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.

Assistance and Accountability in Externally Managed Schools: The Case of Edison Schools, Inc.

ERIC Educational Resources Information Center

Marsh, Julie; Hamilton, Laura; Gill, Brian

2008-01-01

Edison Schools, Inc., is the largest and most visible among a growing number of Education Management Organizations that have entered into contracts to manage public schools, including both conventional and charter schools. Edison's approach to managing schools is comprehensive, and it distinguishes itself from most other school improvement…

Enrollment Management in the Comprehensive Community College: A Case Study of Bronx Community College

ERIC Educational Resources Information Center

Ritze, Nancy

2006-01-01

Faced with growing pressure to demonstrate student success and achieve financial stability, community colleges have increasingly turned to enrollment management. Using Bronx Community College as an example, this chapter examines the role institutional research can play in the enrollment management process.

Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates.

PubMed

Alshabanat, Abdulmajeed; Otterstatter, Michael C; Sin, Don D; Road, Jeremy; Rempel, Carmen; Burns, Jane; van Eeden, Stephan F; FitzGerald, J M

2017-01-01

COPD accounts for the highest rate of hospital admissions among major chronic diseases. COPD hospitalizations are associated with impaired quality of life, high health care utilization, and poor prognosis and result in an economic and a social burden that is both substantial and increasing. The aim of this study is to determine the efficacy of a comprehensive case management program (CCMP) in reducing length of stay (LOS) and risk of hospital admissions and readmissions in patients with COPD. We retrospectively compared outcomes across five large hospitals in Vancouver, BC, Canada, following the implementation of a systems approach to the management of COPD patients who were identified in the hospital and followed up in the community for 90 days. We compared numbers, rates, and intervals of readmission and LOS during 2 years of active program delivery compared to 1 year prior to program implementation. A total of 1,564 patients with a clinical diagnosis of COPD were identified from 2,719 hospital admissions during the 3 years of study. The disease management program reduced COPD-related hospitalizations by 30% and hospitalizations for all causes by 13.6%. Similarly, the rate of readmission for all causes showed a significant decline, with hazard ratios (HRs) of 0.55 (year 1) and 0.51 (year 2) of intervention ( P <0.001). In addition, patients' mean LOS (days) for COPD-related admissions declined significantly from 10.8 to 6.8 ( P <0.05). A comprehensive disease management program for COPD patients, including education, case management, and follow-up, was associated with significant reduction in hospital admissions and LOS.

[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.

A comprehensive approach in high-grade glioma management: position statement from the Neuro-Oncology Scientific Club (NOSC), Shiraz, Iran

PubMed Central

Ansari, Mansour; Mosalaei, Ahmad; Ahmadloo, Niloufar; Rasekhi, Alireza; Geramizadeh, Bita; Razmkon, Ali; Anvari, Kazem; Afarid, Mohammad; Dadras, Ali; Nafarieh, Leila; Mohammadianpanah, Mohammad; Nasrolahi, Hamid; Hamedi, Seyed Hasan; Omidvari, Shapour; Nami, Mohammad

2017-01-01

Establishing a robust teamwork model in the practice of neuro-oncology requires continued interdisciplinary efforts. The Neuro-Oncology Scientific Club (NOSC) initiative is an interdisciplinary clinical forum promoting the comprehensive approach across involved disciplines in the management of central nervous system (CNS) malignancies. With its provincial founding panels and national steering board, NOSC has been operational in Iran since 2011. This initiative has pursued its mission through interval strategic meetings, tumor boards, case discussions as well as publishing neuro-oncology updates, case study periodicals, and newsletters. A provincial meeting of NOSC in Shiraz put together insights from international practice guidelines, emerging evidence, and expert opinions to draw a position statement on high-grade glioma management in adults. The present report summarizes key highlights from the above clinical forum. PMID:28325997

A comprehensive approach in high-grade glioma management: position statement from the Neuro-Oncology Scientific Club (NOSC), Shiraz, Iran.

PubMed

Ansari, Mansour; Mosalaei, Ahmad; Ahmadloo, Niloufar; Rasekhi, Alireza; Geramizadeh, Bita; Razmkon, Ali; Anvari, Kazem; Afarid, Mohammad; Dadras, Ali; Nafarieh, Leila; Mohammadianpanah, Mohammad; Nasrolahi, Hamid; Hamedi, Seyed Hasan; Omidvari, Shapour; Nami, Mohammad

2017-01-01

Establishing a robust teamwork model in the practice of neuro-oncology requires continued interdisciplinary efforts. The Neuro-Oncology Scientific Club (NOSC) initiative is an interdisciplinary clinical forum promoting the comprehensive approach across involved disciplines in the management of central nervous system (CNS) malignancies. With its provincial founding panels and national steering board, NOSC has been operational in Iran since 2011. This initiative has pursued its mission through interval strategic meetings, tumor boards, case discussions as well as publishing neuro-oncology updates, case study periodicals, and newsletters. A provincial meeting of NOSC in Shiraz put together insights from international practice guidelines, emerging evidence, and expert opinions to draw a position statement on high-grade glioma management in adults. The present report summarizes key highlights from the above clinical forum.

Migraine with Aura or Sports-Related Concussion: Case Report, Pathophysiology, and Multidisciplinary Approach to Management.

PubMed

Ellis, Michael J; Cordingley, Dean; Girardin, Richard; Ritchie, Lesley; Johnston, Janine

The evaluation and management of athletes presenting with clinical features of migraine headache with aura in the setting of sports-related head trauma is challenging. We present a case report of a 15-yr-old boy with a history of migraine with visual aura that developed acute visual disturbance and headache after a head injury during an ice hockey game. The patient underwent comprehensive assessment at a multidisciplinary concussion program, including neuro-ophthalmological examination, neurocognitive testing, and graded aerobic treadmill testing. Clinical history and multidisciplinary assessment was consistent with the diagnosis of coexisting sports-related concussion and migraine with brainstem aura. The authors discuss the pearls and pitfalls of managing patients who develop migraine headache with visual aura after sports-related head injury and the value of a comprehensive multidisciplinary approach to this unique patient population.

Obstetric Fistula in Burundi: a comprehensive approach to managing women with this neglected disease

PubMed Central

2013-01-01

Background In Burundi, the annual incidence of obstetric fistula is estimated to be 0.2-0.5% of all deliveries, with 1000–2000 new cases per year. Despite this relatively high incidence, national capacity for identifying and managing obstetric fistula is very limited. Thus, in July 2010, Medecins Sans Frontieres (MSF) set up a specialised Obstetric Fistula Centre in Gitega (Gitega Fistula Centre, GFC), the only permanent referral centre for obstetric fistula in Burundi. A comprehensive model of care is offered including psychosocial support, conservative and surgical management, post-operative care and follow-up. We describe this model of care, patient outcomes and the operational challenges. Methods Descriptive study using routine programme data. Results Between July 2010 and December 2011, 470 women with obstetric fistula presented for the first time at GFC, of whom 458 (98%) received treatment. Early urinary catheterization (conservative management) was successful in four out of 35 (11%) women. Of 454 (99%) women requiring surgical management, 394 (87%) were discharged with a closed fistula, of whom 301 (76%) were continent of urine and/or faeces, while 93 (24%) remained incontinent of urine and/or faeces. In 59 (13%) cases, the fistula was complex and could not be closed. Outcome status was unknown for one woman. Median duration of stay at GFC was 39 days (Interquartile range IQR, 31–51 days). The main operational challenges included: i) early case finding and recruitment for conservative management, ii) national capacity building in obstetric fistula surgical repair, and iii) assessing the psychosocial impact of this model. Conclusion In a rural African setting, it is feasible to implement a comprehensive package of fistula care using a dedicated fistula facility, and satisfactory surgical repair outcomes can be achieved. Several operational challenges are discussed. PMID:23965150

Special Plans and Operations: Assessment of DOD Wounded Warrior Matters - Fort Sam Houston

DTIC Science & Technology

2011-03-17

nurse case managers, and squad leaders • Assess WTB unit order and discipline • Develop comprehensive training programs for nurse case managers...consist of, but are not limited to, military cadre, physicians, nurses , TBI and behavioral health specialists such as psychologists and social workers...and access to care standards. Triad of Care At the nucleus of the WTU is the “Triad of Care,” which is comprised of a squad leader, a nurse case

Managing Athletic Liability: An Assessment Guide.

ERIC Educational Resources Information Center

Burling, Philip; And Others

1992-01-01

A comprehensive risk-management program associated with athletic activities contains the following essential components: (1) policies and procedures; (2) training; (3) supervision; (4) corrective action; (5) review and revision; (6) legal counsel and support. Action steps follow each of these major areas. (29 case references) (MLF)

Helping Crisis Managers Protect Reputational Assets: Initial Tests of the Situational Crisis Communication Theory.

ERIC Educational Resources Information Center

Coombs, W. Timothy; Holladay, Sherry J.

2002-01-01

Explains a comprehensive, prescriptive, situational approach for responding to crises and protecting organizational reputation: the situational crisis communication theory (SCCT). Notes undergraduate students read two crisis case studies from a set of 13 cases and responded to questions following the case. Validates a key assumption in SCCT and…

The Implementation of Enrollment Management at Two Public Universities Experiencing Demographic and Funding Challenges

ERIC Educational Resources Information Center

Lee, Stephen

2010-01-01

The purpose of this study was to evaluate the implementation of enrollment management at two public universities. The theoretical framework was conceptual and centered on the effectiveness of the implementation process as a pivotal factor in the development of a comprehensive enrollment management operation. This multi-site case study included 14…

Analysis of Risks in a Learning Management System: A Case Study in the Spanish National University of Distance Education (UNED)

ERIC Educational Resources Information Center

Vázquez-Cano, Esteban; Sevillano García, Ma. Luisa

2015-01-01

This article presents a research that examines the university students' risk perception when using a Learning Management System called "aLF" and implemented by the Spanish National University of Distance Education (UNED) for the development of its university distance studies. The development of comprehensive Learning Management Systems…

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

Iowa Case Management for Rural Drug Abuse

PubMed Central

Hall, James A.; Sarrazin, Mary S. Vaughan; Huber, Diane L.; Vaughn, Thomas; Block, Robert I.; Reedy, Amanda R.; Jang, MiJin

2011-01-01

Objective The purpose of this research was to evaluate the effectiveness of a comprehensive, strengths-based model of case management for clients in drug abuse treatment. Method 503 volunteers from residential or intensive outpatient treatment were randomly assigned to one of three conditions of Iowa Case Management (ICM) plus treatment as usual (TAU), or to a fourth condition of TAU only. All were assessed at intake and followed at 3, 6, and 12 months. Results Clients in all four conditions significantly decreased substance use by 3 months after intake and maintained most gains over time. However, the addition of ICM to TAU did not improve substance use outcomes. Conclusion Overall, the addition of case management did not significantly improve drug treatment as hypothesized by both researchers and clinicians. Some results were mixed, possibly due to the heterogeneous sample, wide range of case management activities, or difficulty retaining participants over time. PMID:22065018

Case management considerations of progressive dementia in a home setting.

PubMed

Pierce, Mary Ellen

2010-01-01

Nursing theory, research, and best practice guidelines contribute substantially to the field of dementia care. Interventional plans are challenged most by those dementias considered progressive and deteriorative in nature, requiring ongoing reassessment and modification of care practices as the clinical course changes. The purpose of this article is to provide guidelines for case managers in the development of effective, individualized care plans for clients with progressive dementia residing in a home setting. The application of these guidelines is illustrated through the presentation of an actual case. The practice setting is a private home in the Pacific Northwest. Geriatric case management is provided by an RN case manager. Progressive dementia presents challenges to home care. Professional case management using comprehensive, holistic assessment, collaborative approaches, and best practice fundamentals serve to create an effective, individualized plan of care. The increasing geriatric population presents great opportunities for case managers in strategic management for creating successful home care models in clients with progressive dementia. Use of nursing diagnoses, dementia research, and collaborative approaches with families and other medical providers creates a viable alternative for clients with progressive dementia.

Formal Foundations for Hierarchical Safety Cases

NASA Technical Reports Server (NTRS)

Denney, Ewen; Pai, Ganesh; Whiteside, Iain

2015-01-01

Safety cases are increasingly being required in many safety-critical domains to assure, using structured argumentation and evidence, that a system is acceptably safe. However, comprehensive system-wide safety arguments present appreciable challenges to develop, understand, evaluate, and manage, partly due to the volume of information that they aggregate, such as the results of hazard analysis, requirements analysis, testing, formal verification, and other engineering activities. Previously, we have proposed hierarchical safety cases, hicases, to aid the comprehension of safety case argument structures. In this paper, we build on a formal notion of safety case to formalise the use of hierarchy as a structuring technique, and show that hicases satisfy several desirable properties. Our aim is to provide a formal, theoretical foundation for safety cases. In particular, we believe that tools for high assurance systems should be granted similar assurance to the systems to which they are applied. To this end, we formally specify and prove the correctness of key operations for constructing and managing hicases, which gives the specification for implementing hicases in AdvoCATE, our toolset for safety case automation. We motivate and explain the theory with the help of a simple running example, extracted from a real safety case and developed using AdvoCATE.

[Managing comprehensive care: a case study in a health district in Bahia State, Brazil].

PubMed

dos Santos, Adriano Maia; Giovanella, Ligia

2016-03-01

This study analyzed management of comprehensive care in a health district in Bahia State, Brazil, at the political, institutional, organizational, and healthcare practice levels and the challenges for establishing coordinated care between municipalities. The information sources were semi-structured interviews with administrators, focal groups with healthcare professionals and users, institutional documents, and observations. A comprehensive and critical analysis was produced with dialectical hermeneutics as the reference. The results show that the Inter-Administrators Regional Commission was the main regional governance strategy. There is a fragmentation between various points and lack of communications linkage in the network. Private interests and partisan political interference overlook the formally agreed-upon flows and create parallel circuits, turning the right to health into currency for trading favors. Such issues hinder coordination of comprehensive care in the inter-municipal network.

Management of Mucosal Basal Cell Carcinoma of the Lip: An Update and Comprehensive Review of the Literature.

PubMed

Loh, Tiffany; Rubin, Ashley G; Brian Jiang, Shang I

2016-12-01

Basal cell carcinoma (BCC) is the most common malignancy in the United States. Most BCCs occur on cutaneous surfaces, but rare cases on the mucosal lip have also been documented. Because only a small number of mucosal BCC (mBCC) cases have been reported, data on their clinical characteristics and management are limited. To perform an updated literature review of the management of mBCCs on the lip. A comprehensive literature review was conducted through a search of the PubMed database with the key phrases "mucosal basal cell carcinoma," "basal cell carcinoma mucosa," and "basal cell carcinoma lip mucosa." Forty-eight cases of mBCCs have been reported, and 35 had sufficient data for analysis. The average age at presentation was 66.8 years, and 57% (n = 20) had a history of skin cancer. Most cases were treated with surgical excision or Mohs micrographic surgery (MMS), with only 1 recurrence in the literature. Furthermore, the authors present 8 additional cases of mBCCs successfully treated with MMS. Mucosal basal cell carcinomas are rare, and skin cancer history may be a risk factor. Because the lip is a cosmetically and functionally important area, MMS may be the preferred treatment method for mBCCs in this location.

A Guide to the Identification of Training Needs.

ERIC Educational Resources Information Center

Boydell, T. H.

This comprehensive analysis of training needs, which is illustrated with case studies and factual examples, is directed towards training management, but its concepts are expressed in terms valuable to all management. The first chapter answers the question, "What are training needs?" The following chapters discuss present and future training needs,…

Ready to Respond: Case Studies in Campus Safety and Security

ERIC Educational Resources Information Center

Hyatt, James A.

2010-01-01

Is your campus primed for the next big emergency? The National Campus Safety and Security Project (NCSSP), led by NACUBO, sought to help colleges and universities develop comprehensive emergency management plans that address the four phases of emergency management: prevention/mitigation, preparedness, response, and recovery. A major component of…

Middle-Level Academic Management: A Case Study on the Roles of the Heads of Department at a Vietnamese University

ERIC Educational Resources Information Center

Nguyen, Thi Lan Huong

2013-01-01

Middle-level academic managers play a central role in university management; however, their roles are not always clear and straightforward. Although this research subject has been comprehensively investigated in the last 40 years, most studies are western-biased. This study examines the roles of Heads of Department in a newly established…

A Data Management System for Multi-Phase Case-Control Studies

PubMed Central

Gibeau, Joanne M.; Steinfeldt, Lois C.; Stine, Mark J.; Tullis, Katherine V.; Lynch, H. Keith

1983-01-01

The design of a computerized system for the management of data in multi-phase epidemiologic case-control studies is described. Typical study phases include case-control selection, abstracting of data from medical records, and interview of study subjects or next of kin. In consultation with project personnel, requirements for the system were established: integration of data from all study phases into one data base, accurate follow-up of subjects through the study, sophisticated data editing capabilities, ready accessibility of specified programs to project personnel, and generation of current status and exception reports for project managment. SIR (Scientific Information Retrieval), a commercially available data base management system, was selected as the foundation of this system. The system forms a comprehensive data management system applicable to many types of public health research studies.

Comprehensive Child Welfare Information System. Final rule.

PubMed

2016-06-02

This final rule replaces the Statewide and Tribal Automated Child Welfare Information Systems (S/TACWIS) rule with the Comprehensive Child Welfare Information System (CCWIS) rule. The rule also makes conforming amendments in rules in related requirements. This rule will assist title IV-E agencies in developing information management systems that leverage new innovations and technology in order to better serve children and families. More specifically, this final rule supports the use of cost-effective, innovative technologies to automate the collection of high-quality case management data and to promote its analysis, distribution, and use by workers, supervisors, administrators, researchers, and policy makers.

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

PubMed

Raigrodski, Ariel J; Dogan, Sami

2008-05-01

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

Feasibility and initial efficacy of a culturally sensitive women-centered substance use intervention in Georgia: Sex risk outcomes.

PubMed

Jones, Hendrée E; Kirtadze, Irma; Otiashvili, David; Murphy, Keryn; O'Grady, Kevin E; Zule, William; Krupitsky, Evgeny; Wechsberg, Wendee M

2015-12-08

This paper reports on the feasibility and initial efficacy of a culturally sensitive, comprehensive women-centered substance use intervention for women who inject drugs in Georgia in terms of the primary and secondary sex risk outcomes. The hypothesis under examination was that, relative to case management participants, participants in a culturally sensitive, comprehensive women-specific and -centered intervention would, on average, show significant decreases in past-30-day frequency of unprotected sex, unprotected sex at the last sexual encounter, and increases in condom use and safer sex actions. The study was a two-arm randomized trial, in which 173 potentially eligible women were screened, and those 128 women determined to be eligible were assigned at random to either Reinforcement-based Treatment plus Women's Co-Op (RBT + WC) or case management (CM). RBT + WC participants received 12 sessions of a structured intervention with the goal of reducing risky sex and substance use and improving physical and mental health. CM participants received 12 sessions of case management and informational brochures that focused on the same issues on which RBT + WC focused. Participants were assessed at baseline, post-treatment, and 3 months following treatment enrollment. Analyses revealed case management having significantly overall higher Safer Sex action scores than RBT + WC, and a significant decrease over time for past 30-day number of unprotected sex acts. Unprotected sex at the last encounter and Condom Use action scores were nonsignificant. Women who inject drugs in Georgia are engaging in risky sexual practices, and are in need of an intervention that addresses these risky behaviors. Reasons for the failure to find differences between a culturally sensitive, comprehensive women-centered intervention and case management tailored to the needs of women who inject drugs in Georgia may have been the result of inadequate power to detect an effect in a sample whose drug use was not as serious as warranted by the intervention. (ClinicalTrials.gov Identifier: NCT01331460 ).

A Successful Model for a Comprehensive Patient Flow Management Center at an Academic Health System.

PubMed

Lovett, Paris B; Illg, Megan L; Sweeney, Brian E

2016-05-01

This article reports on an innovative approach to managing patient flow at a multicampus academic health system, integrating multiple services into a single, centralized Patient Flow Management Center that manages supply and demand for inpatient services across the system. Control of bed management was centralized across 3 campuses and key services were integrated, including bed management, case management, environmental services, patient transport, ambulance and helicopter dispatch, and transfer center. A single technology platform was introduced, as was providing round-the-clock patient placement by critical care nurses, and adding medical directors. Daily bed meetings with nurse managers and charge nurses drive action plans. This article reports immediate improvements in the first year of operations in emergency department walkouts, emergency department boarding, ambulance diversion, growth in transfer volume, reduction in lost transfers, reduction in time to bed assignment, and bed turnover time. The authors believe theirs is the first institution to integrate services and centralize bed management so comprehensively. © The Author(s) 2014.

A four-tier problem-solving scaffold to teach pain management in dental school.

PubMed

Ivanoff, Chris S; Hottel, Timothy L

2013-06-01

Pain constitutes a major reason patients pursue dental treatment. This article presents a novel curriculum to provide dental students comprehensive training in the management of pain. The curriculum's four-tier scaffold combines traditional and problem-based learning to improve students' diagnostic, pharmacotherapeutic, and assessment skills to optimize decision making when treating pain. Tier 1 provides underpinning knowledge of pain mechanisms with traditional and contextualized instruction by integrating clinical correlations and studying worked cases that stimulate clinical thinking. Tier 2 develops critical decision making skills through self-directed learning and actively solving problem-based cases. Tier 3 exposes students to management approaches taken in allied health fields and cultivates interdisciplinary communication skills. Tier 4 provides a "knowledge and experience synthesis" by rotating students through community pain clinics to practice their assessment skills. This combined teaching approach aims to increase critical thinking and problem-solving skills to assist dental graduates in better management of pain throughout their careers. Dental curricula that have moved to comprehensive care/private practice models are well-suited for this educational approach. The goal of this article is to encourage dental schools to integrate pain management into their curricula, to develop pain management curriculum resources for dental students, and to provide leadership for change in pain management education.

Management strategies on the industrialization road of state-of-the-art technologies for e-waste recycling: the case study of electrostatic separation--a review.

PubMed

Xue, Mianqiang; Li, Jia; Xu, Zhenming

2013-02-01

Electronic waste (e-waste) management is pressing as global production has increased significantly in the past few years and is rising continuously at a fast rate. Many countries are facing hazardous e-waste mountains, most of which are disposed of by backyard recyclers, creating serious threats to public health and ecosystems. Industrialization of state-of-the-art recycling technologies is imperative to enhance the comprehensive utilization of resources and to protect the environment. This article aims to provide an overview of management strategies solving the crucial problems during the process of industrialization. A typical case study of electrostatic separation for recycling waste printed circuit boards was discussed in terms of parameters optimization, materials flow control, noise assessment, risk assessment, economic evaluation and social benefits analysis. The comprehensive view provided by the review could be helpful to the progress of the e-waste recycling industry.

Modified Esthetic Splint Design for Management of Multiple Traumatic Injuries in Children: A Case Report

PubMed Central

Garla, Bharath Kumar; Deshmukh, Seema; Murthy, Prashanth Sadashiva; Satish, G

2015-01-01

Traumatic injuries to the dento-alveolar structures are emergencies that compromise the quality of life of the patients. In addition to symptomatic management, definitive functional restoration and suitable rehabilitation becomes a major treatment objective in such cases. The dynamics of the traumatic forces may cause multiple injuries of different grades to the oral and para-oral structures, which makes comprehensive management a greater challenge to the dentist. The present case report elaborates a modified esthetic splint designed to treat multiple dental injuries in children, which can promote healing, restore optimal functionality along with esthetic rehabilitation to psychologically benefit the child during the time of recovery. PMID:26435631

Laser therapy in the management of dental and oro-facial trauma

NASA Astrophysics Data System (ADS)

Darbar, Arun A.

2007-02-01

This is a clinical presentation demonstrating the efficacy of laser therapy in the treatment of patients presenting with trauma to both the hard and soft tissue in the orofacial region. The use of laser therapy aids the management of these cases where the patients often present with anxiety and a low pain threshold. The outcomes in these cases indicate good patient acceptance of the treatment, enhanced repair and tissue response suggesting that this form of treatment can be indicated for these patients. A combination of hard and soft lasers are used for the comprehensive dental management and treatment of these cases. The lasers used are a 810nm diode and an Er.CrYSGG.

Comprehensive obesity evaluation and treatment of three adolescents: a case series.

PubMed

Taylor, Sharonda J Alston; Peterson, Mitchell A; Garland, Beth H; Hastings, Elisabeth S

2016-02-01

Adolescent obesity is a chronic disease that is impacted from each patient's biopsychosocial milieu. Successfully treating pediatric obesity requires long-term, innovative, systematic involvement to facilitate patient and family engagement and change. Extensive chart review was done for three obese adolescents who underwent comprehensive weight management in an adolescent clinic seen within the past 5 years. The charts were reviewed starting from the time of initial contact through the last visit in the clinic. The patients are no longer receiving care within the clinic. The patients presented with BMI>99th percentile, family history of obesity, severe psychosocial stressors, and multiple obesity-related comorbidities. Their treatment involved comprehensive multidisciplinary intervention in an adolescent weight management clinic within a tertiary care center. In addition to rigorous support through frequent office visits, these patients all eventually required temporary, alternative living arrangements to successfully implement recommendations. One patient resided with another family member; two went to inpatient weight management program care for 2-3 months. All subjects successfully lost weight when away from their primary residence, and they demonstrated improvement or resolution of comorbidities. This case series of three adolescents who underwent comprehensive obesity evaluation and treatment demonstrates multidisciplinary care across interconnected treatment programs and active engagement of family. Those who maintained successful weight loss reduced sedentary time, demonstrated family support (e.g., key members attending follow-up visits), and altered their living environment and were committed to their own health goals.

Terror management and stereotyping: why do people stereotype when mortality is salient?

PubMed

Renkema, Lennart J; Stapel, Diederik A; Maringer, Marcus; van Yperen, Nico W

2008-04-01

Three studies examine two routes by which mortality threats may lead to stereotyping. Mortality salience may activate both a comprehension goal and an enhancement goal. Enhancement goals are likely to be more active in situations where intergroup competition or conflict is salient. If this is not the case, then a comprehension goal will predominate. In line with a why-determines-how logic, when mortality salience activates a comprehension goal, both positive and negative stereotyping occur. In contrast, the activation of an enhancement goal only increases negative stereotyping.

Administrators' Perceptions of the Enrollment Management Practices at the Comprehensive Public Associate's Colleges in Alabama

ERIC Educational Resources Information Center

Abston, Byron O.

2010-01-01

Enrollment management is a major component within the organizational structure of most four-year universities today. However, this is not necessarily the case with community colleges. With the continual decrease in public funding and increased competition with private colleges and universities, public community colleges are now being forced to…

Feasibility Study on the Use of Computer Managed Learning in Secondary Schools in the U.S.A.

ERIC Educational Resources Information Center

Charp, Sylvia

A brief description of computer managed instruction (CMI), including its applications and capabilities, introduces case studies of schools in the United States that are using three different CMI systems. The first system discussed is the Comprehensive Achievement Monitoring (CAM) Program, which was developed by a small school district (Hopkins,…

A Comprehensive Approach to Managing School Safety: Case Studies in Catalonia, Spain

ERIC Educational Resources Information Center

Díaz-Vicario, Anna; Gairín Sallán, Joaquín

2017-01-01

Background: Schools should be safe spaces for students, teaching staff and non-teaching staff. For the concept of "safety" to be meaningful, it must be interpreted broadly to encompass well-being in its widest sense. A common challenge for schools and educational authorities is, therefore, to manage school safety appropriately not only…

Effectiveness of Different Models of Case Management for Substance-Abusing Populations

PubMed Central

Vanderplasschen, Wouter; Wolf, Judith; Rapp, Richard C.; Broekaert, Eric

2007-01-01

Case management has been implemented in substance abuse treatment to improve (cost-) effectiveness, but controversy exists about its potential to realize this objective. A systematic and comprehensive review of peer-reviewed articles (n = 48) published between 1993 and 2003 is presented, focusing on the effects of different models of case management among various substance-abusing populations. Results show that several studies have reported positive effects, but only some randomized and controlled trials have demonstrated the effectiveness of case management compared with other interventions. Longitudinal effects of this intervention remain unclear. Although no compelling evidence was found for the effectiveness of case management, some evidence is available about the (differential) effectiveness of intensive case management and assertive community treatment for homeless and dually-diagnosed substance abusers. Strengths-based and generalist case management have proven to be relatively effective for substance abusers in general. Most positive effects concern reduced use of inpatient services and increased utilization of community-based services, prolonged treatment retention, improved quality of life, and high client satisfaction. Outcomes concerning drug use and psychosocial functioning are less consistent, but seem to be mediated by retention in treatment and case management. Further research is required to learn more about the extent of the effects of this intervention, how long these are sustained and what specific elements cause particular outcomes. PMID:17523588

Management Approaches for Enterocutaneous Fistulas.

PubMed

Heimroth, Jamie; Chen, Eric; Sutton, Erica

2018-03-01

There are very few clinical studies that highlight a definitive and comprehensive guideline for the management of enterocutaneous fistulas. Most accepted guidelines are found in textbooks and are taken from expert advice and case reports. The goal of this review is to highlight advancements relevant to the management of enterocutaneous fistulas from the recent two to three years. Although strong evidence-based guidelines are lacking, the consensus is that a multidisciplinary team working with a clear treatment plan targeting multiple aspects of management can maximize patient outcomes.

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.

Multidisciplinary Management of An Unusual Isolated Alveolar Bone Infection- A Rare Case Report

PubMed Central

B, Dixit Mala; S, Kulkarni Rahul; M, Ramugade Manoj

2015-01-01

Restoration of proximal defect of tooth is of paramount importance as its improper restoration usually results in fracture of the restoration or deteriorated periodontal health. The article reports a case with a discreet mass of alveolar bone necrosis closed to the overhanged amalgam restoration in the proximal box of the maxillary molar. As a result of this improper proximal restoration it led to deep periodontal pocket and subsequent alveolar bone necrosis which was managed successfully with combined Endodontic-Periodontic treatment. This article highlights the unfortunate sequelae of bone necrosis as a consequence of an incorrect or overlooked dental treatment and its comprehensive management. PMID:26155587

Meta-Synthetic Support Frameworks for Reuse of Government Information Resources on City Travel and Traffic: The Case of Beijing

ERIC Educational Resources Information Center

An, Xiaomi; Xu, Shaotong; Mu, Yong; Wang, Wei; Bai, Xian Yang; Dawson, Andy; Han, Hongqi

2012-01-01

Purpose: The purpose of this paper is to propose meta-synthetic ideas and knowledge asset management approaches to build a comprehensive strategic framework for Beijing City in China. Design/methodology/approach: Methods include a review of relevant literature in both English and Chinese, case studies of different types of support frameworks in…

Defense Health Care Reform: Actions Needed to Help Ensure Defense Health Agency Maintains Implementation Progress

DTIC Science & Technology

2015-09-01

business case analyses, and performance measures for the DHA’s shared services. GAO compared this information with key management practices and DOD...headquarters personnel within the MHS in annual budget documents. • Approach to help achieve cost savings - The DHA has developed a business case...comprehensive business case analyses for 2 shared services— Public Health, and Medical Education and Training. Specifically, the DHA has proposed the

[Access barriers to comprehensive care for people affected by tuberculosis and human immunodeficiency virus coinfection in Peru, 2010-2015].

PubMed

García-Fernández, Lisset; Benites, Carlos; Huamán, Byelca

2017-05-25

Identify the programmatic barriers that hinder access to comprehensive care of patients with tuberculosis and human immunodeficiency virus (TB/HIV) coinfection. This is a mixed-method study. Qualitative research was conducted via in-depth interviews with key actors and the quantitative component involved cross-sectional descriptive analysis of programmatic data from 2010-2015 on tuberculosis and HIV programs at health facilities in the cities of Lima and Iquitos. Twenty-two key actors in seven establishments were interviewed. The identified barriers were: little or no coordination between tuberculosis and HIV teams, separate management of tuberculosis and HIV cases at different levels of care, insufficient financing, limited or poorly trained human resources, and lack of an integrated information system. It was found that HIV screening in TB patients increased (from 18.8% in 2011 to 95.2% in 2015), isoniazid coverage of HIV patients declined (from 62% to 9%), and the proportion of deaths among TB/HIV coinfection cases averaged 20%. There is poor coordination between HIV and TB health strategies. Management of TB/HIV coinfection is fragmented into different levels of care, which has an impact on comprehensive patient care. As a result of this research, a technical document was prepared to establish joint procedures that should be implemented to improve comprehensive care of TB/HIV coinfection.

Establishing a clinical service for the management of sports-related concussions.

PubMed

Reynolds, Erin; Collins, Michael W; Mucha, Anne; Troutman-Ensecki, Cara

2014-10-01

The clinical management of sports-related concussions is a specialized area of interest with a lack of empirical findings regarding best practice approaches. The University of Pittsburgh Medical Center Sports Concussion Program was the first of its kind; 13 years after its inception, it remains a leader in the clinical management and research of sports-related concussions. This article outlines the essential components of a successful clinical service for the management of sports-related concussions, using the University of Pittsburgh Medical Center Sports Concussion Program as a case example. Drawing on both empirical evidence and anecdotal conclusions from this high-volume clinical practice, this article provides a detailed account of the inner workings of a multidisciplinary concussion clinic with a comprehensive approach to the management of sports-related concussions. A detailed description of the evaluation process and an in-depth analysis of targeted clinical pathways and subtypes of sports-related concussions effectively set the stage for a comprehensive understanding of the assessment, treatment, and rehabilitation model used in Pittsburgh today.

An open-source job management framework for parameter-space exploration: OACIS

NASA Astrophysics Data System (ADS)

Murase, Y.; Uchitane, T.; Ito, N.

2017-11-01

We present an open-source software framework for parameter-space exporation, named OACIS, which is useful to manage vast amount of simulation jobs and results in a systematic way. Recent development of high-performance computers enabled us to explore parameter spaces comprehensively, however, in such cases, manual management of the workflow is practically impossible. OACIS is developed aiming at reducing the cost of these repetitive tasks when conducting simulations by automating job submissions and data management. In this article, an overview of OACIS as well as a getting started guide are presented.

Development of a comprehensive model for stakeholder management in mental healthcare.

PubMed

Bierbooms, Joyce; Van Oers, Hans; Rijkers, Jeroen; Bongers, Inge

2016-06-20

Purpose - Stakeholder management is not yet incorporated into the standard practice of most healthcare providers. The purpose of this paper is to assess the applicability of a comprehensive model for stakeholder management in mental healthcare organization for more evidence-based (stakeholder) management. Design/methodology/approach - The assessment was performed in two research parts: the steps described in the model were executed in a single case study at a mental healthcare organization in the Netherlands; and a process and effect evaluation was done to find the supporting and impeding factors with regard to the applicability of the model. Interviews were held with managers and directors to evaluate the effectiveness of the model with a view to stakeholder management. Findings - The stakeholder analysis resulted in the identification of eight stakeholder groups. Different expectations were identified for each of these groups. The analysis on performance gaps revealed that stakeholders generally find the collaboration with a mental healthcare provider "sufficient." Finally a prioritization showed that five stakeholder groups were seen as "definite" stakeholders by the organization. Practical implications - The assessment of the model showed that it generated useful knowledge for more evidence-based (stakeholder) management. Adaptation of the model is needed to increase its feasibility in practice. Originality/value - Provided that the model is properly adapted for the specific field, the analysis can provide more knowledge on stakeholders and can help integrate stakeholder management as a comprehensive process in policy planning.

Deaf Education Teacher Preparation: A Phenomenological Case Study of a Graduate Program With a Comprehensive Philosophy.

PubMed

Engler, Karen S; MacGregor, Cynthia J

2018-01-01

At a time when deaf education teacher preparation programs are declining in number, little is known about their actual effectiveness. A phenomenological case study of a graduate-level comprehensive deaf education teacher preparation program at a midwestern university explored empowered and enabled learning of teacher candidates using the Missouri Department of Elementary and Secondary Education educator pillars: (a) commitment to the profession, (b) proficiency in practice, and (c) learning impact, all deemed critical to developing quality teachers. A strong connection was found between the program's comprehensive philosophy and its practice. Embracing diversity of d/Deafness and differentiated instruction were the most prevalent themes expressed by participants. Teacher candidates displayed outstanding commitment to the profession and high proficiency in practice. The findings suggest that additional consideration should be given to classroom and behavior management, teacher candidate workload, teaching beyond academics, and preparation for navigating the public school system.

A case report of an incidental finding of a 46,XX, SRY-negative male with masculine phenotype during standard fertility workup with review of the literature and proposed immediate and long-term management guidance.

PubMed

Ryan, Neil A J; Akbar, Shahnaz

2013-04-01

To describe and explore the current literature on the rare genetic condition of 46,XX SRY-negative males. In addition, we propose comprehensive clinical guidelines in the management of this condition to aid fertility clinicians in their management of affected individuals. Case report with expert consensus-derived clinical management guidance. Fertility outpatient clinic at a tertiary referral center. A 40-year-old male found to have 46,XX disorder of sex development (DSD) on routine fertility screening. A review of the literature, expert consultation, and formulation of comprehensive clinical guidance. We report an interesting and rare case of a phenotypical male with the karyotype 46,XX DSD without an SRY region. There is limited literature exploring this condition, and its etiology remains poorly understood. There is currently no clinical guidance available for fertility clinicians to follow when treating this condition. A male phenotype with a 46 karyotype without the sex-defining region of the Y chromosome. A multidisciplinary approach should be adopted in the management of 46,XX individuals. All patients with azoospermia must be karyotyped. Sperm donation remains the only fertility treatment available. The 46,XX patients need lifelong followup led by an endocrinologist with regular imaging of the gonads, bone density measurements, baseline blood tests, and T supplementation. Psychological support is a key part of a holistic approach. Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Preventing readmissions through comprehensive discharge planning.

PubMed

Hunter, Tabitha; Nelson, James Rex; Birmingham, Jackie

2013-01-01

Case managers, including nurses and social workers, provide essential services to hospitalized patients, including mandated discharge planning that has been shown to impact patient safety and patient outcomes. The heightened attention to readmission is evident in both reimbursement and accreditation initiatives. The Centers for Medicare & Medicaid Services, Office of Clinical Standards & Quality/Survey & Certification Group, is revising worksheets to be used by surveyors to review how hospitals are complying with the Medicare Conditions of Participation with a focus on discharge planning as it relates to patient safety. This is an opportunity for case managers to apply the principles of case management to the targeted problem of readmissions. Now case managers must identify the reasons for readmission on a patient-by-patient basis, collect data, analyze processes, and then change practice in the hospital and work more closely with community-based providers. The purpose of this article is to recommend improvement in a consistent case management practice that will positively influence patient readmissions. Hospital-based case managers who are responsible for discharge planning functions. Hospital administrators will also find this information valuable as a tool to assess strategies to control preventable readmissions and to comply with the Medicare Conditions of Participation for discharge planning. Hospital-based case managers, responsible for discharge planning, have a unique opportunity to interact face-to-face with patients who are readmitted to determine factors that lead to the readmission. Case managers need to change their practice to include assessing patients on the basis of their prior level of care. Pharmacists need to play a bigger role in discharge planning, especially for patients who have experienced a potentially avoidable readmission. Working closely with community-based providers is essential to target reasons for readmission. The Medicare Conditions of Participation for Discharge Planning can be used not only to show compliance but as tools to evaluate current practice and identify areas of improvement. Preventable readmissions or rehospitalizations directly affect patient safety, patient outcome, hospital reimbursement, and hospital accreditation. Preventable readmissions can be controlled by comprehensive discharge planning. Case managers are directly involved in discharge planning and thus have direct accountability regarding readmissions; therefore, they must refine the admission assessment screening to include specific information based on a patient's preadmission level of care. Collaboration with community-based providers is essential to managing readmissions or rehospitalizations. Hospitals will find it beneficial to track readmissions by using specific data points unique to readmissions such as source of admission and previous length of stay. Self-assessment of compliance will help identify opportunities for quality improvement in the case management department. PLEASE NOTE: Rules and regulations are constantly changing. It is critical to monitor changes in standards. Information contained in this article is current at the time of submission, and readers are encouraged to review the content of this article with administration before implementing changes.

Restricted Choice in the Management of Change.

ERIC Educational Resources Information Center

North, R. F. J.

1988-01-01

Instances from case studies of comprehensive schools in the United Kingdom show that cultural influences restrict possibilities of "rational" action by educational leaders. This article warns against business theory and concludes that we need to know more about how people in schools make choices. (Author/TE)

Medical-device risk management and public safety: using cost-benefit as a measurement of effectiveness

NASA Astrophysics Data System (ADS)

Hughes, Allen A.

1994-12-01

Public safety can be enhanced through the development of a comprehensive medical device risk management. This can be accomplished through case studies using a framework that incorporates cost-benefit analysis in the evaluation of risk management attributes. This paper presents a framework for evaluating the risk management system for regulatory Class III medical devices. The framework consists of the following sixteen attributes of a comprehensive medical device risk management system: fault/failure analysis, premarket testing/clinical trials, post-approval studies, manufacturer sponsored hospital studies, product labeling, establishment inspections, problem reporting program, mandatory hospital reporting, medical literature surveillance, device/patient registries, device performance monitoring, returned product analysis, autopsy program, emergency treatment funds/interim compensation, product liability, and alternative compensation mechanisms. Review of performance histories for several medical devices can reveal the value of information for many attributes, and also the inter-dependencies of the attributes in generating risk information flow. Such an information flow network is presented as a starting point for enhancing medical device risk management by focusing on attributes with high net benefit values and potential to spur information dissemination.

The relationship of ecosystem management to NEPA and its goals

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

Phillips, C.G.; Randolph, J.

The National Environmental Policy Act of 1969 (NEPA) was intended to promote a systematic, comprehensive, interdisciplinary approach to planning and decision making, including the integration of the natural and social sciences and the design arts. NEPA critics have cited three key shortcomings in its implementation: (1) a lack of engagement with the NEPA process early in the planning process through interdisciplinary collaboration; (2) a lack of rigorous science and the incorporation of ecological principles and techniques; and (3) a lack of emphasis on the Act's substantive goals and objectives. In recent years and independent of NEPA, a policy of ecosystemmore » management has been developed, which represents a fundamental change from a fragmented, incremental planning and management approach to a holistic, comprehensive, interdisciplinary land and resource management effort. The authors postulate that by incorporating ecosystem management principles in their planning and decisionmaking, federal agencies can address the shortcomings in NEPA implementation and move closes to NEPA's intent. A case analysis of EISs prepared by the USDA Forest Service before and after adopting an ecosystem management approach supports their hypothesis.« less

Implementing case management in New York State's partnerships for publicly funded breast cancer screening.

PubMed

Lillquist, Patricia P

2008-04-01

This research aimed to explore differences in the implementation of case management among local breast cancer screening partnerships in New York State after changes in federal public policy in 1998 and to achieve a better understanding of case management in a new and distinct practice setting. Capacity and willingness to implement change were theorized to explain local differences in implementation. Local breast cancer screening programs that received federal funding through the New York State Department of Health were invited to participate in the study. A mail survey was administered to the directors of New York's 53 local breast cancer screening partnerships in 2003. The survey included questions about willingness and capacity to implement case management and a scale to assess case management program philosophy. Factor analysis and correlations were used to compare willingness and capacity with differences in implementation. Two common factors--task focus and self-identity focus--were identified as factors that differentiated case management programs. Task-focus partnerships undertook a broader range of tasks but were less likely to report autonomy in making program changes. Self-identity partnerships were less likely to report difficulties with other agencies and scored highly on innovation, involvement in work, and interest in client service. Having a nurse as the case manager, being aware of the standards of case management, and providing health education were associated with both task focus and self-identity focus. The study identified distinct styles of implementation. These styles have implications for the breadth of services provided, such as whether client-level services only are offered. Interagency coordination was facilitated in partnerships with comprehensive case management.

International benchmarking of specialty hospitals. A series of case studies on comprehensive cancer centres.

PubMed

van Lent, Wineke A M; de Beer, Relinde D; van Harten, Wim H

2010-08-31

Benchmarking is one of the methods used in business that is applied to hospitals to improve the management of their operations. International comparison between hospitals can explain performance differences. As there is a trend towards specialization of hospitals, this study examines the benchmarking process and the success factors of benchmarking in international specialized cancer centres. Three independent international benchmarking studies on operations management in cancer centres were conducted. The first study included three comprehensive cancer centres (CCC), three chemotherapy day units (CDU) were involved in the second study and four radiotherapy departments were included in the final study. Per multiple case study a research protocol was used to structure the benchmarking process. After reviewing the multiple case studies, the resulting description was used to study the research objectives. We adapted and evaluated existing benchmarking processes through formalizing stakeholder involvement and verifying the comparability of the partners. We also devised a framework to structure the indicators to produce a coherent indicator set and better improvement suggestions. Evaluating the feasibility of benchmarking as a tool to improve hospital processes led to mixed results. Case study 1 resulted in general recommendations for the organizations involved. In case study 2, the combination of benchmarking and lean management led in one CDU to a 24% increase in bed utilization and a 12% increase in productivity. Three radiotherapy departments of case study 3, were considering implementing the recommendations.Additionally, success factors, such as a well-defined and small project scope, partner selection based on clear criteria, stakeholder involvement, simple and well-structured indicators, analysis of both the process and its results and, adapt the identified better working methods to the own setting, were found. The improved benchmarking process and the success factors can produce relevant input to improve the operations management of specialty hospitals.

International benchmarking of specialty hospitals. A series of case studies on comprehensive cancer centres

PubMed Central

2010-01-01

Background Benchmarking is one of the methods used in business that is applied to hospitals to improve the management of their operations. International comparison between hospitals can explain performance differences. As there is a trend towards specialization of hospitals, this study examines the benchmarking process and the success factors of benchmarking in international specialized cancer centres. Methods Three independent international benchmarking studies on operations management in cancer centres were conducted. The first study included three comprehensive cancer centres (CCC), three chemotherapy day units (CDU) were involved in the second study and four radiotherapy departments were included in the final study. Per multiple case study a research protocol was used to structure the benchmarking process. After reviewing the multiple case studies, the resulting description was used to study the research objectives. Results We adapted and evaluated existing benchmarking processes through formalizing stakeholder involvement and verifying the comparability of the partners. We also devised a framework to structure the indicators to produce a coherent indicator set and better improvement suggestions. Evaluating the feasibility of benchmarking as a tool to improve hospital processes led to mixed results. Case study 1 resulted in general recommendations for the organizations involved. In case study 2, the combination of benchmarking and lean management led in one CDU to a 24% increase in bed utilization and a 12% increase in productivity. Three radiotherapy departments of case study 3, were considering implementing the recommendations. Additionally, success factors, such as a well-defined and small project scope, partner selection based on clear criteria, stakeholder involvement, simple and well-structured indicators, analysis of both the process and its results and, adapt the identified better working methods to the own setting, were found. Conclusions The improved benchmarking process and the success factors can produce relevant input to improve the operations management of specialty hospitals. PMID:20807408

A comprehensive grid to evaluate case management's expected effectiveness for community-dwelling frail older people: results from a multiple, embedded case study.

PubMed

Van Durme, Thérèse; Schmitz, Olivier; Cès, Sophie; Anthierens, Sibyl; Maggi, Patrick; Delye, Sam; De Almeida Mello, Johanna; Declercq, Anja; Macq, Jean; Remmen, Roy; Aujoulat, Isabelle

2015-06-18

Case management is a type of intervention expected to improve the quality of care and therefore the quality of life of frail, community-dwelling older people while delaying institutionalisation in nursing homes. However, the heterogeneity, multidimensionality and complexity of these interventions make their evaluation by the means of classical approaches inadequate. Our objective was twofold: (i) to propose a tool allowing for the identification of the key components that explain the success of case management for this population and (ii) to propose a typology based on the results of this tool. The process started with a multiple embedded case study design in order to identify the key components of case management. Based on the results of this first step, data were collected among 22 case management interventions, in order to evaluate their expected effectiveness. Finally, multiple correspondence analyses was conducted to propose a typology of case management. The overall approach was informed by Wagner's Chronic Care Model and the theory of complexity. The study identified a total of 23 interacting key components. Based on the clustering of response patterns of the 22 case management projects included in our study, three types of case management programmes were evidenced, situated on a continuum from a more "socially-oriented" type towards a more "clinically-oriented" type of case management. The type of feedback provided to the general practitioner about both the global geriatric assessment and the result of the intervention turned out to be the most discriminant component between the types. The study design allowed to produce a tool that can be used to distinguish between different types of case management interventions and further evaluate their effect on frail older people in terms of the delaying institutionalisation, functional and cognitive status, quality of life and societal costs.

Perspectives of rural and remote primary healthcare services on the meaning and goals of clinical governance.

PubMed

Kwedza, Ruyamuro K; Larkins, Sarah; Johnson, Julie K; Zwar, Nicholas

2017-10-01

Definitions of clinical governance are varied and there is no one agreed model. This paper explored the perspectives of rural and remote primary healthcare services, located in North Queensland, Australia, on the meaning and goals of clinical governance. The study followed an embedded multiple case study design with semi-structured interviews, document analysis and non-participant observation. Participants included clinicians, non-clinical support staff, managers and executives. Similarities and differences in the understanding of clinical governance between health centre and committee case studies were evident. Almost one-third of participants were unfamiliar with the term or were unsure of its meaning; alongside limited documentation of a definition. Although most cases linked the concept of clinical governance to key terms, many lacked a comprehensive understanding. Similarities between cases included viewing clinical governance as a management and administrative function. Differences included committee members' alignment of clinical governance with corporate governance and frontline staff associating clinical governance with staff safety. Document analysis offered further insight into these perspectives. Clinical governance is well-documented as an expected organisational requirement, including in rural and remote areas where geographic, workforce and demographic factors pose additional challenges to quality and safety. However, in reality, it is not clearly, similarly or comprehensively understood by all participants.

Program Monitoring: Problems and Cases.

ERIC Educational Resources Information Center

Lundin, Edward; Welty, Gordon

Designed as the major component of a comprehensive model of educational management, a behavioral model of decision making is presented that approximates the synoptic model of neoclassical economic theory. The synoptic model defines all possible alternatives and provides a basis for choosing that alternative which maximizes expected utility. The…

[Designing and Operating a Comprehensive Mental Health Management System to Support Faculty at a University That Contains a Medical School and University Hospital].

PubMed

Kawanishi, Chiaki

2016-01-01

In Japan, healthcare professionals and healthcare workers typically practice a culture of self-assessment when it comes to managing their own health. Even where this background leads to instances of mental health disorders or other serious problems within a given organization, such cases are customarily addressed by the psychiatrists or psychiatric departments of the facilities affected. Organized occupational mental health initiatives for professionals and workers within the healthcare system are extremely rare across Japan, and there is little recognition of the need for such initiatives even among those most directly affected. The author has some experience designing and operating a comprehensive health management system to support students and faculty at a university in the Tokyo Metropolitan Area that contains a medical school and university hospital. At this university, various mental health-related problems were routinely being allowed to develop into serious cases, while the fundamental reforms required by the health management center and the mental health management scheme organized through the center had come to represent a challenge for the entire university. From this initial situation, we undertook several successive initiatives, including raising the number of staff in the health management center and its affiliated organizations, revising and drafting new health management rules and regulations, launching an employment support and management system, implementing screenings to identify people with mental ill-health, revamping and expanding a counselling response system, instituting regular collaboration meetings with academic affairs staff, and launching educational and awareness-raising activities. This resulted in the possibility of intervention in all cases of mental health crisis, such as suicidal ideation. We counted more than 2,400 consultations (cumulative total number; more than half of consultations was from the medical school, postgraduate medical course, or hospitals) on a campus comprising 8,700 people, in which our problem-solving approach was able to achieve a certain degree of success in a majority of cases. Amid the increasing prevalence of mental ill-health and signs of worsening mental health problems in all areas of society, I look forward to the establishment of occupational mental health systems that are suited to medical institutions.

Diagnosed a Patient with Central Serous Chorioretinopathy? Now What?: Management of Central Serous Chorioretinopathy.

PubMed

Goldhagen, Brian E; Goldhardt, Raquel

2017-06-01

The goal of this paper is to provide a comprehensive review of the management options for central serous chorioretinopathy (CSCR). The majority of cases of acute CSCR may be managed with observation and cessation of corticosteroids, if possible, as well as life-style modifications including stress reduction and control of hypertension. The management of chronic disease is more challenging and may include either medication or laser-based treatment. Management of CSCR necessitates an individualized and selective treatment approach. There is overall poor evidence for the use of systemic and intravitreal medications. From this class of treatments, mineralocorticoid receptor antagonists appear to have the greatest potential. Although conventional thermal photocoagulation may be used in select cases, the most promising treatment options at this time for chronic CSCR are photodynamic therapy, either half-dose or half-fluence, and non-damaging (subthreshold) retinal laser therapy.

Non-prescription treatment of NSAID induced GORD by Australian pharmacies: a national simulated patient study.

PubMed

MacFarlane, Brett; Matthews, Andrew; Bergin, Jenny

2015-10-01

Patients regularly present to community pharmacies for advice about and treatment for reflux symptoms and NSAIDs are a common cause of these symptoms. There is no published literature detailing the approach that pharmacies take to these enquiries, the pharmacotherapy they recommend or whether they contribute to the safe and effective use of reflux medicines. To assess in an observational study design the clinical history gathering, recommendations for GORD management and counselling provided by community pharmacies in a simulated patient scenario involving suspected NSAID induced reflux symptoms. Setting Australian community pharmacies. Simulated patients visited 223 community pharmacies to request treatment for reflux symptoms. The interaction was audiotaped and assessed against guidelines for the treatment of reflux symptoms. Alignment of community pharmacies with international expert gastroenterologist guidance and national professional practice guidelines for the treatment of reflux symptoms by pharmacists including: consultation with a pharmacist; confirmation of reflux diagnosis based on symptoms; recommendation of short courses proton pump inhibitor (PPI) therapy; advice on the safe and effective use of reflux medicines and referral to a doctor for further assessment. Pharmacists consulted with the simulated patient in 77% of cases. Symptoms were enquired about in 95% of cases and a medicines history taken in 69% of cases. Recommendations for treatment included: PPIs (18%), histamine H2 antagonists (57%) and antacids (19%). Advice on product use was given in 83% of cases. Referral to a doctor to discuss reflux symptoms was made in 63% of cases. When assessing patients for the symptoms of GORD, Australian pharmacists and non-pharmacist support staff take a comprehensive history including symptomatology, duration of symptoms, concomitant medicines and medical conditions and any GORD treatments previously trialled. They provide comprehensive counselling on the use of antisecretory and antacid medicines. Counselling could involve more comprehensive information on lifestyle approaches for GORD management and side effects of antisecretory and antacid medicines. Further alignment with guidelines for the management of GORD would result in greater referral to a doctor for assessment of recurrent GORD and greater recommendation of PPIs for symptoms. However alignment with guidelines by all pharmacists is unrealistic if the guidelines are not universally available to them.

Change management in an environment of ongoing primary health care system reform: A case study of Australian primary health care services.

PubMed

Javanparast, Sara; Maddern, Janny; Baum, Fran; Freeman, Toby; Lawless, Angela; Labonté, Ronald; Sanders, David

2018-01-01

Globally, health reforms continue to be high on the health policy agenda to respond to the increasing health care costs and managing the emerging complex health conditions. Many countries have emphasised PHC to prevent high cost of hospital care and improve population health and equity. The existing tension in PHC philosophies and complexity of PHC setting make the implementation and management of these changes more difficult. This paper presents an Australian case study of PHC restructuring and how these changes have been managed from the viewpoint of practitioners and middle managers. As part of a 5-year project, we interviewed PHC practitioners and managers of services in 7 Australian PHC services. Our findings revealed a policy shift away from the principles of comprehensive PHC including health promotion and action on social determinants of health to one-to-one disease management during the course of study. Analysis of the process of change shows that overall, rapid, and top-down radical reforms of policies and directions were the main characteristic of changes with minimal communication with practitioners and service managers. The study showed that services with community-controlled model of governance had more autonomy to use an emergent model of change and to maintain their comprehensive PHC services. Change is an inevitable feature of PHC systems continually trying to respond to health care demand and cost pressures. The implementation of change in complex settings such as PHC requires appropriate change management strategies to ensure that the proposed reforms are understood, accepted, and implemented successfully. Copyright © 2017 John Wiley & Sons, Ltd.

Assessment of Institutional Strategic Goal Realization: A Case Study

ERIC Educational Resources Information Center

Holwick, Jana W.

2009-01-01

Strategic planning is a common tool utilized at colleges and universities to assist in achieving institutional goals. Leaders in higher education have taken best practices from corporate management and adapted them in an effort to develop comprehensive approaches to institutional planning, assessment and accountability. Various models for planning…

77 FR 38637 - Announcement of the Award of Single-Source Cooperative Agreement to Rubicon Programs, Inc., in...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-28

...-Prisoner Reentry activities to promote responsible fatherhood, family reunification, and economic stability... economic stability. The project will implement a program that includes comprehensive case management to... eliminate barriers to social and economic self-sufficiency for individuals preparing to reenter their...

Towards a sustained, comprehensive, intensive approach to broadening participation in the geosciences - Diversity: The Business Case?

EPA Science Inventory

Understanding perceptions and managing expectations are learnable skills that do not necessarily come with project funding. Finding life balance as one moves through a STEM career path poses unique challenges that require a certain skill set that is not always intuitive. Some of ...

Intervention into a turbulent urban situation: A case study. Ph.D. Thesis

NASA Technical Reports Server (NTRS)

Caldwell, G. M., Jr.

1973-01-01

The application is reported of NASA management philosophy and techniques within New Castle County, Delaware, to meet actual problems of community violence. It resulted in restructuring the county approach to problems of this nature, and development of a comprehensive system for planning, based on the NASA planning process. The method involved federal, state, and local resources with community representatives in solving the problems. The concept of a turbulent environment is presented with parallels drawn between NASA management experience and problems of management within an urban arena.

50 CFR 80.81 - What must an agency submit when applying for a comprehensive-management-system grant?

Code of Federal Regulations, 2011 CFR

2011-10-01

... of the agency's comprehensive management system including inventory, strategic plan, operational plan... for a comprehensive-management-system grant? 80.81 Section 80.81 Wildlife and Fisheries UNITED STATES... when applying for a comprehensive-management-system grant? A State fish and wildlife agency must submit...

Intrinsic ethics regarding integrated assessment models for climate management.

PubMed

Schienke, Erich W; Baum, Seth D; Tuana, Nancy; Davis, Kenneth J; Keller, Klaus

2011-09-01

In this essay we develop and argue for the adoption of a more comprehensive model of research ethics than is included within current conceptions of responsible conduct of research (RCR). We argue that our model, which we label the ethical dimensions of scientific research (EDSR), is a more comprehensive approach to encouraging ethically responsible scientific research compared to the currently typically adopted approach in RCR training. This essay focuses on developing a pedagogical approach that enables scientists to better understand and appreciate one important component of this model, what we call intrinsic ethics. Intrinsic ethical issues arise when values and ethical assumptions are embedded within scientific findings and analytical methods. Through a close examination of a case study and its application in teaching, namely, evaluation of climate change integrated assessment models, this paper develops a method and case for including intrinsic ethics within research ethics training to provide scientists with a comprehensive understanding and appreciation of the critical role of values and ethical choices in the production of research outcomes.

Selective versus comprehensive emergency management in Korea.

PubMed

Ha, Kyoo-Man; Oh, Hyeon-Mun

2014-01-01

In spite of Korean governments' efforts, many emergency management practitioners wonder whether what is actually being practiced is selective or comprehensive management. Using a qualitative content analysis and experiences in practice, the article analyzes the barriers to selective emergency management and the paths to comprehensive emergency management via the same three management elements: stakeholders, phases of the emergency management lifecycle, and hazards and impacts. Four analytical levels are considered: central government level, industry level, community level, and household level. Korea, despite its self-praise, has to transform its selective emergency management into comprehensive emergency management in time.

Creating a comprehensive customer service program to help convey critical and acute results of radiology studies.

PubMed

Towbin, Alexander J; Hall, Seth; Moskovitz, Jay; Johnson, Neil D; Donnelly, Lane F

2011-01-01

Communication of acute or critical results between the radiology department and referring clinicians has been a deficiency of many radiology departments. The failure to perform or document these communications can lead to poor patient care, patient safety issues, medical-legal issues, and complaints from referring clinicians. To mitigate these factors, a communication and documentation tool was created and incorporated into our departmental customer service program. This article will describe the implementation of a comprehensive customer service program in a hospital-based radiology department. A comprehensive customer service program was created in the radiology department. Customer service representatives were hired to answer the telephone calls to the radiology reading rooms and to help convey radiology results. The radiologists, referring clinicians, and customer service representatives were then linked via a novel workflow management system. This workflow management system provided tools to help facilitate the communication needs of each group. The number of studies with results conveyed was recorded from the implementation of the workflow management system. Between the implementation of the workflow management system on August 1, 2005, and June 1, 2009, 116,844 radiology results were conveyed to the referring clinicians and documented in the system. This accounts for more than 14% of the 828,516 radiology cases performed in this time frame. We have been successful in creating a comprehensive customer service program to convey and document communication of radiology results. This program has been widely used by the ordering clinicians as well as radiologists since its inception.

Using the reference framework for good measles management in practice--a case study from North Rhine-Westphalia.

PubMed

Schröter, Matthias; Schröder-Bäck, Peter; Brand, Helmut

2009-12-01

In 2005, WHO Europe reconfirmed the objective of eradicating measles and fixed a strategy plan for the years 2005 up to 2010. While a downward trend of measles infections in Germany between 2001 and 2004 could be observed, as many as 780 cases of measles were reported in 2005 and in 2006 even 2.281 cases. These high figures in 2006 were almost exclusively caused by an outbreak in the German region of North Rhine-Westphalia. This case study describes how a reference framework for good health management of measles prevention was applied for this region. As a result, various recommendations for action could be given, among them the recommendation to implement individual vaccination reminder systems for parents and bonus systems for parents. Based on these results, a comprehensive policy concept has been drawn up and has become the subject of a political agreement process in this region. Thus this case study shows a paradigm how reference frameworks for good health management can be utilised in practice.

Organizational Development in Transition: The Schooling Perspective.

ERIC Educational Resources Information Center

Snyder, Karolyn J.; And Others

This paper presents the initial findings of a comprehensive 28-school multi-site case study, which sought to identify patterns in schools that are changing bureaucratic work patterns to those found in quality-management systems. The schools are located in Florida, Virginia, Minnesota, and Louisiana; all are led by principals who are trainers in…

SUCCESS Program Planning/Evaluation Report for 1992-93. Focus on Program Evaluation.

ERIC Educational Resources Information Center

Sallade, Ronald; Erickson, Cynthia L.

To address the needs of at-risk children, Project SUCCESS of the Des Moines (Iowa) public schools provides employment, health, mental health, and social services in a comprehensive one-stop shopping manner at public schools. Coordinated services are provided through direct provision of services, case management, and referral as appropriate. The…

Trees and business district preferences: a case study of Athens, Georgia, U.S.

Treesearch

Kathleen L. Wolf

2004-01-01

As a National Main Street program participant, Athens, Georgia, U.S., has included streetscape tree plantings in economic development efforts. The Main Street program assists downtown merchant groups with physical improvements planning in order to create vital retail environments. If comprehensively managed, the urban forest can be a...

Hepatitis B: how many patients are counselled on transmission prevention and how many contacts are offered vaccination?

PubMed

Miles, L; Roberts, R; Casey, D; Roberts, C; Williams, S

2002-06-01

The proportion of cases of hepatitis B who receive counselling on how to prevent transmission and for whom at-risk contacts are offered vaccination is low. A centralised arrangement under the management of the local CCDC can provide a comprehensive contract tracing service.

A comprehensive review of amyotrophic lateral sclerosis

PubMed Central

Zarei, Sara; Carr, Karen; Reiley, Luz; Diaz, Kelvin; Guerra, Orleiquis; Altamirano, Pablo Fernandez; Pagani, Wilfredo; Lodin, Daud; Orozco, Gloria; Chinea, Angel

2015-01-01

Amyotrophic lateral sclerosis (ALS) is a late-onset fatal neurodegenerative disease affecting motor neurons with an incidence of about 1/100,000. Most ALS cases are sporadic, but 5–10% of the cases are familial ALS. Both sporadic and familial ALS (FALS) are associated with degeneration of cortical and spinal motor neurons. The etiology of ALS remains unknown. However, mutations of superoxide dismutase 1 have been known as the most common cause of FALS. In this study, we provide a comprehensive review of ALS. We cover all aspects of the disease including epidemiology, comorbidities, environmental risk factor, molecular mechanism, genetic factors, symptoms, diagnostic, treatment, and even the available supplement and management of ALS. This will provide the reader with an advantage of receiving a broad range of information about the disease. PMID:26629397

A Comprehensive Rehabilitation Approach in a Patient With Serious Neuropsychiatric Systemic Lupus Erythematosus.

PubMed

Ko, Yong Jae; Lee, Yang Gyun; Park, Ji Woong; Ahn, Sung Ho; Kwak, Jin Myoung; Choi, Yoon-Hee

2016-08-01

Neuropsychiatric systemic lupus erythematosus (NPSLE) involves the central and peripheral nervous system in patients with systemic lupus erythematosus (SLE). It is essential to specify the problems faced by patients with NPSLE because it causes diverse disabilities and impairs quality of life. After performing a comprehensive evaluation, tailored management should be provided for the patient's specific problems. We report here the case of a 30-year-old female with SLE who experienced serious neuropsychiatric symptoms cerebral infarction followed by posterior reversible encephalopathy syndrome and peripheral polyneuropathy. We systemically assessed the patient using the International Classification of Functioning, Disability and Health model as a clinical problem-solving tool and provided comprehensive rehabilitation by focusing on her problems.

Managing the student with severe food allergies.

PubMed

Robinson, Joanne M; Ficca, Michelle

2012-06-01

School nurses play a key role in managing students with food allergies. It is becoming more common to encounter students with severe allergies to multiple foods, putting them at risk for anaphylaxis. It is essential that the school nurse have a clear understanding of food allergies and how to effectively manage students in the school setting. Effective communication between families, health care providers, faculty, staff, and students, is of utmost importance when developing a plan of care to ensure the safety of the student with food allergies. Using an interdisciplinary approach to case management, the school nurse can develop comprehensive individualized health care plans for all students with food allergies.

Comprehensive safety management and assessment at rugby football competitions.

PubMed

Tajima, T; Chosa, E; Kawahara, K; Nakamura, Y; Yoshikawa, D; Yamaguchi, N; Kashiwagi, T

2014-11-01

The present study aims to improve medical systems by designing objective safety assessment criteria for rugby competitions. We evaluated 195 competitions between 2002 and 2011 using an original safety scale comprising the following sections: 1) competence of staff such as referees, medical attendants and match day doctor; 2) environment such as weather, wet bulb globe temperature and field conditions; and 3) emergency medical care systems at the competitions. Each section was subdivided into groups A, B and C according to good, normal or fair degrees of safety determined by combinations of the results.Overall safety was assessed as A, B and C for 110, 78 and 7 competitions, respectively. The assessments of individual major factors were mostly favorable for staff, but the environment and medical care systems were assessed as C in 25 and 70, respectively, of the 195 competitions. Medical management involves not having a match day doctor, but also comprehensive management including preventive factors and responses from the staff, environment and medical-care systems. 6 cases of severe injuries and accidents occurred between 2002 and 2011, which were observed in Grade A competition. These cases revealed better prognosis without obvious impairment, thus confirming the value of the present assessment scale. © Georg Thieme Verlag KG Stuttgart · New York.

[Evaluation of effect of prevention and control system for imported falciparum malaria in Hanjiang District].

PubMed

She, Guo-lin; Ma, Yu-Cai; Wang, Fu-biao

2013-08-01

To analyze the current situation of the comprehensive prevention and control system for imported falciparum malaria in Hanjiang District and evaluate its effect. According to the Management Scheme on Control of Imported Falciparum Malaria in Yangzhou City, the comprehensive prevention and control system for imported falciparum malaria was implemented, and the relevant malaria data were collected and analyzed statistically. The data included plasmodium blood test ratio of fever patients among exported labors and those returned, the ratio of laboratory-confirmed cases among all reported cases of falciparum malaria, the ratio of falciparum malaria patients who received the standard treatment within 24 hours after onset, etc from 2010 to 2012. After the implementation of the comprehensive prevention and control system, the confirmation ratio of falciparum malaria cases within 24 hours following first visit has reached 60.47%, the average time from first visit to confirmation has shortened to 1.8 d, and the average time from onset to confirmation has shortened to 3.7 d. The health education coverage ratio was 100%, the health knowledge awareness ratio was 95.56%, the ratio of patients seeking treatment on own initiative was 100%, the laboratory-confirmed ratio was 100%, and the ratio of standard treatment after malaria diagnosis was 100%. The comprehensive prevention and control system carried out by Hanjiang District has made remarkable achievements.

Risk factors and impact of orthopaedic monitoring on the outcome of avascular necrosis of the femoral head in adults with sickle cell disease: 215 patients case study with control group.

PubMed

Mukisi-Mukaza, M; Saint Martin, C; Etienne-Julan, M; Donkerwolcke, M; Burny, M E; Burny, F

2011-12-01

Sickle cell disease is a public health problem. The WHO has recommended that global management be implemented to reduce mortality and morbidity. Since no comprehensive care programme for bone and joint complications exists, the Caribbean Sickle Cell Disease Center added orthopaedic consultation to screen for and monitor these complications in 1992. Comprehensive medical and surgical care of patients with sickle cell disease will reduce the complications and disability associated with this disease. Two populations were compared to evaluate the impact of comprehensive disease management on the occurrence of avascular necrosis (AVN) of the femoral head (femoral head AVN). The case-control series, [E-1994], included 115 patients (58 SS and 57 S) without orthopaedic monitoring and was evaluated retrospectively. The other patient series, [E-2008], included 215 patients (94 SS and 121 SC) with systematic orthopaedic care and was followed prospectively. Age, gender, duration of follow-up, haemoglobin levels, genotype, pain before treatment, associated humerus AVN and leg ulcers were analysed. Femoral head AVN occurred in young adult patients (35.3 ± 4 years for [E-1994] and 29 ± 3.4 years for [E-2008]). Only elevated haemoglobin levels were associated with the occurrence of femoral head AVN, which suggests that increased blood viscosity contributes to the condition ([E-1994], P<0.0001; [E-2008], P=0.001). Treatment in [E-2008] patients reduced the number of femoral head AVN cases from 36.5% in [E-1994] to 14.4% in [E-2008] (P<0.0001). The prevention and management of femoral head AVN must include medical treatment of the disease to reduce the occurrence of painful vaso-occlusive crises, which are known to trigger femoral head AVN. The effectiveness of this programme hinged on identifying risk factors and using simple approaches (hydration, pain medication, rest and crutches) to manage painful joint crises before femoral head AVN appeared. These approaches could be implemented in disadvantaged countries where sickle cell disease is prevalent. By knowing the risk factors, symptomatic patients who are at risk for femoral head AVN can be identified and additional evaluations can be performed early on in cases of hip pain. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Minimally invasive image-guided interventional management of hepatic artery pseudoaneurysms.

PubMed

Vyas, Sameer; Khandelwal, Niranjan; Gupta, Vivek; Kamal Ahuja, Chirag; Kumar, Ajay; Kalra, Naveen; Kang, Mandeep; Prakash, Mahesh

2014-01-01

Hepatic artery pseudoaneurysms (HAPs) are uncommon entities. With the development of interventional techniques, their management has evolved from conventional (surgical) to non-surgical minimally invasive image-guided interventional techniques. Fifteen cases of HAPs who had undergone non-surgical interventional management in our department were reviewed. All patients were comprehensively evaluated for demographic information, morphology of pseudoaneurysm, indication for intervention and means of intervention, approach (endovascular or percutaneous), follow up and complications. Trauma and iatrogenic injury were most common causes of HAPs. Most of the HAPs (9 out of 10 in whom long follow up was available) managed with image-guided interventional techniques had favorable outcome. Minimally invasive image-guided interventional management is the preferred modality for HAPs.

Surgery scheduling optimization considering real life constraints and comprehensive operation cost of operating room.

PubMed

Xiang, Wei; Li, Chong

2015-01-01

Operating Room (OR) is the core sector in hospital expenditure, the operation management of which involves a complete three-stage surgery flow, multiple resources, prioritization of the various surgeries, and several real-life OR constraints. As such reasonable surgery scheduling is crucial to OR management. To optimize OR management and reduce operation cost, a short-term surgery scheduling problem is proposed and defined based on the survey of the OR operation in a typical hospital in China. The comprehensive operation cost is clearly defined considering both under-utilization and overutilization. A nested Ant Colony Optimization (nested-ACO) incorporated with several real-life OR constraints is proposed to solve such a combinatorial optimization problem. The 10-day manual surgery schedules from a hospital in China are compared with the optimized schedules solved by the nested-ACO. Comparison results show the advantage using the nested-ACO in several measurements: OR-related time, nurse-related time, variation in resources' working time, and the end time. The nested-ACO considering real-life operation constraints such as the difference between first and following case, surgeries priority, and fixed nurses in pre/post-operative stage is proposed to solve the surgery scheduling optimization problem. The results clearly show the benefit of using the nested-ACO in enhancing the OR management efficiency and minimizing the comprehensive overall operation cost.

The business process management software for successful quality management and organization: A case study from the University of Split School of Medicine.

PubMed

Sapunar, Damir; Grković, Ivica; Lukšić, Davor; Marušić, Matko

2016-05-01

Our aim was to describe a comprehensive model of internal quality management (QM) at a medical school founded on the business process analysis (BPA) software tool. BPA software tool was used as the core element for description of all working processes in our medical school, and subsequently the system served as the comprehensive model of internal QM. The quality management system at the University of Split School of Medicine included the documentation and analysis of all business processes within the School. The analysis revealed 80 weak points related to one or several business processes. A precise analysis of medical school business processes allows identification of unfinished, unclear and inadequate points in these processes, and subsequently the respective improvements and increase of the QM level and ultimately a rationalization of the institution's work. Our approach offers a potential reference model for development of common QM framework allowing a continuous quality control, i.e. the adjustments and adaptation to contemporary educational needs of medical students. Copyright © 2016 by Academy of Sciences and Arts of Bosnia and Herzegovina.

41 CFR 302-1.100 - What is a comprehensive, automated relocation management system?

Code of Federal Regulations, 2014 CFR

2014-07-01

... system? A comprehensive, automated relocation management system is a system that integrates into a single... 41 Public Contracts and Property Management 4 2014-07-01 2014-07-01 false What is a comprehensive, automated relocation management system? 302-1.100 Section 302-1.100 Public Contracts and Property Management...

41 CFR 302-1.100 - What is a comprehensive, automated relocation management system?

Code of Federal Regulations, 2013 CFR

2013-07-01

... system? A comprehensive, automated relocation management system is a system that integrates into a single... 41 Public Contracts and Property Management 4 2013-07-01 2012-07-01 true What is a comprehensive, automated relocation management system? 302-1.100 Section 302-1.100 Public Contracts and Property Management...

41 CFR 302-1.100 - What is a comprehensive, automated relocation management system?

Code of Federal Regulations, 2011 CFR

2011-07-01

... system? A comprehensive, automated relocation management system is a system that integrates into a single... 41 Public Contracts and Property Management 4 2011-07-01 2011-07-01 false What is a comprehensive, automated relocation management system? 302-1.100 Section 302-1.100 Public Contracts and Property Management...

41 CFR 302-1.100 - What is a comprehensive, automated relocation management system?

Code of Federal Regulations, 2012 CFR

2012-07-01

... system? A comprehensive, automated relocation management system is a system that integrates into a single... 41 Public Contracts and Property Management 4 2012-07-01 2012-07-01 false What is a comprehensive, automated relocation management system? 302-1.100 Section 302-1.100 Public Contracts and Property Management...

Comprehensive Behavior Management: Individualized, Classroom, and Schoolwide Approaches. Second Edition

ERIC Educational Resources Information Center

Martella, Ronald C.; Nelson, J. Ron; Marchand-Martella, Nancy E.; O'Reilly, Mark

2011-01-01

"Comprehensive Behavior Management: Schoolwide, Classroom, and Individualized Approaches" supports teachers in preventing management problems and responding to unwanted behavior when it occurs in classrooms. The text offers a comprehensive presentation of three levels of behavior management strategies: individual, classroom, and schoolwide, all…

Comprehensive management of frontal and cerebellar tumor patients with personality changes and suicidal tendencies

PubMed Central

Arifin, Muhammad Zafrullah; Yudoyono, Farid; Setiawan, Cecilia; Sidabutar, Roland; Sutiono, Agung Budi; Faried, Ahmad

2014-01-01

Background: Brain tumor patients have a tendency to suffer from psychiatric disturbances. One of the most frequent disturbance experienced by frontal area tumor patients are personality changes. Case Description: In this paper, the authors report a 28-year-old male patient who presented with headache and personality changes, with no other neurological disturbance. The patient became increasingly pensive and apathetic with frontal and cerebellopontine angle tumor. The diagnosis is based on computed tomography scanning images, and histopathological examination of the excised tumor results in meningioma. Conclusion: Before the operation was performed, the patient suffered from personality changes and suicidal tendencies. After the operation, the patient's suicidal tendency was gone, but the personality changes still persist. For this reason, a comprehensive management of the patient is required, including postoperative pharmacological and psychological treatment. PMID:25593758

The Annual Economic Burden of Syphilis: An Estimation of Direct, Productivity, and Intangible Costs for Syphilis in Guangdong Initiative for Comprehensive Control of Syphilis Sites.

PubMed

Zou, Yaming; Liao, Yu; Liu, Fengying; Chen, Lei; Shen, Hongcheng; Huang, Shujie; Zheng, Heping; Yang, Bin; Hao, Yuantao

2017-11-01

Syphilis has continuously posed a great challenge to China. However, very little data existed regarding the cost of syphilis. Taking Guangdong Initiative for Comprehensive Control of Syphilis area as the research site, we aimed to comprehensively measure the annual economic burden of syphilis from a societal perspective. Newly diagnosed and follow-up outpatient cases were investigated by questionnaire. Reported tertiary syphilis cases and medical institutions cost were both collected. The direct economic burden was measured by the bottom-up approach, the productivity cost by the human capital method, and the intangible burden by the contingency valuation method. Three hundred five valid early syphilis cases and 13 valid tertiary syphilis cases were collected in the investigation to estimate the personal average cost. The total economic burden of syphilis was US $729,096.85 in Guangdong Initiative for Comprehensive Control of Syphilis sites in the year of 2014, with medical institutions cost accounting for 73.23% of the total. Household average direct cost of early syphilis was US $23.74. Average hospitalization cost of tertiary syphilis was US $2,749.93. Of the cost to medical institutions, screening and testing comprised the largest proportion (26%), followed by intervention and case management (22%) and operational cost (21%). Household average productivity cost of early syphilis was US $61.19. Household intangible cost of syphilis was US $15,810.54. Syphilis caused a substantial economic burden on patients, their families, and society in Guangdong. Household productivity and intangible costs both shared positive relationships with local economic levels. Strengthening the prevention and effective treatment of early syphilis could greatly help to lower the economic burden of syphilis.

Risk-based requirements management framework with applications to assurance cases

NASA Astrophysics Data System (ADS)

Feng, D.; Eyster, C.

The current regulatory approach for assuring device safety primarily focuses on compliance with prescriptive safety regulations and relevant safety standards. This approach, however, does not always lead to a safe system design even though safety regulations and standards have been met. In the medical device industry, several high profile recalls involving infusion pumps have prompted the regulatory agency to reconsider how device safety should be managed, reviewed and approved. An assurance case has been cited as a promising tool to address this growing concern. Assurance cases have been used in safety-critical systems for some time. Most assurance cases, if not all, in literature today are developed in an ad hoc fashion, independent from risk management and requirement development. An assurance case is a resource-intensive endeavor that requires additional effort and documentation from equipment manufacturers. Without a well-organized requirements infrastructure in place, such “ additional effort” can be substantial, to the point where the cost of adoption outweighs the benefit of adoption. In this paper, the authors present a Risk-Based Requirements and Assurance Management (RBRAM) methodology. The RBRAM is an elaborate framework that combines Risk-Based Requirements Management (RBRM) with assurance case methods. Such an integrated framework can help manufacturers leverage an existing risk management to present a comprehensive assurance case with minimal additional effort while providing a supplementary means to reexamine the integrity of the system design in terms of the mission objective. Although the example used is from the medical industry, the authors believe that the RBRAM methodology underlines the fundamental principle of risk management, and offers a simple, yet effective framework applicable to aerospace industry, perhaps, to any industry.

Aspirin allergy desensitization in cerebrovascular disease. A report of two cases, literature review and management guide for the neurointerventionalist.

PubMed

Zuckerman, Scott L; Seder, David B; Tsujiura, Crystiana; Cushing, Deborah; Gallup, Holly; Mocco, J; Hanel, Richard A; Ecker, Robert D

2014-01-01

Aspirin (ASA) is the mainstay of treatment in cerebrovascular and systemic vascular disease. ASA hypersensitivity can pose a challenge to achieving optimum medical management prior to and after neurointerventional treatment. Desensitization to ASA is well described in the allergy and cardiovascular literature, but there are no similar discussions specific to neurointervention. The purpose of our study was to describe our experience with ASA hypersensitivity management and review the relevant literature. Two cases of patients with symptomatic cerebrovascular disease requiring neurointervention who were successfully desensitized to their ASA hypersensitivity prior to treatment are described. The subsequent literature is reviewed. Several ASA desensitization protocols exist and have been proven to successfully treat ASA hypersensitivity and allow for ASA therapy to be safely initiated. We describe several previously published protocols. ASA desensitization is a safe and simple way to manage ASA hypersensitivity. We provide comprehensive management guidelines for the neurointerventionalist engaging in ASA desensitization.

Measuring Healthcare Providers' Performances Within Managed Competition Using Multidimensional Quality and Cost Indicators.

PubMed

Portrait, France R M; van der Galiën, Onno; Van den Berg, Bernard

2016-04-01

The Dutch healthcare system is in transition towards managed competition. In theory, a system of managed competition involves incentives for quality and efficiency of provided care. This is mainly because health insurers contract on behalf of their clients with healthcare providers on, potentially, quality and costs. The paper develops a strategy to comprehensively analyse available multidimensional data on quality and costs to assess and report on the relative performance of healthcare providers within managed competition. We had access to individual information on 2409 clients of 19 Dutch diabetes care groups on a broad range of (outcome and process related) quality and cost indicators. We carried out a cost-consequences analysis and corrected for differences in case mix to reduce incentives for risk selection by healthcare providers. There is substantial heterogeneity between diabetes care groups' performances as measured using multidimensional indicators on quality and costs. Better quality diabetes care can be achieved with lower or higher costs. Routine monitoring using multidimensional data on quality and costs merged at the individual level would allow a systematic and comprehensive analysis of healthcare providers' performances within managed competition. Copyright © 2015 John Wiley & Sons, Ltd.

The Evaluation of the National Long Term Care Demonstration: Final Report. Executive Summary.

ERIC Educational Resources Information Center

Mathematica Policy Research, Inc., Plainsboro, NJ.

This report describes the evaluation of the National Long-Term Care (Channeling) Demonstration, a rigorous test of comprehensive case management of community care as a way of containing long-term care costs for the impaired elderly while providing adequate care to those in need. The evaluation process is presented as an experimental design with…

Managing Quality from a Distance: A Case Study of Collaboration between Oman and New Zealand

ERIC Educational Resources Information Center

O'Rourke, Susan; Al Bulushi, H. A.

2010-01-01

Both the public and private higher education sectors in Oman are undergoing rapid change in the number and type of local and foreign degrees offered. The Sultanate is developing a comprehensive quality assurance system to ensure the educational appropriateness of all degrees awarded in Oman. This paper examines the collaboration between the…

A College Marketing Plan That's Working: Final Report. CASE Certification Program in Executive Management.

ERIC Educational Resources Information Center

Noll, Gayle

In response to a 3% decline in fall 1977 enrollments, Odessa College developed and implemented a comprehensive marketing program. After initial planning, a marketing task force and nine mini-task forces were created to deal with the topics of community economic markets, community cultural markets, student retention, student recruitment techniques,…

Proceedings of the sixth California oak symposium: today's challenges, tomorrow's opportunities

Treesearch

Adina Merenlender; Douglas McCreary; Kathryn L. Purcell

2008-01-01

The Sixth Oak Symposium provided a forum for current research and outstanding case studies on oak woodland science and sustainability in California. This symposium was the latest in a series of conferences on this subject held every 5 years since 1979. The proceedings from this conference series represent the most comprehensive source of scientific and management...

Effects of a continuum of care intervention on frail older persons' life satisfaction: a randomized controlled study.

PubMed

Berglund, Helene; Hasson, Henna; Kjellgren, Karin; Wilhelmson, Katarina

2015-04-01

The aim of this study was to analyse effects of a comprehensive continuum of care (intervention group) on frail older persons' life satisfaction, as compared to those receiving usual care (control group). The intervention included geriatric assessment, case management, interprofessional collaboration, support for relatives and organising of care-planning meetings in older persons' own homes. Improvements in older persons' subjective well-being have been shown in studies including care planning and coordination by a case manager. However, effects of more complex continuum of care interventions on frail older persons' life satisfaction are not well explored. Randomised controlled study. The validated LiSat-11 scale was used in face-to-face interviews to assess older persons' life satisfaction at baseline and at three, six and 12 months after the baseline. The odds ratio for improving or maintaining satisfaction was compared for intervention and control groups from baseline to three-month, three- to six-month as well as six- to 12-month follow-ups. Older persons who received the intervention were more likely to improve or maintain satisfaction than those who received usual care, between 6 and 12 month follow-ups, for satisfaction regarding functional capacity, psychological health and financial situation. A comprehensive continuum of care intervention comprising several components had a positive effect on frail older persons' satisfaction with functional capacity, psychological health and financial situation. Frail older persons represent a great proportion of the persons in need of support from the health care system. Health care professionals need to consider continuum of care interventions' impact on life satisfaction. As life satisfaction is an essential part of older persons' well-being, we propose that policy makers and managers promote comprehensive continuum of care solutions. © 2014 John Wiley & Sons Ltd.

The evaluation of the National Long Term Care Demonstration. 10. Overview of the findings.

PubMed Central

Kemper, P

1988-01-01

The channeling demonstration sought to substitute community care for nursing home care through comprehensive case management and expanded community services. The channeling intervention was implemented largely according to design. Although the population served was, as intended, extremely frail, it turned out not to be at high risk of nursing home placement. The costs of the additional case management and community services--provided in most cases to clients who would not have entered nursing homes even without channeling--were not offset by reductions in the cost of nursing home use. Hence, total costs increased. The expanded formal community care did not, however, result in a substantial reduction in informal caregiving. Moreover, channeling benefited clients, and the family and friends who cared for them, in several ways: increased services, reduced unmet needs, increased confidence in receipt of care and satisfaction with arrangements for it, and increased satisfaction with life. Expansion of case management and community services beyond what already exists, then, must be justified on the basis not of cost savings but of benefits to clients and their caregivers. PMID:3130326

Multidisciplinary care considerations for gender nonconforming adolescents with eating disorders: A case series.

PubMed

Donaldson, Abigail A; Hall, Allison; Neukirch, Jodie; Kasper, Vania; Simones, Shannon; Gagnon, Sherry; Reich, Steven; Forcier, Michelle

2018-05-01

Gender nonconforming youth are at risk for body dissatisfaction and disordered eating. Currently, only a small body of literature addresses this high-risk group. The five cases in this series highlight important themes for this patient population from an interdisciplinary perspective. Identified themes include increased risk for self-harm/suicide, complex psychiatric, and medical implications of delay to treatment for either gender dysphoria or disordered eating, and the importance of collaborative management to maximize care and facilitate healthy development to adulthood. The purpose of this case series is to expand the interdisciplinary discussion regarding the breadth of presentation and management considerations for gender nonconforming adolescents with disordered eating. An interdisciplinary approach to care might enhance access to comprehensive, collaborative treatment for disordered eating, and gender dysphoria in this unique population. © 2018 Wiley Periodicals, Inc.

Carotid body tumor imitator: An interesting case of Castleman's disease.

PubMed

Shakir, Hakeem J; Diletti, Sara M; Hart, Alexandra M; Meyers, Joshua E; Dumont, Travis M; Siddiqui, Adnan H

2015-01-01

There are very few reports in the literature of Castleman's disease affecting the carotid artery and a single previous report of a case of Castleman's disease of the neck originally mistaken as a carotid body tumor. We describe a rare case of Castleman's disease, manifesting with classic radiographic hallmarks of a carotid body tumor. The postoperative pathologic examination identified the resected mass as Castleman's lymphadenopathy. The management of this particular case is discussed, and the findings are highlighted. We present a unique case of a tumor initially and incorrectly diagnosed as a carotid body tumor. However, after comprehensive treatment with endovascular and surgical modalities and subsequent pathologic examination, the diagnosis of this rare entity was made.

78 FR 5490 - Draft Environmental Impact Statement for Tuolumne Wild and Scenic River Comprehensive Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-25

... Environmental Impact Statement for Tuolumne Wild and Scenic River Comprehensive Management Plan, Yosemite... Statement (DEIS) for the proposed Tuolumne Wild and Scenic River Comprehensive Management Plan (TRPCMP). The...), and will provide long-term guidance for management of the 54 miles of the Tuolumne River that flows...

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.

Congenital heart surgery: surgical performance according to the Aristotle complexity score.

PubMed

Arenz, Claudia; Asfour, Boulos; Hraska, Viktor; Photiadis, Joachim; Haun, Christoph; Schindler, Ehrenfried; Sinzobahamvya, Nicodème

2011-04-01

Aristotle score methodology defines surgical performance as 'complexity score times hospital survival'. We analysed how this performance evolved over time and in correlation with case volume. Aristotle basic and comprehensive complexity scores and corresponding basic and comprehensive surgical performances were determined for primary (main) procedures carried out from 2006 to 2009. Surgical case volume performance described as unit performance was estimated as 'surgical performance times the number of primary procedures'. Basic and comprehensive complexity scores for the whole cohort of procedures (n=1828) were 7.74±2.66 and 9.89±3.91, respectively. With an early survival of 97.5% (1783/1828), mean basic and comprehensive surgical performances reached 7.54±2.54 and 9.64±3.81, respectively. Basic surgical performance varied little over the years: 7.46±2.48 in 2006, 7.43±2.58 in 2007, 7.50±2.76 in 2008 and 7.79±2.54 in 2009. Comprehensive surgical performance decreased from 9.56±3.91 (2006) to 9.22±3.94 (2007), and then to 9.13±3.77 (2008), thereafter increasing up to 10.62±3.67 (2009). No significant change of performance was observed for low comprehensive complexity levels 1-3. Variation concerned level 4 (p=0.048) which involved the majority of procedures (746, or 41% of cases) and level 6 (p<0.0001) which included a few cases (20, or 1%), whereas for level 5, statistical significance was almost attained: p=0.079. With a mean annual number of procedures of 457, mean basic and comprehensive unit performance was estimated at 3447±362 and 4405±577, respectively. Basic unit performance increased year to year from 3036 (2006, 100%) to 3254 (2007, 107.2%), then 3720 (2008, 122.5%), up to 3793 (2009, 124.9%). Comprehensive unit performance also increased: from 3891 (2006, 100%) to 4038 (2007, 103.8%), 4528 (2008, 116.4%) and 5172 (2009, 132.9%). Aristotle scoring of surgical performance allows quality assessment of surgical management of congenital heart disease over time. The newly defined unit performance appears to well reflect the trend of activity and efficiency of a congenital heart surgery department. Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

A combined disease management and process modeling approach for assessing and improving care processes: a fall management case-study.

PubMed

Askari, Marjan; Westerhof, Richard; Eslami, Saied; Medlock, Stephanie; de Rooij, Sophia E; Abu-Hanna, Ameen

2013-10-01

To propose a combined disease management and process modeling approach for evaluating and improving care processes, and demonstrate its usability and usefulness in a real-world fall management case study. We identified essential disease management related concepts and mapped them into explicit questions meant to expose areas for improvement in the respective care processes. We applied the disease management oriented questions to a process model of a comprehensive real world fall prevention and treatment program covering primary and secondary care. We relied on interviews and observations to complete the process models, which were captured in UML activity diagrams. A preliminary evaluation of the usability of our approach by gauging the experience of the modeler and an external validator was conducted, and the usefulness of the method was evaluated by gathering feedback from stakeholders at an invitational conference of 75 attendees. The process model of the fall management program was organized around the clinical tasks of case finding, risk profiling, decision making, coordination and interventions. Applying the disease management questions to the process models exposed weaknesses in the process including: absence of program ownership, under-detection of falls in primary care, and lack of efficient communication among stakeholders due to missing awareness about other stakeholders' workflow. The modelers experienced the approach as usable and the attendees of the invitational conference found the analysis results to be valid. The proposed disease management view of process modeling was usable and useful for systematically identifying areas of improvement in a fall management program. Although specifically applied to fall management, we believe our case study is characteristic of various disease management settings, suggesting the wider applicability of the approach. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The older persons' assessment and liaison team 'OPAL': evaluation of comprehensive geriatric assessment in acute medical inpatients.

PubMed

Harari, D; Martin, F C; Buttery, A; O'Neill, S; Hopper, A

2007-11-01

Reducing hospital length of stay (LOS) in older acute medical inpatients is a key productivity measure. Evidence-based predictors of greater LOS may be targeted through Comprehensive Geriatric Assessment (CGA). Evaluate a novel service model for CGA screening of older acute medical inpatients linked to geriatric intervention. Urban teaching hospital. Acute medical inpatients aged 70+ years. Multidisciplinary CGA screening of all acute medical admissions aged 70+ years leading to (a) rapid transfer to geriatric wards or (b) case-management on general medical wards by Older Persons Assessment and Liaison team (OPAL). Prospective pre-post comparison with statistical adjustment for baseline factors, and use of national benchmarking LOS data. Pre-OPAL (n = 46) and post-OPAL (n = 49) cohorts were similarly identified as high-risk by the CGA screening tool, but only post-OPAL patients received the intervention. Pre-OPAL, 0% fallers versus 92% post-OPAL were specifically assessed and/or referred to a falls service post-discharge. Management of delirium, chronic pain, constipation, and urinary incontinence similarly improved. Over twice as many patients were transferred to geriatric wards, with mean days from admission to transfer falling from 10 to 3. Mean LOS fell by 4 days post-OPAL. Only the OPAL intervention was associated with LOS (P = 0.023) in multiple linear regression including case-mix variables (e.g. age, function, 'geriatric giants'). Benchmarking data showed the LOS reduction to be greater than comparable hospitals. CGA screening of acute medical inpatients leading to early geriatric intervention (ward-based case management, appropriate transfer to geriatric wards), improved clinical effectiveness and general hospital performance.

Short article: Aspiration of capsule endoscopes: a comprehensive review of the existing literature.

PubMed

Yung, Diana E; Plevris, John N; Koulaouzidis, Anastasios

2017-04-01

Capsule endoscopy (CE) has an excellent safety profile. Although retention is the most cited complication, capsule aspiration is less frequent and is often reported only as isolated cases. This study represents a systematic effort to compile and scrutinize the available data on capsule aspiration to provide comprehensive and conclusive information on this CE complication. A systematic literature search was performed in PubMed, Embase and Chinese National Knowledge Infrastructure. The search terms used were 'capsule endoscopy' AND 'aspiration' (both terms searched as keyword and MeSH). We included case reports and/or series on capsule aspiration, as well as observational cohort studies that reported capsule aspiration among their complications/outcomes. Thirty-four case reports with 37 cases of capsule aspiration were identified. A further four observational studies reported aspiration as part of a cohort of patients undergoing CE. 94.6% of aspirations occurred in elderly men. 87.1% had significant comorbidities. 59.5% had symptoms on aspiration, with cough reported most frequently. The most common location of aspiration was the right main bronchus. Half of the patients required intervention for capsule retrieval; bronchoscopy was the most common management, with good effect. There was a single fatality following capsule aspiration, not directly related to the procedure, and one case of aspiration pneumonia. Outcomes were good for all other patients. The estimated overall aspiration rate is 0.1%. Although very rare and generally safely managed, capsule aspiration should be anticipated in certain patient groups and capsule administration should be approached with necessary precautions.

TERMTrial--terminology-based documentation systems for cooperative clinical trials.

PubMed

Merzweiler, A; Weber, R; Garde, S; Haux, R; Knaup-Gregori, P

2005-04-01

Within cooperative groups of multi-center clinical trials a standardized documentation is a prerequisite for communication and sharing of data. Standardizing documentation systems means standardizing the underlying terminology. The management and consistent application of terminology systems is a difficult and fault-prone task, which should be supported by appropriate software tools. Today, documentation systems for clinical trials are often implemented as so-called Remote-Data-Entry-Systems (RDE-systems). Although there are many commercial systems, which support the development of RDE-systems there is none offering a comprehensive terminological support. Therefore, we developed the software system TERMTrial which consists of a component for the definition and management of terminology systems for cooperative groups of clinical trials and two components for the terminology-based automatic generation of trial databases and terminology-based interactive design of electronic case report forms (eCRFs). TERMTrial combines the advantages of remote data entry with a comprehensive terminological control.

Integrality: life principle and right to health.

PubMed

Viegas, Selma Maria Fonseca; Penna, Cláudia Maria de Mattos

2015-01-01

To understand the health integrality in the daily work of Family Health Strategy (FHS) and its concept according to the managers in Jequitinhonha Valley, Minas Gerais, Brazil. This is a multiple case study of holistic and qualitative approach based on the Quotidian Comprehensive Sociology. The subjects were workers of the Family Health Strategy teams, the support team and managers in a total of 48. The results show the integrality as a principle of life and right to health and to contemplate it in the quotidian of doings in health, others principles of the Unified Health System may be addressed consecutively. The universal right to health care needs is declared in contemplation of integrity of being, the idealization of a subject-centered care, one that is our aim in health care, which signals a step towards a change of attitude in seeking comprehensive care. It is considered that the principle of integrality is a difficult accomplishment in its dimensions.

[Flight nurses' comprehension about their role in the multiprofesional team of aero-medical transport].

PubMed

Scuissiato, Dayane Reinhardt; Boffi, Letícia Valois; da Rocha, Roseline da Rocha; Montezeli, Juliana Helena; Bordin, Michelle Taverna; Peres, Aida Maris

2012-01-01

This is a descriptive qualitative research which aimed at identifying the flight nurses' comprehension by about their role in the aero-medical multiprofesional team. A semi-structured interview was carried out with eight flight nurses from Curitiba-PR, from June to August 2009. The speeches were analyzed by the content analysis, from which three categories emerged. The first describes the responsibilities of the flight nurses as managers of the aero-medical mission, planning for before, during and after the transport, what includes the aircraft check-list and knowledge of the patient's case. The second category deals with aspects of these professionals as care providers to the aero-transferred patient. The third describes communication and team-work as fundamental requirements for flight nurses. It was concluded that the nurse in aero-medical team mixes management and caring in his/her professional practice by the use of specific competences.

Long-term effectiveness of a comprehensive pain management program: strengthening the case for interdisciplinary care

PubMed Central

Oslund, Sarah; Clark, Timothy C.; Garofalo, John P.; Behnk, Pamela; Walker, Becky; Walker, Katherine E.; Gatchel, Robert J.; Mahaney, Micah; Noe, Carl E.

2009-01-01

Chronic pain, a debilitating medical condition affecting approximately 15% of the US population, leads to individual suffering and costs to society in terms of health care dollars and lost productivity. To examine the effectiveness of a comprehensive pain management program, data from 108 program participants were evaluated. Preprogram, postprogram, and 6-month follow-up data were collected from 80 participants, and preprogram, postprogram, and 1-year data were collected from 46 participants. Outcomes data from several domains were assessed: pain severity, emotional distress, interference of pain on function, perceived control of pain, treatment helpfulness, and number of hours resting. Within-subject repeated-measure analyses of variance found statistically significant findings on the six outcome measures utilized in this study for both the 6-month and 1-year samples. Examination of 95% confidence intervals revealed no overlap in pretreatment scores with 6-month and 1-year outcomes in five of the six domains studied. Mean scores on emotional distress did not maintain statistical significance in the 6-month or 1-year review. Overall, this study strengthens the case for interdisciplinary care for chronic pain management and provides evidence for the long-term effectiveness of this therapy. Furthermore, this study lends support to the notion that interdisciplinary treatments are effective in targeting multiple domains affected by the pain condition. PMID:19633738

Management of ingested magnets in children.

PubMed

Hussain, Sunny Z; Bousvaros, Athos; Gilger, Mark; Mamula, Petar; Gupta, Sandeep; Kramer, Robert; Noel, R Adam

2012-09-01

We describe a comprehensive algorithm for the management of ingested rare-earth magnets in children. These newer and smaller neodymium magnets sold as adult toys are much stronger than the traditional magnets, and can attract each other with formidable forces. If >1 magnet is swallowed at the same time, or a magnet is co-ingested with another metallic object, the loops of intestine can be squeezed between them resulting in bowel damage including perforations. An algorithm that uses the number of magnets ingested, location of magnets, and the timing of ingestion before intervention helps to delineate the roles of the pediatric gastroenterologists and surgeons in the management of these cases.

The Implementation of Industrial Training in Tertiary Education in Malaysia: Objectives, Realisations and Outputs in the Case of Foreign Language Students

ERIC Educational Resources Information Center

Machart, Régis

2017-01-01

The large range of jobs that Malaysian undergraduates of foreign languages are often employed in after completion of their studies (education, tourism, banking, business, management, etc.) is not necessarily related to their major field of study. This situation often makes it difficult for lecturers to develop a comprehensive professional training…

The Performance Blueprint: An Integrated Logic Model Developed To Enhance Performance Measurement Literacy: The Case of Performance-Based Contract Management.

ERIC Educational Resources Information Center

Longo, Paul J.

This study explored the mechanics of using an enhanced, comprehensive multipurpose logic model, the Performance Blueprint, as a means of building evaluation capacity, referred to in this paper as performance measurement literacy, to facilitate the attainment of both service-delivery oriented and community-oriented outcomes. The application of this…

Managers Confront Competing Practical, Legal, and Ethical Claims: A Comprehensive Teaching Case

ERIC Educational Resources Information Center

McAdams, Tony

2009-01-01

Law classes help reveal the successes of the American legal system. Students observe that the law is honorable, workable, and effective. At the same time, law classes offer the opportunity to look at those situations where the legal system sometimes struggles to achieve its justice goals. Students certainly need to learn that lesson, but they also…

78 FR 73559 - Moose-Wilson Corridor Comprehensive Management Plan, Environmental Impact Statement, Grand Teton...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-06

...-Wilson Corridor Comprehensive Management Plan, Environmental Impact Statement, Grand Teton National Park... is preparing a Comprehensive Management Plan and Environmental Impact Statement (EIS) for the Moose...; (2) distinguish the corridor's fundamental and other important resources and values; (3) clearly...

Reconstruction With Pedicled Anterolateral Thigh Flap After Wide Local Excision of Penoscrotal Extramammary Paget's Disease: A Case Report and Comprehensive Literature Review

PubMed Central

Skinner, Eila C.; Lee, Gordon K.

2015-01-01

Objective: The clinical characteristics, management, and prognostic indicators of penoscrotal extramammary Paget's disease are not clearly defined. Surgical excision is often an effective treatment modality but results in a large wound after resection of all involved tissues. Methods: Reconstruction of large penoscrotal soft-tissue defects after wide local excision remains a challenge to the reconstructive surgeon. The use of the anterolateral thigh flap for penoscrotal reconstruction after resection of extramammary Paget's disease is infrequent as a reconstruction tool throughout the literature. Results: We discuss a case where the anterolateral thigh flap was effectively used for reconstruction of a large penoscrotal defect after wide local excision of penoscrotal extramammary Paget's disease and present a comprehensive literature review of extramammary Paget's disease key features, diagnosis, prognosis, and treatment. Conclusions: The anterolateral thigh flap is a useful tool for penoscrotal defect reconstruction. PMID:26171098

Rationale, design and conduct of a randomised controlled trial evaluating a primary care-based complex intervention to improve the quality of life of heart failure patients: HICMan (Heidelberg Integrated Case Management)

PubMed Central

Peters-Klimm, Frank; Müller-Tasch, Thomas; Schellberg, Dieter; Gensichen, Jochen; Muth, Christiane; Herzog, Wolfgang; Szecsenyi, Joachim

2007-01-01

Background Chronic congestive heart failure (CHF) is a complex disease with rising prevalence, compromised quality of life (QoL), unplanned hospital admissions, high mortality and therefore high burden of illness. The delivery of care for these patients has been criticized and new strategies addressing crucial domains of care have been shown to be effective on patients' health outcomes, although these trials were conducted in secondary care or in highly organised Health Maintenance Organisations. It remains unclear whether a comprehensive primary care-based case management for the treating general practitioner (GP) can improve patients' QoL. Methods/Design HICMan is a randomised controlled trial with patients as the unit of randomisation. Aim is to evaluate a structured, standardized and comprehensive complex intervention for patients with CHF in a 12-months follow-up trial. Patients from intervention group receive specific patient leaflets and documentation booklets as well as regular monitoring and screening by a prior trained practice nurse, who gives feedback to the GP upon urgency. Monitoring and screening address aspects of disease-specific self-management, (non)pharmacological adherence and psychosomatic and geriatric comorbidity. GPs are invited to provide a tailored structured counselling 4 times during the trial and receive an additional feedback on pharmacotherapy relevant to prognosis (data of baseline documentation). Patients from control group receive usual care by their GPs, who were introduced to guideline-oriented management and a tailored health counselling concept. Main outcome measurement for patients' QoL is the scale physical functioning of the SF-36 health questionnaire in a 12-month follow-up. Secondary outcomes are the disease specific QoL measured by the Kansas City Cardiomyopathy questionnaire (KCCQ), depression and anxiety disorders (PHQ-9, GAD-7), adherence (EHFScBS and SANA), quality of care measured by an adapted version of the Patient Chronic Illness Assessment of Care questionnaire (PACIC) and NT-proBNP. In addition, comprehensive clinical data are collected about health status, comorbidity, medication and health care utilisation. Discussion As the targeted patient group is mostly cared for and treated by GPs, a comprehensive primary care-based guideline implementation including somatic, psychosomatic and organisational aspects of the delivery of care (HICMAn) is a promising intervention applying proven strategies for optimal care. Trial registration Current Controlled Trials ISRCTN30822978. PMID:17716364

Rationale, design and conduct of a randomised controlled trial evaluating a primary care-based complex intervention to improve the quality of life of heart failure patients: HICMan (Heidelberg Integrated Case Management).

PubMed

Peters-Klimm, Frank; Müller-Tasch, Thomas; Schellberg, Dieter; Gensichen, Jochen; Muth, Christiane; Herzog, Wolfgang; Szecsenyi, Joachim

2007-08-23

Chronic congestive heart failure (CHF) is a complex disease with rising prevalence, compromised quality of life (QoL), unplanned hospital admissions, high mortality and therefore high burden of illness. The delivery of care for these patients has been criticized and new strategies addressing crucial domains of care have been shown to be effective on patients' health outcomes, although these trials were conducted in secondary care or in highly organised Health Maintenance Organisations. It remains unclear whether a comprehensive primary care-based case management for the treating general practitioner (GP) can improve patients' QoL. HICMan is a randomised controlled trial with patients as the unit of randomisation. Aim is to evaluate a structured, standardized and comprehensive complex intervention for patients with CHF in a 12-months follow-up trial. Patients from intervention group receive specific patient leaflets and documentation booklets as well as regular monitoring and screening by a prior trained practice nurse, who gives feedback to the GP upon urgency. Monitoring and screening address aspects of disease-specific self-management, (non)pharmacological adherence and psychosomatic and geriatric comorbidity. GPs are invited to provide a tailored structured counselling 4 times during the trial and receive an additional feedback on pharmacotherapy relevant to prognosis (data of baseline documentation). Patients from control group receive usual care by their GPs, who were introduced to guideline-oriented management and a tailored health counselling concept. Main outcome measurement for patients' QoL is the scale physical functioning of the SF-36 health questionnaire in a 12-month follow-up. Secondary outcomes are the disease specific QoL measured by the Kansas City Cardiomyopathy questionnaire (KCCQ), depression and anxiety disorders (PHQ-9, GAD-7), adherence (EHFScBS and SANA), quality of care measured by an adapted version of the Patient Chronic Illness Assessment of Care questionnaire (PACIC) and NT-proBNP. In addition, comprehensive clinical data are collected about health status, comorbidity, medication and health care utilisation. As the targeted patient group is mostly cared for and treated by GPs, a comprehensive primary care-based guideline implementation including somatic, psychosomatic and organisational aspects of the delivery of care (HICMAn) is a promising intervention applying proven strategies for optimal care.

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.

Care management service and falls prevention: a case-control study in a Chinese population.

PubMed

Leung, Angela Y M; Lou, Vivian W Q; Chan, Kin Sun; Yung, Alison; Chi, Iris

2010-04-01

This study evaluates the effect of a care management service (CMS) on falls in older adults. This is a retrospective case-control study with 78 CMS recipients as the case group who received CMS and another 312 community-dwelling frail elders as the control group.The groups were matched by age, gender, activity of daily living, cognitive impairment, and unsteady gait. Thus they were comparable in characteristics and frailty. Among the 390 participants, 89 older adults (23.0%) had falls in the 90 days prior to the survey. After controlling for the identified risk factors for falls, the odds ratio of CMS was 0.27 (95% confidence interval = 0.110-0.663, p < .01). These findings indicate that CMS recipients have a lower chance for falls compared to their counterparts. The two features of CMS (comprehensive assessment and multidisciplinary actions to reduce fall risks) are discussed.

[Management experience of acute renal failure induced by unilateral ureteral calculi obstruction].

PubMed

Tan, Fu-qing; Shen, Bo-hua; Xie, Li-ping; Meng, Hong-zhou; Fang, Dan-bo; Wang, Chao-jun

2013-05-28

To explore the causes and treatment options of acute renal failure induced by unilateral ureteral calculi obstruction. The clinical data of 12 cases of acute renal failure induced by unilateral ureteral calculi obstruction between August 2008 and July 2012 were reviewed retrospectively. There were 5 males and 7 females with an average age of 65.7 years. Their clinical data and treatment options were retrospectively analyzed and summarized. Seven cases showed right side ureteral calculus with hydronephrosis while another 5 presented left side ureteral calculus with hydronephrosis. Serum creatinine was higher than 310 µmol/L in 12 cases. Anuria appeared in 4 cases for 1-7 days while oliguria in 8 cases for 2-10 days. High fever was present in 11 cases, the highest of whom was 40 °C. White blood cell count increased in 10 cases (>10×10(9)/L) and decreased in 2 cases (<4 × 10(9)/L). The therapeutic options included insertion of double J stent for internal drainage (n = 1), percutaneous nephrostomy for external drainage (n = 10) and open operation (n = 1). Traditional treatments were performed to manage ureteral calculus in the above 11 cases with drainage. All cases had improved renal function after comprehensive treatment of anti-infection, antishock, rinsing stones and relieving obstruction. All 12 cases were treated successfully. Unilateral ureteral calculus may impair contralateral renal function and cause acute renal failure due to the absorption of toxin at obstructive side. The keys of management are eliminating toxin and relieving obstruction.

Decision support systems and the healthcare strategic planning process: a case study.

PubMed

Lundquist, D L; Norris, R M

1991-01-01

The repertoire of applications that comprises health-care decision support systems (DSS) includes analyses of clinical, financial, and operational activities. As a whole, these applications facilitate developing comprehensive and interrelated business and medical models that support the complex decisions required to successfully manage today's health-care organizations. Kennestone Regional Health Care System's use of DSS to facilitate strategic planning has precipitated marked changes in the organization's method of determining capital allocations. This case study discusses Kennestone's use of DSS in the strategic planning process, including profiles of key DSS modeling components.

Crisis Management of Accidental Extubation in a Prone-Positioned Patient with Klippel-Feil Syndrome.

PubMed

Spond, Matthew; Burns, Tyler; Rosenbaum, Thea; Lienhart, Kristen

2016-06-15

We present the case of an accidental extubation in a prone-positioned patient with a challenging airway because of Klippel-Feil syndrome and previous cervical spine fusions. The surgical procedure was well underway when this occurred, which added substantially to the difficulties produced by this event. We herein highlight the corrective steps we took in our case. We also recommend the need for a comprehensive preoperative briefing with all operating room personnel together with an action plan for how to prevent this particular scenario.

The comprehensiveness of environmental management systems: The influence of institutional pressures and the impact on environmental performance.

PubMed

Phan, Thanh Nguyet; Baird, Kevin

2015-09-01

This study contributes to the EMS literature by providing a more detailed insight into the comprehensiveness of environmental management systems (EMSs) by focusing on the intensity of use of environmental management practices. In addition, the study examines the influence of institutional pressures (coercive, mimetic and normative) on the comprehensiveness of environmental management systems (EMSs), and the impact of EMS comprehensiveness on environmental performance. A mail survey questionnaire was used to collect data from a random sample of Australian senior managers across various industries. Both coercive and normative pressures were found to influence the comprehensiveness of EMSs. Specifically, the pressure exerted by the government, through the creation of appropriate regulatory pressures and public incentives, and by employees, customers, professional groups, the media, and community, influenced the comprehensiveness of the EMS. In addition, organisations with more comprehensive EMSs were found to experience higher levels of environmental performance. With more than 300,000 organisations worldwide adopting EMSs (ISO, 2013), the findings provide an important insight into the relevance of EMSs. In particular, it is suggested that organisations should endeavour to implement a more comprehensive EMS and be conscious of the role that coercive and normative pressures play in influencing the comprehensiveness of their EMSs. Copyright © 2015 Elsevier Ltd. All rights reserved.

Assessing school disaster preparedness by applying a comprehensive school safety framework: A case of elementary schools in Banda Aceh City

NASA Astrophysics Data System (ADS)

Sakurai, A.; Bisri, M. B. F.; Oda, T.; Oktari, R. S.; Murayama, Y.

2017-02-01

The study assessed the depth of school disaster safety at public elementary schools in Banda Aceh City, Indonesia in terms of comprehensive school safety, especially school location, disaster management and disaster education. The findings indicate that 56% of public elementary schools in Banda Aceh City are exposed to high tsunami risk, and most externally driven school disaster preparedness activities were not continued by the schools due to lack of ownership and funding. To realize comprehensive school safety, disaster preparedness programs should neither be brought in by external donors, nor be in a patchwork. Rather, it should be conducted jointly and sustainably by the local school and the community and supported by multi-sectoral support in the city. Comprehensive school safety of public elementary schools in Banda Aceh City could be realized by reviewing, updating and localizing school disaster preparedness programs by all the education partners in the city with strong political will and commitment.

Comprehensive change management concepts. Development of a participatory approach.

PubMed

Zink, Klaus J; Steimle, Ulrich; Schröder, Delia

2008-07-01

During the last years, many change projects in organizations did not have the planned success. Therefore at first, the causes for these failures and the success factors contributing to organizational change have to be discussed. To get better results, a comprehensive change management concept has been developed and tested in an ongoing research project. By using concepts for an integrated assessment and design of organizations, an approach for analyzing the current situation has been elaborated to identify "lack of integration" in the change initiatives of a company. To realize an integrated overall approach of modernization by harmonizing different methods and concepts, first, one has to prove their relationship to policy and strategy (vertical harmonization). The second step is to take into account the fact that there has to be a logical fit between the single concepts (horizontal harmonization). But even if all elements are logically coherent, that does not mean that the people working in the company also see this coherence. Therefore, in addition to the "logical fit", one has to examine the "psychological fit". In the end, a concept for analyzing the status quo in an organization as a result of "objective data" and "subjective data" originated. Subsequently, instruments for harmonizing different modernizing concepts have been applied. As part of the comprehensive change management concept participatory ergonomic approaches have been used during the project. The present study shows this approach in the case of one company.

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.

Integrated ocean management as a strategy to meet rapid climate change: the Norwegian case.

PubMed

Hoel, Alf Håkon; Olsen, Erik

2012-02-01

The prospects of rapid climate change and the potential existence of tipping points in marine ecosystems where nonlinear change may result from them being overstepped, raises the question of strategies for coping with ecosystem change. There is broad agreement that the combined forces of climate change, pollution and increasing economic activities necessitates more comprehensive approaches to oceans management, centering on the concept of ecosystem-based oceans management. This article addresses the Norwegian experience in introducing integrated, ecosystem-based oceans management, emphasizing how climate change, seen as a major long-term driver of change in ecosystems, is addressed in management plans. Understanding the direct effects of climate variability and change on ecosystems and indirect effects on human activities is essential for adaptive planning to be useful in the long-term management of the marine environment.

77 FR 23652 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; Comprehensive Annual Catch Limit...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-20

... Annual Catch Limit Amendment (Comprehensive ACL Amendment) for the Fishery Management Plan for the... the South Atlantic Fishery Management Council (Council). The Comprehensive ACL Amendment specified, in... FMP. A final rule implementing the Comprehensive ACL Amendment was published in the Federal Register...

Acute appendicitis: proposal of a new comprehensive grading system based on clinical, imaging and laparoscopic findings.

PubMed

Gomes, Carlos Augusto; Sartelli, Massimo; Di Saverio, Salomone; Ansaloni, Luca; Catena, Fausto; Coccolini, Federico; Inaba, Kenji; Demetriades, Demetrios; Gomes, Felipe Couto; Gomes, Camila Couto

2015-01-01

Advances in the technology and improved access to imaging modalities such as Computed Tomography and laparoscopy have changed the contemporary diagnostic and management of acute appendicitis. Complicated appendicitis (phlegmon, abscess and/ or diffuse peritonitis), is now reliably distinguished from uncomplicated cases. Therefore, a new comprehensive grading system for acute appendicitis is necessary. The goal is review and update the laparoscopic grading system of acute appendicitis and to provide a new standardized classification system to allow more uniform patient stratification. During the last World Society of Emergency Surgery Congress in Israel (July, 2015), a panel involving Acute Appendicitis Experts and the author's discussed many current aspects about the acute appendicitis between then, it will be submitted a new comprehensive disease grading system. It was idealized based on three aspect of the disease (clinical and imaging presentation and laparoscopic findings). The new grading system may provide a standardized system to allow more uniform patient stratification for appendicitis research. In addition, may aid in determining optimal management according to grade. Lastly, what we want is to draw a multicenter observational study within the World Society of Emergency Surgery (WSES) based on this design.

Prevention of primary caesarean delivery: comprehensive management of dystocia in nulliparous patients at term.

PubMed

Ragusa, Antonio; Gizzo, Salvatore; Noventa, Marco; Ferrazzi, Enrico; Deiana, Sara; Svelato, Alessandro

2016-10-01

Dystocia is the leading indication for primary caesarean sections. Our aim is to compare two approaches in the management of dystocia in labor in nulliparous women with a singleton fetus in cephalic presentation at term in spontaneous or induced labor. Prospective cohort study. Four hundred and nineteen consecutive patients were divided into two groups: the standard management group (SM), in acceleration of labor was commenced at the "action line" in the case of arrested or protracted labor, and the comprehensive management group (CM) in which arrested or protracted labor was considered as a warning sign promoting further diagnostic assessment prior to considering intervention. Caesarean sections rate was 22.2 % in the SM group (216 patients) and 10.3 % in the CM group (203 patients) (p = 0.001). The rate of oxytocin use decreased from 33.3 % in SM group to 13.8 % in the CM group (p < 0.0005). The rate of amniotomy decreased from 41.7 % in the SM group to 7.4 % in the CM group (p < 0.0005). The percentage of newborns with 5-min Apgar score <7 and/or umbilical cord arterial pH ≤ 7.00 decreased from 2.3 % in SM cohort to 0.5 % in CM cohort (p = ns). The average length of labor did not differ between the two groups of patients (264 vs 277 min; p = ns). Comprehensive management of dystocia enabled us to achieve a reduction in iatrogenic interventions in labor while maintaining good neonatal outcomes.

77 FR 42192 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; Comprehensive Annual Catch Limit...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-18

... Amendment (Comprehensive ACL Amendment) for the Fishery Management Plan for the Snapper-Grouper Fishery of... Fishery Management Council (Council). The Comprehensive ACL Amendment specified, in part, annual catch... implementing the Comprehensive ACL Amendment published on March 16, 2012, and became effective on April 16...

Comprehensive dental management in a Hallermann-Streiff syndrome patient with unusual radiographic appearance of teeth.

PubMed

Gungor, O Erken; Nur, B Guzel; Yalcin, H; Karayilmaz, H; Mihci, E

2015-01-01

Hallermann-Streiff syndrome (HSS) is a genetic disorder characterized by proportionate dwarfism, birdlike facies, hypotrichosis, skin atrophy, dyscephaly, bilateral microphthalmia, congenital cataracts, a narrow, weak, beaked nose, a hypoplastic mandible, and orodental anomalies. Occurrence is sporadic and distinct patterns of inheritance have not been found. This case report describes the dental management of a 3-year-old girl patient with HSS, who had unusual radiographic appearance of teeth. Furthermore, dental treatments and a 30-month follow-up period of the patient with this rare tooth structure malformation have been presented.

Training of midwives in advanced obstetrics in Liberia.

PubMed

Dolo, Obed; Clack, Alice; Gibson, Hannah; Lewis, Naomi; Southall, David P

2016-05-01

The shortage of doctors in Liberia limits the provision of comprehensive emergency obstetric and neonatal care. In a pilot project, two midwives were trained in advanced obstetric procedures and in the team approach to the in-hospital provision of advanced maternity care. The training took two years and was led by a Liberian consultant obstetrician with support from international experts. The training took place in CB Dunbar Maternity Hospital. This rural hospital deals with approximately 2000 deliveries annually, many of which present complications. In February 2015 there were just 117 doctors available in Liberia. In the first 18 months of training, the trainees were involved with 236 caesarean sections, 35 manual evacuations of products of conception, 25 manual removals of placentas, 21 vaginal breech deliveries, 14 vacuum deliveries, four repairs of ruptured uteri, the management of four cases of shoulder dystocia, three hysterectomies, two laparotomies for ruptured ectopic pregnancies and numerous obstetric ultrasound examinations. The trainees also managed 41 cases of eclampsia or severe pre-eclampsia, 25 of major postpartum haemorrhage and 21 of shock. Although, initially they only assisted senior doctors, the trainees subsequently progressed from direct to indirect supervision and then to independent management. To compensate for a shortage of doctors able to undertake comprehensive emergency obstetric and neonatal care, experienced midwives can be taught to undertake advanced obstetric care and procedures. Their team work with doctors can be particularly valuable in rural hospitals in resource-poor countries.

Information Management Strategies for Program Tracking and Formative Evaluation

NASA Astrophysics Data System (ADS)

Siegfried, D.; Detrick, L.; Valaitis, S.; Johnson, A.; Thomas, S. H.; Fauver, A.

2013-05-01

The Institute for Broadening Participation (IBP) has developed information management systems to facilitate programmatic formative evaluation, tracking and outreach activities. Nearly a decade of design solutions and technical implementations in support of IBP's professional development and mentoring programs for students (including the "Pathways to Ocean Science," "Minorities Striving and Pursuing Higher Degrees of Success" in Earth System Science, and "Pathways to Engineering") has provided IBP with a toolbox of proven strategies for addressing program engagement and participant tracking, outreach, and a variety of other information management needs. In this session, IBP will use case-specific examples to share general design strategies for program participant and activities data collection in REUs and other program types. The cases will illustrate an approach that begins with a review of program logic, objectives, expected outcomes, constraints and requirements, which then informs a comprehensive system design. When implemented, such information systems improve administrative efficiency through streamlined data collection processes and easy-to-use data capture forms, and a corresponding set of reporting tools provides access to data that is crucial for ongoing program improvement. IBP presents this information in response to collaborations with administrators of Research Experience for Undergraduates (REU) programs as well as longer duration programs, who have expressed the need for more comprehensive and easy to use information systems. Recently IBP has also worked with the directors of NSF and NASA funded programs seeking assistance in addressing their formative evaluation needs including system design, information collection, and reporting efforts.

Assessing coastal reclamation suitability based on a fuzzy-AHP comprehensive evaluation framework: A case study of Lianyungang, China.

PubMed

Feng, Lan; Zhu, Xiaodong; Sun, Xiang

2014-12-15

Coastal reclamation suitability evaluation (CRSE) is a difficult, complex and protracted process requiring the evaluation of many different criteria. In this paper, an integrated framework employing a fuzzy comprehensive evaluation method and analytic hierarchy process (AHP) was applied to the suitability evaluation for coastal reclamation for future sustainable development in the coastal area of Lianyungang, China. The evaluation results classified 6.63%, 22.99%, 31.59% and 38.79% of the coastline as suitable, weakly suitable, unsuitable and forbidden, respectively. The evaluation results were verified by the marine pollution data and highly consistent with the water quality status. The fuzzy-AHP comprehensive evaluation method (FACEM) was found to be suitable for the CRSE. This CRSE can also be applied to other coastal areas in China and thereby be used for the better management of coastal reclamation and coastline protection projects. Copyright © 2014 Elsevier Ltd. All rights reserved.

What is the difference between comprehensive and selective primary health care? Evidence from a five-year longitudinal realist case study in South Australia.

PubMed

Baum, Fran; Freeman, Toby; Lawless, Angela; Labonte, Ronald; Sanders, David

2017-04-28

Since the WHO's Alma Ata Declaration on Primary Health Care (PHC) there has been debate about the advisability of adopting comprehensive or selective PHC. Proponents of the latter argue that a more selective approach will enable interim gains while proponents of a comprehensive approach argue that it is needed to address the underlying causes of ill health and improve health outcomes sustainably. This research is based on four case studies of government-funded and run PHC services in Adelaide, South Australia. Program logic models were constructed from interviews and workshops. The initial model represented relatively comprehensive service provision in 2010. Subsequent interviews in 2013 permitted the construction of a selective PHC program logic model following a series of restructuring service changes. Comparison of the PHC service program logic models before and after restructuring illustrates the changes to the operating context, underlying mechanisms, service qualities, activities, activity outcomes and anticipated community health outcomes. The PHC services moved from focusing on a range of community, group and individual clinical activities to a focus on the management of people with chronic disease. Under the more comprehensive model, activities were along a continuum of promotive, preventive, rehabilitative and curative. Under the selective model, the focus moved to rehabilitative and curative with very little other activities. The study demonstrates the difference between selective and comprehensive approaches to PHC in a rich country setting and is useful in informing debates on PHC especially in the context of the Sustainable Development Goals. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

76 FR 65525 - Huron, Madison, and Sand Lake Wetland Management District; Comprehensive Conservation Plan

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-21

...] Huron, Madison, and Sand Lake Wetland Management District; Comprehensive Conservation Plan AGENCY: Fish... (CCP) and environmental assessment (EA) for the Huron, Madison, and Sand Lake Wetland Management...), Madison Wetland Management District, and Sand Lake Wetland Management District are part of the National...

Capacity building permitting comprehensive monitoring of a severe case of Lassa hemorrhagic fever in Sierra Leone with a positive outcome: case report.

PubMed

Grove, Jessica N; Branco, Luis M; Boisen, Matt L; Muncy, Ivana J; Henderson, Lee A; Schieffellin, John S; Robinson, James E; Bangura, James J; Fonnie, Mbalu; Schoepp, Randal J; Hensley, Lisa E; Seisay, Alhassan; Fair, Joseph N; Garry, Robert F

2011-06-20

Lassa fever is a neglected tropical disease with a significant impact on the health care system of endemic West African nations. To date, case reports of Lassa fever have focused on laboratory characterisation of serological, biochemical and molecular aspects of the disease imported by infected individuals from Western Africa to the United States, Canada, Europe, Japan and Israel. Our report presents the first comprehensive real time diagnosis and characterization of a severe, hemorrhagic Lassa fever case in a Sierra Leonean individual admitted to the Kenema Government Hospital Lassa Fever Ward. Fever, malaise, unresponsiveness to anti-malarial and antibiotic drugs, followed by worsening symptoms and onset of haemorrhaging prompted medical officials to suspect Lassa fever. A recombinant Lassa virus protein based diagnostic was employed in diagnosing Lassa fever upon admission. This patient experienced a severe case of Lassa hemorrhagic fever with dysregulation of overall homeostasis, significant liver and renal system involvement, the interplay of pro- and anti-inflammatory cytokines during the course of hospitalization and an eventual successful outcome. These studies provide new insights into the pathophysiology and management of this viral illness and outline the improved infrastructure, research and real-time diagnostic capabilities within LASV endemic areas.

Capacity building permitting comprehensive monitoring of a severe case of Lassa hemorrhagic fever in Sierra Leone with a positive outcome: Case Report

PubMed Central

2011-01-01

Lassa fever is a neglected tropical disease with a significant impact on the health care system of endemic West African nations. To date, case reports of Lassa fever have focused on laboratory characterisation of serological, biochemical and molecular aspects of the disease imported by infected individuals from Western Africa to the United States, Canada, Europe, Japan and Israel. Our report presents the first comprehensive real time diagnosis and characterization of a severe, hemorrhagic Lassa fever case in a Sierra Leonean individual admitted to the Kenema Government Hospital Lassa Fever Ward. Fever, malaise, unresponsiveness to anti-malarial and antibiotic drugs, followed by worsening symptoms and onset of haemorrhaging prompted medical officials to suspect Lassa fever. A recombinant Lassa virus protein based diagnostic was employed in diagnosing Lassa fever upon admission. This patient experienced a severe case of Lassa hemorrhagic fever with dysregulation of overall homeostasis, significant liver and renal system involvement, the interplay of pro- and anti-inflammatory cytokines during the course of hospitalization and an eventual successful outcome. These studies provide new insights into the pathophysiology and management of this viral illness and outline the improved infrastructure, research and real-time diagnostic capabilities within LASV endemic areas. PMID:21689444

Management of aplastic anaemia in pregnancy in a resource poor centre.

PubMed

John, Celestine Osita; Korubo, Kaladada; Ogu, Rosemary; Mmom, Chigozirim Faith; Mba, Alpheus Gogo; Chidiadi, Ezenwa-Ahanene; Akani, Chris

2016-01-01

Aplastic anaemia occurring in pregnancy is a rare event with life threatening challenges for both mother and child. We present a successful fetomaternal outcome despite the challenges in the management of this rare condition in a tertiary but resource poor centre. This is case of a 37 year old Nigerian woman G6P0 +5 managed with repeated blood transfusions from 28 weeks of gestation for bone marrow biopsy confirmed aplastic anaemia following presentation with weakness and gingival bleeds. She had a cesarean section at 37 weeks for pre-eclampsia and oligohydraminous with good feto-maternal outcome. She was managed entirely with fresh whole blood and received 21 units. Aplastic Anaemia in Pregnancy is a rare event with poor feto maternal prognosis. Successful management is possible with good multi-disciplinary approach and availability of supportive comprehensive obstetric care.

Effective strategies for comprehensive corridor management

DOT National Transportation Integrated Search

2004-10-01

Despite the increasing importance of comprehensive corridor management at the state and local government level, questions remain regarding effective methods for developing and implementing corridor management plans. Further insight is also needed int...

Adenoid cystic carcinoma of submandibular gland metastatic to great toes: case report and literature review.

PubMed

Rafael, Oana C; Paul, Doru; Chen, Sheng; Kraus, Dennis

2016-08-01

Adenoid cystic carcinoma (ACC) is a rare malignant tumor of the salivary glands, with higher frequency in the submandibular gland, a prolonged clinical course, and poor long-term survival. It tends to metastasize to lungs, bone, liver, brain, and rarely to skin. Comprehensive skin examination and appropriate follow-up is recommended, since cutaneous metastasis represents disease progression, requiring management and prognosis adjustment.

Disparate stakeholder management: the case of elk and bison feeding in southern Greater Yellowstone

USGS Publications Warehouse

Koontz, Lynne; Hoag, Dana; DeLong, Don

2012-01-01

For resource decisions to make the most possible progress toward achieving agency mandates, managers must work with stakeholders and may need to at least partially accommodate some of their key underlying interests. To accommodate stakeholder interests, while also substantively working toward fulfilling legal mandates, managers must understand the sociopolitical factors that influence the decision-making process. We coin the phrase disparate stakeholder management (DSM) to describe situations with disparate stakeholders and disparate management solutions. A DSM approach (DSMA) requires decision makers to combine concepts from many sciences, thus releasing them from disciplinary bonds that often constrain innovation and effectiveness. We combined three distinct approaches to develop a DSMA that assisted in developing a comprehensive range of elk and bison management alternatives in the Southern Greater Yellowstone Area. The DSMA illustrated the extent of compromise between meeting legal agency mandates and accommodating the preferences of certain stakeholder groups.

Quality improvement in basic histotechnology: the lean approach.

PubMed

Clark, David

2016-01-01

Lean is a comprehensive system of management based on the Toyota production system (TPS), encompassing all the activities of an organization. It focuses management activity on creating value for the end-user by continuously improving operational effectiveness and removing waste. Lean management creates a culture of continuous quality improvement with a strong emphasis on developing the problem-solving capability of staff using the scientific method (Deming's Plan, Do, Check, Act cycle). Lean management systems have been adopted by a number of histopathology departments throughout the world to simultaneously improve quality (reducing errors and shortening turnround times) and lower costs (by increasing efficiency). This article describes the key concepts that make up a lean management system, and how these concepts have been adapted from manufacturing industry and applied to histopathology using a case study of lean implementation and evidence from the literature. It discusses the benefits, limitations, and pitfalls encountered when implementing lean management systems.

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

PubMed

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

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

Tricuspid and Mitral Valve Regurgitation with Bi-fascicular Block Following a Horse Kick.

PubMed

Kokubun, Tomoki; Oikawa, Masayoshi; Ichijo, Yasuhiro; Matsumoto, Yoshiyuki; Yokokawa, Tetsuro; Nakazato, Kazuhiko; Sato, Yoshiyuki; Takase, Shinya; Shinjo, Hiroharu; Yokoyama, Hitoshi; Suzuki, Hitoshi; Saitoh, Shu-Ichi; Takeishi, Yasuchika

2018-06-01

A 40-year-old man was transferred to our hospital following an isolated horse kick injury to the anterior chest wall. The case showed bi-fascicular block, severe tricuspid valve regurgitation due to ruptured chordae tendineae of the anterior leaflet, moderate mitral valve regurgitation due to prolapse of mitral anterior leaflet, and hypokinetic motion of the inferior septal wall. Both tricuspid and mitral insufficiency were completely repaired by a surgical operation. Fortunately, these injuries were not fatal in this case, but the comprehensive assessment of cardiac damage and careful observation are important for managing patients with cardiac injury.

Framework for Infectious Disease Analysis: A comprehensive and integrative multi-modeling approach to disease prediction and management.

PubMed

Erraguntla, Madhav; Zapletal, Josef; Lawley, Mark

2017-12-01

The impact of infectious disease on human populations is a function of many factors including environmental conditions, vector dynamics, transmission mechanics, social and cultural behaviors, and public policy. A comprehensive framework for disease management must fully connect the complete disease lifecycle, including emergence from reservoir populations, zoonotic vector transmission, and impact on human societies. The Framework for Infectious Disease Analysis is a software environment and conceptual architecture for data integration, situational awareness, visualization, prediction, and intervention assessment. Framework for Infectious Disease Analysis automatically collects biosurveillance data using natural language processing, integrates structured and unstructured data from multiple sources, applies advanced machine learning, and uses multi-modeling for analyzing disease dynamics and testing interventions in complex, heterogeneous populations. In the illustrative case studies, natural language processing from social media, news feeds, and websites was used for information extraction, biosurveillance, and situation awareness. Classification machine learning algorithms (support vector machines, random forests, and boosting) were used for disease predictions.

Prevention and management of severe pre-eclampsia/eclampsia in Afghanistan

PubMed Central

2013-01-01

Background An evidence-based strategy exists to reduce maternal morbidity and mortality associated with severe pre-eclampsia/eclampsia (PE/E), but it may be difficult to implement in low-resource settings. This study examines whether facilities that provide emergency obstetric and newborn care (EmONC) in Afghanistan have the capacity to manage severe PE/E cases. Methods A further analysis was conducted of the 2009–10 Afghanistan EmONC Needs Assessment. Assessors observed equipment and supplies available, and services provided at 78 of the 127 facilities offering comprehensive EmONC services and interviewed 224 providers. The providers also completed a written case scenario on severe PE/E. Descriptive statistics were used to summarize facility and provider characteristics. Student t-test, one-way ANOVA, and chi-square tests were performed to determine whether there were significant differences between facility types, doctors and midwives, and trained and untrained providers. Results The median number of severe PE/E cases in the past year was just 5 (range 0–42) at comprehensive health centers (CHCs) and district hospitals, compared with 44 (range 0–130) at provincial hospitals and 108 (range 32–540) at regional and specialized hospitals (p < 0.001). Most facilities had the drugs and supplies needed to treat severe PE/E, including the preferred anticonvulsant, magnesium sulfate (MgSO4). One-third of the smallest facilities and half of larger facilities reported administering a second-line drug, diazepam, in some cases. In the case scenario, 96% of doctors and 89% of midwives recognized that MgSO4 should be used to manage severe PE/E, but 42% of doctors and 58% of midwives also thought diazepam had a role to play. Providers who were trained on the use of MgSO4 scored significantly higher than untrained providers on six of 20 items in the case scenario. Providers at larger facilities significantly outscored those at smaller facilities on five items. There was a significant difference between doctors and midwives on only one item: continued use of anti-hypertensives after convulsions are controlled. Conclusions Drugs and supplies needed to treat severe PE/E are widely available at EmONC facilities in Afghanistan, but providers lack knowledge in some areas, especially concerning the use of MgSO4 and diazepam. Providers who have specialized training or work at larger facilities are better at managing cases of severe PE/E. The findings suggest a need to clarify service delivery guidelines, offer refresher training, and reinforce best practices with supervision and reinforcement. PMID:24119329

Prevention and management of severe pre-eclampsia/eclampsia in Afghanistan.

PubMed

Kim, Young Mi; Ansari, Nasratullah; Kols, Adrienne; Tappis, Hannah; Currie, Sheena; Zainullah, Partamin; Bailey, Patricia; van Roosmalen, Jos; Stekelenburg, Jelle

2013-10-12

An evidence-based strategy exists to reduce maternal morbidity and mortality associated with severe pre-eclampsia/eclampsia (PE/E), but it may be difficult to implement in low-resource settings. This study examines whether facilities that provide emergency obstetric and newborn care (EmONC) in Afghanistan have the capacity to manage severe PE/E cases. A further analysis was conducted of the 2009-10 Afghanistan EmONC Needs Assessment. Assessors observed equipment and supplies available, and services provided at 78 of the 127 facilities offering comprehensive EmONC services and interviewed 224 providers. The providers also completed a written case scenario on severe PE/E. Descriptive statistics were used to summarize facility and provider characteristics. Student t-test, one-way ANOVA, and chi-square tests were performed to determine whether there were significant differences between facility types, doctors and midwives, and trained and untrained providers. The median number of severe PE/E cases in the past year was just 5 (range 0-42) at comprehensive health centers (CHCs) and district hospitals, compared with 44 (range 0-130) at provincial hospitals and 108 (range 32-540) at regional and specialized hospitals (p < 0.001). Most facilities had the drugs and supplies needed to treat severe PE/E, including the preferred anticonvulsant, magnesium sulfate (MgSO4). One-third of the smallest facilities and half of larger facilities reported administering a second-line drug, diazepam, in some cases. In the case scenario, 96% of doctors and 89% of midwives recognized that MgSO4 should be used to manage severe PE/E, but 42% of doctors and 58% of midwives also thought diazepam had a role to play. Providers who were trained on the use of MgSO4 scored significantly higher than untrained providers on six of 20 items in the case scenario. Providers at larger facilities significantly outscored those at smaller facilities on five items. There was a significant difference between doctors and midwives on only one item: continued use of anti-hypertensives after convulsions are controlled. Drugs and supplies needed to treat severe PE/E are widely available at EmONC facilities in Afghanistan, but providers lack knowledge in some areas, especially concerning the use of MgSO4 and diazepam. Providers who have specialized training or work at larger facilities are better at managing cases of severe PE/E. The findings suggest a need to clarify service delivery guidelines, offer refresher training, and reinforce best practices with supervision and reinforcement.

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.

Inpatient infectious disease consultations requested by surgeons at a comprehensive cancer center.

PubMed

Kawamura, Ichiro; Kurai, Hanako

2015-10-01

The aim of this study was to describe the value of infectious disease specialist consultations for surgeons at comprehensive cancer centers. A total of 151 cancer surgery inpatients were retrospectively assessed during a 12-month period. We focused on the characteristics of the infectious disease consultations from surgical departments: the referring surgical divisions, the referral phases, and the reasons for the infectious disease consultations. Three-quarters of all consultation requests were made after the day of surgery. Approximately, 60 % of these requests were made within 30 days after surgery for cancer. The reasons for the infectious disease consultations could be classified into three categories: diagnosis and management (54 %), management of established infections (44 %), and surgical antimicrobial prophylaxis (3 %). The most requested reason for consultations was the diagnosis and management of fever or elevated inflammatory markers of unknown etiology. Among the management of established infections, the antimicrobial management of surgical site infections was most frequently requested. Many surgeons would prefer infectious disease specialists to assume a more direct role in the care of difficult or perplexing cases (such as fevers of unknown origin) while also maintaining a traditional relationship in which the consultant recommends antimicrobial agents during a perioperative period. Particularly at cancer centers where oncology specialists account for a significant proportion of the providers, the knowledge and skill of infectious disease physicians are valued.

Challenges in the Management of Geriatric Trauma: A Case Report.

PubMed

Gaebel, Ashley; Keiser, Megan

This article describes geriatric trauma and commonly associated difficulties emphasizing both the epidemiology and assessment of geriatric trauma. There is little data guiding decisions for trauma patients 65 years or older, as there are many unique characteristics to the geriatric population, including comorbidities, medications, and the aging physiology. The geriatric population in the United States has been steadily climbing for the last 20 years and is projected to continue on this trend. Although each patient presents differently, there remains a need for the consistent utilization of standard guidelines to help dictate care for geriatric patients, particularly for patients not receiving care at a trauma center. This review uses a case study about an elderly woman with many comorbidities, followed by a comprehensive discussion of geriatric trauma and the challenges that result from a lack of guideline utilization to direct management.

Get Connected: an HIV prevention case management program for men and women leaving California prisons.

PubMed

Myers, Janet; Zack, Barry; Kramer, Katie; Gardner, Mick; Rucobo, Gonzalo; Costa-Taylor, Stacy

2005-10-01

Individuals leaving prison face challenges to establishing healthy lives in the community, including opportunities to engage in behavior that puts them at risk for HIV transmission. HIV prevention case management (PCM) can facilitate linkages to services, which in turn can help remove barriers to healthy behavior. As part of a federally funded demonstration project, the community-based organization Centerforce provided 5 months of PCM to individuals leaving 3 state prisons in California. Program effects were measured by assessing changes in risk behavior, access to services, reincarnation, and program completion. Although response rates preclude definitive conclusions, HIV risk behavior did decrease. Regardless of race, age, or gender, those receiving comprehensive health services were significantly more likely to complete the program. PCM appears to facilitate healthy behavior for individuals leaving prison.

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.

Effect of attitudes and perceptions of independent community pharmacy owners/managers on the comprehensiveness of strategic planning.

PubMed

Harrison, Donald L

2006-01-01

To assess the attitudes and perceptions of independent community pharmacy owners/managers about the comprehensiveness of strategic planning conducted for their pharmacies. Cross-sectional study. United States. Nationwide random sample of 1,250 owners/managers of independent community pharmacies. Mailed survey. Comprehensiveness of strategic planning conducted; components used in the strategic planning process. Attitudes and perceptions of owners/managers of independent community pharmacies toward strategic planning. A total of 527 (42.1%) usable questionnaires were returned. Of the 141 (26.8%) respondents who indicated that they conduct strategic planning, most components of the process were used. However, only 78 (55.3%) of those respondents conducted a review of pharmacy systems, and only 60 (42.6%) periodically evaluated implemented strategies. Approximately 88% of the variance in comprehensiveness was accounted for by 12 variables identified as significantly associated with the comprehensiveness of strategic planning conducted by owners/managers of independent community pharmacies. These included factors such as favorable cost-benefit relationship, impact of the Medicare Modernization Act of 2003, and remaining competitive in the pharmacy marketplace. While a minority of the survey population, respondents who reported conducting strategic planning used a reasonably comprehensive process. Further, several variables were identified as significant factors associated with comprehensiveness of strategic planning conducted.

The management of work-related asthma guidelines: a broader perspective.

PubMed

Baur, Xaver; Aasen, Tor Brøvig; Burge, P Sherwood; Heederik, Dick; Henneberger, Paul K; Maestrelli, Piero; Schlünssen, Vivi; Vandenplas, Olivier; Wilken, Dennis

2012-06-01

The aim of the European Respiratory Society work-related asthma guidelines is to present the management and prevention options of work-related asthma and their effectiveness. Work-related asthma accounts for 5-25% of all adult asthma cases and is responsible for a significant socioeconomic burden. Several hundred occupational agents, mainly allergens but also irritants and substances with unknown pathological mechanisms, have been identified as causing work-related asthma. The essential message of these guidelines is that the management of work-related asthma can be considerably optimised based on the present knowledge of causes, risk factors, pathomechanisms, and realistic and effective interventions. To reach this goal we urgently require greatly intensified primary preventive measures and improved case management. There is now a substantial body of evidence supporting the implementation of comprehensive medical surveillance programmes for workers at risk. Those workers who fail surveillance programmes need to be referred to a clinician who can confirm or exclude an occupational cause. Once work-related asthma is confirmed, a revised risk assessment in the workplace is needed to prevent further cases. These new guidelines confirm and extend already existing statements and recommendations. We hope that these guidelines will initiate the much-needed research that is required to fill the gaps in our knowledge and to initiate substantial improvements in preventative measures.

Outcome Assessments and Cost Avoidance of an Oral Chemotherapy Management Clinic.

PubMed

Wong, Siu-Fun; Bounthavong, Mark; Nguyen, Cham P; Chen, Timothy

2016-03-01

Increasing use of oral chemotherapy drugs increases the challenges for drug and patient management. An oral chemotherapy management clinic was developed to provide patients with oral chemotherapy management, concurrent medication (CM) education, and symptom management services. This evaluation aims to measure the need and effectiveness of this practice model due to scarce published data. This is a case series report of all patients referred to the oral chemotherapy management clinic. Data collected included patient demographics, depression scores, CMs, and types of intervention, including detection and management outcomes collected at baseline, 3-day, 7-day, and 3-month follow-ups. Persistence rate was monitored. Secondary analysis assessed potential cost avoidance. A total of 86 evaluated patients (32 men and 54 women, mean age of 63.4 years) did not show a high risk for medication nonadherence. The 3 most common cancer diagnoses were rectal, pancreatic, and breast, with capecitabine most prescribed. Patients had an average of 13.7 CMs. A total of 125 interventions (detection and management of adverse drug event detection, compliance, drug interactions, medication error, and symptom management) occurred in 201 visits, with more than 75% of interventions occurring within the first 14 days. A persistence rate was observed in 78% of 41 evaluable patients. The total estimated annual cost avoidance per 1.0 full time employee (FTE) was $125,761.93. This evaluation demonstrated the need for additional support for patients receiving oral chemotherapy within standard of care medical service. A comprehensive oral chemotherapy management referral service can optimize patient care delivery via early interventions for adverse drug events, drug interactions, and medication errors up to 3 months after initiation of treatment. Copyright © 2016 by the National Comprehensive Cancer Network.

Effectiveness of a systematic approach to promote intersectoral collaboration in comprehensive school health promotion-a multiple-case study using quantitative and qualitative data.

PubMed

Pucher, Katharina K; Candel, Math J J M; Krumeich, Anja; Boot, Nicole M W M; De Vries, Nanne K

2015-07-05

We report on the longitudinal quantitative and qualitative data resulting from a two-year trajectory (2008-2011) based on the DIagnosis of Sustainable Collaboration (DISC) model. This trajectory aimed to support regional coordinators of comprehensive school health promotion (CSHP) in systematically developing change management and project management to establish intersectoral collaboration. Multilevel analyses of quantitative data on the determinants of collaborations according to the DISC model were done, with 90 respondents (response 57 %) at pretest and 69 respondents (52 %) at posttest. Nvivo analyses of the qualitative data collected during the trajectory included minutes of monthly/bimonthly personal/telephone interviews (N = 65) with regional coordinators, and documents they produced about their activities. Quantitative data showed major improvements in change management and project management. There were also improvements in consensus development, commitment formation, formalization of the CSHP, and alignment of policies, although organizational problems within the collaboration increased. Content analyses of qualitative data identified five main management styles, including (1) facilitating active involvement of relevant parties; (2) informing collaborating parties; (3) controlling and (4) supporting their task accomplishment; and (5) coordinating the collaborative processes. We have contributed to the fundamental understanding of the development of intersectoral collaboration by combining qualitative and quantitative data. Our results support a systematic approach to intersectoral collaboration using the DISC model. They also suggest five main management styles to improve intersectoral collaboration in the initial stage. The outcomes are useful for health professionals involved in similar ventures.

Management of the Jehovah’s Witness in Obstetrics and Gynecology: A Comprehensive Medical, Ethical and Legal Approach

PubMed Central

Zeybek, Burak; Childress, Andrew; Kilic, Gokhan S.; Phelps, John; Pacheco, Luis; Carter, Michele; Borahay, Mostafa A.

2016-01-01

Importance Obstetricians and gynecologists frequently deal with hemorrhage so they should be familiar with management of patients who refuse blood transfusion. Although there are some reports in the literature about management of Jehovah’s Witness patients in obstetrics and gynecology, most of them are case reports and a comprehensive review about these patients including ethico-legal perspective is lacking. Objective This review outlines the medical, ethical and legal implications of management of Jehovah’s Witness patients in obstetrical and gynecological settings. Evidence Acquisition A search of published literature using Pubmed, Ovid Medline, EMBASE and Cochrane databases was conducted about physiology of oxygen delivery and response to tissue hypoxia, mortality rates at certain hemoglobin levels, medical management options for anemic patients who refuse blood transfusion and ethical/legal considerations in Jehovah’s Witness patients. Results Early diagnosis of anemia and immediate initiation of therapy is essential in patients who refuse blood transfusion. Medical management options include iron supplementation and erythropoietin. There are also some promising therapies that are in development such as anti-hepcidin antibodies and hemoglobin based oxygen carriers. Options to decrease blood loss include anti-fibrinolytics, desmopressin, recombinant Factor VII and factor concentrates. When surgery is the only option, every effort should be made to pursue minimally invasive approaches. Conclusion and Relevance All obstetricians and gynecologists should be familiar with alternatives and ‘less invasive’ options for patients who refuse blood transfusions. Target Audience Obstetricians and gynecologists, family physicians PMID:27526872

Acute lymphoblastic leukemia: a comprehensive review and 2017 update

PubMed Central

Terwilliger, T; Abdul-Hay, M

2017-01-01

Acute lymphoblastic leukemia (ALL) is the second most common acute leukemia in adults, with an incidence of over 6500 cases per year in the United States alone. The hallmark of ALL is chromosomal abnormalities and genetic alterations involved in differentiation and proliferation of lymphoid precursor cells. In adults, 75% of cases develop from precursors of the B-cell lineage, with the remainder of cases consisting of malignant T-cell precursors. Traditionally, risk stratification has been based on clinical factors such age, white blood cell count and response to chemotherapy; however, the identification of recurrent genetic alterations has helped refine individual prognosis and guide management. Despite advances in management, the backbone of therapy remains multi-agent chemotherapy with vincristine, corticosteroids and an anthracycline with allogeneic stem cell transplantation for eligible candidates. Elderly patients are often unable to tolerate such regimens and carry a particularly poor prognosis. Here, we review the major recent advances in the treatment of ALL. PMID:28665419

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

Bolan, N.A.; Hansen-Murray, C.S.; Haynes, R.W.

Implications of the interim comprehensive strategy for improved Pacific salmon and steelhead habitat management (PACFISH) were estimated for those Bureau of Land Management (BLM) districts and National Forest System (NFS) lands west of the Rocky Mountains that have anadromous fish. The physical impacts and associated mitigation costs from implementing the PACFISH strategy over the next decade in Pacific Northwest, Intermountain, Northern, Pacific Southwest, and Alaska Region National Forest and BLM district recreation, range, and timber programs were analyzed with the actual current output as the base. Economic considerations were added to evaluate any change in the perceived ranking of severitymore » among the impacts. Two cases were considered in the analyses: a derived worst case, where a total reduction of the actual current output of the programs in anadromous fishbearing drainages occurs (giving a minimum value for the programs in those drainages), and a mitigated case where all or part of the loss is mitigated and the cost of doing so is evaluated with two phases, one without economics and the other with it.« less

Risk factors for measles mortality and the importance of decentralized case management during an unusually large measles epidemic in eastern Democratic Republic of Congo in 2013

PubMed Central

Polonsky, Jonathan; Ciglenecki, Iza; Bichet, Mathieu; Coldiron, Matthew; Thuambe Lwiyo, Enoch; Akonda, Innocent; Serafini, Micaela; Porten, Klaudia

2018-01-01

In 2013, a large measles epidemic occurred in the Aketi Health Zone of the Democratic Republic of Congo. We conducted a two-stage, retrospective cluster survey to estimate the attack rate, the case fatality rate, and the measles-specific mortality rate during the epidemic. 1424 households containing 7880 individuals were included. The estimated attack rate was 14.0%, (35.0% among children aged <5 years). The estimated case fatality rate was 4.2% (6.1% among children aged <5 years). Spatial analysis and linear regression showed that younger children, those who did not receive care, and those living farther away from Aketi Hospital early in the epidemic had a higher risk of measles related death. Vaccination coverage prior to the outbreak was low (76%), and a delayed reactive vaccination campaign contributed to the high attack rate. We provide evidences suggesting that a comprehensive case management approach reduced measles fatality during this epidemic in rural, inaccessible resource-poor setting. PMID:29538437

Risk factors for measles mortality and the importance of decentralized case management during an unusually large measles epidemic in eastern Democratic Republic of Congo in 2013.

PubMed

Gignoux, Etienne; Polonsky, Jonathan; Ciglenecki, Iza; Bichet, Mathieu; Coldiron, Matthew; Thuambe Lwiyo, Enoch; Akonda, Innocent; Serafini, Micaela; Porten, Klaudia

2018-01-01

In 2013, a large measles epidemic occurred in the Aketi Health Zone of the Democratic Republic of Congo. We conducted a two-stage, retrospective cluster survey to estimate the attack rate, the case fatality rate, and the measles-specific mortality rate during the epidemic. 1424 households containing 7880 individuals were included. The estimated attack rate was 14.0%, (35.0% among children aged <5 years). The estimated case fatality rate was 4.2% (6.1% among children aged <5 years). Spatial analysis and linear regression showed that younger children, those who did not receive care, and those living farther away from Aketi Hospital early in the epidemic had a higher risk of measles related death. Vaccination coverage prior to the outbreak was low (76%), and a delayed reactive vaccination campaign contributed to the high attack rate. We provide evidences suggesting that a comprehensive case management approach reduced measles fatality during this epidemic in rural, inaccessible resource-poor setting.

Management decision of optimal recharge water in groundwater artificial recharge conditions- A case study in an artificial recharge test site

NASA Astrophysics Data System (ADS)

He, H. Y.; Shi, X. F.; Zhu, W.; Wang, C. Q.; Ma, H. W.; Zhang, W. J.

2017-11-01

The city conducted groundwater artificial recharge test which was taken a typical site as an example, and the purpose is to prevent and control land subsidence, increase the amount of groundwater resources. To protect groundwater environmental quality and safety, the city chose tap water as recharge water, however, the high cost makes it not conducive to the optimal allocation of water resources and not suitable to popularize widely. To solve this, the city selects two major surface water of River A and B as the proposed recharge water, to explore its feasibility. According to a comprehensive analysis of the cost of recharge, the distance of the water transport, the quality of recharge water and others. Entropy weight Fuzzy Comprehensive Evaluation Method is used to prefer tap water and water of River A and B. Evaluation results show that water of River B is the optimal recharge water, if used; recharge cost will be from 0.4724/m3 to 0.3696/m3. Using Entropy weight Fuzzy Comprehensive Evaluation Method to confirm water of River B as optimal water is scientific and reasonable. The optimal water management decisions can provide technical support for the city to carry out overall groundwater artificial recharge engineering in deep aquifer.

Who’s on First: Unraveling the Complexity of the United States’ Food and Agricultural Regulatory System in the Realm of Homeland Security

DTIC Science & Technology

2009-12-01

a weapon in food and water. The case involved the radiological poisoning of former Russian spy Alexander Litvinenko with Polonium 210 . An article...SECURITY Gary Wayne Elliott Emergency Management Coordinator for Environmental Health and Division of Food Protection Supervisor, South Carolina...31 c. Bioterrorism, Biodefense, and Health Security .....................31 9. Other Barriers to Comprehensible Food Safety/Defense

Regional economic impacts of current and proposed management alternatives for Don Edwards National Wildlife Refuge

USGS Publications Warehouse

Richardson, Leslie; Huber, Chris; Koontz, Lynne

2012-01-01

The National Wildlife Refuge System Improvement Act of 1997 requires all units of the National Wildlife Refuge System to be managed under a Comprehensive Conservation Plan. The Comprehensive Conservation Plan must describe the desired future conditions of a Refuge and provide long-range guidance and management direction to achieve refuge purposes. The Don Edwards San Francisco Bay National Wildlife Refuge, located at the south end of California's San Francisco Bay and one of seven refuges in the San Francisco Bay National Wildlife Refuge Complex, is in the process of developing a range of management goals, objectives, and strategies for the Comprehensive Conservation Plan. The Comprehensive Conservation Plan must contain an analysis of expected effects associated with current and proposed Refuge management strategies. For Refuge Comprehensive Conservation Plan planning, a regional economic analysis provides a means of estimating how current management (No Action Alternative) and proposed management activities (alternatives) affect the local economy. This type of analysis provides two critical pieces of information: (1) it illustrates the Don Edwards San Francisco Bay National Wildlife Refuge's contribution to the local community, and (2) it can help in determining whether economic effects are or are not a real concern in choosing among management alternatives. This report first presents a description of the local community and economy near the Don Edwards San Francisco Bay National Wildlife Refuge. Next, the methods used to conduct a regional economic impact analysis are described. An analysis of the final Comprehensive Conservation Plan management strategies that could affect stakeholders, residents, and the local economy is then presented. The management activities of economic concern in this analysis are: * Spending in the local community by Refuge visitors; * Refuge personnel salary spending; and * Refuge purchases of goods and services within the local community.

Enamel renal syndrome with associated amelogenesis imperfecta, nephrolithiasis, and hypocitraturia: A case report.

PubMed

Bhesania, Dhvani; Arora, Ankit; Kapoor, Sonali

2015-09-01

Numerous cases of enamel renal syndrome have been previously reported. Various terms, such as enamel renal syndrome, amelogenesis imperfecta and gingival fibromatosis syndrome, and enamel-renal-gingival syndrome, have been used for patients presenting with the dental phenotype characteristic of this condition, nephrocalcinosis or nephrolithiasis, and gingival findings. This report describes a case of amelogenesis imperfecta of the enamel agenesis variety with nephrolithiasis in a 21-year-old male patient who complained of small teeth. The imaging modalities employed were conventional radiography, cone-beam computed tomography, and renal sonography. Such cases are first encountered by dentists, as other organ or metabolic diseases are generally hidden. Hence, cases of amelogenesis imperfecta should be subjected to advanced diagnostic modalities, incorporating both dental and medical criteria, in order to facilitate comprehensive long-term management.

Barosinusitis: Comprehensive review and proposed new classification system

PubMed Central

Vaezeafshar, Reza; Psaltis, Alkis J.; Rao, Vidya K.; Zarabanda, David; Patel, Zara M.

2017-01-01

Background: Barosinusitis, or sinus barotrauma, may arise from changes in ambient pressure that are not compensated by force equalization mechanisms within the paranasal sinuses. Barosinusitis is most commonly seen with barometric changes during flight or diving. Understanding and better classifying the pathophysiology, clinical presentation, and management of barosinusitis are essential to improve patient care. Objectives: To perform a comprehensive review of the available literature regarding sinus barotrauma. Methods: A comprehensive literature search that used the terms “barosinusitis,” “sinus barotrauma,” and “aerosinusitis” was conducted, and all identified titles were reviewed for relevance to the upper airway and paranasal sinuses. All case reports, series, and review articles that were identified from this search were included. Selected cases of sinus barotrauma from our institution were included to illustrate classic signs and symptoms. Results: Fifty-one articles were identified as specifically relevant to, or referencing, barosinusitis and were incorporated into this review. The majority of articles focused on barosinusitis in the context of a single specific etiology rather than independent of etiology. From analysis of all the publications combined with clinical experience, we proposed that barosinusitis seemed to fall within three distinct subtypes: (1) acute, isolated barosinusitis; (2) recurrent acute barosinusitis; and (3) chronic barosinusitis. We introduced this terminology and suggested independent treatment recommendations for each subtype. Conclusion: Barosinusitis is a common but potentially overlooked condition that is primed by shifts in the ambient pressure within the paranasal sinuses. The pathophysiology of barosinusitis has disparate causes, which likely contribute to its misdiagnosis and underdiagnosis. Available literature compelled our proposed modifications to existing classification schemes, which may allow for improved awareness and management strategies for barosinusitis. PMID:29070267

Diagnosis and management of sepsis

NASA Astrophysics Data System (ADS)

Arifin

2018-03-01

Sepsis is the life-threatening condition with organ dysfunction caused by dysregulated host response to the infection. Septic shock is part of sepsis where circulatory abnormalities and cellular metabolism occur. Sepsis and septic shock are still a problem in the world, where one in four people with sepsis will die. As well as any trauma case, acute myocardial infarction, or stroke, early identification and appropriate treatment of sepsis immediately after sepsis will improve the prognosis of the patient. Comprehensive management of septic patients is required, ranging from infection controls that include antibiotic administration and infection source control as well as hemodynamic stabilization that included fluid resuscitation and vasoactive drug delivery.

Developing a database management system to support birth defects surveillance in Florida.

PubMed

Salemi, Jason L; Hauser, Kimberlea W; Tanner, Jean Paul; Sampat, Diana; Correia, Jane A; Watkins, Sharon M; Kirby, Russell S

2010-01-01

The value of any public health surveillance program is derived from the ways in which data are managed and used to improve the public's health. Although birth defects surveillance programs vary in their case volume, budgets, staff, and objectives, the capacity to operate efficiently and maximize resources remains critical to long-term survival. The development of a fully-integrated relational database management system (DBMS) can enrich a surveillance program's data and improve efficiency. To build upon the Florida Birth Defects Registry--a statewide registry relying solely on linkage of administrative datasets and unconfirmed diagnosis codes-the Florida Department of Health provided funding to the University of South Florida to develop and pilot an enhanced surveillance system in targeted areas with a more comprehensive approach to case identification and diagnosis confirmation. To manage operational and administrative complexities, a DBMS was developed, capable of managing transmission of project data from multiple sources, tracking abstractor time during record reviews, offering tools for defect coding and case classification, and providing reports to DBMS users. Since its inception, the DBMS has been used as part of our surveillance projects to guide the receipt of over 200 case lists and review of 12,924 fetuses and infants (with associated maternal records) suspected of having selected birth defects in over 90 birthing and transfer facilities in Florida. The DBMS has provided both anticipated and unexpected benefits. Automation of the processes for managing incoming case lists has reduced clerical workload considerably, while improving accuracy of working lists for field abstraction. Data quality has improved through more effective use of internal edits and comparisons with values for other data elements, while simultaneously increasing abstractor efficiency in completion of case abstraction. We anticipate continual enhancement to the DBMS in the future. While we have focused on enhancing the capacity of our DBMS for birth defects surveillance, many of the tools and approaches we have developed translate directly to other public health and clinical registries.

Superfund Site Information

EPA Pesticide Factsheets

This asset includes a number of individual data sets related to site-specific information for Superfund, which is governed under the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) of 1980, which was amended by the Superfund Amendments and Reauthorization Act (SARA) in 1986. The Superfund Enterprise Management System (SEMS) contains basic site description, location, schedule of activities, enforcement and settlement data, contaminants and selected remedy and much more, as well as the records that clearly document site decisions. This asset also includes sampling data and lab results (CLPSS, EDDs), redevelopment and technical assistance case studies, site reuse and land revitalization information, EPAOSC.net information, Superfund Technical Assistance Grants information, site management information records (RODs, Remediation plans, cleanup directives), contract management information, and more.Superfund site management information can also be found in agency wide systems such as EAS and COMPASS.

Development of sustainable waste management toward zero landfill waste for the petrochemical industry in Thailand using a comprehensive 3R methodology: A case study.

PubMed

Usapein, Parnuwat; Chavalparit, Orathai

2014-06-01

Sustainable waste management was introduced more than ten years ago, but it has not yet been applied to the Thai petrochemical industry. Therefore, under the philosophy of sustainable waste management, this research aims to apply the reduce, reuse, and recycle (3R) concept at the petrochemical factory level to achieve a more sustainable industrial solid waste management system. Three olefin plants in Thailand were surveyed for the case study. The sources and types of waste and existing waste management options were identified. The results indicate that there are four sources of waste generation: (1) production, (2) maintenance, (3) waste treatment, and (4) waste packaging, which correspond to 45.18%, 36.71%, 9.73%, and 8.37% of the waste generated, respectively. From the survey, 59 different types of industrial wastes were generated from the different factory activities. The proposed 3R options could reduce the amount of landfill waste to 79.01% of the amount produced during the survey period; this reduction would occur over a period of 2 years and would result in reduced disposal costs and reduced consumption of natural resources. This study could be used as an example of an improved waste management system in the petrochemical industry. © The Author(s) 2014.

Comprehensive Self-Management Strategies.

PubMed

Bourbeau, J; Lavoie, K L; Sedeno, M

2015-08-01

In this article, we provide a review of the literature on self-management interventions and we are giving some thought to how, when, and by whom they should be offered to patients. The present literature based on randomized clinical trials has demonstrated benefits (reduced hospital admissions and improved health status) for chronic obstructive pulmonary disease (COPD) patients undergoing self-management interventions, although there are still problems with the heterogeneity among interventions, study populations, follow-up time, and outcome measures that make generalization difficult in real life. Key to the success, self-management intervention has to target behavior change. Proper self-management support is a basic prerequisite, for example, techniques and skills used by health care providers "case manager" to instrument patients with the knowledge, confidence, and skills required to effectively self-manage their disease. To improve health behaviors and engagement in self-management, self-management interventions need to target enhancing intrinsic motivation to change. This will best be done using client-centered communication (motivational communication) that encourages patients to express what intrinsically motivates them (e.g., consistent with their values or life goals) to adopt certain health behavior, with the goal of helping them overcome their ambivalence about change. Finally, if we want to be able to design and implement self-management interventions that are integrated, coherent, and have a strong likelihood of success, we need to take a more careful look and give more attention at the case manager, the patient (patient evaluation), and the quality assurance. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Nanomaterial Case Studies: Nanoscale Titanium Dioxide in ...

EPA Pesticide Factsheets

EPA announced the availability of the final report, Nanomaterial Case Studies: Nanoscale Titanium Dioxide in Water Treatment and in Topical Sunscreen. This report is a starting point to determine what is known and what needs to be known about selected nanomaterials as part of a process to identify and prioritize research to inform future assessments of the potential ecological and health implications of these materials. Two specific applications of nanoscale titanium dioxide (nano-TiO2) are considered: (1) as an agent for removing arsenic from drinking water; and (2) as an active ingredient in topical sunscreen. These case studies are organized around a comprehensive environmental assessment (CEA) framework that combines a product life cycle perspective with the risk assessment paradigm. They are intended to help identify what may need to be known in order to conduct a comprehensive environmental assessment of the potential risks related to nano-TiO2. These “case studies” do not represent completed or even preliminary assessments, nor are they intended to serve as a basis for risk management decisions in the near term on these specific uses of nano TiO2. Rather, the intent is to use this document in developing the scientific and technical information needed for future assessment efforts.

A mathematical model for municipal solid waste management - A case study in Hong Kong.

PubMed

Lee, C K M; Yeung, C L; Xiong, Z R; Chung, S H

2016-12-01

With the booming economy and increasing population, the accumulation of waste has become an increasingly arduous issue and has aroused the attention from all sectors of society. Hong Kong which has a relative high daily per capita domestic waste generation rate in Asia has not yet established a comprehensive waste management system. This paper conducts a review of waste management approaches and models. Researchers highlight that mathematical models provide useful information for decision-makers to select appropriate choices and save cost. It is suggested to consider municipal solid waste management in a holistic view and improve the utilization of waste management infrastructures. A mathematical model which adopts integer linear programming and mixed integer programming has been developed for Hong Kong municipal solid waste management. A sensitivity analysis was carried out to simulate different scenarios which provide decision-makers important information for establishing Hong Kong waste management system. Copyright © 2016 Elsevier Ltd. All rights reserved.

FROM ACUTE ACHILLES TENDON RUPTURE TO RETURN TO PLAY - A CASE REPORT EVALUATING RECOVERY OF TENDON STRUCTURE, MECHANICAL PROPERTIES, CLINICAL AND FUNCTIONAL OUTCOMES.

PubMed

Zellers, Jennifer A; Cortes, Daniel H; Silbernagel, Karin Grävare

2016-12-01

Achilles tendon rupture results in significant functional deficits regardless of treatment strategy (surgical versus non-surgical intervention). Recovery post-rupture is highly variable, making comprehensive patient assessment critical. Assessment tools may change along the course of recovery as the patient progresses - for instance, moving from a seated heel-rise to standing heel-rise to jump testing. However, tools that serve as biomarkers for early recovery may be particularly useful in informing clinical decision-making. The purpose of this case report was to describe the progress of a young, athletic individual following Achilles tendon rupture managed non-surgically, using patient reported and functional performance outcome measures and comprehensively evaluating Achilles tendon structure and function incorporating a novel imaging technique (cSWE). The subject is a 26 year-old, female basketball coach who sustained an Achilles tendon rupture and was managed non-surgically. The subject was able to steadily progress using a gradual tendon loading treatment approach well-supported by the literature. Multiple evaluative techniques including the addition of diagnostic ultrasound imaging and continuous shear wave elastography (cSWE) to standard clinical tests and measures were used to assess patient-reported symptoms, tendon structure, and tendon functional performance. Five assessments were performed over the course of 2-14 months post-rupture. By the 14-month follow-up, the subject had achieved full self-reported function. Tendon structural and mechanical properties showed similar shear modulus by 14 months, however, viscosity continued to be lower and tendon length longer on the ruptured side. Functional performance, evidenced by the heel-rise test and jump tests, also showed a positive trajectory, however, deficits of 12-28% remained between ruptured and non-ruptured sides at 14 months. This case report outlines comprehensive outcomes assessment in an athletic individual following non-surgically managed Achilles tendon rupture using a wide variety of tools that capture different aspects of tendon health. Interestingly, the course of recovery of patient symptoms, functional performance, and tendon structure do not occur in the same time frame. Therefore, it is important to assess patient outcomes using multiple outcome measures encompassing different aspects of patient performance to ensure the patient is progressing steadily with rehabilitation. Level 4.

Financial planning on a comprehensive scale.

PubMed

Mishra, Simita

2013-04-01

Hospitals and health systems that wish to explore the shift to comprehensive care management should: Assess the investments in infrastructure necessary to support comprehensive care management, Gauge the financial implications and set quality and financial goals, Monitor performance using metrics such as patient satisfaction, avoidable admissions, out-of-group referrals, and average length of stay.

Two-year comprehensive medical management of degenerative lumbar spine disease (lumbar spondylolisthesis, stenosis, or disc herniation): a value analysis of cost, pain, disability, and quality of life: clinical article.

PubMed

Parker, Scott L; Godil, Saniya S; Mendenhall, Stephen K; Zuckerman, Scott L; Shau, David N; McGirt, Matthew J

2014-08-01

Current health care reform calls for a reduction of procedures and treatments that are less effective, more costly, and of little value (high cost/low quality). The authors assessed the 2-year cost and effectiveness of comprehensive medical management for lumbar spondylolisthesis, stenosis, and herniation by utilizing a prospective single-center multidisciplinary spine center registry in a real-world practice setting. Analysis was performed on a prospective longitudinal quality of life spine registry. Patients with lumbar spondylolisthesis (n = 50), stenosis (n = 50), and disc herniation (n = 50) who had symptoms persisting after 6 weeks of medical management and who were eligible for surgical treatment were entered into a prospective registry after deciding on nonsurgical treatment. In all cases, comprehensive medical management included spinal steroid injections, physical therapy, muscle relaxants, antiinflammatory medication, and narcotic oral agents. Two-year patient-reported outcomes, back-related medical resource utilization, and occupational work-day losses were prospectively collected and used to calculate Medicare fee-based direct and indirect costs from the payer and societal perspectives. The maximum health gain associated with medical management was defined as the improvement in pain, disability, and quality of life experienced after 2 years of medical treatment or at the time a patient decided to cross over to surgery. The maximum health gain in back pain, leg pain, disability, quality of life, depression, and general health state did not achieve statistical significance by 2 years of medical management, except for pain and disability in patients with disc herniation and back pain in patients with lumbar stenosis. Eighteen patients (36%) with spondylolisthesis, 11 (22%) with stenosis, and 17 (34%) with disc herniation eventually required surgical management due to lack of improvement. The 2-year improvement did not achieve a minimum clinically important difference in any outcome measure. The mean 2-year total cost (direct plus indirect) of medical management was $6606 for spondylolisthesis, $7747 for stenosis, and $7097 for herniation. In an institution-wide, prospective, longitudinal quality of life registry that measures cost and effectiveness of all spine care provided, comprehensive medical management did not result in sustained improvement in pain, disability, or quality of life for patients with surgically eligible degenerative lumbar spondylolisthesis, stenosis, or disc herniation. From both the societal and payer perspective, continued medical management of patients with these lumbar pathologies in whom 6 weeks of conservative therapy failed was of minimal value given its lack of health utility and effectiveness and its health care costs. The findings from this real-world practice setting may more accurately reflect the true value and effectiveness of nonoperative care in surgically eligible patient populations.

MANAGEMENT OF PANCREATICOPLEURAL FISTULAS SECONDARY TO CHRONIC PANCREATITIS

PubMed Central

CAZZO, Everton; APODACA-RUEDA, Márcio; GESTIC, Martinho Antonio; CHAIM, Fábio Henrique Mendonça; de SAITO, Helena Paes de Almeida; UTRINI, Murillo Pimentel; CALLEJAS-NETO, Francisco; CHAIM, Elinton Adami

2017-01-01

ABSTRACT Introduction: Pancreaticopleural fistula is a rare complication of chronic pancreatitis. Objective: To describe pancreaticopleural fistula due to chronic pancreatitis and perform an extensive review of literature on this topic. Methods: Comprehensive narrative review through online research on the databases Medline and Lilacs for articles published over the last 20 years. There were 22 case reports and four case series selected. Results: The main indication for surgical treatment is the failure of clinical and/or endoscopic treatments. Surgery is based on internal pancreatic drainage, especially by means of pancreaticojejunostomy, and/or pancreatic resections. Conclusion: Pancreaticopleural fistula is a rare complication of chronic pancreatitis and the Frey procedure may be an appropriate therapeutic option in selected cases when clinical and endoscopic treatments are unsuccessful. PMID:29019567

InteractInteraction mechanism of emergency response in geological hazard perception and risk management: a case study in Zhouqu county

NASA Astrophysics Data System (ADS)

Qi, Yuan; Zhao, Hongtao

2017-04-01

China is one of few several natural disaster prone countries, which has complex geological and geographical environment and abnormal climate. On August 8, 2010, a large debris flow disaster happened in Zhouqu Country, Gansu province, resulting in more than 1700 casualties and more than 200 buildings damaged. In order to percept landslide and debris flow, an early warning system was established in the county. Spatial information technologies, such as remote sensing, GIS, and GPS, play core role in the early warning system, due to their functions in observing, analyzing, and locating geological disasters. However, all of these spatial information technologies could play an important role only guided by the emergency response mechanism. This article takes the establishment of Zhouqu Country's Disaster Emergency Response Interaction Mechanism (DERIM) as an example to discuss the risk management of country-level administrative units. The country-level risk management aims to information sharing, resources integration, integrated prevention and unified command. Then, nine subsystems support DERIM, which included disaster prevention and emergency data collection and sharing system, joint duty system, disaster verification and evaluation system, disaster consultation system, emergency warning and information release system, emergency response system, disaster reporting system, plan management system, mass prediction and prevention management system. At last, an emergency command platform in Zhouqu Country built up to realize DERIM. The core mission of the platform consists of daily management of disaster, monitoring and warning, comprehensive analysis, information release, consultation and decision-making, emergency response, etc. Five functional modules, including module of disaster information management, comprehensive monitoring module (geological monitoring, meteorological monitoring, water conservancy and hydrological monitoring), alarm management module, emergency command and disaster dispatching management module are developed on the basis of this platform. Based on the internet technology, an web-based office platform is exploited for the nodes scattered in departments and towns, which includes daily business, monitoring and warning, alarm notification, alarm recording, personnel management and update in disaster region, query and analysis of real-time observation data, etc. The platform experienced 3 years' test of the duty in flood period since 2013, and two typical disaster cases during this period fully illustrates the effectiveness of the DERIM and the emergency command platform.

Active Intervention Can Decrease Burnout In Ed Nurses.

PubMed

Wei, Rong; Ji, Hong; Li, Jianxin; Zhang, Liyao

2017-03-01

The aim of this study was to evaluate whether active intervention can decrease job burnout and improve performance among ED nurses. This study was carried out in the emergency departments of 3 hospitals randomly selected from 8 comprehensive high-level hospitals in Jinan, China. A total of 102 nurses were enrolled and randomly divided into control and intervention groups. For 6 months, nurses in intervention groups were treated with ordinary treatment plus comprehensive management, whereas nurses in the control group were treated with ordinary management, respectively. Questionnaires were sent and collected at baseline and at the end of the study. The Student t test was used to evaluate the effect of comprehensive management in decreasing burnout. All ED nurses showed symptoms of job burnout at different levels. Our data indicated that comprehensive management significantly decreased emotional exhaustion and depersonalization (P < .01). The findings suggest that active intervention with comprehensive management may effectively reduce job burnout in ED nurses and contribute to relieving work-related stress and may further protect against potential mental health problems. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Endodontic treatment and esthetic management of a primary double tooth with direct composite using silicone buildup guide.

PubMed

Kulkarni, Vinaya Kumar; Ragavendra, T Raju; Deshmukh, Jeevanand; Vanka, Amit; Duddu, Mahesh Kumar; Patil, Anand Kumar G

2012-04-01

Gemination and fusion are morphological dental anomalies, characterized by the formation of a clinically wide tooth. Gemination occurs when one tooth bud tries to divide, while fusion occurs if two buds unite. The terms double teeth, double formation, conjoined teeth, geminifusion, vicinifusion and dental twinning are often used to describe fusion and gemination. Double teeth are associated with clinical problems such as poor esthetics, spacing problems and caries susceptibility. Management of such cases requires a comprehensive knowledge of the clinical entity as well as the problems associated with it. This report presents a case of primary double tooth in a 6-year-old boy involving maxillary left central incisor. The anomalous tooth was carious and pulpally involved. This was treated conservatively by endodontic treatment and esthetic rehabilitation was done with direct composite restoration using a silicone buildup guide. The treated tooth was followed up until exfoliation.

Endodontic treatment and esthetic management of a primary double tooth with direct composite using silicone buildup guide

PubMed Central

Kulkarni, Vinaya Kumar; Ragavendra, T. Raju; Deshmukh, Jeevanand; Vanka, Amit; Duddu, Mahesh Kumar; Patil, Anand Kumar G.

2012-01-01

Gemination and fusion are morphological dental anomalies, characterized by the formation of a clinically wide tooth. Gemination occurs when one tooth bud tries to divide, while fusion occurs if two buds unite. The terms double teeth, double formation, conjoined teeth, geminifusion, vicinifusion and dental twinning are often used to describe fusion and gemination. Double teeth are associated with clinical problems such as poor esthetics, spacing problems and caries susceptibility. Management of such cases requires a comprehensive knowledge of the clinical entity as well as the problems associated with it. This report presents a case of primary double tooth in a 6-year-old boy involving maxillary left central incisor. The anomalous tooth was carious and pulpally involved. This was treated conservatively by endodontic treatment and esthetic rehabilitation was done with direct composite restoration using a silicone buildup guide. The treated tooth was followed up until exfoliation. PMID:22629077

Taking Assent to New Heights: A Case Report on Do-Not-Resuscitate Status in Pediatric Palliative Care Procedures.

PubMed

Ballard, Heather A; Suresh, Santhanam

2018-03-01

Dying adolescents presenting for palliative procedures have complicated developmental and ethical issues, especially when reconsidering do-not-resuscitate orders. Though the American Academy of Pediatrics has guidelines, there is limited information in the literature on how to take care of these patients. We describe the case of a 14-year-old patient presenting to the interventional radiology suite for management of superior vena cava syndrome. The patient's goals of treatment were elucidated through a comprehensive care team consisting of the procedural and oncology teams. Effective communication with the patient and family was paramount for success.

Comprehensive Aristotle score: implications for the Norwood procedure.

PubMed

Sinzobahamvya, Nicodème; Photiadis, Joachim; Kumpikaite, Daiva; Fink, Christoph; Blaschczok, Hedwig C; Brecher, Anne Marie; Asfour, Boulos

2006-05-01

Aristotle score is emerging as a reliable tool to measure surgical performance. We estimated the comprehensive Aristotle score for the Norwood procedure, correlated it with survival, and considered its impact on surgical management of hypoplastic left heart syndrome. Comprehensive Aristotle score was retrospectively calculated for 39 consecutive Norwood procedures performed from 2001 to 2004. Survival was estimated by the Kaplan-Meier method. The Aristotle scores ranged from 14.5 to 23.5 (mean, 19.12 +/- 2.52; median, 19.5). The score was 20 or greater in 44% (17 of 39) of cases. The most frequent patient-adjusted factors were aortic atresia (n = 16), interrupted aortic arch (n = 9), mechanical ventilation to treat cardiorespiratory failure (n = 19) and shock resolved at time of surgery (n = 13). Hospital mortality was 58.8% (10 of 17) in case of score of 20 or more and 9.1% (2 of 22) for score less than 20 (p = 0.0014). From 2003 on, all patients with a score less than 20 survived. Actuarial estimate of survival at 1 year is 56.2% +/- 7.9% and there have been no late deaths after 1 year. One-year survival is much lower (p = 0.001) for patients with scores of 20 or greater (29.4% +/- 11.05%) compared with those whose scores were less than 20 (77.3% +/- 8.9%). This study shows significant correlation of comprehensive Aristotle score with hospital mortality and late survival after Norwood palliation. It suggests that operative survival on the order of 90% may be achieved in patients with comprehensive complexity scores of less than 20. Efforts should be devoted to improve survival of high-risk patients (score > or = 20).

A Comprehensive Approach to Managed Care for Mental Health.

ERIC Educational Resources Information Center

Langman-Dorwart, Nancy; Peebles, Thomas

1988-01-01

Asserts that managing mental health and substance abuse utilization in a complex network health maintenance organization (HMO) can be accomplished through comprehensive approach. Describes prescreening of admissions and preferred provider contracts of one HMO's managed care system. Explains savings resulting from averting unnecessary admissions.…

Investigation on the governance model and effect of medical schools merged with comprehensive universities in China.

PubMed

Bai, Ge; Luo, Li

2013-08-01

This investigation analyzes the management of medical schools merged with comprehensive universities through internet search and research review to reveal management model and effect of the merger. The conclusion is safely reached that governance models are divided into two different patterns: centralized management and decentralized management. Eight universities, representing the two models, were selected and evaluated comprehensively. Among them, the universities that carried out decentralized management have greater development after the merger based on a quality comparison concerning freshmen, faculty, teaching, and research between the two patterns. © 2013 Wiley Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.

Developing performance excellence guidance for rural tourism (case study: wangun lestari village, Bandung, West Java, Indonesia)

NASA Astrophysics Data System (ADS)

Yopy, Maulana; Sitinjak, M. F.

2018-03-01

In response to Indonesian Ministry of Tourism objective to develop and improve the performance of tourism destination, specifically on rural tourism, Where there is no well-prepared implementation yet by the local government due to constrained human resources and lack of management knowledge and stakeholders. This research aims to develop an integrated rural tourism concept at Wangun Lestari Tourism Village. The Guideline of Rural Tourism Development of Ministry of Tourism, Malcolm Baldrige’s Performance Excellence, SWOT Analysis, and Value Proposition Analysis will be used to help to design the Rural Tourism program. The result of this research is a comprehensive concept of Leadership, Strategic Planning, Customer Management System, Knowledge Management, Workforce Engagement, Operation Focus and also Evaluation Metric for Wangun Lestari Tourism Village.

Endocrine Disruptor Screening Program (EDSP) Comprehensive Management Plans

EPA Pesticide Factsheets

The EDSP Comprehensive Management Plan describes the technical review processes that will be used in implementing this program and how the agency intends to factor technology advancements into the program.

Assessing the impact of fisheries co-management interventions in developing countries: a meta-analysis.

PubMed

Evans, Louisa; Cherrett, Nia; Pemsl, Diemuth

2011-08-01

Co-management is now established as a mainstream approach to small-scale fisheries management across the developing world. A comprehensive review of 204 potential cases reveals a lack of impact assessments of fisheries co-management. This study reports on a meta-analysis of the impact of fisheries co-management in developing countries in 90 sites across 29 case-studies. The top five most frequently measured process indicators are participation, influence, rule compliance, control over resources, and conflict. The top five most frequently measured outcome indicators are access to resources, resource well-being, fishery yield, household well-being, and household income. To deal with the diversity of the 52 indicators measured and the different ways these data are collected and analysed, we apply a coding system to capture change over time. The results of the meta-analysis suggest that, overall fisheries co-management delivers benefits to end-users through improvements in key process and outcome indicators. However, the dataset as a whole is constituted primarily of data from the Philippines. When we exclude this body of work, few generalisations can be made about the impact of fisheries co-management. The lack of comparative data suitable for impact assessment and the difficulties in comparing data and generalising across countries and regions reiterates calls in other fields for more systematic approaches to understanding and evaluating governance frameworks. Copyright © 2011 Elsevier Ltd. All rights reserved.

The Evaluation of Land Use Status in Mountainous Counties of Southwest China Based on Comprehensive Evaluation Models: A Case Study of Baoxing County, Sichuan Province

NASA Astrophysics Data System (ADS)

Cao, Mengtian; Shen, Jundi; Chen, Zhehua

2018-06-01

In mountainous areas of Southwest China, the land resources are scarce, and the ecological environment is fragile, so it is particularly important to carry out the evaluation of land use status for the sustainability of land development. Taking Baoxing County in Sichuan Province, the typical mountainous county in Southwest China, as an instance, this study refers to the existing research frameworks to establish the evaluation system of land use status. Meanwhile, the comprehensive evaluation models are used to evaluate land use status. As indicated from the results, in Baoxing County, the comprehensive evaluation score of the overall status of land use, the evaluation score of the development degree of land, the evaluation score of the intensive management degree of land and the evaluation score of the comprehensive benefits of land were 83.5, 108.24, 72.25 and 80.77, respectively. Land use status is generally at the relatively rational use stage, and the main problems are the lack of land investment and the low mechanization level of agricultural production. It is suggested to increase the financial investment in land and enhance the intensive degree and comprehensive benefits of land in the future.

Pacific Walrus and climate change: observations and predictions

PubMed Central

MacCracken, James G

2012-01-01

The extent and duration of sea-ice habitats used by Pacific walrus (Odobenus rosmarus divergens) are diminishing resulting in altered walrus behavior, mortality, and distribution. I document changes that have occurred over the past several decades and make predictions to the end of the 21st century. Climate models project that sea ice will monotonically decline resulting in more ice-free summers of longer duration. Several stressors that may impact walruses are directly influenced by sea ice. How these stressors materialize were modeled as most likely-case, worst-case, and best-case scenarios for the mid- and late-21st century, resulting in four comprehensive working hypotheses that can help identify and prioritize management and research projects, identify comprehensive mitigation actions, and guide monitoring programs to track future developments and adjust programs as needed. In the short term, the most plausible hypotheses predict a continuing northward shift in walrus distribution, increasing use of coastal haulouts in summer and fall, and a population reduction set by the carrying capacity of the near shore environment and subsistence hunting. Alternatively, under worst-case conditions, the population will decline to a level where the probability of extinction is high. In the long term, walrus may seasonally abandon the Bering and Chukchi Seas for sea-ice refugia to the northwest and northeast, ocean warming and pH decline alter walrus food resources, and subsistence hunting exacerbates a large population decline. However, conditions that reverse current trends in sea ice loss cannot be ruled out. Which hypothesis comes to fruition depends on how the stressors develop and the success of mitigation measures. Best-case scenarios indicate that successful mitigation of unsustainable harvests and terrestrial haulout-related mortalities can be effective. Management and research should focus on monitoring, elucidating effects, and mitigation, while ultimately, reductions in greenhouse gas emissions are needed to reduce sea-ice habitat losses. PMID:22957206

Integrating Fuel Treatments into Comprehensive Ecosystem Management

Treesearch

Kevin Hyde; Greg Jones; Robin Silverstein; Keith Stockmann; Dan Loeffler

2006-01-01

To plan fuel treatments in the context of comprehensive ecosystem management, forest managers must meet multiple-use and environmental objectives, address administrative and budget constraints, and reconcile performance measures from multiple policy directives. We demonstrate a multiple criteria approach to measuring success of fuel treatments used in the Butte North...

78 FR 48183 - Rocky Mountain Arsenal National Wildlife Refuge, Commerce City, CO; Comprehensive Conservation...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-07

.... These refuges are currently being managed under Comprehensive Management Plans developed in the mid... of our intentions, and to obtain suggestions and information on the scope of issues to consider in the planning process of revising the management plans for these refuges. DATES: To ensure...

Congenital extrahepatic portosystemic shunt complicated by the development of hepatocellular carcinoma.

PubMed

Sharma, Ruchi; Suddle, Abid; Quaglia, Alberto; Peddu, Praveen; Karani, John; Satyadas, Thomas; Heaton, Nigel

2015-10-01

Congenital extrahepatic portosystemic shunt, also known as Abernethy malformation, is a rare congenital malformation. It causes shunting of blood through a communication between the portal and systemic veins such as a patent ductus venous. We report 3 cases of Abernethy malformation complicated by the development of hepatocellular carcinoma. Additionally, we comprehensively reviewed all previously reported cases and highlighted common features that may help in early diagnosis and appropriate management. Patients with Abernethy malformation may have an increased propensity to develop hepatocellular carcinoma. All 5 previously reported cases, plus the three of our patients, have a type 1 (complete) shunt suggesting a role for absent portal blood flow in the pathogenesis of hepatocellular carcinoma. Congenital extrahepatic portosystemic shunt should be sought for in cases with raised serum ammonia, hepatic encephalopathy or hepatocellular carcinoma in the absence of cirrhosis.

A method to determine the protection zone of chemical industrial park considering air quality, health risk and environmental risk: a case study.

PubMed

Shi, Jingang; Zhang, Mingbo; Li, Dong; Liu, Jia

2018-04-01

In China, chemical enterprises are required to cluster into a large number of chemical industrial parks (CIPs), which increase risks and threats to the environment and human being's health due to aggregation of the complicated chemical process and huge unit scale. Setting a scientific and reasonable protection zone around CIP is a very efficient way to protect surrounding people's health. A method was designed to determine the comprehensive protection zone of CIP, taking into account multiple factors: air quality, health risk and environmental risk. By establishing a comprehensive and multi-levels index system, the protection zone and the corresponding environmental risk management countermeasures can be proposed hierarchically, which are very important to the development and environmental risk management of CIP. A CIP located in coastal area of Shandong Province was studied, and it is turned out that the method to determine the protection zone of chemical industrial park considering air quality, health risk and environmental risk has great advantages compared with other methods.

Aspirin Allergy Desensitization in Cerebrovascular Disease

PubMed Central

Zuckerman, Scott L; Seder, David B; Tsujiura, Crystiana; Cushing, Deborah; Gallup, Holly; Mocco, J; Hanel, Richard A; Ecker, Robert D

2014-01-01

Summary Aspirin (ASA) is the mainstay of treatment in cerebrovascular and systemic vascular disease. ASA hypersensitivity can pose a challenge to achieving optimum medical management prior to and after neurointerventional treatment. Desensitization to ASA is well described in the allergy and cardiovascular literature, but there are no similar discussions specific to neurointervention. The purpose of our study was to describe our experience with ASA hypersensitivity management and review the relevant literature. Two cases of patients with symptomatic cerebrovascular disease requiring neurointervention who were successfully desensitized to their ASA hypersensitivity prior to treatment are described. The subsequent literature is reviewed. Several ASA desensitization protocols exist and have been proven to successfully treat ASA hypersensitivity and allow for ASA therapy to be safely initiated. We describe several previously published protocols. ASA desensitization is a safe and simple way to manage ASA hypersensitivity. We provide comprehensive management guidelines for the neurointerventionalist engaging in ASA desensitization. PMID:24556294

Uncertainty, learning, and the optimal management of wildlife

USGS Publications Warehouse

Williams, B.K.

2001-01-01

Wildlife management is limited by uncontrolled and often unrecognized environmental variation, by limited capabilities to observe and control animal populations, and by a lack of understanding about the biological processes driving population dynamics. In this paper I describe a comprehensive framework for management that includes multiple models and likelihood values to account for structural uncertainty, along with stochastic factors to account for environmental variation, random sampling, and partial controllability. Adaptive optimization is developed in terms of the optimal control of incompletely understood populations, with the expected value of perfect information measuring the potential for improving control through learning. The framework for optimal adaptive control is generalized by including partial observability and non-adaptive, sample-based updating of model likelihoods. Passive adaptive management is derived as a special case of constrained adaptive optimization, representing a potentially efficient suboptimal alternative that nonetheless accounts for structural uncertainty.

Incorporating ethics into your comprehensive organizational plan.

PubMed

Oetjen, Dawn; Rotarius, Timothy

2005-01-01

Today's health care executives find their organizations facing internal and external environments that are behaving in chaotic and unpredictable ways. From inadequate staffing and an increase in clinical errors to outdated risk management procedures and increased competition for scare reimbursements, these health care managers find themselves making decisions without being fully informed of the ethical ramifications of these decisions. A 6-part Comprehensive Organizational Plan is presented that helps the health care decision maker better understand the key success factors for the organization. The Comprehensive Organizational Plan is an overall plan that is intended to protect and serve your organization. The 6 plans in the Comprehensive Organizational Plan cover the following areas: competition, facilities, finances, human resources, information management, and marketing. The comprehensive organizational plan includes an overlay of the ethical considerations for each part of the plan.

Preventive home care of frail older people: a review of recent case management studies.

PubMed

Hallberg, Ingalill Rahm; Kristensson, Jimmie

2004-09-01

Preventive actions targeting community-dwelling frail older people will be increasingly important with the growing number of very old and thereby also frail older people. This study aimed to explore and summarize the empirical literature on recent studies of case/care management interventions for community-dwelling frail older people and especially with regard to the content of the interventions and the nurse's role and outcome of it. Very few of the interventions took either a preventive or a rehabilitative approach using psycho-educative interventions focusing, for instance, on self-care activities, risk prevention, health complaints management or how to preserve or strengthen social activities, community involvement and functional ability. Moreover, it was striking that very few included a family-oriented approach also including support and education for informal caregivers. Thus it seems that the content of case/care management needs to be expanded and more influenced by a salutogenic health care perspective. Targeting frail older people seemed to benefit from a standardized two-stage strategy for inclusion and for planning the interventions. A comprehensive geriatric assessment seemed useful as a base. Nurses, preferably trained in gerontological practice, have a key role in case/care management for frail older people. This approach calls for developing the content of case/care management so that it involves a more salutogenic, rehabilitative and family-oriented approach. To this end it may be useful for nurses to strengthen their psychosocial skills or develop close collaboration with social workers. The outcome measures examined in this study represented one of three perspectives: the consumer's perspective, the perspective of health care consumption or the recipient's health and functional ability. Perhaps effects would be expected in all three areas and thus these should be included in evaluative studies in addition to measures for family and/or informal caregiver's strain and satisfaction.

Social and economic impact of diabetics in Bangladesh: protocol for a case-control study.

PubMed

Shariful Islam, Sheikh Mohammed; Lechner, Andreas; Ferrari, Uta; Froeschl, Guenter; Niessen, Louis W; Seissler, Jochen; Alam, Dewan Shamsul

2013-12-21

Diabetes affects both individuals and their families and has an impact on economic and social development of a country. Information on the availability, cost, and quality of medical care for diabetes is mostly not available for many low- and middle-income countries including Bangladesh. Complications from diabetes, which can be devastating, could largely be prevented by wider use of several inexpensive generic medicines, simple tests and monitoring and can be a cost saving intervention. This study will provide an in-depth and comprehensive picture of social and economic impacts of diabetes in Bangladesh and propose clear recommendations for improving prevention and management of diabetes. The objectives of the study are: 1) To study the association between diabetes and other health problems and its social impacts. 2) To estimate the economic impact of diabetes including total direct and indirect costs. 3) To measure the impact of diabetes on quality of life among diabetes patients in Bangladesh. 4) To study the impact of diabetes on the health care system This is a case-control study comparing cases with type 2 diabetes to controls without diabetes matched on age, sex and place of residence. 564 cases and 564 controls will be selected from the outpatient department of a tertiary hospital in Dhaka, Bangladesh. Data on socioeconomic status, health utility index, direct and indirect costs for diabetes, medication adherence, quality of life, treatment satisfaction, diet, physical activity, mental state examination, weight, height, hip and waist circumference, blood pressure, pulse, medication history, laboratory data and physical examination will be conducted. The primary outcome measures will be association between diabetes and other health problems, cost of diabetes, impact of diabetes on quality of life and secondary outcome measures are impact of diabetes on healthcare systems in Bangladesh. This study will provide an in-depth and comprehensive picture of social and economic impacts of diabetics in Bangladesh and propose clear recommendations for improving prevention and management of diabetics. It will help to develop programs and policies for better management of Diabetics and cost effective strategies in Bangladesh context.

Implementing oral care practices and policy into long-term care: the Brushing up on Mouth Care project.

PubMed

McNally, Mary; Martin-Misener, Ruth; McNeil, Karen; Brillant, Martha; Moorhouse, Paige; Crowell, Sandra; Matthews, Debora; Clovis, Joanne

2015-03-01

Optimal mouth care is integral to the health and quality of life of dependent older adults.Yet, a persistent lack of adequate oral care in long-term care (LTC) facilities exacerbates the burden of disease experienced by residents. The reasons for this are complex and create enormous challenges for care providers, clinicians, and administrators dedicated to comprehensive high quality care. The aim of this study was to develop, implement, and evaluate a comprehensive program for daily mouth care for LTC. A case study design using a participatory and qualitative approach examined how individual, organizational (workplace practices and culture), and system factors (standards and policy) influenced the development and implementation of a comprehensive program to improve the delivery of daily oral care in LTC. The research was undertaken in 3 LTC residences administered under the same health authority and included personal care providers, nurse managers, and directors of care. A comprehensive program for care providers including, education, resources, and organizational guidelines, to improve the delivery of daily mouth care to LTC residents was created, rolled out, and refined over a 12-month period. Data was collected through diary studies, targeted interviews, field notes, oral care activities records, site team meetings, and direct feedback from members of the care team. The oral care intervention resulted in a heightened awareness, support and greater efficiency amongst care team. The presence of a "champion" was a key feature for sustaining processes. Management had a clear role to play to ensure support and accountability for the intervention. Optimizing oral care in long-term care can be achieved through an integrated approach that includes education, provision of resources, an oral care champion, support from managers and administrators, and appropriate organizational policy. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2010-02-01

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

An Exploration of Trainer Filtering Approaches

NASA Technical Reports Server (NTRS)

Hester, Patrick; Tolk, Andreas; Gadi, Sandeep; Carver, Quinn; Roland, Philippe

2011-01-01

Simutator operators face a twofold entity management problem during Live-Virtual-Constructive (LVC) training events. They first must filter potentially hundreds of thousands of simulation entities in order 10 determine which elements are necessary for optimal trainee comprehension. Secondarily, they must manage the number of entities entering the simulation from those present in the object model in order to limit the computational burden on the simulation system and prevent unnecessary entities from entering the simulation, This paper focuses on the first filtering stage and describes a novel approach to entity filtering undertaken to maximize trainee awareness and learning. The feasibility of this novel approach is demonstrated on a case study and limitations to the proposed approach and future work are discussed.

The relationship between deliberate self-harm behavior, body dissatisfaction, and suicide in adolescents: current concepts

PubMed Central

Greydanus, Donald E; Apple, Roger W

2011-01-01

Deliberate self-harm (DSH) is a common though often hidden condition in children and adolescents that may result in suicide. This discussion covers several aspects of DSH including its prevalence, etiology, and management. The relationships of DSH to body dissatisfaction and suicide are specifically considered. Even though most cases of DSH do not end in overt suicide, DSH reflects that potential underlying psychological pathophysiology, and likelihood of eventual death from self-murder, cannot always be predicted or prevented. It is important to take all acts of DSH as serious, and to offer comprehensive management to prevent future acts of DSH and potential suicide. PMID:21811385

[Lower urinary tract dysfunction following radical hysterectomy].

PubMed

Aoun, F; Roumeguère, T

2015-12-01

Radical hysterectomy is associated with a significant amount of urinary functional complications and a negative impact on quality of life. The aim of this review is to provide a comprehensive overview of the neurological etiology of lower urinary tract dysfunction following radical hysterectomy and to establish an optimal postoperative management strategy. We performed a comprehensive overview using the following terms: "radical hysterectomy" and "urologic diseases etiology" or "urologic disease prevention and control". The reported incidence of lower urinary tract dysfunction after radical hysterectomy varies from 12 to 85%. Several animal and clinical urodynamic studies corroborate the neurologic etiology of the dysfunction. Lower urinary tract dysfunction is a common postoperative finding (70-85%) but spontaneous recovery is to be expected within 6-12 months after surgery. The most frequent long term sequela is stress urinary incontinence (40% of cases) and its management is complex and challenging. Postoperative refractory overactive bladder and bladder underactivity can be treated by neuromodulation of sacral roots and superior hypogastric plexus, respectively. In the absence of good clinical predictors, preoperative urodynamic examinations could have a role in understanding the pathophysiology of the dysfunction before such interventions. The pathophysiology of lower urinary tract dysfunction following radical hysterectomy is multifactorial. Its management is complex and should be multidisciplinary. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

[Integrated delivery systems in California--success and failure determining factors for the first 10 years and impetus for Germany].

PubMed

Janus, K; Amelung, V E

2004-10-01

Since the coming into effect of the Health Care Modernization Act (Gesundheitsmodernisierungsgesetz) the conditions for integrated health care delivery are favourable in Germany. However, comprehensive approaches are a long time in coming. In contrast, integrated health care delivery as an integral part of the spreading of managed care entered a further stage of development, which enables health care decision makers to draw conclusions regarding the further development of integrated health care delivery in Germany. Based on case studies integrated delivery systems in the San Francisco Bay Area have been analyzed with the objective to evaluate pitfalls and successful strategies for integrated health care delivery. The major pitfalls refer to an insufficient local focus, a lack of actual integration and the application of per capita reimbursement (which is a key subject on the political agenda in Germany as well) within integrated delivery systems. On the contrary, successful strategies include achieving a dynamic tension between centralized and decentralized coordination, internal and external relationship management, well organised human resource management including a well-defined corporate policy and a comprehensive implementation of information technology. Based on US experiences with integrated delivery systems implications for the design of integrated health care delivery in Germany are discussed.

Case Study of an Aboriginal Community-Controlled Health Service in Australia

PubMed Central

Baum, Fran; Lawless, Angela; Labonté, Ronald; Sanders, David; Boffa, John; Edwards, Tahnia; Javanparast, Sara

2016-01-01

Abstract Universal health coverage provides a framework to achieve health services coverage but does not articulate the model of care desired. Comprehensive primary health care includes promotive, preventive, curative, and rehabilitative interventions and health equity and health as a human right as central goals. In Australia, Aboriginal community-controlled health services have pioneered comprehensive primary health care since their inception in the early 1970s. Our five-year project on comprehensive primary health care in Australia partnered with six services, including one Aboriginal community-controlled health service, the Central Australian Aboriginal Congress. Our findings revealed more impressive outcomes in several areas—multidisciplinary work, community participation, cultural respect and accessibility strategies, preventive and promotive work, and advocacy and intersectoral collaboration on social determinants of health—at the Aboriginal community-controlled health service compared to the other participating South Australian services (state-managed and nongovernmental ones). Because of these strengths, the Central Australian Aboriginal Congress’s community-controlled model of comprehensive primary health care deserves attention as a promising form of implementation of universal health coverage by articulating a model of care based on health as a human right that pursues the goal of health equity. PMID:28559679

Does three-dimensional transesophageal echocardiography provide incremental value in percutaneous closure of ascending aortic pseudoaneurysm?

PubMed

Elkaryoni, Ahmed; Hsiung, Ming C; Arisha, Mohammed J; Ahmad, Amier; Nanda, Navin C; Mohamed, Ahmed H; Attia, Doaa; Sachdeva, Ankush; Singh, Lovepreet; Yin, Wei-Hsian

2017-07-01

Ascending aortic pseudoaneurysms (AO PSAs), if left untreated, are complicated by a high rate of rupture resulting in significant morbidity and mortality. New transcatheter modalities have emerged as acceptable surgical alternatives for their management. We present a case of an ascending aortic PSA in which intraoperative two- and three-dimensional transesophageal echocardiography (2DTEE and 3DTEE) provided a comprehensive assessment of the PSA in pre- and postclosure settings. © 2017, Wiley Periodicals, Inc.

A new frontier: applying comprehensive DM strategies to healthy members.

PubMed

2001-02-01

Extend disease management services to 'healthy' members. Why? Because with all the emphasis on high-cost, chronically ill patients, a health plan's most valuable asset is being ignored. At least that's the case being made by Nashville, TN-based American Healthways, which has rolled out a new program designed to put health plans in touch with all their members, not just the chronically ill. Through the use of predictive modeling, the program is designed to target higher risk members so preventive strategies can be employed.

NASA Marshall Space Flight Center Improves Cooling System Performance: Best Management Practice Case Study #10: Cooling Towers (Fact Sheet)

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

Not Available

National Aeronautics and Space Administration's (NASA) Marshall Space Flight Center (MSFC) has a longstanding sustainability program that revolves around energy and water efficiency as well as environmental protection. MSFC identified a problematic cooling loop with six separate compressor heat exchangers and a history of poor efficiency. The facility engineering team at MSFC partnered with Flozone Services, Incorporated to implement a comprehensive water treatment platform to improve the overall efficiency of the system.

A minor wound with a fatal course

PubMed Central

Loeffler, Christoph; Mols, Georg; Hecksteden, Kai; Pfeiffer, Jens; Ridder, Gerd J

2011-01-01

The authors report on a fatal case of severe tetanus in a 74-year old woman. Despite comprehensive intensive care management they could not achieve a satisfying control of the autonomic dysfunction caused by tetanus. By now there is no established therapy for the treatment of the autonomic dysfunction. This report demonstrates the dismal prognosis of severe tetanus in the older people, which is often complicated by cardiovascular comorbidity and underlines the importance of tetanus prevention by sufficient vaccination. PMID:22693194

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.

Environmental and Management Goal Setting for the Long Island Sound Comprehensive Conservation and Management Plan

EPA Science Inventory

Over the past 3 years the Long Island Sound Study (LISS) has been developing a revised Comprehensive Conservation and Management Plan (CCMP), the blueprint for the protection and restoration of the Sound for the next generation. Long Island Sound is located within the most densel...

Epidermis and Enamel

PubMed Central

Barsley, Robert E.; Bernstein, Mark L.; Brumit, Paula C.; Dorion, Robert B.J.; Golden, Gregory S.; Lewis, James M.; McDowell, John D.; Metcalf, Roger D.; Senn, David R.; Sweet, David; Weems, Richard A.

2018-01-01

Abstract Critics describe forensic dentists' management of bitemark evidence as junk science with poor sensitivity and specificity and state that linkages to a biter are unfounded. Those vocal critics, supported by certain media, characterize odontologists' previous errors as egregious and petition government agencies to render bitemark evidence inadmissible. Odontologists acknowledge that some practitioners have made past mistakes. However, it does not logically follow that the errors of a few identify a systemic failure of bitemark analysis. Scrutiny of the contentious cases shows that most occurred 20 to 40 years ago. Since then, research has been ongoing and more conservative guidelines, standards, and terminology have been adopted so that past errors are no longer reflective of current safeguards. The authors recommend a comprehensive root analysis of problem cases to be used to determine all the factors that contributed to those previous problems. The legal community also shares responsibility for some of the past erroneous convictions. Currently, most proffered bitemark cases referred to odontologists do not reach courts because those forensic dentists dismiss them as unacceptable or insufficient for analysis. Most bitemark evidence cases have been properly managed by odontologists. Bitemark evidence and testimony remain relevant and have made significant contributions in the justice system. PMID:29557817

Epidermis and Enamel: Insights Into Gnawing Criticisms of Human Bitemark Evidence.

PubMed

Barsley, Robert E; Bernstein, Mark L; Brumit, Paula C; Dorion, Robert B J; Golden, Gregory S; Lewis, James M; McDowell, John D; Metcalf, Roger D; Senn, David R; Sweet, David; Weems, Richard A

2018-06-01

Critics describe forensic dentists' management of bitemark evidence as junk science with poor sensitivity and specificity and state that linkages to a biter are unfounded. Those vocal critics, supported by certain media, characterize odontologists' previous errors as egregious and petition government agencies to render bitemark evidence inadmissible. Odontologists acknowledge that some practitioners have made past mistakes. However, it does not logically follow that the errors of a few identify a systemic failure of bitemark analysis. Scrutiny of the contentious cases shows that most occurred 20 to 40 years ago. Since then, research has been ongoing and more conservative guidelines, standards, and terminology have been adopted so that past errors are no longer reflective of current safeguards. The authors recommend a comprehensive root analysis of problem cases to be used to determine all the factors that contributed to those previous problems. The legal community also shares responsibility for some of the past erroneous convictions. Currently, most proffered bitemark cases referred to odontologists do not reach courts because those forensic dentists dismiss them as unacceptable or insufficient for analysis. Most bitemark evidence cases have been properly managed by odontologists. Bitemark evidence and testimony remain relevant and have made significant contributions in the justice system.

Endodontic management of permanent mandibular molars with 6 root canals: report of 3 cases.

PubMed

Malhotra, Amit; Ahlawat, Jyoti; Bansal, Chirag; Tahiliani, Divya

2016-01-01

Aberrations in the internal dental anatomy present challenges for clinicians performing endodontic therapy. These challenges have been partly resolved in recent years by a more comprehensive knowledge of root canal anatomy as well as advancements in the endodontic armamentarium. The aim of this case series is to describe successful root canal treatment, under magnification, in 3 cases of mandibular first molars with 6 root canals. Two of these teeth had 2 roots (mesial and distal) with 3 canals in each root; the third tooth had 3 root canals located mesially and 3 present distally as well as a radix entomolaris. A distal root with 3 canals is rare; however, it is important to look for such anatomical variations to ensure successful endodontic therapy.

Data Management and Data Quality in PERCH, a Large International Case-Control Study of Severe Childhood Pneumonia.

PubMed

Watson, Nora L; Prosperi, Christine; Driscoll, Amanda J; Higdon, Melissa M; Park, Daniel E; Sanza, Megan; DeLuca, Andrea N; Awori, Juliet O; Goswami, Doli; Hammond, Emily; Hossain, Lokman; Johnson, Catherine; Kamau, Alice; Kuwanda, Locadiah; Moore, David P; Neyzari, Omid; Onwuchekwa, Uma; Parker, David; Sapchookul, Patranuch; Seidenberg, Phil; Shamsul, Arifin; Siazeele, Kazungu; Srisaengchai, Prasong; Sylla, Mamadou; Levine, Orin S; Murdoch, David R; O'Brien, Katherine L; Wolff, Mark; Deloria Knoll, Maria

2017-06-15

The Pneumonia Etiology Research for Child Health (PERCH) study is the largest multicountry etiology study of pediatric pneumonia undertaken in the past 3 decades. The study enrolled 4232 hospitalized cases and 5325 controls over 2 years across 9 research sites in 7 countries in Africa and Asia. The volume and complexity of data collection in PERCH presented considerable logistical and technical challenges. The project chose an internet-based data entry system to allow real-time access to the data, enabling the project to monitor and clean incoming data and perform preliminary analyses throughout the study. To ensure high-quality data, the project developed comprehensive quality indicator, data query, and monitoring reports. Among the approximately 9000 cases and controls, analyzable laboratory results were available for ≥96% of core specimens collected. Selected approaches to data management in PERCH may be extended to the planning and organization of international studies of similar scope and complexity. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Oral rehabilitation of a 4-year-old child with early childhood caries under general anaesthesia: a case report on long-term outcome.

PubMed

Cuadros Fernández, C; Armengol Olivares, A; Guinot Jimeno, F; Lorente Rodríguez, A I

2014-07-01

Young patients with early childhood caries (ECC) commonly undergo oral rehabilitation under general anaesthesia (GA), often because of problems with behaviour management. Children with a history of ECC are highly susceptible to the development of new caries, even after comprehensive oral rehabilitation. The present paper reports the case of a female patient, aged 4.1 years, with ECC who was referred for treatment to the Department of Paediatric Dentistry of the Universitat Internacional de Catalunya. On account of the requirement for extensive dental treatment, and because of behaviour management problems, her dentition was restored under GA. A combination of restorative approaches and techniques was used, including the placement of composite resins, preformed metal crown restorations, extractions, and space maintainers. The patient was followed for 24 months, both clinically and radiographically. Conclusion This case reflects the need to provide adequate support to children at high risk for ECC, together with their families by developing more acceptable and effective biological and behavioural interventions in order to reduce caries relapse after oral rehabilitation under GA.

Comparative cost analysis of housing and case management program for chronically ill homeless adults compared to usual care.

PubMed

Basu, Anirban; Kee, Romina; Buchanan, David; Sadowski, Laura S

2012-02-01

To assess the costs of a housing and case management program in a novel sample-homeless adults with chronic medical illnesses. The study used data from multiple sources: (1) electronic medical records for hospital, emergency room, and ambulatory medical and mental health visits; (2) institutional and regional databases for days in respite centers, jails, or prisons; and (3) interviews for days in nursing homes, shelters, substance abuse treatment centers, and case manager visits. Total costs were estimated using unit costs for each service. Randomized controlled trial of 407 homeless adults with chronic medical illnesses enrolled at two hospitals in Chicago, Illinois, and followed for 18 months. Compared to usual care, the intervention group generated an average annual cost savings of (-)$6,307 per person (95 percent CI: -16,616, 4,002; p = .23). Subgroup analyses of chronically homeless and those with HIV showed higher per person, annual cost savings of (-)$9,809 and (-)$6,622, respectively. Results were robust to sensitivity analysis using unit costs. The findings of this comprehensive, comparative cost analyses demonstrated an important average annual savings, though in this underpowered study these savings did not achieve statistical significance. © Health Research and Educational Trust.

A Case of Loeffler Endocarditis That Showed Endomyocardial Systolic Dysfunction Detected by Layer Specific Strain Analysis.

PubMed

Jin, Xuanyi; Ma, Chunyan; Wang, Yonghuai; Yang, Jun

2017-12-12

Loeffler endocarditis is a rare comprehensive cardiac manifestation caused by eosinophilic cell infiltrations and is present in 50%-60% of patients with hypereosinophilic syndrome (HES). Left ventricle (LV) endocardial systolic dysfunction is a major cause of morbidity and mortality in HES and Loeffler endocarditis. We present a case of Loeffler endocarditis, whose left ventricular (LV) systolic dysfunction and endocardial systolic dysfunction were first neglected by conventional transthoracic echocardiography (TTE), but were later pointed out by layer-specific longitudinal strain analysis. With timely initial therapeutic management, the patient's outcome was remarkable. Thus, we strongly recommend strain analysis as a necessary supplementary test of conventional TTE in all patients with Loeffler endocarditis.

Disaster waste management: a review article.

PubMed

Brown, Charlotte; Milke, Mark; Seville, Erica

2011-06-01

Depending on their nature and severity, disasters can create large volumes of debris and waste. The waste can overwhelm existing solid waste management facilities and impact on other emergency response and recovery activities. If poorly managed, the waste can have significant environmental and public health impacts and can affect the overall recovery process. This paper presents a system overview of disaster waste management based on existing literature. The main literature available to date comprises disaster waste management plans or guidelines and isolated case studies. There is ample discussion on technical management options such as temporary storage sites, recycling, disposal, etc.; however, there is little or no guidance on how these various management options are selected post-disaster. The literature does not specifically address the impact or appropriateness of existing legislation, organisational structures and funding mechanisms on disaster waste management programmes, nor does it satisfactorily cover the social impact of disaster waste management programmes. It is envisaged that the discussion presented in this paper, and the literature gaps identified, will form a basis for future comprehensive and cohesive research on disaster waste management. In turn, research will lead to better preparedness and response to disaster waste management problems. Copyright © 2011 Elsevier Ltd. All rights reserved.

Disaster waste management: A review article

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

Brown, Charlotte, E-mail: charlotte.brown@pg.canterbury.ac.nz; Milke, Mark, E-mail: mark.milke@canterbury.ac.nz; Seville, Erica, E-mail: erica.seville@canterbury.ac.nz

2011-06-15

Depending on their nature and severity, disasters can create large volumes of debris and waste. The waste can overwhelm existing solid waste management facilities and impact on other emergency response and recovery activities. If poorly managed, the waste can have significant environmental and public health impacts and can affect the overall recovery process. This paper presents a system overview of disaster waste management based on existing literature. The main literature available to date comprises disaster waste management plans or guidelines and isolated case studies. There is ample discussion on technical management options such as temporary storage sites, recycling, disposal, etc.;more » however, there is little or no guidance on how these various management options are selected post-disaster. The literature does not specifically address the impact or appropriateness of existing legislation, organisational structures and funding mechanisms on disaster waste management programmes, nor does it satisfactorily cover the social impact of disaster waste management programmes. It is envisaged that the discussion presented in this paper, and the literature gaps identified, will form a basis for future comprehensive and cohesive research on disaster waste management. In turn, research will lead to better preparedness and response to disaster waste management problems.« less

Sampling plans, selective insecticides and sustainability: the case for IPM as 'informed pest management'.

PubMed

Castle, Steven; Naranjo, Steven E

2009-12-01

Integrated Pest Management (IPM) is considered the central paradigm of insect pest management and is often characterized as a comprehensive use of multiple control tactics to reduce pest status while minimizing economic and environmental costs. As the principal precursor of IPM, the integrated control concept formulated the economic theory behind pest management decisions and specified an applied methodology for carrying out pest control. Sampling, economic thresholds and selective insecticides were three of the critical elements of that methodology and are now considered indispensable to the goals of IPM. We examine each of these elements in the context of contemporaneous information as well as accumulated experience and knowledge required for their skillful implementation in an IPM program. We conclude that while IPM is principally about integrating control tactics into an effective and sustainable approach to pest control, this overarching goal can only be achieved through well-trained practitioners, knowledgeable of the tenets conceived in the integrated control concept that ultimately yield informed pest management. (c) 2009 Society of Chemical Industry.

Treatment of severe non-infectious uveitis in high-risk conditions (Part I): pregnancy and malignancies, management and safety issues.

PubMed

Cordero-Coma, Miguel; Salazar-Méndez, Raquel; Yilmaz, Taygan

2015-07-01

Management of patients with severe immune-mediated uveitis requires the use of immunosuppressive drugs in selected cases. This may be especially challenging in certain patients with concomitant conditions, which could increase the risk of side effects or modify guidelines for the use of such drugs. Therapeutic decision-making and management may be of particular difficulty in pregnancy as well as in patients with associated malignancies unrelated to a specific ophthalmic inflammatory condition. The main aim of this review is to provide an updated comprehensive practical guide for practitioners regarding the therapeutic decision-making and management of patients with severe immune-mediated uveitis in the context of pregnancy and malignancies. Management of patients with immune-mediated uveitis requiring immunosuppressive/immunomodulatory drugs might be particularly complicated by other conditions affecting their health and immune status. Clinicians should take into account such conditions, which might influence treatment response and the clinical outcome of these patients.

Driver comprehension of managed lane signing.

DOT National Transportation Integrated Search

2009-09-01

A statewide survey of driver comprehension of managed lane signing is reported. Computer-based surveys were conducted using video clips of computer animations as well as still images of signs. The surveys were conducted in four Texas cities with a to...

Surgical management of adult type 1 split cord malformation. Report of two cases with literature review.

PubMed

Viswanathan, Vibhu K; Minnema, Amy J; Farhadi, H Francis

2018-06-01

Split cord malformation (SCM) is a rare form of spinal dysraphism wherein the spinal cord is divided longitudinally into two distinct hemicords. Surgery is usually performed in children while management in adults, who rarely manifest symptoms, remains controversial. Both expectant management and prophylactic surgery have been variously advocated. The present article describes our experience in two adult patients with predominant pain-related complaints who underwent surgical excision of type 1 SCM lesions. A comprehensive review of the literature on SCM in adults is also provided. While pain, disability, and quality of life scores improved in these two patients, further larger studies will be required to define the role of surgery in adults with type 1 SCM and a pain-dominant presentation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Development of a Comprehensive Database System for Safety Analyst

PubMed Central

Paz, Alexander; Veeramisti, Naveen; Khanal, Indira; Baker, Justin

2015-01-01

This study addressed barriers associated with the use of Safety Analyst, a state-of-the-art tool that has been developed to assist during the entire Traffic Safety Management process but that is not widely used due to a number of challenges as described in this paper. As part of this study, a comprehensive database system and tools to provide data to multiple traffic safety applications, with a focus on Safety Analyst, were developed. A number of data management tools were developed to extract, collect, transform, integrate, and load the data. The system includes consistency-checking capabilities to ensure the adequate insertion and update of data into the database. This system focused on data from roadways, ramps, intersections, and traffic characteristics for Safety Analyst. To test the proposed system and tools, data from Clark County, which is the largest county in Nevada and includes the cities of Las Vegas, Henderson, Boulder City, and North Las Vegas, was used. The database and Safety Analyst together help identify the sites with the potential for safety improvements. Specifically, this study examined the results from two case studies. The first case study, which identified sites having a potential for safety improvements with respect to fatal and all injury crashes, included all roadway elements and used default and calibrated Safety Performance Functions (SPFs). The second case study identified sites having a potential for safety improvements with respect to fatal and all injury crashes, specifically regarding intersections; it used default and calibrated SPFs as well. Conclusions were developed for the calibration of safety performance functions and the classification of site subtypes. Guidelines were provided about the selection of a particular network screening type or performance measure for network screening. PMID:26167531

Anomalous origin of the left coronary artery from the pulmonary artery in adults: a comprehensive review of 151 adult cases and a new diagnosis in a 53-year-old woman.

PubMed

Yau, James M; Singh, Rajiv; Halpern, Ethan J; Fischman, David

2011-04-01

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary abnormality associated with early infant mortality and adult sudden death. As it predominantly presents in the first year of life, diagnosis in living adults is extremely rare. Current management is based on limited case series or extrapolated from pediatric cases. Modern advances in noninvasive cardiac imaging have substantially increased the number of diagnoses, uncovering a large adult population that has not been reviewed. The availability of newer diagnostic modalities correlates with an increasing incidence in an older cohort, and true association between sudden death and ALCAPA may be lower, especially among older patients. A comprehensive literature search was performed for all case reports of ALCAPA on MEDLINE and PubMed using the keywords ALCAPA, Bland-White-Garland, and coronary anomaly; and augmented by references from published case reports from 1908 to 2008. All adult cases, defined by age 18 years and older, were reviewed for this article. One hundred fifty-one adult cases of ALCAPA are described, in addition to the case of an asymptomatic 53-year-old woman. The average reported age was 41 years old with the oldest being 83. Sixty-six percent of the patients presented with symptoms of angina, dyspnea, palpitations, or fatigue; 17% presented with ventricular arrhythmia, syncope, or sudden death; and 14% were asymptomatic. Twelve percent were diagnosed at autopsy. The majority had some form of surgical correction during their clinical course. ALCAPA is a rare and life-threatening condition in adults. The availability of newer, less invasive diagnostic modalities has resulted in more frequent identification of this condition in an older cohort. © 2011 Wiley Periodicals, Inc.

Review of Prosthetic Joint Infection from Listeria monocytogenes.

PubMed

Bader, Gilbert; Al-Tarawneh, Mohammed; Myers, James

2016-12-01

Prosthetic joint infection from Listeria monocytogenes is rare. We decided to shed light on this illness and review the reported cases to better understand its characteristics. We conducted a comprehensive review of the English literature using PubMed. We also included one case that we had managed. We found 25 cases of prosthetic joint infection from L. monocytogenes reported individually and a retrospective study of 43 cases of joint and bone listerial infection, including 34 with prosthetic joint infection, conducted in France. We have described their clinical and para-clinical features and tried to elaborate on the pathophysiology, treatment, and prevention. Prosthetic joint infection from L. monocytogenes is mainly late. Systemic inflammation may be absent. Although rare, it must be suspected in patients at high risk for both prosthetic joint and listerial infections. In addition, those patients must be instructed on appropriate preventive measures.

Basal Cell Carcinoma of the Dorsal Foot: An Update and Comprehensive Review of the Literature.

PubMed

Loh, Tiffany Y; Rubin, Ashley G; Jiang, Shang I Brian

2017-01-01

Ultraviolet radiation is a well-known risk factor for basal cell carcinoma (BCC). Therefore, the high incidence of BCCs in sun-exposed areas such as the head and neck is unsurprising. However, unexpectedly, BCCs on the sun-protected dorsal foot have also been reported, and tumor occurrence here suggests that other factors besides ultraviolet radiation may play a role in BCC pathogenesis. Because only few dorsal foot BCCs have been reported, data on their clinical features and management are limited. To perform an updated review of the literature on clinical characteristics and treatment of dorsal foot BCCs. We conducted a comprehensive literature review by searching the PubMed database with the key phrases "basal cell carcinoma dorsal foot," "basal cell carcinoma foot," and "basal cell carcinoma toe." We identified 20 cases of dorsal foot BCCs in the literature, 17 of which had sufficient data for analysis. Only 1 case was treated with Mohs micrographic surgery. We present 8 additional cases of dorsal foot BCCs treated with Mohs micrographic surgery. Basal cell carcinomas on the dorsal foot are rare, and potential risk factors include Caucasian descent and personal history of skin cancer. Mohs micrographic surgery seems to be an effective treatment option.

Basal Cell Carcinoma of the Dorsal Hand: An Update and Comprehensive Review of the Literature.

PubMed

Loh, Tiffany Y; Rubin, Ashley G; Brian Jiang, Shang I

2016-04-01

Excessive ultraviolet radiation (UVR) exposure is the primary predisposing factor for basal cell carcinoma (BCC). However, surprisingly, BCCs occur very rarely on the dorsal hand, which is subject to intense sun exposure, and their infrequent presentation in this location suggests that other factors besides UVR may play a role in BCC pathogenesis. Because dorsal hand BCCs are uncommon, knowledge of their characteristics is limited, and more data are needed to describe their clinical presentation and treatment. To perform an updated review of the literature on the management of dorsal hand BCCs. The authors conducted a comprehensive literature review by searching the PubMed database with the key phrases "basal cell carcinoma dorsal hand," "basal cell carcinoma hand," and "basal cell carcinoma finger," and "basal cell carcinoma thumb." The authors identified 176 cases of dorsal hand BCCs in the literature, 120 of which had sufficient data for analysis. Only 4 cases were treated with Mohs micrographic surgery (MMS). The authors present 14 additional cases of dorsal hand BCCs treated with MMS. Basal cell carcinomas on the dorsal hand occur infrequently, and potential risk factors include being a male of white descent and personal history of skin cancer. Mohs micrographic surgery seems to be an effective treatment method.

[Clinical and communication simulation workshop for fellows in gastroenterology: the trainees' perspective].

PubMed

Lang, Alon; Melzer, Ehud; Bar-Meir, Simon; Eliakim, Rami; Ziv, Amitai

2006-11-01

The continuing development in computer-based medical simulators provides an ideal platform for simulator-assisted training programs for medical trainees. Computer-based endoscopic simulators provide a virtual reality environment for training endoscopic procedures. This study illustrates the use of a comprehensive training model combining the use of endoscopic simulators with simulated (actor) patients (SP). To evaluate the effectiveness of a comprehensive simulation workshop from the trainee perspective. Four case studies were developed with emphasis on communication skills. Three workshops with 10 fellows in each were conducted. During each workshop the trainees spent half of the time in SP case studies and the remaining half working with computerized endoscopic simulators with continuous guidance by an expert endoscopist. Questionnaires were completed by the fellows at the end of the workshop. Seventy percent of the fellows felt that the endoscopic simulator was close or very close to reality for gastroscopy and 63% for colonoscopy. Eighty eight percent thought the close guidance was important for the learning process with the simulator. Eighty percent felt that the case studies were an important learning experience for risk management. Further evaluation of multi-modality simulation workshops in gastroenterologist training is needed to identify how best to incorporate this form of instruction into training for gastroenterologists.

16 CFR 1018.43 - Comprehensive review.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Comprehensive review. 1018.43 Section 1018.43 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL ADVISORY COMMITTEE MANAGEMENT Records, Annual Reports and Audits § 1018.43 Comprehensive review. A comprehensive review of all...

16 CFR 1018.43 - Comprehensive review.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 16 Commercial Practices 2 2011-01-01 2011-01-01 false Comprehensive review. 1018.43 Section 1018.43 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL ADVISORY COMMITTEE MANAGEMENT Records, Annual Reports and Audits § 1018.43 Comprehensive review. A comprehensive review of all...

16 CFR 1018.43 - Comprehensive review.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 16 Commercial Practices 2 2012-01-01 2012-01-01 false Comprehensive review. 1018.43 Section 1018.43 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL ADVISORY COMMITTEE MANAGEMENT Records, Annual Reports and Audits § 1018.43 Comprehensive review. A comprehensive review of all...

16 CFR 1018.43 - Comprehensive review.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 16 Commercial Practices 2 2014-01-01 2014-01-01 false Comprehensive review. 1018.43 Section 1018.43 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL ADVISORY COMMITTEE MANAGEMENT Records, Annual Reports and Audits § 1018.43 Comprehensive review. A comprehensive review of all...

Integrating a comprehensive DNA barcode reference library with a global map of yews (Taxus L.) for forensic identification.

PubMed

Liu, Jie; Milne, Richard I; Möller, Michael; Zhu, Guang-Fu; Ye, Lin-Jiang; Luo, Ya-Huang; Yang, Jun-Bo; Wambulwa, Moses C; Wang, Chun-Neng; Li, De-Zhu; Gao, Lian-Ming

2018-05-22

Rapid and accurate identification of endangered species is a critical component of biosurveillance and conservation management, and potentially policing illegal trades. However, this is often not possible using traditional taxonomy, especially where only small or preprocessed parts of plants are available. Reliable identification can be achieved via a comprehensive DNA barcode reference library, accompanied by precise distribution data. However, these require extensive sampling at spatial and taxonomic scales, which has rarely been achieved for cosmopolitan taxa. Here, we construct a comprehensive DNA barcode reference library and generate distribution maps using species distribution modelling (SDM), for all 15 Taxus species worldwide. We find that trnL-trnF is the ideal barcode for Taxus: It can distinguish all Taxus species and in combination with ITS identify hybrids. Among five analysis methods tested, NJ was the most effective. Among 4,151 individuals screened for trnL-trnF, 73 haplotypes were detected, all species-specific and some population private. Taxonomical, geographical and genetic dimensions of sampling strategy were all found to affect the comprehensiveness of the resulting DNA barcode library. Maps from SDM showed that most species had allopatric distributions, except T. mairei in the Sino-Himalayan region. Using the barcode library and distribution map data, two unknown forensic samples were identified to species (and in one case, population) level and another was determined as a putative interspecific hybrid. This integrated species identification system for Taxus can be used for biosurveillance, conservation management and to monitor and prosecute illegal trade. Similar identification systems are recommended for other IUCN- and CITES-listed taxa. © 2018 John Wiley & Sons Ltd.

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.

Perioperative Management of Pregnant Women With Idiopathic Pulmonary Arterial Hypertension: An Observational Case Series Study From China.

PubMed

Zhang, Jinglan; Lu, Jiakai; Zhou, Xiaorui; Xu, Xuefeng; Ye, Qing; Ou, Qitan; Li, Yanna; Huang, Jiapeng

2018-03-07

The mortality of pregnant women with idiopathic pulmonary arterial hypertension (PAH) is very high. There are limited data on the management of idiopathic PAH during pregnancy. The authors aimed to examine systematically the characteristics of parturient women with idiopathic PAH, to explore the adverse effects of idiopathic PAH on pregnancy outcomes, and to report the multidisciplinary perioperative management strategy from the largest comprehensive cardiac hospital in China. Observational case series study. Tertiary referral acute care hospital in Beijing, China. The cases of 17 consecutive pregnant idiopathic PAH patients undergoing abortion or parturition at Anzhen Hospital were reviewed retrospectively. Preoperative characteristics, anesthesia method, intensive care management, PAH-specific therapy, and maternal and neonatal outcomes were analyzed in this case series study. Maternal and neonatal outcomes were the main measures. The mean ages of the 17 parturient women with idiopathic PAH were 28.3 ± 5.4 years, and the mean systolic pulmonary arterial pressure was 97.9 ± 18.6 mmHg. Fifteen patients (88.2%) received PAH-specific therapy before delivery, including sildenafil, iloprost, and treprostinil. All except 1 parturient received epidural anesthesia for surgery due to an emergency Caesarean section. Three patients experienced pulmonary hypertension crisis that necessitated conversion to general anesthesia. Ten parturients underwent Caesarean delivery at a median gestational age of 31 weeks. Three patients developed acute pulmonary hypertensive crisis intraoperatively. Two patients underwent cardiopulmonary resuscitation and extracorporeal membrane oxygenation support. The maternal mortality was 17.6% (3/17). Of the 10 delivered neonates, 9 (90.0%) survived. The maternal mortality of the idiopathic PAH parturient was high in this case series from China. The authors applied epidural anesthesia, early management with multidisciplinary approaches, PAH-specific therapy, avoidance of oxytocin, and timely delivery or pregnancy termination to improve maternal and neonatal outcomes. Copyright © 2018 Elsevier Inc. All rights reserved.

75 FR 39038 - Tamarac National Wildlife Refuge and Wetland Management District, Minnesota

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-07

... forest birds and their habitats. Alternative 4: Current Management Direction of Conservation, Restoration... Service, Interior. ACTION: Notice of Availability: draft comprehensive conservation plan and environmental... availability of a draft comprehensive conservation plan (CCP) and draft environmental assessment (EA) for...

Obsessive-compulsive disorder and related disorders: a comprehensive survey

PubMed Central

Fornaro, Michele; Gabrielli, Filippo; Albano, Claudio; Fornaro, Stefania; Rizzato, Salvatore; Mattei, Chiara; Solano, Paola; Vinciguerra, Valentina; Fornaro, Pantaleo

2009-01-01

Our aim was to present a comprehensive, updated survey on obsessive-compulsive disorder (OCD) and obsessive-compulsive related disorders (OCRDs) and their clinical management via literature review, critical analysis and synthesis. Information on OCD and OCRD current nosography, clinical phenomenology and etiology, may lead to a better comprehension of their management. Clinicians should become familiar with the broad spectrum of OCD disorders, since it is a pivotal issue in current clinical psychiatry. PMID:19450269

Building Student and Family-Centered Care Coordination Through Ongoing Delivery System Design.

PubMed

Baker, Dian; Anderson, Lori; Johnson, Jody

2017-01-01

In 2016 the National Association of School Nurses released an updated framework for school nurse practice. One highlight of the new framework is 21st century care coordination. That is, moving beyond basic case management to a systems-level approach for delivery of school health services. The framework broadly applies the term care coordination to include direct care and communication across systems. School nurses are often engaged in efforts to create school health care homes that serve as an axis of coordination for students and families between primary care offices and the schools. Effective care coordination requires that the school nurses not only know the principles of traditional case management but also understand complex systems that drive effective care coordination. The outcome of a system-level approach is enhanced access to services in an integrated health care delivery system that includes the school nurse as an integral member of the school's health care team. This article presents a comprehensive, system-level model of care coordination for school nurse leadership and practice.

Down syndrome and neurofibromatosis: a case report.

PubMed

Schaffer, Rebecca; Goss, Lindsay; Romer, Maureen Munnelly; Kalamchi, Sabah

2014-01-01

The dental management of a patient presenting with both Down syndrome and neurofibromatosis type 1 (NF1) has not previously been described well in the dental literature. A 20-year-old male with both of these genetic anomalies sought comprehensive treatment at the Special Needs Dental clinic at the Arizona School of Dentistry and Oral Health. He presented with multiple decayed surfaces, retained primary teeth, and intra/extra oral soft tissue tumors. Dental extractions and tumor reduction surgery took place at a private dental office due to the need for intravenous sedation for patient management. At the conclusion of the patient's -treatment, while his oral health was improved, there was little improvement in the facial aesthetics of his case. Coordinating care among health care providers in a patient with Trisomy 21 and NF1 is essential for a reliable and predictable outcome. However, as neurofibromas are often known to recur, the treatment risks and advantages should be reviewed prior to surgical intervention. © 2013 Special Care Dentistry Association and Wiley Periodicals, Inc.

Depression in women in Indian context.

PubMed

Bohra, Neena; Srivastava, Shruti; Bhatia, M S

2015-07-01

The estimate of the global burden of disease predicts that depression will be the second-leading cause of disability worldwide by 2020. Depression is widely prevalent in women in all age groups especially in India where 1.2 billion population lives. In the current scenario of underdiagnosed, untreated cases of females suffering from depression, the hurdles faced by Indian women include inadequate number of mental health professionals, lack of awareness, stigma, disadvantaged position of women, multiple roles, increased levels of stress, and domestic violence. The literature search included an electronic database, published materials, and standard textbooks. The authors have provided a brief overview of different types of depression in females. Epidemiology, etiology, clinical presentation, and management linked to the reproductive cycle of women have been covered. Awareness through public education, early detection, organized national mental health programs, comprehensive management, with judicious utilization of the limited resources would tackle the rising number of cases of female depression, in a cost effective manner, thereby preventing suicide.

Use of a portable voice organizer to remember therapy goals in traumatic brain injury rehabilitation: a within-subjects trial.

PubMed

Hart, Tessa; Hawkey, Karen; Whyte, John

2002-12-01

To test the efficacy of a portable voice organizer in helping people with traumatic brain injury (TBI) to recall therapy goals and plans discussed with their clinical case managers. Prospective within-subjects trial, in which individualized therapy goals were randomly assigned to intervention or no intervention. Comprehensive postacute TBI rehabilitation program. Ten people with moderate to severe TBI enrolled from 3 months to 18 years after injury. Memory for therapy goals. Clinicians generated statements describing six current therapy goals, half of which were randomly assigned to be recorded on a voice organizer during the next case management session. Participants selected three times per day to listen to the recorded goals, prompted by an alarm. One-week recall was tested using both free- and cued-recall formats. Recorded goals were recalled better than unrecorded goals and appeared to be associated with better awareness or follow-through with therapy objectives. Portable electronic devices have the potential to assist with treatment areas beyond tasks involving prospective memory.

The child welfare system: through the eyes of public health nurses.

PubMed

Schneiderman, Janet U

2005-01-01

This qualitative descriptive study investigates how public health nurses working within the child welfare system view the organization and the organization's effect on their case management practice. Semistructured interviews were conducted utilizing the Bolman-Deal Organizational Model. This model identifies four frames of an organization: symbolic, human resources, political, and structural. A purposive sample of nine nurses and one social worker was selected to participate in comprehensive interviews. Data analysis identified two main themes. The first theme was the presence of organizational structural barriers to providing case management. The second theme was the lack of political influence by the nurses to change the structure of the organization; hence, their skills could be more completely utilized. Public health nurses who work in child welfare will need to systematically analyze their role within the organization and understand how to work in "host settings." Nursing educators need to prepare public health nurses to work in non-health care settings by teaching organizational analysis.

Overcoming Production Disruption When Adopting New Technologies: Application of Macroergonomics and Safety Culture

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

Naca, Christine L.; Rempel, David M.; Imada, Andy S.

Organizations are constantly responding to new technologies that require an appropriate response to remain competitive. Depending on the nature of the technologic changes, incremental changes may be adequate. However, at some point, the technical demands may be disruptive because the organization is unable to respond adequately. In this case study of a biotechnology production facility, rapidly changing customer and technological demands created a crisis manifested in rising employee injuries and production interruptions. The crisis was ultimately addressed through a comprehensive redesign of human-system relationships. Key ingredients included: a management willing to examine the entire production system, a multidisciplinary team coordinatingmore » efforts towards a common goal, engagement of staff at all levels of the organization, and the creation of feedback channels to better guide the actions of supervisors and managers. The methods used in this successful case study, involving a macroergonomics approach, can be applied to any private or public enterprise.« less

Industrial demand side management: A status report

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

Hopkins, M.F.; Conger, R.L.; Foley, T.J.

This report provides an overview of and rationale for industrial demand side management (DSM) programs. Benefits and barriers are described, and data from the Manufacturing Energy Consumption Survey are used to estimate potential energy savings in kilowatt hours. The report presents types and examples of programs and explores elements of successful programs. Two in-depth case studies (from Boise Cascade and Eli Lilly and Company) illustrate two types of effective DSM programs. Interviews with staff from state public utility commissions indicate the current thinking about the status and future of industrial DSM programs. A comprehensive bibliography is included, technical assistance programsmore » are listed and described, and a methodology for evaluating potential or actual savings from projects is delineated.« less

A virtual patient software program to improve pharmacy student learning in a comprehensive disease management course.

PubMed

Douglass, Mark A; Casale, Jillian P; Skirvin, J Andrew; DiVall, Margarita V

2013-10-14

To implement and assess the impact of a virtual patient pilot program on pharmacy students' clinical competence skills. Pharmacy students completed interactive software-based patient case scenarios embedded with drug-therapy problems as part of a course requirement at the end of their third year. Assessments included drug-therapy problem competency achievement, performance on a pretest and posttest, and pilot evaluation survey instrument. Significant improvements in students' posttest scores demonstrated advancement of clinical skills involving drug-therapy problem solving. Students agreed that completing the pilot program improved their chronic disease management skills and the program summarized the course series well. Using virtual patient technology allowed for assessment of student competencies and improved learning outcomes.

Presentation and Treatment of Poland Anomaly.

PubMed

Buckwalter V, Joseph A; Shah, Apurva S

2016-12-01

Background: Poland anomaly is a sporadic, phenotypically variable congenital condition usually characterized by unilateral pectoral muscle agenesis and ipsilateral hand deformity. Methods: A comprehensive review of the medical literature on Poland anomaly was performed using a Medline search. Results: Poland anomaly is a sporadic, phenotypically variable congenital condition usually characterized by unilateral, simple syndactyly with ipsilateral limb hypoplasia and pectoralis muscle agenesis. Operative management of syndactyly in Poland anomaly is determined by the severity of hand involvement and the resulting anatomical dysfunction. Syndactyly reconstruction is recommended in all but the mildest cases because most patients with Poland anomaly have notable brachydactyly, and digital separation can improve functional length. Conclusions: Improved understanding the etiology and presentation of Poland anomaly can improve clinician recognition and management of this rare congenital condition.

β-Thalassemia intermedia: a comprehensive overview and novel approaches.

PubMed

Asadov, Chingiz; Alimirzoeva, Zohra; Mammadova, Tahira; Aliyeva, Gunay; Gafarova, Shahla; Mammadov, Jeyhun

2018-01-29

β-Thalassemia intermedia is a clinical condition of intermediate gravity between β-thalassemia minor, the asymptomatic carrier, and β-thalassemia major, the transfusion-dependent severe anemia. It is characterized by a significant clinical polymorphism, which is attributable to its genetic heterogeneity. Ineffective erythropoiesis, chronic anemia, and iron overload contribute to the clinical complications of thalassemia intermedia through stepwise pathophysiological mechanisms. These complications, including splenomegaly, extramedullary erythropoiesis, iron accumulation, leg ulcers, thrombophilia, and bone abnormalities can be managed via fetal hemoglobin induction, occasional transfusions, chelation, and in some cases, stem cell transplantation. Given its clinical diversity, thalassemia intermedia patients require tailored approaches to therapy. Here we present an overview and novel approaches to the genetic basis, pathophysiological mechanisms, clinical complications, and optimal management of thalassemia intermedia.

Research on the performance evaluation of agricultural products supply chain integrated operation

NASA Astrophysics Data System (ADS)

Jiang, Jiake; Wang, Xifu; Liu, Yang

2017-04-01

The agricultural product supply chain integrated operation can ensure the quality and efficiency of agricultural products, and achieve the optimal goal of low cost and high service. This paper establishes a performance evaluation index system of agricultural products supply chain integration operation based on the development status of agricultural products and SCOR, BSC and KPI model. And then, we constructing rough set theory and BP neural network comprehensive evaluation model with the aid of Rosetta and MATLAB tools and the case study is about the development of agricultural products integrated supply chain in Jing-Jin-Ji region. And finally, we obtain the corresponding performance results, and give some improvement measures and management recommendations to the managers.

Advancing smoke-free policy adoption on the Navajo Nation.

PubMed

Nez Henderson, Patricia; Roeseler, April; Moor, Gregg; Clark, Hershel W; Yazzie, Alfred; Nez, Priscilla; Nez, Chantal; Sabo, Samantha; Leischow, Scott J

2016-10-01

Comprehensive smoke-free laws are effective at protecting non-smokers and reducing tobacco use, yet they are not widely adopted by tribal governments. A series of smoke-free policy initiatives on the Navajo Nation, beginning in 2008, were reviewed to identify key issues, successes and setbacks. It has been essential that proposed policies acknowledge the Navajo people's spiritual use of nát'oh, a sacred plant used for gift-giving, medicinal purposes and traditional ceremonies, while simultaneously discouraging a secular use of commercial tobacco. Concern that smoke-free policies economically harm tribal casinos has been a major barrier to broad implementation of comprehensive smoke-free laws in Navajo Nation. It is necessary for tobacco control researchers and advocates to build relationships with tribal leaders and casino management in order to develop the business case that will take comprehensive smoke-free policies to scale throughout tribal lands. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Executive Order 13514: Federal Leadership in Environmental, Energy, and Economic Performance; Comprehensive Federal Fleet Management Handbook (Book)

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

Daley, R.; Ahdieh, N.; Bentley, J.

2014-01-01

A comprehensive Federal Fleet Management Handbook that builds upon the "Guidance for Federal Agencies on E.O. 13514 Section 12-Federal Fleet Management" and provides information to help fleet managers select optimal greenhouse gas and petroleum reduction strategies for each location, meeting or exceeding related fleet requirements, acquiring vehicles to support these strategies while minimizing fleet size and vehicle miles traveled, and refining strategies based on agency performance.

Non-pharmacological management of abdominal pain-related functional gastrointestinal disorders in children.

PubMed

Paul, Siba Prosad; Basude, Dharamveer

2016-11-01

Abdominal pain-related functional gastrointestinal disorder (AP-FGID) comprises of 4 main conditions: functional dyspepsia, irritable bowel syndrome, abdominal migraine and functional abdominal pain. AP-FGIDs are diagnosed clinically based on the Rome IV criteria for FGIDs of childhood. There is limited evidence for pharmacological therapies. This review article discusses nonpharmacological management of AP-FGID based on the current literature including systematic reviews, randomized controlled trials, cohort and case control studies. We aim to provide a comprehensive overview on the available evidence for the pediatricians and pediatric gastroenterologists involved in managing children with AP-FGID. Managing AP-FGIDs can be challenging. This should follow a stepwise approach with focused history, identification of "red flag" signs and symptoms, physical examination and investigations done following initial consultation. Family needs explaining that there is nothing seriously wrong with the child's abdomen. This explanation and reassurance can achieve symptom control in large number of cases. Non-pharmacological interventions are delivered through lifestyle and dietary changes and bio-psychosocial therapies. Dietary interventions vary depending on the type of AP-FGID. Bio-psychosocial therapies such as hypnotherapy, cognitive behavioral therapy and yoga aim at stress reduction. There is increasing evidence for use of non-pharmacological interventions in children with APFGID.

Water resources management strategies and its implications on hydrodynamic and hydrochemical changes of costal groundwater: Case of Grombalia shallow aquifer, NE Tunisia

NASA Astrophysics Data System (ADS)

Lachaal, Fethi; Chekirbane, Anis; Chargui, Sameh; Sellami, Haykel; Tsujimura, Maki; Hezzi, Hmida; Faycel, Jelassi; Mlayah, Ammar

2016-12-01

Information on groundwater quantity as well as quality is required by water managers and decision-makers for defining a sustainable management strategy. This requires a comprehensive assessment of the surface water and groundwater resources. This paper provides an assessment of water resources management strategy in the Grombalia region (Northeast Tunisia) and its impact on quantity and quality evolution of groundwater resources based on an approach that combines (i) hydro-climatic data, (ii) field monitoring, (iii) historic piezometric records, and (iv) geochemical and stable isotopes (δ18O and δ2H) analyses. We apply this approach to identify the origin of the various water resources and outline how the actual water management impact the quantity and quality of the groundwater in the region. As consequence of poor water resources management, the shallow groundwater levels have been disrupted: a groundwater rise is observed in the centre and a piezometric drawdown is observed in the upstream regions. Groundwater quality degradation was registered especially in the centre and downstream zones.

Regional forestry practices and forest management certification

Treesearch

Steverson O. Moffat; Frederick W. Cubbage; Matthew H. Pelkki

2001-01-01

Under a "mandated" management scenario, landowners in states with comprehensive forest practices laws meet more sustainable forestry standards and certification programs' guidelines than do owners in states with other regulatory approaches. This confers certification advantages to landowners in the Pacific Northwest where comprehensive forest laws...

Principles of effective USA federal fire management plans

USGS Publications Warehouse

Meyer, Marc D.; Roberts, Susan L.; Wills, Robin; Brooks, Matthew L.; Winford, Eric M.

2015-01-01

Federal fire management plans are essential implementation guides for the management of wildland fire on federal lands. Recent changes in federal fire policy implementation guidance and fire science information suggest the need for substantial changes in federal fire management plans of the United States. Federal land management agencies are also undergoing land management planning efforts that will initiate revision of fire management plans across the country. Using the southern Sierra Nevada as a case study, we briefly describe the underlying framework of fire management plans, assess their consistency with guiding principles based on current science information and federal policy guidance, and provide recommendations for the development of future fire management plans. Based on our review, we recommend that future fire management plans be: (1) consistent and compatible, (2) collaborative, (3) clear and comprehensive, (4) spatially and temporally scalable, (5) informed by the best available science, and (6) flexible and adaptive. In addition, we identify and describe several strategic guides or “tools” that can enhance these core principles and benefit future fire management plans in the following areas: planning and prioritization, science integration, climate change adaptation, partnerships, monitoring, education and communication, and applied fire management. These principles and tools are essential to successfully realize fire management goals and objectives in a rapidly changing world.

[Fetal bradycardia: a retrospective study in 9 Spanish centers].

PubMed

Perin, F; Rodríguez Vázquez del Rey, M M; Deiros Bronte, L; Ferrer Menduiña, Q; Rueda Nuñez, F; Zabala Arguelles, J I; García de la Calzada, D; Teodoro Marin, S; Centeno Malfaz, F; Galindo Izquierdo, A

2014-11-01

The aim of this study is to review the current management and outcomes of fetal bradycardia in 9 Spanish centers. Retrospective multicenter study: analysis of all fetuses with bradycardia diagnosed between January 2008 and September 2010. Underlying mechanisms of fetal bradyarrhythmias were studied with echocardiography. A total of 37 cases were registered: 3 sinus bradycardia, 15 blocked atrial bigeminy, and 19 high grade atrioventricular blocks. Sinus bradycardia: 3 cases (100%) were associated with serious diseases. Blocked atrial bigeminy had an excellent outcome, except for one case with post-natal tachyarrhythmia. Of the atrioventricular blocks, 16% were related to congenital heart defects with isomerism, 63% related to the presence of maternal SSA/Ro antibodies, and 21% had unclear etiology. Overall mortality was 20% (37%, if terminations of pregnancy are taken into account). Risk factors for mortality were congenital heart disease, hydrops and/or ventricular dysfunction. Management strategies differed among centers. Steroids were administrated in 73% of immune-mediated atrioventricular blocks, including the only immune-mediated IInd grade block. More than half (58%) of atrioventricular blocks had a pacemaker implanted in a follow-up of 18 months. Sustained fetal bradycardia requires a comprehensive study in all cases, including those with sinus bradycardia. Blocked atrial bigeminy has a good prognosis, but tachyarrhythmias may develop. Heart block has significant mortality and morbidity rates, and its management is still highly controversial. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Improving diabetic foot care in a nurse-managed safety-net clinic.

PubMed

Peterson, Joann M; Virden, Mary D

2013-05-01

This article is a description of the development and implementation of a Comprehensive Diabetic Foot Care Program and assessment tool in an academically affiliated nurse-managed, multidisciplinary, safety-net clinic. The assessment tool parallels parameters identified in the Task Force Foot Care Interest Group of the American Diabetes Association's report published in 2008, "Comprehensive Foot Examination and Risk Assessment." Review of literature, Silver City Health Center's (SCHC) 2009 Annual Report, retrospective chart review. Since the full implementation of SCHC's Comprehensive Diabetic Foot Care Program, there have been no hospitalizations of clinic patients for foot-related complications. The development of the Comprehensive Diabetic Foot Assessment tool and the implementation of the Comprehensive Diabetic Foot Care Program have resulted in positive outcomes for the patients in a nurse-managed safety-net clinic. This article demonstrates that quality healthcare services can successfully be developed and implemented in a safety-net clinic setting. ©2012 The Author(s) Journal compilation ©2012 American Association of Nurse Practitioners.

Post-Closure Strategy for Use-Restricted Sites on the Nevada National Security Site, Nevada Test and Training Range, and Tonopah Test Range, Nevada

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

Silvas, A. J.

The purpose of this Post-Closure Strategy is to provide a consistent methodology for continual evaluation of post-closure requirements for use-restricted areas on the Nevada National Security Site (NNSS), Nevada Test and Training Range (NTTR), and Tonopah Test Range (TTR) to consolidate, modify, or streamline the program. In addition, this document stipulates the creation of a single consolidated Post-Closure Plan that will detail the current post-closure requirements for all active use restrictions (URs) and outlines its implementation and subsequent revision. This strategy will ensure effective management and control of the post-closure sites. There are currently over 200 URs located on themore » NNSS, NTTR, and TTR. Post-closure requirements were initially established in the Closure Report for each site. In some cases, changes to the post-closure requirements have been implemented through addenda, errata sheets, records of technical change, or letters. Post-closure requirements have been collected from these multiple sources and consolidated into several formats, such as summaries and databases. This structure increases the possibility of inconsistencies and uncertainty. As more URs are established and the post-closure program is expanded, the need for a comprehensive approach for managing the program will increase. Not only should the current requirements be obtainable from a single source that supersedes all previous requirements, but the strategy for modifying the requirements should be standardized. This will enable more effective management of the program into the future. This strategy document and the subsequent comprehensive plan are to be implemented under the assumption that the NNSS and outlying sites will be under the purview of the U.S. Department of Energy, National Nuclear Security Administration for the foreseeable future. This strategy was also developed assuming that regulatory control of the sites remains static. The comprehensive plan is not intended to be a permanent long-term stewardship plan. However, it is intended to clarify requirements and identify components to effectively manage the sites until regulatory requirements are met or management of the site changes. The Environmental Management Program is required to manage these sites until the NNSS Environmental Restoration program is completed, currently planned for 2030. Prior to completion of the Environmental Restoration program, additional planning will be conducted to ensure that long-term stewardship of the sites is maintained. A comprehensive post-closure plan can be transitioned effectively into any future site-wide long-term stewardship program that may be developed. Therefore, the post-closure plan will include current aspects of the post-closure program that are also important aspects of long-term stewardship, including the following: • Management of physical and engineering controls such as fences, signs, and soil covers • Management of institutional and administrative controls such as use restrictions and real estate systems • Management of monitoring and maintenance programs • Management of information related to the sites such as geographic information system data and related documentation The strategy will also allow for periodic review and modification of any aspect of the program to ensure continued effectiveness.« less

Green stormwater infrastructure eco-planning and development on the regional scale: a case study of Shanghai Lingang New City, East China

NASA Astrophysics Data System (ADS)

Xu, Haishun; Chen, Liang; Zhao, Bing; Zhang, Qiuzhuo; Cai, Yongli

2016-06-01

Urban underlying surface has been greatly changed with rapid urbanization, considered to be one of the major causes for the destruction of urban natural hydrological processes. This has imposed a huge challenge for stormwater management in cities. There has been a shift from gray water management to green stormwater management thinking. The green stormwater infrastructure (GSI) is regarded as an effective and cost-efficient stormwater management eco-landscape approach. China's GSI practice and the development of its theoretical framework are still in the initial stage. This paper presents an innovative framework for stormwater management, integrating green stormwater infrastructure and landscape security patterns on a regional scale based on an urban master plan. The core concept of green stormwater infrastructure eco-planning is to form an interconnected GSI network (i.e., stormwater management landscape security pattern) which consists of the location, portion, size, layout, and structure of GSI so as to efficiently safeguard natural hydrological processes. Shanghai Lingang New City, a satellite new town of Shanghai, China was selected as a case study for GSI studies. Simulation analyses of hydrological processes were carried out to identify the critical significant landscape nodes in the highpriority watersheds for stormwater management. GSI should be planned and implemented in these identified landscape nodes. The comprehensive stormwater management landscape security pattern of Shanghai Lingang New City is designed with consideration of flood control, stormwater control, runoff reduction, water quality protection, and rainwater utilization objectives which could provide guidelines for smart growth and sustainable development of this city.

A comprehensive framework for the assessment of new end uses in recycled water schemes.

PubMed

Chen, Zhuo; Ngo, Huu Hao; Guo, Wenshan; Lim, Richard; Wang, Xiaochang C; O'Halloran, Kelly; Listowski, Andrzej; Corby, Nigel; Miechel, Clayton

2014-02-01

Nowadays, recycled water has provided sufficient flexibility to satisfy short-term freshwater needs and increase the reliability of long-term water supplies in many water scarce areas, which becomes an essential component of integrated water resources management. However, the current applications of recycled water are still quite limited that are mainly associated with non-potable purposes such as irrigation, industrial uses, toilet flushing and car washing. There is a large potential to exploit and develop new end uses of recycled water in both urban and rural areas. This can greatly contribute to freshwater savings, wastewater reduction and water sustainability. Consequently, the paper identified the potentials for the development of three recycled water new end uses, household laundry, livestock feeding and servicing, and swimming pool, in future water use market. To validate the strengths of these new applications, a conceptual decision analytic framework was proposed. This can be able to facilitate the optional management strategy selection process and thereafter provide guidance on the future end use studies within a larger context of the community, processes, and models in decision-making. Moreover, as complex evaluation criteria were selected and taken into account to narrow down the multiple management alternatives, the methodology can successfully add transparency, objectivity and comprehensiveness to the assessment. Meanwhile, the proposed approach could also allow flexibility to adapt to particular circumstances of each case under study. © 2013.

Resilience theory incorporated into urban wastewater systems management. State of the art.

PubMed

Juan-García, P; Butler, D; Comas, J; Darch, G; Sweetapple, C; Thornton, A; Corominas, Ll

2017-05-15

Government bodies, utilities, practitioners, and researchers have growing interest in the incorporation of resilience into wastewater management. Since resilience is a multidisciplinary term, it is important to review what has been achieved in the wastewater sector, and describe the future research directions for the forthcoming years. This work presents a critical review of studies that deal with resilience in the wastewater treatment sector, with a special focus on understanding how they addressed the key elements for assessing resilience, such as stressors, system properties, metrics and interventions to increase resilience. The results showed that only 17 peer-reviewed papers and 6 relevant reports, a small subset of the work in wastewater research, directly addressed resilience. The lack of consensus in the definition of resilience, and the elements of a resilience assessment, is hindering the implementation of resilience in wastewater management. To date, no framework for resilience assessment is complete, comprehensive or directly applicable to practitioners; current examples are lacking key elements (e.g. a comprehensive study of stressors, properties and metrics, examples of cases study, ability to benchmark interventions or connectivity with broader frameworks). Furthermore, resilience is seen as an additional cost or extra effort, instead of a means to overcome project uncertainty that could unlock new opportunities for investment. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

New Jersey's Medicaid waiver for acquired immunodeficiency syndrome

PubMed Central

Merzel, Cheryl; Crystal, Stephen; Sambamoorthi, Usha; Karus, Daniel; Kurland, Carol

1992-01-01

This article contains data from a study of New Jersey's home and community-based Medicaid waiver program for persons with symptomatic human immunodeficiency virus illness. Major findings include lower hospital costs and utilization for waiver participants compared with general Medicaid acquired immunodeficiency syndrome admissions in New Jersey. Average program expenditures were $2,400 per person per month. Based on study findings, it is evident that the waiver program is an important means of providing financial benefits and access to services and that comprehensive case management is a critical factor in assuring program quality. PMID:10120180

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

PubMed

Kim, H A

1998-12-01

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

Development and application of a comprehensive simulation model to evaluate impacts of watershed structures and irrigation water use on streamflow and groundwater: The case of Wet Walnut Creek Watershed, Kansas, USA

USGS Publications Warehouse

Ramireddygari, S.R.; Sophocleous, M.A.; Koelliker, J.K.; Perkins, S.P.; Govindaraju, R.S.

2000-01-01

This paper presents the results of a comprehensive modeling study of surface and groundwater systems, including stream-aquifer interactions, for the Wet Walnut Creek Watershed in west-central Kansas. The main objective of this study was to assess the impacts of watershed structures and irrigation water use on streamflow and groundwater levels, which in turn affect availability of water for the Cheyenne Bottoms Wildlife Refuge Management area. The surface-water flow model, POTYLDR, and the groundwater flow model, MODFLOW, were combined into an integrated, watershed-scale, continuous simulation model. Major revisions and enhancements were made to the POTYLDR and MODFLOW models for simulating the detailed hydrologic budget for the Wet Walnut Creek Watershed. The computer simulation model was calibrated and verified using historical streamflow records (at Albert and Nekoma gaging stations), reported irrigation water use, observed water-level elevations in watershed structure pools, and groundwater levels in the alluvial aquifer system. To assess the impact of watershed structures and irrigation water use on streamflow and groundwater levels, a number of hypothetical management scenarios were simulated under various operational criteria for watershed structures and different annual limits on water use for irrigation. A standard 'base case' was defined to allow comparative analysis of the results of different scenarios. The simulated streamflows showed that watershed structures decrease both streamflows and groundwater levels in the watershed. The amount of water used for irrigation has a substantial effect on the total simulated streamflow and groundwater levels, indicating that irrigation is a major budget item for managing water resources in the watershed. (C) 2000 Elsevier Science B.V.This paper presents the results of a comprehensive modeling study of surface and groundwater systems, including stream-aquifer interactions, for the Wet Walnut Creek Watershed in west-central Kansas. The main objective of this study was to assess the impacts of watershed structures and irrigation water use on streamflow and groundwater levels, which in turn affect availability of water for the Cheyenne Bottoms Wildlife Refuge Management area. The surface-water flow model, POTYLDR, and the groundwater flow model, MODFLOW, were combined into an integrated, watershed-scale, continuous simulation model. Major revisions and enhancements were made to the POTYLDR and MODFLOW models for simulating the detailed hydrologic budget for the Wet Walnut Creek Watershed. The computer simulation model was calibrated and verified using historical streamflow records (at Albert and Nekoma gaging stations), reported irrigation water use, observed water-level elevations in watershed structure pools, and groundwater levels in the alluvial aquifer system. To assess the impact of watershed structures and irrigation water use on streamflow and groundwater levels, a number of hypothetical management scenarios were simulated under various operational criteria for watershed structures and different annual limits on water use for irrigation. A standard `base case' was defined to allow comparative analysis of the results of different scenarios. The simulated streamflows showed that watershed structures decrease both streamflows and groundwater levels in the watershed. The amount of water used for irrigation has a substantial effect on the total simulated streamflow and groundwater levels, indicating that irrigation is a major budget item for managing water resources in the watershed.A comprehensive simulation model that combines the surface water flow model POTYLDR and the groundwater flow model MODFLOW was used to study the impacts of watershed structures (e.g., dams) and irrigation water use (including stream-aquifer interactions) on streamflow and groundwater. The model was revised, enhanced, calibrated, and verified, then applied to evaluate the hydrologic budget for Wet Wal

An Overview of State Policies Supporting Worksite Health Promotion Programs.

PubMed

VanderVeur, Jennifer; Gilchrist, Siobhan; Matson-Koffman, Dyann

2017-05-01

Worksite health promotion (WHP) programs can reduce the occurrence of cardiovascular disease risk factors. State law can encourage employers and employer-provided insurance companies to offer comprehensive WHP programs. This research examines state law authorizing WHP programs. Quantitative content analysis. Worksites or workplaces. United States (and the District of Columbia). State law in effect in 2013 authorizing WHP programs. Frequency and distribution of states with WHP laws. To determine the content of the laws for analysis and coding, we identified 18 policy elements, 12 from the Centers for Disease Control and Prevention's Worksite Health ScoreCard (HSC) and 6 additional supportive WHP strategies. We used these strategies as key words to search for laws authorizing WHP programs or select WHP elements. We calculated the number and type of WHP elements for each state with WHP laws and selected two case examples from states with comprehensive WHP laws. Twenty-four states authorized onsite WHP programs, 29 authorized WHP through employer-provided insurance plans, and 18 authorized both. Seven states had a comprehensive WHP strategy, addressing 8 or more of 12 HSC elements. The most common HSC elements were weight management, tobacco cessation, and physical activity. Most states had laws encouraging the adoption of WHP programs. Massachusetts and Maine are implementing comprehensive WHP laws but studies evaluating their health impact are needed.

16 CFR § 1018.43 - Comprehensive review.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 16 Commercial Practices 2 2013-01-01 2013-01-01 false Comprehensive review. § 1018.43 Section § 1018.43 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL ADVISORY COMMITTEE MANAGEMENT Records, Annual Reports and Audits § 1018.43 Comprehensive review. A comprehensive review of all...

Analysis of the enablers of capacities to produce primary health care-based reforms in Latin America: a multiple case study

PubMed Central

Báscolo, Ernesto Pablo; Yavich, Natalia; Denis, Jean-Louis

2016-01-01

Abstract Background Primary health care (PHC)-based reforms have had different results in Latin America. Little attention has been paid to the enablers of collective action capacities required to produce a comprehensive PHC approach. Objective To analyse the enablers of collective action capacities to transform health systems towards a comprehensive PHC approach in Latin American PHC-based reforms. Methods We conducted a longitudinal, retrospective case study of three municipal PHC-based reforms in Bolivia and Argentina. We used multiple data sources and methodologies: document review; interviews with policymakers, managers and practitioners; and household and services surveys. We used temporal bracketing to analyse how the dynamic of interaction between the institutional reform process and the collective action characteristics enabled or hindered the enablers of collective action capacities required to produce the envisioned changes. Results The institutional structuring dynamics and collective action capacities were different in each case. In Cochabamba, there was an ‘interrupted’ structuring process that achieved the establishment of a primary level with a selective PHC approach. In Vicente López, there was a ‘path-dependency’ structuring process that permitted the consolidation of a ‘primary care’ approach, but with limited influence in hospitals. In Rosario, there was a ‘dialectic’ structuring process that favoured the development of the capacities needed to consolidate a comprehensive PHC approach that permeates the entire system. Conclusion The institutional change processes achieved the development of a primary health care level with different degrees of consolidation and system-wide influence given how the characteristics of each collective action enabled or hindered the ‘structuring’ processes. PMID:27209640

Integration of remote blood glucose meter upload technology into a clinical pharmacist medication therapy management service.

PubMed

Schenk, Robert J; Schenk, Jenna

2011-01-01

A pharmacist-delivered, outpatient-focused medication therapy management (MTM) program is using a remote blood glucose (BG) meter upload device to provide better care and to improve outcomes for its patients with diabetes. Sharing uploaded BG meter data, presented in easily comprehensible graphs and charts, enables patients, caregivers, and the medical team to better understand how the patients' diabetes care is progressing. Pharmacists are becoming increasingly more active in helping to manage patients' complex medication regimens in an effort to help detect and avoid medication-related problems. Working together with patients and their physicians as part of an interdisciplinary health care team, pharmacists are helping to improve medication outcomes. This article focuses on two case studies highlighting the Diabetes Monitoring Program, one component of the Meridian Pharmacology Institute MTM service, and discusses the clinical application of a unique BG meter upload device. © 2010 Diabetes Technology Society.

Global bioanalytical support.

PubMed

John Lin, Zhongping; Zhang, Tianyi; Pasas-Farmer, Stephanie; Brooks, Stephen D; Moyer, Michael; Connolly, Ron

2014-05-01

With the globalization of drug development, there is an increasing need for global bioanalytical support. Bioanalysis provides pivotal data for toxicokinetic, pharmacokinetic, bioavailability and bioequivalence studies used for regional or global regulatory submission. There are many known complications in building a truly global bioanalytical operation, ranging from lack of global regulatory guidelines and global standard operating procedures to barriers in regional requirements on sample shipping, importation and exportation. The primary objective of this article is to discuss common experiences and challenges facing the biopharmaceutical industry when providing bioanalytical support in a global setting. The key components of global bioanalytical services include the supporting infrastructure, spanning project management, IT support of data management, best practices in bioanalytical method transfer and sample analysis, and comprehensive knowledge of the requirements of bioanalysis guidelines and differences in these guidelines. A case study will highlight best practices for successful management of a global project.

[Development of performance evaluation and management system on advanced schistosomiasis medical treatment].

PubMed

Zhou, Xiao-Rong; Huang, Shui-Sheng; Gong, Xin-Guo; Cen, Li-Ping; Zhang, Cong; Zhu, Hong; Yang, Jun-Jing; Chen, Li

2012-04-01

To construct a performance evaluation and management system on advanced schistosomiasis medical treatment, and analyze and evaluate the work of the advanced schistosomiasis medical treatment over the years. By applying the database management technique and C++ programming technique, we inputted the information of the advanced schistosomiasis cases into the system, and comprehensively evaluated the work of the advanced schistosomiasis medical treatment through the cost-effect analysis, cost-effectiveness analysis, and cost-benefit analysis. We made a set of software formula about cost-effect analysis, cost-effectiveness analysis, and cost-benefit analysis. This system had many features such as clear building, easy to operate, friendly surface, convenient information input and information search. It could benefit the performance evaluation of the province's advanced schistosomiasis medical treatment work. This system can satisfy the current needs of advanced schistosomiasis medical treatment work and can be easy to be widely used.

Noonan syndrome: clinical features, diagnosis, and management guidelines.

PubMed

Romano, Alicia A; Allanson, Judith E; Dahlgren, Jovanna; Gelb, Bruce D; Hall, Bryan; Pierpont, Mary Ella; Roberts, Amy E; Robinson, Wanda; Takemoto, Clifford M; Noonan, Jacqueline A

2010-10-01

Noonan syndrome (NS) is a common, clinically and genetically heterogeneous condition characterized by distinctive facial features, short stature, chest deformity, congenital heart disease, and other comorbidities. Gene mutations identified in individuals with the NS phenotype are involved in the Ras/MAPK (mitogen-activated protein kinase) signal transduction pathway and currently explain ∼61% of NS cases. Thus, NS frequently remains a clinical diagnosis. Because of the variability in presentation and the need for multidisciplinary care, it is essential that the condition be identified and managed comprehensively. The Noonan Syndrome Support Group (NSSG) is a nonprofit organization committed to providing support, current information, and understanding to those affected by NS. The NSSG convened a conference of health care providers, all involved in various aspects of NS, to develop these guidelines for use by pediatricians in the diagnosis and management of individuals with NS and to provide updated genetic findings.

Registered File Support for Critical Operations Files at (Space Infrared Telescope Facility) SIRTF

NASA Technical Reports Server (NTRS)

Turek, G.; Handley, Tom; Jacobson, J.; Rector, J.

2001-01-01

The SIRTF Science Center's (SSC) Science Operations System (SOS) has to contend with nearly one hundred critical operations files via comprehensive file management services. The management is accomplished via the registered file system (otherwise known as TFS) which manages these files in a registered file repository composed of a virtual file system accessible via a TFS server and a file registration database. The TFS server provides controlled, reliable, and secure file transfer and storage by registering all file transactions and meta-data in the file registration database. An API is provided for application programs to communicate with TFS servers and the repository. A command line client implementing this API has been developed as a client tool. This paper describes the architecture, current implementation, but more importantly, the evolution of these services based on evolving community use cases and emerging information system technology.

Development and Implementation of a Comprehensive Risk Management Program at the USAF Academy Hospital.

DTIC Science & Technology

1980-04-01

much less con - cerned about malpractice problems. As a result of the program, they began to view the risk management program as their own and to recog...that con - tributes to better patient care. 131 Implementing Risk Management According to Donovan and Bader, an action plan for the systems approach might...Al87 344 DEVELOPMENT AND IMPLEMENTATION OF A COMPREHENSIVE RISK 1 MANAGEMENT PROGRAM AT THE USAF ACADEMY HOSPITAL(U) ARMY HEALTH CARE STUDIES AND

Comprehensive Yet Scalable Health Information Systems for Low Resource Settings: A Collaborative Effort in Sierra Leone

PubMed Central

Braa, Jørn; Kanter, Andrew S.; Lesh, Neal; Crichton, Ryan; Jolliffe, Bob; Sæbø, Johan; Kossi, Edem; Seebregts, Christopher J.

2010-01-01

We address the problem of how to integrate health information systems in low-income African countries in which technical infrastructure and human resources vary wildly within countries. We describe a set of tools to meet the needs of different service areas including managing aggregate indicators, patient level record systems, and mobile tools for community outreach. We present the case of Sierra Leone and use this case to motivate and illustrate an architecture that allows us to provide services at each level of the health system (national, regional, facility and community) and provide different configurations of the tools as appropriate for the individual area. Finally, we present a, collaborative implementation of this approach in Sierra Leone. PMID:21347003

Applying multi-criteria decision-making to improve the waste reduction policy in Taiwan.

PubMed

Su, Jun-Pin; Hung, Ming-Lung; Chao, Chia-Wei; Ma, Hwong-wen

2010-01-01

Over the past two decades, the waste reduction problem has been a major issue in environmental protection. Both recycling and waste reduction policies have become increasingly important. As the complexity of decision-making has increased, it has become evident that more factors must be considered in the development and implementation of policies aimed at resource recycling and waste reduction. There are many studies focused on waste management excluding waste reduction. This study paid more attention to waste reduction. Social, economic, and management aspects of waste treatment policies were considered in this study. Further, a life-cycle assessment model was applied as an evaluation system for the environmental aspect. Results of both quantitative and qualitative analyses on the social, economic, and management aspects were integrated via the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) method into the comprehensive decision-making support system of multi-criteria decision-making (MCDM). A case study evaluating the waste reduction policy in Taoyuan County is presented to demonstrate the feasibility of this model. In the case study, reinforcement of MSW sorting was shown to be the best practice. The model in this study can be applied to other cities faced with the waste reduction problems.

Indicated Prevention of Fetal Alcohol Spectrum Disorders in South Africa: Effectiveness of Case Management

PubMed Central

de Vries, Marlene M.; Joubert, Belinda; Cloete, Marise; Roux, Sumien; Baca, Beth A.; Hasken, Julie M.; Barnard, Ronel; Buckley, David; Kalberg, Wendy O.; Snell, Cudore L.; Marais, Anna-Susan; Seedat, Soraya; Parry, Charles D. H.; May, Philip A.

2015-01-01

In the Western Cape Province of South Africa (ZA) a subculture of binge drinking produces the highest global documented prevalence of fetal alcohol spectrum disorders (FASD). FASD prevention research activities in ZA use the Comprehensive Prevention approach from the United States Institute of Medicine. Case management (CM) was delivered as a method of indicated prevention to empower heavy drinking pregnant women to achieve cessation or a reduction in drinking. CM activities incorporated life management, Motivational Interviewing (MI) techniques and the Community Reinforcement Approach (CRA). Data were collected at baseline, 6, 12 and 18 months. Mean drinking decreases 6 months into CM; but overall alcohol consumption rose significantly over time to levels higher than baseline at 12 and 18 months. Alcohol consumption drops significantly from before pregnancy to the second and third trimesters. AUDIT scores indicate that problematic drinking decreases significantly even after the vulnerable fetus/baby was born. CM significantly increases client happiness, which correlates with reduced weekend drinking. CM was successful for women with high-risk drinking behaviour, and was effective in helping women stop drinking, or drink less, while pregnant, reducing the risk of FASD. PMID:26703708

The Global Nonalcoholic Fatty Liver Disease Epidemic: What a Radiologist Needs to Know

PubMed Central

Pereira, Keith; Salsamendi, Jason; Casillas, Javier

2015-01-01

Nonalcoholic fatty liver disease (NAFLD) represents a spectrum of disorders from a benign steatosis to hepatocellular carcinoma (HCC). Metabolic syndrome, mainly obesity, plays an important role, both as an independent risk factor and in the pathogenesis of NAFLD. With the progressive epidemics of obesity and diabetes mellitus, the prevalence of NAFLD and its associated complications is expected to increase dramatically. Therapeutic strategies for treating NAFLD and metabolic syndrome, particularly obesity, are continuously being refined. Their goal is the prevention of NAFLD by the management of risk factors, prevention of progression of the disease, as well as management of complications, ultimately preventing morbidity and mortality. Optimal management of NAFLD and metabolic syndrome requires a multidisciplinary collaboration between the government as well as the health system including the nutritionist, primary care physician, radiologist, hepatologist, oncologist, and transplant surgeon. An awareness of the clinical presentation, risk factors, pathogenesis, diagnosis, and management is of paramount importance to a radiologist, both from the clinical perspective as well as from the imaging standpoint. With expertise in imaging modalities as well as minimally invasive percutaneous endovascular therapies, radiologists play an essential role in the comprehensive management, which is highlighted in this article, with cases from our practice. We also briefly discuss transarterial embolization of the left gastric artery (LGA), a novel method that promises to have an enormous potential in the minimally invasive management of obesity, with details of a case from our practice. PMID:26167390

A blueprint-based case study analysis of nutrition services provided in a midterm care facility for the elderly.

PubMed

Paquet, Catherine; St-Arnaud-Mckenzie, Danielle; Ferland, Guylaine; Dubé, Laurette

2003-03-01

Ensuring nutritionally adequate food intake in institutions is a complex and important challenge for dietitians. To tackle this problem, we argue that dietitians need to adopt a systematic, integrative, and patient-centered approach to identify and manage more effectively organizational determinants of the quality of food intake under their control. In this study, we introduce such an approach, the blueprint-based case study, that we applied in the context of a midterm care facility for elderly patients. Data gathered through interviews and field observations were used to develop, from the perspective of key patient encounters, detailed representations of the food, nutrition, and nursing activities necessary to ensure adequate food intake. These service "blueprints" were developed to illustrate all activities that might potentially impact on the nutritional, sensory, functional, and social quality of patients' meals. They were also used as roadmaps to develop a case study analysis in which critical areas were identified and opportunities for improvement put forth, while considering services' resources and priorities. By providing a precise, objective, yet comprehensive mapping of the service operations and management, the blueprint-based case study approach represents a valuable tool to determine the optimal allocation of resources to insure nutritionally adequate food intake to patients.

Consensus oriented fuzzified decision support for oil spill contingency management.

PubMed

Liu, Xin; Wirtz, Kai W

2006-06-30

Studies on multi-group multi-criteria decision-making problems for oil spill contingency management are in their infancy. This paper presents a second-order fuzzy comprehensive evaluation (FCE) model to resolve decision-making problems in the area of contingency management after environmental disasters such as oil spills. To assess the performance of different oil combat strategies, second-order FCE allows for the utilization of lexical information, the consideration of ecological and socio-economic criteria and the involvement of a variety of stakeholders. On the other hand, the new approach can be validated by using internal and external checks, which refer to sensitivity tests regarding its internal setups and comparisons with other methods, respectively. Through a case study, the Pallas oil spill in the German Bight in 1998, it is demonstrated that this approach can help decision makers who search for an optimal strategy in multi-thread contingency problems and has a wider application potential in the field of integrated coastal zone management.

48 CFR 1602.170-3 - Comprehensive medical plan.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Comprehensive medical plan. 1602.170-3 Section 1602.170-3 Federal Acquisition Regulations System OFFICE OF PERSONNEL MANAGEMENT... Definitions of FEHBP Terms 1602.170-3 Comprehensive medical plan. Comprehensive Medical Plan means a plan as...

48 CFR 1602.170-3 - Comprehensive medical plan.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Comprehensive medical plan. 1602.170-3 Section 1602.170-3 Federal Acquisition Regulations System OFFICE OF PERSONNEL MANAGEMENT... Definitions of FEHBP Terms 1602.170-3 Comprehensive medical plan. Comprehensive Medical Plan means a plan as...

48 CFR 1602.170-3 - Comprehensive medical plan.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Comprehensive medical plan. 1602.170-3 Section 1602.170-3 Federal Acquisition Regulations System OFFICE OF PERSONNEL MANAGEMENT... Definitions of FEHBP Terms 1602.170-3 Comprehensive medical plan. Comprehensive Medical Plan means a plan as...

48 CFR 1602.170-3 - Comprehensive medical plan.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Comprehensive medical plan. 1602.170-3 Section 1602.170-3 Federal Acquisition Regulations System OFFICE OF PERSONNEL MANAGEMENT... Definitions of FEHBP Terms 1602.170-3 Comprehensive medical plan. Comprehensive Medical Plan means a plan as...

Promoting Stress Management: The Role of Comprehensive School Health Programs. ERIC Digest.

ERIC Educational Resources Information Center

Massey, Marilyn S.

This Digest examines how Comprehensive School Health Programs (CSHPs) may promote stress management in children and adolescents. CSHPs contain four key elements. The first element, community participation and focus, can be achieved through school health newsletters, health fairs, local newspaper, radio, and television promotions, and guest…

Change@ucsc.edu: Managing a Comprehensive Change Effort.

ERIC Educational Resources Information Center

Coate, L. Edwin

This monograph describes how team- and process-oriented change techniques such as Total Quality Management (TQM) and Business Process Reengineering (BPR), were adapted to an academic environment to effect a comprehensive change program at the University of California Santa Cruz (UCSC). The $3 million program, begun in 1993, produced radical…

76 FR 4637 - Taking and Importing Marine Mammals; U.S. Navy's Atlantic Fleet Active Sonar Training

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-26

... issuance of a Letter of Authorization; request for comments on Integrated Comprehensive Management Program... (Navy) to take marine mammals incidental to Navy training, maintenance, and research, development... notice that the Integrated Comprehensive Management Program (ICMP) Plan, which is intended for use as a...

Managing Stress and Feelings of Mastery among Swedish Comprehensive School Teachers.

ERIC Educational Resources Information Center

Jacobsson, Christian; Pousette, Anders; Thylefors, Ingela

2001-01-01

Created guidelines for stress management intervention by investigating the relationship of 12 factors with stress reactions and feelings of mastery among 826 Swedish teachers in 27 comprehensive schools. Teacher stress reactions were best predicted by perceived work demands, student misbehavior, and negative feedback, while mastery feelings were…

SAN JUAN BAY ESTUARY PROGRAM COMPREHENSIVE CONSERVATION AND MANAGEMENT PLAN IMPLEMENTATION TRACKING REPORT, 2004

EPA Science Inventory

Four years after the approval of its Comprehensive Conservation and Management Plan (CCMP), the San Juan Bay Estuary Program (SJBEP) is working towards the implementation stage of its 49 actions. During the last three years the program has focused its efforts in developing a coll...

Comprehensive integrated planning: A process for the Oak Ridge Reservation, Oak Ridge, Tennessee

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

NONE

1998-05-01

The Oak Ridge Comprehensive Integrated Plan is intended to assist the US Department of Energy (DOE) and contractor personnel in implementing a comprehensive integrated planning process consistent with DOE Order 430.1, Life Cycle Asset Management and Oak Ridge Operations Order 430. DOE contractors are charged with developing and producing the Comprehensive Integrated Plan, which serves as a summary document, providing information from other planning efforts regarding vision statements, missions, contextual conditions, resources and facilities, decision processes, and stakeholder involvement. The Comprehensive Integrated Plan is a planning reference that identifies primary issues regarding major changes in land and facility use andmore » serves all programs and functions on-site as well as the Oak Ridge Operations Office and DOE Headquarters. The Oak Ridge Reservation is a valuable national resource and is managed on the basis of the principles of ecosystem management and sustainable development and how mission, economic, ecological, social, and cultural factors are used to guide land- and facility-use decisions. The long-term goals of the comprehensive integrated planning process, in priority order, are to support DOE critical missions and to stimulate the economy while maintaining a quality environment.« less

Western Cape Primary Care Assessment Tool (PCAT) study: Measuring primary care organisation and performance in the Western Cape Province, South Africa (2013)

PubMed Central

Sayed, Abdul-Rauf; le Grange, Cynthia; Bhagwan, Susheela; Manga, Nayna; Hellenberg, Derek

2016-01-01

Background Major health sector reform and the need for baseline measures of performance to determine impact. Aim Baseline audit of primary healthcare (PHC) performance. Setting Cape Town and Cape Winelands (rural) PHC facilities (PCFs) in Western Cape Province, South Africa. Method The South African cross-culturally validated ZA PCAT to audit PHC performance on 11 subdomains associated with improved health and reduced costs. Adult PCF users systematically sampled. All full-time doctors and nurse practitioners in PCFs sampled and all PCF managers in sub-districts sampled invited into the study. Results Data from 1432 users, 100 clinicians and 64 managers from 13 PCFs in 10 sub-districts analysed (figures show stakeholder percentages scoring subdomain performance ‘acceptable to good’). 11.5% users scored access ‘acceptable to good’; community orientation and comprehensive services provided 20.8% and 39.9%, respectively. Total PHC score for users 50.2%; for managers and practitioners 82.8% and 88.0%, respectively. Among practitioners access was lowest (33.3%); PHC team (98.0%) and comprehensive services available (100.0%) highest. Among managers, access (13.5%) and family centredness (45.6%) are lowest; PHC team (85.9%) and comprehensive services available (90.6%) highest. Managers scored access, family centredness and cultural competence significantly lower than practitioners. Users scored comprehensive services available, comprehensive services provided and community orientation significantly lower than practitioners and managers. Conclusion Gaps between users’ experience and providers’ assessments of PHC performance are identified. Features that need strengthening and alignment with best practice, provincial and national, and health policies are highlighted with implications for practitioner and manager training, health policy, and research. PMID:27247157

Regional economic analysis of current and proposed management alternatives for Rappahannock River Valley National Wildlife Refuge

USGS Publications Warehouse

Koontz, Lynne; Sexton, Natalie; Donovan, Ryan

2009-01-01

The National Wildlife Refuge System Improvement Act of 1997 requires all units of the National Wildlife Refuge System to be managed under a Comprehensive Conservation Plan. The Comprehensive Conservation Plan must describe the desired future conditions of a refuge and provide long-range guidance and management direction to achieve refuge purposes. The Rappahannock River Valley National Wildlife Refuge (refuge) is in the process of developing a range of management goals, objectives, and strategies for the Comprehensive Conservation Plan. The Comprehensive Conservation Plan for the refuge must contain an analysis of expected effects associated with current and proposed refuge management strategies. The purpose of this study was to assess the regional economic implications associated with draft Comprehensive Conservation Plan management strategies. Special interest groups and local residents often criticize a change in refuge management, especially if there is a perceived negative impact to the local economy. Having objective data on economic impacts may show that these fears are overstated. Quite often, the extent of economic benefits a refuge provides to a local community is not fully recognized, yet at the same time the effects of negative changes is overstated. Spending associated with refuge recreational activities, such as wildlife viewing and hunting, can generate considerable tourist activity for surrounding communities. Additionally, refuge personnel typically spend considerable amounts of money purchasing supplies in local stores, repairing equipment and purchasing fuel at the local service stations, and reside and spend their salaries in the local community. For refuge Comprehensive Conservation Plan planning, a regional economic assessment provides a means of estimating how current management (no action alternative) and proposed management activities (alternatives) could affect the local economy. This type of analysis provides two critical pieces of information: (1) it illustrates a refuge's contribution to the local community; and (2) it can help in determining whether local economic effects are or are not a real concern in choosing among management alternatives. It is important to note that the economic value of a refuge encompasses more than just the impacts of the regional economy. Refuges also provide substantial nonmarket values (values for items not exchanged in established markets), such as maintaining endangered species, preserving wetlands, educating future generations, and adding stability to the ecosystem. However, quantifying these types of nonmarket values was beyond the scope of this study because of time and budget constraints.

Dynamic safety assessment of natural gas stations using Bayesian network.

PubMed

Zarei, Esmaeil; Azadeh, Ali; Khakzad, Nima; Aliabadi, Mostafa Mirzaei; Mohammadfam, Iraj

2017-01-05

Pipelines are one of the most popular and effective ways of transporting hazardous materials, especially natural gas. However, the rapid development of gas pipelines and stations in urban areas has introduced a serious threat to public safety and assets. Although different methods have been developed for risk analysis of gas transportation systems, a comprehensive methodology for risk analysis is still lacking, especially in natural gas stations. The present work is aimed at developing a dynamic and comprehensive quantitative risk analysis (DCQRA) approach for accident scenario and risk modeling of natural gas stations. In this approach, a FMEA is used for hazard analysis while a Bow-tie diagram and Bayesian network are employed to model the worst-case accident scenario and to assess the risks. The results have indicated that the failure of the regulator system was the worst-case accident scenario with the human error as the most contributing factor. Thus, in risk management plan of natural gas stations, priority should be given to the most probable root events and main contribution factors, which have identified in the present study, in order to reduce the occurrence probability of the accident scenarios and thus alleviate the risks. Copyright © 2016 Elsevier B.V. All rights reserved.

How Reading Comprehension Is Embodied and Why That Matters

ERIC Educational Resources Information Center

Glenberg, Arthur M.

2011-01-01

Reading comprehension, much like comprehension of situations and comprehension of oral language, is embodied. In all cases, comprehension is the ability to take effective action on the basis of affordances related to the body, the physical world, and personal goals and cultural norms. In language contexts, action-based comprehension arises from…

InWiM: knowledge management for insurance medicine.

PubMed

Bleuer, Juerg P; Bösch, Kurt; Ludwig, Christian A

2008-01-01

Suva (Swiss National Accident Insurance Fund) is the most important carrier of obligatory accident insurance in Switzerland. Its services not only comprise insurance but also prevention, case management and rehabilitation. Suva's medical division supports doctors in stationary and ambulatory care with comprehensive case management and with conciliar advice. Two Suva clinics provide stationary rehabilitation. Medicine in general, including insurance medicine, faces the problem of a diversity of opinions about the facts of a case. One of the reasons is a diversity of knowledge. This is the reason why Suva initiated a knowledge management project called InWiM. "InWiM" is the acronym for "Integrierte Wissensbasen der Medizin" which can be translated as "Integrated Knowledge Bases in Medicine". The project is part of an ISO 9001 certification program and comprises the definition and documentation of all processes in the field of knowledge management as well as the development of the underlying ITC infrastructure. The knowledge representation model used for the ICT implementation considers knowledge as a multidimensional network of interlinked units of information. In contrast to the hyperlink technology in the World Wide Web, links between items are bidirectional: the target knows the source of the link. Links are therefore called cross-links. The model allows annotation for the narrative description of the nature of the units of information (e.g. documents) and the cross-links as well. Information retrieval is achieved by means of a full implementation of the MeSH Index, the thesaurus of the United States National Library of Medicine (NLM). As far as the authors are aware, InWiM is currently the only implementation worldwide - with the exception of the NLM and its national representatives - which supports all MeSH features for in-house retrieval.

Parasite-based malaria diagnosis: Are Health Systems in Uganda equipped enough to implement the policy?

PubMed Central

2012-01-01

Background Malaria case management is a key strategy for malaria control. Effective coverage of parasite-based malaria diagnosis (PMD) remains limited in malaria endemic countries. This study assessed the health system's capacity to absorb PMD at primary health care facilities in Uganda. Methods In a cross sectional survey, using multi-stage cluster sampling, lower level health facilities (LLHF) in 11 districts in Uganda were assessed for 1) tools, 2) skills, 3) staff and infrastructure, and 4) structures, systems and roles necessary for the implementing of PMD. Results Tools for PMD (microscopy and/or RDTs) were available at 30 (24%) of the 125 LLHF. All LLHF had patient registers and 15% had functional in-patient facilities. Three months’ long stock-out periods were reported for oral and parenteral quinine at 39% and 47% of LLHF respectively. Out of 131 health workers interviewed, 86 (66%) were nursing assistants; 56 (43%) had received on-job training on malaria case management and 47 (36%) had adequate knowledge in malaria case management. Overall, only 18% (131/730) Ministry of Health approved staff positions were filled by qualified personnel and 12% were recruited or transferred within six months preceding the survey. Of 186 patients that received referrals from LLHF, 130(70%) had received pre-referral anti-malarial drugs, none received pre-referral rectal artesunate and 35% had been referred due to poor response to antimalarial drugs. Conclusion Primary health care facilities had inadequate human and infrastructural capacity to effectively implement universal parasite-based malaria diagnosis. The priority capacity building needs identified were: 1) recruitment and retention of qualified staff, 2) comprehensive training of health workers in fever management, 3) malaria diagnosis quality control systems and 4) strengthening of supply chain, stock management and referral systems. PMID:22920954

Spinal cord stimulation for FBSS and CRPS: A review of 80 cases with on-table trial of stimulation.

PubMed

Gopal, Hari; Fitzgerald, Joseph; McCrory, Connail

2016-01-01

Spinal cord stimulation (SCS) is used for the treatment of chronic neuropathic pain, a notoriously difficult condition to treat. Failed Back Surgery Syndrome (FBSS) and Complex Regional Pain syndrome (CRPS) remain the strongest indications. Funding remains a difficult issue and the use of trial of stimulation is the traditional method of ensuring best outcomes from implantation. A retrospective and consecutive review of 80 cases of spinal cord stimulation for patients with a diagnosis of FBSS and CRPS having undergone prior comprehensive medical management and interventional treatment with no sustained benefit. Trial of stimulation was performed on-table and if acceptable coverage was achieved, the case proceeded to full implantation. The mean patient age was 50.08 years (range 28-80 years). At 12 months follow-up, thirty two patients (40%) no longer required analgesic medication. Thirty patients (37.5%) reported their pain was manageable with first line analgesics. Fourteen (17.5%) reported their pain was manageable first line analgesic and occasional tramadol or codeine. Four (5%) reported that their pain was manageable with NSAID's, paracetamol, amitriptyline, and regular codeine or tramadol. Seventeen out of eighty patients (21.25%) were unemployed before SCS implant, and at 12 months follow up eight of these patients (47.05%) had returned to work. There was no infective complications or explants. Two patients (2.53%) required one lead revision, which was successful. SCS is the most effective treatment for FBSS and CRPS, which is proven resistant to medical management. On-table trial and implantation is easy to perform with good success rate and low morbidity and if successful will reduce complication rates, especially infection.

Integrated modelling of nitrate loads to coastal waters and land rent applied to catchment-scale water management.

PubMed

Refsgaard, A; Jacobsen, T; Jacobsen, B; Ørum, J-E

2007-01-01

The EU Water Framework Directive (WFD) requires an integrated approach to river basin management in order to meet environmental and ecological objectives. This paper presents concepts and full-scale application of an integrated modelling framework. The Ringkoebing Fjord basin is characterized by intensive agricultural production and leakage of nitrate constitute a major pollution problem with respect groundwater aquifers (drinking water), fresh surface water systems (water quality of lakes) and coastal receiving waters (eutrophication). The case study presented illustrates an advanced modelling approach applied in river basin management. Point sources (e.g. sewage treatment plant discharges) and distributed diffuse sources (nitrate leakage) are included to provide a modelling tool capable of simulating pollution transport from source to recipient to analyse the effects of specific, localized basin water management plans. The paper also includes a land rent modelling approach which can be used to choose the most cost-effective measures and the location of these measures. As a forerunner to the use of basin-scale models in WFD basin water management plans this project demonstrates the potential and limitations of comprehensive, integrated modelling tools.

Upper Cervical Epidural Abscess in Clinical Practice: Diagnosis and Management

PubMed Central

Al-Hourani, Khalid; Al-Aref, Rami; Mesfin, Addisu

2015-01-01

Study Design Narrative review. Objective Upper cervical epidural abscess (UCEA) is a rare surgical emergency. Despite increasing incidence, uncertainty remains as to how it should initially be managed. Risk factors for UCEA include immunocompromised hosts, diabetes mellitus, and intravenous drug use. Our objective is to provide a comprehensive overview of the literature including the history, clinical manifestations, diagnosis, and management of UCEA. Methods Using PubMed, studies published prior to 2015 were analyzed. We used the keywords “Upper cervical epidural abscess,” “C1 osteomyelitis,” “C2 osteomyelitis,” “C1 epidural abscess,” “C2 epidural abscess.” We excluded cases with tuberculosis. Results The review addresses epidemiology, etiology, imaging, microbiology, and diagnosis of this condition. We also address the nonoperative and operative management options and the relative indications for each as reviewed in the literature. Conclusion A high index of suspicion is required to diagnose this rare condition with magnetic resonance imaging being the imaging modality of choice. There has been a shift toward surgical management of this condition in recent times, with favorable outcomes. PMID:27190742

Comprehensive care improves health outcomes among elderly Taiwanese patients with hip fracture.

PubMed

Shyu, Yea-Ing L; Liang, Jersey; Tseng, Ming-Yueh; Li, Hsiao-Juan; Wu, Chi-Chuan; Cheng, Huey-Shinn; Yang, Ching-Tzu; Chou, Shih-Wei; Chen, Ching-Yen

2013-02-01

Few studies have investigated the effects of care models that combine interdisciplinary care with nutrition consultation, depression management, and fall prevention in older persons with hip fracture. The purpose of this study was to compare the effects of a comprehensive care program with those of interdisciplinary care and usual care for elderly patients with hip fracture. A randomized experimental trial was used to explore outcomes for 299 elderly patients with hip fracture receiving three treatment care models: interdisciplinary care (n = 101), comprehensive care (n = 99), and usual care (n = 99). Interdisciplinary care included geriatric consultation, continuous rehabilitation, and discharge planning with post-hospital services. Comprehensive care consisted of interdisciplinary care plus nutrition consultation, depression management, and fall prevention. Usual care included only in-hospital rehabilitation without geriatric consultation, in-home rehabilitation, and home environmental assessment. Participants in the comprehensive care group had better self-care ability (odds ratio, OR = 3.19, p < .01) and less risk of depression (OR = 0.48, p < .01) than those who received usual care. The comprehensive care group had less risk of depression (OR = 0.51, p < .05) and of malnutrition (OR = 0.48, p < .05) than the interdisciplinary care group during the first year following discharge. Older persons with hip fracture benefitted more from the comprehensive care program than from interdisciplinary care and usual care. Older persons with hip fracture benefitted more from comprehensive care including interdisciplinary care and nutrition consultation, depression management, and fall prevention than simply interdisciplinary care.

LANDFIRE

USGS Publications Warehouse

Zahn, Stephen G.

2015-07-13

LANDFIRE data products are primarily designed and developed to be used at the landscape level to facilitate national and regional strategic planning and reporting of wild land fire and other natural resource management activities. However, LANDFIRE’s spatially comprehensive dataset can also be adapted to support a variety of local management applications that need current and comprehensive geospatial data.

50 CFR 80.81 - What must an agency submit when applying for a comprehensive-management-system grant?

Code of Federal Regulations, 2014 CFR

2014-10-01

... for a comprehensive-management-system grant? 80.81 Section 80.81 Wildlife and Fisheries UNITED STATES... SPORT FISH RESTORATION PROGRAM ADMINISTRATIVE REQUIREMENTS, PITTMAN-ROBERTSON WILDLIFE RESTORATION AND DINGELL-JOHNSON SPORT FISH RESTORATION ACTS Application for a Grant § 80.81 What must an agency submit...

50 CFR 80.81 - What must an agency submit when applying for a comprehensive-management-system grant?

Code of Federal Regulations, 2013 CFR

2013-10-01

... for a comprehensive-management-system grant? 80.81 Section 80.81 Wildlife and Fisheries UNITED STATES... SPORT FISH RESTORATION PROGRAM ADMINISTRATIVE REQUIREMENTS, PITTMAN-ROBERTSON WILDLIFE RESTORATION AND DINGELL-JOHNSON SPORT FISH RESTORATION ACTS Application for a Grant § 80.81 What must an agency submit...

[Clinical analysis of using hyperbaric oxygen comprehensive therapy for the treatment of 110 cases noise induced deafness].

PubMed

Tan, Junwu; Li, Liangbo; Peng, Hong

2014-10-01

To observe the clinical effects of using hyperbaric oxygen comprehensive therapy for the treatment of noise induced deafness. From May 2009 to April 2012 in our hospital 220 cases of noise induced deafness patients were chosen and they were all construction workers; According to different treatments all patients were divided into the control group (110 cases) only having hyperbaric oxygen treatment and the treatment group (110 cases) using hyperbaric oxygen comprehensive therapy, including control group simply by. Hearing improvements of the two groups were recorded and compared. The cure rate of the comprehensive therapy group was 53.6%which was higher than that of the control group 38.2% (χ(2) = 5.290, P < 5.290), while the total effective rate of the comprehensive therapy group was 79.1%which was also significantly higher than that of the control group 67.3% (χ(2) = 3.914, P < 0.05). After two courses of comprehensive treatment the cure rate and total effective rate were 47.3%and 73.6%respectively, while after four courses of comprehensive treatment group the cure rate and total effective rate turned to be 60.9% and 84.5% respectively, which had significant difference (χ(2) values were 4.118 and 3.958, P < 0.05). The cure rate and total effective rate of the comprehensive therapy group are higher than the simple hyperbaric oxygen treatment group, which is worthy of clinical application and promotion in the future.

Establishing a nursing strategic agenda: the whys and wherefores.

PubMed

Young, Claire

2008-01-01

The health system nursing leader is responsible for providing high-quality, service-oriented nursing care to deliver such care with disciplined cost management; to lead and develop a group of nursing executives and managers at the facility level; to establish nursing professional development programs; to build and maintain an effective supply of nurses; and to advocate for nurses and patients. Balancing these imperatives requires thoughtful strategic planning and disciplined execution. In their absence, organizations flounder to address a single problem in isolation and struggle to perform against outcomes. One organization approached the challenge by engaging in a comprehensive, accelerated strategic planning process. The experience brought together 11 hospital nursing executives in consensus around a prioritized strategic agenda. This article is a case study of the approach used to define a nursing agenda.

A Virtual Patient Software Program to Improve Pharmacy Student Learning in a Comprehensive Disease Management Course

PubMed Central

Casale, Jillian P.; Skirvin, J. Andrew; DiVall, Margarita V.

2013-01-01

Objective. To implement and assess the impact of a virtual patient pilot program on pharmacy students’ clinical competence skills. Design. Pharmacy students completed interactive software-based patient case scenarios embedded with drug-therapy problems as part of a course requirement at the end of their third year. Assessment. Assessments included drug-therapy problem competency achievement, performance on a pretest and posttest, and pilot evaluation survey instrument. Significant improvements in students’ posttest scores demonstrated advancement of clinical skills involving drug-therapy problem solving. Students agreed that completing the pilot program improved their chronic disease management skills and the program summarized the course series well. Conclusion. Using virtual patient technology allowed for assessment of student competencies and improved learning outcomes. PMID:24159213

When siting works, Canada-style.

PubMed

Rabe, B G

1992-01-01

Hazardous waste management poses increasing problems for Canadian provinces and American states, given the vast quantities and types of wastes generated and the virtual inability to open new storage, treatment, or disposal facilities. The Canadian experience is very similar to the American one in many respects, except for the fact that three provinces (Alberta, Manitoba, and Quebec) have devised alternative approaches to siting that appear successful in moving beyond the political gridlock so common on this issue. In each of these cases, traditional, top-down approaches to siting have been eschewed in favor of a more comprehensive approach that includes extensive public participation, economic and social compensation packages, formal partnerships between public and private organizations, and direct links between siting proposals and other aspects of waste management, including waste reduction, recycling, and export/import control.

Presentation and Treatment of Poland Anomaly

PubMed Central

Buckwalter V, Joseph A.; Shah, Apurva S.

2016-01-01

Background: Poland anomaly is a sporadic, phenotypically variable congenital condition usually characterized by unilateral pectoral muscle agenesis and ipsilateral hand deformity. Methods: A comprehensive review of the medical literature on Poland anomaly was performed using a Medline search. Results: Poland anomaly is a sporadic, phenotypically variable congenital condition usually characterized by unilateral, simple syndactyly with ipsilateral limb hypoplasia and pectoralis muscle agenesis. Operative management of syndactyly in Poland anomaly is determined by the severity of hand involvement and the resulting anatomical dysfunction. Syndactyly reconstruction is recommended in all but the mildest cases because most patients with Poland anomaly have notable brachydactyly, and digital separation can improve functional length. Conclusions: Improved understanding the etiology and presentation of Poland anomaly can improve clinician recognition and management of this rare congenital condition. PMID:28149203

[Epidemic situation of oversea imported schistosomiasis in China and thinking about its prevention and control].

PubMed

Zhu, Rong; Xu, Jing

2014-04-01

The imported schistosomiasis cases in the Chinese literature and reports from the infectious disease monitoring information system from 1979 to 2013 were collected and compiled. Totally 365 cases were reported to be infected with outside schistosomiasis, including 239 cases of schistosomiasis haematobia (74.0%) and 71 cases of schistosomiasis mansoni (22.0%), and 42 foreigners (11.5%) and 323 Chinese (88.5%). The infection areas involved 15 countries and regions in Africa. Totally 74.92% of patients worked in the construction or geological prospecting in the wild field. According to the analysis of these cases, we found that the management system of prevention and control of imported schistosomiasis cases was not perfect including the high missing re-port rate, high misdiagnosis rate, and no standard diagnostic criteria. We suggest that all the levels of CDC or health administrative authorities should adopt the following relevant control measures to strengthen the imported schistosomiasis prevention and control in order to reduce the damage to the public health and the risk of the spread of African schistosomiasis in China: (1) to establish and perfect the imported schistosomiasis monitoring and control system in China; (2) to integrate the dynamic information platform of labor export and establish the comprehensive prevention and control management system of infectious diseases; (3) to standardize the diagnosis and treatment of oversea imported schistosomiasis; (4) to strengthen the research on the transmission risk of imported schistosomiasis in the territory of China.

Simulation: A Complementary Method for Teaching Health Services Strategic Management

PubMed Central

Reddick, W. T.

1990-01-01

Rapid change in the health care environment mandates a more comprehensive approach to the education of future health administrators. The area of consideration in this study is that of health care strategic management. A comprehensive literature review suggests microcomputer-based simulation as an appropriate vehicle for addressing the needs of both educators and students. Seven strategic management software packages are reviewed and rated with an instrument adapted from the Infoworld review format. The author concludes that a primary concern is the paucity of health care specific strategic management simulations.

A holistic approach to the mycetoma management.

PubMed

Bakhiet, Sahar Mubarak; Fahal, Ahmed Hassan; Musa, Ahmed Mudawi; Mohamed, El Samani Wadaa; Omer, Rowa Fathelrahman; Ahmed, Eiman Siddig; El Nour, Mustafa; Mustafa, El Rayah Mohamed; Sheikh A Rahman, Manar El; Suliman, Suliman Hussein; El Mamoun, Mohamed A Gadir; El Amin, Hajo Mohamed

2018-05-01

Mycetoma, one of the badly neglected tropical diseases, it is a localised chronic granulomatous inflammatory disease characterised by painless subcutaneous mass and formation of multiple sinuses that produce purulent discharge and grains. If untreated early and appropriately, it usually spread to affect the deep structures and bone resulting in massive damage, deformities and disabilities. It can also spread via the lymphatics and blood leading to distant secondary satellites associated with high morbidity and mortality. To date and despite progress in mycetoma research, a huge knowledge gap remains in mycetoma pathogenesis and epidemiology resulting in the lack of objective and effective control programmes. Currently, the available disease control method is early case detection and proper management. However, the majority of patients present late with immense disease and for many of them, heroic substantial deforming surgical excisions or amputation are the only prevailing treatment options. In this communication, the Mycetoma Research Center (MRC), Sudan shares its experience in implementing a new holistic approach to manage mycetoma patients locally at the village level. The MRC in collaboration with Sennar State Ministry of Health, Sudan had established a region mycetoma centre in one of the endemic mycetoma villages in the state. The patients were treated locally in that centre, the local medical and health personals were trained on early case detection and management, the local community was trained on mycetoma advocacy, and environmental conditions improvement. This comprehensive approach had also addressed the patients' socioeconomic constraints that hinder early presentation and treatment. This approach has also included the active local health authorities, community and civil society participation and contributions to deliver the best management. This holistic approach for mycetoma patients' management proved to be effective for early case detection and management, optimal treatment and treatment outcome and favourable disease prognosis. During the study period, the number of patients with massive lesions and the amputation rate had dropped and that had reduced the disease medical and socioeconomic burdens on patients and families.

Alternative Endpoints and Approaches Selected for the Remediation of Contaminated Groundwater at Complex Sites

NASA Astrophysics Data System (ADS)

Deeb, R. A.; Hawley, E.

2011-12-01

This presentation will focus on findings, statistics, and case studies from a recently-completed report for the Department of Defense's Environmental Security Technology Certification Program (ESTCP) (Project ER-0832) on alternative endpoints and alternative remedial strategies for groundwater remediation under a variety of Federal and state cleanup programs, including technical impracticability (TI) and other Applicable or Relevant and Appropriate Requirement (ARAR) waivers, state and local designations such as groundwater management zones, Alternate Concentration Limits (ACLs), use of monitored natural attenuation (MNA) over long timeframes, and more. The primary objective of the project was to provide environmental managers and regulators with tools, metrics, and information needed to evaluate alternative endpoints for groundwater remediation at complex sites. A statistical analysis of Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) sites receiving TI waivers will be presented as well as case studies of other types of alternative endpoints and alternative remedial strategies to illustrate the variety of approaches used at complex sites and the technical analyses used to predict and document cost, timeframe, and potential remedial effectiveness. Case studies provide examples of the flexible, site-specific, application of alternative endpoints and alternative remedial strategies that have been used in the past to manage and remediate groundwater contamination at complex sites. For example, at least 13 states consider some designation for groundwater containment in their corrective action policies, such as groundwater management zones, containment zones, and groundwater classification exemption areas. These designations typically indicate that groundwater contamination is present above permissible levels. Soil and groundwater within these zones are managed to protect human health and the environment. Lesson learned for the analyses conducted and the case studies evaluated allow for a more careful consideration of alternative, beneficial, and cost-effective cleanup objectives and metrics that can be achieved over the short-term (while eventually meeting long-term cleanup objectives or demonstrating the applicability of alternative endpoints), thus improving the site cleanup process at complex sites where appropriate.

The Union Health Center: a working model of clinical care linked to preventive occupational health services.

PubMed

Herbert, R; Plattus, B; Kellogg, L; Luo, J; Marcus, M; Mascolo, A; Landrigan, P J

1997-03-01

As health care provision in the United States shifts to primary care settings, it is vital that new models of occupational health services be developed that link clinical care to prevention. The model program described in this paper was developed at the Union Health Center (UHC), a comprehensive health care center supported by the International Ladies Garment Workers Union (now the Union of Needletrades, Industrial and Textile Employees) serving a population of approximately 50,000 primarily minority, female garment workers in New York City. The objective of this paper is to describe a model occupational medicine program in a union-based comprehensive health center linking accessible clinical care with primary and secondary disease prevention efforts. To assess the presence of symptoms suggestive of occupational disease, a health status questionnaire was administered to female workers attending the UHC for routine health maintenance. Based on the results of this survey, an occupational medicine clinic was developed that integrated direct clinical care with worker and employer education and workplace hazard abatement. To assess the success of this new approach, selected cases of sentinel health events were tracked and a chart review was conducted after 3 years of clinic operation. Prior to initiation of the occupational medicine clinic, 64% (648) of the workers surveyed reported symptoms indicative of occupational illnesses. However, only 42 (4%) reported having been told by a physician that they had an occupational illness and only 4 (.4%) reported having field a workers' compensation claim for an occupational disease. In the occupational medicine clinic established at the UHC, a health and safety specialist acts as a case manager, coordinating worker and employer education as well as workplace hazard abatement focused on disease prevention, ensuring that every case of occupational disease is treated as a potential sentinel health event. As examples of the success of this approach, index cases of rotator cuff tendonitis, lead poisoning, and formaldehyde overexposure in three patients and their preventative workplace follow-up, affecting approximately 150 workers at three worksites, are described. Work-related conditions diagnosed during the first 3 years of clinic operation included cumulative trauma disorders (141 cases), carpal tunnel syndrome (47 cases), low back disorders (33 cases), lead poisoning (20 cases), and respiratory disease (9 cases). This pilot project represents a new model for effective integration of clinical care and occupational disease prevention efforts within a primary care center. It could serve as a prototype for development of such services in other managed and primary care settings.

Building Comprehensive Career Guidance Programs for Secondary Schools: A Handbook of Programs, Practices, and Models. Research and Development Series No. 147.

ERIC Educational Resources Information Center

Campbell, Robert E.; And Others

This handbook presents management techniques, program ideas, and student activities for building comprehensive secondary career guidance programs. Part 1 (chapter 1) traces the history of guidance to set the stage for the current emphasis on comprehensive programs, summarizes four representative models for designing comprehensive programs, and…

JOINT MOBILIZATION IN THE MANAGEMENT OF PERSISTENT INSERTIONAL ACHILLES TENDINOPATHY: A CASE REPORT.

PubMed

Jayaseelan, Dhinu J; Post, Andrew A; Mischke, John J; Sault, Josiah D

2017-02-01

Insertional Achilles tendinopathy (IAT) can be a challenging condition to manage conservatively. Eccentric exercise is commonly used in the management of chronic tendinopathy; however, it may not be as helpful for insertional tendon problems as compared to mid-portion dysfunction. While current evidence describing the physical therapy management of IAT is developing, gaps still exist in descriptions of best practice. The purpose of this case report is to describe the management of a patient with persistent IAT utilizing impairment-based joint mobilization, self-mobilization, and exercise. A 51-year-old male was seen in physical therapy for complaints of posterior heel pain and reduced running capacity. He was seen by multiple physical therapists previously, but reported continued impairment, and functional restriction. Joint-based non-thrust mobilization and self-mobilization exercise were performed to enhance his ability to run and reduce symptoms. The subject was seen for four visits over the course of two months. He made clinically significant improvements on the Foot and Ankle Activity Measure and Victorian Institute of Sport Assessment-Achilles tendon outcomes, was asymptomatic, and participated in numerous marathons. Improvements were maintained at one-year follow-up. Mobility deficits can contribute to the development of tendinopathy, and without addressing movement restrictions, symptoms and functional decline related to tendinopathy may persist. Joint-directed manual therapy may be a beneficial intervention in a comprehensive plan of care in allowing patients with chronic tendon changes to optimize function. Therapy, Level 4.

Bringing Back a Healthy Buzz? Invertebrate Parasites and Reintroductions: A Case Study in Bumblebees.

PubMed

Brown, Mark J F; Sainsbury, Anthony W; Vaughan-Higgins, Rebecca J; Measures, Gavin H; Jones, Catherine M; Gammans, Nikki

2017-03-01

Reintroductions can play a key role in the conservation of endangered species. Parasites may impact reintroductions, both positively and negatively, but few case studies of how to manage parasites during reintroductions exist. Bumblebees are in decline at regional and global scales, and reintroductions can be used to re-establish extinct local populations. Here we report on how the risks associated with parasites are being managed in an ongoing reintroduction of the short-haired bumblebee, Bombus subterraneus, to the UK. Disease risk analysis was conducted and disease risk management plans constructed to design a capture-quarantine-release system that minimised the impacts on both the bumblebees and on their natural parasites. Given that bumblebee parasites are (i) generalists, (ii) geographically ubiquitous, and (iii) show evidence of local adaptation, the disease risk management plan was designed to limit the co-introduction of parasites from the source population in Sweden to the destination site in the UK. Results suggest that this process at best eliminated, or at least severely curtailed the co-introduction of parasites, and ongoing updates of the plan enabled minimization of impacts on natural host-parasite dynamics in the Swedish source population. This study suggests that methods designed for reintroductions of vertebrate species can be successfully applied to invertebrates. Future reintroductions of invertebrates where the parasite fauna is less well known should take advantage of next-generation barcoding and multiple survey years prior to the start of reintroductions, to develop comprehensive disease risk management plans.

How Mode of Delivery Affects Comprehension of an Operations Management Simulation: Online vs Face-to-Face Classrooms

ERIC Educational Resources Information Center

Riley, Jason M.; Ellegood, William A.; Solomon, Stanislaus; Baker, Jerrine

2017-01-01

Purpose: This study aims to understand how mode of delivery, online versus face-to-face, affects comprehension when teaching operations management concepts via a simulation. Conceptually, the aim is to identify factors that influence the students' ability to learn and retain new concepts. Design/methodology/approach: Leveraging Littlefield…

Comprehensive Instructional Management System (CIMS). A Cyclical Mathematics Curriculum. Workbook Part 2. Experimental. Level K.

ERIC Educational Resources Information Center

New York City Board of Education, Brooklyn, NY. Div. of Curriculum and Instruction.

This document is part 2 of the workbook for kindergarten pupils in the Comprehensive Instructional Management System, a unified mathematics curriculum for kindergarten through grade 7. Each objective is developed by a variety of strategies, with mastery of objectives diagnosed through a testing component. The activities in the student workbook are…

50 CFR 80.81 - What must an agency submit when applying for a comprehensive-management-system grant?

Code of Federal Regulations, 2012 CFR

2012-10-01

... for a comprehensive-management-system grant? 80.81 Section 80.81 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) FINANCIAL ASSISTANCE-WILDLIFE SPORT... DINGELL-JOHNSON SPORT FISH RESTORATION ACTS Application for a Grant § 80.81 What must an agency submit...

Preoperative Evaluation and Endovascular Procedure of Intraoperative Aneurysm Rupture During Thoracic Endovascular Aortic Repair

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

Zha, Bin-Shan, E-mail: binszha2013@163.com; Zhu, Hua-Gang, E-mail: huagzhu@yeah.net; Ye, Yu-Sheng, E-mail: yeyusheng@aliyun.com

Thoracic aortic aneurysms are now routinely repaired with endovascular repair if anatomically feasible because of advantages in safety and recovery. However, intraoperative aneurysm rupture is a severe complication which may have an adverse effect on the outcome of treatment. Comprehensive preoperative assessment and considerate treatment are keys to success of endovascular aneurysm repair, especially during unexpected circumstances. Few cases have reported on intraoperative aortic rupture, which were successfully managed by endovascular treatment. Here, we present a rare case of an intraoperative aneurysm rupture during endovascular repair of thoracic aortic aneurysm with narrow neck and angulated aorta arch (coarctation-associated aneurysm), whichmore » was successfully treated using double access route approach and iliac limbs of infrarenal devices.Level of EvidenceLevel 5.« less

The "Total Worker Health" Concept: A Case Study in a Rural Workplace.

PubMed

Watkins, Cecilia; Macy, Gretchen; Golla, Vijay; Lartey, Grace; Basham, Jacqueline

2018-05-01

This case study was conducted to identify barriers of integration of health protection and health promotion in rural workplaces with tailored interventions that address the identified barriers. Data on a workplace's ability to integrate wellness programs and health protection programs were collected through a questionnaire along with a seven-question interview. Descriptive statistics were used to analyze the quantitative data. Qualitative measures were assessed using thematic analysis. Based off the results of the assessments, the company received tailored training sessions. The largest hindrance to organizational support was time. However, improved knowledge about the need and importance of integration helped the participants to conceptualize and plan for more collaboration between departments. New ways to increase integration at workplaces, especially rural workplaces are needed. More comprehensive interventions that include management are also needed.

Esthetic enhancement of a traumatized anterior tooth with a combination of forced eruption and tooth alignment: a case report

PubMed Central

Kang, So-Hee; Jin, Myoung-Uk; Kim, Sung-Kyo

2016-01-01

Exposing sound structure of a subgingivally fractured tooth using orthodontic extrusion is considered to be a conservative way to re-establish biologic width without sacrificing esthetics or jeopardizing periodontal support of neighboring teeth. When a misaligned tooth is traumatically involved, a more comprehensive approach combining tooth extrusion and re-alignment may be necessary for a successful restorative outcome. This case report describes a successful esthetic management of a patient with complicated crown-root fracture on the maxillary right central incisor and pre-existing malocclusion in the maxillary anterior region. Forced eruption along with re-alignment of teeth by orthodontic movement seems to allow re-positioning of the fracture line to a favorable position and correction of crowding, providing a better esthetic result. PMID:27508163

Orthodontic treatment for a patient with hereditary angiodema: a case report.

PubMed

Waldon, Kate; Barber, Sophy Kathleen; Spencer, Richard James

2015-05-01

Hereditary angiodema (HAE), also known as C1 esterase inhibitor deficiency, causes sufferers to experience episodic subcutaneous and submucosal oedema. These episodes can be triggered by dental treatment and manifest as life-threatening oedematous swelling in the head and neck region. This case report reviews an adolescent with hereditary angiodema whose malocclusion required orthodontic intervention. Due to her complex and unpredictable reaction to dental treatment, various options were explored before determining the appropriate care pathway for this patient. Trial placement of a sectional fixed appliance tested the tissue reaction prior to comprehensive treatment including extractions and fixed orthodontic appliances. This report demonstrates successful interdisciplinary management facilitating orthodontic care in a patient with HAE. © 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

PubMed

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

2016-01-01

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

Integrating care for older people with complex needs: key insights and lessons from a seven-country cross-case analysis.

PubMed

Wodchis, Walter P; Dixon, Anna; Anderson, Geoff M; Goodwin, Nick

2015-01-01

To address the challenges of caring for a growing number of older people with a mix of both health problems and functional impairment, programmes in different countries have different approaches to integrating health and social service supports. The goal of this analysis is to identify important lessons for policy makers and service providers to enable better design, implementation and spread of successful integrated care models. This paper provides a structured cross-case synthesis of seven integrated care programmes in Australia, Canada, the Netherlands, New Zealand, Sweden, the UK and the USA. All seven programmes involved bottom-up innovation driven by local needs and included: (1) a single point of entry, (2) holistic care assessments, (3) comprehensive care planning, (4) care co-ordination and (5) a well-connected provider network. The process of achieving successful integration involves collaboration and, although the specific types of collaboration varied considerably across the seven case studies, all involved a care coordinator or case manager. Most programmes were not systematically evaluated but the two with formal external evaluations showed benefit and have been expanded. Case managers or care coordinators who support patient-centred collaborative care are key to successful integration in all our cases as are policies that provide funds and support for local initiatives that allow for bottom-up innovation. However, more robust and systematic evaluation of these initiatives is needed to clarify the 'business case' for integrated health and social care and to ensure successful generalization of local successes.

The enigma of nonarteritic anterior ischemic optic neuropathy: an update for the comprehensive ophthalmologist.

PubMed

Gaier, Eric D; Torun, Nurhan

2016-11-01

Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common cause of acute optic nerve injury, and frequently presents to comprehensive ophthalmologists. We review the typical and atypical clinical features and current literature on various treatment modalities for NAION. The epidemiology and clinical presentation of this disease can be variable, making a definitive diagnosis difficult in many cases. In addition, the differential diagnoses for this disorder, although comprising much less prevalent entities, are quite broad and can have substantial systemic implications if these alternatives go unrecognized. NAION has many systemic associations and comorbidities that deserve inquiry when the diagnosis is made. There are currently no widely accepted, evidence-based treatments for NAION. All recommendations made to patients to reduce their risk of sequential eye involvement, including avoidance of potential nocturnal hypotension, erectile dysfunction medication, and treatment of obstructive sleep apnea, have theoretical bases. NAION is a common cause of acute vision loss in adult and older patients, and thus, comprehensive ophthalmologists need to be able to diagnose and appropriately manage this disorder. We anticipate fruitful results from current and future trials aimed at neuroprotection in the affected eye and prevention of sequential eye involvement.

[Team work and interdiciplinarity: challenges facing the implementation of comprehensive outpatient care for people with HIV/Aids in Pernambuco].

PubMed

Borges, Maria Jucineide Lopes; Sampaio, Aletheia Soares; Gurgel, Idê Gomes Dantas

2012-01-01

The complexity of providing healthcare to people with HIV/Aids requires investment in comprehensive action and care, constituting a challenge for the multidisciplinary work teams to build an interdisciplinary practice. This study sought to analyze comprehensive healthcare in the Specialized Assistance Services for HIV/Aids (SAE-HIV/Aids) in Recife, in the State of Pernambuco, starting with the process and organization of team work. This is a case study developed in three SAE-HIV/Aids units, based on a qualitative approach using different research techniques. The results show that SAE-HIV/Aids have complied with most of the Brazilian Health Ministry recommendations in terms of basic infrastructure, though none of them had a team of appropriate size. These services have shown signs of fragmentation and difficulty in establishing a systematic intersectorial and interdisciplinary practice, with failings in ensuring the reference and counter-reference flow. It was seen that there was little appreciation of the role of the manager as team leader. The need to perceive the user as a whole was identified, as well as for the team to work in a coordinated manner in order to ensure communicative and relational activities.

The Business Change Initiative: A Novel Approach to Improved Cost and Schedule Management

NASA Technical Reports Server (NTRS)

Shinn, Stephen A.; Bryson, Jonathan; Klein, Gerald; Lunz-Ruark, Val; Majerowicz, Walt; McKeever, J.; Nair, Param

2016-01-01

Goddard Space Flight Center's Flight Projects Directorate employed a Business Change Initiative (BCI) to infuse a series of activities coordinated to drive improved cost and schedule performance across Goddard's missions. This sustaining change framework provides a platform to manage and implement cost and schedule control techniques throughout the project portfolio. The BCI concluded in December 2014, deploying over 100 cost and schedule management changes including best practices, tools, methods, training, and knowledge sharing. The new business approach has driven the portfolio to improved programmatic performance. The last eight launched GSFC missions have optimized cost, schedule, and technical performance on a sustained basis to deliver on time and within budget, returning funds in many cases. While not every future mission will boast such strong performance, improved cost and schedule tools, management practices, and ongoing comprehensive evaluations of program planning and control methods to refine and implement best practices will continue to provide a framework for sustained performance. This paper will describe the tools, techniques, and processes developed during the BCI and the utilization of collaborative content management tools to disseminate project planning and control techniques to ensure continuous collaboration and optimization of cost and schedule management in the future.

Obstructive sleep apnoea in adults: a common chronic condition in need of a comprehensive chronic condition management approach.

PubMed

Heatley, Emer M; Harris, Melanie; Battersby, Malcolm; McEvoy, R Doug; Chai-Coetzer, Ching Li; Antic, Nicholas A

2013-10-01

Obstructive sleep apnoea (OSA) is a common disorder that has all the characteristics of a chronic condition. As with other chronic conditions, OSA requires ongoing management of treatments and problems, such as residual symptoms, deficits and co-morbidities. Also, many OSA patients have modifiable lifestyle factors that contribute to their disease, which could be improved with intervention. As health systems are in the process of developing more comprehensive chronic care structures and supports, tools such as chronic condition management programs are available to enable OSA patients and their health care providers to further engage and collaborate in health management. This review explains why the OSA patient group requires a more comprehensive approach to disease management, describes the chronic care model as a platform for management of chronic conditions, and assesses the suitability of particular chronic disease management programs in relation to the needs of the OSA population. Implementation of an evidence-based health-professional-led chronic condition management program into OSA patient care is likely to provide a context in which health risks are properly acknowledged and addressed. Such programs present an important opportunity to enable more optimal health outcomes than is possible by device-focused management alone. Copyright © 2012 Elsevier Ltd. All rights reserved.

Paracoccidioidomycosis: case report and review.

PubMed

Manns, B J; Baylis, B W; Urbanski, S J; Gibb, A P; Rabin, H R

1996-11-01

A previously well 59-year-old man presented with paracoccidioidomycosis, more than 15 years after leaving South America. He failed to respond to conventional therapies, first with oral itraconazole and then with amphotericin B plus sulfadiazine, and eventually died of recurrent arterial emboli possibly due to paracoccidioidomycotic aortitis. This patient's presentation demonstrates the difficulties that may be encountered in diagnosing and managing this disease. Paracoccidioidomycosis should be suspected in patients with an appropriate travel history who experience weight loss and have pulmonary, mucosal, and cutaneous lesions. This article comprehensively reviews the literature, with emphasis on epidemiology, clinical presentation, diagnosis, and therapy with imidazole antifungal medications.

Suggested guidelines for the management of high-profile fatality cases.

PubMed

Perper, Joshua A; Juste, Gertrude M; Schueler, Harold E; Motte, Reinhard W; Cina, Stephen J

2008-10-01

The investigation of high-profile fatalities poses special challenges to medical examiners and coroners. Most high-profile cases can be readily recognized early in the course of the investigation. Commonly encountered examples include police-related fatalities or deaths in custody, deaths of celebrities, and mass fatalities or clustered deaths (eg, serial killers). Medical examiner and coroner offices should have policies and procedures in place for adequately handling such cases. A rational approach to these high-profile cases includes activating medical examiner or coroner investigative teams, preplanning before the autopsy, using special autopsy techniques and toxicology procedures, skillful questioning of key witnesses, preparing detailed and comprehensive reports, and planning effective communication with the media. The investigation of the sudden and unexpected death of Anna Nicole Smith, an entertainment personality, is presented as an example of how to address the challenging issues inherent in high-profile fatalities and how to adequately prepare for the forensic investigation of high-profile cases. This article presents a methodical approach to the investigation of high-profile deaths. A comprehensive, preplanned forensic investigation and autopsy (including use of adjunctive studies) following the death of Anna Nicole Smith resulted in the accurate determination of the cause and manner of her death while adequately convincing the public of the objectivity and reliability of the Medical Examiners Office with respect to its conclusions. The forensic investigation of death in high-profile cases can be much more tedious and demanding than the investigation of routine cases. It requires more stringent safekeeping of the body and its evidence, more extensive and sophisticated dissection techniques on occasion, and exhaustive toxicologic analysis to exclude low-probability allegations. Procedures for honest, unbiased, and judicious communication with outside agencies and the media must be followed. Failure to follow such procedures might have serious consequences for the medical examiner, the family of the deceased, and the community at large. Adherence to these suggested guidelines may resolve most of the intricate problems involved in the investigation of these types of cases.

Evaluation of the mechanism and principles of management of temporomandibular joint dislocation. Systematic review of literature and a proposed new classification of temporomandibular joint dislocation

PubMed Central

2011-01-01

Background Virtually all the articles in literature addressed only a specific type of dislocation. The aim of this review was to project a comprehensive understanding of the pathologic processes and management of all types of dislodgement of the head of the mandibular condyle from its normal position in the glenoid fossa. In addition, a new classification of temporomandibular joint dislocation was also proposed. Method and materials A thorough computer literature search was done using the Medline, Cochrane library and Embase database. Key words like temporo-mandibular joint dislocation were used for the search. Additional manual search was done by going through published home-based and foreign articles. Case reports/series, and original articles that documented the type of dislocation, number of cases treated in the series and original articles. Treatment done and outcome of treatment were included in the study. Result A total of 128 articles were reviewed out which 79 were found relevant. Of these, 26 were case reports, 17 were case series and 36 were original articles. 79 cases were acute dislocations, 35 cases were chronic protracted TMJ dislocations and 311 cases were chronic recurrent TMJ dislocations. Etiology was predominantly trauma in 60% of cases and other causes contributed about 40%. Of all the cases reviewed, only 4 were unilateral dislocation. Various treatment modalities are outlined in this report as indicated for each type of dislocation. Conclusion The more complex and invasive method of treatment may not necessarily offer the best option and outcome of treatment, therefore conservative approaches should be exhausted and utilized appropriately before adopting the more invasive surgical techniques. PMID:21676208

Evaluation of the mechanism and principles of management of temporomandibular joint dislocation. Systematic review of literature and a proposed new classification of temporomandibular joint dislocation.

PubMed

Akinbami, Babatunde O

2011-06-15

Virtually all the articles in literature addressed only a specific type of dislocation. The aim of this review was to project a comprehensive understanding of the pathologic processes and management of all types of dislodgement of the head of the mandibular condyle from its normal position in the glenoid fossa. In addition, a new classification of temporomandibular joint dislocation was also proposed. A thorough computer literature search was done using the Medline, Cochrane library and Embase database. Key words like temporo-mandibular joint dislocation were used for the search. Additional manual search was done by going through published home-based and foreign articles. Case reports/series, and original articles that documented the type of dislocation, number of cases treated in the series and original articles. Treatment done and outcome of treatment were included in the study. A total of 128 articles were reviewed out which 79 were found relevant. Of these, 26 were case reports, 17 were case series and 36 were original articles. 79 cases were acute dislocations, 35 cases were chronic protracted TMJ dislocations and 311 cases were chronic recurrent TMJ dislocations. Etiology was predominantly trauma in 60% of cases and other causes contributed about 40%. Of all the cases reviewed, only 4 were unilateral dislocation. Various treatment modalities are outlined in this report as indicated for each type of dislocation. The more complex and invasive method of treatment may not necessarily offer the best option and outcome of treatment, therefore conservative approaches should be exhausted and utilized appropriately before adopting the more invasive surgical techniques.

A system dynamics approach for hospital waste management in a city in a developing country: the case of Nablus, Palestine.

PubMed

Al-Khatib, Issam A; Eleyan, Derar; Garfield, Joy

2016-09-01

Hospitals and health centers provide a variety of healthcare services and normally generate hazardous waste as well as general waste. General waste has a similar nature to that of municipal solid waste and therefore could be disposed of in municipal landfills. However, hazardous waste poses risks to public health, unless it is properly managed. The hospital waste management system encompasses many factors, i.e., number of beds, number of employees, level of service, population, birth rate, fertility rate, and not in my back yard (NIMBY) syndrome. Therefore, this management system requires a comprehensive analysis to determine the role of each factor and its influence on the whole system. In this research, a hospital waste management simulation model is presented based on the system dynamics technique to determine the interaction among these factors in the system using a software package, ithink. This model is used to estimate waste segregation as this is important in the hospital waste management system to minimize risk to public health. Real data has been obtained from a case study of the city of Nablus, Palestine to validate the model. The model exhibits wastes generated from three types of hospitals (private, charitable, and government) by considering the number of both inpatients and outpatients depending on the population of the city under study. The model also offers the facility to compare the total waste generated among these different types of hospitals and anticipate and predict the future generated waste both infectious and non-infectious and the treatment cost incurred.

A Comprehensive Treatment Program for a Case of Disturbed Anger

ERIC Educational Resources Information Center

DiGiuseppe, Raymond

2011-01-01

Santanello (2011) presented the case of a man with long-term anger problems who does not meet the criteria for any "DSM-IV-TR" diagnosis for treatment recommendations by several authors. This paper presents a comprehensive treatment package applied to this case. Of crucial importance is the building of a therapeutic alliance. In addition to…

Bridging a clinical gap in psychogenic nonepileptic seizures: Mental health provider preferences of biopsychosocial assessment approaches.

PubMed

Jimenez, Xavier F; Bautista, Jocelyn F; Tilahun, Bikat S; Fan, Youran; Ford, Paul J; Tesar, George E

2016-03-01

Management of psychogenic nonepileptic seizures (PNES) is complex, requiring multidisciplinary care. A standardized assessment and formulation approach to PNES is lacking, yet use of a comprehensive model may alleviate problems such as mental health aftercare noncompliance. Although a biopsychosocial (BPS) approach to PNES balancing predisposing, precipitating, and perpetuating (PPP) variables has been described and has been recently tested in pilot form, it is unclear how this assessment style is perceived among community mental health practitioners such as psychotherapists (including psychologists, counselors, and social workers). We predicted preference of a comprehensive "BPS/PPP" assessment style by those most involved in PNES care (i.e., community psychotherapists). One hundred and forty-three community-based social workers and counselors completed a survey featuring a fictional PNES case followed by assessment style options ("Multiaxial," "Narrative," and "BPS/PPP"). Respondents clearly preferred the robust BPS/PPP approach over less-comprehensive multiaxial and narrative assessments (p<0.0001). Reasons for choosing the BPS/PPP by respondents include ease of organization, clear therapeutic goals, and comprehensive nature. This assessment of acceptability of a BPS/PPP approach to PNES assessment among community mental health practitioners may provide a patient-centered mechanism to enhance referrals from the neurological to mental health setting. Implications and future directions are explored. Copyright © 2015 Elsevier Inc. All rights reserved.

Adaptive management for mitigating Cryptosporidium risk in source water: a case study in an agricultural catchment in South Australia.

PubMed

Bryan, Brett A; Kandulu, John; Deere, Daniel A; White, Monique; Frizenschaf, Jacqueline; Crossman, Neville D

2009-07-01

Water-borne pathogens such as Cryptosporidium pose a significant human health risk and catchments provide the first critical pollution 'barrier' in mitigating risk in drinking water supply. In this paper we apply an adaptive management framework to mitigating Cryptosporidium risk in source water using a case study of the Myponga catchment in South Australia. Firstly, we evaluated the effectiveness of past water quality management programs in relation to the adoption of practices by landholders using a socio-economic survey of land use and management in the catchment. The impact of past management on the mitigation of Cryptosporidium risk in source water was also evaluated based on analysis of water quality monitoring data. Quantitative risk assessment was used in planning the next round of management in the adaptive cycle. Specifically, a pathogen budget model was used to identify the major remaining sources of Cryptosporidium in the catchment and estimate the mitigation impact of 30 alternative catchment management scenarios. Survey results show that earlier programs have resulted in the comprehensive adoption of best management practices by dairy farmers including exclusion of stock from watercourses and effluent management from 2000 to 2007. Whilst median Cryptosporidium concentrations in source water have decreased since 2004 they remain above target levels and put pressure on other barriers to mitigate risk, particularly the treatment plant. Non-dairy calves were identified as the major remaining source of Cryptosporidium in the Myponga catchment. The restriction of watercourse access of non-dairy calves could achieve a further reduction in Cryptosporidium export to the Myponga reservoir of around 90% from current levels. The adaptive management framework applied in this study was useful in guiding learning from past management, and in analysing, planning and refocusing the next round of catchment management strategies to achieve water quality targets.

Representing Geospatial Environment Observation Capability Information: A Case Study of Managing Flood Monitoring Sensors in the Jinsha River Basin

PubMed Central

Hu, Chuli; Guan, Qingfeng; Li, Jie; Wang, Ke; Chen, Nengcheng

2016-01-01

Sensor inquirers cannot understand comprehensive or accurate observation capability information because current observation capability modeling does not consider the union of multiple sensors nor the effect of geospatial environmental features on the observation capability of sensors. These limitations result in a failure to discover credible sensors or plan for their collaboration for environmental monitoring. The Geospatial Environmental Observation Capability (GEOC) is proposed in this study and can be used as an information basis for the reliable discovery and collaborative planning of multiple environmental sensors. A field-based GEOC (GEOCF) information representation model is built. Quintuple GEOCF feature components and two GEOCF operations are formulated based on the geospatial field conceptual framework. The proposed GEOCF markup language is used to formalize the proposed GEOCF. A prototype system called GEOCapabilityManager is developed, and a case study is conducted for flood observation in the lower reaches of the Jinsha River Basin. The applicability of the GEOCF is verified through the reliable discovery of flood monitoring sensors and planning for the collaboration of these sensors. PMID:27999247

The why of practice: utilizing PIE to analyze social work practice in Australian hospitals.

PubMed

Nilsson, David; Joubert, Lynette; Holland, Lucy; Posenelli, Sonia

2013-01-01

This research used a collaborative approach to gain a comprehensive, quantitative understanding of the breadth and depth of the social work role in health care. Data was collected from individual interviews with all employed hospital social workers (N = 120) across five Melbourne, Australia health networks about their most recently completed case. This data was coded using a revised version of the Karls and Wandrei (1994) Person-in-Environment (PIE) tool to retrospectively analyze the reasons for social work involvement over the course of the case. The findings demonstrate that the hospital social work role is multidimensional across a number of domains but centers predominantly on assisting clients and their significant others with issues of altered social roles and functioning; particularly in relation to role responsibility, dependency, and managing associated role-change losses. The findings of this study will assist hospital social workers, managers, and academics to better describe and effectively undertake this complex work. These findings will also assist in the development of professional training and education to up-skill social workers who operate within this complex setting.

Representing Geospatial Environment Observation Capability Information: A Case Study of Managing Flood Monitoring Sensors in the Jinsha River Basin.

PubMed

Hu, Chuli; Guan, Qingfeng; Li, Jie; Wang, Ke; Chen, Nengcheng

2016-12-16

Sensor inquirers cannot understand comprehensive or accurate observation capability information because current observation capability modeling does not consider the union of multiple sensors nor the effect of geospatial environmental features on the observation capability of sensors. These limitations result in a failure to discover credible sensors or plan for their collaboration for environmental monitoring. The Geospatial Environmental Observation Capability (GEOC) is proposed in this study and can be used as an information basis for the reliable discovery and collaborative planning of multiple environmental sensors. A field-based GEOC (GEOCF) information representation model is built. Quintuple GEOCF feature components and two GEOCF operations are formulated based on the geospatial field conceptual framework. The proposed GEOCF markup language is used to formalize the proposed GEOCF. A prototype system called GEOCapabilityManager is developed, and a case study is conducted for flood observation in the lower reaches of the Jinsha River Basin. The applicability of the GEOCF is verified through the reliable discovery of flood monitoring sensors and planning for the collaboration of these sensors.

16 CFR 16.11 - Annual comprehensive review.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Annual comprehensive review. 16.11 Section 16.11 Commercial Practices FEDERAL TRADE COMMISSION ORGANIZATION, PROCEDURES AND RULES OF PRACTICE ADVISORY COMMITTEE MANAGEMENT § 16.11 Annual comprehensive review. (a) The Commission shall conduct an...

Improving state Medicaid contracts and plan practices for children with special needs.

PubMed

Fox, H B; McManus, M A

1998-01-01

The rapid transition of state Medicaid beneficiaries into fully capitated managed care plans requires a special focus on children with chronic or disabling conditions, who often depend on numerous pediatric physicians and other specialty services for health care and related services. Because managed care arrangements for this population are growing in popularity nationwide, it is important that states craft managed care contracts to address the unique needs of children with complex physical, developmental, and mental health problems. Based on the research reported in this article, in-depth interviews with state Medicaid agency staff, interviews with medical directors and administrators of managed care plans serving Medicaid recipients, and input from experts in pediatrics and managed care, a set of recommendations is made for tailoring managed care contracts to meet the needs of this vulnerable group of children. Six contracting elements that should be adopted by state Medicaid agencies include (1) clarifying the specificity of pediatric benefits, (2) defining appropriate pediatric provider capacity requirements, (3) developing a medical necessity standard specific to children, (4) identifying pediatric quality-of-care measures, (5) setting appropriate pediatric capitation rates, and (6) creating incentives for high-quality pediatric care. Nine approaches that should be adopted by managed care practices interested in providing high-quality care for children with special needs also are identified. These include (1) ensuring that assigned primary care providers have appropriate training and experience, (2) offering support systems for primary care practices, (3) providing specialty consultation for primary care providers, (4) establishing arrangements for the comanagement of primary and specialty pediatric services, (5) arranging for comprehensive care coordination, (6) establishing flexible service authorization policies, (7) implementing provider profiling systems that adjust for pediatric case mix, (8) creating financial incentives for serving children with special needs, and (9) encouraging family involvement in plan operations. Implementing these changes to managed care contracting could have a major impact on the quality and comprehensiveness of health care received by children with special needs. Successful implementation, however, requires strong support from both state Medicaid agencies and the managed care plans dedicated to serving this population.

The effect of professional identity on comprehensiveness in strategic decision making: physician executives in the Canadian health care context.

PubMed

Karmali, Shazia

2012-01-01

This paper explores differences in decision-making approaches between physician executives and nonphysician executives in a managerial setting. Fredrickson and Mitchell's (1984) conceptualization of the construct of comprehensiveness in strategic decision making is the central construct of this paper. Theories of professional identity, socialization, and institutional/dominant logics are applied to illustrate their impact on strategic decision-making approaches of physician and nonphysician executives. This paper proposes that high-status professionals, specifically physicians, occupying senior management roles are likely to approach decision making in a way that is consistent with their professional identity, and by extension, that departments led by physician executives are less likely to exhibit comprehensiveness in strategic decision-making processes than departments led by nonphysician executives. This paper provides conceptual evidence that physicians and nonphysicians approach management differently, and introduces the utility of comprehensiveness as a construct for strategic decision making in the context of health care management.

Implementation and utilization of a comprehensive information network in an integrated private not-for-profit regional health care system

NASA Astrophysics Data System (ADS)

Long, James M., III

1995-10-01

The capacity to access, integrate, and analyze demographic, financial, and clinical data within a regional health care system represents an opportunity to ensure and enhance clinical quality and to reduce costs in a carefully planned and controlled manner. Properly used, such capability should improve health care delivery for local populations and provide the institution with a level of integration of services achieved by few health care organizations. The Baptist Health System (BHS), based in Birmingham, Alabama, is currently standardizing operating procedures among its various components and implementing a comprehensive, enterprise-wide information network. Clinical quality improvement and case management are being promulgated throughout the enterprise using a continuum-of-care model developed internally. Having successfully completed a pilot project using teleconferences for core lectures in internal medicine between two large teaching hospitals, BHS is taking advantage of enterprise- wide teleconference capability using a combination of fiberoptic (T3) and standard digital telephone (T1) transmission to speed installation and reduce the cost of implementation into two office buildings and eleven hospitals. The information system will serve to prepare BHS for the advent of managed care and other anticipated changes in health care, while ensuring continued ability to deliver high quality, cost-effective medical and health-related services.

Process evaluation of a food marketing and environmental change intervention in Tiendas that serve Latino immigrants in North Carolina.

PubMed

Baquero, Barbara; Linnan, Laura; Laraia, Barbara A; Ayala, Guadalupe X

2014-11-01

This article describes a comprehensive process evaluation of an efficacious store-based intervention that increased store customers' fruit and vegetable consumption. The process evaluation plan was designed at study inception and implemented at baseline, during the intervention, and at immediate postintervention. Four Latino food stores were randomly assigned either to an intervention or to a control condition. Data were collected from store managers, employees, and 139 Latino customers. Researchers used manager, employee, and customer interviews; weekly observations of the store environment; and implementation logs to assess reach, dose delivered, dose received, and fidelity. Results indicated that it is possible to reach customers in a store-based intervention. Indicators of dose delivered demonstrated that the intervention was implemented as planned, and in the case of employee training, it exceeded the plan. Dose received data indicated that customers moderately engaged with the intervention activities. Together these suggest that the intervention was delivered with good fidelity. Comprehensive process evaluation efforts can facilitate the identification and elimination of barriers to implementation. This approach can serve as a model for future store-based interventions. The study demonstrated that it is feasible to implement Latino food store-based interventions to increase access to and consumption of fruits and vegetables. © 2014 Society for Public Health Education.

Hydro-economic modeling of the role of forests on water resources production in Andalusia, Spain

NASA Astrophysics Data System (ADS)

Beguería, Santiago; Serrano-Notivoli, Roberto; Álvarez-Palomino, Alejandro; Campos, Pablo

2014-05-01

The development of more refined information tools is a pre-requisite for supporting decision making in the context of integrated water resources management. Among these tools, hydro-economic models are favoured because they allow integrating the ecological, hydrological, infrastructure and economic aspects into a coherent, scientifically-informed framework. We present a case study that assesses physically the water resources of forest lands of the Andalusia region in Spain and conducts an economic environmental income and asset valuation of the forest surface water yield. We show how, based on available hydrologic and economic data, we can develop a comprehensive water account for all the forest lands at the regional scale. This forest water environmental valuation is part of the larger RECAMAN project, which aims at providing a robust and easily replicable accounting tool to evaluate yearly the total income an capital generated by the forest land, encompassing all measurable sources of private and public incomes (timber and cork production, auto-consumption, recreational activities, biodiversity conservation, carbon sequestration, water production, etc.). Only a comprehensive integrated tool such as the one built within the RECAMAN project may serve as a basis for the development of integrated policies such as those internationally agreed and recommended for the management of water resources.

Modelling the role of forests on water provision services: a hydro-economic valuation approach

NASA Astrophysics Data System (ADS)

Beguería, S.; Campos, P.

2015-12-01

Hydro-economic models that allow integrating the ecological, hydrological, infrastructure, economic and social aspects into a coherent, scientifically- informed framework constitute preferred tools for supporting decision making in the context of integrated water resources management. We present a case study of water regulation and provision services of forests in the Andalusia region of Spain. Our model computes the physical water flows and conducts an economic environmental income and asset valuation of forest surface and underground water yield. Based on available hydrologic and economic data, we develop a comprehensive water account for all the forest lands at the regional scale. This forest water environmental valuation is integrated within a much larger project aiming at providing a robust and easily replicable accounting tool to evaluate yearly the total income and capital of forests, encompassing all measurable sources of private and public incomes (timber and cork production, auto-consumption, recreational activities, biodiversity conservation, carbon sequestration, water production, etc.). We also force our simulation with future socio-economic scenarios to quantify the physical and economic efects of expected trends or simulated public and private policies on future water resources. Only a comprehensive integrated tool may serve as a basis for the development of integrated policies, such as those internationally agreed and recommended for the management of water resources.

Illustrative cases for monitoring by quantitative analysis of BRAF/NRAS ctDNA mutations in liquid biopsies of metastatic melanoma patients who gained clinical benefits from anti-PD1 antibody therapy.

PubMed

Seremet, Teofila; Planken, Simon; Schreuer, Max; Jansen, Yanina; Delaunoy, Mélanie; El Housni, Hakim; Lienard, Danielle; Del Marmol, Véronique; Heimann, Pierre; Neyns, Bart

2018-02-01

Anti-programmed death 1 (PD-1) monoclonal antibodies improve the survival of metastatic melanoma patients. Predictive or monitoring biomarkers for response to this therapy could improve the clinical management of these patients. To date, no established biomarkers are available for monitoring the response to immunotherapy. Tumor- specific mutations in circulating tumor DNA (ctDNA) such as BRAF and NRAS mutations for melanoma patients have been proposed for monitoring of immunotherapy response. We present seven illustrative cases for the use of ctDNA BRAF and NRAS mutations' monitoring in plasma. The cases described exemplify four distinct clinical benefit patterns: rapid and durable complete response (CR), early progression, followed by CR, CR followed by early progression after interrupting treatment and long-term disease stabilization. These representative cases suggest that comprehensive BRAF/NRAS ctDNA monitoring during anti-PD1 therapy is informative and can be of added value for the monitoring of melanoma patients gaining clinical benefit on anti-PD1 treatment. An important advantage of our approach is that using the cartridge system on the Idylla platform for mutation analysis, the results become available the same day 2 h after plasma collection. Therefore, in the future, the ctDNA level can be an element in the clinical management of the patients.

[Histopathological diagnostic concordance in bone and soft tissue sarcomas between two comprehensive cancer centers from eastern and western Europe: a collaborative experience].

PubMed

Somcutian, Oana; Buiga, Rares; Galatir, Mihaela; Tudor Eniu, Dan; Rachieru, Claudiu; Coza, Daniela; Terrier, Philippe

2015-01-01

This study aims to assess the degree of concordance of histological diagnosis of bone and soft tissue sarcomas between a Comprehensive Cancer Center (CCC) of Eastern Europe - not specialized in this area of pathology - and an important CCC of Western Europe, which is one of the coordinators of a clinical reference network in sarcoma pathology. The goal is to have an overview of the sarcomatous pathology in a region of Eastern Europe and to discover diagnostic discrepancies between the two centers, while determining their cause. The initial diagnosis was compared with the revised diagnosis on 110 specimens from 88 patients with bone or soft tissue sarcomas from East-European CCC, in a one-year period of time. Complete diagnostic agreement was observed in 55 cases (62.5%), a partial agreement in 23 cases (26.1%) and a major disagreement in 10 cases (11.4%). Major discrepancies of the histological type was observed in only 3 cases (3.4%): one case of discordance benign/malignant and 2 cases of discordance mesenchymal/non mesenchymal. Minor histological discrepancies - not affecting the management of the patient - were observed in 18 cases (20.4%). A major discordance in grading - potentially changing the management of the patient - was noted in 7 cases (7.9%), and a minor discrepancy in 5 cases (5.7%). Some histological types were clearly overdiagnosed, like "adult fibrosarcomas" and "malignant peripheral nerve sheet tumors" (MPNST), mostly converted after the audit into "undifferentiated spindle cell sarcomas" or other types of sarcomas. Some "unclassified" sarcomas and "undifferentiated pleomorphic sarcomas" could be re-classified with the aid of an extensive panel of antibodies. Overall, immunohistochemistry was responsible, but not in exclusivity, for half of the minor discrepancies, and for 2 out of 3 cases of major histological discrepancies. Otherwise, the main cause of discrepancies was the difficulties in the interpretation of the morphology. Molecular biology was decisive in one case. Most grading discrepancies resulted from the appreciation of the mitotic index. The profile of the sarcomatous pathology in the northwest region of Romania does not appear to differ significantly from other parts of Europe or the world, but a prospective epidemiological study would be necessary to confirm this assessment. The expansion of immunohistochemical antibody panel, the over-specialization of pathologists and, in the future, the establishment of a national network of referral centers in sarcoma pathology, are required for a high level of histological diagnosis in Eastern Europe. A periodic external audit, continuing this trans-European collaboration between the two centers, would be beneficial for monitoring progress. Copyright © 2014. Published by Elsevier Masson SAS.

Predicting Employment Outcomes of Consumers of State-Operated Comprehensive Rehabilitation Centers

ERIC Educational Resources Information Center

Beach, David Thomas

2009-01-01

This study used records from a state-operated comprehensive rehabilitation center to investigate possible predictive factors related to completing comprehensive rehabilitation center programs and successful vocational rehabilitation (VR) case closure. An analysis of demographic data of randomly selected comprehensive rehabilitation center…

Transnasal endoscopic partial maxillectomy: Operative nuances and proposal for a comprehensive classification system based on 1378 cases.

PubMed

Turri-Zanoni, Mario; Battaglia, Paolo; Karligkiotis, Apostolos; Lepera, Davide; Zocchi, Jacopo; Dallan, Iacopo; Bignami, Maurizio; Castelnuovo, Paolo

2017-04-01

Despite the development of functional endoscopic endonasal surgery, there are still areas of the maxillary sinus that remain technically difficult to access using a standard middle meatal antrostomy as well as deep-seated skull base lesions requiring expanded transmaxillary approaches. All patients who underwent transnasal endoscopic partial maxillectomy (TEPM) in a single institution from 2000 to 2014 were retrospectively reviewed. The TEPM was classified into 5 types according to the anatomic structures progressively removed and to the access provided. The TEPM was performed in 1378 patients for the management of: inflammatory diseases in 513 cases (37%), benign sinonasal tumors in 425 cases (31%), skull base malignancies in 285 cases (21%), and as a corridor to address deep-seated skull base lesions in 155 cases (11%). The TEPM is a stepwise approach offering increasing access that can be tailored to different maxillary, sinonasal, and skull base pathologies with minimal morbidity for patients. © 2016 Wiley Periodicals, Inc. Head Neck 39: 754-766, 2017. © 2016 Wiley Periodicals, Inc.

Apotemnophilia or body integrity identity disorder: a case report review.

PubMed

Bou Khalil, Rami; Richa, Sami

2012-12-01

Apotemnophilia or body integrity identity disorder (BIID) denotes a syndrome in which a person is preoccupied with the desire to amputate a healthy limb. In this report, we review the available case reports in the literature in order to enhance psychiatrists' and physicians' comprehension of this disorder. A search for the case reports available via MEDLINE was done since the first case report published by Money et al in 1977 till May 2011, using the following terms: apotemnophilia, self-demand amputation, body integrity identity disorder, and BIID. In all, 14 case reports were found relevant to our search. The desire to amputate one's healthy limb seems to be related to a major disturbance in the person's perception of one's own identity, where limb amputation can relieve temporarily the patient's feeling of distress without necessarily and uniformly adjusting the patient's own identity misperception. More investigations are needed in this domain in order to develop noninvasive treatment strategies that approach this aspect of the patient's distress within a globalist perspective. In addition, the health professionals' awareness regarding this disorder is required to ensure professional management of patients' suffering.

Risk Management in Agriculture for Food Security in Latin America and the Caribbean

NASA Astrophysics Data System (ADS)

Martinez, A.; National Research CouncilScientific; Technological Research (Conicet)

2013-05-01

The Americas are extremely important as a unique contributor to Food Security. It provides from tropical to temperate crops. Not only they are able to feed their own population, but contribute significantly to the food supply of the population in developed, emergent and underdeveloped countries. This fact has given the region a unique responsibility to develop a regional risk-management strategy to manage food insecurity at a local, national, regional and global level. Although international agencies such as UN Food and Agriculture Organization (FAO), Instituto Interamericano para la Cooperación en Agricultura (IICA) and the regional centres of the Consultative Group for International Agriculture Research (CGIAR) and the World Bank (WB), are engaged in actions for Risk Management in Agriculture for reducing Food Insecurity. However there is a need to build a framework and/or comprehensive regional strategy for the Americas. It would identify areas for promoting research projects where natural and social science work together for producing relevant scientific information and tools i.e. maps, indicators, models and scenarios, early warning systems, etc. to cooperate with both policy and decision makers in the public and private sectors. This would eventually lead to a comprehensive regional programme for reducing food insecurity. The purpose of International Council for Science-International Research and the International Research for Disaster Risk programme (ICSU-IRDR) and ICSU Regional Office for Latinamerica and the Caribbean (ICSU-ROLAC) is to promote the cooperation of the relevant scientific fields in both natural science and social science in a multi and trans-disciplinary approach on risk management to reduce food insecurity. Also both ICSU-IRDR and ICSU-ROLAC are building a case for the inclusion of the scientific community in the revision of the Hjogo Framework for Action for Disaster Reduction to be held in 2015 as risk management for reducing food insecurity is part of the agenda.

Assessment and management of adult cancer pain: a systematic review and synthesis of recent qualitative studies aimed at developing insights for managing barriers and optimizing facilitators within a comprehensive framework of patient care.

PubMed

Luckett, Tim; Davidson, Patricia M; Green, Anna; Boyle, Frances; Stubbs, John; Lovell, Melanie

2013-08-01

Cancer pain is a common, burdensome problem, which is not well managed despite evidence-based guidelines. To develop insights for managing barriers and optimizing facilitators to adult cancer pain assessment and management within a comprehensive framework of patient care. We undertook a systematic review and synthesis of qualitative studies. Medline, PsycINFO, Embase, AMED, CINAHL, and Sociological Abstracts were searched from May 20 to 26, 2011. To be included, the articles had to be published in a peer-reviewed journal since 2000; written in English; and report original qualitative studies on the perspectives of patients, their significant others, or health care providers. Article quality was rated using the checklist of Kitto et al. Thematic synthesis followed a three-stage approach using Evidence for Policy and Practice Information and Co-ordinating Centre-Reviewer 4 software: 1) free line-by-line coding of "Results," 2) organization into "descriptive" themes, and 3) development of "analytical" themes informative to our objective. At Stage 3, a conceptual framework was selected from the peer-reviewed literature according to prima facie "fit" for descriptive themes. Of 659 articles screened, 70 met the criteria, reporting 65 studies with 48 patient, 19 caregiver, and 21 health care provider samples. Authors rarely reported reflexivity or negative cases. Mead and Bower's model of patient-centered care accommodated 85% of the descriptive themes; 12% more related to the caregiver and service/system factors. Three themes could not be accommodated. Findings highlight the need to integrate patient/family education within improved communication, individualize care, use more nonpharmacological strategies, empower patients/families to self-manage pain, and reorganize multidisciplinary roles around patient-centered care and outcomes. These conclusions require validation via consensus and intervention trials. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

77 FR 30506 - Fisheries of the Caribbean, Gulf of Mexico, South Atlantic; Comprehensive Amendment

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-23

... environment of management measures proposed in its draft Comprehensive Ecosystem-Based Amendment 3 (CE-BA 3). CE-BA 3 would amend the Fishery Management Plan (FMP) for: the Snapper-Grouper Fishery of the South... scope of the issues to be addressed in CE-BA 3 will be accepted until June 22, 2012, at 5 p.m. ADDRESSES...

Training and Development Announcement; A Comprehensive Review of the Department of the Army Management Intern Program, August 1968.

ERIC Educational Resources Information Center

Babcock, Elaine P.

A comprehensive review of the Department of the Army Management Intern Program, August, 1968, presents details about the aims of the program, the recruitment procedure, the characteristics (including qualification) of the participants, and the achievement and rate of promotion of these individuals who are being trained for civilian careers in the…

Cost-Effectiveness Evaluation of a Novel Integrated Bite Case Management Program for the Control of Human Rabies, Haiti 2014–2015

PubMed Central

Undurraga, Eduardo A.; Meltzer, Martin I.; Tran, Cuc H.; Atkins, Charisma Y.; Etheart, Melissa D.; Millien, Max F.; Adrien, Paul; Wallace, Ryan M.

2017-01-01

Haiti has the highest burden of rabies in the Western hemisphere, with 130 estimated annual deaths. We present the cost-effectiveness evaluation of an integrated bite case management program combining community bite investigations and passive animal rabies surveillance, using a governmental perspective. The Haiti Animal Rabies Surveillance Program (HARSP) was first implemented in three communes of the West Department, Haiti. Our evaluation encompassed all individuals exposed to rabies in the study area (N = 2,289) in 2014–2015. Costs (2014 U.S. dollars) included diagnostic laboratory development, training of surveillance officers, operational costs, and postexposure prophylaxis (PEP). We used estimated deaths averted and years of life gained (YLG) from prevented rabies as health outcomes. HARSP had higher overall costs (range: $39,568–$80,290) than the no-bite-case-management (NBCM) scenario ($15,988–$26,976), partly from an increased number of bite victims receiving PEP. But HARSP had better health outcomes than NBCM, with estimated 11 additional annual averted deaths in 2014 and nine in 2015, and 654 additional YLG in 2014 and 535 in 2015. Overall, HARSP was more cost-effective (US$ per death averted) than NBCM (2014, HARSP: $2,891–$4,735, NBCM: $5,980–$8,453; 2015, HARSP: $3,534–$7,171, NBCM: $7,298–$12,284). HARSP offers an effective human rabies prevention solution for countries transitioning from reactive to preventive strategies, such as comprehensive dog vaccination. PMID:28719253

Cost-Effectiveness Evaluation of a Novel Integrated Bite Case Management Program for the Control of Human Rabies, Haiti 2014-2015.

PubMed

Undurraga, Eduardo A; Meltzer, Martin I; Tran, Cuc H; Atkins, Charisma Y; Etheart, Melissa D; Millien, Max F; Adrien, Paul; Wallace, Ryan M

2017-06-01

AbstractHaiti has the highest burden of rabies in the Western hemisphere, with 130 estimated annual deaths. We present the cost-effectiveness evaluation of an integrated bite case management program combining community bite investigations and passive animal rabies surveillance, using a governmental perspective. The Haiti Animal Rabies Surveillance Program (HARSP) was first implemented in three communes of the West Department, Haiti. Our evaluation encompassed all individuals exposed to rabies in the study area ( N = 2,289) in 2014-2015. Costs (2014 U.S. dollars) included diagnostic laboratory development, training of surveillance officers, operational costs, and postexposure prophylaxis (PEP). We used estimated deaths averted and years of life gained (YLG) from prevented rabies as health outcomes. HARSP had higher overall costs (range: $39,568-$80,290) than the no-bite-case-management (NBCM) scenario ($15,988-$26,976), partly from an increased number of bite victims receiving PEP. But HARSP had better health outcomes than NBCM, with estimated 11 additional annual averted deaths in 2014 and nine in 2015, and 654 additional YLG in 2014 and 535 in 2015. Overall, HARSP was more cost-effective (US$ per death averted) than NBCM (2014, HARSP: $2,891-$4,735, NBCM: $5,980-$8,453; 2015, HARSP: $3,534-$7,171, NBCM: $7,298-$12,284). HARSP offers an effective human rabies prevention solution for countries transitioning from reactive to preventive strategies, such as comprehensive dog vaccination.

European Heart Rhythm Association (EHRA) position paper on arrhythmia management and device therapies in endocrine disorders, endorsed by Asia Pacific Heart Rhythm Society (APHRS) and Latin American Heart Rhythm Society (LAHRS).

PubMed

Gorenek, Bulent; Boriani, Giuseppe; Dan, Gheorge-Andrei; Fauchier, Laurent; Fenelon, Guilherme; Huang, He; Kudaiberdieva, Gulmira; Lip, Gregory Y H; Mahajan, Rajiv; Potpara, Tatjana; Ramirez, Juan David; Vos, Marc A; Marin, Francisco

2018-03-16

Endocrine disorders are associated with various tachyarrhythmias, including atrial fibrillation (AF), ventricular tachycardia (VT), ventricular fibrillation (VF), and bradyarrhythmias. Along with underlying arrhythmia substrate, electrolyte disturbances, glucose, and hormone levels, accompanying endocrine disorders contribute to development of arrhythmia. Arrhythmias may be life-threatening, facilitate cardiogenic shock development and increase mortality. The knowledge on the incidence of tachy- and bradyarrhythmias, clinical and prognostic significance as well as their management is limited; it is represented in observational studies and mostly in case reports on management of challenging cases. It should be also emphasized, that the topic is not covered in detail in current guidelines. Therefore, cardiologists and multidisciplinary teams participating in care of such patients do need the evidence-based, or in case of limited evidence expert-opinion based recommendations, how to treat arrhythmias using contemporary approaches, prevent their complications and recurrence in patients with endocrine disorders. In recognizing this close relationship between endocrine disorders and arrhythmias, the European Heart Rhythm Association (EHRA) convened a Task Force, with representation from Asia-Pacific Heart Rhythm Society (APHRS) and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLAECE), with the remit of comprehensively reviewing the available evidence and publishing a joint consensus document on endocrine disorders and cardiac arrhythmias, and providing up-to-date consensus recommendations for use in clinical practice.

Modelling inter-supply chain competition with resource limitation and demand disruption

NASA Astrophysics Data System (ADS)

Chen, Zhaobo; Teng, Chunxian; Zhang, Ding; Sun, Jiayi

2016-05-01

This paper proposes a comprehensive model for studying supply chain versus supply chain competition with resource limitation and demand disruption. We assume that there are supply chains with heterogeneous supply network structures that compete at multiple demand markets. Each supply chain is comprised of internal and external firms. The internal firms are coordinated in production and distribution and share some common but limited resources within the supply chain, whereas the external firms are independent and do not share the internal resources. The supply chain managers strive to develop optimal strategies in terms of production level and resource allocation in maximising their profit while facing competition at the end market. The Cournot-Nash equilibrium of this inter-supply chain competition is formulated as a variational inequality problem. We further study the case when there is demand disruption in the plan-execution phase. In such a case, the managers need to revise their planned strategy in order to maximise their profit with the new demand under disruption and minimise the cost of change. We present a bi-criteria decision-making model for supply chain managers and develop the optimal conditions in equilibrium, which again can be formulated by another variational inequality problem. Numerical examples are presented for illustrative purpose.

Cryptosporidium and Giardia in surface water: a case study from Michigan, USA to inform management of rural water systems.

PubMed

Dreelin, Erin A; Ives, Rebecca L; Molloy, Stephanie; Rose, Joan B

2014-10-14

Cryptosporidium and Giardia pose a threat to human health in rural environments where water supplies are commonly untreated and susceptible to contamination from agricultural animal waste/manure, animal wastewater, septic tank effluents and septage. Our goals for this paper are to: (1) explore the prevalence of these protozoan parasites, where they are found, in what quantities, and which genotypes are present; (2) examine relationships between disease and land use comparing human health risks between rural and urban environments; and (3) synthesize available information to gain a better understanding of risk and risk management for rural water supplies. Our results indicate that Cryptosporidium and Giardia were more prevalent in rural versus urban environments based on the number of positive samples. Genotyping showed that both the human and animal types of the parasites are found in rural and urban environments. Rural areas had a higher incidence of disease compared to urban areas based on the total number of disease cases. Cryptosporidiosis and giardiasis were both positively correlated (p < 0.001) with urban area, population size, and population density. Finally, a comprehensive strategy that creates knowledge pathways for data sharing among multiple levels of management may improve decision-making for protecting rural water supplies.

Breast cancer: surgery at the South egypt cancer institute.

PubMed

Salem, Ahmed A S; Salem, Mohamed Abou Elmagd; Abbass, Hamza

2010-09-30

Breast cancer is the most frequent malignant tumor in women worldwide. In Egypt, it is the most common cancer among women, representing 18.9% of total cancer cases (35.1% in women and 2.2% in men) among the Egypt National Cancer Institute's (NCI) series of 10,556 patients during the year 2001, with an age-adjusted rate of 49.6 per 100,000 people. In this study, the data of all breast cancer patients presented to the surgical department of the South Egypt cancer Institute (SECI) hospital during the period from Janurary 2001 to December 2008 were reviewed .We report the progress of the availability of breast cancer management and evaluation of the quality of care delivered to breast cancer patients. The total number of patients with a breast lump presented to the SECI during the study period was 1,463 patients (32 males and 1431 females); 616 patients from the total number were admitted at the surgical department .There was a decline in advanced cases. Since 2001, facilities for all lines of comprehensive management have been made accessible for all patients. We found that better management could lead to earlier presentation, and better overall outcome in breast cancer patients.The incidence is steadily increasing with a tendency for breast cancer to occur in younger age groups and with advanced stages.

A Fuzzy Robust Optimization Model for Waste Allocation Planning Under Uncertainty

PubMed Central

Xu, Ye; Huang, Guohe; Xu, Ling

2014-01-01

Abstract In this study, a fuzzy robust optimization (FRO) model was developed for supporting municipal solid waste management under uncertainty. The Development Zone of the City of Dalian, China, was used as a study case for demonstration. Comparing with traditional fuzzy models, the FRO model made improvement by considering the minimization of the weighted summation among the expected objective values, the differences between two extreme possible objective values, and the penalty of the constraints violation as the objective function, instead of relying purely on the minimization of expected value. Such an improvement leads to enhanced system reliability and the model becomes especially useful when multiple types of uncertainties and complexities are involved in the management system. Through a case study, the applicability of the FRO model was successfully demonstrated. Solutions under three future planning scenarios were provided by the FRO model, including (1) priority on economic development, (2) priority on environmental protection, and (3) balanced consideration for both. The balanced scenario solution was recommended for decision makers, since it respected both system economy and reliability. The model proved valuable in providing a comprehensive profile about the studied system and helping decision makers gain an in-depth insight into system complexity and select cost-effective management strategies. PMID:25317037

Survey of cases of paracetamol overdose in the UK referred to National Poisons Information Service (NPIS) consultants.

PubMed

Thanacoody, H K R; Good, A M; Waring, W S; Bateman, D N

2008-03-01

Paracetamol is the most common means of drug overdose in the UK. Guidance on management is available to junior doctors through TOXBASE, the online resource managed by the UK National Poisons Information Service (NPIS) and in poster form. TOXBASE is supported by NPIS units and further by a UK national rota of clinical toxicologists. A study was undertaken to examine reasons why calls about paracetamol are referred to consultants to better understand issues in managing this common poisoning. Calls relating to paracetamol overdose referred by a poisons information specialist to the duty NPIS consultant between 1 May 2005 and 30 April 2006 were identified from the database and the number of TOXBASE accesses during the same time period was determined. Enquiries that resulted in consultant referral were classified into six categories. Calls referred to NPIS consultants pertain mainly to patients who present late, staggered overdoses, adverse reactions to N-acetylcysteine, and interpretation of blood results. This information has been used to inform the development of TOXBASE so that comprehensive advice is readily available to end users. The operation of a national consultant rota enables information on difficult or unusual cases of poisoning to be pooled so that treatment guidelines can be developed to optimise treatment throughout the UK.

A Fuzzy Robust Optimization Model for Waste Allocation Planning Under Uncertainty.

PubMed

Xu, Ye; Huang, Guohe; Xu, Ling

2014-10-01

In this study, a fuzzy robust optimization (FRO) model was developed for supporting municipal solid waste management under uncertainty. The Development Zone of the City of Dalian, China, was used as a study case for demonstration. Comparing with traditional fuzzy models, the FRO model made improvement by considering the minimization of the weighted summation among the expected objective values, the differences between two extreme possible objective values, and the penalty of the constraints violation as the objective function, instead of relying purely on the minimization of expected value. Such an improvement leads to enhanced system reliability and the model becomes especially useful when multiple types of uncertainties and complexities are involved in the management system. Through a case study, the applicability of the FRO model was successfully demonstrated. Solutions under three future planning scenarios were provided by the FRO model, including (1) priority on economic development, (2) priority on environmental protection, and (3) balanced consideration for both. The balanced scenario solution was recommended for decision makers, since it respected both system economy and reliability. The model proved valuable in providing a comprehensive profile about the studied system and helping decision makers gain an in-depth insight into system complexity and select cost-effective management strategies.

Cryptosporidium and Giardia in Surface Water: A Case Study from Michigan, USA to Inform Management of Rural Water Systems

PubMed Central

Dreelin, Erin A.; Ives, Rebecca L.; Molloy, Stephanie; Rose, Joan B.

2014-01-01

Cryptosporidium and Giardia pose a threat to human health in rural environments where water supplies are commonly untreated and susceptible to contamination from agricultural animal waste/manure, animal wastewater, septic tank effluents and septage. Our goals for this paper are to: (1) explore the prevalence of these protozoan parasites, where they are found, in what quantities, and which genotypes are present; (2) examine relationships between disease and land use comparing human health risks between rural and urban environments; and (3) synthesize available information to gain a better understanding of risk and risk management for rural water supplies. Our results indicate that Cryptosporidium and Giardia were more prevalent in rural versus urban environments based on the number of positive samples. Genotyping showed that both the human and animal types of the parasites are found in rural and urban environments. Rural areas had a higher incidence of disease compared to urban areas based on the total number of disease cases. Cryptosporidiosis and giardiasis were both positively correlated (p < 0.001) with urban area, population size, and population density. Finally, a comprehensive strategy that creates knowledge pathways for data sharing among multiple levels of management may improve decision-making for protecting rural water supplies. PMID:25317981

Evaluation of an E-learning resource on approach to the first unprovoked seizure.

PubMed

Le Marne, Fleur A; McGinness, Hannah; Slade, Rob; Cardamone, Michael; Balbir Singh, Shirleen; Connolly, Anne M; Bye, Ann Me

2016-09-01

To develop and evaluate an online educational package instructing paediatricians and trainees in the diagnosis and management of a first unprovoked seizure in children. The E-learning content was created following a comprehensive literature review that referenced current international guidelines. Rigorous consultation with local paediatric neurologists, paediatricians and epilepsy nurses was undertaken. A series of learning modules was created and sequenced to reflect steps needed to achieve optimal diagnosis and management in a real-life situation of a child presenting with a paroxysmal event. Paediatric registrars and advanced trainees from the Sydney Children's Hospitals Network were assessed before and after using the E-learning Resource. Measures included general epilepsy knowledge, case-based scenario knowledge; self-rated measures of satisfaction with instruction and confidence regarding clinical approach to the child with first unprovoked seizure; and open ended questions evaluating the usefulness of the E-learning resource. Performance on measures of general epilepsy knowledge and on the seizure-related case scenarios improved significantly following completion of the E-learning as did self-rated satisfaction with instruction and confidence across all aspects of managing first seizure. The E-learning resource has been validated as a useful educational resource regarding the first afebrile unprovoked seizure for paediatricians. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

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

PubMed

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

2009-06-01

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

[Managing and identifying the causes of IUGR].

PubMed

Salomon, L J; Malan, V

2013-12-01

The management and identification of the causes for a small for gestational age (SGA) and/or an intrauterine growth restriction (IUGR) fetus is a common but complex problem in Obstetrics. The Medline, Embase and the Cochrane Library databases were examined over the last 15 years, with no language restrictions, using a combination of the words PAG (SGA), IUGR (IUGR), fetal weight (Fetal weight), sonography (ultrasound), management, cause (etiology), examinations (examinations). Some references not selected by this strategy, but associated with these publications or suggested by members of the working group were also added. The relevant articles were used to establish the text of recommendation following discussion between experts of the working group. Once the diagnosis of SGA is raised (whether on clinical, echocardiographic or Doppler), a management strategy to look for potential causes must be proposed and discussed with parents (Expert reviews). The extent of additional explorations varies depending on the exact presentation of the case (term at diagnosis, severity of anomalies). Additional explorations only make sense if they are likely to change the management of the current pregnancy and particularly to reduce perinatal morbidity and mortality. Explorations have two main objectives: (i) assess fetal vitality and possibilities for continuing the pregnancy in terms of safety for the mother and the foetus; (ii) establish the origin of SGA. The latter is detailed in this chapter recommendation. The earlier and the more severe the biometric anomalies, the more comprehensive the investigations. Maternal symptoms or fetal Doppler anomalies also require urgent management. Explorations to establish the origin of SGA and/or IUGR must follow a rigorous and systematic approach. In all cases, the practitioner will provide clear information to parents and collect information including detailed clinical and ultrasound examinations. Additional tests and in particular fetal invasive testing must be performed in some cases after parental consent and according to clinical and sonographic guidance elements. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Short-term Evaluation of a Comprehensive Education Program Including Inhaler Training and Disease Management on Chronic Obstructive Pulmonary Disease.

PubMed

Yoo, Kwang Ha; Chung, Wou Young; Park, Joo Hun; Hwang, Sung Chul; Kim, Tae Eun; Oh, Min Jung; Kang, Dae Ryong; Rhee, Chin Kook; Yoon, Hyoung Kyu; Kim, Tae Hyung; Kim, Deog Kyeom; Park, Yong Bum; Kim, Sang Ha; Yum, Ho Kee

2017-10-01

Proper education regarding inhaler usage and optimal management of chronic obstructive pulmonary disease (COPD) is essential for effectively treating patients with COPD. This study was conducted to evaluate the effects of a comprehensive education program including inhaler training and COPD management. We enlisted 127 patients with COPD on an outpatient basis at 43 private clinics in Korea. The patients were educated on inhaler usage and disease management for three visits across 2 weeks. Physicians and patients were administered a COPD assessment test (CAT) and questionnaires about the correct usage of inhalers and management of COPD before commencement of this program and after their third visit. The outcomes of 127 COPD patients were analyzed. CAT scores (19.6±12.5 vs. 15.1±12.3) improved significantly after this program (p<0.05). Patients with improved CAT scores of 4 points or more had a better understanding of COPD management and the correct technique for using inhalers than those who did not have improved CAT scores (p<0.05). A comprehensive education program including inhaler training and COPD management at a primary care setting improved CAT scores and led to patients' better understanding of COPD management. Copyright©2017. The Korean Academy of Tuberculosis and Respiratory Diseases

Reimbursement for pediatric diabetes intensive case management: a model for chronic diseases?

PubMed

Beck, Joni K; Logan, Kathy J; Hamm, Robert M; Sproat, Scott M; Musser, Kathleen M; Everhart, Patricia D; McDermott, Harrold M; Copeland, Kenneth C

2004-01-01

Current reimbursement policies serve as potent disincentives for physicians who provide evaluation and management services exclusively. Such policies threaten nationwide availability of care for personnel-intensive services such as pediatric diabetes. This report describes an approach to improving reimbursement for highly specialized, comprehensive pediatric diabetes management through prospective contracting for services. The objective of this study was to determine whether pediatric diabetes intensive case management services are cost-effective to the payer, the patient, and a pediatric diabetes program. A contract with a third-party payer was created to reimburse for 3 key pediatric diabetes intensive case management components: specialty education, 24/7 telephone access to an educator (and board-certified pediatric endocrinologist as needed), and quarterly educator assessments of self-management skills. Data were collected and analyzed for 15 months after signing the contract. Within the first 15 months after the contract was signed, 22 hospital admissions for diabetic ketoacidosis (DKA) occurred in 16 different patients. After hospitalizations for DKA, all 16 patients were offered participation in the program. All were followed during the subsequent 1 to 15 months of observation. Ten patients elected to participate, and 6 refused participation. Frequency of rehospitalization, emergency department visits, and costs were compared between the 2 groups. Among the 10 participating patients, there was only 1 subsequent DKA admission, whereas among the 6 who refused participation, 5 were rehospitalized for DKA on at least 1 occasion. The 10 patients who participated in the program had greater telephone contact with the team compared with those who did not (16 crisis-management calls vs 0). Costs (education, hospitalization, and emergency department visits) per participating patient were approximately 1350 dollars less than those for nonparticipating patients. Differences between participating and nonparticipating groups included age (participants were of younger age), double-parent households (participants were more likely to be from double parent households), and number of medical visits kept (participants kept more follow-up visits). No differences in duration of diabetes, months followed in the program, sex, or ethnicity were observed. Contracting with third-party payers for pediatric diabetes intensive case management services reduces costs by reducing emergency department and inpatient hospital utilizations, likely a result of intensive education and immediate access to the diabetes health care team for crisis management. Such strategies may prove to be cost saving not only for diabetes management but also for managing other costly and personnel-intensive chronic diseases.

Towards Designing a Secure Exchange Platform for Diabetes Monitoring and Therapy.

PubMed

Weiß, Jan-Patrick; Welzel, Tobias; Hartmann, Bernd J; Hübner, Ursula; Teuteberg, Frank

2018-01-01

Diabetes mellitus is one of the most prominent examples of chronic conditions that requires an active patient self-management and a network of specialists. The aim of this study was to analyze the user and legal requirements and develop a rough technology concept for a secure and patient-centered exchange platform. To this end, 14 experts representing different stakeholders were interviewed and took part in group discussions at three workshops, the pertinent literature and legal texts were analyzed. The user requirements embraced a comprehensive set of use cases and the demand for "one platform for all" which is underlined by the right for data portability according to new regulations. In order to meet these requirements a distributed ledger technology was proposed. We will therefore focus on a patient-centered application that showcases self-management and exchange with health specialists.

Risk assessment and optimization (ALARA) analysis for the environmental remediation of Brookhaven National Laboratory`s hazardous waste management facility

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

Dionne, B.J.; Morris, S.C. III; Baum, J.W.

1998-01-01

The Department of Energy`s (DOE) Office of Environment, Safety, and Health (EH) sought examples of risk-based approaches to environmental restoration to include in their guidance for DOE nuclear facilities. Extensive measurements of radiological contamination in soil and ground water have been made at Brookhaven National Laboratory`s Hazardous Waste Management Facility (HWMF) as part of a Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) remediation process. This provided an ideal opportunity for a case study. This report provides a risk assessment and an {open_quotes}As Low as Reasonably Achievable{close_quotes} (ALARA) analysis for use at other DOE nuclear facilities as an example ofmore » a risk-based decision technique. This document contains the Appendices for the report.« less

Surgical Management of Endometrial Polyps in Infertile Women: A Comprehensive Review

PubMed Central

Petrini, Allison C.; Lekovich, Jovana P.; Elias, Rony T.; Spandorfer, Steven D.

2015-01-01

Endometrial polyps are benign localized lesions of the endometrium, which are commonly seen in women of reproductive age. Observational studies have suggested a detrimental effect of endometrial polyps on fertility. The natural course of endometrial polyps remains unclear. Expectant management of small and asymptomatic polyps is reasonable in many cases. However, surgical resection of endometrial polyps is recommended in infertile patients prior to treatment in order to increase natural conception or assisted reproductive pregnancy rates. There is mixed evidence regarding the resection of newly diagnosed endometrial polyps during ovarian stimulation to improve the outcomes of fresh in vitro fertilization cycles. Hysteroscopy polypectomy remains the gold standard for surgical treatment. Evidence regarding the cost and efficacy of different methods for hysteroscopic resection of endometrial polyps in the office and outpatient surgical settings has begun to emerge. PMID:26301260

A guide for roadside vegetation management

DOT National Transportation Integrated Search

2009-10-01

Implementing a comprehensive turf management program significantly reduces the overall cost of managing the vegetation along state roadways. This guide provides methods for efficiently and effectively managing the activities that will achieve and mai...

A time-and-motion approach to micro-costing of high-throughput genomic assays

PubMed Central

Costa, S.; Regier, D.A.; Meissner, B.; Cromwell, I.; Ben-Neriah, S.; Chavez, E.; Hung, S.; Steidl, C.; Scott, D.W.; Marra, M.A.; Peacock, S.J.; Connors, J.M.

2016-01-01

Background Genomic technologies are increasingly used to guide clinical decision-making in cancer control. Economic evidence about the cost-effectiveness of genomic technologies is limited, in part because of a lack of published comprehensive cost estimates. In the present micro-costing study, we used a time-and-motion approach to derive cost estimates for 3 genomic assays and processes—digital gene expression profiling (gep), fluorescence in situ hybridization (fish), and targeted capture sequencing, including bioinformatics analysis—in the context of lymphoma patient management. Methods The setting for the study was the Department of Lymphoid Cancer Research laboratory at the BC Cancer Agency in Vancouver, British Columbia. Mean per-case hands-on time and resource measurements were determined from a series of direct observations of each assay. Per-case cost estimates were calculated using a bottom-up costing approach, with labour, capital and equipment, supplies and reagents, and overhead costs included. Results The most labour-intensive assay was found to be fish at 258.2 minutes per case, followed by targeted capture sequencing (124.1 minutes per case) and digital gep (14.9 minutes per case). Based on a historical case throughput of 180 cases annually, the mean per-case cost (2014 Canadian dollars) was estimated to be $1,029.16 for targeted capture sequencing and bioinformatics analysis, $596.60 for fish, and $898.35 for digital gep with an 807-gene code set. Conclusions With the growing emphasis on personalized approaches to cancer management, the need for economic evaluations of high-throughput genomic assays is increasing. Through economic modelling and budget-impact analyses, the cost estimates presented here can be used to inform priority-setting decisions about the implementation of such assays in clinical practice. PMID:27803594

The business case for quality: combining medical literature research with health plan data to establish value for nonclinical managers.

PubMed

Fetterolf, Donald; West, Rebecca

2004-01-01

Clinical managers face a growing need to communicate the value of what they do in terms that can be interpreted by nonclinical financial managers. We have sought to link the evidence basis of current guidelines to variables that will demonstrate in more financial terms the very real benefit of treating diseases aggressively. We have developed an approach using the medical literature that is designed to describe clinical initiatives in more concrete terms as desired by senior management. This becomes specifically critical during budget time and when justification for various clinical programs is needed. The approach uses medical research from the peer-reviewed literature to estimate the economic impact of various initiatives and then combines the analysis with an organization's actual data to impute potential benefit. A sample grid for developing the analysis is attached. A comprehensive bibliography that will assist others with similar endeavors has been included. Although not as rigorous as formal methods, actuarial analyses, or health services research activities, it presents a beginning framework around which an organization can create operational estimates of initiative effectiveness.

Contrast medium extravasation injury: guidelines for prevention and management.

PubMed

Bellin, Marie-France; Jakobsen, Jarl A; Tomassin, Isabelle; Thomsen, Henrik S; Morcos, Sameh K; Thomsen, H S; Morcos, S K; Almén, T; Aspelin, P; Bellin, M F; Clauss, W; Flaten, H; Grenier, N; Ideé, J-M; Jakobsen, J A; Krestin, G P; Stacul, F; Webb, J A W

2002-11-01

Extravasation of contrast material is a well-recognized complication of contrast-enhanced imaging studies. The management of this complication is contentious; therefore, the Contrast Media Safety Committee of The European Society of Urogenital Radiology decided to review the literature and issue guidelines. A comprehensive literature search was carried out. The resulting report was discussed at the 8th European Symposium on Urogenital Radiology in Genoa, Italy. Automated power injection may result in extravasation of large volumes and may or can lead to severe tissue damage. Infants, young children and unconscious and debilitated patients are particularly at risk of extravasation during contrast media injection. Fortunately, most extravasations result in minimal swelling or erythema, with no long-term sequelae; however, severe skin necrosis and ulceration may occur. Large volumes of high osmolar contrast media are known to induce significant tissue damage. Compartment syndrome may be seen associated with extravasation of large volumes. Conservative management is often adequate, but in serious cases the advice of a plastic surgeon is recommended. Based on the review simple guidelines for prophylaxis and management of contrast medium extravasation injuries are proposed.

Design of a case management model for people with chronic disease (Heart Failure and COPD). Phase I: modeling and identification of the main components of the intervention through their actors: patients and professionals (DELTA-icE-PRO Study).

PubMed

Morales-Asencio, Jose M; Martin-Santos, Francisco J; Morilla-Herrera, Juan C; Fernández-Gallego, Magdalena Cuevas; Celdrán-Mañas, Miriam; Navarro-Moya, Francisco J; Rodríguez-Salvador, Maria M; Muñoz-Ronda, Francisco J; Gonzalo-Jiménez, Elena; Carrasco, Almudena Millán

2010-12-02

Chronic diseases account for nearly 60% of deaths around the world. The extent of this silent epidemic has not met determined responses in governments, policies or professionals in order to transform old Health Care Systems, configured for acute diseases. There is a large list of research about alternative models for people with chronic conditions, many of them with an advanced practice nurse as a key provider, as case management. But some methodological concerns raise, above all, the design of the intervention (intensity, frequency, components, etc). General: To develop the first and second phases (theorization and modeling) for designing a multifaceted case-management intervention in people with chronic conditions (COPD and heart failure) and their caregivers. 1) To identify key events in people living with chronic disease and their relation with the Health Care System, from their point of view. 2) To know the coping mechanisms developed by patients and their caregivers along the story with the disease. 3) To know the information processing and its utilization in their interactions with health care providers. 4) To detect potential unmet needs and the ways deployed by patients and their caregivers to resolve them. 5) To obtain a description from patients and caregivers, about their itineraries along the Health Care System, in terms of continuity, accessibility and comprehensiveness of care. 6) To build up a list of promising case-management interventions in patients with Heart Failure and COPD with this information in order to frame it into theoretical models for its reproducibility and conceptualization. 7) To undergo this list to expert judgment to assess its feasibility and pertinence in the Andalusian Health Care. Qualitative research with two phases: For the first five objectives, a qualitative technique with biographic stories will be developed and, for the remaining objectives, an expert consensus through Delphi technique, on the possible interventions yielded from the first phase. The study will be developed in the provinces of Almería, Málaga and Granada in the Southern Spain, from patients included in the Andalusian Health Care Service database with the diagnosis of COPD or Heart Failure, with the collaboration of case manager nurses and general practitioners for the assessment of their suitability to inclusion criteria. Patients and caregivers will be interviewed in their homes or their Health Centers, with their family or their case manager nurse as mediator. First of a series of studies intended to design a case-management service for people with heart failure and COPD, in the Andalusian Health Care System, where case management has been implemented since 2002. Accordingly with the steps of a theoretical model for complex interventions, in this study, theorization and intervention modeling phases will be developed.

A Model-Based Prognostics Approach Applied to Pneumatic Valves

NASA Technical Reports Server (NTRS)

Daigle, Matthew J.; Goebel, Kai

2011-01-01

Within the area of systems health management, the task of prognostics centers on predicting when components will fail. Model-based prognostics exploits domain knowledge of the system, its components, and how they fail by casting the underlying physical phenomena in a physics-based model that is derived from first principles. Uncertainty cannot be avoided in prediction, therefore, algorithms are employed that help in managing these uncertainties. The particle filtering algorithm has become a popular choice for model-based prognostics due to its wide applicability, ease of implementation, and support for uncertainty management. We develop a general model-based prognostics methodology within a robust probabilistic framework using particle filters. As a case study, we consider a pneumatic valve from the Space Shuttle cryogenic refueling system. We develop a detailed physics-based model of the pneumatic valve, and perform comprehensive simulation experiments to illustrate our prognostics approach and evaluate its effectiveness and robustness. The approach is demonstrated using historical pneumatic valve data from the refueling system.

NCCN Consensus Guidelines for the Diagnosis and Management of Breast Implant-Associated Anaplastic Large Cell Lymphoma.

PubMed

Clemens, Mark W; Horwitz, Steven M

2017-03-01

Published case series demonstrate a lack of treatment standardization for breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) with a wide variety of therapeutic strategies being employed at all stages of disease. The National Comprehensive Cancer Network (NCCN) annually publishes Clinical Practice Guidelines for Non-Hodgkin Lymphomas. For the first time, BIA-ALCL management will be included which signifies an important and needed guideline addition. The new BIA-ALCL guideline was achieved by a consensus of lymphoma oncologists, plastic surgeons, radiation oncologists, and surgical oncologists. NCCN guidelines focus on the diagnosis and management throughout the stages of many lymphoma subtypes based upon the most current data available. This article summarizes the essential recommendations and optimal therapeutic strategies of the NCCN guidelines critical to the plastic surgery community. We encourage international adoption of these BIA-ALCL treatment standards by our specialty societies across the oncology and surgery disciplines. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

Identifying hotspots and management of critical ecosystem services in rapidly urbanizing Yangtze River Delta Region, China.

PubMed

Cai, Wenbo; Gibbs, David; Zhang, Lang; Ferrier, Graham; Cai, Yongli

2017-04-15

Rapid urbanization has altered many ecosystems, causing a decline in many ecosystem services, generating serious ecological crisis. To cope with these challenges, we presented a comprehensive framework comprising five core steps for identifying and managing hotspots of critical ecosystem services in a rapid urbanizing region. This framework was applied in the case study of the Yangtze River Delta (YRD) Region. The study showed that there was large spatial heterogeneity in the hotspots of ecosystem services in the region, hotspots of supporting services and regulating services aggregately distributing in the southwest mountainous areas while hotspots of provisioning services mainly in the northeast plain, and hotspots of cultural services widespread in the waterbodies and southwest mountainous areas. The regionalization of the critical ecosystem services was made through the hotspot analysis. This study provided valuable information for environmental planning and management in a rapid urbanizing region and helped improve China's ecological redlines policy at regional scale. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

PubMed

Harrison, Lindsay

2012-01-01

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

A comprehensive space management model for facilitating programmatic research.

PubMed

Libecap, Ann; Wormsley, Steven; Cress, Anne; Matthews, Mary; Souza, Angie; Joiner, Keith A

2008-03-01

In FY04, the authors developed and implemented models to manage existing and incremental research space, and to facilitate programmatic research, at the University of Arizona College of Medicine. Benchmarks were set for recovery of total sponsored research dollars and for facilities and administrative (F&A) dollars/net square foot (nsf) of space, based on college-wide metrics. Benchmarks were applied to units (departments, centers), rather than to individual faculty. Performance relative to the benchmark was assessed using three-year moving averages, and applied to existing blocks of space. Space was recaptured or allocated, in all cases to programmatic themes, using uniform policies. F&A revenues were returned on the basis of performance relative to a benchmark. During the first two years after implementation of the model (FY05 and FY06), and for the 24 units occupying research space, median total sponsored research revenue/nsf increased from $393.96 to $474.46 (20.4%), and median F&A revenue/nsf increased from $57.42 to $91.86 (60.0%). These large increases in median values are driven primarily from redistribution and recapturing of space. Recruiting policies for unit heads were developed to facilitate joint hires among units. In combination, these policies created a comprehensive space management model for facilitating programmatic research. Although challenges remain in implementing the programmatic recruitment strategy, and selected modifications to the original policy were introduced later (e.g., research space for newly recruited junior faculty is now exempted from calculations for three years), overall, the models have created a climate of transparency that is now accepted and that allows efficient and equitable management of research space.

Curbing the costly trend: exploring the need for a progressive approach to the management of specialty pharmaceuticals under the medical benefit.

PubMed

Jacobs, Michael S; Johnson, Kjel A

2012-07-01

Specialty injectables and protein-based biologic therapies represent the fastest growing segment of the drug trend for many plan sponsors. Coupled with the decline in spending on traditional pharmaceuticals and so-called blockbuster drugs coming off patent, the upward trend of specialty drug spending continues at an unprecedented rate, precipitating a shift in the focus of payers who manage prescription drugs. To characterize the current and future specialty drug spending and describe contemporary trends among payers for managing cost and quality in this segment, as well as to elucidate the shortcomings of the current efforts and to explore a comprehensive approach for addressing the cost and quality concerns directly associated with specialty injectables and protein-based biologics through interrelated management interventions. Although a notable decrease in spending on traditional pharmaceuticals was realized in 2010, disproportionate increases in specialty drug utilization and cost per unit fueled the continuing growth of the injectable and biologic markets. Each course of these therapies can cost in the tens of thousands of dollars, and this upward trend of specialty spending represents an escalation of an already significant spending for payers, employers, and members. Beyond the high cost and growing utilization of specialty pharmaceuticals, current management efforts have been met with variable degrees of success and have often proved challenging and, in some cases, even counterproductive. Common interventions used by payers nationwide for addressing specialty drug spending trend include specialty drug formularies, provider reimbursement strategies, distribution channel management, benefit design modifications, utilization management, and operational and administrative improvements such as postclaim edits. Although often overlooked, appropriate implementation of these tactics, and the extent to which they are integrated with overall drug benefit management, are key to the success of the pharmaceutical management program. Conventional specialty pharmaceutical management initiatives offer promise in various areas, but incentives for the best protocols may be misaligned when they are applied individually. Conversely, a comprehensive approach that integrates effective components of the specialty pharmaceutical management interventions can improve the quality of care and control costs associated with these agents, with significant specialty drug management expertise and access to benchmarking data serving as the foundation for appropriate decision-making.

Comprehensive Environmental Assessment and U.S. EPA Nanomaterial Case Studies

EPA Science Inventory

These case studies are not completed risk assessments but are structured around an approach known as comprehensive environmental assessment (CEA), which combines a product life cycle framework with the risk assessment paradigm (Davis, J.M., J. Nanosci. Nanotech. 7:402-9, 2007). ...

Conflict coaching training for nurse managers: a case study of a two-hospital health system.

PubMed

Brinkert, Ross

2011-01-01

This study evaluated the application of the Comprehensive Conflict Coaching model in a hospital environment. Conflict coaching involves a coach working with a client to improve the client's conflict understanding, interaction strategies and/or interaction skills. The training of nurse managers as conflict coaches is an innovative continuing education programme that partially addresses conflict-related concerns in nursing. Twenty nurse managers trained as conflict coaches and each coached a supervisee. Qualitative data were gathered from nurse managers, supervisees and senior nursing leaders over an 8-month period and organized using standard programme evaluation themes. Benefits included supervisor conflict coaching competency and enhanced conflict communication competency for nurse managers and supervisees facing specific conflict situations. Challenges included the management of programme tensions. Additional benefits and challenges are discussed, along with study limitations. Conflict coaching was a practical and effective means of developing the conflict communication competencies of nurse managers and supervisees. Additional research is needed. Conflict is common in nursing. Conflict coaching is a new conflict communication and supervision intervention that demonstrates initial promise. Conflict coaching seems to work best when supported by a positive conflict culture and integrated with other conflict intervention processes. © 2010 The Author. Journal compilation © 2010 Blackwell Publishing Ltd.

Radiofrequency Ablation in Coccydynia: A Case Series and Comprehensive, Evidence-Based Review.

PubMed

Chen, Yian; Huang-Lionnet, Julie H Y; Cohen, Steven P

2017-06-01

Coccydynia is a condition with a multitude of different causes, characterized by ill-defined management. There are multiple prospective studies, including several controlled trials, that have evaluated conservative therapies. Additionally, a plethora of observational studies have assessed coccygectomy, but few studies have reported results for nonsurgical interventional procedures. In this report, we describe the treatment results of 12 patients who received conventional or pulsed radiofrequency for coccydynia and systematically review the literature on management. We performed a retrospective data analysis evaluating patients who underwent pulsed or conventional radiofrequency treatment at Johns Hopkins Hospital and Walter Reed National Military Medical Center. A comprehensive literature review was also performed to contextualize these results. The mean age of patients treated was 50.25 years (SD = 11.20 years, range = 32-72 years), with the mean duration of symptoms being 3.6 years (SD = 3.36 years, range 1-10 years). There were 10 males and two females in this cohort. Among patients who received radiofrequency treatment, the average benefit was 55.5% pain relief (SD = 30.33%, range = 0-100%). Those who underwent conventional (vs pulsed radiofrequency) and who received prognostic blocks were more likely to experience a positive outcome. There were two cases of neuritis, which resolved spontaneously after several weeks. Radiofrequency ablation of the sacrococcygeal nerves may serve as a useful treatment option for patients with coccydynia who have failed more conservative measures. Further research into this therapeutic approach and its benefit for coccydynia should incorporate a control group for comparison. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

National Structural Survey of Veterans Affairs Home-Based Primary Care Programs.

PubMed

Karuza, Jurgis; Gillespie, Suzanne M; Olsan, Tobie; Cai, Xeuya; Dang, Stuti; Intrator, Orna; Li, Jiejin; Gao, Shan; Kinosian, Bruce; Edes, Thomas

2017-12-01

To describe the current structural and practice characteristics of the Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) program. We designed a national survey and surveyed HBPC program directors on-line using REDCap. We received 236 surveys from 394 identified HBPC sites (60% response rate). HBPC site characteristics were quantified using closed-ended formats. HBPC program directors were most often registered nurses, and HBPC programs primarily served veterans with complex chronic illnesses that were at high risk of hospitalization and nursing home care. Primary care was delivered using interdisciplinary teams, with nurses, social workers, and registered dietitians as team members in more than 90% of the sites. Most often, nurse practitioners were the principal primary care providers (PCPs), typically working with nurse case managers. Nearly 60% of the sites reported dual PCPs involving VA and community-based physicians. Nearly all sites provided access to a core set of comprehensive services and programs (e.g., case management, supportive home health care). At the same time, there were variations according to site (e.g., size, location (urban, rural), use of non-VA hospitals, primary care models used). HBPC sites reflected the rationale and mission of HBPC by focusing on complex chronic illness of home-based veterans and providing comprehensive primary care using interdisciplinary teams. Our next series of studies will examine how HBPC site structural characteristics and care models are related to the processes and outcomes of care to determine whether there are best practice standards that define an optimal HBPC structure and care model or whether multiple approaches to HBPC better serve the needs of veterans. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

25 CFR 163.11 - Forest management planning and sustained yield management.

Code of Federal Regulations, 2010 CFR

2010-04-01

... implementation of integrated resource management plans which provide coordination for the comprehensive management of all natural resources on Indian land. If the integrated resource management planning process... 25 Indians 1 2010-04-01 2010-04-01 false Forest management planning and sustained yield management...

A performance improvement case study in aircraft maintenance and its implications for hazard identification.

PubMed

Ward, Marie; McDonald, Nick; Morrison, Rabea; Gaynor, Des; Nugent, Tony

2010-02-01

Aircraft maintenance is a highly regulated, safety critical, complex and competitive industry. There is a need to develop innovative solutions to address process efficiency without compromising safety and quality. This paper presents the case that in order to improve a highly complex system such as aircraft maintenance, it is necessary to develop a comprehensive and ecologically valid model of the operational system, which represents not just what is meant to happen, but what normally happens. This model then provides the backdrop against which to change or improve the system. A performance report, the Blocker Report, specific to aircraft maintenance and related to the model was developed gathering data on anything that 'blocks' task or check performance. A Blocker Resolution Process was designed to resolve blockers and improve the current check system. Significant results were obtained for the company in the first trial and implications for safety management systems and hazard identification are discussed. Statement of Relevance: Aircraft maintenance is a safety critical, complex, competitive industry with a need to develop innovative solutions to address process and safety efficiency. This research addresses this through the development of a comprehensive and ecologically valid model of the system linked with a performance reporting and resolution system.

Eosinophilic pustular folliculitis: A published work-based comprehensive analysis of therapeutic responsiveness.

PubMed

Nomura, Takashi; Katoh, Mayumi; Yamamoto, Yosuke; Miyachi, Yoshiki; Kabashima, Kenji

2016-08-01

Eosinophilic pustular folliculitis (EPF) is a non-infectious inflammatory dermatosis of unknown etiology that principally affects the hair follicles. There are three variants of EPF: (i) classic EPF; (ii) immunosuppression-associated EPF, which is subdivided into HIV-associated (IS/HIV) and non-HIV-associated (IS/non-HIV); and (iii) infancy-associated EPF. Oral indomethacin is efficacious, especially for classic EPF. No comprehensive information on the efficacies of other medical management regimens is currently available. In this study, we surveyed regimens for EPF that were described in articles published between 1965 and 2013. In total, there were 1171 regimens; 874, 137, 45 and 115 of which were applied to classic, IS/HIV, IS/non-HIV and infancy-associated EPF, respectively. Classic EPF was preferentially treated with oral indomethacin with efficacy of 84% whereas topical steroids were preferred for IS/HIV, IS/non-HIV and infancy-associated EPF with efficacy of 47%, 73% and 82%, respectively. Other regimens such as oral Sairei-to (a Chinese-Japanese herbal medicine), diaminodiphenyl sulfone, cyclosporin and topical tacrolimus were effective for indomethacin-resistant cases. Although the preclusion of direct comparison among cases was one limitation, this study provides a dataset that is applicable to the construction of therapeutic algorithms for EPF. © 2016 Japanese Dermatological Association.

Evaluative methodology for comprehensive water quality management planning

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

Dyer, H. L.

Computer-based evaluative methodologies have been developed to provide for the analysis of coupled phenomena associated with natural resource comprehensive planning requirements. Provisions for planner/computer interaction have been included. Each of the simulation models developed is described in terms of its coded procedures. An application of the models for water quality management planning is presented; and the data requirements for each of the models are noted.

Comprehensive Care

MedlinePlus

... also a priority. Your Whole Health, Your Whole Team: Managing Your Complex MS Symptoms Webinar/telelearning presented ... MS and how to form a comprehensive care team. Watch now Share Smaller Text Larger Text Print ...

Nationwide implementation of integrated community case management of childhood illness in Rwanda

PubMed Central

Mugeni, Catherine; Levine, Adam C; Munyaneza, Richard M; Mulindahabi, Epiphanie; Cockrell, Hannah C; Glavis-Bloom, Justin; Nutt, Cameron T; Wagner, Claire M; Gaju, Erick; Rukundo, Alphonse; Habimana, Jean Pierre; Karema, Corine; Ngabo, Fidele; Binagwaho, Agnes

2014-01-01

ABSTRACT Background: Between 2008 and 2011, Rwanda introduced integrated community case management (iCCM) of childhood illness nationwide. Community health workers in each of Rwanda's nearly 15,000 villages were trained in iCCM and equipped for empirical diagnosis and treatment of pneumonia, diarrhea, and malaria; for malnutrition surveillance; and for comprehensive reporting and referral services. Methods: We used data from the Rwanda health management information system (HMIS) to calculate monthly all-cause under-5 mortality rates, health facility use rates, and community-based treatment rates for childhood illness in each district. We then compared a 3-month baseline period prior to iCCM implementation with a seasonally matched comparison period 1 year after iCCM implementation. Finally, we compared the actual changes in all-cause child mortality and health facility use over this time period with the changes that would have been expected based on baseline trends in Rwanda. Results: The number of children receiving community-based treatment for diarrhea and pneumonia increased significantly in the 1-year period after iCCM implementation, from 0.83 cases/1,000 child-months to 3.80 cases/1,000 child-months (P = .01) and 0.25 cases/1,000 child-months to 5.28 cases/1,000 child-months (P<.001), respectively. On average, total under-5 mortality rates declined significantly by 38% (P<.001), and health facility use declined significantly by 15% (P = .006). These decreases were significantly greater than would have been expected based on baseline trends. Conclusions: This is the first study to demonstrate decreases in both child mortality and health facility use after implementing iCCM of childhood illness at a national level. While our study design does not allow for direct attribution of these changes to implementation of iCCM, these results are in line with those of prior studies conducted at the sub-national level in other low-income countries. PMID:25276592

Using a fuzzy comprehensive evaluation method to determine product usability: A test case

PubMed Central

Zhou, Ronggang; Chan, Alan H. S.

2016-01-01

BACKGROUND: In order to take into account the inherent uncertainties during product usability evaluation, Zhou and Chan [1] proposed a comprehensive method of usability evaluation for products by combining the analytic hierarchy process (AHP) and fuzzy evaluation methods for synthesizing performance data and subjective response data. This method was designed to provide an integrated framework combining the inevitable vague judgments from the multiple stages of the product evaluation process. OBJECTIVE AND METHODS: In order to illustrate the effectiveness of the model, this study used a summative usability test case to assess the application and strength of the general fuzzy usability framework. To test the proposed fuzzy usability evaluation framework [1], a standard summative usability test was conducted to benchmark the overall usability of a specific network management software. Based on the test data, the fuzzy method was applied to incorporate both the usability scores and uncertainties involved in the multiple components of the evaluation. Then, with Monte Carlo simulation procedures, confidence intervals were used to compare the reliabilities among the fuzzy approach and two typical conventional methods combining metrics based on percentages. RESULTS AND CONCLUSIONS: This case study showed that the fuzzy evaluation technique can be applied successfully for combining summative usability testing data to achieve an overall usability quality for the network software evaluated. Greater differences of confidence interval widths between the method of averaging equally percentage and weighted evaluation method, including the method of weighted percentage averages, verified the strength of the fuzzy method. PMID:28035942

Using a fuzzy comprehensive evaluation method to determine product usability: A test case.

PubMed

Zhou, Ronggang; Chan, Alan H S

2017-01-01

In order to take into account the inherent uncertainties during product usability evaluation, Zhou and Chan [1] proposed a comprehensive method of usability evaluation for products by combining the analytic hierarchy process (AHP) and fuzzy evaluation methods for synthesizing performance data and subjective response data. This method was designed to provide an integrated framework combining the inevitable vague judgments from the multiple stages of the product evaluation process. In order to illustrate the effectiveness of the model, this study used a summative usability test case to assess the application and strength of the general fuzzy usability framework. To test the proposed fuzzy usability evaluation framework [1], a standard summative usability test was conducted to benchmark the overall usability of a specific network management software. Based on the test data, the fuzzy method was applied to incorporate both the usability scores and uncertainties involved in the multiple components of the evaluation. Then, with Monte Carlo simulation procedures, confidence intervals were used to compare the reliabilities among the fuzzy approach and two typical conventional methods combining metrics based on percentages. This case study showed that the fuzzy evaluation technique can be applied successfully for combining summative usability testing data to achieve an overall usability quality for the network software evaluated. Greater differences of confidence interval widths between the method of averaging equally percentage and weighted evaluation method, including the method of weighted percentage averages, verified the strength of the fuzzy method.

Comprehensive primary health care under neo-liberalism in Australia.

PubMed

Baum, Fran; Freeman, Toby; Sanders, David; Labonté, Ronald; Lawless, Angela; Javanparast, Sara

2016-11-01

This paper applies a critical analysis of the impact of neo-liberal driven management reform to examine changes in Australian primary health care (PHC) services over five years. The implementation of comprehensive approaches to primary health care (PHC) in seven services: five state-managed and two non-government organisations (NGOs) was tracked from 2009 to 2014. Two questions are addressed: 1) How did the ability of Australian PHC services to implement comprehensive PHC change over the period 2009-2014? 2) To what extent is the ability of the PHC services to implement comprehensive PHC shaped by neo-liberal health sector reform processes? The study reports on detailed tracking and observations of the changes and in-depth interviews with 63 health service managers and practitioners, and regional and central health executives. The documented changes were: in the state-managed services (although not the NGOs) less comprehensive service coverage and more focus on clinical services and integration with hospitals and much less development activity including community development, advocacy, intersectoral collaboration and attention to the social determinants. These changes were found to be associated with practices typical of neo-liberal health sector reform: considerable uncertainty, more directive managerial control, budget reductions and competitive tendering and an emphasis on outputs rather than health outcomes. We conclude that a focus on clinical service provision, while highly compatible with neo-liberal reforms, will not on its own produce the shifts in population disease patterns that would be required to reduce demand for health services and promote health. Comprehensive PHC is much better suited to that task. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Follow the Money: A Comprehensive Review of the Funding Mechanisms of Voucher Programs in Six Cases. Informing Policy & Improving Practice Research Brief

ERIC Educational Resources Information Center

Stewart, Molly S.; Moon, Jodi S.

2016-01-01

This comprehensive review is part of a three-part report, Follow the "Money: A Detailed Analysis of the Funding Mechanisms of Voucher Programs in Six Cases"; this review contains the cross-case analysis and findings of the funding mechanisms of voucher programs across five states (Arizona, Indiana, Louisiana, Ohio, and Wisconsin) and the…

Wastewater treatment evaluation for enterprises based on fuzzy-AHP comprehensive evaluation: a case study in industrial park in Taihu Basin, China.

PubMed

Hu, Wei; Liu, Guangbing; Tu, Yong

2016-01-01

This paper applied the fuzzy comprehensive evaluation (FCE) technique and analytic hierarchy process (AHP) procedure to evaluate the wastewater treatment for enterprises. Based on the characteristics of wastewater treatment for enterprises in Taihu basin, an evaluating index system was established for enterprise and analysis hierarchy process method was applied to determine index weight. Then the AHP and FCE methods were combined to validate the wastewater treatment level of 3 representative enterprises. The results show that the evaluation grade of enterprise 1, enterprise 2 and enterprise 3 was middle, good and excellent, respectively. Finally, the scores of 3 enterprises were calculated according to the hundred-mark system, and enterprise 3 has the highest wastewater treatment level, followed by enterprise 2 and enterprises 1. The application of this work can make the evaluation results more scientific and accurate. It is expected that this work may serve as an assistance tool for managers of enterprise in improving the wastewater treatment level.

Pareto frontier analyses based decision making tool for transportation of hazardous waste.

PubMed

Das, Arup; Mazumder, T N; Gupta, A K

2012-08-15

Transportation of hazardous wastes through a region poses immense threat on the development along its road network. The risk to the population, exposed to such activities, has been documented in the past. However, a comprehensive framework for routing hazardous wastes has often been overlooked. A regional Hazardous Waste Management scheme should incorporate a comprehensive framework for hazardous waste transportation. This framework would incorporate the various stakeholders involved in decision making. Hence, a multi-objective approach is required to safeguard the interest of all the concerned stakeholders. The objective of this study is to design a methodology for routing of hazardous wastes between the generating units and the disposal facilities through a capacity constrained network. The proposed methodology uses posteriori method with multi-objective approach to find non-dominated solutions for the system consisting of multiple origins and destinations. A case study of transportation of hazardous wastes in Kolkata Metropolitan Area has also been provided to elucidate the methodology. Copyright © 2012 Elsevier B.V. All rights reserved.

Anima: Modular Workflow System for Comprehensive Image Data Analysis

PubMed Central

Rantanen, Ville; Valori, Miko; Hautaniemi, Sampsa

2014-01-01

Modern microscopes produce vast amounts of image data, and computational methods are needed to analyze and interpret these data. Furthermore, a single image analysis project may require tens or hundreds of analysis steps starting from data import and pre-processing to segmentation and statistical analysis; and ending with visualization and reporting. To manage such large-scale image data analysis projects, we present here a modular workflow system called Anima. Anima is designed for comprehensive and efficient image data analysis development, and it contains several features that are crucial in high-throughput image data analysis: programing language independence, batch processing, easily customized data processing, interoperability with other software via application programing interfaces, and advanced multivariate statistical analysis. The utility of Anima is shown with two case studies focusing on testing different algorithms developed in different imaging platforms and an automated prediction of alive/dead C. elegans worms by integrating several analysis environments. Anima is a fully open source and available with documentation at www.anduril.org/anima. PMID:25126541

A comprehensive model for executing knowledge management audits in organizations: a systematic review.

PubMed

Shahmoradi, Leila; Ahmadi, Maryam; Sadoughi, Farahnaz; Piri, Zakieh; Gohari, Mahmood Reza

2015-01-01

A knowledge management audit (KMA) is the first phase in knowledge management implementation. Incomplete or incomprehensive execution of the KMA has caused many knowledge management programs to fail. A study was undertaken to investigate how KMAs are performed systematically in organizations and present a comprehensive model for performing KMAs based on a systematic review. Studies were identified by searching electronic databases such as Emerald, LISA, and the Cochrane library and e-journals such as the Oxford Journal and hand searching of printed journals, theses, and books in the Tehran University of Medical Sciences digital library. The sources used in this study consisted of studies available through the digital library of the Tehran University of Medical Sciences that were published between 2000 and 2013, including both Persian- and English-language sources, as well as articles explaining the steps involved in performing a KMA. A comprehensive model for KMAs is presented in this study. To successfully execute a KMA, it is necessary to perform the appropriate preliminary activities in relation to the knowledge management infrastructure, determine the knowledge management situation, and analyze and use the available data on this situation.

Life cycle costing of waste management systems: Overview, calculation principles and case studies

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

Martinez-Sanchez, Veronica, E-mail: vems@env.dtu.dk; Kromann, Mikkel A.; Astrup, Thomas Fruergaard

2015-02-15

Highlights: • We propose a comprehensive model for cost assessment of waste management systems. • The model includes three types of LCC: Conventional, Environmental and Societal LCCs. • The applicability of the proposed model is tested with two case studies. - Abstract: This paper provides a detailed and comprehensive cost model for the economic assessment of solid waste management systems. The model was based on the principles of Life Cycle Costing (LCC) and followed a bottom-up calculation approach providing detailed cost items for all key technologies within modern waste systems. All technologies were defined per tonne of waste input, andmore » each cost item within a technology was characterised by both a technical and an economic parameter (for example amount and cost of fuel related to waste collection), to ensure transparency, applicability and reproducibility. Cost items were classified as: (1) budget costs, (2) transfers (for example taxes, subsidies and fees) and (3) externality costs (for example damage or abatement costs related to emissions and disamenities). Technology costs were obtained as the sum of all cost items (of the same type) within a specific technology, while scenario costs were the sum of all technologies involved in a scenario. The cost model allows for the completion of three types of LCC: a Conventional LCC, for the assessment of financial costs, an Environmental LCC, for the assessment of financial costs whose results are complemented by a Life Cycle Assessment (LCA) for the same system, and a Societal LCC, for socio-economic assessments. Conventional and Environmental LCCs includes budget costs and transfers, while Societal LCCs includes budget and externality costs. Critical aspects were found in the existing literature regarding the cost assessment of waste management, namely system boundary equivalency, accounting for temporally distributed emissions and impacts, inclusions of transfers, the internalisation of environmental impacts and the coverage of shadow prices, and there was also significant confusion regarding terminology. The presented cost model was implemented in two case study scenarios assessing the costs involved in the source segregation of organic waste from 100,000 Danish households and the subsequent co-digestion of organic waste with animal manure. Overall, source segregation resulted in higher financial costs than the alternative of incinerating the organic waste with the residual waste: 1.6 M€/year, of which 0.9 M€/year was costs for extra bins and bags used by the households, 1.0 M€/year for extra collections and −0.3 M€/year saved on incineration.« less

Comprehensive Stuttering Treatment or Adolescents: A Case Study

ERIC Educational Resources Information Center

Coleman, Craig E.

2018-01-01

Purpose: This article will focus on a hypothetical case study to highlight comprehensive assessment and treatment for adolescent children who stutter. Method: Assessment and treatment are laid out with a literature review utilizing the components of the International Classification of Functioning, Disability and Health model. Specific assessment…

An evaluation of a risk-based environmental regulation in Brazil: Limitations to risk management of hazardous installations

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

Naime, Andre, E-mail: andre.naime.ibama@gmail.com

The environmental regulation of hazardous projects with risk-based decision-making processes can lead to a deficient management of human exposure to technological hazards. Such an approach for regulation is criticized for simplifying the complexity of decisions involving the economic, social, and environmental aspects of the installation and operation of hazardous facilities in urban areas. Results of a Brazilian case study indicate that oil and gas transmission pipelines may represent a threat to diverse communities if the relationship between such linear projects and human populations is overlooked by regulatory bodies. Results also corroborate known challenges to the implementation of EIA processes andmore » outline limitations to an effective environmental and risk management. Two preliminary topics are discussed to strengthen similar regulatory practices. Firstly, an effective integration between social impact assessment and risk assessment in EIA processes to have a more comprehensive understanding of the social fabric. Secondly, the advancement of traditional management practices for hazardous installations to pursue a strong transition from assessment and evaluation to management and control and to promote an effective interaction between land-use planning and environmental regulation.« less

Impact of the social networking applications for health information management for patients and physicians.

PubMed

Sahama, Tony; Liang, Jian; Iannella, Renato

2012-01-01

Most social network users hold more than one social network account and utilize them in different ways depending on the digital context. For example, friendly chat on Facebook, professional discussion on LinkedIn, and health information exchange on PatientsLikeMe. Thus many web users need to manage many disparate profiles across many distributed online sources. Maintaining these profiles is cumbersome, time consuming, inefficient, and leads to lost opportunity. In this paper we propose a framework for multiple profile management of online social networks and showcase a demonstrator utilising an open source platform. The result of the research enables a user to create and manage an integrated profile and share/synchronise their profiles with their social networks. A number of use cases were created to capture the functional requirements and describe the interactions between users and the online services. An innovative application of this project is in public health informatics. We utilize the prototype to examine how the framework can benefit patients and physicians. The framework can greatly enhance health information management for patients and more importantly offer a more comprehensive personal health overview of patients to physicians.

Performance Evaluation and Analysis of Rural Drinking Water Safety Project——A Case Study in Jiangsu, China

NASA Astrophysics Data System (ADS)

Du, Xiaorong

2017-04-01

Water is the basic condition for human survival and development. As China is the most populous country, rural drinking water safety problems are most conspicuous. Therefore, the Chinese government keeps increasing investment and has built a large number of rural drinking water safety projects. Scientific evaluation of project performance is of great significance to promote the sustainable operation of the project and the sustainable development of rural economy. Previous studies mainly focus on the economic benefits of the project, while ignoring the fact that the rural drinking water safety project is quasi-public goods, which has economic, social and ecological benefits. This paper establishes a comprehensive evaluation model for rural drinking water safety performance, which adapts the rules of "5E" (economy, efficiency, effectiveness, equity and environment) as the value orientation, and selects a rural drinking water safety project as object in case study at K District, which is in the north of Jiangsu Province, China. The results shows: 1) the comprehensive performance of K project is in good condition; 2) The performance of every part shows that the scores of criteria "efficiency", "environment" and "effect" are higher than the mean performance, while the "economy" is slightly lower than the mean and the "equity" is the lowest. 3) The performance of indicator layer shows that: the planned completion rate of project, the reduction rate of project cost and the penetration rate of water-use population are significantly lower than other indicators. Based on the achievements of previous studies and the characteristics of rural drinking water safety project, this study integrates the evaluation dimensions of equity and environment, which can contribute to a more comprehensive and systematic assessment of project performance and provide empirical data for performance evaluation and management of rural drinking water safety project. Key Words: Rural drinking water safety project; Performance evaluation; 5E rules; Comprehensive evaluation model

Development of a Medicare Beneficiary Comprehension Test: Assessing Medicare Part D Beneficiaries' Comprehension of Their Benefits

PubMed Central

Aruru, Meghana V.; Salmon, J. Warren

2013-01-01

Background Medicare Part D, the senior prescription drug benefit plan, was introduced through the Medicare Modernization Act of 2003. Medicare beneficiaries receive information about plan options through multiple sources, and it is often assumed by consumer health plans and healthcare providers that beneficiaries can understand and compare plan information. Medicare beneficiaries are older, may have cognitive problems, and may not have a true understanding of managed care. They are more likely than younger persons to have inadequate health literacy, thereby demonstrating significant gaps in knowledge and information about healthcare. Objective To develop a Medicare Beneficiary Comprehension Test (MBCT) to evaluate Medicare beneficiaries' understanding of Part D plan concepts, as presented in the 2008 Medicare & You handbook. Methods A 10-question MBCT was developed using a case-vignette approach that required beneficiaries to read portions of the Medicare & You handbook and answer Part D–related questions associated with healthcare decision-making. The test was divided into 2 sections: (I) insurance concepts and (II) utilization management/appeals and grievances to cover standard terminology, as well as newer utilization management and appeals and grievances procedures that are unique to Part D. The test was administered to 100 beneficiaries at 2 sites—a university geriatrics clinic and a private retirement facility. Beneficiaries were tested for cognition and health literacy before being administered the test. Results The mean score on the MBCT was 3.5 of a maximum of 5, with no statistical difference found between both sites. Ten faculty members and 4 graduate students assessed the content validity of the instrument using a 4-point Likert rating rubric. The construct validity of the instrument was assessed using a principal components analysis with varimax rotation. The principal components analysis yielded 4 factors that were labeled as “Plan D concepts,” “managed care/utilization management,” “cost-sharing,” and “plan comparisons.” The factor analysis indicated that the test is multidimensional and did measure the construct. Conclusions Medicare beneficiaries' understanding of Part D may play a key role in the management of their drug use and health and the associated outcomes. The MBCT and its pending revisions can be administered to beneficiaries with differing health outcomes. Medicare beneficiaries are often faced with several pieces of information involving a complex array of choices amidst bewildering plan options. It is crucial that beneficiaries and/or their family members involved in the decision-making process understand the plan benefits to truly make an informed decision. As the number of Medicare beneficiaries increases over the coming years with the baby boomers, it becomes even more imperative that the elderly have improved access to treatments that can achieve desirable outcomes. Measuring comprehension by Medicare beneficiaries may be an initial step toward understanding more complex issues, such as treatment adherence, decision-making, and, ultimately, trends in healthcare utilization and outcomes. PMID:24991375

Lessons learnt from the management of a case of Lassa fever and follow-up of nosocomial primary contacts in Nigeria during Ebola virus disease outbreak in West Africa.

PubMed

Iroezindu, Michael O; Unigwe, Uche S; Okwara, Celestine C; Ozoh, Gladys A; Ndu, Anne C; Ohanu, Martin E; Nwoko, Ugochukwu O; Okoroafor, Uwadiegwu W; Ejimudo, Esinulo; Tobin, Ekaete A; Asogun, Danny A

2015-11-01

To describe our experiences in the management of a case of Lassa fever (LF) and follow-up of nosocomial primary contacts during the 2014 Ebola outbreak in West Africa. Clinical management of the index case and infection control/surveillance activities for primary contacts are described. Laboratory confirmation was by Lassa virus-specific reverse-transcriptase PCR. A 28-year-old man with a 10-day history of febrile illness was referred to a major tertiary hospital in south-east Nigeria from a city that previously experienced a LF outbreak and was recently affected by Ebola. On observation of haemorrhagic features, clinicians were at a crossroads. Diagnosis of LF was confirmed at a National Reference Centre. The patient died despite initiation of ribavirin therapy. Response activities identified 121 primary contacts comprising 78 (64.5%) hospital staff/interns, 19 (15.7%) medical students, 18 (14.9%) inpatients and 6 (5.0%) relatives. Their mean age was 32.8 ± 6.6 years, and 65.3% were women. Twenty (16.5%) had high-risk exposure and were offered ribavirin as post-exposure prophylaxis. No secondary case of LF occurred. Fatigue (43.8%) and dizziness (31.3%) were the commonest side effects of ribavirin. Response activities contained nosocomial spread of LF, but challenges were experienced including lack of a purpose-built isolation facility, absence of local Lassa virus laboratory capacity, failure to use appropriate protective equipment and stigmatisation of contacts. A key lesson is that the weak health systems of Africa should be comprehensively strengthened; otherwise, we might win the Ebola battle but lose the one against less virulent infections for which effective treatment exists. © 2015 John Wiley & Sons Ltd.

Nurses' performance on primary care in the National Health Service in England.

PubMed

Toso, Beatriz Rosana Gonçalves de Oliveira; Filippon, Jonathan; Giovanella, Ligia

2016-01-01

To analyze the expansion of nursing roles in primary care in the English National Health Service and the implications for professional practice. qualitative research in case study format, held in London, England, in six primary care units. Data were obtained through interviews with nine nurses. After the thematic data analysis, two units emerged: the nurses' performance characteristics and effects of the expansion of nursing roles. expansion of nurses' roles: consultation, diagnosis and drug therapy, case management and monitoring of chronic conditions. Repercussions: for the user, there was improved access, communication and comprehensive care, increased duration of consultations, resulting in greater adherence; for nurses, there was the expansion of professional skills, knowledge and professional recognition; to the health care system, it resulted in cost savings. benefits in expanding nursing roles, were visible, contributing to primary care quality.

Treatment of Patellar Tendinopathy Refractory to Surgical Management Using Percutaneous Ultrasonic Tenotomy and Platelet-Rich Plasma Injection: A Case Presentation.

PubMed

Nanos, Katherine N; Malanga, Gerard A

2015-12-01

Chronic proximal patellar tendinopathy is a common condition in sports medicine that may be refractory to nonoperative treatments, including activity modification, medications, and comprehensive rehabilitation. Percutaneous ultrasonic tenotomy is a recently developed technique designed to cut and debride tendinopathic tissue, thus promoting pain relief and functional recovery. We present a case of a collegiate athlete with chronic proximal patellar tendinopathy who was effectively treated with percutaneous ultrasonic tenotomy after not responding to extensive nonoperative treatment, surgical debridement, and platelet-rich plasma injections. Percutaneous ultrasonic tenotomy can be considered as a treatment option in patients presenting with refractory proximal patellar tendinopathy, including those who do not respond to previous operative intervention. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

A business case evaluation of workplace engineering noise control: a net-cost model.

PubMed

Lahiri, Supriya; Low, Colleen; Barry, Michael

2011-03-01

This article provides a convenient tool for companies to determine the costs and benefits of alternative interventions to prevent noise-induced hearing loss (NIHL). Contextualized for Singapore and in collaboration with Singapore's Ministry of Manpower, the Net-Cost model evaluates costs of intervention for equipment and labor, avoided costs of productivity losses and medical care, and productivity gains from the employer's economic perspective. To pilot this approach, four case studies are presented, with varying degrees of economic benefits to the employer, including one in which multifactor productivity is the main driver. Although compliance agencies may not require economic analysis of NIHL, given scarce resources in a market-driven economy, this tool enables stakeholders to understand and compare the costs and benefits of NIHL interventions comprehensively and helps in determining risk management strategies.

Transient Diabetes Insipidus Following Thermal Burn; A Case Report and Literature Review.

PubMed

Dash, Suvashis; Ghosh, Shibajyoti

2017-10-01

Diabetes insipidus is a disease charaterised by increased urine production and thrist. Neurogenic diabetes insipidus following head trauma,autoimmune disease and infection is quite common but diabetes insipidus following thermal burn injury is a rare complication.We should know about this complication as its management need a comprehensive approach for satisfactory outcome. Thermal burn can cause different complications in early post burn period like electrolyte imbalance, dehydration, acute renal failure, but diabetes insipidus is a very rare and unusual complication that may come across in thermal burn. We should be aware about this condition to prevent and treat mortality and morbidity in burn patients. We have reported a case of transient diabetes insipidus in a patient of thermal burn in early post burn period. Patient was treated accordingly, leading to complete recovery.

Treating disorganized attachment in the Group Attachment-Based Intervention (GABI©): A case study.

PubMed

Knafo, Hannah; Murphy, Anne; Steele, Howard; Steele, Miriam

2018-05-24

This paper describes the treatment of a mother and child who demonstrated disorganized attachment behaviors in their interactions with one another. The mother, who was diagnosed with Borderline Personality Disorder, felt incapable of managing her aggressive toddler and his emotional needs. The dyad was referred for therapy due to concerns about his developmental progress, evident delays having been mainly attributed to the problems observed within the parent-child relationship. The primary intervention applied to working with the dyad was the Group Attachment-Based Intervention (GABI©), developed by Anne Murphy in collaboration with Miriam Steele and Howard Steele. The mother also received individual psychotherapy as a supplement to the dyadic and group work of GABI©. The process and outcome of this comprehensive approach to treating a vulnerable dyad is explored in this case study. © 2018 Wiley Periodicals, Inc.

Comprehensive self management and routine monitoring in chronic obstructive pulmonary disease patients in general practice: randomised controlled trial.

PubMed

Bischoff, Erik W M A; Akkermans, Reinier; Bourbeau, Jean; van Weel, Chris; Vercoulen, Jan H; Schermer, Tjard R J

2012-11-28

To assess the long term effects of two different modes of disease management (comprehensive self management and routine monitoring) on quality of life (primary objective), frequency and patients' management of exacerbations, and self efficacy (secondary objectives) in patients with chronic obstructive pulmonary disease (COPD) in general practice. 24 month, multicentre, investigator blinded, three arm, pragmatic, randomised controlled trial. 15 general practices in the eastern part of the Netherlands. Patients with COPD confirmed by spirometry and treated in general practice. Patients with very severe COPD or treated by a respiratory physician were excluded. A comprehensive self management programme as an adjunct to usual care, consisting of four tailored sessions with ongoing telephone support by a practice nurse; routine monitoring as an adjunct to usual care, consisting of 2-4 structured consultations a year with a practice nurse; or usual care alone (contacts with the general practitioner at the patients' own initiative). The primary outcome was the change in COPD specific quality of life at 24 months as measured with the chronic respiratory questionnaire total score. Secondary outcomes were chronic respiratory questionnaire domain scores, frequency and patients' management of exacerbations measured with the Nijmegen telephonic exacerbation assessment system, and self efficacy measured with the COPD self-efficacy scale. 165 patients were allocated to self management (n=55), routine monitoring (n=55), or usual care alone (n=55). At 24 months, adjusted treatment differences between the three groups in mean chronic respiratory questionnaire total score were not significant. Secondary outcomes did not differ, except for exacerbation management. Compared with usual care, more exacerbations in the self management group were managed with bronchodilators (odds ratio 2.81, 95% confidence interval 1.16 to 6.82) and with prednisolone, antibiotics, or both (3.98, 1.10 to 15.58). Comprehensive self management or routine monitoring did not show long term benefits in terms of quality of life or self efficacy over usual care alone in COPD patients in general practice. Patients in the self management group seemed to be more capable of appropriately managing exacerbations than did those in the usual care group. Clinical trials NCT00128765.

Adult encephalitis surveillance: experiences from an Australian prospective sentinel site study.

PubMed

Eastwood, K; Paterson, B J; Levi, C; Givney, R; Loewenthal, M; DE Malmanche, T; Lai, K; Granerod, J; Durrheim, D N

2015-11-01

Few countries routinely collect comprehensive encephalitis data, yet understanding the epidemiology of this condition has value for clinical management, detecting novel and emerging pathogens, and guiding timely public health interventions. When this study was conducted there was no standardized diagnostic algorithm to aid identification of encephalitis or systematic surveillance for adult encephalitis. In July 2012 we tested three pragmatic surveillance options aimed at identifying possible adult encephalitis cases admitted to a major Australian hospital: hospital admissions searches, clinician notifications and laboratory test alerts (CSF herpes simplex virus requests). Eligible cases underwent structured laboratory investigation and a specialist panel arbitrated on the final diagnosis. One hundred and thirteen patients were initially recruited into the 10-month study; 20/113 (18%) met the study case definition, seven were diagnosed with infectious or immune-mediated encephalitis and the remainder were assigned alternative diagnoses. The laboratory alert identified 90% (102/113) of recruited cases including six of the seven cases of confirmed encephalitis suggesting that this may be a practical data source for case ascertainment. The application of a standardized diagnostic algorithm and specialist review by an expert clinical panel aided diagnosis of patients with encephalitis.

Nurses' understanding influences comprehension of patients admitted in the observation unit.

PubMed

Desme, Aline; Mendes, Nathalie; Perruche, Franck; Veillard, Elsa; Elie, Caroline; Moulinet, Françoise; Sanson, Fabienne; Georget, Jean-Michel; Tissier, Anne; Pourriat, Jean-Louis; Claessens, Yann-Erick

2013-01-01

Comprehension is poor in patients admitted in the emergency observation unit. Teamwork communication gaps could contribute to patients' misunderstanding of their health condition. To determine in patients admitted in the emergency observation unit whether comprehension of diagnosis, prognosis, and management depended on nurses' comprehension, the authors conducted a prospective observational study in a busy adult emergency department of a tertiary teaching hospital in Paris over 2 months. Consecutive patients admitted in the emergency observation unit were included. Patients' and nurses' comprehension of diagnosis, prognosis, and management was compared with the statements of the emergency department attending physicians for these items. The authors observed whether patients' misunderstanding was associated with nurses' misunderstanding. A total of 544 patients were evaluated. For each patient, nurses' and patients' comprehension was available. Patients understood severity in 40%, organ involved in 69%, medical wording in 57%, reason for admission in 48%, and discharge instruction in 67%. In comparison with patients, nurses better understood each item except for discharge instruction. The authors observed that patients' comprehension was better when nurses understood diagnosis (p <.0001), reasons for admission (p =.032) and discharge instructions (p =.002). Nurses' understanding of severity did not modify patients' comprehension. These results support the conclusions that communication gaps in teamwork alter patients' comprehension and that nurses' and patients' misunderstandings are associated. Therefore, improving communication by nurses and physicians to patients may improve patients' understanding.

Application of two quality indices as monitoring and management tools of rivers. Case study: the Imera Meridionale River, Italy.

PubMed

Bonanno, Giuseppe; Lo Giudice, Rosa

2010-04-01

On the basis of the European Water Framework Directive (2000/60), the water resources of the member states of the European Community should reach good quality standards by 2015. Although such regulations illustrate the basic points for a comprehensive and effective policy of water monitoring and management, no practical tools are provided to face and solve the issues concerning freshwater ecosystems such as rivers. The Italian government has developed a set of regulations as adoption of the European Directive but failed to indicate feasible procedures for river monitoring and management. On a local scale, Sicilian authorities have implemented monitoring networks of watersheds, aiming at describing the general conditions of rivers. However, such monitoring programs have provided a relatively fragmentary picture of the ecological conditions of the rivers. In this study, the integrated use of environmental quality indices is proposed as a methodology able to provide a practical approach to river monitoring and management. As a case study, the Imera Meridionale River, Sicily's largest river, was chosen. The water quality index developed by the U.S. National Sanitation Foundation and the floristic quality index based on the Wilhelm method were applied. The former enabled us to describe the water quality according to a spatial-temporal gradient, whereas the latter focused on the ecological quality of riparian vegetation. This study proposes a holistic view of river ecosystems by considering biotic and abiotic factors in agreement with the current European regulations. How the combined use of such indices can guide sustainable management efforts is also discussed.

A roadmap for knowledge exchange and mobilization research in conservation and natural resource management.

PubMed

Nguyen, Vivian M; Young, Nathan; Cooke, Steven J

2017-08-01

Scholars across all disciplines have long been interested in how knowledge moves within and beyond their community of peers. Rapid environmental changes and calls for sustainable management practices mean the best knowledge possible is needed to inform decisions, policies, and practices to protect biodiversity and sustainably manage vulnerable natural resources. Although the conservation literature on knowledge exchange (KE) and knowledge mobilization (KM) has grown in recent years, much of it is based on context-specific case studies. This presents a challenge for learning cumulative lessons from KE and KM research and thus effectively using knowledge in conservation and natural resources management. Although continued research on the gap between knowledge and action is valuable, overarching conceptual frameworks are now needed to enable summaries and comparisons across diverse KE-KM research. We propose a knowledge-action framework that provides a conceptual roadmap for future research and practice in KE/KM with the aim of synthesizing lessons learned from contextual case studies and guiding the development and testing of hypotheses in this domain. Our knowledge-action framework has 3 elements that occur at multiple levels and scales: knowledge production (e.g., academia and government), knowledge mediation (e.g., knowledge networks, actors, relational dimension, and contextual dimension), and knowledge-based action (e.g., instrumental, symbolic, and conceptual). The framework integrates concepts from the sociology of science in particular, and serves as a guide to further comprehensive understanding of knowledge exchange and mobilization in conservation and sustainable natural resource management. © 2016 Society for Conservation Biology.

Acute Surgical Unit: a new model of care.

PubMed

Cox, Michael R; Cook, Lyn; Dobson, Jennifer; Lambrakis, Paul; Ganesh, Shanthan; Cregan, Patrick

2010-06-01

The traditional on-call system for the management of acute general surgical admissions is inefficient and outdated. A new model, Acute Surgical Unit (ASU), was developed at Nepean Hospital in 2006. The ASU is a consultant-driven, independent unit that manages all acute general surgical admissions. The team has the same make up 7 days a week and functions the same every day, including weekends and public holidays. The consultant does a 24-h period of on-call, from 7 pm to 7 pm. They are on remote call from 7 pm to 7 am and are in the hospital from 7 am to 7 pm with their sole responsibility being to the ASU. The ASU has a day team with two registrars, two residents and a nurse practitioner. All patients are admitted and stay in the ASU until discharge or transfer to other units. Handover of the patients at the end of each day is facilitated by a comprehensive ASU database. The implementation of the ASU at Nepean Hospital has improved the timing of assessment by the surgical unit. There has been significant improvement in the timing of operative management, with an increased number and proportion of cases being done during daylight hours, with an associated reduction in the proportion of cases performed afterhours. There is greater trainee supervision with regard to patient assessment, management and operative procedures. There has been an improvement in the consultants' work conditions. The ASU provides an excellent training opportunity for surgical trainees, residents and interns in the assessment and management of acute surgical conditions.

Case Study of an Institutionalized Urban Comprehensive School Physical Activity Program

ERIC Educational Resources Information Center

Doolittle, Sarah A.; Rukavina, Paul B.

2014-01-01

This single case study (Yin, 2009) compares an established urban physical education/ sport/physical activity program with two models: Comprehensive School Physical Activity Program/CSPAP (AAHPERD, 2013; CDC, 2013); and Lawson's propositions (2005) for sport, exercise and physical education for empowerment and community development to determine…

7 CFR 210.29 - Management evaluations.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 4 2014-01-01 2014-01-01 false Management evaluations. 210.29 Section 210.29... AGRICULTURE CHILD NUTRITION PROGRAMS NATIONAL SCHOOL LUNCH PROGRAM Additional Provisions § 210.29 Management evaluations. (a) Management evaluations. FNS will conduct a comprehensive management evaluation of each State...

7 CFR 210.29 - Management evaluations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 4 2010-01-01 2010-01-01 false Management evaluations. 210.29 Section 210.29... AGRICULTURE CHILD NUTRITION PROGRAMS NATIONAL SCHOOL LUNCH PROGRAM Additional Provisions § 210.29 Management evaluations. (a) Management evaluations. FNS will conduct a comprehensive management evaluation of each State...

Forest Fire Management: A Comprehensive And Operational Approach

NASA Astrophysics Data System (ADS)

Fabrizi, Roberto; Perez, Bruno; Gomez, Antonio

2013-12-01

Remote sensing plays an important role in obtaining rapid and complete information on the occurrence and evolution in space and time of forest fires. In this paper, we present a comprehensive study of fire events through Earth Observation data for early warning, crisis monitoring and post-event damage assessment or a synthesis of the fire event, both in a wide spatial range (local to regional) and temporal scale (short to long term). The fire products are stored and distributed by means of a WebGIS and a Geoportal with additional auxiliary geospatial data. These products allow fire managers to perform analysis and decision making in a more comprehensive manner.

Victorian paramedics' encounters and management of women in labour: an epidemiological study.

PubMed

McLelland, Gayle; Morgans, Amee; McKenna, Lisa

2015-02-05

Although it is generally accepted that paramedics attend unexpected births, there is a paucity of literature about their management of women in labour. This study aimed to investigate the caseload of women in labour attended by a statewide ambulance service in Australia during one year and the management provided by paramedics. Retrospective clinical data collected on-scene by paramedics via in-field electronic patient care records were provided by Ambulance Victoria. Patient case reports were electronically extracted from the Ambulance Victoria's Clinical Data Warehouse via comprehensive filtering followed by manual sorting. Descriptive statistics were analysed using Statistical Package for Social Sciences (SPSS v.19). Over a 12-month period, paramedics were called to 1517 labouring women. Two thirds of women were at full-term gestation, and 40% of pre-term pregnancies were less than 32 weeks gestation. Paramedics documented 630 case reports of women in early labour and a further 767 in established labour. There were 204 women thought to be second stage labour, including 134 who progressed to childbirth under paramedic care. When paramedics assisted with births, the on-scene time was significantly greater than those patients transported in labour. Pain relief was provided significantly more often to women in established labour than in early labour. Oxygen was given to significantly more women in preterm labour. While paramedics performed a range of procedures including intravenous cannulation, administration of analgesia and oxygen, most women required minimal intervention. Paramedics needed to manage numerous obstetric and medical complications during their management. Paramedics provide emergency care and transportation for women in labour. Most of the women were documented to be at term gestation with minimal complications. To enable appropriate decision making about management and transportation, paramedics require a range of clinical assessment skills comprising essential knowledge about antenatal and intrapartum care.

Wichita Mountains Wildlife Refuge - Comprehensive Alternative Transportation Plan

DOT National Transportation Integrated Search

2014-05-01

The Comprehensive Alternative Transportation Plan for Wichita Mountains Wildlife Refuge in southwestern Oklahoma analyzes a range of transportation and resource management challenges and documents a holistic set of alternative transportation strategi...

Obesity in the Workplace: Impact, Outcomes, and Recommendations.

PubMed

Yarborough, Charles M; Brethauer, Stacy; Burton, Wayne N; Fabius, Raymond J; Hymel, Pamela; Kothari, Shanu; Kushner, Robert F; Morton, John Magaña; Mueller, Kathryn; Pronk, Nicolaas P; Roslin, Mitchell S; Sarwer, David B; Svazas, Brian; Harris, Jeffrey S; Ash, Garrett I; Stark, Jamie T; Dreger, Marianne; Ording, Julie

2018-01-01

To conduct a comprehensive literature review to develop recommendations for managing obesity among workers to improve health outcomes and to explore the impact of obesity on health costs to determine whether a case can be made for surgical interventions and insurance coverage. We searched PubMed from 2011 to 2016, and CINAHL, Scopus, and Cochrane Registry of Clinical Trials for interventions addressing obesity in the workplace. A total of 1419 articles were screened, resulting in 275 articles being included. Several areas were identified that require more research and investigation. Our findings support the use of both lifestyle modification and bariatric surgery to assist appropriate patients in losing weight.

The management of tics.

PubMed

Shprecher, David; Kurlan, Roger

2009-01-15

A tic is a stereotyped repetitive involuntary movement or sound, frequently preceded by premonitory sensations or urges. Most tic disorders are genetic or idiopathic in nature, possibly due to a developmental failure of inhibitory function within frontal-subcortical circuits modulating volitional movements. Currently available oral medications can reduce the severity of tics, but rarely eliminate them. Botulinum toxin injections can be effective if there are a few particularly disabling motor tics. Deep brain stimulation has been reported to be an effective treatment for the most severe cases, but remains unproven. A comprehensive evaluation accounting for secondary causes, psychosocial factors, and comorbid neuropsychiatric conditions is essential to successful treatment of tic disorders.

The Management of Tics

PubMed Central

Shprecher, David; Kurlan, Roger

2009-01-01

A tic is a stereotyped repetitive involuntary movement or sound, frequently preceded by premonitory sensations or urges. Most tic disorders are genetic or idiopathic in nature, possibly due to a developmental failure of inhibitory function within frontal-subcortical circuits modulating volitional movements. Currently available oral medications can reduce the severity of tics, but rarely eliminate them. Botulinum toxin injections can be effective if there are a few particularly disabling motor tics. Deep brain stimulation has been reported to be an effective treatment for the most severe cases, but remains unproven. A comprehensive evaluation accounting for secondary causes, psychosocial factors, and comorbid neuropsychiatric conditions is essential to successful treatment of tic disorders. PMID:19170198

Endodontic therapy of a mandibular third molar with 5 canals: a case report.

PubMed

Silberman, Adrian; Heilborn, Carlos; Cohenca, Nestor

2009-06-01

Endodontic treatment of third molars often becomes part of comprehensive treatment plans, as it represents a more conservative and less invasive approach than its therapeutic alternatives. The frequency of anatomic variations in mandibular molars, particularly root canal configuration, requires 2 periapical radiographs from different angles. Upon reading and interpretation of the radiographs, the clinician should consider the anatomy and level of difficulty of the endodontic procedure and refer the patient to an endodontist, if deemed necessary. The present article discusses the successful treatment and preservation of a mandibular third molar with 5 root canals, as well as methods for its clinical management.

78 FR 68088 - Dungeness National Wildlife Refuge, Clallam County, WA; Comprehensive Conservation Plan and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-13

... and controlled. Other management activities include fire management, maintenance of existing... management, conservation, legal mandates, and our policies. In addition to outlining broad management...- riparian habitats will continue, with an increased level of active habitat management, monitoring, and...

A Comprehensive Evaluation System for Military Hospitals' Response Capability to Bio-terrorism.

PubMed

Wang, Hui; Jiang, Nan; Shao, Sicong; Zheng, Tao; Sun, Jianzhong

2015-05-01

The objective of this study is to establish a comprehensive evaluation system for military hospitals' response capacity to bio-terrorism. Literature research and Delphi method were utilized to establish the comprehensive evaluation system for military hospitals' response capacity to bio-terrorism. Questionnaires were designed and used to survey the status quo of 134 military hospitals' response capability to bio-terrorism. Survey indicated that factor analysis method was suitable to for analyzing the comprehensive evaluation system for military hospitals' response capacity to bio-terrorism. The constructed evaluation system was consisted of five first-class and 16 second-class indexes. Among them, medical response factor was considered as the most important factor with weight coefficient of 0.660, followed in turn by the emergency management factor with weight coefficient of 0.109, emergency management consciousness factor with weight coefficient of 0.093, hardware support factor with weight coefficient of 0.078, and improvement factor with weight coefficient of 0.059. The constructed comprehensive assessment model and system are scientific and practical.

mTOR inhibitor-induced interstitial lung disease in cancer patients: Comprehensive review and a practical management algorithm.

PubMed

Willemsen, Annelieke E C A B; Grutters, Jan C; Gerritsen, Winald R; van Erp, Nielka P; van Herpen, Carla M L; Tol, Jolien

2016-05-15

Mammalian target of rapamycin inhibitors (mTORi) have clinically significant activity against various malignancies, such as renal cell carcinoma and breast cancer, but their use can be complicated by several toxicities. Interstitial lung disease (ILD) is an adverse event of particular importance. Mostly, mTORi-induced ILD remains asymptomatic or mildly symptomatic, but it can also lead to severe morbidity and even mortality. Therefore, careful diagnosis and management of ILD is warranted. The reported incidence of mTORi-induced ILD varies widely because of a lack of uniform diagnostic criteria and active surveillance. Because of the nonspecific clinical features, a broad differential diagnosis that includes (opportunistic) infections should be considered in case of suspicion of mTORi-induced ILD. The exact mechanism or interplay of mechanisms leading to the development of ILD remains to be defined. Suggested mechanisms are either a direct toxic effect or immune-mediated mechanisms, considering mTOR inhibitors have several effects on the immune system. The clinical course of ILD varies widely and is difficult to predict. Consequently, the discrimination between when mTOR inhibitors can be continued safely and when discontinuation is indicated is challenging. In this review, we give a comprehensive review of the incidence, clinical presentation and pathophysiology of mTORi-induced ILD in cancer patients. We present newly developed diagnostic criteria for ILD, which include clinical symptoms as well as basic pulmonary function tests and radiological abnormalities. In conjunction with these diagnostic criteria, we provide a detailed and easily applicable clinical management algorithm. © 2015 UICC.

Building the chronic kidney disease management team.

PubMed

Spry, Leslie

2008-01-01

The need to be efficient and the demands for performance-based service are changing how nephrologists deliver care. Chronic kidney disease (CKD) occurs in patients with complex medical and social problems. CKD management requires that multidisciplinary professionals provide patient education, disease management, and psychosocial support. To remain cost-efficient, many physicians are training and supervising midlevel practitioners in the delivery of specialized health care. Specialized care that meets present CKD patient needs is best delivered in a CKD clinic. Three models of CKD clinic are identified: (1) anemia management CKD clinic, (2) the basic CKD clinic, and (3) the comprehensive CKD clinic. Each clinic model is based on critical elements of staffing, billable services, and patient-focused health care. Billable services are anemia-management services, physician services that may be provided by midlevel practitioners, and medical nutrition therapy. In some cases, social worker services may be billable. Building a patient-focused clinic that offers CKD management requires planning, familiarity with federal regulations and statutes, and skillful practitioners. Making services cost-efficient and outcome oriented requires careful physician leadership, talented midlevel practitioners, and billing professionals who understand the goals of the CKD clinic. As Medicare payment reforms evolve, a well-organized CKD program can be well poised to meet the requirements of payers and congressional mandates for performance-based purchasing.

Systematic Review of Radiofrequency Ablation and Pulsed Radiofrequency for Management of Cervicogenic Headaches.

PubMed

Grandhi, Ravi K; Kaye, Alan David; Abd-Elsayed, Alaa

2018-02-23

Cervicogenic headache (CHA) is a secondary headache which has a source in the upper cervical spine. Many traditional analgesic choices lack good efficacy in managing the associated pain. As a result, in management of CHA, radiofrequency ablation (RFA) or pulse radiofrequency (PRF) has been tried with success. Our study investigated the use of RFA and PRF for the management of CHA. In the present investigation, a review of the literature was conducted using PubMed (1966 to February 2017). The quality assessment was determined using The Cochrane Risk of Bias. After initial search and consultation with experts, 34 articles were identified for initial review and 10 articles met inclusion for review. Criteria for inclusion were primarily based on identification of articles discussing cervicogenic headaches which were previously treatment resistant and occurred without any other pathology of the craniofacial region or inciting event such as trauma. This systematic review demonstrated that RFA and PRFA provide very limited benefit in the management of CHA. At present, there is no high-quality RCT and/or strong non-RCTs to support the use of these techniques, despite numerous case reports which have demonstrated benefit. This review is one of the first to provide a comprehensive overview of the use of RFA and PRF in the management of CHA.

The Centers for Medicare and Medicaid Services' Nursing Home Case-Mix and Quality Demonstration: a descriptive overview.

PubMed

Reilly, Karen E; Mueller, Christine; Zimmerman, David R

2007-01-01

This paper presents the first comprehensive account of a major national demonstration designed to integrate skilled nursing facilities (SNF) prospective case-mix payment and quality of care. It describes the Centers for Medicare and Medicaid Services' Nursing Home Case-Mix and Quality (NHCMQ) Demonstration-the template for Medicare's SNF Prospective Payment System (PPS) implemented July 1998. The NHCMQ Demonstration provided the basis for one of the most significant changes in SNF reimbursement and quality monitoring policies to date. Prospective reimbursement policies created positive incentive for providers to admit Medicare residents under more equitable payment rates. However, controversy regarding unanticipated perverse provider incentives remains. The quality management system designed under the NHCMQDemonstration is currently used in over 17,000 nursing homes. Furthermore, under the NHCMQ Demonstration, one standardized assessment tool-the MDS-was used to assess a resident's clinical condition, to monitor quality, and to calculate provider reimbursement. Experiences from the NHCMQ Demonstration and continued evaluation of the current national PPS, along with state systems, provide a rich information source regarding prospective, case-mix reimbursement, and provider incentives.

Based on Fuzzy Comprehensive Evaluation Method The Investment Risk Assessment of Chinese Enterprises in The Countries Along “The Belt and Road”

NASA Astrophysics Data System (ADS)

Chen, Yanyu; Chai, Huaqi; Huang, Yimiao

2018-01-01

“Belt and Road Forum for International Cooperation” held in Beijing in May this year. once again, “The Belt and Road” strategic initiative to the world, causing the world’s enthusiastic response. The core of the “One Belt, One Road” strategy initiative is to promote infrastructure construction and interconnection, dock national policies and development strategies, deepen pragmatic cooperation, promote coordinated and coordinated development and achieve common prosperity. With the “The Belt and Road” strategy in-depth, Chinese enterprises will go abroad, in the countries along the country to invest in more and more examples, accompanied by the increasing risk. Analysis of the failure of investment cases, we can easily find that this is the majority of enterprises overseas investment in the lack of careful assessment of risk and risk of foreign investment risk management has a great relationship. In this paper, the risk factors are used to identify the risk factors table, and the fuzzy comprehensive evaluation method is used to estimate the comprehensive risk value of many uncertain factors that cannot be determined by the overseas investment. The risk assessment system is constructed to help Chinese enterprises to follow the " Investment to avoid risks, improve the success rate.

Reconsidering the Simple View of Reading in an Intriguing Case of Equivalent Models: Commentary on Tunmer and Chapman (2012)

ERIC Educational Resources Information Center

Wagner, Richard K.; Herrera, Sarah K.; Spencer, Mercedes; Quinn, Jamie M.

2015-01-01

Recently, Tunmer and Chapman provided an alternative model of how decoding and listening comprehension affect reading comprehension that challenges the simple view of reading. They questioned the simple view's fundamental assumption that oral language comprehension and decoding make independent contributions to reading comprehension by arguing…

An ethical framework for pharmacy management: balancing autonomy and other principles.

PubMed

Glassman, Peter A; Schneider, Paul L; Good, Chester B

2014-04-01

Decisions to control pharmaceutical costs can cause conflicts as to what medications are covered. Such conflicts have ethical implications, however implicit, and given this fact, an ethical framework can help address them. In the following commentary, we discuss the more traditional, individual-level ethical considerations likely familiar to most clinicians. We, then, discuss population-level ethical constructs that clinicians may not as readily embrace. We also present a hypothetical cancer-care case to illustrate how imbalances in ethical foci between individual- and population-level constructs may lead to conflicts among health care actors and promote shifts in pharmaceutical decision making away from providers and toward payers, paradoxically reducing provider autonomy and hence patient autonomy. Finally, we propose a more comprehensive ethical framework to help converge individual, payer, and societal interests when making pharmaceutical use decisions. Pharmacists play a crucial role as pharmacy benefits managers and should be familiar with individual- and population-based ethical constructs.

Anthrax vaccines: present status and future prospects.

PubMed

Kaur, Manpreet; Singh, Samer; Bhatnagar, Rakesh

2013-08-01

The management of anthrax remains a top priority among the biowarfare/bioterror agents. It was the Bacillus anthracis spore attack through the US mail system after the September 11, 2001, terrorist attacks in the USA that highlighted the potential of B. anthracis as a bioterrorism agent and the threat posed by its deliberate dissemination. These attacks invigorated the efforts toward understanding the anthrax pathogenesis and development of more comprehensive medical intervention strategies for its containment in case of both natural disease and manmade, accidental or deliberate infection of a non-suspecting population. Currently, efforts are directed toward the development of safe and efficacious vaccines as well as intervention tools for controlling the disease in the advanced fulminant stage when toxemia has already developed. This work presents an overview of the current understanding of anthrax pathogenesis and recent advances made, particularly after 2001, for the successful management of anthrax and outlines future perspectives.

Safe teleradiology: information assurance as project planning methodology.

PubMed

Collmann, Jeff; Alaoui, Adil; Nguyen, Dan; Lindisch, David

2005-01-01

The Georgetown University Medical Center Department of Radiology used a tailored version of OCTAVE, a self-directed information security risk assessment method, to design a teleradiology system that complied with the regulation implementing the security provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The system addressed threats to and vulnerabilities in the privacy and security of protected health information. By using OCTAVE, Georgetown identified the teleradiology program's critical assets, described threats to the assurance of those assets, developed and ran vulnerability scans of a system pilot, evaluated the consequences of security breaches, and developed a risk management plan to mitigate threats to program assets, thereby implementing good information assurance practices. This case study illustrates the basic point that prospective, comprehensive planning to protect the privacy and security of an information system strategically benefits program management as well as system security.

The Utility of the Frailty Index in Clinical Decision Making.

PubMed

Khatry, K; Peel, N M; Gray, L C; Hubbard, R E

2018-01-01

Using clinical vignettes, this study aimed to determine if a measure of patient frailty would impact management decisions made by geriatricians regarding commonly encountered clinical situations. Electronic surveys consisting of three vignettes derived from cases commonly seen in an acute inpatient ward were distributed to geriatricians. Vignettes included patients being considered for intensive care treatment, rehabilitation, or coronary artery bypass surgery. A frailty index was generated through Comprehensive electronic Geriatric Assessment. For each vignette, respondents were asked to make a recommendation for management, based on either a brief or detailed amount of clinical information and to reconsider their decision after the addition of the frailty index. The study suggests that quantification of frailty might aid the clinical judgment now employed daily to proceed with usual care, or to modify it based on the vulnerability of the person to whom it is aimed.

Resilience, Integrity and Ecosystem Dynamics: Bridging Ecosystem Theory and Management

NASA Astrophysics Data System (ADS)

Müller, Felix; Burkhard, Benjamin; Kroll, Franziska

In this paper different approaches to elucidate ecosystem dynamics are described, illustrated and interrelated. Ecosystem development is distinguished into two separate sequences, a complexifying phase which is characterized by orientor optimization and a destruction based phase which follows disturbances. The two developmental pathways are integrated in a modified illustration of the "adaptive cycle". Based on these fundamentals, the recent definitions of resilience, adaptability and vulnerability are discussed and a modified comprehension is proposed. Thereafter, two case studies about wetland dynamics are presented to demonstrate both, the consequences of disturbance and the potential of ecosystem recovery. In both examples ecosystem integrity is used as a key indicator variable. Based on the presented results the relativity and the normative loading of resilience quantification is worked out. The paper ends with the suggestion that the features of adaptability could be used as an integrative guideline for the analysis of ecosystem dynamics and as a well-suited concept for ecosystem management.

Managing Your Loved One's Health: Development of a New Care Management Measure for Dementia Family Caregivers.

PubMed

Sadak, Tatiana; Wright, Jacob; Borson, Soo

2018-05-01

The National Alzheimer's Plan calls for improving health care for people living with dementia and supporting their caregivers as capable health care partners. Clinically useful measurement tools are needed to monitor caregivers' knowledge and skills for managing patients' often complex health care needs as well as their own self-care. We created and validated a comprehensive, caregiver-centered measure, Managing Your Loved One's Health (MYLOH), based on a core set of health care management domains endorsed by both providers and caregivers. In this article, we describe its development and preliminary cultural tailoring. MYLOH is a questionnaire containing 29 items, grouped into six domains, which requires <20 min to complete. MYLOH can be used to guide conversations between clinicians and caregivers around health care management of people with dementia, as the basis for targeted health care coaching, and as an outcome measure in comprehensive dementia care management interventions.

The healthy learner model for student chronic condition management--part I.

PubMed

Erickson, Cecelia DuPlessis; Splett, Patricia L; Mullett, Sara Stoltzfus; Heiman, Mary Bielski

2006-12-01

A significant number of children have chronic health conditions that interfere with normal activities, including school attendance and active participation in the learning process. Management of students' chronic conditions is complex and requires an integrated system. Models to improve chronic disease management have been developed for the medical system and public health. Programs that address specific chronic disease management or coordinate school health services have been implemented in schools. Lacking is a comprehensive, integrated model that links schools, students, parents, health care, and other community providers. The Healthy Learner Model for chronic condition management identifies seven elements for creating, implementing, and sustaining an efficient and effective, comprehensive community-based system for improving the management of chronic conditions for school children. It has provided the framework for successful chronic condition management in an urban school district and is proposed for replication in other districts and communities.

Early Incorporation of an Evidence-Based Aquatic-Assisted Approach to Arthroscopic Rotator Cuff Repair Rehabilitation: Prospective Case Study.

PubMed

Burmaster, Chris; Eckenrode, Brian J; Stiebel, Matthew

2016-01-01

Both traditional and progressive rotator cuff repair rehabilitation protocols often delay active motion of the shoulder for 6 weeks or more. The early inclusion of a comprehensive aquatic-assisted exercise program presents a unique approach to postoperative management. The purpose of this case study is to describe a comprehensive evidence-based, aquatic-assisted rehabilitation program following arthroscopic rotator cuff repair. A 73-year-old woman with a nonretracted, medium-size, full-thickness tear (2.5 cm) of the supraspinatus tendon underwent arthroscopic rotator cuff repair and was referred for postoperative physical therapy. The rehabilitation program was initiated at 2 weeks postoperatively and consisted of concurrent land- and aquatic-based interventions over 6 weeks for a total of 18 physical therapy visits. Improvements were made in all 5 patient-reported outcome measures that were recorded weekly over the course of care. Improvements reached or exceeded minimal detectable change levels for the Shoulder Pain and Disability Index and the Penn Shoulder Score. Her numeric pain rating scale score at rest decreased from 4/10 at the initial evaluation to 2/10 at 8 weeks postoperatively and with activity decreased from 9/10 to 6/10. Shoulder strength and range of motion values also exhibited improvement over the course of care. No adverse events occurred during the case study. This case study illustrates the safe inclusion of low-stress aquatic exercises as an early adjunct to traditional land-based rotator cuff repair rehabilitation programs in small- to medium-size repairs. Further studies are needed to determine the long-term effectiveness of adding aquatic therapy to traditional postoperative programs. © 2016 American Physical Therapy Association.

Electronic integrated disease surveillance system and pathogen asset control system.

PubMed

Wahl, Tom G; Burdakov, Aleksey V; Oukharov, Andrey O; Zhilokov, Azamat K

2012-06-20

Electronic Integrated Disease Surveillance System (EIDSS) has been used to strengthen and support monitoring and prevention of dangerous diseases within One Health concept by integrating veterinary and human surveillance, passive and active approaches, case-based records including disease-specific clinical data based on standardised case definitions and aggregated data, laboratory data including sample tracking linked to each case and event with test results and epidemiological investigations. Information was collected and shared in secure way by different means: through the distributed nodes which are continuously synchronised amongst each other, through the web service, through the handheld devices. Electronic Integrated Disease Surveillance System provided near real time information flow that has been then disseminated to the appropriate organisations in a timely manner. It has been used for comprehensive analysis and visualisation capabilities including real time mapping of case events as these unfold enhancing decision making. Electronic Integrated Disease Surveillance System facilitated countries to comply with the IHR 2005 requirements through a data transfer module reporting diseases electronically to the World Health Organisation (WHO) data center as well as establish authorised data exchange with other electronic system using Open Architecture approach. Pathogen Asset Control System (PACS) has been used for accounting, management and control of biological agent stocks. Information on samples and strains of any kind throughout their entire lifecycle has been tracked in a comprehensive and flexible solution PACS.Both systems have been used in a combination and individually. Electronic Integrated Disease Surveillance System and PACS are currently deployed in the Republics of Kazakhstan, Georgia and Azerbaijan as a part of the Cooperative Biological Engagement Program (CBEP) sponsored by the US Defense Threat Reduction Agency (DTRA).

Comprehensive genomic profiling reveals inactivating SMARCA4 mutations and low tumor mutational burden in small cell carcinoma of the ovary, hypercalcemic-type.

PubMed

Lin, Douglas I; Chudnovsky, Yakov; Duggan, Bridget; Zajchowski, Deborah; Greenbowe, Joel; Ross, Jeffrey S; Gay, Laurie M; Ali, Siraj M; Elvin, Julia A

2017-12-01

Small cell carcinoma of the ovary, hypercalcemic-type (SCCOHT) is a rare, extremely aggressive neoplasm that usually occurs in young women and is characterized by deleterious germline or somatic SMARCA4 mutations. We performed comprehensive genomic profiling (CGP) to potentially identify additional clinically and pathophysiologically relevant genomic alterations in SCCOHT. CGP assessment of all classes of coding alterations in up to 406 genes commonly altered in cancer and intronic regions for up to 31 genes commonly rearranged in cancer was performed on 18 SCCOHT cases (16 exhibiting classic morphology and 2 cases exhibiting exclusive a large cell variant morphology). In addition, a retrospective database search for clinically advanced ovarian tumors with genomic profiles similar to SCCOHT yielded 3 additional cases originally diagnosed as non-SCCOHT. CGP revealed inactivating SMARCA4 alterations and low tumor mutational burden (TMB) (<6mutations/Mb) in 94% (15/16) of SCCOHT with classic morphology. In contrast, both (2/2) cases exhibiting only large cell variant morphology were hypermutated (TMB scores of 90 and 360mut/Mb) and were wildtype for SMARCA4. In our retrospective search, an index ovarian cancer patient harboring inactivating SMARCA4 alterations, initially diagnosed as endometrioid carcinoma, was re-classified as SCCOHT and responded to an SCCOHT chemotherapy regimen. The vast majority of SCCOHT demonstrate genomic SMARCA4 loss with only rare co-occurring alterations. Our data support a role for CGP in the diagnosis and management of SCCOHT and of other lesions with overlapping histological and clinical features, since identifying the former by genomic profile suggests benefit from an appropriate regimen and treatment decisions, as illustrated by an index patient. Copyright © 2017 Elsevier Inc. All rights reserved.

The Effect of a Course Management System (CMS)-Supported Strategy Instruction on EFL Reading Comprehension and Strategy Use

ERIC Educational Resources Information Center

Tsai, Yea-Ru; Talley, Paul C.

2014-01-01

This paper reports on the effect of a Moodle-supported strategy instruction on both reading comprehension and strategy use among EFL (English as a Foreign Language) students. Specific reading strategy training was first integrated into a Moodle system, which included reading exercises on problem identification, monitoring comprehension,…

78 FR 38782 - Public Review and Comment; Public Hearing-2013 Update of Comprehensive Plan

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-27

... management of the basin's water resources. As part of the public comment process, the Commission will hold a... 2013 Update of the Comprehensive Plan for the Water Resources of the Susquehanna River Basin and other... Susquehanna River Basin Commission released a proposed 2013 Update of the Comprehensive Plan for the Water...

A Case Study of the Partnership Schools Comprehensive School Reform (CSR) Model

ERIC Educational Resources Information Center

Epstein, Joyce L.

2005-01-01

This case study reports the feasibility of the Partnership Schools Comprehensive School Reform (CSR) model for school improvement in a Title I elementary school. Interviews were conducted and documents were collected for 3 years to study whether and how the school implemented key policy attributes--specificity, consistency, authority, power, and…

An Ethnographic Case Study of the Administrative Organization, Processes, and Behavior in a Model Comprehensive High School.

ERIC Educational Resources Information Center

Zimman, Richard N.

Using ethnographic case study methodology (involving open-ended interviews, participant observation, and document analysis) theories of administrative organization, processes, and behavior were tested during a three-week observation of a model comprehensive (experimental) high school. Although the study is limited in its general application, it…

Crisis management systems: staff nurses demand more support from their supervisors.

PubMed

Tzeng, Huey-Ming; Yin, Chang-Yi

2008-08-01

This study illustrates the contributions of the necessity, comprehensiveness, and difference (between necessity and comprehensiveness) levels of crisis management systems to participants' general satisfaction with their working institutions' nursing-related crisis management activities. Crisis management systems include strategic, technical/structural, assessment, public communication, and psychological/cultural aspects. An effective institutional crisis management system might help to decrease the number of incidents related to medical disputes or to prevent a crisis from worsening and becoming disastrous. A cross-sectional survey was administered during a nursing conference held in Taipei, Taiwan, on June 27, 2005. Two hundred ninety questionnaires were distributed, and 121 were retrieved (response rate, 41.7%; nursing administrators and staff). Univariate and multivariate analyses were performed. Ordinal logistic regression analyses show that being a public hospital managed by the government and having more difference on the strategic aspect between the necessity and comprehensiveness levels contribute to lower satisfaction with nursing-related crisis management activities (Nagelkerke R(2) = .441). In addition, staff nurses perceive higher necessity levels on all five aspects compared to nursing administrators. This study provides important insights into how the policies and activities of a medical institution's crisis management system can be prioritized and implemented. It is also important for students in nursing programs and for currently employed nurses to learn how to manage disputes related to nursing practice, so that early resolution can be achieved and crises can be avoided. These results suggest that staff nurses demand more support from their supervisors.

76 FR 8349 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-14

... provides the Military Health System (MHS) with a comprehensive enterprise wide Blood Donor Management System (DBMS) and Blood Transfusion Management System (BTMS) with capabilities to manage blood donors... donors, patients, and products; automated, blood order issue, and transfusion records; manage enterprise...

Responsibility Center Management: An Assessment of RCM at IUPUI.

ERIC Educational Resources Information Center

Robbins, David L.; Rooney, Patrick Michael

1995-01-01

Indiana University-Purdue University at Indianapolis is the first public institution to implement Responsibility Center Management (RCM), a comprehensive decentralized, incentive-base financial management system. RCM has strengthened academic planning, budget management, general accountability, and multiyear fiscal planning. Organizational…

75 FR 41892 - Solicitation for a Cooperative Agreement: Guidebook for Building High Performance Correctional...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-19

... of the guidebook on leadership, assessments, intervention, change management and other related topics...: (1) Leadership and management development, (2) information and knowledge management; (3) comprehensive criminal justice planning, (4) offender management, (5) collaborative partnerships, (6...

Changing patient safety culture in China: a case study of an experimental Chinese hospital from a comparative perspective.

PubMed

Xu, Xiao Ping; Deng, Dong Ning; Gu, Yong Hong; Ng, Chui Shan; Cai, Xiao; Xu, Jun; Zhang, Xin Shi; Ke, Dong Ge; Yu, Qian Hui; Chan, Chi Kuen

2018-01-01

The World Health Organization highlights that patient safety interventions are not lacking but that the local context affects their successful implementation. Increasing attention is being paid to patient safety in Mainland China, yet few studies focus on patient safety in organizations with mixed cultures. This paper evaluates the current patient safety culture in an experimental Chinese hospital with a Hong Kong hospital management culture, and it aims to explore the application of Hong Kong's patient safety strategies in the context of Mainland China. A quantitative survey of 307 hospital staff members was conducted using the Hospital Survey on Patient Safety Culture questionnaire. The findings were compared with a similar study on general Chinese hospitals and were appraised with reference to the Manchester Patient Safety Framework. Lower scores were observed among participants with the following characteristics: males, doctors, those with more work experience, those with higher education, and those from the general practice and otolaryngology departments. However, the case study hospital achieved better scores in management expectations, actions and support for patient safety, incident reporting and communication, and teamwork within units. Its weaknesses were related to non-punitive responses to errors, teamwork across units, and staffing. The case study hospital contributes to a changing patient safety culture in Mainland China, yet its patient safety culture remains mostly bureaucratic. Further efforts could be made to deepen the staff's patient safety culture mind-set, to realize a "bottom-up" approach to cultural change, to build up a comprehensive and integrated incident management system, and to improve team building and staffing for patient safety.

Clinical overlap between malaria and pneumonia: can malaria rapid diagnostic test play a role?

PubMed

Ukwaja, Kingsley Nnanna; Aina, Olufemi B; Talabi, Ademola A

2011-03-21

Malaria and pneumonia account for 40% of mortality among children under five years of age in sub-Saharan Africa. Due to lack of diagnostic facilities, their management is based on the integrated management of childhood illnesses (IMCI) strategy. Symptoms of malaria and pneumonia overlap in African children, necessitating dual IMCI classifications at health centres and treatment with both antibiotics and antimalarials. This study determined the prevalence of malaria-pneumonia symptom overlap and confirmed the diagnosis of malaria in these cases using a rapid diagnostic test. Consecutive consultations of 1,216 children (two months to five years old) were documented over a three-month period in a comprehensive health centre. Malaria rapid diagnostic tests were conducted only for children who had symptom overlap. Of the 1,216 children enrolled, 1,090 (90%) reported cough or fever. Among the children fulfilling the malaria case definition, 284 (30%) also met the pneumonia case definition. Twenty-three percent (284) of all children enrolled met the criteria for both malaria and pneumonia. However, only 130 (46%) of them had a positive result for malaria using a malaria rapid diagnostic test. During a malaria-pneumonia overlap, female children (chi-square 5.9, P = 0.01) and children ≥ one year (chi-square 4.8, P = 0.003) were more likely to seek care within two days of fever. Dual treatment with antimalarials and antibiotics in children with malaria-pneumonia overlap may result in unnecessary over-prescription of antimalarial medications. Use of rapid diagnostic tests in their management can potentially avoid over-prescribing of malaria medications.

System dynamic modeling on construction waste management in Shenzhen, China.

PubMed

Tam, Vivian W Y; Li, Jingru; Cai, Hong

2014-05-01

This article examines the complexity of construction waste management in Shenzhen, Mainland China. In-depth analysis of waste generation, transportation, recycling, landfill and illegal dumping of various inherent management phases is explored. A system dynamics modeling using Stella model is developed. Effects of landfill charges and also penalties from illegal dumping are also simulated. The results show that the implementation of comprehensive policy on both landfill charges and illegal dumping can effectively control the illegal dumping behavior, and achieve comprehensive construction waste minimization. This article provides important recommendations for effective policy implementation and explores new perspectives for Shenzhen policy makers.

Physicians' perspectives of managing tensions around dimensions of effective communication in the emergency department.

PubMed

Dean, Marleah; Oetzel, John G

2014-01-01

The purpose of this study was to explore emergency department (ED) physicians' perspectives of guidelines for effective communication. More specifically, the ways in which physicians manage the tensions among effective communication dimensions framed by relational dialectics theory are examined. This study used in-depth interviews with 17 ED physicians and 70 hours of observations to identify five dimensions of effective communication: efficiency, clarity/accuracy, relevance, comprehension, and rapport. Two communication tensions resulted from these dimensions: efficiency versus rapport and efficiency versus comprehension. In almost all instances, physicians chose efficient communication at the expense of comprehension or rapport. In addition, there was a tension between patient and physician perspectives of clarity and relevance that physicians tended to resolve by emphasizing what was relevant and clear from their own perspective. Implications for managing tensions in terms of efficiency and a physician-centered approach are discussed.

STUMP un"stumped": anti-tumor response to anaplastic lymphoma kinase (ALK) inhibitor based targeted therapy in uterine inflammatory myofibroblastic tumor with myxoid features harboring DCTN1-ALK fusion.

PubMed

Subbiah, Vivek; McMahon, Caitlin; Patel, Shreyaskumar; Zinner, Ralph; Silva, Elvio G; Elvin, Julia A; Subbiah, Ishwaria M; Ohaji, Chimela; Ganeshan, Dhakshina Moorthy; Anand, Deepa; Levenback, Charles F; Berry, Jenny; Brennan, Tim; Chmielecki, Juliann; Chalmers, Zachary R; Mayfield, John; Miller, Vincent A; Stephens, Philip J; Ross, Jeffrey S; Ali, Siraj M

2015-06-11

Recurrent, metastatic mesenchymal myxoid tumors of the gynecologic tract present a management challenge as there is minimal evidence to guide systemic therapy. Such tumors also present a diagnostic dilemma, as myxoid features are observed in leiomyosarcomas, inflammatory myofibroblastic tumors (IMT), and mesenchymal myxoid tumors. Comprehensive genomic profiling was performed in the course of clinical care on a case of a recurrent, metastatic myxoid uterine malignancy (initially diagnosed as smooth muscle tumor of uncertain malignant potential (STUMP)), to guide identify targeted therapeutic options. To our knowledge, this case represents the first report of clinical response to targeted therapy in a tumor harboring a DCTN1-ALK fusion protein. Hybridization capture of 315 cancer-related genes plus introns from 28 genes often rearranged or altered in cancer was applied to >50 ng of DNA extracted from this sample and sequenced to high, uniform coverage. Therapy was given in the context of a phase I clinical trial ClinicalTrials.gov Identifier: ( NCT01548144 ). Immunostains showed diffuse positivity for ALK1 expression and comprehensive genomic profiling identified an in frame DCTN1-ALK gene fusion. The diagnosis of STUMP was revised to that of an IMT with myxoid features. The patient was enrolled in a clinical trial and treated with an anaplastic lymphoma kinase (ALK) inhibitor (crizotinib/Xalkori®) and a multikinase VEGF inhibitor (pazopanib/Votrient®). The patient experienced an ongoing partial response (6+ months) by response evaluation criteria in solid tumors (RECIST) 1.1 criteria. For myxoid tumors of the gynecologic tract, comprehensive genomic profiling can identify clinical relevant genomic alterations that both direct treatment targeted therapy and help discriminate between similar diagnostic entities.

A GIS-Enabled, Michigan-Specific, Hierarchical Groundwater Modeling and Visualization System

NASA Astrophysics Data System (ADS)

Liu, Q.; Li, S.; Mandle, R.; Simard, A.; Fisher, B.; Brown, E.; Ross, S.

2005-12-01

Efficient management of groundwater resources relies on a comprehensive database that represents the characteristics of the natural groundwater system as well as analysis and modeling tools to describe the impacts of decision alternatives. Many agencies in Michigan have spent several years compiling expensive and comprehensive surface water and groundwater inventories and other related spatial data that describe their respective areas of responsibility. However, most often this wealth of descriptive data has only been utilized for basic mapping purposes. The benefits from analyzing these data, using GIS analysis functions or externally developed analysis models or programs, has yet to be systematically realized. In this talk, we present a comprehensive software environment that allows Michigan groundwater resources managers and frontline professionals to make more effective use of the available data and improve their ability to manage and protect groundwater resources, address potential conflicts, design cleanup schemes, and prioritize investigation activities. In particular, we take advantage of the Interactive Ground Water (IGW) modeling system and convert it to a customized software environment specifically for analyzing, modeling, and visualizing the Michigan statewide groundwater database. The resulting Michigan IGW modeling system (IGW-M) is completely window-based, fully interactive, and seamlessly integrated with a GIS mapping engine. The system operates in real-time (on the fly) providing dynamic, hierarchical mapping, modeling, spatial analysis, and visualization. Specifically, IGW-M allows water resources and environmental professionals in Michigan to: * Access and utilize the extensive data from the statewide groundwater database, interactively manipulate GIS objects, and display and query the associated data and attributes; * Analyze and model the statewide groundwater database, interactively convert GIS objects into numerical model features, automatically extract data and attributes, and simulate unsteady groundwater flow and contaminant transport in response to water and land management decisions; * Visualize and map model simulations and predictions with data from the statewide groundwater database in a seamless interactive environment. IGW-M has the potential to significantly improve the productivity of Michigan groundwater management investigations. It changes the role of engineers and scientists in modeling and analyzing the statewide groundwater database from heavily physical to cognitive problem-solving and decision-making tasks. The seamless real-time integration, real-time visual interaction, and real-time processing capability allows a user to focus on critical management issues, conflicts, and constraints, to quickly and iteratively examine conceptual approximations, management and planning scenarios, and site characterization assumptions, to identify dominant processes, to evaluate data worth and sensitivity, and to guide further data-collection activities. We illustrate the power and effectiveness of the M-IGW modeling and visualization system with a real case study and a real-time, live demonstration.

Prognostics and health management design for rotary machinery systems—Reviews, methodology and applications

NASA Astrophysics Data System (ADS)

Lee, Jay; Wu, Fangji; Zhao, Wenyu; Ghaffari, Masoud; Liao, Linxia; Siegel, David

2014-01-01

Much research has been conducted in prognostics and health management (PHM), an emerging field in mechanical engineering that is gaining interest from both academia and industry. Most of these efforts have been in the area of machinery PHM, resulting in the development of many algorithms for this particular application. The majority of these algorithms concentrate on applications involving common rotary machinery components, such as bearings and gears. Knowledge of this prior work is a necessity for any future research efforts to be conducted; however, there has not been a comprehensive overview that details previous and on-going efforts in PHM. In addition, a systematic method for developing and deploying a PHM system has yet to be established. Such a method would enable rapid customization and integration of PHM systems for diverse applications. To address these gaps, this paper provides a comprehensive review of the PHM field, followed by an introduction of a systematic PHM design methodology, 5S methodology, for converting data to prognostics information. This methodology includes procedures for identifying critical components, as well as tools for selecting the most appropriate algorithms for specific applications. Visualization tools are presented for displaying prognostics information in an appropriate fashion for quick and accurate decision making. Industrial case studies are included in this paper to show how this methodology can help in the design of an effective PHM system.

Optimal management of on-farm resources in small-scale dairy systems of Central Mexico: model development and evaluation.

PubMed

Castelán-Ortega, Octavio Alonso; Martínez-García, Carlos Galdino; Mould, Fergus L; Dorward, Peter; Rehman, Tahir; Rayas-Amor, Adolfo Armando

2016-06-01

This study evaluates the available on-farm resources of five case studies typified as small-scale dairy systems in central Mexico. A comprehensive mixed-integer linear programming model was developed and applied to two case studies. The optimal plan suggested the following: (1) instruction and utilization of maize silage, (2) alfalfa hay making that added US$140/ha/cut to the total net income, (3) allocation of land to cultivated pastures in a ratio of 27:41(cultivated pastures/maize crop) rather than at the current 14:69, and dairy cattle should graze 12 h/day, (4) to avoid grazing of communal pastures because this activity represented an opportunity cost of family labor that reduced the farm net income, and (5) that the highest farm net income was obtained when liquid milk and yogurt sales were included in the optimal plan. In the context of small-scale dairy systems of central Mexico, the optimal plan would need to be implemented gradually to enable farmers to develop required skills and to change management strategies from reliance on forage and purchased concentrate to pasture-based and conserved forage systems.

Assessment of environmental risk for red mud storage facility in China: a case study in Shandong Province.

PubMed

Wen, Zhi-Chao; Ma, Shu-Hua; Zheng, Shi-Li; Zhang, Yi; Liang, Yan

2016-06-01

Red mud storage facility (RM-SF) pollution remains a serious problem in China mainly due to the RM's huge quantity, little recyclability, and high alkalinity. And, there is also a risk of dam failure because almost all RM-SFs are processed by damming. In order to address this challenge and improve the level of risk management, it is necessary to evaluate the environmental risk of RM-SFs systematically. So, this paper firstly designs a comprehensive evaluation index system with a three-level evaluation index in the terms of RM characteristics, RM-SF characteristics, ambient environment of RM-SF, the management of RM-SF, and the application aspect of RM by the analytic hierarchy process (AHP) method. Then, a case of RM-SF from a typical alumina production enterprise is studied according to this system, as is assisted by several experts from different fields when determining the weights of all indicators. The results show that the risk of selected RM-SF primarily depends on the former factors, that is, RM and RM-SF characteristics, while the contributions of the other factors are quite smaller.

School of pharmacy-based medication therapy management program: development and initial experience.

PubMed

Lam, Annie; Odegard, Peggy Soule; Gardner, Jacqueline

2012-01-01

To describe a school of pharmacy-community pharmacy collaborative model for medication therapy management (MTM) service and training. University of Washington (UW) School of Pharmacy (Seattle), from July to December 2008. MTM services and training. A campus-based MTM pharmacy was established for teaching, practice, and collaboration with community pharmacies to provide comprehensive medication reviews (CMRs) and MTM training. Number of collaborating pharmacies, number of patients contacted, number of CMRs conducted, and estimated cost avoidance (ECA). UW Pharmacy Cares was licensed as a Class A pharmacy (nondispensing) and signed "business associate" agreements with six community pharmacies. During July to December 2008, 10 faculty pharmacists completed training and 5 provided CMR services to 17 patients (5 telephonic and 12 face-to-face interviews). A total of 67 claims (17 CMRs and 50 CMR-generated claims) were submitted for reimbursement of $1,642 ($96.58/CMR case). Total ECA was $54,250, averaging $3,191.19 per patient. Seven student pharmacists gained CMR interview training. Interest in collaboration by community pharmacies was lower than expected; however, the campus-community practice model addressed unmet patient care needs, reduced outstanding MTM CMR case loads, increased ECA, and facilitated faculty development and training of student pharmacists.

Treatment of Chronic Cough.

PubMed

Soni, Resha S; Ebersole, Barbara; Jamal, Nausheen

2017-01-01

Objective Chronic cough remains a challenging condition, especially in cases where it persists despite comprehensive medical management. For these particular patients, there appears to be an emerging role for behavior modification therapy. We report a series of patients with refractory chronic cough to assess if there is any benefit of adding behavioral therapy to their treatment regimen. Study Design A case series with planned chart review of patients treated for chronic cough. Setting The review was performed with an outpatient electronic health record system at a tertiary care center. Subjects and Methods The charts of all patients treated for chronic cough by a single laryngologist over a 30-month period were analyzed. Patients' response to treatment and rate of cough improvement were assessed for those with refractory chronic cough who underwent behavior modification therapy. Results Thirty-eight patients with chronic cough were initially treated empirically for the most common causes of cough, of which 32% experienced improvement. Nineteen patients who did not significantly improve with medical management underwent behavior modification therapy with a speech-language pathologist. Of these patients, 84% experienced resolution or marked improvement of their symptoms. Conclusion Behavioral therapy may be underutilized in practice and could lead to improvement of otherwise recalcitrant cough.

Interval linear programming model for long-term planning of vehicle recycling in the Republic of Serbia under uncertainty.

PubMed

Simic, Vladimir; Dimitrijevic, Branka

2015-02-01

An interval linear programming approach is used to formulate and comprehensively test a model for optimal long-term planning of vehicle recycling in the Republic of Serbia. The proposed model is applied to a numerical case study: a 4-year planning horizon (2013-2016) is considered, three legislative cases and three scrap metal price trends are analysed, availability of final destinations for sorted waste flows is explored. Potential and applicability of the developed model are fully illustrated. Detailed insights on profitability and eco-efficiency of the projected contemporary equipped vehicle recycling factory are presented. The influences of the ordinance on the management of end-of-life vehicles in the Republic of Serbia on the vehicle hulks procuring, sorting generated material fractions, sorted waste allocation and sorted metals allocation decisions are thoroughly examined. The validity of the waste management strategy for the period 2010-2019 is tested. The formulated model can create optimal plans for procuring vehicle hulks, sorting generated material fractions, allocating sorted waste flows and allocating sorted metals. Obtained results are valuable for supporting the construction and/or modernisation process of a vehicle recycling system in the Republic of Serbia. © The Author(s) 2015.

Breast Cancer: Surgery at the South Egypt Cancer Institute

PubMed Central

Salem, Ahmed A.S.; Salem, Mohamed Abou Elmagd; Abbass, Hamza

2010-01-01

Breast cancer is the most frequent malignant tumor in women worldwide. In Egypt, it is the most common cancer among women, representing 18.9% of total cancer cases (35.1% in women and 2.2% in men) among the Egypt National Cancer Institute’s (NCI) series of 10,556 patients during the year 2001, with an age-adjusted rate of 49.6 per 100,000 people. In this study, the data of all breast cancer patients presented to the surgical department of the South Egypt cancer Institute (SECI) hospital during the period from Janurary 2001 to December 2008 were reviewed .We report the progress of the availability of breast cancer management and evaluation of the quality of care delivered to breast cancer patients. The total number of patients with a breast lump presented to the SECI during the study period was 1,463 patients (32 males and 1431 females); 616 patients from the total number were admitted at the surgical department .There was a decline in advanced cases. Since 2001, facilities for all lines of comprehensive management have been made accessible for all patients. We found that better management could lead to earlier presentation, and better overall outcome in breast cancer patients.The incidence is steadily increasing with a tendency for breast cancer to occur in younger age groups and with advanced stages. PMID:24281200

Fear of Recurrence as a Predictor of Care Needs for Long-Term Breast Cancer Survivors.

PubMed

Fang, Su-Ying; Fetzer, Susan Jane; Lee, Kuo-Ting; Kuo, Yao-Lung

The improved survival rate for breast cancer has increased the number of women living with the diagnosis for more than 5 years. Limited studies have focused on the care needs for long-term healthy survivors of breast cancer. The aims of this study were to understand the care needs of long-term breast cancer survivors and identify related factors that influence these needs. A convenience sampling with a correlational study design was used. Women at least 20 years old, who were given a diagnosis of breast cancer at least 5 years, were recruited from 2 hospital clinics in southern Taiwan. A self-administered questionnaire measuring cancer survivors' unmet needs was administered after obtaining informed consent. Binary logistic regression was used to examine variables associated with unmet care needs. Of the 192 women participating, the highest unmet needs related to existential survivorship. The most frequently endorsed unmet need was for an ongoing case manager. Fear of recurrence was associated with 3 aspects including existential survivorship, comprehensive cancer, and quality-of-life unmet needs (odds ratio, 1.14-1.21). Even 5 years after the diagnosis and completion of therapy, women continue to report unmet needs. Evaluating women's fear of recurrence to identify high-risk women with unmet needs is critical to providing quality care. Developing appropriate survivorship care programs combined with managing concerns regarding recurrence by a nursing case manager is needed.

Comprehensive Review and Case Study on the Management of Buried Penis Syndrome and Related Panniculectomy

PubMed Central

Burns, Hadley; Chowdhry, Saeed; Lee, Thomas; Schulz, Steven; Wilhelmi, Bradon J.

2018-01-01

Objective: This paper discusses the various surgical techniques and outcomes associated with management of buried penis syndrome. Methods: Presented is the case of a 49-year-old man with morbid obesity, leading to massive panniculus and buried penis. We review our technique for reconstruction of the buried penis and treatment of the overlying large panniculus. Literature search was conducted to review current techniques in correcting buried penis syndrome. Results: The patient underwent a successful panniculectomy with removal of all excess skin and tissue. Thoughtful planning and coordination between plastic surgery and urology were paramount to externalize the penis for an excellent functional and cosmetic result. Conclusions: Management of a buried, hidden penis is complex and difficult. Patients are often obese and have poor hygiene due to the inability to cleanse areas that are entrapped by excessive fat. Following removal of the overhanging panniculus, satisfactory reconstruction of a hidden penis is possible when proper care is taken to adhere the base of the penis to the pubis. Split-thickness skin grafts are often necessary but depend on the viability of the penile skin and whether it is restricting penile length. Complications with wound dehiscence and infection are not uncommon; however, patients generally recover well, are satisfied with results, and are reported to have fully regained urinary and sexual functions following surgical correction of the buried penis. PMID:29467914

Non-front-fanged colubroid snakes: a current evidence-based analysis of medical significance.

PubMed

Weinstein, Scott A; White, Julian; Keyler, Daniel E; Warrell, David A

2013-07-01

Non-front-fanged colubroid snakes (NFFC; formerly and artificially taxonomically assembled as "colubrids") comprise about 70% of extant snake species and include several taxa now known to cause lethal or life threatening envenoming in humans. Although the medical risks of bites by only a handful of species have been documented, a growing number of NFFC are implicated in medically significant bites. The majority of these snakes have oral products (Duvernoy's secretions, or venoms) with unknown biomedical properties and their potential for causing harm in humans is unknown. Increasingly, multiple NFFC species are entering the commercial snake trade posing an uncertain risk. Published case reports describing NFFC bites were assessed for evidence-based value, clinical detail and verified species identification. These data were subjected to meta-analysis and a hazard index was generated for select taxa. Cases on which we consulted or personally treated were included and subjected to the same assessment criteria. Cases involving approximately 120 species met the selection criteria, and a small subset designated Hazard Level 1 (most hazardous), contained 5 species with lethal potential. Recommended management of these cases included antivenom for 3 species, Dispholidus typus, Rhabdophis tiginis, Rhabdophis subminiatus, whereas others in this subset without commercially available antivenoms (Thelotornis spp.) were treated with plasma/erythrocyte replacement therapy and supportive care. Heparin, antifibrinolytics and/or plasmapheresis/exchange transfusion have been used in the management of some Hazard Level 1 envenomings, but evidence-based analysis positively contraindicates the use of any of these interventions. Hazard Level 2/3 species were involved in cases containing mixed quality data that implicated these taxa (e.g. Boiga irregularis, Philodryas olfersii, Malpolon monspessulanus) with bites that caused rare systemic effects. Recommended management may include use of acetylcholinesterase inhibitors (e.g. neostigmine) and wound care on a case-by-case basis. Hazard level 3 species comprised a larger group capable of producing significant local effects only, often associated with a protracted bite (eg Heterodon nasicus, Borikenophis (Alsophis) portoricensis, Platyceps (Coluber) rhodorachis). Management is restricted to wound care. Bites by Hazard level 4 species comprised the majority of surveyed taxa and these showed only minor effects of no clinical importance. This study has produced a comprehensive evidence-based listing of NFFC snakes tabulated against medical significance of bites, together with best-practice management recommendations. This analysis assumes increasing importance, as there is growing exposure to lesser-known NFFC snakes, particularly in captive collections that may uncover further species of significance in the future. Careful and accurate documentation of bites by verified species of NFFC snakes is required to increase the evidence base and establish the best medical management approach for each species. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.