prosthetics and Orthotics 2014.

Patient and Nurse Experiences in a Rural Chronic Disease Management Program: A Qualitative Evaluation.

PubMed

Davisson, Erica A; Swanson, Elizabeth A

Rural status confounds chronic disease self-management. The purpose of this qualitative, descriptive study was to evaluate the nurse-led "Living Well" chronic disease management program reporting patient recruitment and retention issues since program initiation in 2013. The Chronic Care Model (CCM) was the guiding framework used to reinforce that interdisciplinary teams must have productive patient interactions for their program(s) to be sustainable. A rural, Midwest county clinic's chronic disease management program. Observations, interviews, and within- and across-case coding were used. Patients' responses were analyzed to identify (1) reasons for recruitment and retention problems and (2) program elements that were viewed as successful or needing improvement. A convenience sample of 6 rural, English-speaking adults (65 years or older, with no severe cognitive impairment) with at least one chronic condition was recruited and interviewed. Themes emerged related to nurse knowledge, availability, and value; peer support; overcoming barriers; adherence enhancement; and family/friends' involvement. Patients reported engagement in self-management activities because of program elements such as support groups and productive nurse-patient interactions. Interdisciplinary communication, commitment, and patient referral processes were identified as reasons for recruitment and retention issues. Findings substantiated that certain elements must be present and improved upon for future rural programs to be successful. Interdisciplinary communication may need to be improved to address recruitment and retention problems. It was clear from patient interviews that the nurse coordinators played a major role in patients' self-management adherence and overall satisfaction with the program. This is important to case management because results revealed the need for programs of this nature that incorporate the vital role of nurse coordinators and align with the CCM value of providing a supportive community health care resource for patients with chronic disease.

Toward a Conceptual Knowledge Management Framework in Health

PubMed Central

Lau, Francis

2004-01-01

This paper describes a conceptual organizing scheme for managing knowledge within the health setting. First, a brief review of the notions of knowledge and knowledge management is provided. This is followed by a detailed depiction of our proposed knowledge management framework, which focuses on the concepts of production, use, and refinement of three specific knowledge sources-policy, evidence, and experience. These concepts are operationalized through a set of knowledge management methods and tools tailored for the health setting. We include two case studies around knowledge translation on parent-child relations and virtual networks in community health research to illustrate how this knowledge management framework can be operationalized within specific contexts and the issues involved. We conclude with the lessons learned and implications. PMID:18066388

Cinemeducation: A pilot student project using movies to help students learn medical professionalism.

PubMed

Lumlertgul, Nuttha; Kijpaisalratana, Naruchorn; Pityaratstian, Nuttorn; Wangsaturaka, Danai

2009-07-01

Using movies has been accepted worldwide as a tool to help students learn medical professionalism. In the second year, a group of medical students conducted the "Cinemeducation" project to promote professionalism in the "Medical Ethics and Critical Thinking" course. Five movies with professionalism issues were screened with 20-30 students attending each session. After the show, participants then were asked to reflect on what they had learned in terms of professionalism. Two students led group discussion emphasizing questioning and argumentation for 60 min. Additional learning issues emerging from each session were also explored in more depth and arranged into a report. In the Cinemeducation Project, medical students have learned five main ethical issues in each film, which were the doctor-patient relationship, informed consent and clinical trials in patients, management of genetic disorders, patient management, and brain death and organ transplantation. In addition to issues of professionalism, they also developed critical thinking and moral reasoning skills. Using a case-based scenario in movies has proven to be an effective and entertaining method of facilitating students with learning on professionalism.

Case management in oncology rehabilitation (CAMON): the effect of case management on the quality of life in patients with cancer after one year of ambulant rehabilitation. a study protocol for a randomized controlled clinical trial in oncology rehabilitation.

PubMed

Bachmann-Mettler, Irene; Steurer-Stey, Claudia; Senn, Oliver; Wang, Mathyas; Bardheci, Katarina; Rosemann, Thomas

2011-04-28

Cancer diseases and their therapies have negative effects on the quality of life. The aim of this study is to assess the effectiveness of case management in a sample of oncological outpatients with the intent of rehabilitation after cancer treatment. Case management wants to support the complex information needs of the patients in addition to the segmented structure of the health care system. Emphasis is put on support for self-management in order to enhance health - conscious behaviour, learning to deal with the burden of the illness and providing the opportunity for regular contacts with care providers. We present a study protocol to investigate the efficacy of a case management in patients following oncology rehabilitation after cancer treatment. The trial is a multicentre, two-arm randomised controlled study. Patients are randomised parallel in either 'usual care' plus case management or 'usual care' alone. Patients with all types of cancer can be included in the study, if they have completed the therapy with chemo- and/or radiotherapy/surgery with curative intention and are expected to have a survival time >1 year. To determine the health-related quality of life the general questionnaire FACT G is used. The direct correlation between self-management and perceived self-efficacy is measured with the Jerusalem & Schwarzer questionnaire. Patients satisfaction with the care received is measured using the Patient Assessment of Chronic Illness Care 5 As (PACIC-5A). Data are collected at the beginning of the trial and after 3, 6 and 12 months. The power analysis revealed a sample size of 102 patients. The recruitment of the centres began in 2009. The inclusion of patients began in May 2010. Case management has proved to be effective regarding quality of life of patients with chronic diseases. When it comes to oncology, case management is mainly used in cancer treatment, but it is not yet common in the rehabilitation of cancer patients. Case management in oncology rehabilitation is not well-established in Switzerland. A major challenge of the study will therefore probably be the recruitment of the patients due to the physicians' and patients' scarcely existing awareness of this issue. Trial registrationISRCTN41474586

Use of simulation to assess electronic health record safety in the intensive care unit: a pilot study

PubMed Central

March, Christopher A; Steiger, David; Scholl, Gretchen; Mohan, Vishnu; Hersh, William R; Gold, Jeffrey A

2013-01-01

Objective To establish the role of high-fidelity simulation training to test the efficacy and safety of the electronic health record (EHR)–user interface within the intensive care unit (ICU) environment. Design Prospective pilot study. Setting Medical ICU in an academic medical centre. Participants Postgraduate medical trainees. Interventions A 5-day-simulated ICU patient was developed in the EHR including labs, hourly vitals, medication administration, ventilator settings, nursing and notes. Fourteen medical issues requiring recognition and subsequent changes in management were included. Issues were chosen based on their frequency of occurrence within the ICU and their ability to test different aspects of the EHR–user interface. ICU residents, blinded to the presence of medical errors within the case, were provided a sign-out and given 10 min to review the case in the EHR. They then presented the case with their management suggestions to an attending physician. Participants were graded on the number of issues identified. All participants were provided with immediate feedback upon completion of the simulation. Primary and secondary outcomes To determine the frequency of error recognition in an EHR simulation. To determine factors associated with improved performance in the simulation. Results 38 participants including 9 interns, 10 residents and 19 fellows were tested. The average error recognition rate was 41% (range 6–73%), which increased slightly with the level of training (35%, 41% and 50% for interns, residents, and fellows, respectively). Over-sedation was the least-recognised error (16%); poor glycemic control was most often recognised (68%). Only 32% of the participants recognised inappropriate antibiotic dosing. Performance correlated with the total number of screens used (p=0.03). Conclusions Despite development of comprehensive EHRs, there remain significant gaps in identifying dangerous medical management issues. This gap remains despite high levels of medical training, suggesting that EHR-specific training may be beneficial. Simulation provides a novel tool in order to both identify these gaps as well as foster EHR-specific training. PMID:23578685

Using the autonomic standards to assess orthostatic hypotension in persons with SCI: a case series.

PubMed

Wecht, Jill M; Wilson, James; Previnaire, Jean-Gabriel

2017-01-01

Spinal cord injury (SCI) creates a complex and unique syndrome of medical issues related to disruption of somatic and autonomic pathways. Among these impaired control of blood pressure (BP) can significantly impede patients' activities of daily living. The International Standards for the Assessment of Autonomic Function after SCI (ISAFSCI) is used to document the impact of SCI on resting BP (abnormal if below 90 mmHg) and the presence or absence of orthostatic hypotension (OH), defined as a symptomatic or asymptomatic decrease in BP (>/=20/10 mmHg) upon moving to an upright position. Case 1 documents the adverse influence of prescribed medications (antidepressants for neuropathic pain) on OH; case 2 describes the influence of bladder management on cardiovascular instability (autonomic dysreflexia and subsequent OH); case 3 describes the association between spasticity and OH; case 4 describes OH associated with a Valsalva maneuver. Impaired control of BP can stem from a combination of medical issues and autonomic dysfunction in persons with SCI. Management strategies for OH will vary depending on the stage of the SCI, the root cause of the OH and other confounding medical conditions. Non-pharmacological treatment should be considered as a first line of intervention and consideration should be given to cessation of potentially contributory medications prior to implementing pharmaceutical interventions. The systematic use of ISAFSCI by clinicians is recommended to document BP irregularities and to describe the effects of treatment strategies aimed at improving BP control in the SCI population.

State-and-transition models: Conceptual versus simulation perspectives, usefulness and breadth of use, and land management applications

USGS Publications Warehouse

Provencher, Louis; Frid, Leonardo; Czembor, Christina; Morisette, Jeffrey T.

2016-01-01

State-and-Transition Simulation Modeling (STSM) is a quantitative analysis method that can consolidate a wide array of resource management issues under a “what-if” scenario exercise. STSM can be seen as an ensemble of models, such as climate models, ecological models, and economic models that incorporate human dimensions and management options. This chapter presents STSM as a tool to help synthesize information on social–ecological systems and to investigate some of the management issues associated with exotic annual Bromus species, which have been described elsewhere in this book. Definitions, terminology, and perspectives on conceptual and computer-simulated stochastic state-and-transition models are given first, followed by a brief review of past STSM studies relevant to the management of Bromus species. A detailed case study illustrates the usefulness of STSM for land management. As a whole, this chapter is intended to demonstrate how STSM can help both managers and scientists: (a) determine efficient resource allocation for monitoring nonnative grasses; (b) evaluate sources of uncertainty in model simulation results involving expert opinion, and their consequences for management decisions; and (c) provide insight into the consequences of predicted local climate change effects on ecological systems invaded by exotic annual Bromus species.

Guest Editors' introduction

NASA Astrophysics Data System (ADS)

Magee, Jeff; Moffett, Jonathan

1996-06-01

Special Issue on Management This special issue contains seven papers originally presented at an International Workshop on Services for Managing Distributed Systems (SMDS'95), held in September 1995 in Karslruhe, Germany. The workshop was organized to present the results of two ESPRIT III funded projects, Sysman and IDSM, and more generally to bring together work in the area of distributed systems management. The workshop focused on the tools and techniques necessary for managing future large-scale, multi-organizational distributed systems. The open call for papers attracted a large number of submissions and the subsequent attendance at the workshop, which was larger than expected, clearly indicated that the topics addressed by the workshop were of considerable interest both to industry and academia. The papers selected for this special issue represent an excellent coverage of the issues addressed by the workshop. A particular focus of the workshop was the need to help managers deal with the size and complexity of modern distributed systems by the provision of automated support. This automation must have two prime characteristics: it must provide a flexible management system which responds rapidly to changing organizational needs, and it must provide both human managers and automated management components with the information that they need, in a form which can be used for decision-making. These two characteristics define the two main themes of this special issue. To satisfy the requirement for a flexible management system, workers in both industry and universities have turned to architectures which support policy directed management. In these architectures policy is explicitly represented and can be readily modified to meet changing requirements. The paper `Towards implementing policy-based systems management' by Meyer, Anstötz and Popien describes an approach whereby policy is enforced by event-triggered rules. Krause and Zimmermann in their paper `Implementing configuration management policies for distributed applications' present a system in which the configuration of the system in terms of its constituent components and their interconnections can be controlled by reconfiguration rules. Neumair and Wies in the paper `Case study: applying management policies to manage distributed queuing systems' examine how high-level policies can be transformed into practical and efficient implementations for the case of distributed job queuing systems. Koch and Krämer in `Rules and agents for automated management of distributed systems' describe the results of an experiment in using the software development environment Marvel to provide a rule based implementation of management policy. The paper by Jardin, `Supporting scalability and flexibility in a distributed management platform' reports on the experience of using a policy directed approach in the industrial strength TeMIP management platform. Both human managers and automated management components rely on a comprehensive monitoring system to provide accurate and timely information on which decisions are made to modify the operation of a system. The monitoring service must deal with condensing and summarizing the vast amount of data available to produce the events of interest to the controlling components of the overall management system. The paper `Distributed intelligent monitoring and reporting facilities' by Pavlou, Mykoniatis and Sanchez describes a flexible monitoring system in which the monitoring agents themselves are policy directed. Their monitoring system has been implemented in the context of the OSIMIS management platform. Debski and Janas in `The SysMan monitoring service and its management environment' describe the overall SysMan management system architecture and then concentrate on how event processing and distribution is supported in that architecture. The collection of papers gives a good overview of the current state of the art in distributed system management. It has reached a point at which a first generation of systems, based on policy representation within systems and automated monitoring systems, are coming into practical use. The papers also serve to identify many of the issues which are open research questions. In particular, as management systems increase in complexity, how far can we automate the refinement of high-level policies into implementations? How can we detect and resolve conflicts between policies? And how can monitoring services deal efficiently with ever-growing complexity and volume? We wish to acknowledge the many contributors, besides the authors, who have made this issue possible: the anonymous reviewers who have done much to assure the quality of these papers, Morris Sloman and his Programme Committee who convened the Workshop, and Thomas Usländer and his team at the Fraunhofer Institute in Karlsruhe who acted as hosts.

Malfunction of subpectorally implanted cardiac resynchronization therapy defibrillators due to weakened header bond.

PubMed

Hayat, Sajad A; Kojodjojo, Pipin; Mason, Anthony; Benfield, Ann; Wright, Ian; Whinnett, Zachary; Lim, Phang Boon; Davies, D Wyn; Lefroy, David; Peters, Nicholas S; Kanagaratnam, Prapa

2013-03-01

Implantable cardioverter defibrillator (ICD) implantation has increased significantly over the last 10 years. Concerns about the safety and reliability of ICD systems have been raised, with premature lead failure and battery malfunctions accounting for the majority of reported adverse events. We describe the unique mode of presentation, diagnosis, and management of cardiac resynchronization therapy defibrillators (CRT-D) malfunctions that were caused by weakened bonding between the generator and header. Between June 2008 and December 2009, 22 Teligen™ ICDs and 24 Cognis™ CRT-Ds were implanted subpectorally at our institution, until a product advisory was issued. Of 24 Cognis™ CRT-D implants, 3 patients presented with CRT-D malfunctions. All our cases presented with initially intermittent and then persisting increases in shock lead impedance, associated with nonphysiological noise in the shock electrogram channels. These issues were rectified by generator change. Postexplant laboratory analysis confirmed inadequate bonding between device header and titanium casing in all cases, resulting in loosening and rocking of the header followed by fatigue-induced fracture of the shock circuitry. Weakened bonding between the header and generator casing of subpectorally implanted CRT-Ds can result in fractures and malfunction of the HV circuit. Physicians monitoring patients with devices affected by the product advisory should remain vigilant in order to diagnose and manage similar device malfunction expediently. © 2012 Wiley Periodicals, Inc.

Community owned solutions for fire management in tropical ecosystems: case studies from Indigenous communities of South America

PubMed Central

2016-01-01

Fire plays an increasingly significant role in tropical forest and savanna ecosystems, contributing to greenhouse gas emissions and impacting on biodiversity. Emerging research shows the potential role of Indigenous land-use practices for controlling deforestation and reducing CO2 emissions. Analysis of satellite imagery suggests that Indigenous lands have the lowest incidence of wildfires, significantly contributing to maintaining carbon stocks and enhancing biodiversity. Yet acknowledgement of Indigenous peoples' role in fire management and control is limited, and in many cases dismissed, especially in policy-making circles. In this paper, we review existing data on Indigenous fire management and impact, focusing on examples from tropical forest and savanna ecosystems in Venezuela, Brazil and Guyana. We highlight how the complexities of community owned solutions for fire management are being lost as well as undermined by continued efforts on fire suppression and firefighting, and emerging approaches to incorporate Indigenous fire management into market- and incentive-based mechanisms for climate change mitigation. Our aim is to build a case for supporting Indigenous fire practices within all scales of decision-making by strengthening Indigenous knowledge systems to ensure more effective and sustainable fire management. This article is part of the themed issue ‘The interaction of fire and mankind’. PMID:27216507

Community owned solutions for fire management in tropical ecosystems: case studies from Indigenous communities of South America.

PubMed

Mistry, Jayalaxshmi; Bilbao, Bibiana A; Berardi, Andrea

2016-06-05

Fire plays an increasingly significant role in tropical forest and savanna ecosystems, contributing to greenhouse gas emissions and impacting on biodiversity. Emerging research shows the potential role of Indigenous land-use practices for controlling deforestation and reducing CO2 emissions. Analysis of satellite imagery suggests that Indigenous lands have the lowest incidence of wildfires, significantly contributing to maintaining carbon stocks and enhancing biodiversity. Yet acknowledgement of Indigenous peoples' role in fire management and control is limited, and in many cases dismissed, especially in policy-making circles. In this paper, we review existing data on Indigenous fire management and impact, focusing on examples from tropical forest and savanna ecosystems in Venezuela, Brazil and Guyana. We highlight how the complexities of community owned solutions for fire management are being lost as well as undermined by continued efforts on fire suppression and firefighting, and emerging approaches to incorporate Indigenous fire management into market- and incentive-based mechanisms for climate change mitigation. Our aim is to build a case for supporting Indigenous fire practices within all scales of decision-making by strengthening Indigenous knowledge systems to ensure more effective and sustainable fire management.This article is part of the themed issue 'The interaction of fire and mankind'. © 2016 The Author(s).

Key aspects in managing safety when working with multiple contractors: A case study.

PubMed

Drupsteen, Linda; Rasmussen, Hanna B; Ustailieva, Erika; van Kampen, Jakko

2015-01-01

Working with multiple contractors in a shared workplace can introduce and increase safety risks due to complexity. The aim of this study was to explore how safety issues are recognized in a specific case and to identify whether clients and contractors perceive problems similarly. The safety issues are explored through a brief survey and a workshop in the maintenance department of a logistics company. The results indicate that culture and behavior are recognized differently by clients and by contractors. The contractors and client had different perceptions of involvement of contractors by the client. The contractors complained on lack of involvement, which was not fully recognized by the client. The case study used a practical approach to show differences in perception of safety within a project. The study illustrates the need for more applied studies and interventions on contractor safety.

[Modern nursing work management trends: the case of cooperative companies].

PubMed

Guimarães, Raphael Mendonça; Muzi, Camila Drumond; Mauro, Maria Yvone Chaves

2004-01-01

This article introduces the issue of nursing work management from a theoretical and conceptual perspective by raising some implications for the management of organizations, as well as its impact on work relationships and, consequently, on the worker's health. The main results about ways and modalities of cooperative companies bring about the consideration that proposals of positive changes in the category run contrary to progress. Indecent work conditions, poor quality assistance and low compensation make up the main negative factors in this work process. Therefore, it is urgent to resume the discussion of what one expects from nursing for the future.

A case study of polypharmacy management in nine European countries: Implications for change management and implementation

PubMed Central

MacLure, Katie; Stewart, Derek; Kempen, Thomas; Mair, Alpana; Castel-Branco, Margarida; Codina, Carles; Fernandez-Llimos, Fernando; Fleming, Glenda; Gennimata, Dimitra; Gillespie, Ulrika; Harrison, Cathy; Illario, Maddalena; Junius-Walker, Ulrike; Kampolis, Christos F.; Kardas, Przemyslaw; Lewek, Pawel; Malva, João; Menditto, Enrica; Scullin, Claire; Wiese, Birgitt

2018-01-01

Background Multimorbidity and its associated polypharmacy contribute to an increase in adverse drug events, hospitalizations, and healthcare spending. This study aimed to address: what exists regarding polypharmacy management in the European Union (EU); why programs were, or were not, developed; and, how identified initiatives were developed, implemented, and sustained. Methods Change management principles (Kotter) and normalization process theory (NPT) informed data collection and analysis. Nine case studies were conducted in eight EU countries: Germany (Lower Saxony), Greece, Italy (Campania), Poland, Portugal, Spain (Catalonia), Sweden (Uppsala), and the United Kingdom (Northern Ireland and Scotland). The workflow included a review of country/region specific polypharmacy policies, key informant interviews with stakeholders involved in policy development and implementation and, focus groups of clinicians and managers. Data were analyzed using thematic analysis of individual cases and framework analysis across cases. Results Polypharmacy initiatives were identified in five regions (Catalonia, Lower Saxony, Northern Ireland, Scotland, and Uppsala) and included all care settings. There was agreement, even in cases without initiatives, that polypharmacy is a significant issue to address. Common themes regarding the development and implementation of polypharmacy management initiatives were: locally adapted solutions, organizational culture supporting innovation and teamwork, adequate workforce training, multidisciplinary teams, changes in workflow, redefinition of roles and responsibilities of professionals, policies and legislation supporting the initiative, and data management and information and communication systems to assist development and implementation. Depending on the setting, these were considered either facilitators or barriers to implementation. Conclusion Within the studied EU countries, polypharmacy management was not widely addressed. These results highlight the importance of change management and theory-based implementation strategies, and provide examples of polypharmacy management initiatives that can assist managers and policymakers in developing new programs or scaling up existing ones, particularly in places currently lacking such initiatives. PMID:29668763

Innovative Approaches to Collaborative Groundwater Governance in the United States: Case Studies from Three High-Growth Regions in the Sun Belt.

PubMed

Megdal, Sharon B; Gerlak, Andrea K; Huang, Ling-Yee; Delano, Nathaniel; Varady, Robert G; Petersen-Perlman, Jacob D

2017-05-01

Groundwater is an increasingly important source of freshwater, especially where surface water resources are fully or over-allocated or becoming less reliable due to climate change. Groundwater reliance has created new challenges for sustainable management. This article examines how regional groundwater users coordinate and collaborate to manage shared groundwater resources, including attention to what drives collaboration. To identify and illustrate these facets, this article examines three geographically diverse cases of groundwater governance and management from the United States Sun Belt: Orange County Water District in southern California; Prescott Active Management Area in north-central Arizona; and the Central Florida Water Initiative in central Florida. These regions have different surface water laws, groundwater allocation and management laws and regulations, demographics, economics, topographies, and climate. These cases were selected because the Sun Belt faces similar pressures on groundwater due to historical and projected population growth and limited availability of usable surface water supplies. Collectively, they demonstrate groundwater governance trends in the United States, and illustrate distinctive features of regional groundwater management strategies. Our research shows how geophysical realities and state-level legislation have enabled and/or stimulated regions to develop groundwater management plans and strategies to address the specific issues associated with their groundwater resources. We find that litigation involvement and avoidance, along with the need to finance projects, are additional drivers of regional collaboration to manage groundwater. This case study underscores the importance of regionally coordinated and sustained efforts to address serious groundwater utilization challenges faced by the regions studied and around the world.

Innovative Approaches to Collaborative Groundwater Governance in the United States: Case Studies from Three High-Growth Regions in the Sun Belt

NASA Astrophysics Data System (ADS)

Megdal, Sharon B.; Gerlak, Andrea K.; Huang, Ling-Yee; Delano, Nathaniel; Varady, Robert G.; Petersen-Perlman, Jacob D.

2017-05-01

Groundwater is an increasingly important source of freshwater, especially where surface water resources are fully or over-allocated or becoming less reliable due to climate change. Groundwater reliance has created new challenges for sustainable management. This article examines how regional groundwater users coordinate and collaborate to manage shared groundwater resources, including attention to what drives collaboration. To identify and illustrate these facets, this article examines three geographically diverse cases of groundwater governance and management from the United States Sun Belt: Orange County Water District in southern California; Prescott Active Management Area in north-central Arizona; and the Central Florida Water Initiative in central Florida. These regions have different surface water laws, groundwater allocation and management laws and regulations, demographics, economics, topographies, and climate. These cases were selected because the Sun Belt faces similar pressures on groundwater due to historical and projected population growth and limited availability of usable surface water supplies. Collectively, they demonstrate groundwater governance trends in the United States, and illustrate distinctive features of regional groundwater management strategies. Our research shows how geophysical realities and state-level legislation have enabled and/or stimulated regions to develop groundwater management plans and strategies to address the specific issues associated with their groundwater resources. We find that litigation involvement and avoidance, along with the need to finance projects, are additional drivers of regional collaboration to manage groundwater. This case study underscores the importance of regionally coordinated and sustained efforts to address serious groundwater utilization challenges faced by the regions studied and around the world.

Auckland: city of syphilis?

PubMed

Azariah, Sunita

2016-12-16

To briefly report on the large increase in cases of syphilis managed at Auckland Regional Sexual Health Service (ARSHS) in 2015. To raise awareness of syphilis as an emerging significant public health issue in Auckland. A search was conducted of the electronic patient management system at ARSHS for cases of syphilis diagnosed between 1st of January 2015 and 31st of December 2015. Those that fitted the Institute of Environmental Science and Research Ltd (ESR) case definitions for infectious syphilis were included and demographic, clinical and behavioural characteristics were described. One hundred and fifty-two cases of infectious syphilis were managed at ARSHS in 2015, which was a 78% increase from the previous year. The crude incidence rate was 9.5 cases per 100,000 head of population. As in previous years, the majority of cases were male (92%) and most of these were gay or bisexual men (GBM). Thirty-nine percent of cases were asymptomatic and 22% of cases were diagnosed with another STI. Twenty-eight percent of GBM were co-infected with HIV. While the overall number of heterosexual cases was small (n=35); there was a 3.8-fold increase from the numbers diagnosed in 2014 (n=9). The largest number of syphilis cases in recent decades was managed by the Auckland Regional Sexual Health Service in 2015. The increase in numbers is concerning as syphilis can enhance transmission and acquisition of HIV. Furthermore, other countries have noted increases in congenital syphilis cases when incidence in females has increased. It is important that all persons at risk of STI are tested for syphilis and that sexually active GBM in particular are tested regularly. Health professionals need to be made aware of who and when to test, and to refer or discuss any suspected cases with a specialist service as management of syphilis requires significant expertise.

[Case study: school meals' management in Santiago de Cali and Bogota].

PubMed

Díaz, Mónica del Pilar; Montoya, Iván A; Montoya, Luz A

2011-10-01

This research was aimed at ascertaining the state's role regarding hunger and how it manages to combat this matter; a food security program in two Colombian cities was thus assessed (i.e. school meals' provision in Cali and Bogota). A qualitative approach was adopted; documentary analysis, participant observation and in-depth interviews with various actors for both selected cases were used as data collection techniques. It was found that several measures taken in this area were not covered by regulatory principles aimed at covering all the dimensions of food security. Serious weaknesses in school meals' management in Cali were associated with a weak environment regarding the fight against hunger. School meals' management in Bogotá was aimed at recognizing the right to food as being supported by an institutional process where the issue of reducing hunger has become a firm purpose. School meals' program management was associated with the characteristics of its product, thereby affecting the program and the population's food and nutritional status; state management thus becomes another dimension of food security.

The strategic planning of health management information systems.

PubMed

Smith, J

1995-01-01

This paper discusses the roles and functions of strategic planning of information systems in health services. It selects four specialised methodologies of strategic planning for analysis with respect to their applicability in the health field. It then examines the utilisation of information planning in case studies of three health organisations (two State departments of health and community services and one acute care institution). Issues arising from the analysis concern the planning process, the use to which plans are put, and implications for management.

Teaching medical management and operations engineering for systems-based practice to radiology residents.

PubMed

Brandon, Catherine J; Mullan, Patricia B

2013-03-01

To better prepare radiology residents for providing care within the context of the larger health care system, this study evaluated the feasibility and impact of a curriculum to enhance radiology residents' understanding and ability to apply concepts from medical management and industrial and operational engineering to systems-based practice problems in radiology practice. A multiprofessional team including radiology, medical education, and industrial and operational engineering professionals collaborated in developing a seven-module curriculum, including didactic lectures, interactive large-group analysis, and small-group discussions with case-based radiology examples, which illustrated real-life management issues and the roles physicians held. Residents and faculty participated in topic selection. Pre- and post-instruction formative assessments were administered, and results were shared with residents during teaching sessions. Attendance and participation in case-based scenario resolutions indicate the feasibility and impact of the interactive curriculum on residents' interest and ability to apply curricular concepts to systems-based practice in radiology. Paired t test analyses (P < .05) and effect sizes showed residents significantly increased their knowledge and ability to apply concepts to systems-based practice issues in radiology. Our iterative curriculum development and implementation process demonstrated need and support for a multiprofessional team approach to teach management and operational engineering concepts. Curriculum topics are congruent with Accreditation Council for Graduate Medical Education requirements for systems-based practice. The case-based curriculum using a mixed educational format of didactic lectures and small-group discussion and problem analysis could be adopted for other radiology programs, for both residents and continuing medical education applications. Copyright © 2013 AUR. Published by Elsevier Inc. All rights reserved.

Environmental ethics and professional practice: A case study of an environmental challenge for century 2000

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

Malone, C.

1995-12-01

Objective resolution of environmental issues involves questions of facts and values, and, for environmental issues to be resolved ethically, a proper synthesis of environmental facts with questions of ethics must occur. In this case study, the proposal by the U.S. Department of Energy (DOE) to use the Yucca Mountain site in southwest Nevada as a deep geologic repository for the permanent disposal of the nation`s high-level nuclear waste is examined in part in the context of the {open_quotes}Code of Ethics and Standards of Practice for Environmental Professionals{close_quotes} adopted by the National Association of Environmental Professionals (NAEP). Current plans are thatmore » a repository at the Yucca Mountain site would begin functioning in 2010 and would be sealed after about 150 years. The requirement that a geologic repository must isolate nuclear waste from the environment for at least 10,000 years poses unique challenges to environmental professionals. This case study also analyzes the challenges in terms of the implications of a new federal Executive Order on Ecosystem Management and corresponding internal orders within all federal agencies to conform to the Executive Order. The imposition of the principles and practices of ecosystem-based resource management on federal agencies provides an opportunity to also address, in the context of the DOE Yucca Mountain Project, (1) the ecosystem approach to environmental management, (2) concepts of holistic resource management planning, and (3) the concepts of sustainability and biodiversity. Within this framework there are important implications for environmental ethics and professional practice that must remain at the forefront of concerns of the NAEP over the next two decades.« less

Teaching the Ethical Aspects of Environmental Science

NASA Astrophysics Data System (ADS)

Palinkas, C. M.

2014-12-01

Environmental and societal issues are often inherently linked, especially in coastal and estuarine environments, and science and social values must often be balanced in ecosystem management and decision-making. A new seminar course has been developed for the Marine Estuarine and Environmental Science (MEES) graduate program, an inter-institutional program within the University System of Maryland, to examine these issues. This 1-credit course, offered for the first time in Spring 2015, takes a complex systems perspective on major environmental and societal challenges to examine these linked issues in a variety of contexts. After a brief introduction to the emerging field of "geoethics," students develop a list of issues to examine throughout the seminar. Example topics could include fracking, offshore wind technology, dam removal, and iron fertilization, among others. A case-study approach is taken, with each class meeting focusing on one issue. For each case study, students are asked to 1) identify relevant scientific principles and major knowledge gaps, 2) predict potential outcomes, 3) identify stakeholders and likely viewpoints, and 4) construct communication plans to disseminate findings to these stakeholders. At the end of the semester, students give a brief presentation of the ethical aspects of their own research topics.

How can sludge dewatering devices be assessed? Development of a new DSS and its application to real case studies.

PubMed

Bertanza, Giorgio; Papa, Matteo; Canato, Matteo; Collivignarelli, Maria Cristina; Pedrazzani, Roberta

2014-05-01

A key issue in biological Waste Water Treatment Plants (WWTPs) operation is represented by the sludge management. Mechanical dewatering is a crucial stage for sludge volume reduction; though, being a costly operation, its optimization is required. We developed an original experimental methodology to evaluate the technical (dewatering efficiency) and financial (total treatment costs) performance of dewatering devices, which might be used as a DSS (Decision Support System) for WWTP managers. This tool was then applied to two real case studies for comparing, respectively, three industrial size centrifuges, and two different operation modes of the same machine (fixed installation vs. outsourcing service). In both the cases, the best option was identified, based jointly on economic and (site-specific) technical evaluations. Copyright © 2014 Elsevier Ltd. All rights reserved.

Mutism as the Presenting Symptom: Three Case Reports and Selective Review of Literature

PubMed Central

Aggarwal, Ashish; Sharma, Dinesh Dutt; Kumar, Ramesh; Sharma, Ravi C.

2010-01-01

Mutism, defined as an inability or unwillingness to speak, resulting in an absence or marked paucity of verbal output, is a common clinical symptom seen in psychiatric as well as neurology outpatient department. It rarely presents as an isolated disability and often occurs in association with other disturbances in behavior, thought processes, affect, or level of consciousness. It is often a focus of clinical attention, both for the physician and the relatives. Mutism occurs in a number of conditions, both functional and organic, and a proper diagnosis is important for the management. We hereby present three cases, who presented with mutism as the presenting symptom and the differential diagnosis and management issues related to these cases are discussed. The authors also selectively reviewed the literature on mutism, including psychiatric, neurologic, toxic-metabolic, and drug-induced causes. PMID:21799563

Mutism as the presenting symptom: three case reports and selective review of literature.

PubMed

Aggarwal, Ashish; Sharma, Dinesh Dutt; Kumar, Ramesh; Sharma, Ravi C

2010-01-01

Mutism, defined as an inability or unwillingness to speak, resulting in an absence or marked paucity of verbal output, is a common clinical symptom seen in psychiatric as well as neurology outpatient department. It rarely presents as an isolated disability and often occurs in association with other disturbances in behavior, thought processes, affect, or level of consciousness. It is often a focus of clinical attention, both for the physician and the relatives. Mutism occurs in a number of conditions, both functional and organic, and a proper diagnosis is important for the management. We hereby present three cases, who presented with mutism as the presenting symptom and the differential diagnosis and management issues related to these cases are discussed. The authors also selectively reviewed the literature on mutism, including psychiatric, neurologic, toxic-metabolic, and drug-induced causes.

Maintaining Momentum and Quality in a Time of Decline: A Case Study.

ERIC Educational Resources Information Center

Potter, David; And Others

1992-01-01

A discussion of the response of George Mason University (Virginia) to economic decline in 1989-92 looks at four stages in the downturn and examines a variety of planning and policy issues, including management of both unplanned and planned reductions, continued uncertainty, politics of decline, organizational communication and morale,…

Maintaining Web-based Bibliographies: A Case Study of Iter, the Bibliography of Renaissance Europe.

ERIC Educational Resources Information Center

Castell, Tracy

1997-01-01

Introduces Iter, a nonprofit research project developed for the World Wide Web and dedicated to increasing access to all published materials pertaining to the Renaissance and, eventually, the Middle Ages. Discusses information management issues related to building and maintaining Iter's first Web-based bibliography, focusing on printed secondary…

Library Faculty Workload: A Case Study in Implementing a Teaching Faculty Model.

ERIC Educational Resources Information Center

Goudy, Frank Wm.

In the January 1988 issue of "Library Administration & Management," an article titled "The Dilemma of Library Faculty Workload: One Solution" described the efforts of the library faculty at Western Illinois University to achieve a more equitable situation compared to other faculty on the campus. A totally new approach to…

Scale issues in soil hydrology related to measurement and simulation: A case study in Colorado

USDA-ARS?s Scientific Manuscript database

State variables, such as soil water content (SWC), are typically measured or inferred at very small scales while being simulated at larger scales relevant to spatial management or hillslope areas. Thus there is an implicit spatial disparity that is often ignored. Surface runoff, on the other hand, ...

Athletic Liability: Managing Liability in Athletics and Physical Education.

ERIC Educational Resources Information Center

Association of School Business Officials International, Reston, VA.

The trend toward more litigation and higher monetary awards in cases of injury of student athletes is a threat to school athletic programs. This document is a workshop aid for addressing legal issues surrounding student athletic activities, in particular, those involving the safety and health of student athletes, injury prevention, and preparation…

Cross-cultural issues in CRM training

NASA Technical Reports Server (NTRS)

Merritt, A.; Helmreich, R. L. (Principal Investigator)

1995-01-01

The author presents six stages of intercultural awareness and relates them to cockpit resource management training. A case study examines cultural differences between South American and United States flight crews and the problems that can occur when pilots minimize differences. Differences in leadership styles are highlighted and strategies for training South American pilots are provided.

Taking the High Road: Privacy in the Age of Drones

ERIC Educational Resources Information Center

Hamilton, Lucas; Harrington, Michael; Lawrence, Cameron; Perrot, Remy; Studer, Severin

2017-01-01

This case examines the technological, ethical and legal issues surrounding the use of drones in business. Mary McKay, a recent Management Information Systems (MIS) graduate sets up a professional photography and videography business. She gains a leg up on the competition with drone-mounted cameras and live video streaming through the free…

The Impact of Occupational Stress on Academic and Administrative Staff, and on Students: An Empirical Case Analysis

ERIC Educational Resources Information Center

Ablanedo-Rosas, Jose Humberto; Blevins, Randall C.; Gao, Hongman; Teng, Wen-Yuan; White, Joann

2011-01-01

This article examines the impact of occupational stress among academic staff, administrative staff, and students in a well-established US university environment. The results show that there are different correlations associated with stress such as organisational demand, health issues, and stress management. Findings suggest that occupational…

Being an Instructional Designer: A Job Requiring Innovation and Trust

ERIC Educational Resources Information Center

Gerin-Lajoie, Serge

2015-01-01

This case study deals with the development and implementation of two online art courses. It outlines the concerns of the faculty member responsible for these courses and those of the instructional designer assisting him. The key design issues deal with the management of copyright material available via the Internet, the difficulty of implementing…

Stakeholder Analysis in Higher Education: A Case Study of the University of Portsmouth

ERIC Educational Resources Information Center

Chapleo, Chris; Simms, Christopher

2010-01-01

The issue of stakeholder identification and management is relatively well understood in the literature for private sector organisations, and its importance is increasing across all developed countries. However, whilst stakeholder theory has been advanced in commercial arenas, there is less research in the public and non-profit areas, particularly…

Ustilago echinata: Infection in a Mixed Martial Artist Following an Open Fracture.

PubMed

Stewart, Ethan; Waldman, Sarah; Sutton, Deanna A; Sanders, Carmita; Lindner, Jonathan; Fan, Hongxin; Wiederhold, Nathan P; Thompson, George R

2016-04-01

Ustilago, a common fungal parasite of grains, is infrequently isolated as a pathogen in humans. We describe a case of Ustilago echinata infection following an open distal tibia fracture, review the current literature of this genus as a cause of invasive fungal infection in humans, and discuss management issues.

Computing Newsletter for Schools of Business.

ERIC Educational Resources Information Center

Couger, J. Daniel, Ed.

1973-01-01

The first of the two issues included here reports on various developments concerning the use of computers for schools of business. One-page articles cover these topics: widespread use of simulation games, survey of computer use in higher education, ten new computer cases which teach techniques for management analysis, advantages of the use of…

Knowledge Production within the Innovation System: A Case Study from the United Kingdom

ERIC Educational Resources Information Center

Wilson-Medhurst, Sarah

2010-01-01

This paper focuses on a key issue for university managers, educational developers and teaching practitioners: that of producing new operational knowledge in the innovation system. More specifically, it explores the knowledge required to guide individual and institutional styles of teaching and learning in a large multi-disciplinary faculty. The…

Language and Literacy in Workplace Education: Learning at Work. Language in Social Life Series.

ERIC Educational Resources Information Center

Mawer, Giselle; Fletcher, Lee; McCall, Julia; O'Grady, Catherine; Ong, Bee Jong

Interweaving theory and commentary with case studies, this book explores a multifaceted approach to workplace education that develops workers' skills and integrates learning, language, and cross-cultural issues into work, communication, and management practices. Chapter 1 explores the changing world of work and implications for workforce skill…

Blended Learning: Communication, Locations and Work-Life Practices

ERIC Educational Resources Information Center

Moe, Carl Erik; Rye, Stale Angen

2011-01-01

The article discusses blended learning and how various delivery formats affect the way learning is situated in work-life practices. The authors approached this issue through an empirical study of an in-service training programme for middle-level managers in a number of case organisations. The programme used a combination of e-learning, textbooks…

Management of Children Using Cochlear Implants and Hearing Aids.

ERIC Educational Resources Information Center

Ching, Teresa Y. C.; Psarros, Colleen; Incerti, Paula; Hill, Mandy

2001-01-01

Four case studies identify six factors affecting successful use of a hearing aid with a cochlear implant: duration of hearing aid use prior to implantation, amount of residual hearing in the non-implanted ear, educational and listening demands, cosmetic issues, hearing aid rejection, and extended period of non-use of hearing aid. (Contains…

A STUDY ON IMPLEMENTATION OF PROCUREMENT MANAGEMENT METHOD THAT DELIVERLY'S UNCERTAINTY OF EQUIPMENTS, MATERIALS AND INSTRUCTIONS

NASA Astrophysics Data System (ADS)

Asaine, Keita; Asaine, Wataru; Shiratsuchi, Ryoma; Yoshida, Takaichi; Hashimoto, Masaaki

This paper highlights the issues of procurement management in construction projects, such as late delivery of purchased equipments/materials and missing instructions from customers, which cause delays of construction schedule and over-budget cost. We point that most of these problems are caused by lack of synchronization between procurement activities and process control. Therefore, we propose a managerial method which enables better synchronization between the two by applying this method to a construction company. We discuss the necessary conditions and validity of incorporating it and show the way how to establish the mechanics through the case study. Furthermore, we analyze that the feature of this method is not only addressing procurement issues but also bringing additional benefits, such as shortening project lead time and reducing project cost.

Management of patients with amyotrophic lateral sclerosis.

PubMed

Pautex, Sophie; Janssens, Jean-Paul; Vuagnat, Hubert; Conne, Pierre; Zulian, Gilbert B

2005-10-15

Standard recommendations for the clinical management of patient with ALS have been edited in recent years. These documents emphasise the importance of patient's autonomy. To measure how these different recommendations can be applied in the context of a general hospital without a specific ALS clinic. Review of medical records of 21 patients with an ALS diagnosis treated by the University Hospitals Geneva who died from 1996-2002. Patients suffered from distressing symptoms during their last hospitalisation. Artificial nutrition was given to 5 patients. Six patients had non invasive ventilation (NIV). Written advance directives were only available in 2 cases. Discussions about theses issues were also conducted late in the evolution of the disease. Some discrepancies between our daily practice and the existing recommendations exist, particularly regarding the key issues of artificial nutrition and ventilatory support.

Managing healthcare information: analyzing trust.

PubMed

Söderström, Eva; Eriksson, Nomie; Åhlfeldt, Rose-Mharie

2016-08-08

Purpose - The purpose of this paper is to analyze two case studies with a trust matrix tool, to identify trust issues related to electronic health records. Design/methodology/approach - A qualitative research approach is applied using two case studies. The data analysis of these studies generated a problem list, which was mapped to a trust matrix. Findings - Results demonstrate flaws in current practices and point to achieving balance between organizational, person and technology trust perspectives. The analysis revealed three challenge areas, to: achieve higher trust in patient-focussed healthcare; improve communication between patients and healthcare professionals; and establish clear terminology. By taking trust into account, a more holistic perspective on healthcare can be achieved, where trust can be obtained and optimized. Research limitations/implications - A trust matrix is tested and shown to identify trust problems on different levels and relating to trusting beliefs. Future research should elaborate and more fully address issues within three identified challenge areas. Practical implications - The trust matrix's usefulness as a tool for organizations to analyze trust problems and issues is demonstrated. Originality/value - Healthcare trust issues are captured to a greater extent and from previously unchartered perspectives.

Surviving self-employment: a personal case history.

PubMed

Kasnot, K

1993-01-01

In the popular perception of what determines one's success as a free-lance illustrator, issues other than natural talent or artistic ability are seldom emphasized. In addition to a firm philosophical foundation and a good work ethic, the organization and management of practical concerns play significant roles in the successful operation of any free-lance business. Presented as a personal history, this article discusses some of the most important, yet most neglected, issues that are essential to the economic security and survival of anyone considering a career as a free-lance illustrator.

Measure of librarian pressure using fuzzy inference system: A case study in Longyan University

NASA Astrophysics Data System (ADS)

Huang, Jian-Jing

2014-10-01

As the hierarchy of middle managers in college's librarian. They may own much work pressure from their mind. How to adapt psychological problem, control the emotion and keep a good relationship in their work place, it becomes an important issue. Especially, they work in China mainland environment. How estimate the librarians work pressure and improve the quality of service in college libraries. Those are another serious issues. In this article, the authors would like discuss how can we use fuzzy inference to test librarian work pressure.

Medical and health issues in coal arbitration

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

Volz, M.M.

The role of arbitration in settling coal mining health and safety issues is limited in each case to the facts and contractual provisions which apply to a specific grievance. The author reviews various situations under the physical or mental inability to perform the work, personnel or sick leave, allergies, and alcoholism. The weight given to medical opinions needs to be tempered by good faith on the part of management. Personnel have the right to seek opinions from physicians of their choice to supplement the opinions of company medical staff.

Neurosurgical rare disease: solitary plasmacytoma of the skull - case report and literature review.

PubMed

Rizea, Radu Eugen; Popescu, Mihai; Gheorghiţă, Karina Lidia; Popescu, George; Neamţu, Marius Cristian; Busuioc, Cristina Jana; Ciurea, Alexandru Vlad

2018-01-01

Solitary extranevraxial plasmacytoma (SEP), as a clinical entity without signs of systemic myelomatosis, is extremely rare; it is difficult to find literature on the issue of patient management and proper course of action in the presence of associated pathology. The authors present a rare case of plasmacytoma of the skull vault associated with severe cardiac pathology, which made surgery extremely difficult and possible only through temporization of the interventions, as presented. We discuss our findings and opportunities for treatment in this case, which seemed unapproachable at presentation, in connection with the associated cardiac pathology. The case was followed-up for eight years with no recurrences.

Can the management of blood sugar levels in gestational diabetes mellitus cases be an indicator of maternal and fetal outcomes? The results of a prospective cohort study from India

PubMed Central

Jain, Rajesh; Davey, Sanjeev; Davey, Anuradha; Raghav, Santosh K.; Singh, Jai V.

2016-01-01

Background: Gestational diabetes mellitus (GDM) is emerging as an important public health problem in India owing to its increasing prevalence since the last decade. The issue addressed in the study was whether the management of blood sugar levels in GDM cases can predict maternal and fetal outcomes. Materials and Methods: A prospective cohort study was done for 1 year from October 1, 2013, to September 31, 2014, at 652 diabetic screening units as a part of the Gestational Diabetes Prevention and Control Project approved by the Indian Government in the district of Kanpur, state of Uttar Pradesh. A total of 57,108 pregnant women were screened during their 24–28th weeks of pregnancy by impaired oral glucose test. All types of maternal and perinatal outcomes were followed up in both GDM and non-GDM categories in the 2nd year (2013–2014) after blood sugar levels were controlled. Results: It was seen that for all kinds of maternal and fetal outcomes, the differences between GDM cases and non-GDM cases were highly significant (P < 0.0001, relative risk >1 in every case). Moreover, perinatal mortality also increased significantly from 5.7% to 8.9% when blood sugar levels increased from 199 mg/dl and above. Perinatal and maternal outcomes in GDM cases were also significantly related to the control of blood sugar levels (P < 0.0001). Conclusion: Blood sugar levels can be an indicator of maternal and perinatal morbidity and mortality in GDM cases, provided unified diagnostic criteria are used by Indian laboratories. However, to get an accurate picture on this issue, all factors need further study. PMID:27186155

Management issues in hematopoietic stem cell transplantation.

PubMed

Rice, Robert David; Bailey, Gay

2009-05-01

To describe the leadership and management challenges of creating and maintaining a comprehensive hematopoietic stem cell transplant program. Research studies, review articles, databases, and web sites. Nurses at all levels of practice must conceptualize and execute expert specialized care through all phases of transplantation. Attention must be paid to specialized functions such as care coordination and case management, as well as scope of practice. Focus must be given to quality assessment and improvement. As the field of transplant grows and evolves, expert nursing leadership will be required to manage the continuum of care as patients move between health care settings. The increased emphasis on outpatient care, cost containment, and consumer and regulatory demand for quality will continue to challenge nurse leaders to manage creative enterprises.

Proceedings: 1989 electric utility franchise conference

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

Romo, R.G.

The primary purpose of the Conference was to present and discuss strategic issues related to franchising electric service. The theme for the conference was to both improve the management of existing franchises and the negotiation of new franchises. To promote a better understanding of the planning issues related to this theme, the following sessions were designed: (1) public utility franchising, (2) investor owned utility and community perspectives on franchising, (3) franchise case study presentations, (4) alternatives to franchise renewal: the public acquisition option, and (5) special franchise issues. The Conference combined results from research coupled with actual franchise negotiating experiences,more » and concepts and ideas considered or implemented by utilities, government agencies, consultants and others.« less

Managing United States public lands in response to climate change: a view from the ground up.

PubMed

Ellenwood, Mikaela S; Dilling, Lisa; Milford, Jana B

2012-05-01

Federal land managers are faced with the task of balancing multiple uses and goals when making decisions about land use and the activities that occur on public lands. Though climate change is now well recognized by federal agencies and their local land and resource managers, it is not yet clear how issues related to climate change will be incorporated into on-the-ground decision making within the framework of multiple use objectives. We conducted a case study of a federal land management agency field office, the San Juan Public Lands Center in Durango, CO, U.S.A., to understand from their perspective how decisions are currently made, and how climate change and carbon management are being factored into decision making. We evaluated three major management sectors in which climate change or carbon management may intersect other use goals: forests, biofuels, and grazing. While land managers are aware of climate change and eager to understand more about how it might affect land resources, the incorporation of climate change considerations into everyday decision making is currently quite limited. Climate change is therefore on the radar screen, but remains a lower priority than other issues. To assist the office in making decisions that are based on sound scientific information, further research is needed into how management activities influence carbon storage and resilience of the landscape under climate change.

Diabetes Management via a Mobile Application: a Case Report.

PubMed

Jo, In-Young; Yoo, Seung-Hyun; Lee, Da Young; Park, Cheol-Young; Kim, Eun Mi

2017-01-01

Recently, mobile health care has been applied to manage diabetes requiring self-management. Health care by mobile applications (apps) has a great advantage when applied to patients with diabetes; the adherence to self-management activities for diabetes can be improved through mobile apps. The Food and Drug Administration (FDA) has cleared and approved the use of some mobile apps as medical devices for the management of diabetes since 2010. However, mobile apps may not be effective for all patients. We here report the effect of use of mobile-based diabetes care app (Healthy-note app) for 2 patients with diabetes, and discuss issues and strategies for effective mobile intervention. Further study is needed on improving patient's participation to increase the effect of management via a mobile app.

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

Assessing Health Implications of the Potential Radiation Exposure in the Community During Pregnancy: A Case Study

PubMed Central

Clark, Haley; Corns, Robert; Tyldesley, Scott

2017-01-01

The unintentional radiation exposure can have significant implications. We present a case of a 30-year-old pregnant female who was exposed to a potentially radioactive rock for over a one week period during her 13th week of pregnancy. After an arduous process of obtaining activity measurements, the most conservative estimate of dose, the female was exposed to, was found to fall within the permissible limits. We briefly describe the literature on fetal radiation toxicity levels and discuss logistical issues faced in managing such cases. PMID:29238629

CASE tools and UML: state of the ART.

PubMed

Agarwal, S

2001-05-01

With increasing need for automated tools to assist complex systems development, software design methods are becoming popular. This article analyzes the state of art in computer-aided software engineering (CASE) tools and unified modeling language (UML), focusing on their evolution, merits, and industry usage. It identifies managerial issues for the tools' adoption and recommends an action plan to select and implement them. While CASE and UML offer inherent advantages like cheaper, shorter, and efficient development cycles, they suffer from poor user satisfaction. The critical success factors for their implementation include, among others, management and staff commitment, proper corporate infrastructure, and user training.

Carcinoma of unknown primary: key radiological issues from the recent National Institute for Health and Clinical Excellence guidelines

PubMed Central

Taylor, M B; Bromham, N R; Arnold, S E

2012-01-01

Carcinoma of unknown primary origin (CUP) accounts for 3–5% of cancer cases and is the fourth most common cause of cancer death in the UK. CUP management is challenging, partly owing to the heterogeneity of the condition and its presentation, but also owing to the lack of dedicated clinical services for these patients. The recent National Institute for Health and Clinical Excellence (NICE) guidelines on metastatic malignancy of unknown primary origin were developed to improve the co-ordination of diagnostic and clinical services at hospitals treating cancer patients in England and Wales, in particular by the setting up of CUP teams to manage these patients. Radiologists have a vital role in the diagnosis of these patients and should work closely with the CUP team to streamline the diagnostic pathway. This article summarises areas of the NICE guidelines relevant to radiology and discusses the radiological management of patients with CUP, including initial investigation, the importance of biopsy, the management of specific presentations, special investigations and organisational issues. PMID:22374278

Feasibility study for early removal of HEU from CPP-651-Phase II

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

Smith, C.V.; Henry, R.; Milligan, C.

1997-09-01

A two-phase feasibility study was initiated in late 1996 to identify a way to expedite the removal of SNM from the CPP-651 vault. The first phase of this study provided preliminary information that appeared promising, but needed additional detailed planning and evaluate to validate the concepts and conclusions. The focus of Phase 2 was to provide the validation via resource-loaded schedules and more detailed cost estimates. Section 1 describes the purpose and objectives of the Phase 2 tasks and the programmatic drivers that influence related CPP-651 high-enriched uranium (HEU) management issues. Section 2 identifies the evaluation criteria and methodology andmore » the transfer issues and barriers preventing shipment. Section 3 provides site-specific background information for the CPP-651 facility and the Idaho National Engineering and Environmental Laboratory (INEEL) and describes the development of the basic material removal schedule, the proposed base case plan for removal of SNM, and the proposed HEU material management/shipping issues and strategies. Section 4 identifies the proposed options for accelerated removal of SNM and how they were evaluated via detailed scheduling, resource histograms, and cost analysis. Section 5 summarizes principal tasks for implementing this plan and other related HEU CPP-651 management issues that require continued planning efforts to assure successful implementation of this proposed early removal strategy.« less

Man-machine interface analysis of the flight design system

NASA Technical Reports Server (NTRS)

Ramsey, H. R.; Atwood, M. E.; Willoughby, J. K.

1978-01-01

The objective of the current effort was to perform a broad analysis of the human factors issues involved in the design of the Flight Design System (FDS). The analysis was intended to include characteristics of the system itself, such as: (1) basic structure and functional capabilities of FDS; (2) user backgrounds, capabilities, and possible modes of use; (3) FDS interactive dialogue, problem solving aids; (4) system data management capabilities; and to include, as well, such system related matters as: (1) flight design team structure; (2) roles of technicians; (3) user training; and (4) methods of evaluating system performance. Wherever possible, specific recommendations are made. In other cases, the issues which seem most important are identified. In some cases, additional analyses or experiments which might provide resolution are suggested.

[Regional health systems management: a case study in Rio Grande do Sul, Brazil].

PubMed

Lima, Juliano de Carvalho; Rivera, Francisco Javier Uribe

2006-10-01

This article analyzes the management system in a health district in the State of Rio Grande do Sul, Brazil, through qualitative analysis, using a case study as the methodology and macro-organization theory as the analytical framework. For the current management system in the 6th Health Region, a clear mission statement and wide acceptance by health workers are facilitating factors for the current organizational practices within the health system. Nevertheless, the way health coordinators are currently prioritizing their time has diverted necessary resources from critical problems towards more remedial issues. The 6th Health Region has encouraged social control (or public oversight) in order to improve accountability. However, there is room for improvement in quality assurance management, since there were no well-defined goals, objectives, or accountability. Decentralized consultancy provided to the municipalities and the funding model itself have both promoted decentralization and autonomy, although the strategy requires better regional integration and greater commitment in managerial practices.

[Positional plagiocephaly in infancy: diagnosis and management].

PubMed

Gautschi, Oliver P; Rilliet, Benedict; Schaller, Karl; Jenny, Benoît

2013-12-11

Positional plagiocephaly in the newborn corresponds to a posterior flattening and asymetry of the head. Its incidence has significantly increased since the "back to sleep" campain in the nineteen nineties to prevent sudden infant death syndrome. The posterior deformation usually worsens during the first six months of life when the skull is susceptible to posterior constant pressure which induces the deformation. Spontaneous outcome can be favorable. Treatment is always conservative and consists in positionnal exercise, physiotherapy and osteopathy. In some cases treatment with a helmet is recommended for a period of three months usually. Posterior positionnal plagiocephaly has no consequences on the brain's developement an is considered as an esthetic issue. In most cases good results are obtained after management with a custom fitted helmet when needed.

New control concepts for uncertain water resources systems: 1. Theory

NASA Astrophysics Data System (ADS)

Georgakakos, Aris P.; Yao, Huaming

1993-06-01

A major complicating factor in water resources systems management is handling unknown inputs. Stochastic optimization provides a sound mathematical framework but requires that enough data exist to develop statistical input representations. In cases where data records are insufficient (e.g., extreme events) or atypical of future input realizations, stochastic methods are inadequate. This article presents a control approach where input variables are only expected to belong in certain sets. The objective is to determine sets of admissible control actions guaranteeing that the system will remain within desirable bounds. The solution is based on dynamic programming and derived for the case where all sets are convex polyhedra. A companion paper (Yao and Georgakakos, this issue) addresses specific applications and problems in relation to reservoir system management.

Optimizing medication safety in the home.

PubMed

LeBlanc, Raeanne Genevieve; Choi, Jeungok

2015-06-01

Medication safety among community-dwelling older adults in the United States is an ongoing health issue impacting health outcomes, chronic disease management, and aging in place at home. This article describes a medication safety improvement project that aimed to: (1) Increase the ability of participants to manage medications, (2) Identify and make necessary medication changes, (3) Create an accurate up-to-date medication list to be available in the home, and (4) Provide communication between the primary care provider, participant, and case manager. An in-home medication assessment was completed for 25 participants using an evidence-based medication management software system. This process was used to review medications; identify medication-related problems; create a shared medication list; and convey this information to the primary care provider, case manager, and client while addressing needed medication changes. Educational interventions on management and understanding of medications were provided to participants to emphasize the correct use of medications and use of a personal medication record. Outcome improvements included provision of an accurate medication list, early identification of medication-related problems, identification of drug duplication, and identification of medication self-management challenges that can be useful for optimizing medication safety-related home healthcare and inform future interventions.

An analysis of Indonesia’s information security index: a case study in a public university

NASA Astrophysics Data System (ADS)

Yustanti, W.; Qoiriah, A.; Bisma, R.; Prihanto, A.

2018-01-01

Ministry of Communication and Informatics of the Republic of Indonesia has issued the regulation number 4-2016 about Information Security Management System (ISMS) for all kind organizations. Public university as a government institution must apply this standard to assure its level of information security has complied ISO 27001:2013. This research is a preliminary study to evaluate the readiness of university IT services (case study in a public university) meets the requirement of ISO 27001:2013 using the Indonesia’s Information Security Index (IISI). There are six parameters used to measure the level of information security, these are the ICT role, governance, risk management, framework, asset management and technology. Each parameter consists of serial questions which must be answered and convert to a numeric value. The result shows the level of readiness and maturity to apply ISO 27001 standard.

The new challenges of end-of-life tyres management systems: A Spanish case study

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

Uruburu, Ángel, E-mail: angel.uruburu@upm.es; Ponce-Cueto, Eva, E-mail: eva.ponce@upm.es; Center for Transportation and Logistics, Massachusetts Institute of Technology, Cambridge, MA

Highlights: ► Impact of the implementation of the Directive 2008/98/EC in Spain for end-of-life tyres. ► Characterization of the reverse supply chain for collecting, recovering, and treating end-of-life tyres. ► Identification of challenges to be coped and issues to be covered. ► Potential new applications for end-of-life tyres and development of new management related strategies. - Abstract: Directive 2008/98/EC released by the European Union represents a significant step forward in all relevant aspects of waste management. Under the already established, extended produced responsibility (EPR) principle, new policies have been enunciated to continuously achieve better overall environmental performance of key productsmore » throughout their life phases. This paper discusses how the directive is being articulated in Spain by the main integrated management system (IMS) for end-of-life (EOL) tyres since its creation in 2006. Focusing on the IMS technological, economic and legal aspects, the study provides a global perspective and evaluation of how the IMS is facing the current issues to resolve, the new challenges that have appeared and the management vision for the coming years.« less

Managing nuclear power plant induced disasters.

PubMed

Kyne, Dean

2015-01-01

To understand the management process of nuclear power plant (NPP) induced disasters. The study shields light on phases and issues associated with the NPP induced disaster management. This study uses Palo Verde Nuclear Generation Station as study subject and Arizona State as study area. This study uses the Radiological Assessment System for Consequence Analysis (RASCAL) Source Term to Dose (STDose) of the Nuclear Regulatory Commission, a computer software to project and assess the source term dose and release pathway. This study also uses ArcGIS, a geographic information system to analyze geospatial data. A detailed case study of Palo Verde Nuclear Power Generation (PVNPG) Plant was conducted. The findings reveal that the NPP induced disaster management process is conducted by various stakeholders. To save lives and to minimize the impacts, it is vital to relate planning and process of the disaster management. Number of people who expose to the radioactive plume pathway and level of radioactivity could vary depending on the speed and direction of wind on the day the event takes place. This study findings show that there is a need to address the burning issue of different racial and ethnic groups' unequal exposure and unequal protection to potential risks associated with the NPPs.

Dental management for head and neck cancer patients undergoing radiation therapy: comprehensive patient based planning--a case report.

PubMed

Higham, Paola; Quek, Samuel; Cohen, Harold V

2009-01-01

Medical management of the head and neck cancer patient (HNCP) most often will include radiation therapy to the head and neck region. HNCPs with malignant disease require judicious dental treatment planning prior to radiation therapy (RT) and/or chemotherapy. RT can result in a multitude of adverse effects, both reversible and irreversible. We report a case of a patient with squamous cell carcinoma of the throat above the larynx (supraglottic), who did not adhere to dental treatment recommendations for both pre- and post radiation dental management. The focus of this case report is to create awareness within the clinician that, in addition to evaluating the patient for the disease related issues that may affect the oral cavity and dentition, a total management plan should include factors beyond the structural oral problems related to the cancer. Final treatment plans for the HNCP should include medical assessment of past dental history, oral hygiene, potential compliance, or lack of, to dental care recommendations, the emotional state of the patient, socio-economic status of the patient (lifestyle, cost of care), future quality of life, the medical and/or life prognosis of the patient.

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.

Diagnosing and managing anorexia nervosa in UK primary care: a focus group study.

PubMed

Hunt, D; Churchill, R

2013-08-01

Anorexia is a leading cause of adolescent hospital admission and death from psychiatric disorder. Despite the potential role of general practitioners in diagnosis, appropriate referral and coordinating treatment, few existing studies provide fine-grained accounts of GPs' beliefs about anorexia. To identify GPs' understandings and experiences of diagnosing and managing patients with anorexia in primary care. Case-based focus groups with co-working general practitioners in the East Midlands region of England were used to explore attitudes towards issues common to patients with eating disorders. Group discussions were transcribed and analysed using corpus linguistic and discourse analytic approaches. Participants' discussion focused on related issues of making hesitant diagnoses, the utility of the body mass index, making referrals and overcoming patient resistance. Therapeutic relationships with patients with anorexia are considered highly complex, with participants using diagnostic tests as rhetorical strategies to help manage communicative obstacles. Overcoming patient repudiation and securing referrals are particular challenges with this patient group. Successfully negotiating these problems appears to require advanced communication skills.

Nationwide trends in the current management of desmoid (aggressive) fibromatosis.

PubMed

Eastley, N C; Hennig, I M; Esler, C P; Ashford, R U

2015-06-01

The optimal management of desmoid fibromatosis remains unclear, leading to significant variability in patient management. To assess this problem, the current approach of clinicians managing this complex condition in the UK was investigated. A hypothetical case of intramuscular limb girdle desmoid fibromatosis in a fit 65-year-old patient was devised. Surgical and non-surgical oncology members of the British Sarcoma Group were questioned on how they would manage this case in three scenarios: primary disease with function-sparing surgery possible, primary disease with neurovascular involvement and disease recurrence after a previous R0 resection. Initial management, management of symptomatic disease progression, follow-up preferences and any differences in respondents' management choices in a younger case were investigated. The responses from 14 sarcoma surgeons and 23 oncologists (14 clinical, nine medical) were analysed. Desmoid fibromatosis management is generally shared by surgeons and oncologists within sarcoma multidisciplinary teams in the UK. Variation exists in the chosen initial management of primary desmoid fibromatosis in the UK, with function-sparing surgery possible (observation 51%, resection 51%), primary desmoid fibromatosis with neurovascular involvement (hormone therapy with non-steroidal anti-inflammatory drugs 51%, radiotherapy 27%, observation 22%) and for cases of desmoid fibromatosis recurrence (radiotherapy 41%, hormone therapy and non-steroidal anti-inflammatory drugs 27%, observation 24%). There was a clear preference of surgical resection of symptomatic disease progression in cases of primary desmoid fibromatosis without neurovascular involvement (60%). By contrast, radiotherapy was the preferred treatment for progression in cases with neurovascular involvement (47%) or cases of recurrence after a previous R0 resection (34%). Clinical follow-up was selected 3 months after intervention in 68% of scenarios. Follow-up imaging was selected 3 or 6 months after intervention in 57% and 21% of cases, respectively. Most respondents would not change their chosen management in younger patients. Several groups have issued formal guidelines for clinicians managing desmoid fibromatosis, including the British Sarcoma Group, the National Comprehensive Cancer Network and the European Society for Medical Oncology. However, these are in some ways contradictory and may not reflect recent publications, potentially explaining the significant variation in the management of desmoid fibromatosis in the UK shown by this survey. We propose a review of current evidence; a national consensus or a desmoid fibromatosis registry may help to standardise desmoid fibromatosis care. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Evaluating the underlying factors behind variable rate debt.

PubMed

McCue, Michael J; Kim, Tae Hyun Tanny

2007-01-01

Recent trends show a greater usage of variable rate debt among health care bond issues. In 2004, 63.4% of the total health care bonds issued were variable rate compared with 30.6% in 1995 (Fitch Ratings, 2005). The purpose of this study is to gain a better understanding of the underlying factors, credit spread, issue characteristics, and issuer factors behind why hospitals and health system borrowers select variable rate debt compared with fixed rate debt. From 2000 to 2004, this study sampled 230 newly issued tax-exempt bonds issued by acute care hospitals and health care systems that included both variable and fixed rate debt issues. Using a logistic regression model, hospitals with variable rate debt issues were assigned a value of 1, whereas hospitals with fixed rate debt issues were assigned a value of 0. This study found a positive association between bond insurance and variable rate debt and a negative association between callable feature and variable rate debt. Facilities located in certificate-of-need states that possessed higher case mix acuity, earned higher profit margins, generated higher debt service coverage, and held less debt were more likely to issue variable rate debt. Overall, hospital managers and board members of hospitals possessing a strong financial performance have an interest in utilizing variable rate debt to lower their cost of capital. In addition, this outcome may also reflect that investment bankers are doing a better job in educating senior hospital management about the interest rate savings benefit of variable rate compared with fixed rate debt.

Round One? Judge Issues Rulings in Long-Awaited Copyright Infringement Lawsuit against Georgia State University

ERIC Educational Resources Information Center

Enghagen, Linda K.

2014-01-01

Long-awaited rulings in the copyright infringement lawsuit provide the most specific guidance available to date on the fair use of certain types of materials in e-reserves systems and online course management systems. Unless successfully appealed or otherwise overturned, this case represents a significant victory for Georgia State University…

10 CFR Appendix to Part 719 - Guidance for Legal Resource Management

Code of Federal Regulations, 2011 CFR

2011-01-01

... resolution (ADR) at various stages of an issue in dispute, e.g., before a case is filed, pre-discovery, after initial discovery and pre-trial. This evaluation should be done in coordination with the Department's ADR liaison if one has been established or appointed or the Department counsel if an ADR liaison has not been...

National Symposium on Information Technology: Proceedings (7th, Myrtle Beach, South Carolina, May 3-6, 1992). Volume 6.

ERIC Educational Resources Information Center

Lesser, Donna L., Ed.

Twenty-three papers address issues of access, case management, innovative computer applications, and information and referral in the use of information technology by individuals with disabilities and their families. The papers are: "Improving the Use of Information Technology by Individuals with Disabilities and Their Families" (William H.…

Managing Heuristics as a Method of Inquiry in Autobiographical Graphic Design Theses

ERIC Educational Resources Information Center

Ings, Welby

2011-01-01

This article draws on case studies undertaken in postgraduate research at AUT University, Auckland. It seeks to address a number of issues related to heuristic inquiries employed by graphic design students who use autobiographical approaches when developing research-based theses. For this type of thesis, heuristics as a system of inquiry may…

Counselor Meaning-Making: Working with Childhood Sexual Abuse Survivors

ERIC Educational Resources Information Center

Viviani, Anna Michele

2011-01-01

Childhood sexual abuse is a prevalent but taboo topic in society. Conservatively 80,000 new cases are reported each year with many more either unreported or unsubstantiated within the legal system. Survivors of childhood sexual abuse often times seek counseling assistance to manage the variety of short-and long-term emotional issues that may arise…

The Role of Negotiations in the Equation "Declining School Enrollment=Layoffs": A Management Perspective

ERIC Educational Resources Information Center

Spenla, William A.; And Others

1978-01-01

Discusses economic and legal issues related to declining public school enrollments and pressures for "reduction in force" (RIF) of teachers. Reviews developments involving RIF cases in New Jersey and Yonkers, New York. Recommends school boards not agree to contracts that limit their ability to lay off personnel for economic reasons. (JG)

The virtues of localism and arctic wilderness politics

Treesearch

James N. Gladden

2007-01-01

An analysis of co-managing structures and land use issues in three case studies of arctic wilderness politics shows that more formal and informal power sharing by government officials with local people results in less conflict. Greater input and control by nearby communities may also help to protect wilderness ecosystems and traditional values of northern cultures....

Sustainability and Higher Education, a [Hypothetical] Love Story

ERIC Educational Resources Information Center

Wagner, Lindsay Eva

2013-01-01

It is quite clear that sustainability is here to stay, but in many cases one has yet to determine what it actually is. The buzz words and issues--solar panels, wind turbines, recycling, green cleaning, energy management, green buildings, green products, public transportation, and carbon neutrality to mention a few--have all been part of the…

Difficulties in Reforming Education Policy: The Hong Kong Case.

ERIC Educational Resources Information Center

Godwin, C. D.

1999-01-01

Over the past decade, the education-policy machinery in Hong Kong has been faced with important quality issues emerging that concern the history and culture of the school system. Evaluates two change-management initiatives between 1990 and 1995 and examines their outcomes in light of the endemic features of Hong Kong civil-service culture and…

Female circumcision: obstetric issues.

PubMed

Baker, C A; Gilson, G J; Vill, M D; Curet, L B

1993-12-01

Female circumcision is a problem unfamiliar to most Western obstetrician-gynecologists. We present a case illustrative of the unique management problems posed by these patients during labor. A method of releasing the anterior vulvar scar tissue to allow vaginal delivery is described. Sensitivity and a nonjudgmental approach as to what is culturally appropriate care for these women are of paramount importance.

Issues in Lecturing in a Second Language: Lecturer's Behaviour and Students' Perceptions

ERIC Educational Resources Information Center

Miller, Lindsay

2007-01-01

This article explores how Hong Kong Chinese engineering students with low English language proficiency manage to cope with their lectures given in English. An ethnographic case study approach was used with multiple sources of data triangulated to provide a picture of the lecture event from both the students' and the lecturer's perspectives. One of…

Managing Digital Identity on Twitter: The Case of School Administrators

ERIC Educational Resources Information Center

Cho, Vincent; Jimerson, Jo Beth

2017-01-01

What does it mean to be and to act like a school leader online? Although many school leaders might be comfortable navigating issues of identity in face-to-face environments, online environments may present new and unprecedented challenges. These challenges may range from concerns about privacy and surveillance to questions about how best to…

Moral Judgement Changes among Undergraduates in a Capstone Internship Experience

ERIC Educational Resources Information Center

Craig, Patricia J.; Oja, Sharon Nodie

2013-01-01

This mixed-methods study explored the moral growth of undergraduates in a recreation management internship experience. The quantitative phase reported moral judgement gains in Personal Interest and Post-conventional schema, and N-2 scores, as measured by the Defining Issues Test 2 (DIT-2), among 33 interns. The case-study method used a pattern…

Community College Journal for Research and Planning, Volume VII, Numbers 1 and 2.

ERIC Educational Resources Information Center

Carter, Edith H., Ed.

1990-01-01

Providing a forum for the exchange of information among members of the National Council for Research and Planning, this refereed journal offers articles on various aspects of community college research, management, and planning. The two issues of volume 7 contain the following articles: (1) "Case Studies of Community College High Risk Students:…

Managerialist vis-à-vis Learning and Development Goals for EAL Teachers: A Case Study of an In-Service Professional Development Provider

ERIC Educational Resources Information Center

Gurney, Laura; Liyanage, Indika

2015-01-01

Under current Western neoliberal philosophy, promotion of efficiency and resolution of issues are typically expected to result from effective management. The education sector, too, has responded well to these expectations. Amongst such expectations, engagement in professional development activities (PDAs) by teachers of English as an additional…

Challenges of Integrating Environmental Sustainability Issues into Business School Curriculum: A Case Study from the University of Jyvaskyla, Finland.

ERIC Educational Resources Information Center

Pesonen, Hanna-Leena

2003-01-01

Reviews the history and foundations of a master's program in corporate environmental management at a Finnish university. Provides insights for program development: (1) clear commitment from administrators; (2) content based on environmental science and technology; (3) interdisciplinary approach; (4) diverse approaches to sustainability; and (5)…

Volcano Monitoring: A Case Study in Pervasive Computing

NASA Astrophysics Data System (ADS)

Peterson, Nina; Anusuya-Rangappa, Lohith; Shirazi, Behrooz A.; Song, Wenzhan; Huang, Renjie; Tran, Daniel; Chien, Steve; Lahusen, Rick

Recent advances in wireless sensor network technology have provided robust and reliable solutions for sophisticated pervasive computing applications such as inhospitable terrain environmental monitoring. We present a case study for developing a real-time pervasive computing system, called OASIS for optimized autonomous space in situ sensor-web, which combines ground assets (a sensor network) and space assets (NASA’s earth observing (EO-1) satellite) to monitor volcanic activities at Mount St. Helens. OASIS’s primary goals are: to integrate complementary space and in situ ground sensors into an interactive and autonomous sensorweb, to optimize power and communication resource management of the sensorweb and to provide mechanisms for seamless and scalable fusion of future space and in situ components. The OASIS in situ ground sensor network development addresses issues related to power management, bandwidth management, quality of service management, topology and routing management, and test-bed design. The space segment development consists of EO-1 architectural enhancements, feedback of EO-1 data into the in situ component, command and control integration, data ingestion and dissemination and field demonstrations.

Understanding safety and production risks in rail engineering planning and protection.

PubMed

Wilson, John R; Ryan, Brendan; Schock, Alex; Ferreira, Pedro; Smith, Stuart; Pitsopoulos, Julia

2009-07-01

Much of the published human factors work on risk is to do with safety and within this is concerned with prediction and analysis of human error and with human reliability assessment. Less has been published on human factors contributions to understanding and managing project, business, engineering and other forms of risk and still less jointly assessing risk to do with broad issues of 'safety' and broad issues of 'production' or 'performance'. This paper contains a general commentary on human factors and assessment of risk of various kinds, in the context of the aims of ergonomics and concerns about being too risk averse. The paper then describes a specific project, in rail engineering, where the notion of a human factors case has been employed to analyse engineering functions and related human factors issues. A human factors issues register for potential system disturbances has been developed, prior to a human factors risk assessment, which jointly covers safety and production (engineering delivery) concerns. The paper concludes with a commentary on the potential relevance of a resilience engineering perspective to understanding rail engineering systems risk. Design, planning and management of complex systems will increasingly have to address the issue of making trade-offs between safety and production, and ergonomics should be central to this. The paper addresses the relevant issues and does so in an under-published domain - rail systems engineering work.

The Management, Storage, Utilization of Astronomical Data in the 21st Century Version 1.00

NASA Astrophysics Data System (ADS)

Hanisch, Bob; Quinn, Peter; Lawrence, Andy; Hanisch, Bob

2004-03-01

The costs and resources associated with the development of forefront astronomical research capabilities often greatly exceed the funding capacities of individual universities, research organizations, and nations (e.g., Atacama Large Millimeter Array [ALMA], The Square Kilometre Array [SKA], and Extremely Large (optical) Telescopes in the 30m-100m class [ELTs]). Collaborative alliances of organizations and nations are therefore being formed to build new, facility-class astronomical observatories across the globe. This expansion and globalization of the astronomical research effort raises a number of major issues that need to be confronted and solved by astronomers, research funding bodies, and governments. Some of these issues are being met by other sciences and some are unique to the research diversity inherent in exploring the Universe through multiple, complementary wavelength windows. In all cases, the challenges of managing, maximally utilizing, and collaboratively sharing the huge volume of digital information flowing from these new observatories is focusing and leading the discussion of critical issues for success. This discussion paper seeks to identify a number of these major issues, to highlight a new vision for a common research infrastructure that will enable some of these issues to be addressed, and further, to identify some of the practical and policy issues associated with long term solutions and the maximal return on a global research investments.

Abscess inside craniopharyngioma: diagnostic and management implications.

PubMed

Bhaisora, Kamlesh Singh; Prasad, Surya Nandan; Das, Kuntal Kanti; Lal, Hira

2018-02-03

Abscess inside the pituitary fossa is very rare. Such abscess can be primary, occurring in an otherwise healthy pituitary gland, or secondary, developing inside a diseased gland (ie, harbouring craniopharyngioma, Rathke's cleft cyst, etc). Secondary pituitary abscess inside a craniopharyngioma remains an extremely rare occurrence. Our literature search revealed only six such cases reported so far. In this report, we present the seventh case of craniopharyngioma with abscess in a 38-year-old woman. We describe the uniqueness of the clinical presentation of our case, the radiological pointers to the possible diagnosis and the management issues in our patient. A review of literature is also included to provide a comprehensive picture of this rare condition to the readers. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A reflective lens: applying critical systems thinking and visual methods to ecohealth research.

PubMed

Cleland, Deborah; Wyborn, Carina

2010-12-01

Critical systems methodology has been advocated as an effective and ethical way to engage with the uncertainty and conflicting values common to ecohealth problems. We use two contrasting case studies, coral reef management in the Philippines and national park management in Australia, to illustrate the value of critical systems approaches in exploring how people respond to environmental threats to their physical and spiritual well-being. In both cases, we used visual methods--participatory modeling and rich picturing, respectively. The critical systems methodology, with its emphasis on reflection, guided an appraisal of the research process. A discussion of these two case studies suggests that visual methods can be usefully applied within a critical systems framework to offer new insights into ecohealth issues across a diverse range of socio-political contexts. With this article, we hope to open up a conversation with other practitioners to expand the use of visual methods in integrated research.

Issues and challenges of involving users in medical device development.

PubMed

Bridgelal Ram, Mala; Grocott, Patricia R; Weir, Heather C M

2008-03-01

User engagement has become a central tenet of health-care policy. This paper reports on a case study in progress that highlights user engagement in the research process in relation to medical device development. To work with a specific group of medical device users to uncover unmet needs, translating these into design concepts, novel technologies and products. To validate a knowledge transfer model that may be replicated for a range of medical device applications and user groups. In depth qualitative case study to elicit and analyse user needs. The focus is on identifying design concepts for medical device applications from unmet needs, and validating these in an iterative feedback loop to the users. The case study has highlighted three interrelated challenges: ensuring unmet needs drive new design concepts and technology development; managing user expectations and managing the research process. Despite the challenges, active participation of users is crucial to developing usable and clinically effective devices.

Issues on Building Kazakhstan Geospatial Portal to Implement E-Government

NASA Astrophysics Data System (ADS)

Sagadiyev, K.; Kang, H. K.; Li, K. J.

2016-06-01

A main issue in developing e-government is about how to integrate and organize many complicated processes and different stakeholders. Interestingly geospatial information provides an efficient framework to integrate and organized them. In particular, it is very useful to integrate the process of land management in e-government with geospatial information framework, since most of land management tasks are related with geospatial properties. In this paper, we present a use-case on the e-government project in Kazakhstan for land management. We develop a geoportal to connect many tasks and different users via geospatial information framework. This geoportal is based on open source geospatial software including GeoServer, PostGIS, and OpenLayers. With this geoportal, we expect three achievements as follows. First we establish a transparent governmental process, which is one of main goal of e-government. Every stakeholder monitors what is happening in land management process. Second, we can significantly reduce the time and efforts in the government process. For example, a grant procedure for a building construction has taken more than one year with more than 50 steps. It is expected that this procedure would be reduced to 2 weeks by the geoportal framework. Third we provide a collaborative environment between different governmental structures via the geoportal, while many conflicts and mismatches have been a critical issue of governmental administration processes.

A falls case summary: Application of the public health nursing intervention wheel.

PubMed

Leahy-Warren, Patricia; Day, Mary Rose; Philpott, Lloyd; Glavin, Kari; Gjevjon, Edith Roth; Steffenak, Anne Kjersti Myhrene; Nordhagen, Live S; Egge, Hilde; Healy, Elizabeth; Mulcahy, Helen

2018-04-20

The Public Health Intervention Wheel (PHIW) is a population-based practice model that encompasses three levels of practice (community, systems, and individual/family) and 17 public health interventions. Each intervention and practice level contributes to improving population health. Public health nurses (PHNs) provide care at the three levels of practice. Prevention of falls is a public health issue and the majority of falls happen at home. Therefore, prevention and management of falls in the community could benefit from a public health systems approach by PHNs underpinned by the PHIW. A hypothetical case is presented of a 78-year-old gentleman who had a fall which resulted in a fractured right acetabulum and surgery before being discharged home. The aim of this paper was to use a case summary to illustrate PHN practice in the context of the PHIW as applied to falls management and prevention. This paper focuses on fall incidence and PHN response in Ireland and Norway. The PHIW is described and relevant interventions from the PHIW are applied to PHN practice in managing the case. The PHIW model provides insight into the potential scope of public health nursing in falls, articulating PHN practice in the community. © 2018 Wiley Periodicals, Inc.

Issues Management and the Role of Strategic Planning. AIR 1985 Annual Forum Paper.

ERIC Educational Resources Information Center

Lozier, G. Gregory; Chittipeddi, Kumar

The integration of issues management into the institutional strategic planning process at Pennsylvania State University is discussed. The significance of issues management as an organizational process is also considered. Stages of the issues management process are: (1) scanning the external environment to identify strategic issues; (2) analyzing…

A Case Study of Obsolescence Management Constraints During Development of Sustainment-Dominated Systems

NASA Astrophysics Data System (ADS)

Welch, Jonathan

This case study focused on obsolescence management constraints that occur during development of sustainment-dominated systems. Obsolescence management constraints were explored in systems expected to last 20 years or more and that tend to use commercial off-the-shelf products. The field of obsolescence has received little study, but obsolescence has a large cost for military systems. Because developing complex systems takes an average of 3 to 8 years, and commercial off-the-shelf components are typically obsolete within 3 to 5 years, military systems are often deployed with obsolescence issues that are transferred to the sustainment community to determine solutions. The main problem addressed in the study was to identify the constraints that have caused 70% of military systems under development to be obsolete when they are delivered. The purpose of the study was to use a qualitative case study to identify constraints that interfered with obsolescence management occurring during the development stages of a program. The participants of this case study were managers, subordinates, and end-users who were logistics and obsolescence experts. Researchers largely agree that proactive obsolescence management is a lower cost solution for sustainment-dominated systems. Program managers must understand the constraints and understand the impact of not implementing proactive solutions early in the development program lifecycle. The conclusion of the study found several constraints that prevented the development program from early adoption of obsolescence management theories, specifically pro-active theories. There were three major themes identified: (a) management commitment, (b) lack of details in the statement of work, and (c) vendor management. Each major theme includes several subthemes. The recommendation is future researchers should explore two areas: (a) comparing the cost of managing obsolescence early in the development process versus the costs of managing later, (b) exploring the costs and value to start a centralized obsolescence group at each major defense contractor location.

Improving Performance of the System Safety Function at Marshall Space Flight Center

NASA Technical Reports Server (NTRS)

Kiessling, Ed; Tippett, Donald D.; Shivers, Herb

2004-01-01

The Columbia Accident Investigation Board (CAIB) determined that organizational and management issues were significant contributors to the loss of Space Shuttle Columbia. In addition, the CAIB observed similarities between the organizational and management climate that preceded the Challenger accident and the climate that preceded the Columbia accident. To prevent recurrence of adverse organizational and management climates, effective implementation of the system safety function is suggested. Attributes of an effective system safety program are presented. The Marshall Space Flight Center (MSFC) system safety program is analyzed using the attributes. Conclusions and recommendations for improving the MSFC system safety program are offered in this case study.

Data Grid Management Systems

NASA Technical Reports Server (NTRS)

Moore, Reagan W.; Jagatheesan, Arun; Rajasekar, Arcot; Wan, Michael; Schroeder, Wayne

2004-01-01

The "Grid" is an emerging infrastructure for coordinating access across autonomous organizations to distributed, heterogeneous computation and data resources. Data grids are being built around the world as the next generation data handling systems for sharing, publishing, and preserving data residing on storage systems located in multiple administrative domains. A data grid provides logical namespaces for users, digital entities and storage resources to create persistent identifiers for controlling access, enabling discovery, and managing wide area latencies. This paper introduces data grids and describes data grid use cases. The relevance of data grids to digital libraries and persistent archives is demonstrated, and research issues in data grids and grid dataflow management systems are discussed.

Detecting distant homologies on protozoans metabolic pathways using scientific workflows.

PubMed

da Cruz, Sérgio Manuel Serra; Batista, Vanessa; Silva, Edno; Tosta, Frederico; Vilela, Clarissa; Cuadrat, Rafael; Tschoeke, Diogo; Dávila, Alberto M R; Campos, Maria Luiza Machado; Mattoso, Marta

2010-01-01

Bioinformatics experiments are typically composed of programs in pipelines manipulating an enormous quantity of data. An interesting approach for managing those experiments is through workflow management systems (WfMS). In this work we discuss WfMS features to support genome homology workflows and present some relevant issues for typical genomic experiments. Our evaluation used Kepler WfMS to manage a real genomic pipeline, named OrthoSearch, originally defined as a Perl script. We show a case study detecting distant homologies on trypanomatids metabolic pathways. Our results reinforce the benefits of WfMS over script languages and point out challenges to WfMS in distributed environments.

Ethical issues in engineering models: an operations researcher's reflections.

PubMed

Kleijnen, J

2011-09-01

This article starts with an overview of the author's personal involvement--as an Operations Research consultant--in several engineering case-studies that may raise ethical questions; e.g., case-studies on nuclear waste, water management, sustainable ecology, military tactics, and animal welfare. All these case studies employ computer simulation models. In general, models are meant to solve practical problems, which may have ethical implications for the various stakeholders; namely, the modelers, the clients, and the public at large. The article further presents an overview of codes of ethics in a variety of disciples. It discusses the role of mathematical models, focusing on the validation of these models' assumptions. Documentation of these model assumptions needs special attention. Some ethical norms and values may be quantified through the model's multiple performance measures, which might be optimized. The uncertainty about the validity of the model leads to risk or uncertainty analysis and to a search for robust models. Ethical questions may be pressing in military models, including war games. However, computer games and the related experimental economics may also provide a special tool to study ethical issues. Finally, the article briefly discusses whistleblowing. Its many references to publications and websites enable further study of ethical issues in modeling.

Distributed Information System Development: Review of Some Management Issues

NASA Astrophysics Data System (ADS)

Mishra, Deepti; Mishra, Alok

Due to the proliferation of the Internet and globalization, distributed information system development is becoming popular. In this paper we have reviewed some significant management issues like process management, project management, requirements management and knowledge management issues which have received much attention in distributed development perspective. In this literature review we found that areas like quality and risk management issues could get only scant attention in distributed information system development.

Infectious diseases of animals and plants: an interdisciplinary approach.

PubMed

Wilkinson, Katy; Grant, Wyn P; Green, Laura E; Hunter, Stephen; Jeger, Michael J; Lowe, Philip; Medley, Graham F; Mills, Peter; Phillipson, Jeremy; Poppy, Guy M; Waage, Jeff

2011-07-12

Animal and plant diseases pose a serious and continuing threat to food security, food safety, national economies, biodiversity and the rural environment. New challenges, including climate change, regulatory developments, changes in the geographical concentration and size of livestock holdings, and increasing trade make this an appropriate time to assess the state of knowledge about the impact that diseases have and the ways in which they are managed and controlled. In this paper, the case is explored for an interdisciplinary approach to studying the management of infectious animal and plant diseases. Reframing the key issues through incorporating both social and natural science research can provide a holistic understanding of disease and increase the policy relevance and impact of research. Finally, in setting out the papers in this Theme Issue, a picture of current and future animal and plant disease threats is presented.

Patient complaints about hospital services: applying a complaint taxonomy to analyse and respond to complaints.

PubMed

Harrison, Reema; Walton, Merrilyn; Healy, Judith; Smith-Merry, Jennifer; Hobbs, Coletta

2016-04-01

To explore the applicability of a patient complaint taxonomy to data on serious complaint cases. Qualitative descriptive study. Complaints made to the New South Wales (NSW) Health Care Complaints Commission, Australia between 2005 and 2010. All 138 cases of serious complaints by patients about public hospitals and other health facilities investigated in the 5-year period. A thematic analysis of the complaints was conducted to identify particular complaint issues and the Reader et al. (Patient complaints in healthcare systems: a systematic review and coding taxonomy. BMJ Qual Saf 2014;23:678-89.) patient complaint taxonomy was then used to classify these issues into categories and sub-categories. The 138 investigated cases revealed 223 complaint issues. Complaint issues were distributed into the three domains of the patient complaint taxonomy: clinical, management and relationships. Complaint issue most commonly related to delayed diagnosis, misdiagnosis, medication errors, inadequate examinations, inadequate/nil treatment and quality of care including nursing care. The types of complaints from patients about their healthcare investigated by the NSW Commission were similar to those received by other patient complaint entities in Australia and worldwide. The application of a standard taxonomy to large numbers of complaints cases from different sources would enable the creation of aggregated data. Such data would have better statistical capacity to identify common safety and quality healthcare problems and so point to important areas for improvement. Some conceptual challenges in devising and using a taxonomy must be addressed, such as inherent problems in ensuring coding consistency, and giving greater weight to patient concerns about their treatment. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Why Leading Consumer Product Companies Develop Proactive Chemical Management Strategies.

PubMed

Scruggs, Caroline E; Van Buren, Harry J

2016-05-01

Scholars have studied the various pressures that companies face related to socially responsible behavior when stakeholders know the particular social issues under consideration. Many have examined social responsibility in the context of environmental responsibility and the general approaches companies take regarding environmental management. The issue of currently unregulated, but potentially hazardous, chemicals in consumer products is not well understood by the general public, but a number of proactive consumer product companies have voluntarily adopted strategies to minimize use of such chemicals. These companies are exceeding regulatory requirements by restricting from their products chemicals that could harm human or environmental health, despite the fact that these actions are costly. They do not usually advertise the details of their strategies to end consumers. This article uses interviews with senior environmental directors of 20 multinational consumer product companies to investigate why these companies engage in voluntary chemicals management. The authors conclude that the most significant reasons are to achieve a competitive advantage and stay ahead of regulations, manage relationships and maintain legitimacy with stakeholders, and put managerial values into practice. Many of the characteristics related to the case of chemicals management are extendable to other areas of stakeholder management in which risks to stakeholders are either unknown or poorly understood.

Why Leading Consumer Product Companies Develop Proactive Chemical Management Strategies

PubMed Central

Scruggs, Caroline E.; Van Buren, Harry J.

2014-01-01

Scholars have studied the various pressures that companies face related to socially responsible behavior when stakeholders know the particular social issues under consideration. Many have examined social responsibility in the context of environmental responsibility and the general approaches companies take regarding environmental management. The issue of currently unregulated, but potentially hazardous, chemicals in consumer products is not well understood by the general public, but a number of proactive consumer product companies have voluntarily adopted strategies to minimize use of such chemicals. These companies are exceeding regulatory requirements by restricting from their products chemicals that could harm human or environmental health, despite the fact that these actions are costly. They do not usually advertise the details of their strategies to end consumers. This article uses interviews with senior environmental directors of 20 multinational consumer product companies to investigate why these companies engage in voluntary chemicals management. The authors conclude that the most significant reasons are to achieve a competitive advantage and stay ahead of regulations, manage relationships and maintain legitimacy with stakeholders, and put managerial values into practice. Many of the characteristics related to the case of chemicals management are extendable to other areas of stakeholder management in which risks to stakeholders are either unknown or poorly understood. PMID:27471326

Key factors of case management interventions for frequent users of healthcare services: a thematic analysis review

PubMed Central

Hudon, Catherine; Chouinard, Maud-Christine; Lambert, Mireille; Diadiou, Fatoumata; Bouliane, Danielle; Beaudin, Jérémie

2017-01-01

Objective The aim of this paper was to identify the key factors of case management (CM) interventions among frequent users of healthcare services found in empirical studies of effectiveness. Design Thematic analysis review of CM studies. Methods We built on a previously published review that aimed to report the effectiveness of CM interventions for frequent users of healthcare services, using the Medline, Scopus and CINAHL databases covering the January 2004–December 2015 period, then updated to July 2017, with the keywords ‘CM’ and ‘frequent use’. We extracted factors of successful (n=7) and unsuccessful (n=6) CM interventions and conducted a mixed thematic analysis to synthesise findings. Chaudoir’s implementation of health innovations framework was used to organise results into four broad levels of factors: (1) environmental/organisational level, (2) practitioner level, (3) patient level and (4) programme level. Results Access to, and close partnerships with, healthcare providers and community services resources were key factors of successful CM interventions that should target patients with the greatest needs and promote frequent contacts with the healthcare team. The selection and training of the case manager was also an important factor to foster patient engagement in CM. Coordination of care, self-management support and assistance with care navigation were key CM activities. The main issues reported by unsuccessful CM interventions were problems with case finding or lack of care integration. Conclusions CM interventions for frequent users of healthcare services should ensure adequate case finding processes, rigorous selection and training of the case manager, sufficient intensity of the intervention, as well as good care integration among all partners. Other studies could further evaluate the influence of contextual factors on intervention impacts. PMID:29061623

XDR-TB: an outcome of programmatic management of TB in India.

PubMed

Mishra, Gyanshankar; Ghorpade, S V; Mulani, Jasmin

2014-01-01

A significantly strengthened Revised National Tuberculosis Control Programme (RNTCP) is currently operational in India. In this case-based commentary, we describe the plight of a patient who developed extensive drug-resistant tuberculosis (XDR-TB) despite having received treatment under the RNTCP for a long period. Our aim is to analyse the programmatic management of tuberculosis in India by highlighting and discussing various issues related to the treatment received by the patient. Further, the article explores whether there is a need to incorporate an ethical element into the RNTCP as it stands today.

Quality of Maternal and Neonatal Care in Albania, Turkmenistan and Kazakhstan: A Systematic, Standard-Based, Participatory Assessment

PubMed Central

Tamburlini, Giorgio; Siupsinskas, Gelmius; Bacci, Alberta

2011-01-01

Background Progress in maternal and neonatal mortality has been slow in many countries despite increasing access to institutional births, suggesting deficiencies in the quality of care. We carried out a systematic assessment of the quality of maternal and newborn care in three CEE/CIS countries, using an innovative approach to identify priority issues and promote action. Methods A standard-based tool, covering over 400 items grouped in 13 main areas ranging from support services to case management, was used to assess a sample of ten maternity hospitals in Albania, Kazakhstan and Turkmenistan. Sources of information were visit to services, medical records, observation of cases, and interviews with staff and mothers. A score (range 0 to 3) was attributed to each item and area of care. The assessment was carried out by a multidisciplinary team of international and national professionals. Local managers and staff provided the necessary information and were involved in discussing the findings and the priority actions. Results Quality of care was found to be substandard in all 13 areas. The lowest scores (between one and two) were obtained by: management of normal labour, delivery, obstetric complications and sick babies; infection prevention; use of guidelines and audits; monitoring and follow-up. Neonatal care as a whole scored better than obstetric care. Interviewed mothers identified lack of information, insufficient support during labour and lack of companionship as main issues. Actions to improve quality of care were identified at facility as well as at central level and framed according to main health system functions. Conclusions Quality of care is a key issue to improve maternal and neonatal outcomes, particularly in countries such as CEE/CIS where access to institutional births is nearly universal. Approaches that involve health professionals and managers in comprehensive, action-oriented assessments of quality of care are promising and should be further supported. PMID:22216110

Energy management study: A proposed case of government building

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

Tahir, Mohamad Zamhari; Nawi, Mohd Nasrun Mohd; Baharum, Mohd Faizal

Align with the current needs of the sustainable and green technology in Malaysian construction industry, this research is conducted to seek and identify opportunities to better manage energy use including the process of understand when, where, and how energy is used in a building. The purpose of this research is to provide a best practice guideline as a practical tool to assist construction industry in Malaysia to improve the energy efficiency of the office building during the post-production by reviewing the current practice of the building operation and maintenance in order to optimum the usage and reduce the amount ofmore » energy input into the building. Therefore, this paper will review the concept of maintenance management, current issue in energy management, and on how the research process will be conducted. There are several process involves and focuses on technical and management techniques such as energy metering, tracing, harvesting, and auditing based on the case study that will be accomplish soon. Accordingly, a case study is appropriate to be selected as a strategic research approach in which involves an empirical investigation of a particular contemporary phenomenon within its real life context using multiple sources of evidence for the data collection process. A Government office building will be selected as an appropriate case study for this research. In the end of this research, it will recommend a strategic approach or model in a specific guideline for enabling energy-efficient operation and maintenance in the office building.« less

Energy management study: A proposed case of government building

NASA Astrophysics Data System (ADS)

Tahir, Mohamad Zamhari; Nawi, Mohd Nasrun Mohd; Baharum, Mohd Faizal

2015-05-01

Align with the current needs of the sustainable and green technology in Malaysian construction industry, this research is conducted to seek and identify opportunities to better manage energy use including the process of understand when, where, and how energy is used in a building. The purpose of this research is to provide a best practice guideline as a practical tool to assist construction industry in Malaysia to improve the energy efficiency of the office building during the post-production by reviewing the current practice of the building operation and maintenance in order to optimum the usage and reduce the amount of energy input into the building. Therefore, this paper will review the concept of maintenance management, current issue in energy management, and on how the research process will be conducted. There are several process involves and focuses on technical and management techniques such as energy metering, tracing, harvesting, and auditing based on the case study that will be accomplish soon. Accordingly, a case study is appropriate to be selected as a strategic research approach in which involves an empirical investigation of a particular contemporary phenomenon within its real life context using multiple sources of evidence for the data collection process. A Government office building will be selected as an appropriate case study for this research. In the end of this research, it will recommend a strategic approach or model in a specific guideline for enabling energy-efficient operation and maintenance in the office building.

Earnings Management before Rights Issues and the Subsequent Cash Transfer in Chinese Firms

NASA Astrophysics Data System (ADS)

Tsai, Bi-Huei

2009-08-01

Unlike private enterprises in developed markets, political influence is profound upon Chinese state-dominated firms. Under this consideration, this paper demonstrates how political impact interferes in Chinese managers' decisions. State-assigned managers were found to deliberately transfer cash raised via rights issues from the public shareholders to the state by cash dividends in order to please Chinese politicians. Especially, to meet the regulatory requirement of rights issues, managers from firms which distributed more cash dividends in the same year of rights issues were more likely to inflate earnings before rights issues. The earnings inflation which managers use to boost firm's incomes is defined as "earnings management." Furthermore, the empirical results also exhibit that firm's close relationship with the state enables managers to obtain approvals of rights issues easily, which reduces the firm's earnings management tendency. The manager's incentives of earnings management is closely attributed to the political intervention.

The Views of Ex-Police Officers on Child Abuse Case Attrition in the United Kingdom.

PubMed

Krahenbuhl, Sarah J; Dent, Helen R

2017-11-01

Attrition in child abuse cases is of continuing concern. International research has produced evidence to suggest that the form and quality of the evidence available in many child abuse cases is of insufficient quality to allow progression through the judicial system. Recent revelations have led to an increase in public and professional awareness of the prevalence of child sexual abuse, and how this is managed by the legal and social care systems. The aim of this research was to explore the opinions of ex-Police Officers who had direct experience relating to the management of child abuse cases about the factors affecting case progression. Seven ex-Police Officers were interviewed and the transcribed data were thematically analyzed. The five main themes derived from the data were Global Myths, Assumptions, and Misconceptions; Suitability; Resources; Professionals' Attributes; and Working Together. These themes demonstrated that the primary issues indicated by ex-Police Officers were more about relationships between professionals, an understanding of the child's perspective, and their subsequent involvement in the legal processes than simply being related to a lack of resources.

What Can You Do with a Returned Sample of Martian Dust?

NASA Technical Reports Server (NTRS)

Zolensky, Michael E.; Nakamura-Messenger, K.

2007-01-01

A major issue that we managed to successfully address for the Stardust Mission was the magnitude and manner of preliminary examination (PET) of the returned samples, which totaled much less than 1 mg. Not since Apollo and Luna days had anyone faced this issue, and the lessons of Apollo PET were not extremely useful because of the very different sample masses in this case, and the incredible advances in analytical capabilities since the 1960s. This paper reviews some of the techniques for examination of small very rare samples that would be returned from Mars missions.

Mental health issues in the workplace: maintaining a productive work force.

PubMed

Raderstorf, Mark; Kurtz, Jennifer

2006-08-01

Occupational health nurses must intervene early and validate the conditions and experiences of employees with psychiatric disabilities. Occupational health nurses must ensure employees are receiving appropriate treatment. They must be aware of and prepared to mitigate iatrogenic influences. Occupational health nurses can facilitate resolution of workplace conflicts and issues regarding changing supervisors or departments. They can also facilitate return to work by establishing clear restrictions and coordinating accommodations. compassionate and supportive, yet assertive, approach is key to managing mental health disability. It will, in most cases, facilitate successful return to full-time work.

Cervicobrachialgia after spinal surgery.

PubMed

Breivik, Harald

2014-12-01

A case of cervicobrachialgia is presented in which the patient expressed fear of becoming addicted to opioids. Alternative analgesic approaches including anticonvulsants, transcutaneous electrical nerve stimulation (TENS), and physical therapy are discussed. This report is adapted from paineurope 2014; Issue 2, ©Haymarket Medical Publications Ltd, and is presented with permission. Paineurope is provided as a service to pain management by Mundipharma International, LTD and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication.

Conducting a surveillance problem analysis on poor feedback from Reference Laboratory, Liberia, February 2016.

PubMed

Frimpong, Joseph Asamoah; Amo-Addae, Maame Pokuah; Adewuyi, Peter Adebayo; Hall, Casey Daniel; Park, Meeyoung Mattie; Nagbe, Thomas Knue

2017-01-01

The laboratory plays a major role in surveillance, including confirming the start and end of an outbreak. Knowing the causative agent for an outbreak informs the development of response strategies and management plans for a public health event. However, issues and challenges may arise that limit the effectiveness or efficiency of laboratories in surveillance. This case study applies a systematic approach to analyse gaps in laboratory surveillance, thereby improving the ability to mitigate these gaps. Although this case study concentrates on factors resulting in poor feedback from the laboratory, practise of this general approach to problem analysis will confer skills required in analysing most public health issues. This case study was developed based on a report submitted by the district surveillance officer in Grand Bassa County, Liberia, as a resident of the Liberian Frontline Field Epidemiology Training Program in 2016. This case study will serve as a training tool to reinforce lectures on surveillance problem analysis using the fishbone approach. It is designed for public health training in a classroom setting and can be completed within 2 hours 30 minutes.

Deontological and utilitarian ethics: a brief introduction in the context of disorders of consciousness.

PubMed

Playford, Richard C; Roberts, Tom; Playford, E Diane

2015-01-01

The aims of this paper are to discuss three different ethical frameworks; to briefly consider some of the philosophical positions concerning the nature of personhood. Clear consideration of these issues demonstrates the complexity of decision making in persisting disorders of consciousness. Three different ethical frameworks, Kantian deontology, act utilitarianism and rule utilitarianism, are described and three different accounts of personhood are presented and analysed. These result in very different approaches to the management of patients in permanent vegetative states (PVSs), making it possible to argue for withdrawal of clinically assisted nutrition and hydration in all cases, considering the issues on a case by case basis or continuing to treat all patients whatever their wishes. These results explain why doctors often have different views on how to treat patients in PVS, particularly with regard to the withdrawal of clinically assisted nutrition and hydration. Understanding such issues may help clinicians articulate more clearly the reasons for their intuitions surrounding the management of patients in PVSs. Implications for Rehabilitation Patients with persisting disorders of consciousness pose significant dilemmas for clinicians and family members. Utilitarianism is a consequentialist theory, that is, it is concerned with the outcome of our actions to determine their morality. It is the concept that the right action is the one that will result in "the greatest amount of good for the greatest number". Deontological ethics suggests that there are certain sorts of acts that are wrong in themselves independent of the result of such actions. Personhood can be approached from a variety of perspectives including biological, relational, religious and psychological. Understanding different ethical frameworks, and the nature of personhood, may help clinicians articulate more clearly the reasons for their intuitions.

Current causes and management of violence against women in Nigeria.

PubMed

Aimakhu, C O; Olayemi, O; Iwe, C A B; Oluyemi, F A; Ojoko, I E; Shoretire, K A; Adeniji, R A; Aimakhu, V E

2004-01-01

Violence against women is an important health and human rights issue. It carries with it both short- and long-term sequelae for women that can affect both their physical and psychological wellbeing. Every day obstetric providers treat patients who have been assaulted. Timely identification can interrupt the cycle of violence, prevent further injury and initiate the help-seeking process. The objectives of this study were to survey how often Nigerian obstetrician-gynaecologists see these patients in their practice and to describe the demographics and management of their most recent case so as to give an idea of the extent of the problem. This is especially important as abuse is grossly under-reported because the victims are afraid to report it because of male dominance in society and the fear of losing their homes. We used a self-administered questionnaire survey of 138 practising obstetricians and gynaecologists in Nigeria. Questions were asked about the yearly estimation of cases seen and how recently a case was seen. The type of abuse, risk factors and management of their most recent case was also documented. Most (98.6%) obstetricians surveyed had previously managed a case of violence. The mean estimate of abused women seen was 7.0 per year. Details of the last case managed were recollected by 91.3% of respondents. The majority (51.6%) of patients were pregnant. The assailant was the husband in 69.8% of cases and the most common factor for abuse was as a result of women requesting money for the family needs from their husbands. The most common type of abuse was physical (79.4%), with 34.9% of patients sustaining cuts. Treatment and counselling were the forms of management in most cases. The police were informed in 9.5% of cases and one obstetrician had to give evidence in court. Of the pregnant abused women, 73.8% had live births. Better job opportunities and female empowerment can reduce the risk of violence. Obstetricians should screen routinely for battery, provide education about violence, assess the danger, review safety plans and refer women appropriately. We cannot solve the problem alone, but sensitivity and commitment can begin to make a difference.

Perspective: Conflict of interest and professional organizations: considerations and recommendations.

PubMed

Camilleri, Michael; Parke, David W

2010-01-01

There are differences in conflicts of interest (COIs) in professional organizations compared with academic medical centers. The authors discuss nine major questions pertaining to industry relationships of professional organizations: (1) What makes COI management different in professional membership organizations? (2) What COI challenges are specific to professional organizations? (3) What are potential impacts of perceived or real COIs involving professional organizations and the management of COIs? (4) Is regulation necessary, or should professional organizations proactively resolve COI issues independently? (5) Are guidelines portable from academic medical centers to professional organizations? (6) What approaches may be considered for managing COIs of the organization's leaders? (7) What approaches are reasonable for managing COI issues at professional meetings? (8) What approaches are important for integrity of educational programs, publications, and products? and (9) What approaches are reasonable for managing and enforcing COI guidelines on an ongoing basis? Responses to these questions focus on four principles: First, a code of ethics governing general behavior of members and safeguarding the interest of patients must be in place; second, the monitoring and management of COI for leadership, including, in some cases, recusal from certain activities; third, the pooling and consistent, transparent management of unrestricted grants from corporate sponsors; and, fourth, the management of industry marketing efforts at membership meetings to ensure their appropriateness. The perspectives offered are intended to encourage individuals and learned bodies to further study and provide commentary and recommendations on managing COIs of a professional organization.

Missing Link: Integrated Individual Leadership Development, Employee Engagement, and Customer Value-Added Improvement

ERIC Educational Resources Information Center

Heldenbrand, Lois; Simms, Michael S.

2012-01-01

Long-term care is a key public issue that affects all of us in some way at some time of our lives. Nowhere is performance improvement and quality management more imperative. Through an 8-month field study and follow-up case study, we discuss how using an integrated approach to individual leadership development, employee engagement, and customer…

The Impact of Fathers' Work and Family Conflicts on Children's Self-Esteem: The Hong Kong Case

ERIC Educational Resources Information Center

Lau, Yuk King

2010-01-01

Work and family conflicts are always viewed as issues of human resource management or occupational health. Insufficient attention has been focused on the impact on child development and quality of parenting, especially regarding the impact of a father's work. To examine the impact of work and family conflicts on the quality of father-child…

Accounting Control Technology Using SAP: A Case-Based Approach

ERIC Educational Resources Information Center

Ragan, Joseph; Puccio, Christopher; Talisesky, Brandon

2014-01-01

The Sarbanes-Oxley Act (SOX) revolutionized the accounting and audit industry. The use of preventative and process controls to evaluate the continuous audit process done via an SAP ERP ECC 6.0 system is key to compliance with SOX and managing costs. This paper can be used in a variety of ways to discuss issues associated with auditing and testing…

The Management of Pupil Difference in Catholic-Protestant and Palestinian-Jewish Integrated Education in Northern Ireland and Israel

ERIC Educational Resources Information Center

McGlynn, Claire; Bekerman, Zvi

2007-01-01

This paper considers issues related to integration in education, specifically those related to the integration of ethnic/religious populations in conflict. The case study we will use is the educating together of Catholic and Protestant children and Palestinian and Jewish children in two troubled societies, Northern Ireland and Israel, where…

The Regulation of Teaching as Symbolic Politics: Rituals of Order, Blame and Redemption

ERIC Educational Resources Information Center

Lefstein, Adam

2013-01-01

This article explores the school inspection as a political ritual for the management of tensions between competition and equality inherent in neo-liberal educational regulatory regimes. At the centre of the article is a case study of how teachers in an allegedly failing working-class English primary school coped with issues of social class,…

Knowledge Sharing and Dialogue among Information Technology Workers: A Case Study Using a Public Works Department

ERIC Educational Resources Information Center

Harrison, Priscilla

2013-01-01

The problem addressed in this study is the willingness or reluctance of information technology (IT) knowledge workers and managers to share knowledge. The purpose of the study was to examine the willingness or unwillingness of technical personnel in IT to share technical knowledge and the issues surrounding their reluctance, if any. The study…

A Scientific Approach to Monitoring Public Perceptions of Scientific Issues

ERIC Educational Resources Information Center

Fisher, N. I.; Lee, A. J.; Cribb, J. H. J.

2013-01-01

This article reports on a three-year study to evaluate a new approach to increasing the impact and adoption of new scientific findings and technologies. The purpose of the case study was to monitor the public's perception of the severity of problems posed by invasive animal species and of possible methods of managing them. A real-time "moving…

Finding the forest in the trees. The challenge of combining diverse environmental data

NASA Technical Reports Server (NTRS)

1995-01-01

Development of analytical and functional guidelines to help researchers and technicians engaged in interdisciplinary research to better plan and implement their supporting data management activities is addressed. An emphasis is on the projects that involve both geophysical and ecological issues. Six case studies were used to identify and to understand problems associated with collecting, integrating, and analyzing environmental data from local to global spatial scales and over a range of temporal scales. These case studies were also used to elaborate the common barriers to interfacing data of disparate sources and types. A number of lessons derived from the case studies are summarized and analyzed.

Ethical decision making in pain management: a conceptual framework.

PubMed

Carvalho, Ana Sofia; Martins Pereira, Sandra; Jácomo, António; Magalhães, Susana; Araújo, Joana; Hernández-Marrero, Pablo; Costa Gomes, Carlos; Schatman, Michael E

2018-01-01

The practice and study of pain management pose myriad ethical challenges. There is a consensual opinion that adequate management of pain is a medical obligation rooted in classical Greek practice. However, there is evidence that patients often suffer from uncontrolled and unnecessary pain. This is inconsistent with the leges artis, and its practical implications merit a bioethical analysis. Several factors have been identified as causes of uncontrolled and unnecessary pain, which deprive patients from receiving appropriate treatments that theoretically they have the right to access. Important factors include (with considerable regional, financial, and cultural differences) the following: 1) failure to identify pain as a priority in patient care; 2) failure to establish an adequate physician-patient relationship; 3) insufficient knowledge regarding adequate prescription of analgesics; 4) conflicting notions associated with drug-induced risk of tolerance and fear of addiction; 5) concerns regarding "last-ditch" treatments of severe pain; and 6) failure to be accountable and equitable. The aim of this article was to establish that bioethics can serve as a framework for addressing these challenging issues and, from theoretical to practical approaches, bioethical reflection can contextualize the problem of unrelieved pain. This article is organized into three parts. First, we illustrate that pain management and its undertreatment are indeed ethical issues. The second part describes possible ethical frameworks that can be combined and integrated to better define the ethical issues in pain management. Finally, we discuss possible directions forward to improve ethical decision making in pain management. We argue that 1) the treatment of pain is an ethical obligation, 2) health science schools, especially medical training institutions, have the duty to teach pain management in a comprehensive fashion, and 3) regulatory measures, which prevent patients from access to opioid treatment as indicated in their cases, are unethical and should be reconsidered. Developing an ethical framework for pain management will result in enhanced quality of care, linking the epistemic domains of pain management to their anthropological foundations, thereby making them ethically sound.

Identifying emerging issues in forestry as a tool for research planning.

Treesearch

Hans M. Gregersen; Allen L. Lundgren; Pamela J. Jakes; David N. Bengston

1989-01-01

A Delphi exercise is used to identify emerging issues in National Forest management and use, the relative importance of the issues, and barriers to resolving issues. USDA Forest Service managers agree on the importance of the 11 issues identified; however, researchers and National Forest managers do not always agree on the importance of issues or barriers.

Centralized remote structural monitoring and management of real-time data

NASA Astrophysics Data System (ADS)

Han, Liting; Newhook, John P.; Mufti, Aftab A.

2004-07-01

Structural health monitoring (SHM) activities in civil engineering are increasing at a rapid pace in both research and field applications. This paper addresses the specific issue of incorporating internet technology into a structural health monitoring program. The issue of data volume versus communication speed is discussed along with a practical solution employed by ISIS Canada. The approach is illustrated through reference to several current case studies which include two bridges and a statue. It is seen that although the specifics of the projects and monitoring needs are different, the manner in which on-line monitoring can be conducted is very similar and easily allows for centralized monitoring. A general framework for website construction integrating sensing data and web camera options are presented. Issues related to simple real-time performance indices versus more comprehensive complex data analysis are discussed. Examples of on-line websites which allow visualization of new and historic data are presented. The paper also discusses future activities and research needs related to centralized remote structural monitoring and management of real-time data.

Nurse managers' experience with ethical issues in six government hospitals in Malaysia: a cross-sectional study.

PubMed

Musa, Maizura binti; Harun-Or-Rashid, M D; Sakamoto, Junichi

2011-11-16

Nurse managers have the burden of experiencing frequent ethical issues related to both their managerial and nursing care duties, according to previous international studies. However, no such study was published in Malaysia. The purpose of this study was to explore nurse managers' experience with ethical issues in six government hospitals in Malaysia including learning about the way they dealt with the issues. A cross-sectional study was conducted in August-September, 2010 involving 417 (69.2%) of total 603 nurse managers in the six Malaysian government hospitals. Data were collected using three-part self-administered questionnaire. Part I was regarding participants' demographics. Part II was about the frequency and areas of management where ethical issues were experienced, and scoring of the importance of 11 pre-identified ethical issues. Part III asked how they dealt with ethical issues in general; ways to deal with the 11 pre-identified ethical issues, and perceived stress level. Data were analyzed using descriptive statistics, cross-tabulations and Pearson's Chi-square. A total of 397 (95.2%) participants experienced ethical issues and 47.2% experienced them on weekly to daily basis. Experiencing ethical issues were not associated with areas of practice. Top area of management where ethical issues were encountered was "staff management", but "patient care" related ethical issues were rated as most important. Majority would "discuss with other nurses" in dealing generally with the issues. For pre-identified ethical issues regarding "patient care", "discuss with doctors" was preferred. Only 18.1% referred issues to "ethics committees" and 53.0% to the code of ethics. Nurse managers, regardless of their areas of practice, frequently experienced ethical issues. For dealing with these, team-approach needs to be emphasized. Proper understanding of the code of ethics is needed to provide basis for reasoning.

The revised WHO dengue case classification: does the system need to be modified?

PubMed

Hadinegoro, Sri Rezeki S

2012-05-01

There has been considerable debate regarding the value of both the 1997 and 2009 World Health Organization (WHO) dengue case classification criteria for its diagnosis and management. Differentiation between classic dengue fever (DF) and dengue haemorrhagic fever (DHF) or severe dengue is a key aspect of dengue case classification. The geographic expansion of dengue and its increased incidence in older age groups have contributed to the limited applicability of the 1997 case definitions. Clinical experience of dengue suggests that the illness presents as a spectrum of disease instead of distinct phases. However, despite the rigid grouping of dengue into DF, DHF and dengue shock syndrome (DSS), overlap between the different manifestations has often been observed, which has affected clinical management and triage of patients. The findings of the DENCO study evaluating the 1997 case definitions formed the basis of the revised 2009 WHO case definitions, which classified the illness into dengue with and without warning signs and severe dengue. Although the revised scheme is more sensitive to the diagnosis of severe dengue, and beneficial to triage and case management, there remain issues with its applicability. It is considered by many to be too broad, requiring more specific definition of warning signs. Quantitative research into the predictive value of these warning signs on patient outcomes and the cost-effectiveness of the new classification system is required to ascertain whether the new classification system requires further modification, or whether elements of both classification systems can be combined.

Case for real-time systems development - Quo vadis?

NASA Technical Reports Server (NTRS)

Erb, Dona M.

1991-01-01

The paper focuses on the distinctive issues of computer-aided software engineering (CASE) products for the development of real-time systems. CASE technologies and associated standardization efforts are evolving from sets of conflicting interests. The majority of case products are intended for use in the development of management information systems. CASE products to support the development of large, complex real-time systems must provide additional capabilities. Generic concerns include the quality of the implementation of the required method for the phase of the system's development and whether the vendor is stable and committed to evolving the products in parallel with nonproprietary standards. The CASE market is undergoing considerable consolidation. The paper describes the major forces, cooperating entities, and remaining uncertainties that need to be weighed in near-term CASE procurements to limit risk of loss of investment in project time, trianing, and money.

Presentation and outcome of clinical poor performance in one health district over a 5-year period: 2002-2007.

PubMed

Cox, Stephen J; Holden, John D

2009-05-01

The detection, assessment, and management of primary care poor performance raise difficult issues for all those involved. Guidance has largely focused on managing the most serious cases where patient safety is severely compromised. The management of primary care poor performance has become an increasingly important part of primary care trust (PCT) work, but its modes of presentation and prevalence are not well known. To report the prevalence, presentation modes, and management of primary care poor performance cases presenting to one PCT over a 5-year period. A retrospective review of primary care poor performance cases in one district. St Helens PCT administered 35 practices with 130 GPs on the performers list, caring for 190 110 patients in North West England, UK. Cases presenting during 2002-2007 were initially reviewed by the chair of the PCT clinical executive committee. Anonymised data were then jointly reviewed by the assessor and another experienced GP advisor. There were 102 individual presentations (20 per year or one every 2-3 weeks) where clinician performance raised significant cause for concern occurred over the 5-year period. These concerns related to 37 individual clinicians, a range of 1-14 per clinician (mean 2.7). Whistleblowing by professional colleagues on 43 occasions was the most common presentation, of which 26 were from GPs about GPs. Patient complaints (18) were the second most common presentation. Twenty-seven clinicians were GPs, of whom the General Medical Council (GMC) were notified or involved in 13 cases. Clinicians were supported locally, and remedying was exclusively locally managed in 14 cases, and shared with an external organisation (such as the GMC or deanery) in another 12. Professional whistleblowing and patient complaints were the most common sources of presentation. Effective PCT teams are needed to manage clinicians whose performance gives cause for concern. Sufficient resources and both formal and informal ways of reporting concerns are essential.

How do primary health care teams learn to integrate intimate partner violence (IPV) management? A realist evaluation protocol.

PubMed

Goicolea, Isabel; Vives-Cases, Carmen; San Sebastian, Miguel; Marchal, Bruno; Kegels, Guy; Hurtig, Anna-Karin

2013-03-23

Despite the existence of ample literature dealing, on the one hand, with the integration of innovations within health systems and team learning, and, on the other hand, with different aspects of the detection and management of intimate partner violence (IPV) within healthcare facilities, research that explores how health innovations that go beyond biomedical issues-such as IPV management-get integrated into health systems, and that focuses on healthcare teams' learning processes is, to the best of our knowledge, very scarce if not absent. This realist evaluation protocol aims to ascertain: why, how, and under what circumstances primary healthcare teams engage (if at all) in a learning process to integrate IPV management in their practices; and why, how, and under what circumstances team learning processes lead to the development of organizational culture and values regarding IPV management, and the delivery of IPV management services. This study will be conducted in Spain using a multiple-case study design. Data will be collected from selected cases (primary healthcare teams) through different methods: individual and group interviews, routinely collected statistical data, documentary review, and observation. Cases will be purposively selected in order to enable testing the initial middle-range theory (MRT). After in-depth exploration of a limited number of cases, additional cases will be chosen for their ability to contribute to refining the emerging MRT to explain how primary healthcare learn to integrate intimate partner violence management. Evaluations of health sector responses to IPV are scarce, and even fewer focus on why, how, and when the healthcare services integrate IPV management. There is a consensus that healthcare professionals and healthcare teams play a key role in this integration, and that training is important in order to realize changes. However, little is known about team learning of IPV management, both in terms of how to trigger such learning and how team learning is connected with changes in organizational culture and values, and in service delivery. This realist evaluation protocol aims to contribute to this knowledge by conducting this project in a country, Spain, where great endeavours have been made towards the integration of IPV management within the health system.

Infectious diseases of animals and plants: an interdisciplinary approach

PubMed Central

Wilkinson, Katy; Grant, Wyn P.; Green, Laura E.; Hunter, Stephen; Jeger, Michael J.; Lowe, Philip; Medley, Graham F.; Mills, Peter; Phillipson, Jeremy; Poppy, Guy M.; Waage, Jeff

2011-01-01

Animal and plant diseases pose a serious and continuing threat to food security, food safety, national economies, biodiversity and the rural environment. New challenges, including climate change, regulatory developments, changes in the geographical concentration and size of livestock holdings, and increasing trade make this an appropriate time to assess the state of knowledge about the impact that diseases have and the ways in which they are managed and controlled. In this paper, the case is explored for an interdisciplinary approach to studying the management of infectious animal and plant diseases. Reframing the key issues through incorporating both social and natural science research can provide a holistic understanding of disease and increase the policy relevance and impact of research. Finally, in setting out the papers in this Theme Issue, a picture of current and future animal and plant disease threats is presented. PMID:21624914

Countertransference and failure to report child abuse and neglect.

PubMed

Pollak, J; Levy, S

1989-01-01

Though every state has laws requiring the report of suspected child abuse and neglect, failure to report remains a significant problem. Review of previous research on failure to report suggests that the reporters' anxieties about disrupting their relationship with the child's family as well as the reporters' gender, experience, and training affect willingness to report. Countertransference fear, guilt, shame, and sympathy are discussed as a basis for understanding the reporter's anxieties. We suggest that countertransference issues should be addressed in the training and ongoing practice of mandated reporters. The following mechanisms are offered to deal with this issue in training and practice: (1) teaching professionals about how countertransference reactions may arise during the reporting process (this training may include the use of risk management groups for private practitioners); (2) identification of a community child abuse expert for consultation; and (3) educating child protection workers about psychodynamics aspects of case management.

The Canadian Management of Bovine Spongiform Encephalopathy in Historical and Scientific Perspective, 1990-2014.

PubMed

Quimby, Alexandra E; Shamy, Michel C F

2015-11-01

On February 11, 2015, the Canadian Food Inspection Agency announced that a cow born and raised in Alberta had tested positive for bovine spongiform encephalopathy (BSE), commonly known as mad cow disease. BSE is a prion disease of cattle that, when transmitted to humans, produces a fatal neurodegenerative disease known as variant Creutzfeldt-Jakob disease. We believe that this latest case of BSE in Canadian cattle suggests the timeliness of a review of the management of BSE in Canada from a historically and scientifically informed perspective. In this article, we ask: how did the Canadian management of BSE between 1990 and 2014 engage with the contemporary understanding of BSE's human health implications? We propose that Canadian policies largely ignored the implicit medical nature of BSE, treating it as a purely agricultural and veterinary issue. In this way, policies to protect Canadians were often delayed and incomplete, in a manner disturbingly reminiscent of Britain's failed management of BSE. Despite assurances to the contrary, it is premature to conclude that BSE (and with it the risk of variant Creutzfeldt-Jakob disease) is a thing of Canada's past: BSE remains very much an issue in Canada's present.

Management issues of congenital adrenal hyperplasia during the transition from pediatric to adult care.

PubMed

Choi, Jin-Ho; Yoo, Han-Wook

2017-02-01

Steroid 21-hydroxylase deficiency is the most prevalent form of congenital adrenal hyperplasia (CAH), accounting for approximately 95% of cases. With the advent of newborn screening and hormone replacement therapy, most children with CAH survive into adulthood. Adolescents and adults with CAH experience a number of complications, including short stature, obesity, infertility, tumor, osteoporosis, and reduced quality of life. Transition from pediatric to adult care and management of long-term complications are challenging for both patients and health-care providers. Psychosocial issues frequently affect adherence to glucocorticoid treatment. Therefore, the safe transition of adolescents to adult care requires regular follow-up of patients by a multidisciplinary team including pediatric and adult endocrinologists. The major goals for management of adults with 21-hydroxylase deficiency are to minimize the long-term complications of glucocorticoid therapy, reduce hyperandrogenism, prevent adrenal or testicular adrenal rest tumors, maintain fertility, and improve quality of life. Optimized medical or surgical treatment strategies should be developed through coordinated care, both during transition periods and throughout patients' lifetimes. This review will summarize current knowledge on the management of adults with CAH, and suggested appropriate approaches to the transition from pediatric to adult care.

Management of Colorectal Trauma

PubMed Central

2011-01-01

Although the treatment strategy for colorectal trauma has advanced during the last part of the twentieth century and the result has improved, compared to other injuries, problems, such as high septic complication rates and mortality rates, still exist, so standard management for colorectal trauma is still a controversial issue. For that reason, we designed this article to address current recommendations for management of colorectal injuries based on a review of literature. According to the reviewed data, although sufficient evidence exists for primary repair being the treatment of choice in most cases of nondestructive colon injuries, many surgeons are still concerned about anastomotic leakage or failure, and prefer to perform a diverting colostomy. Recently, some reports have shown that primary repair or resection and anastomosis, is better than a diverting colostomy even in cases of destructive colon injuries, but it has not fully established as the standard treatment. The same guideline as that for colonic injury is applied in cases of intraperitoneal rectal injuries, and, diversion, primary repair, and presacral drainage are regarded as the standards for the management of extraperitoneal rectal injuries. However, some reports state that primary repair without a diverting colostomy has benefit in the treatment of extraperitoneal rectal injury, and presacral drainage is still controversial. In conclusion, ideally an individual management strategy would be developed for each patient suffering from colorectal injury. To do this, an evidence-based treatment plan should be carefully developed. PMID:21980586

Lessons about Virtual-Environment Software Systems from 20 years of VE building

PubMed Central

Taylor, Russell M.; Jerald, Jason; VanderKnyff, Chris; Wendt, Jeremy; Borland, David; Marshburn, David; Sherman, William R.; Whitton, Mary C.

2010-01-01

What are desirable and undesirable features of virtual-environment (VE) software architectures? What should be present (and absent) from such systems if they are to be optimally useful? How should they be structured? To help answer these questions we present experience from application designers, toolkit designers, and VE system architects along with examples of useful features from existing systems. Topics are organized under the major headings of: 3D space management, supporting display hardware, interaction, event management, time management, computation, portability, and the observation that less can be better. Lessons learned are presented as discussion of the issues, field experiences, nuggets of knowledge, and case studies. PMID:20567602

Knowledge Value Creation Characteristics of Virtual Teams: A Case Study in the Construction Sector

NASA Astrophysics Data System (ADS)

Vorakulpipat, Chalee; Rezgui, Yacine

Any knowledge environment aimed at virtual teams should promote identification, access, capture and retrieval of relevant knowledge anytime / anywhere, while nurturing the social activities that underpin the knowledge sharing and creation process. In fact, socio-cultural issues play a critical role in the successful implementation of Knowledge Management (KM), and constitute a milestone towards value creation. The findings indicate that Knowledge Management Systems (KMS) promote value creation when they embed and nurture the social conditions that bind and bond team members together. Furthermore, technology assets, human networks, social capital, intellectual capital, and change management are identified as essential ingredients that have the potential to ensure effective knowledge value creation.

Limb deficiency and prosthetic management. 2. Aging with limb loss.

PubMed

Flood, Katherine M; Huang, Mark E; Roberts, Toni L; Pasquina, Paul F; Nelson, Virginia S; Bryant, Phillip R

2006-03-01

This self-directed learning module highlights the issues faced by people aging with limb loss. It is part of the study guide on limb deficiency and vascular rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the impact that limb loss has on health and physical function throughout the life span. Case examples are used to illustrate what effect limb loss in childhood or young adulthood has on the incidence and management of new impairments or disease processes commonly associated with aging. To discuss the impact of early-life limb loss on the incidence and management of physiologic and functional changes associated with aging.

Developing high-performance cross-functional teams: Understanding motivations, functional loyalties, and teaming fundamentals

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

Miller, M.A.

1996-08-01

Teamwork is the key to the future of effective technology management. Today`s technologies and markets have become too complex for individuals to work alone. Global competition, limited resources, cost consciousness, and time pressures have forced organizations and project managers to encourage teamwork. Many of these teams will be cross-functional teams that can draw on a multitude of talents and knowledge. To develop high-performing cross-functional teams, managers must understand motivations, functional loyalties, and the different backgrounds of the individual team members. To develop a better understanding of these issues, managers can learn from experience and from literature on teams and teamingmore » concepts. When studying the literature to learn about cross-functional teaming, managers will find many good theoretical concepts, but when put into practice, these concepts have varying effects. This issue of varying effectiveness is what drives the research for this paper. The teaming concepts were studied to confirm or modify current understanding. The literature was compared with a {open_quotes}ground truth{close_quotes}, a survey of the reality of teaming practices, to examine the teaming concepts that the literature finds to be critical to the success of teams. These results are compared to existing teams to determine if such techniques apply in real-world cases.« less

The Australian and New Zealand Audit of Surgical Mortality-birth, deaths, and carriage.

PubMed

Raju, R S; Guy, G S; Majid, A J; Babidge, W; Maddern, G J

2015-02-01

This article outlines the formation of the Australian and New Zealand Audit of Surgical Mortality (ANZASM) and describes its objectives, governance, functioning and challenges. A nationwide audit of surgical mortality provides an overview of the leading causes of death in patients who require surgical care. It identifies system or process errors, trends in deficiency of care and helps develop strategies to reduce deaths in the surgical arena. A standardized tool is used to systematically collect data after every surgical death. Patient details are reviewed by a peer surgeon (and in certain cases a second) to identify issues with patient management and hospital processes. The treating surgeon is then offered confidential feedback and alternate views on patient management. From January 2009 to December 2012, 19,096 deaths were reported to the ANZASM. Eighty-six percent of the audited deaths occurred in patients requiring an emergency admission. Significant criticism of patient care was reported in 13% of cases with 16% of clinical issues perceived to be preventable. Western Australia, which first began the audit process, has shown a 30% reduction in surgical deaths. Nationwide mortality audits are a useful and worthwhile exercise. Recommendations identified in the audit reports direct educational workshops and seminars to address these issues. They allow Departments of Health to make informed decisions in their hospitals. Through this model, and the lessons learnt, we would encourage other countries planning to set up their own audits to follow a similar concept.

Evidence-based policy-making in the NHS: exploring the interface between research and the commissioning process.

PubMed

Harries, U; Elliott, H; Higgins, A

1999-03-01

The UK National Health Service (NHS) R&D strategy acknowledges the importance of developing an NHS where practice and policy is more evidence-based. This paper is based on a qualitative study which aimed to identify factors which facilitate or impede evidence-based policy-making at a local level in the NHS. The study involved a literature review and case studies of social research projects which were initiated by NHS health authority managers or general practitioner (GP) fundholders in one region of the NHS. Data were collected through in-depth interviews with lead policy-makers, GPs and researchers working on each of the case studies and analysis of project documentation. An over-arching theme from the analysis was that of the complexity of R&D in purchasing. The two worlds of research and health services management often sit uncomfortably together. For this reason it was not possible to describe a 'blueprint' for successful R&D, although several important issues emerged. These include sharing an appropriate model for research utilization, the importance of relationships in shaping R&D, the importance of influence and commitment in facilitating evidence-based change, and the resourcing of R&D in purchasing. These issues have important implications for the strategic development of R&D as well as for individual project application. Moving beyond the rhetoric of evidence-based policy-making is more likely if both policy-makers and researchers openly acknowledge this complexity and give due concern to the issues outlined.

Assessing the role of regulatory bodies in managing health professional issues and errors in Europe.

PubMed

Risso-Gill, Isabelle; Legido-Quigley, H; Panteli, D; Mckee, M

2014-08-01

This paper explores how medical regulatory bodies in nine European countries manage professional issues involving quality and patient safety, to build on limited existing information on procedures for regulating medical professionals in Europe. Twelve vignettes describing scenarios of concerns about standards of physicians were developed, covering clinical, criminal and administrative matters. Medical regulatory bodies in nine European countries were asked what action they would normally take in each situation. Their responses were related to their regulatory mandate. Responses varied greatly across participating countries. Regulators are always involved where patients are at risk or where a criminal offence is committed within the clinical setting. Non-criminal medical issues were generally handled by the employer, if any, at their discretion. Countries varied in the use of punitive measures, the extent to which they took an interest in issues arising outside professional activities, and whether they dealt with issues themselves or referred cases to another regulatory authority or took no action at all. There is little consistency across Europe on the regulation of medical professionals. There is considerable diversity in the range of topics that regulatory bodies oversee, with almost all covering health care quality and safety and others encompassing issues related to reputation, respect and trust. These inconsistencies have significant implications for professional mobility, patient safety and quality of care. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Case management of individuals with long-term conditions by community matrons: report of qualitative findings of a mixed method evaluation.

PubMed

Randall, Sue; Daly, Guy; Thunhurst, Colin; Mills, Natalie; Guest, David A; Barker, Annette

2014-01-01

To consider findings from a study that evaluated case management of individuals with long-term conditions (LTCs) by a community matron (CM) service. The paper highlights issues related to the implementation of a new role and the impact this had on the experience of care across hospital and community settings for patients and their carers. The introduction of the role of CM was intended to increase effective management of patients with complex comorbid LTCs through the introduction of case management, thereby reducing unplanned hospital admissions. The overall methodological approach was one of mixed methods. This paper reports the qualitative findings from CMs (n = 15); patients (n = 13); family carers (n = 8); and secondary care staff who interface with the CM service (n = 7). Data were collected between October 2009 and May 2010. A thematic analysis resulted in the identification of four themes: (1) visibility; (2) interpersonal relationships; (3) leadership; and (4) systems/professional boundaries. Patients enjoyed being seen as a whole and family carers appreciated the coordination aspect of the role. Difficulties arose from the limited understanding of the CM role and from a lack of a shared vision across healthcare professionals concerning the role and its goals.

Delivering a primary care-based social prescribing initiative: a qualitative study of the benefits and challenges.

PubMed

Skivington, Kathryn; Smith, Mathew; Chng, Nai Rui; Mackenzie, Mhairi; Wyke, Sally; Mercer, Stewart W

2018-05-21

Social prescribing is a collaborative approach to improve inter-sectoral working between primary health care and community organisations. The Links Worker Programme (LWP) is a social prescribing initiative in areas of high deprivation in Glasgow, Scotland, that is designed to mitigate the negative impacts of the social determinants of health. To investigate issues relevant to implementing a social prescribing programme to improve inter-sectoral working to achieve public health goals. Qualitative interview study with community organisation representatives and community links practitioners (CLPs) in LWP areas. Audiorecordings of semi-structured interviews with 30 community organisation representatives and six CLPs were transcribed verbatim and analysed thematically. Participants identified some benefits of collaborative working, particularly the CLPs' ability to act as a case manager for patients, and their position in GP practices, which operated as a bridge between organisations. However, benefits were seen to flow from new relationships between individuals in community organisations and CLPs, rather than more generally with the practice as a whole. Challenges to the LWP were related to capacity and funding for community organisations in the context of austerity. The capacity of CLPs was also an issue given that their role involved time-consuming, intensive case management. Although the LWP appears to be a fruitful approach to collaborative case management, integration initiatives such as social prescribing cannot be seen as 'magic bullets'. In the context of economic austerity, such approaches may not achieve their potential unless funding is available for community organisations to continue to provide services and make and maintain their links with primary care. © British Journal of General Practice 2018.

Mr. Ngao's proposal: introducing client fees. Case scenarios for training and group discussion.

PubMed

1992-01-01

In this supplement to the issue of "The Family Planning Manager" devoted to fees, a hypothetical case scenario is presented to illustrate the introduction of client fees to a family planning program. Managers are instructed to prepare a plan that includes the necessary information for deciding what to charge for, who to charge, and how much to charge; identifies the administrative changes involved in charging fees; and outlines steps that clinic managers should take before introducing client fees. Decisions should be based on factors such as the objectives of fee charging, client willingness and ability to pay, client perception of the quality of current services, services for which clients would be most willing to pay, estimated cost of providing services, and the cost of new administrative procedures inherent in a fee-for-service approach. Administrative procedures for collecting, handling, and accounting for cash; reporting income and expenses; and implementing a fair and flexible system of waivers and exemptions must be defined. Clients should be informed well in advance of fee introduction, and staff trained to manage potential client complaints.

Extensively Drug-Resistant Tuberculosis: Principles of Resistance, Diagnosis, and Management.

PubMed

Wilson, John W; Tsukayama, Dean T

2016-04-01

Extensively drug-resistant (XDR) tuberculosis (TB) is an unfortunate by-product of mankind's medical and pharmaceutical ingenuity during the past 60 years. Although new drug developments have enabled TB to be more readily curable, inappropriate TB management has led to the emergence of drug-resistant disease. Extensively drug-resistant TB describes Mycobacterium tuberculosis that is collectively resistant to isoniazid, rifampin, a fluoroquinolone, and an injectable agent. It proliferates when established case management and infection control procedures are not followed. Optimized treatment outcomes necessitate time-sensitive diagnoses, along with expanded combinations and prolonged durations of antimicrobial drug therapy. The challenges to public health institutions are immense and most noteworthy in underresourced communities and in patients coinfected with human immunodeficiency virus. A comprehensive and multidisciplinary case management approach is required to optimize outcomes. We review the principles of TB drug resistance and the risk factors, diagnosis, and managerial approaches for extensively drug-resistant TB. Treatment outcomes, cost, and unresolved medical issues are also discussed. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Socio-economic appraisal of fishing community in Pulicat lagoon, south east coast of India: case study.

PubMed

Devi, V Vandhana; Krishnaveni, M

2012-10-01

Assessment of socio-economic issues of fishing community is an important aspect in framing a strategy for the preservation of eco-systems which leads to sustainable lagoon management. The present investigation analyses the current potential socio-economic status of the fishing community of Pulicat lagoon, the second largest lagoon in India. The socio-economic indicators considered in the study include demography, economic aspects, social aspects and occupation details. The relevant details were collected from 300 fisher folk family by conducting field survey through a well prepared questionnaire in the villages around Pulicat lagoon. The data analysis was done using Statistical Program for Social Sciences (SPSS) to assess the adequacy and precision of the collected data. The important and encouraging socio-economic indicators identified from the field survey for effective lagoon management includes significant presence of younger generation in the region; affinity and self-belongingness of fisher folk towards the lake; better economic status and moderate education level; appreciable fishing income and affinity towards fishing profession. It is emphasized to motivate the fisher folk to improve their work attitude for betterment in economic status. The pertinent lagoon issues, comprising seasonal variation, local fishing issues, pollution from industries, water intake to thermal power plant which directly or indirectly affects the socio-economic status of fishing community, also need much emphasis while proposing sustainable lagoon management system. The information and observation from this study will be very helpful in formulating management policies on the conservation of the Pulicat lagoon ecosystem.

A qualitative study of primary care professionals’ views of case finding for depression in patients with diabetes or coronary heart disease in the UK

PubMed Central

2013-01-01

Background Routinely conducting case finding (also commonly referred to as screening) in patients with chronic illness for depression in primary care appears to have little impact. We explored the views and experiences of primary care nurses, doctors and managers to understand how the implementation of case finding/screening might impact on its effectiveness. Methods Two complementary qualitative focus group studies of primary care professionals including nurses, doctors and managers, in five primary care practices and five Community Health Partnerships, were conducted in Scotland. Results We identified several features of the way case finding/screening was implemented that may lead to systematic under-detection of depression. These included obstacles to incorporating case finding/screening into a clinical review consultation; a perception of replacing individualised care with mechanistic assessment, and a disconnection for nurses between management of physical and mental health. Far from being a standardised process that encouraged detection of depression, participants described case finding/screening as being conducted in a way which biased it towards negative responses, and for nurses, it was an uncomfortable task for which they lacked the necessary skills to provide immediate support to patients at the time of diagnosis. Conclusion The introduction of case finding/screening for depression into routine chronic illness management is not straightforward. Routinized case finding/screening for depression can be implemented in ways that may be counterproductive to engagement (particularly by nurses), with the mental health needs of patients living with long term conditions. If case finding/screening or engagement with mental health problems is to be promoted, primary care nurses require more training to increase their confidence in raising and dealing with mental health issues and GPs and nurses need to work collectively to develop the relational work required to promote cognitive participation in case finding/screening. PMID:23557512

A qualitative study of primary care professionals' views of case finding for depression in patients with diabetes or coronary heart disease in the UK.

PubMed

Maxwell, Margaret; Harris, Fiona; Hibberd, Carina; Donaghy, Eddie; Pratt, Rebekah; Williams, Chris; Morrison, Jill; Gibb, Jennifer; Watson, Philip; Burton, Chris

2013-04-04

Routinely conducting case finding (also commonly referred to as screening) in patients with chronic illness for depression in primary care appears to have little impact. We explored the views and experiences of primary care nurses, doctors and managers to understand how the implementation of case finding/screening might impact on its effectiveness. Two complementary qualitative focus group studies of primary care professionals including nurses, doctors and managers, in five primary care practices and five Community Health Partnerships, were conducted in Scotland. We identified several features of the way case finding/screening was implemented that may lead to systematic under-detection of depression. These included obstacles to incorporating case finding/screening into a clinical review consultation; a perception of replacing individualised care with mechanistic assessment, and a disconnection for nurses between management of physical and mental health. Far from being a standardised process that encouraged detection of depression, participants described case finding/screening as being conducted in a way which biased it towards negative responses, and for nurses, it was an uncomfortable task for which they lacked the necessary skills to provide immediate support to patients at the time of diagnosis. The introduction of case finding/screening for depression into routine chronic illness management is not straightforward. Routinized case finding/screening for depression can be implemented in ways that may be counterproductive to engagement (particularly by nurses), with the mental health needs of patients living with long term conditions. If case finding/screening or engagement with mental health problems is to be promoted, primary care nurses require more training to increase their confidence in raising and dealing with mental health issues and GPs and nurses need to work collectively to develop the relational work required to promote cognitive participation in case finding/screening.

Effects of a nurse-managed program on hepatitis A and B vaccine completion among homeless adults.

PubMed

Nyamathi, Adeline; Liu, Yihang; Marfisee, Mary; Shoptaw, Steven; Gregerson, Paul; Saab, Sammy; Leake, Barbara; Tyler, Darlene; Gelberg, Lillian

2009-01-01

Hepatitis B virus (HBV) infection constitutes a major health problem for homeless persons. Ability to complete an HBV vaccination series is complicated by the need to prioritize competing needs, such as addiction issues, safe places to sleep, and food, over health concerns. The objectives of this study were to evaluate the effectiveness of a nurse-case-managed intervention compared with that of two standard programs on completion of the combined hepatitis A virus (HAV) and HBV vaccine series among homeless adults and to assess sociodemographic factors and risk behaviors related to the vaccine completion. A randomized, three-group, prospective, quasi-experimental design was conducted with 865 homeless adults residing in homeless shelters, drug rehabilitation sites, and outdoor areas in the Skid Row area of Los Angeles. The programs included (a) nurse-case-managed sessions plus targeted hepatitis education, incentives, and tracking (NCMIT); (b) standard targeted hepatitis education plus incentives and tracking (SIT); and (c) standard targeted hepatitis education and incentives only (SI). Sixty-eight percent of the NCMIT participants completed the three-series vaccine at 6 months, compared with 61% of SIT participants and 54% of SI participants. NCMIT participants had almost 2 times greater odds of completing vaccination than those of participants in the SI program. Completers were more likely to be older, to be female, to report fair or poor health, and not to have participated in a self-help drug treatment program. Newly homeless White adults were significantly less likely than were African Americans to complete the vaccine series. The use of vaccination programs incorporating nurse case management and tracking is critical in supporting adherence to completion of a 6-month HAV/HBV vaccine. The finding that White homeless persons were the least likely to complete the vaccine series suggests that programs tailored to address their unique cultural issues are needed.

Overview of legislation on sewage sludge management in developed countries worldwide.

PubMed

Christodoulou, A; Stamatelatou, K

2016-01-01

The need to apply innovative technologies for maximizing the efficiency and minimizing the carbon footprint of sewage treatment plants has upgraded sewage sludge management to a highly sophisticated research and development sector. Sewage sludge cannot be regarded solely as 'waste'; it is a renewable resource for energy and material recovery. From this perspective, legislation on sewage sludge management tends to incorporate issues related to environmental protection, public health, climate change impacts and socio-economic benefits. This paper reviews the existing legislative frameworks and policies on sewage sludge management in various countries, highlighting the common ground as well as the different priorities in all cases studied. More specifically, the key features of legislation regarding sludge management in developed countries such as the USA, Japan, Australia, New Zealand and the European Union (EU27) are discussed.

Primary immunodeficiency disease: a model for case management of chronic diseases.

PubMed

Burton, Janet; Murphy, Elyse; Riley, Patty

2010-01-01

Patient-centered chronic care management is a new model for the management of rare chronic diseases such as primary immunodeficiency disease (PIDD). This approach emphasizes helping patients become experts on the management of their disease as informed, involved, and interactive partners in healthcare decisions with providers. Because only a few patients are affected by rare illnesses, these patients are forced to become knowledgeable about their disease and therapies and to seek treatment from a healthcare team, which includes physicians and nurse specialists who are equipped to manage the complexity of the disease and its comorbidities. Importantly, therapy for PIDD can be self-administered at home, which has encouraged the transition toward a proactive stance that is at the heart of patient-centered chronic care management. We discuss the evolution of therapy, the issues with the disease, and challenges with its management within the framework of other chronic disease management programs. Suggestions and rationale to move case management of PIDD forward are presented with the intent that sharing our experiences will improve process and better manage outcomes in this patient population. The patient-centered model for the management of PIDD is applicable to the primary care settings, where nurse case managers assist patients through education, support them and their families, and facilitate access to community resources in an approach, which has been described as "guided care." The model also applies specifically to immunology centers where patients receive treatment or instruction on its self-administration at home. Patient-centered management of PIDD, with its emphasis on full involvement of patients in their treatment, has the potential to improve compliance with treatment, and thus patient outcomes, as well as patients' quality of life. The patient-centered model expands the traditional model of chronic disease management, which relies on evidence-based medicine, provider expertise, clinical information systems, and patient education. This approach supports patient self-management with strategies that empower and prepare them for their role as expert patients.

Public–private partnerships in solid waste management: sustainable development strategies for Brazil.

PubMed

Kruljac, Shani

2012-01-01

An often overlooked issue in the discussion of sustainable development is that of municipal solid waste management. Yet solid waste management is pervasive in all sustainable development objectives: its management, or lack thereof, can have major implications for the health of the environment, economy and society. This article argues the need for a governance dimension in the sustainability model, taking into account implementation strategies, monitoring and institutional controls. This focus heavily relies on integrated public–private partnerships and deliberative democracy approaches in order to achieve sustainability within the solid waste management sector. In this article, national and local policies in Brazil are analysed, primarily focusing on the inclusion of informal waste collection into municipal solid waste management schemes. The city of Curitiba, in the state of Paraná, which is world-renowned for its innovative sustainable development policies, is used to frame and illustrate the case.

Theoretical Framework for Plastic Waste Management in Ghana through Extended Producer Responsibility: Case of Sachet Water Waste.

PubMed

Quartey, Ebo Tawiah; Tosefa, Hero; Danquah, Kwasi Asare Baffour; Obrsalova, Ilona

2015-08-20

Currently, use and disposal of plastic by consumers through waste management activities in Ghana not only creates environmental problems, but also reinforces the notion of a wasteful society. The magnitude of this problem has led to increasing pressure from the public for efficient and practical measures to solve the waste problem. This paper analyses the impact of plastic use and disposal in Ghana. It emphasizes the need for commitment to proper management of the impacts of plastic waste and effective environmental management in the country. Sustainable Solid Waste Management (SSWM) is a critical problem for developing countries with regards to climate change and greenhouse gas emission, and also the general wellbeing of the populace. Key themes of this paper are producer responsibility and management of products at end of life. The paper proposes two theatrical recovery models that can be used to address the issue of sachet waste in Ghana.

Managing the public health risk of a 'sex worker' with hepatitis B infection: legal and ethical considerations.

PubMed

Poll, Ray

2011-10-01

This paper examines the ethical issues faced by health workers managing a fictional case of a female sex worker who is hepatitis B positive with a high level of virus but is asymptomatic. According to guidelines she does not require treatment herself, but is potentially highly infectious to others. Recent legal cases in the UK show it can be criminal to pass on HIV or hepatitis B infection sexually if the risk is known and the partner has not been informed. However, there is no statute or case law showing that health workers are required to intervene to prevent such a potential 'crime', particularly when the partners are unknown, as in this case. The health workers could respond in various ways. They could do nothing, thus making further infection probable. They could advise the sex worker to use condoms and to inform her clients. They could treat the sex worker to reduce her level of infectivity, although there is no benefit to her. They could disclose the sex worker's status, although breaking confidentiality is a serious matter ethically and may be of no benefit to the unknown client group. Regulating prostitution might help; but sex workers with infection may work off licence. This paper discusses the clinical, moral and ethical issues associated with such a scenario and concludes that the most beneficial course is to target clients, through health education, to recognise the potential risks of infection from a sex worker and to take suitable precautions including immunisation against hepatitis B.

Plant invasions in mountains: Global lessons for better management

USGS Publications Warehouse

McDougall, K.L.; Khuroo, A.A.; Loope, L.L.; Parks, C.G.; Pauchard, A.; Reshi, Z.A.; Rushworth, I.; Kueffer, C.

2011-01-01

Mountains are one of few ecosystems little affected by plant invasions. However, the threat of invasion is likely to increase because of climate change, greater anthropogenic land use, and continuing novel introductions. Preventive management, therefore, will be crucial but can be difficult to promote when more pressing problems are unresolved and predictions are uncertain. In this essay, we use management case studies from 7 mountain regions to identify common lessons for effective preventive action. The degree of plant invasion in mountains was variable in the 7 regions as was the response to invasion, which ranged from lack of awareness by land managers of the potential impact in Chile and Kashmir to well-organized programs of prevention and containment in the United States (Hawaii and the Pacific Northwest), including prevention at low altitude. In Australia, awareness of the threat grew only after disruptive invasions. In South Africa, the economic benefits of removing alien plants are well recognized and funded in the form of employment programs. In the European Alps, there is little need for active management because no invasive species pose an immediate threat. From these case studies, we identify lessons for management of plant invasions in mountain ecosystems: (i) prevention is especially important in mountains because of their rugged terrain, where invasions can quickly become unmanageable; (ii) networks at local to global levels can assist with awareness raising and better prioritization of management actions; (iii) the economic importance of management should be identified and articulated; (iv) public acceptance of management programs will make them more effective; and (v) climate change needs to be considered. We suggest that comparisons of local case studies, such as those we have presented, have a pivotal place in the proactive solution of global change issues. ?? International Mountain Society.

Management of fetal growth restriction using the contraction stress test: a case-control study.

PubMed

Tanaka, Hiroaki; Furuhashi, Fumi H; Toriyabe, Kuniaki; Matsumoto, Takeshi; Magawa, Shoich; Nii, Masafumi; Watanabe, Junko; Tanaka, Kayo; Umekawa, Takashi; Kamimoto, Yuki; Ikeda, Tomoaki

2018-04-18

Fetal growth restriction (FGR) is a concerning health issue. However, studies on FGR management are limited due to its rarity. We aimed to evaluate the efficacy of the contraction stress test (CST) for FGR management. A case-control retrospective study design. Our institute innovated CST in FGR management in 2017. We included women in their 33rd-40th week of pregnancy with a diagnosis of FGR and retrospectively divided them into groups: the CST group (FGR management with CST) and no CST group (FGR management without CST) before and after CST development. Neonatal outcome, pH, and pO 2 of umbilical artery (UA) were compared between the two groups. No significant differences in the rate of birth weight, Apgar score <7 (5 minutes), neonatal death, hospitalization to newborn childhood intensive care unit (NICU), and UA pH were found between groups. Average UA pH was 7.29 ± 0.05 and 7.29 ± 0.04 in the CST and no CST groups, respectively (p = .864). Average UA pO 2 values were 21.1 ± 8.6 and 15.7 ± 5.0 mmHg in the CST and no CST groups, respectively (p = .016), showing significant differences. Neonatal outcomes and UA pH were slightly different between the groups managed with and without CST. However, UA pO 2 values significantly differed between the groups. For FGR management, the use of a CST may allow for early intervention before fetal acidemia and acidosis. For establishing the effects of a CST for FGR management, analysis including several cases and investigation of long-term outcomes of newborn infants is necessary.

On risky ground: the water professional in politics.

PubMed

Holmes, P R

2004-01-01

Best practice in drainage basin management requires consultation and stakeholder engagement in the formulation and implementation of plans. The water management professional, engaging with the political world, is on risky ground, thanks to many stakeholders' accidental or chosen unwillingness to accept science-based advice. Technical specialists produce good advice, yet progress is inhibited because they do not connect effectively with politicians, administrators and managers. A series of short case studies from three countries in different but related fields provides evidence of the problems that are encountered. Professionals may be cut off from the political world within comfort zones defined by the cultural norms and behaviours of bureaucracy, their profession or their preferred communications style. The consequence of the professionals' lack of engagement in the political world can be that scarce money and effort is wasted on low priority issues, and the case for sound, sustainable environmental management is discredited. Stakeholder support is worth winning, because it can bring positive benefits in the effectiveness of environmental management programmes. Where outside help is needed to bring about this result, it should be provided by advisers who are sensitive to the culture, at the national, professional and organizational level, of the recipients.

PM₂.₅ opened a door to public participation addressing environmental challenges in China.

PubMed

Huang, Ganlin

2015-02-01

China has long been regarded as a centralized society where the public has little influence on decision-making. Such a top-down management scheme is perceived as a major obstacle to address complicated environment issues. The recent public campaign in China to urge creation of a nationwide PM₂.₅ monitoring network and mitigation plan provides an unprecedented case of how the public participated and influenced policy-making in a centralized society. This paper reviews key incidents in the campaign chronologically. Here we identify information technology, public awareness of air quality's health impacts and the fact air quality affects everyone as public goods as the major factors promoting public participation. This case demonstrates that public participation can happen in a centralized, top-down society such as China. Continued environmental deterioration may stimulate similar campaigns for other issues. We anticipate this essay to be a starting point for more studies on how environmental issues stimulate incremental social change by making people involved in decision-making process, especially in societies where they are rarely able to do so. Copyright © 2014 Elsevier Ltd. All rights reserved.

Disease Management Evaluation: A Comprehensive Review of Current State of the Art.

PubMed

Conklin, Annalijn; Nolte, Ellen

2011-01-01

Many countries across Europe and elsewhere have been experimenting with various structured approaches to manage patients with chronic illness as a way to improve quality of care, reduce costs and lead to better population health outcomes in the long run. Despite a body of studies of disease management interventions, uncertainty about the effects of these remains not least because current guidance on evaluation methods and metrics require further development to enhance scientific rigour while also being practical in routine operations. This article provides details from a report that reviews the academic and grey literature to help advance the task of improving the science of assessing disease management initiatives in Europe. Challenges identified are methodological, analytical and conceptual in nature, with a key issue being the establishment of the counterfactual. An array of sophisticated statistical techniques and analytical frameworks can assist in the construction of a sound comparison strategy when a randomised controlled trial is not possible. Issues to consider include: a clear framework of the mechanisms of action and expected effects of disease management; an understanding of the characteristics of disease management (scope, content, dose, context), and of the intervention and target populations (disease type, severity, case-mix); a period of observation over multiple years; and a logical link between performance measures and the intervention's aims and underlying theory of behaviour change.

Community matron caseload numbers: a literature review.

PubMed

Auckland, Samantha

2012-10-01

In early 2005, the Department of Health published its strategy for addressing the health and social care needs of people with long-term conditions (2005a; b). Community matrons were recruited to deliver this strategy. Since this time, there has been some debate around the optimum caseload number for community matrons to function effectively (Abell et al, 2010). One study by Sargent et al (2008) concluded that community matrons were struggling to achieve and maintain 50 patients on their caseload, due to nine areas that impact on caseload manageability. This literature review concluded there is a wide variation regarding the optimum caseload number ranging from 14 patients in intensive case management to 80-100 families per full-time health visitor. A number of authors do not specify caseload numbers due to the complexity of the task. However, what clearly emerges is that the factors that impact on case management appear to correlate with the issues identified by Sargent et al (2008).

Decision exploration lab: a visual analytics solution for decision management.

PubMed

Broeksema, Bertjan; Baudel, Thomas; Telea, Arthur G; Crisafulli, Paolo

2013-12-01

We present a visual analytics solution designed to address prevalent issues in the area of Operational Decision Management (ODM). In ODM, which has its roots in Artificial Intelligence (Expert Systems) and Management Science, it is increasingly important to align business decisions with business goals. In our work, we consider decision models (executable models of the business domain) as ontologies that describe the business domain, and production rules that describe the business logic of decisions to be made over this ontology. Executing a decision model produces an accumulation of decisions made over time for individual cases. We are interested, first, to get insight in the decision logic and the accumulated facts by themselves. Secondly and more importantly, we want to see how the accumulated facts reveal potential divergences between the reality as captured by the decision model, and the reality as captured by the executed decisions. We illustrate the motivation, added value for visual analytics, and our proposed solution and tooling through a business case from the car insurance industry.

Acute adrenal insufficiency: an aide-memoire of the critical importance of its recognition and prevention.

PubMed

Gargya, A; Chua, E; Hetherington, J; Sommer, K; Cooper, M

2016-03-01

Adrenal crisis is a life-threatening emergency that causes significant excess mortality in patients with adrenal insufficiency. Delayed recognition by medical staff of an impending adrenal crisis and failure to give timely hydrocortisone therapy within the emergency department continue to be commonly encountered, even in metropolitan teaching hospitals. Within the authors' institutions, several cases of poorly handled adrenal crises have occurred over the last 2 years. Anecdotal accounts from members of the Addison's support group suggest that these issues are common in Australia. This manuscript is a timely reminder for clinical staff on the critical importance of the recognition, treatment and prevention of adrenal crisis. The manuscript: (i) outlines a case and the clinical outcome of sub-optimally managed adrenal crisis, (ii) summarises the clinical features and acute management of adrenal crisis, (iii) provides recommendations on the prevention of adrenal crisis and (iv) provides guidance on the management of 'sick days' in patients with adrenal insufficiency. © 2016 Royal Australasian College of Physicians.

Management of Acute Isolated Soleal Vein Thrombosis in a Pregnant Patient With an Osteopathic Approach to Evaluation.

PubMed

Martingano, Daniel; Eisenberg, Justin; Aglialoro, George C

2016-01-01

In pregnant women, the risk of venous thromboembolism increases 4 to 5 fold over that in nonpregnant women. Deep vein thromboses in the calf occur in approximately 6% of cases, with a 20% incidence of propagation, but new imaging methods suggest a higher rate. Nevertheless, the management of isolated soleal vein thrombosis is currently one of the most debated issues in the field of venous thromboembolism, and a clear set of principles for the management of this unique clinical problem remains undefined. The authors present the case of a 37-year-old woman with a history of recurrent spontaneous abortions and cervical insufficiency who presented with a short cervix and acute right isolated soleal vein thrombosis. Long-term anticoagulantion therapy was recommended. Future studies on the risk of isolated soleal vein thrombosis propagation in the setting of pregnancy are required to identify the most effective treatment options for this clinical problem.

Environmental and sustainability ethics in supply chain management.

PubMed

Beamon, Benita M

2005-04-01

Environmentally Conscious Supply Chain Management (ECSCM refers to the control exerted over all immediate and eventual environmental effects of products and processes associated with converting raw materials into final products. While much work has been done in this area, the focus has traditionally been on either: product recovery (recycling, remanufacturing, or re-use) or the product design function only (e.g., design for environment). Environmental considerations in manufacturing are often viewed as separate from traditional, value-added considerations. However, the case can be made that professional engineers have an ethical responsibility to consider the immediate and eventual environmental impacts of products and processes that they design and/or manage. This paper describes ECSCM as a component of engineering ethics, and highlights the major issues associated with ethical decision-making in supply chain management.

A framework for considering externalities in urban water asset management.

PubMed

Marlow, David; Pearson, Leonie; Macdonald, Darla Hatton; Whitten, Stuart; Burn, Stewart

2011-01-01

Urban communities rely on a complex network of infrastructure assets to connect them to water resources. There is considerable capital investment required to maintain, upgrade and extend this infrastructure. As the remit of a water utility is broader than just financial considerations, infrastructure investment decisions must be made in light of environmental and societal issues. One way of facilitating this is to integrate consideration of externalities into decision making processes. This paper considers the concept of externalities from an asset management perspective. A case study is provided to show the practical implications to a water utility and asset managers. A framework for the inclusion of externalities in asset management decision making is also presented. The potential for application of the framework is highlighted through a brief consideration of its key elements.

The Management Issues of Implementing Telecommuting: A Case Study

DTIC Science & Technology

1993-09-01

telecommuting ; benefits for both the employers and employees. These benefits include: (JALA (b) 1990) * Significantly increased productivity (10 to 20% on...1992 to April 1993. B. RESEARCH QUESTIONS Prior research reveals that a successful telecommuting program has the following benefits : "* Flexibility...State, Jack Nilles outlines a different set of important factors and points out that: While telecommuting has many benefits , there also are potential

Expanding Access to Secondary Schooling in Sub-Saharan Africa: Key Planning and Finance Issues. Create Pathways to Access. Research Monograph No. 8

ERIC Educational Resources Information Center

Lewin, Keith M.

2007-01-01

This paper makes the case for managed expansion of secondary schooling in Sub-Saharan Africa. The great majority of secondary age African children remain excluded from access to good quality secondary schooling. Increasing numbers are graduating from primary schools where enrolments are rapidly growing as a result of successful Education for All…

Women, money, and psychodynamic group psychotherapy.

PubMed

Motherwell, Lise

2002-01-01

Developmental concerns and sociocultural expectations may keep female patients and therapists from addressing financial issues openly in group psychotherapy. Interpersonal theory provides a different view of nurturing that may help women leaders deal better with financial discussions in group. This paper includes a review of the literature on group psychotherapy and fees; feminist literature relevant to leadership; money management in group therapy; countertransference; and case examples.

The Value of Writing-to-Learn when Using Question Prompts to Support Web-Based Learning in Ill-Structured Domains

ERIC Educational Resources Information Center

Papadopoulos, Pantelis M.; Demetriadis, Stavros N.; Stamelos, Ioannis G.; Tsoukalas, Ioannis A.

2011-01-01

This study investigates the effectiveness of two variants of a prompting strategy that guides students to focus on important issues when learning in an ill-structured domain. Students in three groups studied individually Software Project Management (SPM) cases for a week, using a web-based learning environment designed especially for this purpose.…

Overview of Diabetes in Children and Adolescents. A Fact Sheet from the National Diabetes Education Program

ERIC Educational Resources Information Center

National Diabetes Education Program (NDEP), 2006

2006-01-01

Type 1 diabetes in U.S. children and adolescents may be increasing and many more new cases of type 2 diabetes are being reported in young people. Standards of care for managing children with diabetes issued by the American Diabetes Association in January 2005 provide more guidance than previously given. To update primary care providers and their…

Spinal cord stimulation during the antepartum and intrapartum periods: a case report showing no deleterious effect of conventional paraesthesia producing stimulation.

PubMed

Moussa, Ahmad Abdelhai; Glancz, Laurence; Das, Mausumi; Basu, Surajit

2016-12-01

We report on a 25-year-old woman who used her spinal cord stimulator (SCS), previously inserted for chronic regional pain syndrome (CPRS), to assist with both chronic and pregnancy-related pain management. We describe the therapeutic effect of the stimulator and briefly highlight the issues surrounding the use of SCS during pregnancy.

Status of e-Learning Quality in Kenya: Case of Jomo Kenyatta University of Agriculture and Technology Postgraduate Students

ERIC Educational Resources Information Center

Hadullo, Kennedy; Oboko, Robert; Omwenga, Elijah

2018-01-01

There is a substantial increase in the use of learning management systems (LMSs) to support e-learning in higher education institutions, particularly in developing countries. This has been done with some measures of success and failure as well. There is evidence from literature that the provision of e-learning faces several quality issues relating…

A Case Study Investigating the Use of Facebook as a Learning Management System in Higher Education

ERIC Educational Resources Information Center

Gutschmidt, Adam M.

2012-01-01

This dissertation addresses the issue of using the social networking website, Facebook, for educational purposes by examining how it was used in an upper-level public relations course. Research on education suggests instructors should find ways for their students to take a more active approach in learning and can do so by having them engage in…

75 FR 22706 - Defense Federal Acquisition Regulation Supplement; Service Contract Surveillance (DFARS Case 2008...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-30

...DoD is issuing a final rule amending the Defense Federal Acquisition Regulation Supplement (DFARS) to ensure that the requirement for a quality assurance surveillance plan is addressed for each contract with a dollar value above the simplified acquisition threshold, and that contracts for services have appropriate performance management or surveillance plans prepared for the work being performed under the contract.

[Decision-making process and administrative practice: managing the State Health Secretariat in Bahia, Brazil].

PubMed

Coelho, Thereza Christina Bahia; Paim, Jairnilson Silva

2005-01-01

This case study is based on research performed by the Bahia State Health Secretariat (SESAB), aimed at analyzing management practices during the implementation of a State government administrative reform. The institutional agenda shows evidence of limited participation by civil society and technical and operational staff in problem selection and prioritization, resulting from a work process pressured by high-level executive government staff. Decisions regarding "output" (projects, services, and activities) were made under the responsibility of subordinate operational levels and did not appear as issues in the institutional routine. Concerns related to "input" (financial and human resources) consumed most of the high-level efforts, with internal and external negotiations and compromises to assure access to them. Meanwhile the possible "outcome", namely public health status, represents the "occult subject" of the institutional discourse. Information emerges in institutional disputes as a technical "power resource" in its medical, epidemiological, health, and administrative dimensions. The issue of government "representation" and allied interests is based on ideological dispositions and authoritarian practices, thus contradicting the need for management transparency and modernization.

Hurricane Andrew: Impact on hazardous waste management

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

Kastury, S.N.

1993-03-01

On August 24, 1992, Hurricane Andrew struck the eastern coast of South Florida with winds of 140 mph approximately and a storm surge of 15 ft. The Florida Department of Environmental Regulation finds that the Hurricane Andrew caused a widespread damage throughout Dade and Collier County as well as in Broward and Monroe County and has also greatly harmed the environment. The Department has issued an emergency final order No. 92-1476 on August 26, 1992 to address the environmental cleanup and prevent any further spills of contaminants within the emergency area. The order authorizes the local government officials to designatemore » certain locations in areas remote from habitation for the open burning in air certain incinerators of hurricane generated yard trash and construction and demolition debris. The Department staff has assisted the county and FEMA staff in establishing procedures for Hazardous Waste Management, Waste Segregation and disposal and emergency responses. Local governments have issued these burn permits to public agencies including FDOT and Corps of Engineering (COE). Several case studies will be discussed on the Hazardous Waste Management at this presentation.« less

Workshop 2b (synthesis): linking drainage basin management to local action plans and national security--theory and practice in eastern European countries.

PubMed

Söderbaum, P; Tropp, H

2004-01-01

Efforts to link and balance national water policies, local water action and national security issues are discussed. There needs to be greater clarity of water roles, rights and responsibilities among national stakeholders as well as between states. In some cases, insufficient attention has been paid to local concerns and, in balancing national and local actions, it is necessary to address decentralization in the context of a transboundary state. There is a strong need for enhanced stakeholder participation in the formulation and implementation of national and local water management plans.

Psychosocial Issues in Palliative Care: A Review of Five Cases

PubMed Central

Onyeka, Tonia C

2010-01-01

Palliative care is not just vital in controlling symptoms of the patient’s disease condition, but also aims to extend the patient’s life, giving it a better quality. However, several times in the course of management, the psychosocial impact of cancer, HIV/AIDS, and other life-limiting disease conditions may not be noticed and dealt with during the admission period, thereby giving rise to a more complex situation than the disease condition itself. This article aims to review some psychosocial issues and measures that can be taken to address them. It highlights the various roles and the importance of the clinician, nurse, social worker, and other members of the multidisciplinary team in tackling these issues and will help healthcare professionals in this field achieve better practice in the future. PMID:21218001

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

Case-based clinical reasoning in feline medicine: 3: Use of heuristics and illness scripts.

PubMed

Whitehead, Martin L; Canfield, Paul J; Johnson, Robert; O'Brien, Carolyn R; Malik, Richard

2016-05-01

This is Article 3 of a three-part series on clinical reasoning that encourages practitioners to explore and understand how they think and make case-based decisions. It is hoped that, in the process, they will learn to trust their intuition but, at the same time, put in place safeguards to diminish the impact of bias and misguided logic on their diagnostic decision-making. Article 1, published in the January 2016 issue of JFMS, discussed the relative merits and shortcomings of System 1 thinking (immediate and unconscious) and System 2 thinking (effortful and analytical). In Article 2, published in the March 2016 issue, ways of managing cognitive error, particularly the negative impact of bias, in making a diagnosis were examined. This final article explores the use of heuristics (mental short cuts) and illness scripts in diagnostic reasoning. © The Author(s) 2016.

"The Barking Girl": A Case Report of Psychogenic Cough in a Child with a Review of Literature.

PubMed

Jakati, Praveen Kumar; Naskar, Subrata; Khanna, Anisha

2017-01-01

A 9-year-old girl presented with 2-month history of continuous coughing; despite detailed evaluation, no organic cause was found. Considering the provisional diagnosis of a psychogenic cough, she was advised for psychiatry consultation. After a psychological assessment, she was found to have comorbid anxiety (Screen for Child Anxiety Related Disorders score- 25) along with punitive parenting and sibling rivalry issues. She was initially treated with parental psychoeducation, play therapy, and behavior therapy. Since she did not show expected progress with the treatment, low-dose escitalopram was started along with the ongoing therapy, considering her anxiety. There was a significant improvement in her symptoms in 1-month follow-up. She maintained improvement during further follow-ups. This case illustrates the need to identify and treat comorbid psychiatric issues in the management of a psychogenic cough.

“The Barking Girl”: A Case Report of Psychogenic Cough in a Child with a Review of Literature

PubMed Central

Jakati, Praveen Kumar; Naskar, Subrata; Khanna, Anisha

2017-01-01

A 9-year-old girl presented with 2-month history of continuous coughing; despite detailed evaluation, no organic cause was found. Considering the provisional diagnosis of a psychogenic cough, she was advised for psychiatry consultation. After a psychological assessment, she was found to have comorbid anxiety (Screen for Child Anxiety Related Disorders score- 25) along with punitive parenting and sibling rivalry issues. She was initially treated with parental psychoeducation, play therapy, and behavior therapy. Since she did not show expected progress with the treatment, low-dose escitalopram was started along with the ongoing therapy, considering her anxiety. There was a significant improvement in her symptoms in 1-month follow-up. She maintained improvement during further follow-ups. This case illustrates the need to identify and treat comorbid psychiatric issues in the management of a psychogenic cough. PMID:28852260

Integration of Case Mix and Drug Utilization Data in the Long Term Care Setting

PubMed Central

Miller, R. Paul; Coblio, Nick; Bellnier, Terrance J.; Veneron, John P.

1989-01-01

Federal and state regulations mandate that a pharmacist perform a monthly review of the medical chart of residents at nursing homes. The review focuses on 31 quality issues which center on nursing and physician practice. We have computerized the data gathered by the pharmacist review with microcomputer technology and a relational data base manager. By introducing a “severity code” for each quality issue, we are able to pinpoint those data elements which physician staff can choose to focus on. The data can be studied longitudinally for trend analysis. The data was linked to that captured during the reimbursement case mix screens. Thus, two disparate data bases were integrated to allow further insights into our patient population. We conclude that computerization of disparate federal or state mandated data sets at nursing homes can be linked to aid patient care and quality assurance programs.

Resource allocation for mitigating regional air pollution–related mortality: A summertime case study for five cities in the United States

PubMed Central

Liao, Kuo-Jen; Hou, Xiangting; Strickland, Matthew J.

2016-01-01

ABSTRACT An important issue of regional air quality management is to allocate air quality management funds to maximize environmental and human health benefits. In this study, we use an innovative approach to tackle this air quality management issue. We develop an innovative resource allocation model that allows identification of air pollutant emission control strategies that maximize mortality avoidances subject to a resource constraint. We first present the development of the resource allocation model and then a case study to show how the model can be used to identify resource allocation strategies that maximize mortality avoidances for top five Metropolitan Statistical Areas (MSAs) (i.e., New York, Los Angeles, Chicago, Dallas-Fort Worth, and Philadelphia) in the continental United States collectively. Given budget constraints in the U.S. Environmental Protection Agency’s (EPA) Clean Air Act assessment, the results of the case study suggest that controls of sulfur dioxide (SO2) and primary carbon (PC) emissions from EPA Regions 2, 3, 5, 6, and 9 would have significant health benefits for the five selected cities collectively. Around 30,800 air pollution–related mortalities could be avoided during the selected 2-week summertime episode for the five cities collectively if the budget could be allocated based on the results of the resource allocation model. Although only five U.S. cities during a 2-week episode are considered in the case study, the resource allocation model can be used by decision-makers to plan air pollution mitigation strategies to achieve the most significant health benefits for other seasons and more cities over a region or the continental U.S.Implications: Effective allocations of air quality management resources are challenging and complicated, and it is desired to have a tool that can help decision-makers better allocate the funds to maximize health benefits of air pollution mitigation. An innovative resource allocation model developed in this study can help decision-makers identify the best resource allocation strategies for multiple cities collectively. The results of a case study suggest that controls of primary carbon and sulfur dioxides emissions would achieve the most significant health benefits for five selected cities collectively. PMID:27441782

A life cycle model of public policy issues in health care: the importance of strategic issues management.

PubMed

Rakich, J S; Feit, M D

2001-01-01

Public policy affects health and social services organizations. Senior management has a responsibility to prevent inappropriate demands of stakeholders from predominating and to influence the outcome of public policy to the benefit of their organization through the strategic issues management process. This article presents a public policy issue life cycle model, life-cycle stages and suggested strategies, paths issues can take in the life cycle, and factors that affect issue paths. An understanding of these dynamics can aid senior managers in shaping and changing public policy issues and lessening external environment threats to their organization.

Fostering Ecological Literacy: A Case Study of the Saint John Harbour in Two High School English Language Arts Classrooms

NASA Astrophysics Data System (ADS)

Douglas, Velta

Integrating environmental education into curriculum in a way that tackles the holistic and complicated nature of multi-dimensional issues continues to be a challenge for educators and administrators. There is potential in using ecological literacy to introduce local environmental case studies into English Language Arts high school classrooms. This research examines the experiences of two ELA classrooms in one Saint John, NB, high school with a two-week unit based on stakeholder relationships within the Saint John Harbour. Through presentations by guest speakers and research sourced from local community groups, students learned about the highly complex environmental issues that inform management decisions for the Harbour. Using these materials as background, students participated in a mock stakeholders meeting. Case study methodology was used to explore student learning in both a higher-level and a lower-level grade 10 ELA class. Data for the analysis included: cognitive mapping exercises; oral and written classroom assignments and activities; a videotape of the mock stakeholder meetings; a focus group interview with selected students; and researcher field notes. Data demonstrated significant student learning about environmental issues including increased sophistication in describing links between and among environmental issues affecting the harbour, and much more complex understandings of the positions and roles of the various stakeholder groups. Some important areas of resistance to new learning were also evident. Implications for practice and policy and recommendations for future research are discussed.

The economic case for low carbon waste management in rapidly growing cities in the developing world: The case of Palembang, Indonesia.

PubMed

Papargyropoulou, Effie; Colenbrander, Sarah; Sudmant, Andrew Heshedahl; Gouldson, Andy; Tin, Lee Chew

2015-11-01

The provision of appropriate waste management is not only an indicator of development but also of broader sustainability. This is particularly relevant to expanding cities in developing countries faced with rising waste generation and associated environmental health problems. Despite these urgent issues, city authorities often lack the evidence required to make well-informed decisions. This study evaluates the carbon and economic performance of low-carbon measures in the waste sector at a city level, within the context of a developing country. Palembang in Indonesia is used as a case of a medium-sized city in a newly industrialized country, with relevance to other similar cities in the developing world. Evidence suggests that the waste sector can achieve substantial carbon emission reductions, and become a carbon sink, in a cost effective way. Hence there is an economic case for a low carbon development path for Palembang, and possibly for other cities in developing and developed countries facing similar challenges. Copyright © 2015 Elsevier Ltd. All rights reserved.

Women, work and health: issues and implications for worksite health promotion.

PubMed

Collins, B S; Hollander, R B; Koffman, D M; Reeve, R; Seidler, S

1997-01-01

This paper identifies issues related to worksite health promotion programs for women by examining ways that work factors, health behaviors, family roles and responsibilities, and women's health are linked. Work conditions may affect women uniquely, as in the case of chemical exposure affecting reproductive health; disproportionately, such as the interaction between work and family roles; or differently from men, as in women's experience of stress in the workplace. The focus is on the differences and uniqueness of working women's health. Drawing on a public health perspective, implications for consideration by worksite health promotion programs specialist, human resource managers, and researchers are presented.

Walking the line. Palliative sedation for existential distress: still a controversial issue?

PubMed

Schur, Sophie; Radbruch, Lukas; Masel, Eva K; Weixler, Dietmar; Watzke, Herbert H

2015-12-01

Adequate symptom relief is a central aspect of medical care of all patients especially in those with an incurable disease. However, as an illness progresses and the end of life approaches, physical or psychoexistential symptoms may remain uncontrollable requiring palliative sedation. Although palliative sedation has become an increasingly implemented practice in the care of terminally ill patients, sedation in the management of refractory psychological symptoms and existential distress is still a controversial issue and much debated. This case report presents a patient who received palliative sedation for the treatment of existential distress and discusses considerations that may arise from such a therapeutic approach.

Nurse managers' experience with ethical issues in six government hospitals in Malaysia: A cross-sectional study

PubMed Central

2011-01-01

Background Nurse managers have the burden of experiencing frequent ethical issues related to both their managerial and nursing care duties, according to previous international studies. However, no such study was published in Malaysia. The purpose of this study was to explore nurse managers' experience with ethical issues in six government hospitals in Malaysia including learning about the way they dealt with the issues. Methods A cross-sectional study was conducted in August-September, 2010 involving 417 (69.2%) of total 603 nurse managers in the six Malaysian government hospitals. Data were collected using three-part self-administered questionnaire. Part I was regarding participants' demographics. Part II was about the frequency and areas of management where ethical issues were experienced, and scoring of the importance of 11 pre-identified ethical issues. Part III asked how they dealt with ethical issues in general; ways to deal with the 11 pre-identified ethical issues, and perceived stress level. Data were analyzed using descriptive statistics, cross-tabulations and Pearson's Chi-square. Results A total of 397 (95.2%) participants experienced ethical issues and 47.2% experienced them on weekly to daily basis. Experiencing ethical issues were not associated with areas of practice. Top area of management where ethical issues were encountered was "staff management", but "patient care" related ethical issues were rated as most important. Majority would "discuss with other nurses" in dealing generally with the issues. For pre-identified ethical issues regarding "patient care", "discuss with doctors" was preferred. Only 18.1% referred issues to "ethics committees" and 53.0% to the code of ethics. Conclusions Nurse managers, regardless of their areas of practice, frequently experienced ethical issues. For dealing with these, team-approach needs to be emphasized. Proper understanding of the code of ethics is needed to provide basis for reasoning. PMID:22085735

Managing resources in NHS dentistry: using health economics to inform commissioning decisions.

PubMed

Holmes, Richard D; Steele, Jimmy; Exley, Catherine E; Donaldson, Cam

2011-05-31

The aim of this study is to develop, apply and evaluate an economics-based framework to assist commissioners in their management of finite resources for local dental services. In April 2006, Primary Care Trusts in England were charged with managing finite dental budgets for the first time, yet several independent reports have since criticised the variability in commissioning skills within these organisations. The study will explore the views of stakeholders (dentists, patients and commissioners) regarding priority setting and the criteria used for decision-making and resource allocation. Two inter-related case studies will explore the dental commissioning and resource allocation processes through the application of a pragmatic economics-based framework known as Programme Budgeting and Marginal Analysis. The study will adopt an action research approach. Qualitative methods including semi-structured interviews, focus groups, field notes and document analysis will record the views of participants and their involvement in the research process. The first case study will be based within a Primary Care Trust where mixed methods will record the views of dentists, patients and dental commissioners on issues, priorities and processes associated with managing local dental services. A Programme Budgeting and Marginal Analysis framework will be applied to determine the potential value of economic principles to the decision-making process. A further case study will be conducted in a secondary care dental teaching hospital using the same approach. Qualitative data will be analysed using thematic analysis and managed using a framework approach. The recent announcement by government regarding the proposed abolition of Primary Care Trusts may pose challenges for the research team regarding their engagement with the research study. However, whichever commissioning organisations are responsible for resource allocation for dental services in the future; resource scarcity is highly likely to remain an issue. Wider understanding of the complexities of priority setting and resource allocation at local levels are important considerations in the development of dental commissioning processes, national oral health policy and the future new dental contract which is expected to be implemented in April 2014.

Enhancement of an antenatal diagnosis and counselling service (ADACS) through the ready availability of telemedicine services.

PubMed

Morris, D G; Hayward, T

2000-01-01

The early diagnosis of fetal abnormalities and their consequent management comprise a relatively new specialty, which has developed to a large extent from the advances in and availability of ultrasound imaging techniques. The Women's and Children's antenatal diagnosis and counselling service (ADACS) is composed of a multidisciplinary group of health professionals and deals with issues relating to pre-pregnancy counselling, fetal diagnosis of abnormalities and the management of these conditions, including all aspects of pregnancy loss. Detailed minutes are recorded for each case and key information is stored in a relational database. Weekly meetings are held to discuss selected cases and, where possible, are presented to the group by the referring practitioner, either in person or using the telemedicine facilities. Telemedicine has provided a significant enhancement to the ADACS service.

The community case management program: for 12 years, caring at its best.

PubMed

Luzinski, Cyndy Hunt; Stockbridge, Eleanor; Craighead, Janet; Bayliss, Deborah; Schmidt, Marie; Seideman, Janice

2008-01-01

One of the most complex issues currently under debate in this country is how best to provide health care for our society. Since 1995, Poudre Valley Hospital in Fort Collins, Colorado, has been effectively addressing one facet of this national crisis by providing services to a population of primarily elderly, chronically ill individuals perpetually caught in the gaps between acute and end-of-life services. Community case managers link program participants with appropriate health care services and providers that enhance physiological and functional status, identify resources that enrich quality of life, and encourage relationships and skills which foster self-efficacy. By emphasizing timely access to health-maximizing services, this program documented an impressive 81% reduction in financial losses to the organization during 2006 for emergency and inpatient services provided to a specific sample from this population.

Different approaches for centralized and decentralized water system management in multiple decision makers' problems

NASA Astrophysics Data System (ADS)

Anghileri, D.; Giuliani, M.; Castelletti, A.

2012-04-01

There is a general agreement that one of the most challenging issues related to water system management is the presence of many and often conflicting interests as well as the presence of several and independent decision makers. The traditional approach to multi-objective water systems management is a centralized management, in which an ideal central regulator coordinates the operation of the whole system, exploiting all the available information and balancing all the operating objectives. Although this approach allows to obtain Pareto-optimal solutions representing the maximum achievable benefit, it is based on assumptions which strongly limits its application in real world contexts: 1) top-down management, 2) existence of a central regulation institution, 3) complete information exchange within the system, 4) perfect economic efficiency. A bottom-up decentralized approach seems therefore to be more suitable for real case applications since different reservoir operators may maintain their independence. In this work we tested the consequences of a change in the water management approach moving from a centralized toward a decentralized one. In particular we compared three different cases: the centralized management approach, the independent management approach where each reservoir operator takes the daily release decision maximizing (or minimizing) his operating objective independently from each other, and an intermediate approach, leading to the Nash equilibrium of the associated game, where different reservoir operators try to model the behaviours of the other operators. The three approaches are demonstrated using a test case-study composed of two reservoirs regulated for the minimization of flooding in different locations. The operating policies are computed by solving one single multi-objective optimal control problem, in the centralized management approach; multiple single-objective optimization problems, i.e. one for each operator, in the independent case; using techniques related to game theory for the description of the interaction between the two operators, in the last approach. Computational results shows that the Pareto-optimal control policies obtained in the centralized approach dominate the control policies of both the two cases of decentralized management and that the so called price of anarchy increases moving toward the independent management approach. However, the Nash equilibrium solution seems to be the most promising alternative because it represents a good compromise in maximizing management efficiency without limiting the behaviours of the reservoir operators.

Ovarian preservation in a young patient with Gorlin syndrome and multiple bilateral ovarian masses.

PubMed

Morse, Christopher B; McLaren, Janet F; Roy, Darshan; Siegelman, Evan S; Livolsi, Virginia A; Gracia, Clarisa R

2011-07-01

To report a case of bilateral ovarian fibromas and ovarian leiomyomas in a young patient with Gorlin syndrome and to highlight issues of fertility preservation, ovarian conservation, and preimplantation genetic diagnosis in this population. Case report. University hospital. A 15-year-old female patient with Gorlin syndrome and bilateral ovarian masses. Ultrasound, magnetic resonance imaging, hormone analysis, and laparotomy with resection of ovarian fibromas. Preservation of ovarian function, pathologic diagnosis. Our patient represented an adolescent case of bilateral ovarian fibromas and leiomyomas in Gorlin syndrome presenting with menstrual irregularities. She was managed surgically with resection of the lesions and conservation of normal ovarian tissue. In Gorlin syndrome, ovarian fibromas are a common clinical manifestation. Patients with ovarian involvement may present with complex gynecologic needs and may have decreased fertility potential. Careful surgical management, follow-up, and counseling on options for future fertility should be offered to all patients. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Pregnancy and childbirth in a patient with multiple sclerosis: A case report of successful management.

PubMed

Wang, Chun-Kai; Lin, Chi-Kang; Wang, Tun-Jun; Wang, Chen-Yu; Hsu, Po-Chao; Su, Her-Young

2018-06-01

Multiple sclerosis (MS) preferentially affects females of reproductive age, making reproduction an important issue for women with MS. An increased incidence of poor labor progress often results in assisted vaginal delivery or a cesarean section. However, with good pre-pregnancy counseling and management, women with MS can conceive and give birth safely. Here, we present a case of pregnancy with MS, which was carried to term uneventfully and ended with unassisted vaginal delivery. A 36-year-old woman was treated for MS for three years before she conceived. Because of her mild clinical presentation, medication was discontinued when her pregnancy was confirmed. Counseling was completed, and she had a smooth pregnancy course and gave birth vaginally at 38 weeks and two days. Based on this case report, women with mild clinical presentation of MS before pregnancy can conceive and carry successfully to term with no or improved disease presentation. Copyright © 2018. Published by Elsevier B.V.

A study of patient safety management in the framework of clinical governance according to the nurses working in the ICU of the hospitals in the East of Tehran.

PubMed

Sahebalzamani, Mohammad; Mohammady, Mohsen

2014-05-01

The improvement of patient safety conditions in the framework of clinical service governance is one of the most important concerns worldwide. The importance of this issue and its effects on the health of patients encouraged the researcher to conduct this study to evaluate patient safety management in the framework of clinical governance according to the nurses working in the intensive care units (ICUs) of the hospitals of the east of Tehran, Iran in 2012. This descriptive study, which was based on census method, was conducted on 250 nurses sampled from the hospitals located in the east of Tehran. For the collection of data, a researcher-made questionnaire in five categories, including culture, leadership, training, environment, and technology, as well as on safety items was used. To test the validity of the questionnaire, content validity test was conducted, and the reliability of the questionnaire was assessed by retest method, in which the value of alpha was equal to 91%. The results showed that safety culture was at a high level in 55% of cases, safety leadership was at a high level in 40% cases and at a low level in 2.04% cases, safety training was at a high level in 64.8% cases and at a low level in 4% cases, safety of environment and technology was at a high level in 56.8% cases and at a low level in 1.6% cases, and safety items of the patients in their reports were at a high level in approximately 44% cases and at a low level in 6.5% cases. The results of Student's t-test (P < 0.001) showed that the average score of all safety categories of the patients was significantly higher than the average points. Diligence of the management and personnel of the hospital is necessary for the improvement of safety management. For this purpose, the management of hospitals can show interest in safety, develop an events reporting system, enhance teamwork, and implement clinical governance plans.

Building organizational supports for knowledge sharing in county human service organizations: a cross-case analysis of works-in-progress.

PubMed

Lee, Chris; Austin, Michael J

2012-01-01

Building on the literature related to evidence-based practice, knowledge management, and learning organizations, this cross-case analysis presents twelve works-in-progress in ten local public human service organizations seeking to develop their own knowledge sharing systems. The data for this cross-case analysis can be found in the various contributions to this Special Issue. The findings feature the developmental aspects of building a learning organization that include knowledge sharing systems featuring transparency, self-assessment, and dissemination and utilization. Implications for practice focus on the structure and processes involved in building knowledge sharing teams inside public human service organizations. Copyright © Taylor & Francis Group, LLC

Audit of deaths less than a week after admission through an emergency department: how accurate was the ED diagnosis and were any deaths preventable?

PubMed

Nafsi, Tabassum; Russell, Rob; Reid, Cilla M; Rizvi, Syed M M

2007-10-01

To review the causes of death in patients admitted via the emergency department (ED) who died within 7 days of admission and to identify any ways in which ED care could have been better. The study also aims to compare the diagnosis made in the ED and the mortality diagnosis. A retrospective study; subjects were all patients who attended the ED over 4 months and died within 7 days of admission. The paramedics' notes, ED case cards, inpatient medical notes and details of postmortem findings were examined to identify the time and date of arrival in the ED, presenting complaint, provisional diagnosis made by the ED, treatment plan devised by the ED, diagnosis made in wards, and the cause of death as issued on death certificates or from postmortem findings. Summary sheets of cases where the care provided by the emergency department could have been improved were reviewed, errors were identified and deaths were classified as preventable or unpreventable. Database revealed 3521 admissions via the ED over 4 months, of which 95 cases (2.69%) died within 7 days of admission. 78 patients (82.1% of cases) were appropriately diagnosed and managed whereas 17 (17.87% of cases) were identified with deficiencies in either the diagnosis or the management provided in the ED. We reviewed the quality of care provided in the ED for these cases and rated deaths according to our preventability criteria: 5 (5.26%) deaths were unpreventable despite the deficiency in care provided in the ED; 3 (3.15%) deaths were definitely preventable; 3 (3.15%) were probably preventable; and 6 (6.31%) were possibly preventable deaths. The ED is playing a good role in the management of critically ill patients, with appropriate diagnosis and management in 82% of cases. Training of junior doctors is required to prevent occurrence of errors and thus preventable deaths, but all deaths are not preventable. New guidelines for sepsis management and management of undifferentiated clinical presentations are being introduced and we intend to audit the implications of new guidelines.

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.

Ethical Implications of Case-Based Payment in China: A Systematic Analysis.

PubMed

Jin, Pingyue; Biller-Andorno, Nikola; Wild, Verina

2015-12-01

How health care providers are paid affects how medicine is practiced. It is thus important to assess provider payment models not only from the economic perspective but also from the ethical perspective. China recently started to reform the provider payment model in the health care system from fee-for-service to case-based payment. This paper aims to examine this transition from an ethical perspective. We collected empirical studies on the impact of case-based payment in the Chinese health care system and applied a systematic ethical matrix that integrates clinical ethics and public health ethics to analyze the empirical findings. We identified eleven prominent ethical issues related to case-based payment. Some ethical problems of case-based payment in China are comparable to ethical problems of managed care and diagnosis related groups in high-income countries. However, in this paper we discuss in greater detail four specific ethical issues in the Chinese context: professionalism, the patient-physician relationship, access to care and patient autonomy. Based on the analysis, we cautiously infer that case-based payment is currently more ethically acceptable than fee-for-service in the context of China, mainly because it seems to lower financial barriers to access care. Nonetheless, it will be difficult to justify the implementation of case-based payment if no additional measures are taken to monitor and minimize its existing negative ethical implications. © 2014 John Wiley & Sons Ltd.

Forest fire management to avoid unintended consequences: a case study of Portugal using system dynamics.

PubMed

Collins, Ross D; de Neufville, Richard; Claro, João; Oliveira, Tiago; Pacheco, Abílio P

2013-11-30

Forest fires are a serious management challenge in many regions, complicating the appropriate allocation to suppression and prevention efforts. Using a System Dynamics (SD) model, this paper explores how interactions between physical and political systems in forest fire management impact the effectiveness of different allocations. A core issue is that apparently sound management can have unintended consequences. An instinctive management response to periods of worsening fire severity is to increase fire suppression capacity, an approach with immediate appeal as it directly treats the symptom of devastating fires and appeases the public. However, the SD analysis indicates that a policy emphasizing suppression can degrade the long-run effectiveness of forest fire management. By crowding out efforts to preventative fuel removal, it exacerbates fuel loads and leads to greater fires, which further balloon suppression budgets. The business management literature refers to this problem as the firefighting trap, wherein focus on fixing problems diverts attention from preventing them, and thus leads to inferior outcomes. The paper illustrates these phenomena through a case study of Portugal, showing that a balanced approach to suppression and prevention efforts can mitigate the self-reinforcing consequences of this trap, and better manage long-term fire damages. These insights can help policymakers and fire managers better appreciate the interconnected systems in which their authorities reside and the dynamics that may undermine seemingly rational management decisions. Copyright © 2013 Elsevier Ltd. All rights reserved.

Integrated Hydrographical Basin Management. Study Case - Crasna River Basin

NASA Astrophysics Data System (ADS)

Visescu, Mircea; Beilicci, Erika; Beilicci, Robert

2017-10-01

Hydrographical basins are important from hydrological, economic and ecological points of view. They receive and channel the runoff from rainfall and snowmelt which, when adequate managed, can provide fresh water necessary for water supply, irrigation, food industry, animal husbandry, hydrotechnical arrangements and recreation. Hydrographical basin planning and management follows the efficient use of available water resources in order to satisfy environmental, economic and social necessities and constraints. This can be facilitated by a decision support system that links hydrological, meteorological, engineering, water quality, agriculture, environmental, and other information in an integrated framework. In the last few decades different modelling tools for resolving problems regarding water quantity and quality were developed, respectively water resources management. Watershed models have been developed to the understanding of water cycle and pollution dynamics, and used to evaluate the impacts of hydrotechnical arrangements and land use management options on water quantity, quality, mitigation measures and possible global changes. Models have been used for planning monitoring network and to develop plans for intervention in case of hydrological disasters: floods, flash floods, drought and pollution. MIKE HYDRO Basin is a multi-purpose, map-centric decision support tool for integrated hydrographical basin analysis, planning and management. MIKE HYDRO Basin is designed for analyzing water sharing issues at international, national and local hydrographical basin level. MIKE HYDRO Basin uses a simplified mathematical representation of the hydrographical basin including the configuration of river and reservoir systems, catchment hydrology and existing and potential water user schemes with their various demands including a rigorous irrigation scheme module. This paper analyzes the importance and principles of integrated hydrographical basin management and develop a case study for Crasna river basin, with the use of MIKE HYDRO Basin advanced hydroinformatic tool for integrated hydrographical basin analysis, planning and management.

Gender identity disorder and autism spectrum disorder in a 23-year-old female.

PubMed

Lemaire, Mathieu; Thomazeau, Barbara; Bonnet-Brilhault, Frédérique

2014-02-01

We describe the case of a 23-year-old woman with Gender Identity Disorder (GID) asking for a cross-sex hormonal treatment with sex reassignment surgery and who was recently diagnosed with Autism Spectrum Disorder (ASD). Gender identity clinics are now reporting an overrepresentation of individuals with ASD among GID patients. The prevalence of ASD is 10-fold higher among GID patients than in general population. However, few case reports or studies have explored the co-occurrence of ASD and GID. This co-occurrence is relevant for diagnostic and clinical management and also raises important theoretical issues.

A patient with autism and severe depression: medical and ethical challenges for an adolescent medicine unit.

PubMed

Skinner, S Rachel; Ng, Cindy; McDonald, Ann; Walters, Tamara

2005-10-17

An adolescent with autism and intellectual disability presented with severe depression related to menstruation. Because of the complex medical, psychiatric and ethical issues involved, her care was coordinated by a hospital-based adolescent medicine unit. After trials of other therapies over an extended period and interdisciplinary and intersectoral case conferencing, it was decided that hysterectomy was the most appropriate management. This case highlights the complexity of adolescent health care in a tertiary hospital, the importance of intersectoral cooperation between hospital and community, and the integral role of interdisciplinary care of adolescent patients with chronic conditions.

Methadone detoxification of tramadol dependence.

PubMed

Leo, R J; Narendran, R; DeGuiseppe, B

2000-10-01

Tramadol hydrochloride is a centrally acting analgesic with a partial affinity for the opiate receptor (mu), having an analgesic potency estimated to be one tenth that of morphine. While preclinical investigations suggested that abuse liability associated with tramadol use is low, there are increasing numbers of cases reported to the U.S. Food and Drug Administration of abuse, dependence, and withdrawal associated with tramadol use. A case of a patient with tramadol dependence requiring detoxification with methadone is presented. Acute management of significant tramadol dependence has not yet been reported in the literature. Long-term treatment issues are also discussed.